Federal Priorities for the 119th 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 lawsuit. Congress and the Administration must ensure that individuals continue to receive lifesaving preventive services based on the US Preventive Services Task Force recommendations 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 fully implement the 2024 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. Congress and the Administration must limit the proliferation of inadequate insurance, such as short-term limited duration and association health plans as well as healthcare sharing ministries.

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 and the Administration 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.

Changes to the structure of Medicaid funding, including how states can finance their share of program expenses, will jeopardize coverage for the low-income children, adults and people with disabilities served by the program.  Similarly, work reporting requirements are aimed at adding paperwork and red tape that lead eligible people to lose their healthcare coverage. Congress must protect funding for Medicaid and Medicaid expansion, and reject block grants, per capita caps, work requirements and other policies that reduce the number of people with healthcare coverage.

Many states now implement key pieces of their Medicaid program through Section 1115 demonstration waivers. CMS must 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, strengthening standardized plan requirements, and making other changes that expand quality coverage. CMS must also ensure that the ACA marketplaces remain accessible by preserving the length of open enrollment, maintaining a robust enrollment website, and rejecting any waivers that would jeopardize access to quality, affordable care. 

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

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 the Supplemental Oxygen Access Reform (SOAR) Act, a bipartisan and bicameral legislation that is patient-centric and will ensure that patients can access the appropriate oxygen modality needed for their health.