The Fair Care Act - Forthcoming Additions

September 11, 2019
Blog Post

Title 1 – Private Sector Health Insurance Reforms

  • Establish that all policy holders with an actuarial value of 70% or lower be eligible for Health Savings Accounts (HSAs), along with those with high-deductible plans. 
  • Allow Health Savings Accounts (HSAs) to be used for direct primary care providers.
  • Allow those with Employer Subsidized Insurance (ESI) to opt out and receive Advanced Premium Tax Credits (APTCs) if eligible by income.
  • Codify the Administration’s rule allowing Health Reimbursement Accounts (HRAs) to be used to purchase individual market insurance.
  • Require newly incorporated businesses that sponsor health coverage do so through a Health Reimbursement Arrangement (HRA).
  • Allow premium assistance and cost sharing subsidies for purchasing exchange plans to be used to purchase copper and bronze plans.

Title 2 – Medicare, Medicaid, and Miscellaneous Reforms

  • Require the Secretary to pilot an integrated drug benefit for Medicare Parts A/B/D under the Center for Medicare and Medicaid Innovation (CMMI).
  • Default Medicare beneficiary enrollment to Medicare Advantage Plans.
  • Enact Medicare Competitive Bidding.

Title 3 – Prescription Drug Competition

  • Ban Pharmaceutical Benefit Manager (PBM) rebates in the commercial market.
  • Institute a 5-year exclusivity period for biological and small molecule drugs.
  • Expand conditional approval process to all therapeutic areas.
  • Require branded biologic manufacturers to disclose their patents ahead of time in a transparent manner.
  • Allow private health insurers to jointly negotiate with drug manufacturers for prices and formulary access.

Title 4 – Provider Competition and Price Transparency

  • Repeal incentives to form hospital-led Accountable Care Organizations (ACOs) that encourage consolidation among providers.
  • End Surprise Medical Bills by having insurers pay providers the median in-network rate for the service provided in that specific geographic region.
  • Establish an advisory group on reducing hospital administrative burdens.
  • Require insurers and third-party administrators of self-insured employer plans submit anonymized claims data to the HHS Secretary and require this information to be published.
  • Allow private health insurers to jointly negotiate with hospitals for prices and network access.
  • Exempt hospitals in the 800 U.S. counties with the lowest population density from hospital consolidation rules.
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