A bipartisan bill introduced in the House last week would let high-deductible insurance plans with health savings accounts allow pre-deductible coverage for managing chronic diseases.
Currently, insurance plans can cover only certain preventative services like immunizations and screenings for blood pressure or cholesterol without cost sharing before a deductible is met. The bill would add services for managing illnesses like asthma and diabetes to that list.
Use of health savings accounts has increased rapidly since the Affordable Care Act was passed and, according to Families USA, more than 40% of adults have plans with deductibles of $1,500 or more.
The Centers for Disease Control estimates that about 86% of healthcare spending is on chronic conditions.
John Rother, CEO of the National Coalition on Health Care, said research shows the legislation could decrease spending in the long run.
“It's pretty well established that those in high deductible plans don't use the services that would keep them out of the hospital because of high out-of-pocket costs,” he said.
The biggest concern for the bill is whether there is enough time to get it passed. Lawmakers will soon leave for a long summer break, the presidential election is likely to stall legislation when they return, he said.
If the bill does not pass this session, advocates will pressing the issue next year, Rother said.
The Smarter Health Care Coalition, a group of several health and consumer organizations that has advocated for the change, said in a memo that including the management of chronic conditions within preventative coverage is more aligned with the movement toward value-based payment in medicine.
“(The current) interpretation contravenes modern understandings of prevention, which recognize that in addition to improving outcomes and enhancing productivity, management of chronic conditions prevents adverse, costly and often avoidable acute exacerbations,” they wrote.
High out-of-pocket costs have been an issue on the presidential campaign trail. Presumptive Democratic nominee Hillary Clinton has suggested a refundable tax credit for costs exceeding 5% of a family's income and a cap on prescription drug out-of-pocket costs. Donald Trump, her presumed opponent in the general election, has advocated for expanding the use of health savings accounts.
In introducing the legislation, Rep. Diane Black (R-Tenn.), a nurse, said it would improve quality of life and lower costs by removing regulatory burdens.
“We are constantly looking for innovative policy solutions to lower the cost of health care without compromising its quality, and this legislation does just that,” she said.
