Federal Priorities for the 118th Congress: Access to Care

Millions of people have access to preventive services – including lung cancer screening, tobacco cessation and vaccinations – at no cost due to the Affordable Care Act (ACA). However, this coverage is at risk due to the Braidwood v. Becerra lawsuit. Congress and the administration must ensure that individuals continue to receive lifesaving preventive services without cost-sharing.

Section 1557 of the ACA protects disadvantaged communities, including those living with pre-existing conditions, women, LGBTQI+ individuals, people with disabilities and those with limited English proficiency, from discrimination when seeking healthcare. The administration must promptly finalize and fully enforce a new 1557 rule restoring and expanding protections against discriminatory practices in the healthcare system.

Junk or “skimpy” plans that are not required to adhere to the protections included within the ACA pose a grave threat to the health of many individuals, especially patients with pre-existing conditions. The administration must repeal rules enabling the proliferation of inadequate insurance, such as short-term limited duration and association health plans as well as healthcare sharing ministries, and work with Congress to take additional action to limit the sale and purchase of these plans.

Anxiety and depression are both more common in people living with chronic conditions, including COPD, than they are in the general population. Unfortunately, these mental health conditions often go unrecognized and untreated by patients, caregivers and providers. Approximately 35% of cigarette smokers have a behavioral health condition and often need more help to quit smoking and have their comorbid behavioral health condition treated. Congress should expand coverage of and parity for mental health services.

Patients who unknowingly see an out-of-network provider, such as during an emergency, should not have to pay any more than if they had been seen by an in-network provider. The administration must continue to implement the No Surprises Act and its important patient protections.

Eleven states have not expanded their Medicaid programs, leaving millions of low-income individuals without healthcare coverage. Congress must permanently close the coverage gap in states that haven’t expanded Medicaid. A solution must include comprehensive coverage tailored to the populations that Medicaid serves and protection from out-of-pocket costs.

An estimated 15 million individuals – including 4.6 million Latino and 2.2 million Black Americans – will lose their Medicaid coverage when the continuous coverage provisions in place during the COVID-19 Public Health Emergency expire. Congress and the administration must maintain access to care for patients, including by improving the transition to Marketplace coverage, ensuring robust data collection from and oversight of state Medicaid programs, and making permanent changes to improve enrollment and redetermination processes.

Continuous eligibility reduces gaps in coverage that can delay access to preventive care, medications, and other treatments and services for patients with lung disease. Congress should expand 12-month continuous eligibility for adults.

Many states now implement key pieces of their Medicaid program through Section 1115 demonstration waivers. CMS must issue new regulations regarding the Section 1115 demonstration process and approve waivers that expand access to coverage, while denying requests to impose financial and administrative barriers to care.

Open enrollment education and outreach programs are essential to enabling individuals to find and select the healthcare coverage that is best for them. Congress must continue to increase funding for outreach and enrollment activities, to allow for as many individuals to access and enroll in the most appropriate coverage as possible.

Every year, CMS issues a new rule governing the ACA marketplaces. CMS must ensure ACA plans offer quality coverage by implementing network adequacy standards, updating essential health benefit standards, strengthening standardized plan requirements, and making other changes that expand quality coverage.

Despite the great strides made by the Affordable Care Act, many Americans still struggle to afford healthcare. Congress and the administration must enact policies to improve the affordability of care for all, such as by permanently expanding enhanced subsidies for marketplace coverage and implementing the family glitch rule.

The inappropriate application of measures such as prior authorization can inflict significant harm to patients. Congress and the administration must ensure that lung disease patients are able to access the treatment they need in Medicare without inappropriate barriers. 

Many people on Medicare are attempting to manage complex medical conditions while on a fixed income. Congress included an out-of-pocket cap and smoothing mechanism to lower patients’ out-of-pocket prescription drug costs in the Inflation Reduction Act. The administration must implement these policies in a patient-focused manner.

Any disease that damages the lungs, including COPD, pulmonary fibrosis (PF) and COVID-19, can lead to someone needing supplemental oxygen. However, many people are unable to obtain the proper type of oxygen for their condition, especially those who require liquid oxygen, giving them a higher flow of oxygen.  Congress must pass patient-centric legislation to appropriate oxygen modalities for these vulnerable patients.