Will Insurance Coverage Bring “Meaningful Access”?

February 19, 2021

February brings good news for people who don’t have health insurance. Due to a special enrollment period, the federal insurance marketplace is once again open for people to sign up for private coverage.

President Joe Biden ordered the marketplace’s reopening through May 15 as part of his COVID-19 relief plan. In the last year, millions of people lost their employer-sponsored health coverage when they lost their jobs. Now, they’ll have another opportunity to enroll in a plan of their choice. 

“As we continue to battle COVID-19, it’s even more critical that Americans have meaningful access to health care,” President Biden avowed. 

Having insurance coverage is an important first step toward meaningful access. But beyond having insurance, patients should be able to see their provider of choice and get the medications their doctor prescribes. Health plans – both private and public – don’t always allow that.

Instead, patients often face: 

  • Prior authorization, which forces patients to wait for their insurer to pre-approve their treatment, test or procedure. This tactic was once used only for expensive medications or procedures, but prior authorization’s use has grown to include even routine care.
  • Step therapy, which requires patients to first try an insurer-preferred prescription before gaining access to the one their doctor prescribed. The medications may be cheaper for the insurance company but not necessarily appropriate for the patient. Step therapy delays can also cause patients unnecessary pain.
  • Non-medical switching, which occurs when patients’ medication is changed by their insurance company for a non-medical cause. Insurers make the switch in pursuit of cost savings, though research has shown the approach can increase downstream health care costs.

Cost sharing also factors into insured patients’ ability to access care. Some patients might choose a plan with a low monthly premium without realizing that it requires higher out-of-pocket costs to see the doctor or fill a prescription. The prospect of hefty medical bills can cause patients to delay the care they need.

Policymakers across the country are taking note of patients’ experiences. Legislators in Oklahoma and Iowa, for example, are considering bills to address the harmful impacts of non-medical switching. Meanwhile, half a dozen other states are looking at regulating the use of step therapy. 

A special enrollment period offers a valuable opportunity for uninsured Americans to secure coverage. Looking ahead, policymakers can deliver even more good news by reforming the barriers that keep insured patients from accessing timely and optimal care.

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