2023 ACA Proposal Aims to Advance Health Equity & Improve Access to Health Care Coverage

January 27, 2022

The Association for Clinical Oncology (ASCO) submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) Patient Protection and Affordable Care Act 2023 Notice of Benefit and Payment Parameters proposed rule. The rule includes proposed changes to standards for issuers and marketplaces and reinstates many beneficiary protections reversed under the previous administration.

ASCO’s comments address proposed changes affecting health equity and access to coverage. Highlights include support for:

  • Regulations that prohibit a health insurance issuer from employing marketing practices or benefit designs that would discourage the enrollment of sexual and gender minority individuals and restore protections for sexual and gender minority individuals established under the Obama administration.
  • CMS’ proposal to revert to the previous interpretation of the guaranteed availability rules, which would prevent insurers from requiring payment of past-due premiums before accepting the applicant for new coverage. Current policy creates barriers to health coverage that disproportionately affect low-income individuals. Finalizing this proposal will ensure coverage for individuals who stand to benefit the most from enrollment and advance equitable access to coverage.
  • CMS’ proposal to refine the essential health benefit (EHB) nondiscrimination policy to ensure that benefit designs are based on clinical evidence and do not discriminate based on age, health conditions, and sociodemographic factors. ASCO submitted comments in support of this refinement. The Association supports policies based on clinical evidence and that ensure all individuals with cancer have equitable access to health insurance coverage. 
  • Reinstatement of standardized benefit plans at each metal level where a non-standardized plan is offered and differential display of the standardized plans, enabling consumers, especially those with limited English proficiency, inadequate internet access, complex medical needs, and low health literacy, to compare plans more easily during the selection process.

Although ASCO appreciates the efforts CMS has made in its proposal to advance health equity and bolster enrollee access to health care coverage, we are extremely disappointed that the agency did not reverse the copay accumulator policy that was finalized in the 2021 Notice of Benefit and Payment Parameters final rule. The policy allows issuers to disregard manufacturer copay assistance when determining whether an enrollee has met their annual deductible and/or out-of-pocket limit. The Association strongly opposes the use of copay accumulator adjustment and copay maximizer programs for patients with cancer. ASCO urges CMS to reverse the current policy and eliminate copay accumulator programs.

Read the full comment letter.

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