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State insurance regulators are asking Robert F. Kennedy Jr. for help with issues such as clarifying federal health insurance nondiscrimination rules and regulating prescription drug copayment accumulator programs.
Leaders of the National Association of Insurance Commissioners talk about their federal health insurance policy priorities in a letter they sent last week to Kennedy, who is now the secretary of the U.S. Department of Health and Human Services.
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Much of the letter focuses on issues affecting the market for Medicare plans or individual major medical insurance.
One of the sections that could affect employers and their benefits advisors involves age-discrimination provisions in newly updated regulations based on section 1557 of the Patient Protection and Affordable Care Act, which is one of the two laws in the Affordable Care Act package.
The updated regulations "limit health insurers' ability to treat enrollees differently based on age or disease status," NAIC leaders write in the letter to Kennedy.
State regulators agree with the general goal of the regulations, but they believe the current rules are too broad and might disrupt the current pricing rules for excepted benefits products, officials write.
The list of "excepted benefits," or products not directly affected by the federal benefits requirements that apply to major medical insurance, includes products such as dental insurance, hospital indemnity insurance and critical illness insurance.
Issuers in many states charge age-based premiums for those products.
"A more limited application of the rule would offer more clarity and allow these plans and services to be offered without interruption," NAIC officials write.
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The "copay accumulator" section of the NAIC letter refers to health plan provisions that prevent patients from counting outside aid for prescription drugs toward their deductibles or out-of-pocket maximums.
Patients and many state regulators believe that copay accumulator rules hurt patients by keeping patients from using financial aid from manufacturers or other sources to pay for desperately needed drugs that would otherwise be unaffordable.
Health plans contend that copay assistance programs get around plan efforts to discourage patients from using unnecessary or overly expensive medications.
HHS developed a copay accumulator regulation in 2020. It then tried to update the copay accumulator rule in 2021. A court invalidated the 2021 rule.
"Since 2023, however, HHS declined to enforce the 2020 rule and has promised updated rulemaking," officials write. "States have also enacted rules to allow or restrict the use of copay accumulators. State regulators ask for greater clarification from HHS on the status of federal rules so that we can provide consistent guidance to health insurers on these programs."
The NAIC began its spring national meeting in Indianapolis Sunday. The meeting is set to run until Wednesday.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
