The Fair Care Act - Forthcoming Additions
September 11, 2019
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.