Help Ensure Lower Patient Copays Act; HELP Copays Act
Summary
The Help Ensure Lower Patient Copays Act (HELP Copays Act) amends Title XXVII of the Public Health Service Act and the Patient Protection and Affordable Care Act. It ensures that financial assistance, including that from non-profits and drug manufacturers, counts towards patient cost-sharing requirements like deductibles, coinsurance, and copayments. This applies to group and individual health insurance plans.
Expected Effects
The primary effect of this bill is to lower out-of-pocket healthcare costs for individuals with health insurance. It mandates that financial assistance received by patients be counted towards their deductibles, coinsurance, and copayments. This change will take effect for plan years beginning on or after January 1, 2026.
Potential Benefits
- Reduced out-of-pocket healthcare expenses for patients.
- Increased access to necessary medications and treatments.
- Greater financial stability for individuals with chronic conditions.
- Simplification of cost-sharing calculations for health plans.
- Encourages the use of financial assistance programs.
Potential Disadvantages
- Potential for increased healthcare premiums due to higher utilization.
- Possible administrative complexities for health insurance providers.
- Risk of fraud or abuse in financial assistance programs.
- May disproportionately benefit individuals with access to financial assistance.
- Could lead to higher drug prices if manufacturers factor in assistance programs.
Constitutional Alignment
The bill aligns with the general welfare clause of the Constitution (Preamble), as it aims to improve access to healthcare and lower costs for individuals. Congress has the power to regulate interstate commerce (Article I, Section 8), which includes health insurance markets. The bill does not appear to infringe upon any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).