Academy Backs Push for HDHP Primary Care Deductible Waivers

The Primary and Virtual Care Affordability Act (H.R. 5541) would “ensure that patients can access primary care — both in person and virtually — which is especially critical during the ongoing pandemic to keep patients out of the hospital, address lapses in care and catch them up on missed routine and preventive services,” the AAFP said in an Oct. 8 letter.

The letter was sent to H.R. 5541 co-sponsors Reps. Brad Schneider, D-Ill., and Brad Wenstrup, R-Ohio, and signed by AAFP Board Chair Ada Stewart, M.D., of Columbia, S.C.

Last year’s Coronavirus Aid, Relief and Economic Security Act temporarily allowed HDHPs to cover telehealth services pre-deductible, in response to the COVID-19 pandemic. Without new legislation, that flexibility will expire at the end of 2021.

The AAFP explained to the legislators the importance of not only preserving access to virtual care, but ensuring that coverage disparities between telehealth and in-person care don’t steer patients away from primary care.

“By allowing HDHPs to waive the deductible for both telehealth and primary care, your legislation supports physicians’ and patients’ freedom to decide the most appropriate modality of care,” the letter said.

The both, the Academy added, has become increasingly important as the COVID-19 pandemic continues to cycle through surges. Citing recent America’s Health Insurance Plans survey results indicating that a strong majority of respondents favored flexibility to cover both primary care and telehealth benefits pre-deductible, the letter also noted that disparities in coverage and out-of-pocket costs between telehealth and in-person services were contributing to care fragmentation.

“While HDHPs have been touted as innovative structures to control health care costs, they can compound access problems and ultimately lead to worse and costlier health outcomes, especially for low-income Americans,” the letter said.

Meanwhile, the Academy reminded lawmakers, the significant growth of HDHPs among enrollees in employer-sponsored health plans over the past decade and a half had set the stage for millions of Americans delaying or forgoing care — including treatment for COVID-19 symptoms — due to high out-of-pocket costs.   

“As we continue to deal with the COVID-19 pandemic, patients in HDHPs should not have to worry about delaying or losing access to their primary care physician,” the letter said. “Moreover, health plans and employers want to expand predeductible coverage, especially for primary care office visits and certain telehealth visits.”

The Oct. 8 letter extends longstanding work by the Academy to close HDHP coverage gaps. Continued or expanded HDHP waivers were among the considerations the Academy called on Congress to include in the American Rescue Plan. In 2020, the AAFP advocated for passage of a bill to eliminate deductibles for outpatient pediatric care and also has lobbied for legislation allowing two no-cost primary care visits a year for HDHP enrollees.

A new Academy Speak Out campaign helps members ask their legislators to co-sponsor the Primary and Virtual Care Affordability Act.