PRIVATE-PLAN TELEHEALTH QUESTIONS — Congress appears poised to extend eased access to telehealth for Medicare patients, but the fate of virtual care in high-deductible plans remains less certain as lawmakers plan for a year-end package. Tens of millions of Americans are on high-deductible health plans, which might have lower premiums, but out-of-pocket costs could be higher before patients hit their deductibles. The plans also come with health savings accounts with major tax advantages that can be used to cover health care expenses. Extension debate: Many Republicans and some Democrats have supported expanding what the plans cover more broadly, though other Democrats have cautioned the changes could undermine the Affordable Care Act by offering insufficient coverage. A March 2020 Covid-19 spending bill allowed high-deductible health plans to cover telehealth for patients before they reach their deductibles to help curb the virus’ spread. Congress allowed those provisions to lapse for the first few months of 2022 before restoring them, leading some patients to incur unexpected costs for virtual care. In late 2022, a narrowly Democratic-controlled Congress and White House extended the rules through the end of 2024, aligning their expiration with that of eased Medicare telehealth rules. But key Democrats are skeptical of continuing the telehealth rules for high-deductible plans, casting doubt about their fate. The telehealth industry and groups representing employers’ benefit interests are pushing for an extension in an end-of-year package. Rep. Richard Neal (D-Mass.), top Democrat on the Ways and Means Committee, has been wary of extending the telehealth provisions. Other Democrats joined him in voting against legislation from Rep. Michelle Steel (R-Calif.) that would make the high-deductible telehealth provisions permanent. Neal pointed to the cost and argued that Republicans have used the plans to undermine the ACA. The Congressional Budget Office estimated the legislation would cost about $5 billion over a decade. Rep. Lloyd Doggett (D-Texas), ranking member of the Ways and Means Health Subcommittee, also voted against the bill, but Congressional Telehealth Caucus founder Rep. Mike Thompson (D-Calif.) and four other Democrats voted for it. “Democratic opposition to access to telehealth for HDHPs is a little puzzling,” said Neil Trautwein, executive director of the Partnership for Employer-Sponsored Coverage. “This is not replacement coverage but rather helps in those odd times when your doctor isn’t available.” Melissa Bartlett, senior vice president of health policy for the ERISA Industry Committee, which represents large employers’ benefits and supports extending the provisions, told Pulse that the House’s move to pass legislation allowing HSAs to cover chronic care predeductible last month gives her optimism. She said Congress is in a “holding pattern” amid uncertainty about how much room there will be in a potential end-of-year package. “We’re fighting to make sure it gets included. Americans are going to lose out if it’s allowed to lapse,” Kyle Zebley, vice president of public policy at the American Telemedicine Association, told Pulse, adding that it might be a shorter-term extension than the Medicare rules. WELCOME TO FRIDAY PULSE. Are you hearing about potential HHS picks in a new administration? We want to hear from you — and can keep you off the record. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com. and follow along @_BenLeonard_ and @ChelseaCirruzzo.
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