ShareFacebook Twitter

Sign In | Register.


Untitled Document

Facebook Twittter


This Week in Health Care Reform: June 22nd, 2018

Lawmakers pass critical legislation to aid in the ongoing fight against the opioid epidemic; a new actuarial analysis points to rising medical costs as one of the primary drivers of premium increases; the Administration issues its final rule expanding association health plans; and, a growing focus on the interchange between Medicaid and social health factors opens the way to new innovations.

Week in Review

OPPS Act: Earlier this week, lawmakers in the U.S. House of Representatives passed H.R. 6082 “The Overdose Prevention and Patient Safety (OPPS) Act,” legislation aimed at better aligning outdated privacy restrictions with current HIPAA guidelines in order to provide health plans and health providers with more comprehensive access to a patient’s complete health information.  That access has proven to be an effective and necessary tool in combatting the opioid epidemic ravaging families and communities across the country.  Prior to the measure coming up for a vote, stakeholders across the health care spectrum came together in support of the legislation.  We also asked you, our Health Action Network members, to urge lawmakers to support the OPPS Act.  Thanks to all of you who took action!

Medical Costs: With the 2019 rate filing process underway, discussion now turns to consideration of what’s driving premium increases.  In their latest issue brief, the American Academy of Actuaries point to a handful of factors affecting why premiums next year will look different from the ones seen in 2018, beginning with projected medical costs.  While the medical trend – which refers to the increase in costs for both medical services and prescription drugs – for 2019 is expected to be in line with this year’s, experts caution that this trend, although steady, is ultimately unsustainable for consumers, leaving others to wonder why health care continues to cost so much.

On Tuesday, the Administration announced its finalized rule allowing for the expansion of association health plans (AHPs).  That rule, initially proposed by the Department of Labor in January, allows employers to either join or form AHPs in order to purchase large group coverage.  Although the idea itself isn’t new, the finalized rule loosens the restrictions around the types of organizations that can now participate, broadening the boundaries to allow organizations to join or form AHPs based on industry or geography.  The rule is part of the larger effort by the Administration to offer consumers cheaper alternatives to those Affordable Care Act health plans that are compliant with the protections enshrined in the law, prompting stakeholders and consumer advocates to warn that the broad expansion of AHPs could result in higher premiums for those securing coverage through the individual or small group market, not to mention lower quality for those now seeking coverage through these AHPs.

Medicaid & SDoH:
The growing focus on social determinants of health (SDoH) is rooted, not just in looking to improve health outcomes, but also in finding ways to bring down the cost of care – twin aims that are by no means mutually exclusive.  Unstated in this pursuit is the implicit acknowledgment that perhaps the populations that would most benefit from this holistic approach to health care delivery might also be some of the costliest to treat, for instance, Medicaid beneficiaries.  Against that backdrop, health plans, providers, and other interested organizations are increasingly finding ways to address SDoH in the Medicaid space.  However, despite the collective goals of stakeholders to better exploit SDoH in benefit design, there remains the persistent challenge of encouraging the much-needed investment in bringing these innovations to this market.      

Return to archives...



We encourage you to stay involved as implementation efforts surrounding health care reform progress.  Visit the Health Action Network and be sure to let us know what's on your mind.



Approximately 180 million Americans receive their health coverage through their employer.  A new campaign from AHIP seeks to highlight the role that employer-sponsored coverage plays in connecting so many with the kinds of innovative programs and support services that lower costs and improve quality of care.

You can keep up with the latest by following the Health Action Network on Twitter and by liking us on Facebook.