Health plans: Ending tax role prevents SUS collapse, says Congress

Health plans: Ending tax role prevents SUS collapse, says Congress

The approval of the bill scrapping the so-called comprehensive list of actions for the National Agency for Complementary Health (ANS) caused real conflict between health plans and users. While experts note that the new law will avoid overburdening the public health system, operators believe that the measure will affect the “sustainability” of companies, threatening to pass on any losses to consumers.

Proponents of the proposal claim that retaining the ruling by the Supreme Court of Justice (STJ) on June 8 would lead to a “real collapse” in the public health network. The risks, according to a House technical note, stem from the need to integrate treatments not on the ANS list, through the Unified Health System (SUS).

According to legislature technicians, based on a study by the Federal University of Rio de Janeiro (UFRJ), SUS will need to accommodate an additional 35 million users, given the tax role of the ANS. This amount indicates the 80% of health plan users who will need to relay their procedures to the public network for cases not covered by the plans or due to the impossibility of affording treatment.

Currently, the country has more than 49 million health plan users, according to the ANS.

“Great victory”

The numbers are backed up by analysis of National Health Council (CNS) members. Council members believe that the new legislation will maintain a balance between public and private health networks.

“There is a clear and obvious impact of the SUS. The private market and the SUS act in parallel as communication vessels, therefore, coverage restrictions are slipping into the public system. Doors that close in private health end with serious consequences for public health. We have seen this with serological testing for Covid- 19 During the pandemic: Only 7% of all tests performed by health plans, explains Ana Navarrete, a central nervous system consultant at the Brazilian Institute for Consumer Protection (Idec).

The representative of the National Statistics Council rated the approval of the National Congress of the bill that eliminated the restrictive role of the ANS as a “great victory”. “The typical role is a more than 10-year-old jurisprudence construct. When we look at the health plan data, there has never been a breakdown—on the contrary. Denying off-list coverage has had no systemic effect, the companies are calling,” he said.

Attorney Tiago Moraes Gonçalves, in turn, understands that the new law will calm the deadlock around the operators’ operations. “It is very important for consumers of insurance and health plans in Brazil. This is a necessary legislative response. In this way, Congress prevents operators from denying the cost of proven procedures and drugs. It is undoubtedly a victory for civil society over the operators’ lobby,” the advocate says.

ANS fears of ‘rupture’

In a memo sent to the Federal Senate, the Director of the President of the ANS, Paulo Rebelo, said the proposal approved by the senators would have a “negative impact” on the supplement health sector. And he asserts that “the recognition of the exemplary nature of the list of measures will lead to the disruption of the economic and financial balance of the health plan contracts.”

Health plans’ commitment to ensuring that procedures outside the list of health insurance services are covered, says Rabelo, as before, “will change the economic and financial planning of operators.” He warns that “the change in contractual terms will lead to an increase in health plans prices, which in turn will affect the potential for beneficiaries to be excluded from the supplemental health system.”

In addition, the plans emphasize that “any change associated with the implementation of a model list will be passed on to the group of beneficiaries.”

Next steps

Bill No. 2.033/2022, which was approved in a plenary session on Monday (8/29), was approved to circumvent the STJ decision that made the list of measures that health plans must cover in Brazil comprehensive.

For the proposal to go into effect, it still needs the approval of President Jair Bolsonaro (PL). The deadline is 15 working days. In the event of a penalty, the new law shall enter into force as of the date of its publication.

However, there is a risk that the federal chief executive will veto the proposal, in part or in whole, given that the federal government has taken a stand against the action. On the 23rd, at a hearing in the Federal Senate, the Minister of Health, Marcelo Quiroga, criticized the bill and supported the STJ’s decision.

The wallet holder shares the same perspective as the ANS and believes that health plans will become more expensive. “Of course, as I said here, the goal is to expand access, but with quality, because in the absence of such an assessment, the costs of mergers that are not in line with the best scientific evidence will be passed on to the complementary healthcare beneficiaries,” he said at the time.

The National Congress must hold a joint session of senators and representatives to analyze a possible veto by Bolsonaro, and parliamentarians will decide whether to retain or veto it.

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