On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
Repeal and Replace: Overview of Graham-Cassidy’s Market-based Health Care Allotment
Deborah Bachrach, April Grady, Jocelyn Guyer and Cindy Mann, Manatt Health
This brief, prepared by Manatt Health, provides an overview of the proposal developed by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) and filed on July 27th as a substitute for the American Health Care Act passed by the House to “repeal and replace” the Affordable Care Act (ACA). The proposal retains many features of the July 20th version of the Better Care Reconciliation Act (BCRA) released by Senate leadership (and rejected by the Senate on July 25th), including per capita caps on Medicaid spending and elimination of the individual and employer mandates.
At a high level, the Graham-Cassidy proposal would replace federal funding for Marketplace coverage and some aspects of Medicaid with a capped allotment that would be distributed to states in the form of block grants. States would have significant flexibility to use their block grant funds for coverage, payments to providers or other health care-related purposes.