Stay up-to-date on Healthcare Reform.
Below is a summary of recent events to help you stay current on healthcare reform news all in one place.
Healthcare Reform News Update for July 1, 2022
California Provides Health Coverage Access to Undocumented Immigrants
The state of California expanded healthcare access to low-income California residents aged 26 to 49, regardless of their immigration status, after Gov. Gavin Newsom signed a new budget into law on Thursday. It is the only state in the U.S. to provide coverage at no cost to undocumented immigrants.
Approximately 764,000 people will qualify for coverage. The program will go into effect in 2024.
Healthcare Reform News Update for June 29, 2022
Study: Health Insurance Is Americans’ Third Highest Living Expense
Approximately 10.69% of the average American’s annual salary goes towards health insurance premiums, behind childcare (18.41%) and rent (28.24%), according to a new study by NiceRX. The average annual cost of health insurance across all 50 states is $6,487.20.
The study also found that the highest percentage of salaries goes towards health insurance in West Virginia (20.85%, average cost of health insurance of $9,972), followed by Louisiana (16.05%, $8,736), and Vermont (15.28%, $9,120).
Healthcare Reform News Update for June 28, 2022
CMS Testing New Payment Model To Improve Medicare Cancer Care
The Centers for Medicare and Medicaid Services (CMS) will launch the Enhancing Oncology Model (EOM), a voluntary payment model intended to help Medicare beneficiaries who are cancer patients, in July of 2023. Participants in the EOM will include oncology practices.
Medicare beneficiaries will not be responsible for the new EOM payment, the full amount will be covered by Medicare.
Services provided by EOM participants may include:
- 24/7 access to a clinician with real-time access to your medical records
- Patient navigation services
- A detailed care plan
- Screening for needs related to food, transportation, and housing
- Questions regarding your overall cancer care experience and health outcomes
The program will run for a five-year testing period.
Healthcare Reform News Update for June 24, 2022
Supreme Court Upholds HHS Statutory Interpretation
In a 5-4 decision, the Supreme Court ruled in favor of the U.S. Department of Health and Human Services (HHS) and against the hospital industry in Becerra v. Empire Health Foundation.
The case involved a challenge to the way HHS understands the phrase “Medicare fraction,” which is used to calculate reimbursement rates for hospitals that provide treatment for a lot of low-income patients. HHS interpreted the regulation to mean that individuals “entitled to Medicare Part A benefits” consist of those who qualify for Medicare, even if Medicare doesn’t pay for all or part of a patient’s hospital stay.
The Court decided that HHS’s interpretation was correct, which means some providers may be unable to get back some of their expenses when providing healthcare for low-income patients.
Healthcare Reform News Update for June 23, 2022
HHS Announces New Lower Premium Colorado Health Plan
The U.S Department of Health and Human Services (HHS) approved a state innovation waiver from Colorado, creating a new state-based new health coverage option. Colorado Option health insurance plans will be required to lower premiums by 5% in 2023, by 10% in 2024, and by 15% in 2025.
Additionally, the plans provide coverage for Affordable Care Act (ACA) essential health benefits, primary care, mental health, behavioral health, and prenatal visits. The state estimates that around 32,000 Coloradans will get health insurance by 2027 as a result of this plan.
The Colorado Option will become available to state residents who apply for health insurance on the individual market in 2023.
Healthcare Reform News Update for June 22, 2022
Supreme Court Sides With Health Plan
In a 7-2 decision, the Supreme Court ruled in favor of an employer-sponsored group health plan and against a kidney dialysis provider in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc.
The case involved whether the health policy’s coverage differentiated between individuals with and without End-Stage Renal Disease (ESRD), a potential violation of the Medicare Secondary Payer statue.
The Court found that there was no such violation, and that the plan doesn’t discriminate against patients with ESRD.
Healthcare Reform News Update for June 21, 2022
Study: Medicare Could Save Billions on Generic Drugs
If Medicare purchased generic drugs at the prices offered by Dallas billionaire Mark Cuban’s newly launched digital pharmacy in 2020, it could have saved the government program approximately $4 billion, according to a study published in Annals of Internal Medicine.
The report compared the cost of 89 generic drugs at Cuban’s company in 2022 with the price Medicare Part D plans paid for the same drugs in 2020. After adjusting for changes in drug costs between 2020 and 2022, the researchers found that Medicare paid more for 77 generic drugs.
Cuban recently announced on Twitter that his pharmacy plans to add more than 1,000 additional drugs in the next year.
Healthcare Reform News Update for June 16, 2022
Survey: 4 in 10 U.S. Adults Have Health Care Debt
One hundred million people in America – or four in 10 adults – have medical debt, according to a new investigation by the Kaiser Family Foundation. That means approximately 41% of adults have debt caused by medical or dental bills.
The findings also included:
- Approximately 1 in 5 adults with healthcare debt believe they’ll never pay it off.
- Half of U.S. adults wouldn’t be able to pay an unexpected $500 healthcare bill.
- One in 7 adults with healthcare debt said they’ve been denied provider care because of unpaid bills.
- 24% of adults say they have medical bills past due or that they’re unable to pay.
- One third of adults with health care debt owe less than $1,000.
Report: Medicare Advantage Enrollment Surpasses 50% in 123 Congressional Districts
Medicare Advantage enrollment has overtaken 50% of Medicare beneficiaries in more than 120 Congressional districts, which is an increase of 37% (90 districts) over last year, according to new data from the Better Medicare Alliance. Eighty-three of the districts are represented by Democratic members of Congress, while 40 are represented by Republicans.
The top 3 districts are:
- FL-24 – 76% Medicare Advantage enrollment.
- NY-15 – 73% Medicare Advantage enrollment.
- NY-25 –71% Medicare Advantage enrollment.
Healthcare Reform News Update for June 15, 2022
Supreme Court Rules Against HHS
In a unanimous decision, the Supreme Court ruled against the Department of Health and Human Services (HHS) and in favor of a nonprofit hospital group in American Hospital Association v. Becerra.
The case involved whether HHS had the discretion to alter the group’s annual Medicare reimbursement rates for outpatient drugs. The Court ruled that they did not and had acted unlawfully by reducing them, overturning a lower court’s 2020 decision.
Healthcare Reform News Update for June 3, 2022
Medicare Part A Trust Fund to Be Depleted by 2028
The projected date for when Medicare’s hospital trust fund will run out of money has been pushed back two years, from 2026 to 2028, according to the annual Social Security and Medicare trustees report. The trust fund pays for services like Medicare Part A inpatient care.
The report also projects that Social Security’s trust fund reserves will be depleted by the end of 2034, one year later than previously estimated.
Healthcare Reform News Update for May 27, 2022
HHS Withdraws SUNSET Rule
The Department of Health and Human Services (HHS) has officially withdrawn the Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) final rule. Originally published in January 2021, the regulation would have required HHS to thoroughly review and potentially eliminate existing rules unless the agency could have made a persuasive case for retaining them.
The new final rule abandoning the SUNSET rule means that it will not go into effect.
Healthcare Reform News Update for May 20, 2022
2020 CMS Medicaid Drug Price Rebate Rule Struck Down
A December 2020 rule finalized by the Centers for Medicare and Medicaid Services (CMS) exceeds the agency’s authority, according to a D.C. federal judge’s ruling. The government intended to require drug companies to use available coupons when calculating the “best price” for a drug.
The Pharmaceutical Research & Manufacturers of America successfully challenged the CMS regulation, claiming the policy was outside of federal Medicaid rebate law.
Healthcare Reform News Update for May 17, 2022
Research: Private Insurance Plans Paid Hospitals 224% More Than Medicare Rates in 2020
Employers and private insurance companies paid 224% more than Medicare would have paid in 2020 for inpatient and outpatient services, according to new research by RAND. This is a 23% decrease from the 2018 study’s percentage.
The findings also included:
- Hawaii, Arkansas, and Washington had relative rates that are about 175% of Medicare rates.
- Florida, West Virginia, and South Carolina had relative rates that were at or above 310% of Medicare rates.
- If the employer and private plans were paying Medicare rates for the same services, they would have saved $49.9 billion.
Healthcare Reform News Update for May 13, 2022
Research: Almost 41 Million Americans Received Mental Health Support Through Employer Coverage in 2020
Approximately 41 million people, or 1 in 4 Americans, received mental health support through their employer coverage in 2020, according to new research by AHIP.
The findings also included:
- Six million children received mental health services and treatment through a parent or guardian’s employer plan in 2020.
- Nearly 40% of psychotherapy visits were held virtually via a telehealth appointment in 2020, a 100-fold increase from 2019.
- Patients spent less than $15 in out-of-pocket expenses for most mental health prescription drugs.
Healthcare Reform News Update for May 11, 2022
Study: American Medical Debt Decreases
The percent of adults under 65 with medical debt dropped from 23.6% in March 2019 to 16.8% in April 2021, according to a new study by the Urban Institute. The report also found that self-reported medical debt and medical debt in collections declined across adults in all age ranges since the start of the pandemic.
The findings also included:
- The number of adults under 65 with difficulties paying medical bills in the past year decreased from 17% to 12.2%.
- The number of adults with credit records who have medical debt in collections decreased from 15.3% in February 2020 to 13.9% in August 2021.
- Medical debt decreased across racial and ethnic groups.
Healthcare Reform News Update for May 5, 2022
30 Million People Uninsured in 2021
Approximately 30 million people across all age ranges were uninsured in 2021 according to a new survey on health coverage conducted by the National Center for Health Statistics.
The findings also included:
- In 2021, across all age ranges, 9.2% were uninsured, 39.5% had public coverage, and 60.4% had private coverage.
- In 2021, 24.5% of adults aged 18-64 with family incomes less than 100% of the Federal Poverty Level (FPL) were uninsured; 23.7% with family incomes from 100% to less than 200% FPL were uninsured; and 8.4% of those with family incomes at or above 200% FPL were uninsured.
- The amount of people under 65 with exchange-based coverage increased to 4.3% in 2021 from 3.7% in 2019.
Healthcare Reform News Update for May 2, 2022
More Than 35 Million People Have ACA Coverage in Early 2022
A record number of people, more than 35 million, have health coverage related to the Affordable Care Act (ACA) as of early this year, according to a new federal report from the Department of Health and Human Services (HHS).
The report also states:
- The uninsured rate for the U.S. population decreased 1.5%, from 10.3% in Q4 2020 to 8.8% in Q4 2021.
- People with incomes above 200% of the Federal Poverty Level (FPL) have the lowest uninsured rate, which decreased from 7.6% to 6.4% in 2021.
- 14.5 million people signed up for marketplace health coverage during the 2022 Open Enrollment Period.
Healthcare Reform News Update for April 20, 2022
Analysis: Medicare Advantage Beneficiaries Save Almost $2K Over FFS Medicare
Beneficiaries enrolled in Medicare Advantage spend $1,965 less on out-of-pocket costs and premiums than fee-for-service (FFS) Medicare beneficiaries, according to a new study by Better Medicare Alliance.
The study also found:
- More than 52% of beneficiaries with Medicare Advantage live under 200% of the Federal Poverty Level (FPL).
- 38.3% of beneficiaries with FFS Medicare live under 200% of the FPL.
- 94.9% of Medicare Advantage beneficiaries and 96% of FFS Medicare beneficiaries report being “satisfied” or “very satisfied” with the quality of health care they received in the past year.
Healthcare Reform News Update for April 14, 2022
Report: Average ACA Benchmark Premiums Declined by 1.8% in 2022
Average Affordable Care Act (ACA) benchmark premiums fell 1.8% between 2021 and 2022, according to a new report from the Urban Institute. It was the third straight year that average benchmark premiums fell. The analysis also found that 32 states had benchmark premium reductions.
Healthcare Reform News Update for April 8, 2022
U.S. Postal Service Reform Bill Signed Into Law
President Biden signed the Postal Service Reform Act of 2022 into law on Wednesday. The legislation creates the Postal Service Health Benefits Program starting in January 2025 and addresses financial issues with the agency.
The bill performs the following functions:
- Eliminates a 2006 Congressional mandate that the Postal Service fund future retiree health benefits.
- Requires retired Postal Service employees to enroll in Medicare Parts B and D.
- Saves $50 billion over the next decade.
CMS Updates Medicare’s Alzheimer’s Drug Coverage Guidelines
The Centers for Medicare & Medicaid Services (CMS) finalized a rule on Thursday limiting coverage for the Alzheimer’s drug Aduhelm. Going forward, Medicare will only cover the cost of the prescription for those participating in clinical trials.
In making this final decision, CMS allowed flexibility for approving future medications for the treatment of Alzheimer’s. If the prescriptions show that they can benefit patients, they could potentially be covered by Medicare.
Healthcare Reform News Update for April 5, 2022
President Biden Signs Executive Order to Expand Health Coverage
President Joe Biden signed an executive order on Tuesday that directs federal agencies to continue expanding health coverage for Americans.
The order includes the following instructions:
- Make it easier for people to apply for and keep health coverage.
- Help people understand their coverage options.
- Expand coverage eligibility and lower costs for Americans with Affordable Care Act (ACA), Medicare, or Medicaid plans.
- Reduce medical debt for Americans.
Healthcare Reform News Update for March 23, 2022
HHS Analyzes 2022 Open Enrollment Period
The Department of Health and Human Services (HHS) released a new report featuring data on health plans chosen by consumers during the 2022 Open Enrollment Period, which occurred from November 1, 2021, through January 15, 2022, in most states.
Findings from the report include:
- 5 million more people signed up for coverage during the 2022 Open Enrollment Period vs. 2021’s Open Enrollment Period, a 21% increase.
- 3 million people enrolled in health coverage in the 33 states on the federal exchange.
- 3 million people applied for health coverage in the 18 state-based marketplaces.
- 20% more new people signed up for coverage during the 2022 Open Enrollment Period vs. 2021’s Open Enrollment Period, an increase from 2.5 million to 3.1 million.
- The average monthly 2022 premium for enrollees on the federal exchange was $111 after subsidies from the American Rescue Plan Act.
Healthcare Reform News Update for March 21, 2022
Medical Debt To Be Eliminated From U.S. Credit Reports
Credit-reporting firms Equifax, Experian, and Transunion will update their processes for reporting medical debt starting in July 2022.
This summer, these companies will excise medical debt that was paid after it had been sent to collections from consumer reports. In 2023, they’ll take off unpaid medical debts that are less than $500.
The changes to the credit-reporting could make it easier for Americans to borrow and qualify for loans.
A March 2022 Health System Tracker study found that 23 million people owe significant medical debt, with 1 in 10 adults across the U.S. owing at least $250 in medical debt.
Healthcare Reform News Update for February 23, 2022
Covered California Appoints New Chief Executive Officer
Jessica Altman, the insurance commissioner for the Pennsylvania Insurance Department, has been selected as the new Chief Executive Officer for Covered California. The appointment comes after Covered California executive director Peter Lee announced his departure in September 2021.
Altman helmed the launch of “Pennie,” Pennsylvania’s state-based health insurance marketplace, and served in a variety of positions with the National Association of Insurance Commissioners.
Altman will begin the role in March 2022.
Healthcare Reform News Update for February 14, 2022
Medicare Increases Access to Lung Cancer Screening Tool
Low dose computed tomography (LDCT), a tool used to detect lung cancer, will now be available to more people on Medicare, according to a new Centers for Medicare & Medicaid Services (CMS) final decision.
CMS expanded eligibility requirements in an effort to help people determine if they have lung cancer sooner.
- The eligibility age for LDCT has decreased from 55 to 50 years.
- Tobacco smoking history eligibility has decreased from 30 packs a year to 20.
- A requirement for radiologist documentation has been eliminated.
- A requirement for radiology facilities to use a “standardized lung nodule identification, classification, and reporting system” has been added back.
Healthcare Reform News Update for February 9, 2022
Idaho Expands Heath Insurance Benefits for Teachers
A new law in Idaho brings health insurance for educators in line with that of state employees. The state will increase its contribution towards teacher health insurance premiums by around $4,000 per teacher.
The legislation establishes a fund for school districts that opt to join the state’s health plan.
Previously, Idaho put $8,400 per year towards teacher health insurance expenses, as compared to $12,500 for legislator health insurance expenses.
Healthcare Reform News Update for February 3, 2022
Medicare to Provide Coverage for At-Home COVID-19 Tests
Medicare will provide coverage for over-the-counter COVID-19 rapid tests, according to a Centers for Medicare and Medicaid Services (CMS) statement.
Tests will be available at no cost to beneficiaries beginning in spring 2022. People with Medicare Part B, whether enrolled in a Medicare Advantage plan or not, will be able to visit their local pharmacy and retrieve the COVID-19 tests. Up to eight tests per person per month will be covered.
Healthcare Reform News Update for February 2, 2022
New York Extends 2022 Open Enrollment Deadline
New York has extended its Open Enrollment Period for residents to apply for Affordable Care Act (ACA) health coverage until February 15, 2022. Coverage will begin on March 1, 2022 for New Yorkers who enroll in an ACA plan between February 1 and February 15, 2022.
Healthcare Reform News Update for January 27, 2022
White House: 14.5 Million Americans Sign Up for ACA Plans
Since November 1, 2021, a record 14.5 million Americans have signed up for Affordable Care Act (ACA) health plans, according to a new statement from the White House.
The federal government also revealed new data from the Centers for Disease Control and Prevention (CDC), which indicates that 1 in 7 uninsured Americans found coverage from the end of 2020 through September 2021.
Federal Open Enrollment ended on January 15, but California, Kentucky, New Jersey, New York, Rhode Island, and Washington, D.C. residents have until January 31 to apply for ACA coverage, while Maryland residents have until February 28.
Healthcare Reform News Update for January 25, 2022
Kentucky, Maryland Extend 2022 Open Enrollment Periods
Kentucky has extended its Open Enrollment Period for residents to apply for Affordable Care Act (ACA) health coverage until January 31, 2022. Coverage will begin on March 1, 2022 for Kentucky residents who enroll in an ACA plan between January 16 and January 31, 2022.
Maryland has also extended its Open Enrollment Period through February 28, 2022. Residents who enroll by January 31 will have coverage beginning on February 1, 2022; for residents who enroll during February, coverage will start March 1, 2022.
Recent reports of consumer technical difficulties and a December 2021 severe weather natural disaster have also led to an extension of Kentucky’s Special Enrollment Period until January 31, 2022. Residents affected by either circumstance can obtain coverage that begins retroactively on January 1, 2022.
Healthcare Reform News Update for January 21, 2022
Mark Cuban Starts Online Prescription Drug Company
Dallas Mavericks owner, “Shark Tank” investor, and entrepreneur Mark Cuban has launched the Cost Plus Drug Company, an online pharmacy that seeks to lower drug prices by negotiating directly with manufacturers and skipping the middleman in the process.
The business will sell generic medications to consumers with a 15% markup and $3 pharmacist fee.
Healthcare Reform News Update for January 19, 2022
Report: Medicare Advantage Enrollment Increased in 2021
Federal data has revealed that Medicare Advantage enrollment increased 8.8% year-over-year, according to a new independent analysis.
From January 1, 2021 – January 1, 2022, more than 28.5 million seniors and people with disabilities enrolled in a Medicare Advantage plan.
Healthcare Reform News Update for January 11, 2022
Insurance Companies Required to Cover At-Home COVID-19 Tests
Private health insurance companies and group health plans will be required to provide coverage for the cost of at-home COVID-19 rapid tests beginning January 15, 2022, according to new guidance issued by the federal government.
Consumers can purchase over-the-counter COVID-19 diagnostic tests online, in a pharmacy, or at a store. Up to eight tests per person per month must be covered. A physician order is not necessary to buy tests.
Contact your plan or insurance company for additional details.
Healthcare Reform News Update for January 3, 2022
New Mexico Adds 2.75% Surtax on Health Insurance Premiums
A bill approved by the New Mexico legislature in 2021 has gone into effect, increasing a health insurance surtax on premiums to 2.75% for state residents as of January 1, 2022. Previously, the surtax was 1%.
The intent of the higher surtax is to help fund health insurance offerings for lower-income New Mexicans beginning in 2023. Some legislators fear that the insurance companies paying the surtax will pass the expense on to businesses and consumers.
Healthcare Reform News Update for December 29, 2021
CMS Expands Medicare Part B Durable Medical Equipment Coverage
Adjunctive continuous glucose monitors (CGMs) for diabetes treatment will now be classified as Durable Medical Equipment (DME) under Medicare Part B coverage, according to a final rule issued by the Centers for Medicare & Medicaid Services (CMS).
The rule also finalizes DME payment provisions that were previously included in 2018 and 2020 interim final rules.
The new classification will go into effect on February 28, 2022.
Healthcare Reform News Update for December 22, 2021
White House: More Than 4.6 Million Enrolled in ACA Coverage in 2021
Over 4.6 million Americans have acquired Affordable Care Act (ACA) health coverage since January 2021, according to a White House statement. The administration also observed that from November 1 – December 15, 2021, more than 13.6 million Americans applied for ACA health plans through government websites, a new record. This includes 1.8 million new enrollees.
The Open Enrollment Period deadline is January 15, 2022 in most U.S. states. There’s still time to apply for health coverage.
Healthcare Reform News Update for December 16, 2021
Report: Health Care Spending Increased 9.7% in 2020
U.S. health care spending surpassed $4 trillion in 2020, an increase of 9.7%, according to new data released by the Centers for Medicare & Medicaid Services (CMS).
Other findings from the report include:
- Private health insurance spending decreased by 1.2% to $1.15 trillion.
- Medicare spending increased 3.5% to $829.5 billion.
- Medicaid spending increased 9.2% to $671.2 billion.
- Out-of-pocket spending decreased 3.7% to $388.6 billion.
Healthcare Reform News Update for November 23, 2021
Original Medicare Premiums & Deductibles to Increase in 2022
Premiums and deductibles for Medicare Parts A and B will rise in 2022, according to the Centers for Medicare & Medicaid Services (CMS).
New rates for 2022:
- The Medicare Part B standard monthly premium will be $170.10, an increase of $21.60.
- The Medicare Part B annual deductible will be $233, an increase of $30.
- The Medicare Part A inpatient hospital deductible will be $1,556, an increase of $72.
- Medicare Part A coinsurance will be $389 per day for days 61-90, an increase of $18.
CMS has attributed the rise in costs to increased healthcare system use, the effort to keep Medicare Part B premiums lower in 2021, and the uncertainty of whether Medicare will cover the expensive Alzheimer’s drug, Aduhulelm™, in the future.
Medicare Open Enrollment is currently underway but will end on December 7, 2021.
Healthcare Reform News Update for October 26, 2021
Average 2022 ACA Premiums in Federal Exchange States to Decrease By 3%
Average premiums for 2022 Affordable Care Act (ACA) benchmark silver plans available in states on the federal exchange will decline by 3% a month according to a report from the Centers for Medicare & Medicaid Services (CMS).
This is the fourth consecutive year that premiums have lowered.
Other information in the report includes:
- Four out of five consumers will be able to find health coverage for $10 or less per month after subsidies.
- An additional 32 insurance companies will provide ACA coverage in 2022, for a total of 213.
- More than 89% of enrollees will have access to plans from three or more insurance companies.
- The average 2022 ACA benchmark plan premium for a family of four will be $1,440.
Healthcare Reform News Update for October 5, 2021
CMS: Employer Group Health Plans Can Offer Premium Discounts to Vaccinated Customers
The Centers for Medicare and Medicaid Services (CMS) provided new guidance this week for health insurance companies in regards to the COVID-19 vaccine.
While plans and companies cannot refuse benefits to customers who are unvaccinated, they can offer premium discounts to customers who have received a COVID-19 vaccine under current wellness program rules.
Any discounts offered for vaccination cannot be more than 30% of the total cost of employee-only coverage. Eligible participants must be allowed to qualify for potential rewards at least once a year.
Kentucky, Maine, New Mexico Launch State-Run Marketplaces
Kentucky, Maine, and New Mexico have left the federal marketplace and launched their own state health insurance marketplaces ahead of the 2022 Open Enrollment Period. The Open Enrollment Period for all three states will begin on November 1, 2021 and end on January 15, 2022.
Healthcare Reform News Update for September 30, 2021
2022 Medicare Advantage & Part D Premium Information Released
The Centers for Medicare and Medicaid Services (CMS) has released average premiums for 2022 Medicare Advantage and Part D plans. The average 2022 Medicare Advantage premium has decreased to $19/month from $21.22/month in 2021. For Medicare Part D, the average 2022 premium has increased slightly to $33/month, up from $31.47 in 2021.
Medicare Open Enrollment will run from October 15 through December 7.
Healthcare Reform News Update for September 20, 2021
2022 Open Enrollment Period Extended Through January 15
The Centers for Medicare and Medicaid Services (CMS) has extended the 2022 Affordable Care Act (ACA) Open Enrollment Period into the new year, adding 30 more days during which Americans can apply for health insurance. The Open Enrollment Period will now occur from November 1, 2021, through January 15, 2022.
CMS also announced a new monthly Special Enrollment Period for qualified individuals who are eligible for premium subsidies and whose income does not exceed 150% of the Federal Poverty Line (FPL).
Covered California Executive Director to Step Down
Peter Lee, the first and only executive director of Covered California, will be leaving his position in March 2022. With Lee at the helm, the state’s uninsured rate decreased from 17.2% in 2013 to 7.7% in 2019. He has served the organization since 2011.
Covered California’s Board of Directors plan to start a national search for Lee’s successor.
Healthcare Reform News Update for September 16, 2021
California Opens Special Enrollment Period for COBRA Recipients
Covered California has opened a Special Enrollment Period (SEP) for those who are losing the federal financial subsidy and receive health insurance via the Consolidated Omnibus Budget Reconciliation Act (COBRA). On September 30, a provision of the American Rescue Plan Act that provided qualifying COBRA recipients with premium subsidies will expire. This SEP will allow eligible Californians to find new health coverage.
The SEP will run through November 29.
Healthcare Reform News Update for September 15, 2021
2.8 Million Americans Gain ACA Health Coverage During SEP
From February 15 to August 15, 2.8 million Americans signed up for Affordable Care Act (ACA) health insurance during a Special Enrollment Period (SEP), according to a new White House statement.
The statement also reports:
- 2 million Americans are currently enrolled in ACA health coverage, an all-time high.
- Americans with an ACA plan have seen their premiums decrease an average of $67/month.
- 40% found a plan for $10 or less during the SEP.
The next opportunity to apply for ACA health insurance will occur during the Open Enrollment Period, which starts on November 1.
Healthcare Reform News Update for September 2, 2021
CMS Names First Chief Dental Officer
The Centers for Medicare and Medicaid Services (CMS) has announced that Dr. Natalia Chalmers will be its first-ever Chief Dental Officer. The primary focus of the position will be “commitment to care for the whole person, a key to reducing health disparities and advancing health equity.”
Chalmers previously served as a dental officer at the U.S. Food and Drug Administration.
Healthcare Reform News Update for August 24, 2021
Price Transparency Rule Enforcement Delayed Until July 2022
The Centers for Medicare & Medicaid Services (CMS) will be delaying the enforcement of a new Transparency in Coverage final rule for group health insurance plans and companies until July 1, 2022.
The rule, issued in October 2020, requires group health insurance policies and insurance carriers to make public in-network rates, out-of-network amounts and billed charges, and prescription drug prices.
Previously, the rule was scheduled to be implemented on January 1, 2022.
Healthcare Reform News Update for August 19, 2021
California Launches Special Enrollment Period for Wildfire Survivors
California has opened a Special Enrollment Period (SEP) for residents of 11 counties where a state of emergency was declared in response to local wildfires. Californians who live in Alpine, Butte, El Dorado, Lassen, Nevada, Placer, Plumas, Shasta, Siskiyou, Tehama and Trinity counties are eligible to apply for health coverage if they are currently uninsured.
Those who qualify for the SEP have 60 days from the date the emergency was declared to sign up for health insurance. Participants who enroll by August 31 will have coverage beginning September 1.
Healthcare Reform News Update for August 10, 2021
Over 2.5 Million Sign Up For ACA Health Coverage During SEP
Approximately 2.5 million Americans have chosen Affordable Care Act (ACA) health insurance plans since the start of a Special Enrollment Period (SEP) on February 15, according to a Centers for Medicare and Medicaid Services (CMS) report.
Other findings from the report include:
- Since the implementation of the American Rescue Plan Act (ARPA), 2.6 million people have returned to apply for health coverage and are paying 39% less on average compared to their previous monthly premiums.
- Thirty-five percent of new and returning customers found plans for $10 or less per month after advance payments of premium tax credits.
The SEP will end this upcoming Sunday, August 15.
Healthcare Reform News Update for August 6, 2021
Connecticut Extends ACA Special Enrollment Period
Connecticut’s state Affordable Care Act (ACA) exchange has extended its Special Enrollment Period (SEP) until October 31 for uninsured residents.
The SEP will end the day before the annual Open Enrollment Period usually begins, November 1. Connecticuters will have until December 31 to apply for health coverage.
Healthcare Reform News Update for August 5, 2021
Report: American Rescue Plan Act Reduces ACA Premiums for Returning Customers
After the enactment of the American Rescue Plan Act (ARPA) in March 2021, customers who returned to apply for health coverage in U.S. states on the federal exchange are finding lower Affordable Care Act (ACA) health insurance premiums, according to a new Centers for Medicare & Medicaid Services (CMS) report. The average savings over their previous monthly premiums, across 36 states, is approximately 40% – a result of enhanced premium tax subsidies.
The report also found that 34% of new and returning enrollees have found an ACA health insurance plan for $10 or less per month.
Healthcare Reform News Update for August 3, 2021
Report: ACA Increases Coverage for Americans with Disabilities
From 2010-2018, the amount of working-age adults with disabilities who had continuous coverage increased from approximately 71% to 81%, according to a new report from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the Department of Health and Human Services (HHS).
These increases were concentrated in 2014 after the passage of the Affordable Care Act (ACA).
Other findings from the report include:
- The uninsured rate for adults with disabilities decreased to 9% in 2017-2018 from 17% in 2010.
- Approximately 532,000 uninsured adults with disabilities (67%) may have access to a zero-premium health plan after subsidies as a result of the 2021 American Rescue Plan Act.
Healthcare Reform News Update for July 26, 2021
CMS & IRS To Maintain Tax Subsidies for Americans Who Didn’t File Their Taxes
Americans with ACA health insurance subsidies who did not file tax returns and reconcile the previous year’s advance premium tax credit (APTC) will get to keep those subsidies during plan years 2021 and 2022, according to a Centers for Medicare and Medicaid Services (CMS) and the Internal Revenue Service (IRS) announcement.
Per federal regulations, Americans must reconcile their APTC when filing federal income taxes each year. The reconciliation adjusts the tax credit based on the amount actually earned that year. Failure to take this action could result in the loss of subsidies in the future.
Those who were informed that the CMS may verify their fail to file and reconcile (FTR) status in fall 2020 will not have their status checked again. FTR operations will be suspended for the upcoming Open Enrollment Period.
Healthcare Reform News Update for July 23, 2021
Department of Labor Issues Insurer Guidance on PrEP
The U.S. Department of Labor (DOL) provided new guidance to insurance companies regarding the preventive HIV drug pre-exposure prophylaxis (PrEP) on Monday.
The HIV+Hepatitis Policy Institute, an HIV patient advocacy group, found that many Affordable Care Act (ACA) health plans haven’t implemented January 2021 regulations that require plans to provide access to PreP without cost-sharing.
The DOL notice serves as a reminder that insurance companies have 60 days to provide PreP coverage without cost-sharing; failure to do so will result in enforcement actions.
Healthcare Reform News Update for July 15, 2021
More Than 2 Million Sign Up For ACA Coverage Since February
According to the Centers for Medicare & Medicaid Services (CMS), more than 2 million Americans have enrolled in Affordable Care Act (ACA) plans since the start of a Special Enrollment Period (SEP) on February 15. Of the enrollees, 1.2 million applicants were able to choose a health plan that costs $10 or less per month after premium reductions.
This June Marketplace report also shows that 81 million people have found coverage via Medicaid and the Children’s Health Insurance Program (CHIP) since February.
The special enrollment period will end on August 15.
Healthcare Reform News Update for July 14, 2021
Study: ACA Improves Affordability of Health Care Expenses for Younger Cancer Survivors
Cancer survivors between the ages of 18-64 were less likely to delay medical treatments and were more likely to afford medications and dental care during the five-year period after the implementation of the Affordable Care Act (ACA), according to a new study conducted by researchers at the University of Michigan.
Other findings from the study of include:
- A decrease in the number of the younger cancer survivors without health insurance.
- An increase in Medicaid enrollment for the younger cancer survivors.
- Younger cancer survivors were more likely to be able to afford healthcare during this time than any other since 2000.
Healthcare Reform News Update for July 12, 2021
President Biden Signs Executive Order Promoting Competition
President Joe Biden signed an executive order on Friday that directs the U.S. Department of Health and Human Services (HHS), among others, to strengthen and promote competition in the American economy.
As HHS Secretary, Xavier Becerra was ordered to “ensure that Americans can choose health insurance plans that meet their needs and compare plan offerings, implement standardized options in the national Health Insurance Marketplace and any other appropriate mechanisms to improve competition and consumer choice.”
The order also declared that it is the policy of the current administration to support the enactment of a public health insurance option.
Healthcare Reform News Update for July 7, 2021
The Director of Center for Medicare Announced by CMS
The Centers for Medicare and Medicaid Services (CMS) has announced that Dr. Meena Seshamani will be the Deputy Administrator and Director of the Center for Medicare.
Seshamani previously served as Vice President of Clinical Care Transformation at MedStar Health and as Director of the Office of Health Reform at the U.S. Department of Health and Human Services (HHS).
Healthcare Reform News Update for July 6, 2021
Federal Government Issues Rule Banning Surprise Billing
The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury and the Office of Personnel Management released a final rule on Thursday regarding surprise medical bills and balance billing for patients.
Implementing legislation passed by Congress in December 2020, the new rule:
- Prohibits surprise billing for emergency services.
- Bans high out-of-network cost-sharing for emergency and non-emergency services.
- Bans out-of-network charges for ancillary care received in an in-network facility.
- Prohibits other out-of-network charges without advance notice.
The rule is not applicable to those with coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE, all of which already prevent balance billing.
These new regulations will go into effect on Jan. 1, 2022, for healthcare providers and insurance plans that begin on or after Jan. 1, 2022.
Healthcare Reform News Update for June 30, 2021
Increased ACA Subsidies Available for Unemployed Americans Beginning July 1
Starting July 1, 2021, Americans who have received unemployment benefits during any week in 2021 may qualify for new health insurance subsidies, due to provisions in the American Rescue Plan Act.
According to the Department of Health and Humans Services (HHS), an average of three out of five eligible uninsured Americans will be able to choose $0 Affordable Care Act health insurance plans after advanced payment of tax credits.
The Centers for Medicare & Medicaid Services (CMS) recommends anyone who has received unemployment compensation during 2021 to update their application and enrollment from July 1 – August 15.
Healthcare Reform News Update for June 24, 2021
CMS to Award $20M for Improvements to State ACA Exchanges
The Centers for Medicare & Medicaid Services (CMS) plans to distribute $20 million in grants to help fund state-based Affordable Care Act marketplaces improvements.
The funds come from a provision of the American Rescue Plan and will be awarded to help states finance upgrades that will improve exchange performance and customer experience. The grants can be used for technology updates, improving eligibility determination, consumer education, state and federal reporting, staff training, and oversight and monitoring activities .
States have until July 20 to apply for the funding which is expected to be distributed by CMS in September.
Healthcare Reform News Update for June 23, 2021
Supreme Court Declines to Hear ACA Cost-Sharing Reduction Payments Case
The case was a response to a Trump administration decision in 2017 that halted CSR reimbursements. The appeal from Maine Community Health Options and Community Health Choice sought to recoup the lost payments. A previous court had ruled that plans that had engaged in “silver loading” were not eligible for reimbursement of lost CSR payments.
Healthcare Reform News Update for June 17, 2021
Supreme Court Dismisses Challenge to the ACA
In a 7 to 2 ruling, the U.S. Supreme Court struck down a challenge from Republican-led states against the Affordable Care Act (ACA), leaving the healthcare law in place.
The challenge argued that the repeal of the individual mandate invalidated the entire law. The Supreme Court ruled that the argument did not have standing, which means the plaintiffs did not have the legal right to initiate the case.
Healthcare Reform News Update for June 15, 2021
Report: Over 1 Million ACA Enrollees Pay $10 or Less on Premiums
More than 1 million Americans who have signed up for an Affordable Care Act (ACA) plan during the extended Special Enrollment Period (SEP) pay $10 or less per month in premiums, according to a new report.
Of the total number of people who have signed up for ACA plans during this period, 43% of new enrollees and 30% of returning enrollees pay $10 a month or less after a tax credit.
Other findings in the report:
- 1,034,624 enrollees selected ACA plans with premiums of $10 or less per month after the tax credit.
- Over 1.2 million new enrollees have signed up for ACA plans since February 15, when the extended SEP began.
- 3 million returning enrollees reduced their monthly premiums by 40% on average, from $103 to $61.
- 331,000 people who applied for coverage were determined eligible for state Medicaid or the Children’s Health Insurance Program (CHIP).
Healthcare Reform News Update for June 10, 2021
Nevada Governor Signs Bill to Create Public Health Insurance Option
Nevada Governor Steve Sisolak signed a bill into law Wednesday that seeks to establish a state-managed public insurance option for residents by 2026. The plan must first undergo an actuarial study, and the law must be approved by the federal government before it can be implemented.
If approved, the law would require selected state-run insurance plans to set premiums 5% less than the average Affordable Care Act (ACA) plan for the first four years; premiums would be required to be 15% lower thereafter.
Healthcare Reform News Update for June 7, 2021
ACA Enrollment Hits Record-High 31 Million
Enrollment in Affordable Care Act (ACA) plans has reached a record high, according to a report released Saturday by the Department of Health and Human Services (HHS).
As of February 2021, approximately 31 million Americans had ACA-related coverage. Enrollees had coverage either through an ACA plan directly or through Medicaid due to the ACA’s expansion of eligibility requirements in late 2020. The total does not include more than 1 million people who have enrolled during the Special Enrollment Period (SEP) that runs until August 15.
Enrollment data as of February:
- 3 million were enrolled in ACA plans
- 8 million were newly enrolled in Medicaid through ACA expansion
- 4 million were previously eligible for Medicaid, but are newly enrolled due to outreach efforts
- 1 million were enrolled in the ACA’s Basic Health Program option
Healthcare Reform News Update for May 26, 2021
Senate Confirms Brooks-LaSure to Lead CMS
The Senate on Tuesday confirmed Chiquita Brooks-LaSure as head of the Centers for Medicare and Medicaid Services (CMS). The department oversees health insurance programs for more than 130 million Americans, including the Affordable Care Act (ACA) and children’s health coverage.
Brooks-LaSure previously served at CMS under Barack Obama and in the White House budget office during George W. Bush’s presidency.
Healthcare Reform News Update for May 25, 2021
ACA Plan Premiums Show Three-Year Decline
The national average benchmark premiums for Affordable Care Act (ACA) plans have fallen for the third straight year, according to a new analysis by the Urban Institute.
The study found that, in 2021, premiums fell by 1.7%, which follows decreases of 3.2% in 2020 and 1.2% in 2019.
- ACA premiums fell while employer plans increased during the same period.
- Average premiums dropped in 43 states, with only one state experiencing an increase higher than 6%.
- Areas with multiple carriers have lower premiums than those with only one or two insurer options.
- Regions with Medicaid options tend to have lower premiums.
- State marketplaces have lower benchmark premiums than those on the federal exchange.
- States with expanded Medicaid and reinsurance programs have lower premiums.
Healthcare Reform News Update for May 19, 2021
Study: Dual-Eligible Enrollees May Have Had Better Access to Care Under Medicare Advantage Plans than Original Medicare During Past Year
Low-income Americans enrolled in dual-eligible Medicare Advantage plans throughout the pandemic were less likely to experience difficulties accessing medical care than those with Original Medicare, according to a new study from NORC at the University of Chicago.
The analysis shows that, even though enrollees with dual-eligible plans are older, sicker, and more racially diverse than those in traditional plans, they had better access to healthcare.
Other findings from the analysis include:
- 51% of dual-eligible enrollees with Original Medicare were unable to receive a regular checkup compared to 35% of those with Medicare Advantage.
- 23.1 % of dual eligibles felt socially isolated compared to 32.8% of Original Medicare enrollees.
- 63% of dual eligibles had access to telemedicine visits compared to 52% of Original Medicare enrollees.
Healthcare Reform News Update for May 14, 2021
One Million Americans Sign Up for ACA Coverage During Special Enrollment Period
As of this week, one million Americans have signed up for Affordable Care Act (ACA) health insurance coverage since a Special Enrollment Period (SEP) began February 15, according to a statement from the Biden administration.
Click here for more information on the SEP, which ends August 15.
Healthcare Reform News Update for May 7, 2021
New ACA Sign Ups Pass 900k Since Start of Special Enrollment Period
The Centers for Medicare & Medicaid Services reported that 939,575 people made new Affordable Care Act plan selections on the federal exchange website from February 15 to April 30. This special enrollment period ends August 15.
The report also notes that around 1.9 million existing ACA customers re-enrolled in plans to reduce monthly premiums by over 40 percent on average, due to provisions in the American Rescue Plan Act (ARP) that went into effect April 1.
Additional data regarding ARP out-of-pocket reductions:
- Premiums were lowered for existing enrollees from an average of $100 per month to $57.
- The average premium for new enrollees fell over 25 percent from $177 to $86 per month.
- The median deductible for new enrollees fell by nearly 90 percent from $450 to $50.
Healthcare Reform News Update for May 3, 2021
CMS Finalizes Cost-Sharing & SEP Provisions for 2022 ACA Plans
The Centers for Medicare & Medicaid Services (CMS) released a final rule for 2022 Affordable Care Act (ACA) plans that includes new provisions for cost-sharing limits and eligibility for special enrollment periods (SEPs).
Though out-of-pocket limits for ACA health insurance vary by plan, CMS establishes an amount each year that no plan can exceed. For 2022, the maximum annual limit for people earning over 250% of the federal poverty level (FPL) will be $8,700 for individuals and $17,400 for families. That compares to $8,550 and $17,100 for 2021 plans.
Other 2022 cost sharing maximums:
- Incomes between 100% and 200% of FPL: $2,900 for individuals; $5,800 for families
- Incomes between 200% and 250% of FPL: $6,950 for individuals; $13,900 for families
The new SEP rule also expands who can sign-up outside of the Annual Enrollment Period (AEP), including people who did not receive a timely notice when they had a qualifying event and those who no longer receive employer contributions or government subsidies.
Healthcare Reform News Update for April 13, 2021
Study: Medicare Advantage Users Spend 40% Less
People with Medicare Advantage plans spend 40% less per year than people enrolled in Original Medicare, according to resources used in a recent UnitedHealth Group publication.
The analysis found that average spending for annual out-of-pocket costs and premiums for Medicare Advantage beneficiaries is $3,558. That compares to $5,361 for people with Original Medicare and a Part D plan and $5,992 for those with Original Medicare, a Part D plan, and Medicare Supplement Plan G.
Other findings in the study:
- Annual cost sharing for Medicare Advantage Prescription Drug (MA-PD) users is 10.7% compared to 16.3% for Original Medicare beneficiaries.
- Medicare Advantage Prescription Drug (MA-PD) users spend between $64,321 and $98,878 less in lifetime costs than those with Original Medicare and Medigap Plan G, respectively.
Healthcare Reform News Update for April 8, 2021
528,000 Have Signed Up During ACA Special Enrollment Period
More than 528,000 people have signed up for Affordable Care Act (ACA) coverage during a Special Enrollment Period (SEP) that began February 15 in the 36 states that use the federal exchange, according to a report from the Centers for Medicare and Medicaid Services (CMS).
CMS also reports that the percentage of minority and low-income enrollees has increased compared to last year, with a 6% increase in Black consumers and 5% increase in households that earn between 100% and 138% of the federal poverty level.
Learn more about your state’s SEP here.
Healthcare Reform News Update for April 7, 2021
New Medicare Advantage Plan Created for Older Beneficiaries in VT, NY
MVP Health Care and the University of Vermont Health Network have partnered to launch a new Medicare Advantage plan in 2022 for older residents in Vermont and northern New York. Details of plan benefits will be available this fall.
Healthcare Reform News Update for March 24, 2021
ACA Special Enrollment Period Extended Through August 15
The Biden administration announced Tuesday that the Affordable Care Act (ACA) Special Enrollment Period (SEP) for the federal healthcare exchange has been extended through August 15.
The expansion will enable individuals and families more time to access the increased tax subsidy credits included under the American Rescue Plan stimulus, according to the Centers for Medicare and Medicaid Services (CMS).
The additional premium financial assistance will be available beginning April 1. To take advantage of the reductions, current ACA plan enrollees must submit an application update through the federal exchange on – or after – April 1. After receiving a new eligibility determination, consumers can continue their current health plan with a new lower premium, or they can choose a new plan.
Healthcare Reform News Update for March 23, 2021
Special Enrollment Period Adds Over 206,000 ACA Signups in First Two Weeks
During the first two weeks of a Special Enrollment Period (SEP), more than 206,000 consumers enrolled in Affordable Care Act plans, according to the Centers for Medicare and Medicaid Services (CMS).
Data shows that 206,236 new enrollees signed up between February 15-28 in states that use the federal Affordable Care Act (ACA) exchange.
Healthcare Reform News Update for March 19, 2021
Becerra Confirmed as Health & Human Services Secretary
The Senate confirmed Former California attorney general Xavier Becerra as the new secretary for the Department of Health and Human Services (HHS) in a 50-49 Senate vote on Thursday.
Becerra previously represented a Los Angeles district for 12 terms in the House of Representatives, serving on the Ways and Means Committee, which set healthcare policy. Becerra also helped draft the Affordable Care Act (ACA) and has defended it in court.
As HHS Secretary, Becerra will have an important voice in deciding federal policy regarding Covid-19. Becerra has said he will “work on a bipartisan basis to safeguard insurance-coverage protections for people with pre-existing conditions, reduce healthcare costs, and sustain the ACA market.”
Healthcare Reform News Update for March 12, 2021
Stimulus Package Expands ACA Tax Subsidies and COBRA Coverage
President Biden signed a stimulus bill into law on Thursday that includes a temporary expansion of people eligible to receive premium tax subsidies for Affordable Care Act health plans, increased subsidy amounts for those previously eligible, and expanded COBRA coverage to those who lose their jobs.
Called the American Rescue Plan Act, the law will now enable Americans who earn over 400% of the federal poverty level (FPL) to receive premium tax credits when the premium for the silver benchmark plan in their area exceeds 8.5% of their annual income.
Those who were previously eligible for a tax subsidy will receive larger premium tax credits. The percentage of income that individuals and families are expected to contribute towards premiums for plan years 2021 and 2022 was reduced, thereby increasing the amount of premium tax subsidies available to those earning less than 400% of the FPL.
In addition, people who lose their jobs and enroll in COBRA coverage will receive a premium subsidy that will cover the total monthly cost through September 30, 2021. Those who missed their original COBRA deadlines will now have an additional 60 days to enroll.
Healthcare Reform News Update for March 4, 2021
Over 206,000 Sign Up for ACA Plans in First Weeks of Special Enrollment Period
More than 206,000 Americans signed up for Affordable Healthcare Act health insurance plans in the first two weeks of a 2021 Special Enrollment Period (SEP), according to the Centers for Medicare & Medicaid Services. The report accounts for the 36 states that use the federal exchange.
Normally only those with qualifying life events are eligible for an SEP and allowed to purchase insurance outside of the Open Enrollment Period. However this current SEP is open to anyone who needs coverage.
Healthcare Reform News Update for March 2, 2021
Study Shows ACA Subsidies Reduced Financial Burden for Low-income Adults
Low-income households eligible for both Affordable Care Act premium subsidies and cost-sharing reductions spent 17% less on out-of-pocket healthcare costs and had a 30% lower probability of catastrophic healthcare expenses than those who did not qualify for any subsidies, according to a new study published in Health Affairs.
The analysis also showed that middle-income adults eligible only for premium subsidies did not have lower-out-pocket healthcare costs or a lower probability of catastrophic healthcare expenses.
CMS Adds $2.3 Million in Navigator Funding for SEP
The Centers for Medicare and Medicaid Services announced it will provide $2.3 million in funding to Affordable Care Act Navigators in states that use the federal marketplace for the Special Enrollment Period (SEP) that runs through May.
The funds will be used by 30 eligible organizations for outreach, education, and enrollment efforts.
CMS also said that it plans to increase navigator funding for the 2022 ACA enrollment period.
Healthcare Reform News Update for February 22, 2021
Chiquita Brooks-LaSure Announced as CMS Nominee
President Joe Biden has announced Chiquita Brooks-LaSure as his nominee to head the Centers for Medicare and Medicaid Services (CMS).
Brooks-LaSure previously served as deputy director for policy at the Center for Consumer Information and Insurance Oversight within CMS and as director of coverage policy for the Department of Health & Human Services (HHS).
Healthcare Reform News Update for February 17, 2021
Aetna Plans to Re-enter ACA Marketplace in 2022
Aetna will sell plans on the Affordable Care Act exchanges in 2022, according to parent company CVS Health Corp’s CEO Karen Lynch. Aetna previously withdrew from the ACA marketplace in 2018.
Lynch did not specify what exchange markets the company would reenter, but she said it would likely concentrate on areas where its 650 CVS HealthHub stores are located.
The plan will include the CVS name and may offer similar benefits as its employer plans such as no-copay visits to CVS MinuteClinics, discounts on some items sold at CVS stores, and ties to Health Hub offerings.
Healthcare Reform News Update for February 11, 2021
Biden Administration Supports ACA in Supreme Court Case
The Department of Justice (DOJ) sent a letter to the Supreme Court on Wednesday withdrawing the previous administration’s push to overturn the Affordable Care Act (ACA).
Previously, the Trump administration sided with Republican challengers to the ACA who argued that the repeal of the individual mandate invalidated the entire healthcare law. President Joe Biden’s position now puts the DOJ on the side of 20 Democratic states that want to uphold the ACA.
Healthcare Reform News Update for February 8, 2021
Medicare Advantage Extra Benefits Enrollment Triples in 2021
Enrollment in Medicare Advantage plans that offer special supplemental benefits for the chronically ill (SSBCI) increased from 1 million in 2020 to 3 million in 2021, according to research from Avalere Health.
Beginning last year, Medicare Advantage plans were allowed to offer non-primary health-related benefits to people with conditions such as diabetes and asthma. These plans represent 16% of all 2021 Medicare Advantage plans that were analyzed.
The most commonly offered SSBCI are meals, food and produce, and pest control.
The analysis found that 86% of Medicare beneficiaries live in a county with at least one plan that offers an SSBCI benefit. Overall, 15% of 2021 Medicare Advantage enrollees are enrolled in plans offering SSBCI, compared to 6% in 2020.
Healthcare Reform News Update for February 4, 2021
Pennsylvania and New Jersey Announce ACA Special Enrollment Periods
State Affordable Care Act exchanges in Pennsylvania and New Jersey have opened Special Enrollment Periods for any uninsured residents.
Pennsylvanians can enroll in an ACA plan from February 15 through May 15. New Jersey’s exchange will remain open through May 15 with coverage starting the first day of the month after enrollment.
Healthcare Reform News Update for January 29, 2021
California Announces ACA Special Enrollment
California’s state Affordable Care Act (ACA) exchange will open a Special Enrollment Period (SEP) from February 1 through May 15 for any uninsured resident.
The SEP immediately follows the state’s current Open Enrollment Period (OEP), which runs through January 31 for coverage that starts February 1.
Healthcare Reform News Update for January 28, 2021
President Biden Orders ACA Special Enrollment Starting February 15
President Joe Biden signed an executive order Thursday that will open an Affordable Care Act (ACA) Special Enrollment Period (SEP) from February 15 to May 15 for the 36 states that use the federal ACA exchange.
The SEP will apply to anyone without insurance coverage who would like to sign up for a plan.
Healthcare Reform News Update for January 19, 2021
CMS Oks New Medicare Part D Drug Tier
The Centers for Medicare & Medicaid Services (CMS) finalized a rule that will allow insurance companies to create a second “preferred” specialty tier for some high-cost Medicare Part D specialty drugs.
The new preferred tier will have lower out-of-pocket costs for Medicare patients than the current “specialty” tier. Currently, all drugs on a Part D plan’s specialty tier have the same level of cost sharing.
Healthcare Reform News Update for January 15, 2021
Federal Lawsuit Challenges Georgia Plan to Block ACA Exchange
A federal lawsuit has been filed against the Trump administration over a Georgia Affordable Care Act (ACA) waiver that would replace the federal exchange with private broker sites beginning in 2023.
The lawsuit argues that blocking access to the federal marketplace would increase the number of uninsured residents, weaken coverage offerings, and increase premiums. Advocates for the plan believe the waiver will increase competition and available options.
Healthcare Reform News Update for January 13, 2021
Medicare Rule Allows Faster Coverage for Innovative Technologies
The Centers for Medicare and Medicaid Services (CMS) issued a final rule that will allow innovative medical devices to be covered more quickly by Medicare.
The rule approves devices designated as “breakthrough” to be covered as soon as the same day the device is authorized by the Food and Drug Administration (FDA). Devices will receive an initial four years of Medicare coverage.
Healthcare Reform News Update for January 5, 2021
Maryland has implemented a special enrollment period that allows residents to sign up for Affordable Care Act health insurance from now until March 15.
Coverage begins depending on when a resident enrolls in a plan:
- Enrolled from now through January 15: coverage starts on January 1.
- Enrolled from January 16–February 15: coverage starts February 1.
- Enrolled from February 16–March 15: coverage starts March 1.
Healthcare Reform News Update for December 22, 2020
Congress Passes Spending Package That Includes a Ban on Surprise Billing
Congress on Monday passed a $900 billion economic relief package including legislation that eliminates the practice of “surprise billing” beginning in 2022.
Surprise bills result from insured patients unexpectedly using out-of-network providers, most commonly in emergency settings.
The bill applies to doctors, hospitals, and air ambulances. Ground ambulances are unaffected. An exception is made if a patient gives consent prior to visiting an out-of-network physician.
Instead of charging patients, non-network providers will work directly with insurance companies regarding payment. Disagreements will be sent to outside mediators to negotiate.
Healthcare Reform News Update for December 15, 2020
Daily Average ACA Signups Increase by 14%
The daily average number of consumers signing up for Affordable Care Act plans on the federal exchange is about 14% higher than last year, according to recent federal data.
Approximately 3.8 million people signed up for plans from Open Enrollment’s start through December 5, including 2.9 million returning enrollees and 916,000 new enrollees.
Today marks the final day of enrollment for the 36 states that use the federal exchange. Final enrollment totals will be released in early 2021.
Healthcare Reform News Update for December 10, 2020
Gallup Poll: Majority of Americans Support Affordable Care Act
American’s approval of the Affordable Care Act is tied with the record-high of 55%, according to a new poll from Gallup. Approval previously reached 55% in April 2017.
Some of the poll findings include:
- 94% of Democrats approve of the ACA, compared to 13% of Republicans and 57% of independent voters
- 20% of overall respondents approve and do not believe the current law needs to be changed; 34% approve but want to see changes
- 68% of those who do not support the ACA favor replacing the law; 28% prefer to alter the existing legislation
New Study Claims Medicare Advantage Better for High-Need Beneficiaries
Americans with Medicare Advantage (MA) plans who have high needs and high costs achieve better outcomes than those with Original Medicare, according to a new study by the Better Medicare Alliance, a Medicare Advantage advocacy group.
High-need, high-cost beneficiaries, as defined by the study, include those individuals underage 65 who are disabled, the frail elderly, and those with major complex chronic conditions. The analysis compared MA to Original Medicare on a host of quality measures including preventative screenings, prescription drug use, and hospitalizations.
The study found that high-need, high-cost beneficiaries with MA plans:
- Had prescription drug costs 41% lower than Original Medicare; and had combined medical and prescription drug costs that were 15% lower.
- Had a 57% lower rate of avoidable hospitalizations for acute conditions when dealing with a major complex chronic condition.
- Had a 66% higher rate of outpatient visits if the enrollee was frail, and a 46 percent higher visit rate if the enrollee was under 65 and disabled.
- Received 49% more pneumonia vaccines and 11% more flu vaccines.
- Received more screenings for depression, breast cancer, and prostate cancer.
- Had a 16% lower rate of skilled nursing facility stays if the enrollee had a major complex chronic condition.
Healthcare Reform News Update for November 23, 2020
Trump Administration Finalizes Rules to Lower Medicare Prescription Drug Costs
The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) finalized two new rules last week that could lower Medicare prescription drug costs for beneficiaries.
The first rule announced a Most Favored Nation (MFN) Model for Medicare Part B drugs. Drug payments will be based on the lowest price that drug manufacturers obtain in similar countries and will go into effect January 1, 2021.
The second rule eliminates Medicare Part D prescription drug rebates for insurance companies, which could provide patients up to 30% in savings and will go into effect January 1, 2022. Instead, the rebates would go directly to the beneficiaries.
Healthcare Reform News Update for November 20, 2020
Over 800,000 Enroll in 2021 ACA Plans During 2nd Week of Open Enrollment
During the second week of the 2021 Open Enrollment Period, 803,741 people signed up for Affordable Care Act (ACA) health insurance plans using the Heathcare.gov federal exchange. This includes 633,457 renewals and 170,284 new enrollees. This number does not include those who chose plans using a state-based exchange.
In total, over 1.6 million customers have enrolled in coverage using the federal exchange during the first two weeks of Open Enrollment this year.
Healthcare Reform News Update for November 19, 2020
Anthem Medicare Advantage Virtual Visits Increase Greatly in 2020
The number of virtual healthcare visits made by Anthem Medicare Advantage beneficiaries between March and May of 2020 was 136 times greater than during the same period last year, according to a new report from the company’s Public Policy Institute.
The coronavirus (COVID-19) pandemic and stay at home orders are attributed with increasing the number of virtual visits from 4,400 in 2019 to 600,000 in 2020.
Some of the findings of how the company’s Medicare Advantage members used virtual healthcare include:
- Care delivered by providers with existing relationships to the patient accounted for 98% of virtual visits.
- Mental health conditions and substance abuse were the most common diagnoses treated virtually, with an increase of 5,000% over last year.
- Cardiovascular problems were the most commonly addressed physical conditions, followed by musculoskeletal ailments and endocrine and metabolic conditions.
Healthcare Reform News Update for November 16, 2020
Over 800,000 Sign Up for 2021 ACA Plans During First Week of Open Enrollment
During the first week of the 2021 Open Enrollment Period, 818,365 people signed up for Affordable Care Act (ACA) health insurance plans using the Heathcare.gov federal exchange. That includes 645,021 people who renewed coverage and 173,344 new consumers. This number does not include those who chose plans using a state-based exchange.
Healthcare Reform News Update for November 12, 2020
Medicare to Cover COVID-19 Antibody Treatment for Beneficiaries
A new coronavirus (COVID-19) monoclonal antibody treatment will be available with no cost-sharing to people on Medicare, the Centers for Medicare & Medicaid Services said Tuesday.
The drug, called bamlanivimab, was approved by the U.S. Food and Drug Administration (FDA) this week and can be administered via infusion by a variety of providers, including hospitals, infusion centers, home health agencies, and nursing homes.
Healthcare Reform News Update for November 9, 2020
Supreme Court Will Hear Affordable Care Act Case This Week
Beginning Tuesday, the Supreme Court will hear oral arguments in a case against the Affordable Care Act (ACA) brought by Republican state officials and backed by the Trump administration.
Previously, a lower court ruled in favor of the Republicans, agreeing that Congress’ removal of the uninsured tax penalty invalidated the entire law.
A ruling is not expected until early next year.
2021 Original Medicare Premiums & Deductibles Rise Slightly
Premiums and deductibles for 2021 Medicare Parts A and B will marginally increase, according to the Centers for Medicare & Medicaid Services (CMS).
New rates for 2021 include:
- The Medicare Part B standard premium will be $148.50, an increase of $3.90.
- The Part B annual deductible will be $203, an increase of $5.
- The Medicare Part A inpatient hospital deductible will be $1,484, an increase of $76.
- Medicare Part A coinsurance will be $371 per day for days 61-90, an increase of $19.
Healthcare Reform News Update for November 2, 2020
Trump Administration Approves Georgia Plan to Eliminate Federal Exchange
The Centers for Medicare and Medicaid Services (CMS) has approved Georgia’s request to eliminate the federal Affordable Care Act (ACA) exchange website as an enrollment option beginning in 2023.
Georgia’s plan will direct consumers to private brokers and insurance companies instead of the federal website. The approval makes Georgia the first state without a government-run enrollment site for residents.
CMS also approved Georgia’s request to establish a reinsurance program to help lower premium costs.
Survey: 78% of Current Enrollees Are Prepared for Open Enrollment
Most Americans (78%) who have healthcare coverage say they are prepared for the current Affordable Care Act (ACA) Open Enrollment Period, according to a UnitedHealthcare survey.
The company’s Consumer Sentiment Survey gathers information and opinions on a variety of healthcare-related topics.
Other findings from the survey include:
- 44% say that the coronavirus (COVID-19) will influence their choice of a healthcare plan.
- Of those influenced by COVID-19: 16% want lower out-of-pocket costs; 11% want more well-being programs or resources; 10% want more comprehensive benefits; and 6% want a national plan rather than a regional one.
- 68% of Gen-Z consumers and 29% of Baby Boomers were influenced by the virus.
- 84% of respondents said the availability of vision and dental coverage options during enrollment was important to them.
Healthcare Reform News Update for October 30, 2020
New Trump Administration Rule Would Require Health Insurers to Post Costs
Health insurance companies will be required to disclose their upfront costs for the common tests and procedures, according to a new rule finalized Thursday by the Trump administration.
Under the rule, consumers could review the full costs of procedures and out-of-pocket estimates for their own plan and those of other companies through yet-to-be-developed apps.
The requirements are designed to help increase price transparency and consumer empowerment, according to government officials. However, the regulation is facing opposition from a major health insurance group that says it would raise premiums.
The new regulations are scheduled to go into effect gradually over three years, beginning in 2022.
Healthcare Reform News Update for October 29, 2020
Medicare Will Pay for Future COVID-19 Vaccine
Medicare will cover all costs for government-approved coronavirus (COVID-19) vaccines under a new rule announced Wednesday by the Trump administration.
The plan ensures that Medicare beneficiaries will receive any and all doses at no charge once they are available.
Healthcare Reform News Update for October 23, 2020
Blue Cross Blue Shield of North Dakota Launches New Medicare Advantage Provider
Blue Cross Blue Shield of North Dakota (BCBSND) has debuted NextBlue, its new Medicare Advantage health insurance affiliate.
NextBlue is initially offering Medicare Advantage products for the 2021 plan year to Medicare-eligible residents in Burleigh, Cass, Morton, Richland and Stutsman counties, with the intent to expand in the future.
Healthcare Reform News Update for October 20, 2020
Average 2021 Premiums on Federal ACA Exchange to Drop by 2%
Premiums for 2021 Affordable Care Act benchmark silver plans on the federal exchange will decline by 2 percent on average according to a report from the Centers for Medicare & Medicaid Services.
Benchmark plans are the second-lowest cost plans available in an area. The reduction marks the third consecutive year that premiums have declined.
Other information in the report includes:
- An additional 22 insurance companies will provide ACA coverage in 2021, for a total of 181.
- Four states will see double-digit premium reductions for benchmark plans purchased by a 27-year-old: Iowa, Maine, New Hampshire, and Wyoming.
- Four percent of enrollees will have access to plans from only one insurance company.
- More than 75 percent of enrollees will have access to plans from three or more insurance companies.
- The average 2021 ACA benchmark plan premium for a family of four will be $1,486.
Healthcare Reform News Update for October 16, 2020
Georgia Will Leave the ACA Exchange by 2023
The Trump administration has approved Georgia Governor Brian Kemp’s proposals to exit the federal Affordable Care Act (ACA) exchange and enact a partial Medicaid expansion.
Georgia will be the first state to leave the federal marketplace and offer residents health insurance only through private brokers or websites. Plans that meet ACA requirements will continue to be offered to consumers, but companies will also be allowed to sell lower-priced noncompliant coverage. The plan will be phased in by 2023.
Healthcare Reform News Update for October 12, 2020
CMS: Enrollment in Unsubsidized ACA Plans Declined 45% From 2016 to 2019
Between 2016 and 2019, the number of people who purchased Affordable Care Act (ACA) plans without a tax subsidy declined 45%, representing 2.8 million Americans, according to a new report from the Centers for Medicare and Medicaid Services (CMS).
CMS attributes the drop to consumers who do not qualify for subsidies being priced out of the market due to the rising cost of health insurance premiums.
Some findings from the report include:
- Rhode Island had the lowest percentage change of unsubsidized enrollment at 4%. Iowa had the highest at 90%.
- 80% of overall ACA enrollment decreases from 2018 to 2019 occurred among those who did not qualify for subsidies.
- Unsubsidized enrollment in 2019 declined by 9%, which was considerably lower than the 24% drop in 2018 and the 20% drop in 2017.
- States with larger declines in unsubsidized enrollment were more likely to have larger increases in average premiums.
Healthcare Reform News Update for October 9, 2020
Report: Uninsured Rate for Children Has Highest Yearly Increase in Over a Decade
The number of uninsured American children rose by 320,000 between 2018 and 2019—the largest annual increase in more than a decade, according to a new report by the Georgetown Center for Children and Families.
Other findings in the report include:
- Although the uninsured rate for children was at a record low in 2016, it has risen every year since 2017, representing approximately 726,000 more uninsured children.
- Texas represents one-third of all increases with 243,000 more children living without coverage since 2016. Florida follows with 55,000.
- New York is the only state that significantly reduced the number of uninsured children between 2016 and 2019.
Several factors were cited as contributors to the loss of children’s health insurance coverage, including efforts to repeal the Affordable Care Act, cuts to ACA enrollment outreach, and inadequate oversight over state Medicaid programs.
Colorado 2021 ACA Rates Drop By 1.4%
Premiums on Colorado’s state Affordable Care Act (ACA) exchange will drop an average of 1.4% for 2021 individual plans. Premiums for Colorado’s small-group plans will increase by 3.8%.
2021 premiums for individuals and families will be about 20.8% lower than they would have been without the state’s reinsurance program, according to state officials.
Healthcare Reform News Update for October 6, 2020
Aetna Broadens Medicare Advantage Plan Availability
Aetna announced its 2021 Medicare Advantage plans will be available in 115 new counties, making the plans accessible to 1.9 additional people.
Benefits under the company’s 2021 Medicare Advantage (non-special needs) plans include:
- $0 coronavirus (COVID-19) testing and expanded coverage of virtual mental health services while the public health emergency is in effect (all plans).
- Virtual primary and urgent care visits, including after hours or weekend care, sick visits and prescription refills (all plans).
- An annual $0 in-home visit from a clinician that includes a comprehensive health risk assessment and non-invasive physical exam (all plans).
- The Aetna Resources for Living program, which connects enrollees to community resources such as transportation, housing, food programs, caregiver support and utility assistance (all plans).
- Access to MinuteClinic walk-in and telehealth services for the same copay as a regular primary care physician visit (select PPO and HMO plans).
- Fitness memberships though Aetna’s SilverSneakers program (all plans).
The company will also offer its Dual Eligible Special Needs plans to select counties in nine new states: California, Connecticut, Kentucky, Maine, Michigan, Mississippi, Nevada, New Jersey, and New York.
In addition, Aetna will offer a new standalone Medicare Part D plan, SilverScript SmartRx. At an average of $7.15, the plan will have the lowest PDP premium available in the country.
Clover Health & Walmart Launch New Medicare Advantage Plans in Georgia
Clover Health has partnered with Walmart to offer two new Medicare Advantage plans in eight Georgia counties (Bartow, Bibb, Cherokee, Cobb, Gwinnett, Henry, Paulding, and Rockdale).
Benefits of the LiveHealthy: Clover Powered, Walmart Enhanced and the LiveHealthy LI: Clover Powered, Walmart Enhanced plans include:
- $0 copays on primary care visits, lab tests, preventative dental exams, and annual physicals.
- In-network access to 31 hospitals and over 8,000 providers.
- Access to select Walmart Health centers.
Healthcare Reform News Update for October 5, 2020
UnitedHealthcare to Offer 2021 Medicare Advantage Plans in Nearly 300 New Counties
UnitedHealthcare announced its Medicare Advantage plans will be available to nearly an additional 3.2 million people in close to 300 counties in 2021, signaling the company’s largest expansion in five years.
Benefits that will be available for the company’s 2021 Medicare Advantage (non-special needs) plans include:
- $0 copays for telehealth visits (all plans).
- $0 copays for medical and behavioral telehealth visits, labs, routine vision and hearing exams, colonoscopies, mammograms, and cardiac rehab (most plans).
- $0 copays for tier 1 and tier drugs when ordered via OptumRX home delivery pharmacy (most plans).
- HouseCalls, a program that provides a yearly home visit with a licensed clinician to help coordinate needed care (most plans).
- Navigate4Me, which offers a dedicated support representative to those with complex healthcare needs such as surgery, cancer treatments, or chronic illnesses (all plans).
- A $35 per month cap on out-of-pocket insulin costs (some plans).
- Renew Active™ Fitness Program, which includes gyms, classes, and events to stay healthy (most plans).
Healthcare Reform News Update for October 2, 2020
Humana Adds New Counties and Benefits for 2021 Medicare Advantage Plans
Humana’s Medicare Advantage HMO plans will expand into 125 new counties for the 2021 plan year, and its Medicare Advantage PPO plans will be available in 98 new counties, according to a press release.
New benefits for the company’s 2021 Medicare Advantage and prescription drug plans include:
- $0 copays for telehealth visits and coronavirus (COVID-19) testing.
- A Health Essentials Kit including items to help prevent the spread of COVID-19.
- $0 copay for COVID-19 treatment and 14 days of home-delivered meals (up to 28) for patients with the virus.
- An Insulin Savings Program (ISP) for select plans with out-of-pocket costs for insulin capped at $35 per month.
- A Healthy Foods Card for Dual Eligible Special Needs Plan (D-SNP) members with a monthly food allowance of up to $75 per month.
Healthcare Reform News Update for October 1, 2020
Cigna Adds 5 States to 2021 Medicare Advantage Plans
Cigna’s Medicare Advantage offerings are expanding by 22% in 2021 with the addition of five new states and 67 new counties. In total, Cigna will offer plans across 369 counties in 23 states for the 2021 plan year.
According to a press release, the company will now offer Medicare Advantage plans in select regions of the following states:
- New Mexico – Albuquerque area,
- Ohio – Cleveland area,
- Oklahoma – Oklahoma City area,
- Utah – Salt Lake City area, and
- Virginia (Tri-Cities area in the southwest part of the state).
Cigna also announced new virtual physical therapy services to all Medicare Advantage enrollees and, in select areas, a program that provides an allowance of up to $30 per month for fresh fruits and vegetables.
Healthcare Reform News Update for September 30, 2020
CDC: Uninsured Americans Cite Affordability as Primary Cause
The majority of uninsured adults under 65 say that affordability was the main factor in not having health coverage in 2019, according to a new study from the Centers for Disease Control and Prevention (CDC). In 2019, 73.7% of respondents said coverage was not affordable, according to the National Health Interview Survey.
Other factors included not being eligible, not wanting coverage, difficulty in enrolling, or not finding a suitable plan.
Other findings from the study include:
- 14.5% of Americans were uninsured at the time of the survey.
- Women and adults aged 50-64 were more likely to be uninsured due to cost.
- A higher percentage of men said coverage was not needed or wanted.
- Women and Hispanics were more likely to cite ineligibility as a reason for not having health insurance coverage.
Healthcare Reform News Update for September 28, 2020
Five States Extend Open Enrollment Deadlines
With the Open Enrollment Period beginning November 1, several states with their own healthcare exchanges have already decided to extend the December 15 deadline.
The following states have extended their OEP deadlines:
- California: January 31, 2021
- Minnesota: December 22, 2020
- Nevada: January 15, 2021
- New Jersey: January 31, 2021
- Pennsylvania: January 15, 2021
Effective dates for coverage will depend on when the policy is purchased.
Healthcare Reform News Update for September 25, 2020
Trump Signs Executive Order on ‘Surprise’ Medical Billing
President Donald Trump on Thursday signed two executive healthcare orders, one of which focuses on ending “surprise” medical billing.
The second of the two executive orders addresses “surprise” medical billing for out-of-pocket expenses not covered by a patient’s health insurance. Often, these medical bills are a result of patients receiving care from an out-of-network provider in emergency situations or through nonsurgical hospital stays – instances in which patients cannot choose their healthcare provider.
The order instructs Congress to work with Health and Human Services (HHS) Secretary Alex Azar to develop a legislative solution to this issue by December 31. If Congress fails to act by that date, HHS will have the authority to pursue a regulatory approach. Azar did not offer specific details.
The first order declares it a U.S. policy to “ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates” – despite the future of the Affordable Care Act (ACA).
Healthcare Reform News Update for September 16, 2020
U.S. Census Bureau: Number of Uninsured Americans Decreased Slightly in 2019
In 2019, 8% of Americans, or 26.1 million people, did not have insurance coverage at any point during the year—a 0.5% decrease from 2018, according to a new study by the U.S. Census Bureau.
The report includes data gathered from two surveys conducted in 2019. Some of the highlights include:
- People with employer-sponsored coverage increased from 55.2% in 2018 to 55.4% in 2019.
- The 32 states that implemented Affordable Care Act (ACA) Medicaid expansion had an average uninsured rate of 9.8%, which was lower than non-expansion states’ 18.4% uninsured rate.
- Massachusetts had the lowest uninsured rate at 3%; Texas had the highest at 18.4%.
- Between 2018 and 2019, the percentage of people without health insurance in Virginia decreased 0.9%; that percentage increased in 19 other states. All other states and the District of Columbia remained stable during this time frame.
Healthcare Reform News Update for September 15, 2020
New Jersey Healthcare Leaders Team Up to Launch New Medicare Advantage Plan
Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) and health network Hackensack Meridian Health have partnered to launch Braven Health, a new Medicare Advantage plan. RWJBarnabas Health will also join the plan, pending state regulatory approval.
These plans will be offered for the 2021 plan year to Medicare-eligible residents in eight New Jersey counties: Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic, and Union.
Healthcare Reform News Update for September 14, 2020
Ambetter ACA Plans Expand Into 400 New Counties for 2021
Ambetter’s 2021 Affordable Care Act health insurance plans will expand into 400 new counties across 13 states in which the company currently operates. The company is also adding New Mexico and Michigan to its ACA marketplace offerings. With this expansion, there will now be 22 states offering Ambetter ACA health plans.
UnitedHealthcare & Canopy Health to Offer New Employer-Sponsored Plan in CA
UnitedHealthcare and Canopy Health are partnering to offer a new group health plan for employees in Northern California.
The California Doctors Plan includes 19 medical centers and 5,000 physicians across nine Bay Area counties. Premiums are expected to be up to 25% less than traditional PPO plans.
Healthcare Reform News Update for September 9, 2020
Cigna 2021 ACA Plans to Expand Into 80 New Counties
Cigna announced that their Affordable Care Act (ACA) health insurance plans will be available in 80 new counties in 2021, increasing their reach by 27%.
The expansion will make Cigna ACA plans available to a total of 300 counties in 10 states: Arizona, Colorado, Florida, Illinois, Kansas, Missouri, North Carolina, Tennessee, Utah, and Virginia.
Healthcare Reform News Update for September 3, 2020
Georgia Governor Requests Exit From Federal ACA Exchange
Georgia Governor Brian Kemp has applied for an Affordable Care Act (ACA) waiver from the Trump Administration that would prohibit residents from using the federal government’s healthcare exchange to purchase health insurance.
Other states have left the federal exchange, but residents can still purchase ACA plans from a state-based exchange. Georgia does not plan to create a state-based exchange, which means consumers would need to shop for health insurance through web brokers or directly from insurance companies.
The proposal would also make the state responsible for determining each applicant’s eligibility for enrollment and premium subsidies.
The application argues that the change would increase competition in the private insurance marketplace and provide consumers with better access and options. Critics say the proposal would cause tens of thousands to lose coverage.
Approximately 450,000 Georgia residents currently purchase ACA plans on the federal exchange, according to the state.
Healthcare Reform News Update for September 1, 2020
CMS Proposes Faster Medicare Coverage for New ‘Breakthrough’ Devices
The Centers for Medicare and Medicaid Services (CMS) has proposed a rule that will shorten the time between when new medical devices are approved for use by the Food and Drug Administration (FDA) and when they are covered by Medicare.
The rule will help fast-track devices designated by the FDA as “breakthrough” technology that treats unmet medical needs.
In the current process, manufacturers receive Medicare approval on a regional basis. The Medicare Coverage of Innovative Technology pathway would enable devices to receive national Medicare coverage approval concurrently with FDA approval.
Healthcare Reform News Update for August 24, 2020
Commonwealth Fund Survey: Over 43% of U.S. Adults are Underinsured
In the first six months of 2020, 43.4% of working-age adults in the U.S. were underinsured, according to the latest Biennial Health Insurance Survey by the Commonwealth Fund.
Those who are considered underinsured have a deductible that is 5% or more of household income or have out-of-pocket costs that equal 10% or more of their household income (5% for individuals living under 200% of the federal poverty level guidelines). Out-of-pocket costs do not include premiums.
This latest survey found no significant statistical changes in coverage compared to when the study was previously run in 2018, even considering the early months of the coronavirus (COVID-19) pandemic. However, researchers point out there is “persistent vulnerability” in consumers’ ability to afford coverage that could worsen if the economic downturn continues.
Some of the additional findings from the survey:
- 12.5% of adults were uninsured.
- Half of adults who were uninsured for any length of time said they had problems paying medical bills or were paying off medical bills over time.
- The percentage of people enrolled in plans with deductibles of $1,000 or more doubled over the past 10 years. This group also was more likely to report financial problems due to medical bills.
- The majority of consumers who shopped for ACA plans but did not purchase a policy cited cost as the main reason.
Oscar Partners with South Florida Health Groups For New Medicare Advantage Offering
Health insurance company Oscar has partnered with Holy Cross Health and Memorial Healthcare System to provide a new Medicare Advantage plan for residents of Broward County, Florida.
The plan will provide enrollees access to Holy Cross Health’s and Memorial Healthcare System’s network of healthcare providers, dedicated care guides, and $0 unlimited virtual visits beginning January 2021.
The plan will be available during this fall’s Medicare annual election period pending approval from state regulators.
Healthcare Reform News Update for August 20, 2020
Blue Cross Blue Shield of Michigan to Issue Premium Refunds, Increase 2021 Premiums
Citing fewer claims due to coronavirus (COVID-19), Blue Cross Blue Shield of Michigan plans to distribute 30% premium refunds to enrollees in its Affordable Care Act (ACA) and dental plans. The refunds are expected to be issued as credits on November invoices after approval by state regulators.
Also, the company has filed to increase 2021 premiums for its ACA and small group plans. Proposed average rate increases are as follows:
- 2.5% for Blue Care Network HMO plans
- 1.7% for Blue Cross plans
- 1.9% for its Blue Care Network small group plans
- 0.9% for Blue Cross small group plans
Supreme Court Sets Date for Oral Arguments in ACA Lawsuit
The Supreme Court will hear oral arguments November 10 in the case concerning a lawsuit that seeks to strike down the Affordable Care Act (ACA).
The justices will review a federal appeals court decision that the repeal of the individual tax mandate invalidated the law in its entirety.
Federal Appeals Court Backs Resumption of ACA Cost-Sharing Reduction Payments
The judges referred to a Supreme Court decision that resumed payments for the ACA’s risk corridor program as a basis for their conclusion.
Healthcare Reform News Update for August 13, 2020
New Mexico Health Connections to Cease Operations in 2021
New Mexico Health Connections, an insurance co-op that provides Affordable Care Act plans to 14,000 residents, will cease operations on January 1, 2021.
Current customers will be covered through the end of this year but will need to find a new insurance plan for 2021. Five insurance companies are expected to provide New Mexico residents with ACA plans on the state exchange in the 2021.
Premiums for ACA Plans in Georgia to May Increase Slightly
Premium rates for 2021 Affordable Care Act plans will increase an average of 6.53%, according to initial filings with the state’s insurance department. The proposed rates are expected to be finalized in September.
Most of the six insurance companies that sell ACA plans in Georgia have asked for increases of 10% or less. Kaiser Permanente has proposed a premium reduction of around 20 percent.
Healthcare Reform News Update for August 10, 2020
Maryland ACA Special Enrollment Period Reopened until December 15
Maryland has reopened its coronavirus (COVID-19) special enrollment period in response to the coronavirus (COVID-19, according to the Maryland Health Benefit Exchange . Residents will now have until December 15 to sign up for health coverage–making this the longest special enrollment period in the U.S.
Previously, Maryland’s special enrollment period ran from March 16 to July 15. More than 54,000 uninsured Marylanders successfully found health plans during that time.
|Enrollment Date||Coverage Begins|
|By August 15||August 1|
|August 16–September 15||September 1|
|September 16–October 15||October 1|
|October 16–November 15||November 1|
|November 16–December 15||December 1|
Healthcare Reform News Update for August 5, 2020
CMS Proposes Policies to Expand Medicare Coverage
The Centers for Medicare & Medicaid Services (CMS) on Tuesday proposed several new policies that could affect Medicare beneficiaries.
The proposals include:
- Expanding the amount of procedures that Medicare would pay for in the hospital outpatient setting to more than 1,700 services, including around 300 musculoskeletal services (e.g. specific joint-replacement procedures).
- Covering 11 additional surgical services performed in ambulatory surgical center (ASC) settings.
- Reducing the payment rate for hospital outpatient drugs.
CMS will accept public comments until Monday, October 5.
Healthcare Reform News Update for August 4, 2020
Trump Expands Medicare Telehealth Services
President Donald Trump issued an executive order August 3 that permanently expands Medicare telehealth services in rural communities throughout the United States, prompting the Centers for Medicare & Medicaid Services (CMS) to propose changes to the current system.
CMS previously expanded the availability of telehealth services because of the coronavirus (COVID-19); this executive order builds upon those efforts. Over the past several months, Medicare telehealth visits have grown to over 1 million per week – a significant increase from the previous thousands per week.
The executive order directs the following actions:
- Strategic investments in rural communications infrastructure.
- New “payment model testing innovations” for rural hospitals.
- The launch of a joint initiative to improve healthcare communication infrastructure.
Healthcare Reform News Update for July 31, 2020
Oscar to Launch New $0 Virtual Visits and Enter New Markets in 2021
Health insurance company Oscar announced plans to include $0 virtual care in some areas and expand their Affordable Care Act offerings to 19 additional markets in 2021.
Virtual Primary Care will provide unlimited visits and a wide variety of services, such as Tier 1 prescriptions, labs, diagnostic imaging orders, and initial specialist referrals. Virtual Urgent Care will provide 24/7 access to providers, Tier 1 prescriptions, and labs.
$0 virtual visits are expected to be available in 10 markets within California, Colorado, Florida, New York, and Texas.
Upon regulatory approval, the company will offer ACA plans for the first time in parts of Arkansas, Iowa, North Carolina, and Oklahoma. It will also expand its existing footprint in Arizona, California, Colorado, Florida, Ohio, and Pennsylvania.
Healthcare Reform News Update for July 30, 2020
California ACA Special Enrollment Deadline Extended to August 31
California residents now have until August 31 to sign up for health coverage, according to Covered California, the state’s Affordable Care Act exchange.
The special enrollment period was extended from the previous deadline of July 31 due to the ongoing coronavirus (COVID-19) pandemic and subsequent high number of Californians who have lost employer coverage.
Uninsured residents will be able to sign up for plans both on and off the exchange. Coverage will begin on September 1.
Medicare Drug Premiums to Rise Slightly in 2021
The Centers for Medicare & Medicaid Services (CMS) announced that Medicare Part D prescription premiums will only slightly increase in 2021. The average premiums will be $30.50, compared to $30 this year.
Part D premium prices continue a trend of lower costs with a 12% decline since 2017.
Healthcare Reform News Update for July 24, 2020
ACA Enrollment Remains Steady for Third Consecutive Year
Enrollment in 2020 Affordable Care Act (ACA) plans sold on the federal and state exchanges was 10.7 million, a 100,000 increase from 2019, according to a report issued Thursday by the Centers for Medicare & Medicaid Services (CMS). ACA enrollment has now remained steady for the third year in a row, according to the report.
Additional data in the report:
- The average total monthly premium in 2020 was $576.16, compared to $594.17 in 2019.
- 86% of enrollees received tax premium subsidies, about a 1% decline compared to 2019.
- The average tax subsidy amount in 2020 was $491.53, 4% less than in 2019.
Aetna to Offer 2 New Employer Healthcare Plan Benefits
Aetna will offer two new employer healthcare benefit designs to help enrollees in high-deductible plans seek the care they may be avoiding due to high costs.
The Upfront Advantage benefit will provide members free access to some preventive services that cost up to $500 for individuals and $1,000 for families before their deductible is met.
The Flexible Five benefit provides five coupons per person that can be applied to a variety of services such as primary care visits, behavioral health visits, urgent care (including lab tests and X-rays), and generic drugs.
The new plan benefit designs were created in response to data that showed that 86% of high-deductible plan enrollees failed to meet their annual deductibles.
Healthcare Reform News Update for July 21, 2020
Trump Administration Sued Over ACA LGBTQ Protections
A group of Democratic attorneys general from 22 states and Washington, D.C., is suing the Trump administration over a recent rule that rolls back the Affordable Care Act’s nondiscrimination protections for the LGBTQ community.
The lawsuit argues that the rule:
- violates equal protections for transgender and nonbinary patients,
- abandons a prior antidiscrimination policy, and
- imposes undue burden on vulnerable populations.
Attorneys general Maura Healey (Massachusetts), Letitia James (New York), and Xavier Becerra (California) are leading the lawsuit.
Clover Health to Triple Medicare Advantage Availability
Clover Health plans to expand its 2021 Medicare Advantage plan offerings to 74 additional counties, tripling its current reach.
The company’s expansion adds 69 counties to states it already serves, which includes Arizona, Georgia, New Jersey, Pennsylvania, South Carolina, Tennessee, and Texas. It will also expand into five counties in Mississippi, a new market for the company.
Healthcare Reform News Update for July 20, 2020
Rule Grants Workers More Time to Enroll in COBRA Coverage
Under the new rule, individuals can enroll in COBRA up to 120 days after the coronavirus (COVID-19) national emergency is over. That date is currently undetermined due to rising cases across the United States. Previously, workers had 60 days from the time of a layoff or reduction in hours to decide whether to continue with their employer’s health plan though COBRA.
However, the COBRA enrollment extension only applies to people who:
- were employed with companies that have 20 or more workers.
- had employer-sponsored health coverage prior to being laid off or furloughed.
Workers who opt for COBRA coverage are still responsible for all back premium payments regardless of when they enroll.
Healthcare Reform News Update for July 14, 2020
Record Number of Americans Have Lost Health Insurance in 2020
An estimated 5.4 million Americans have lost health insurance coverage between February and March of this year because of layoffs related to the coronavirus (COVID-19), according to consumer advocacy group Families U.S.A.
The record-high increase in uninsured adults is 39% higher than the previous annual high of 3.9 million, which occurred between 2008 and 2009.
The study is a state-by-state analysis of how the pandemic has affected health insurance coverage for workers under age 65. Some of the findings include:
- Five states account for 46% of the increase: California, Florida, New York, North Carolina, and Texas.
- Eight states now have uninsured rates of 20% or more: Florida, Georgia, Mississippi, Nevada, North Carolina, Oklahoma, South Carolina, and Texas.
- Five states have an over 40% increase in uninsured residents: Hawaii, Massachusetts, Michigan, New Hampshire, and Rhode Island.
Healthcare Reform News Update for July 13, 2020
Analysis: New ACA Enrollment Could Reach 1 Million Due to COVID-19
Affordable Care Act marketplace plans could add more than 1 million new enrollees due to coronavirus (COVID-19) job losses, according to analysis by Avalere.
The federal ACA exchange has added 487,000 new enrollees since the close of the open enrollment period in December. This is a 47 percent increase over the same time period last year. In eight of the 12 states that run their own ACA exchanges, nearly 263,000 people have signed up for coverage since March.
Medigap Enrollees Prefer the Most Comprehensive Coverage
The majority of Medicare Supplement enrollees choose more comprehensive coverage, according to a new study from America’s Health Insurance Plans (AHIP).
Around 9.3 million people were enrolled in a Medicare Supplement Plans F and G, in 2018, accounting for 70 percent of all enrollment. Plans F and G are two of the most comprehensive plans, but Plan F was discontinued to new enrollees as of January of this year.
Other finding from the study include:
- In 2018, total enrollment in Medicare Supplement plans was 14 million, an increase of 3.7 percent compared to 2017.
- Only 5 percent of Medicare Supplement plan enrollees reported having difficulty paying medical bills in the last year, compared to 12 percent of people with Original Medicare who do not have Medicare Supplement plans.
- Plan F has the largest enrollment with 7,043,000 enrollees.
Healthcare Reform News Update for July 9, 2020
Supreme Court Upholds Religious Exemptions to ACA Birth Control Mandate
The Supreme Court ruled Wednesday that employers can limit birth control coverage under the Affordable Care Act (ACA) on the grounds of religious or moral objections.
The 7-2 ruling upholds a Trump administration change that allows employers to opt-out of providing no-cost contraception required under the ACA.
Healthcare Reform News Update for July 1, 2020
Oklahoma Voters Approve Medicaid Expansion
Citizens in Oklahoma voted on Tuesday to expand Medicaid under the Affordable Care Act by amending the state constitution. Those who earn up to 138% of the federal poverty level will now qualify for Medicaid, which is approximately $17,200 for individuals and $35,500 for a family of four.
The expansion is projected to cover around 215,000 residents for an estimated total annual cost of $1.3 billion. The state is expected to increase a fee hospitals pay from 2.5% to 4% help fund the expansion.
Healthcare Reform News Update for June 30, 2020
House Democrats Pass Bill to Extend ACA Provisions
The House voted to expand the Affordable Care Act on Monday. The measure is the first significant ACA bill to pass since the law was enacted.
The legislation passed primarily along party lines, with Democrats in support and Republicans opposing. The bill is not expected to pass in the Republican-controlled senate, and the White House announced that the president would veto the measure if it comes before him.
Some of the provisions in the bill include:
- Capping premiums for benchmark silver plans at 8.5% of income for all enrollees, instead of only offering ACA premium tax subsidies to those earning under 400 percent of the federal poverty level.
- Increasing funding for ACA outreach and enrollment to $100 million per year.
- Allowing federal health officials to negotiate the price of prescription drugs under Medicare.
- Reestablishing the 3-month duration limit for short-term health insurance.
- Reducing Medicaid funding for states that have not expanded Medicaid, but also allowing the federal government to pay the entire initial cost for expansion.
Healthcare Reform News Update for June 26, 2020
Trump Administration Asks Supreme Court to Overturn Affordable Care Act
The Department of Justice filed a legal brief to the Supreme Court on Thursday night that argues the Affordable Care Act should be overturned. The brief contends that the entire health law was invalidated when its individual mandate tax penalty was struck down in 2017.
The Court is expected to hear oral arguments in the case later this year and make a ruling in early 2021.
Almost Half a Million Enroll in ACA Plans After Losing Coverage
The Centers for Medicare and Medicaid Services said that approximately 487,000 Americans signed up for Affordable Care Act plans after the open enrollment period ended in December, a 46 percent increase from last year.
The increase was concentrated in April and May, which suggests that the surge in enrollments is linked to layoffs due to the coronavirus pandemic (COVID-19).
Healthcare Reform News Update for June 9, 2020
N.Y. Insurers Request ACA Premium Hikes Averaging Almost 12%
New York insurance companies that sell health plans on the Affordable Care Act (ACA) marketplace have asked the state Department of Financial Services to raise premiums an average of 11.7% for 2021.
Some insurers said the requested rate hikes are a result of increased costs related to the coronavirus (COVID-19). Requested premium changes include:
- Oscar: 19.1% increase
- Fidelis Care: 18.8% increase
- Empire BlueCross BlueShield HealthPlus: 16.6% increase
- UnitedHealthcare: 13.8% increase
- Emblem: 9.5% increase
- HealthNow: 1.9% decrease
- Independent Health: 3.7% decrease
The state should determine final rate changes in August.
Molina Waives Coronavirus Cost-Sharing Through 2020
Molina Healthcare will continue to waive customer out-of-pocket costs for coronavirus (COVID-19) testing and treatment for the remainder of the year. The initiative applies to all of its Affordable Care Act, Medicare, and Medicaid plans.
Healthcare Reform News Update for June 4, 2020
Anthem to Provide Premium Discounts up to 15%
Anthem Inc. announced that it will offer premium discounts between 10 and 15 percent in July for some customers enrolled in individual plans and fully insured employers.
The company joins other insurers that recently announced discounts for some customers, including Premera Blue Cross, Blue Cross Blue Shield of Michigan, Priority Health, and UnitedHealth Group Inc. The offerings are a response to the savings insurance companies are seeing due to a decline in surgeries and non-essential procedures during the coronavirus (COVID-19) pandemic.
Healthcare Reform News Update for June 2, 2020
Cigna Eliminates Cost-Sharing for All Plans and Increases MA Meal Benefits
Cigna announced that it is expanding and extending its cost-sharing relief initiatives for all enrollees with individual, family and Medicare Advantage plans.
Effective immediately, the company will:
- Waive all copays, deductibles and coinsurance for in-person and telehealth visits for in-network primary care physicians and specialists, including behavioral health.
- Extend coronavirus (COVID-19) cost-sharing elimination, which includes testing and treatment.
- Increase the Medicare Advantage meal benefit to 28 home-delivered meals available for 14 days after a hospital stay.
These new measures will be in effect for Medicare Advantage through the end of this year. For individual and family plans, the changes will apply until the end of applicable federal and state public health emergencies.
Healthcare Reform News Update for May 27, 2020
CMS: 1,750 Medicare Advantage & Part D Plans Will Cap Insulin Costs
Beginning in 2021, more than 1,750 standalone Medicare Advantage and Medicare Part D prescription drug plans will cap monthly out-of-pocket costs for insulin at $35, according to the Centers for Medicare & Medicaid Services (CMS).
Plans in all 50 states, the District of Columbia, and Puerto Rico will participate in the program, called the Part D Senior Savings Model. The pricing will be available for a range of insulins, including pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins.
CMS projects that the average savings for consumers will be $446 per year.
Healthcare Reform News Update for May 26, 2020
Cigna Adds Digital Behavioral Health Services to Employer Plans
Cigna is expanding customer access to digital mental health support services in response to pressures caused by the coronavirus (COVID-19).
Effective immediately, Cigna’s employer-sponsored plans will cover access to licensed therapists via text, phone, or video. The company also will offer virtual programs in select states for anxiety, depression, burnout, substance use recovery, and obsessive compulsive disorder (OCD).
CMS Expands Telehealth Benefits for 2021 Medicare Advantage Plans
The Centers for Medicare & Medicaid Services (CMS) released final rules for 2021 Medicare Advantage (MA) plans that allow increased flexibility to offer and discount telehealth services for specialty care.
Other finalized changes/enhancements include:
- People with End Stage Renal Disease (ESRD) will be eligible to enroll in MA plans. Currently, individuals with ESRD can enroll in an MA plan only if they develop ESRD after enrolling in an MA plan, receive benefits through the same organization that offers MA plans (such as an employer-sponsored plan), or have had a successful kidney transplant.
- Member feedback will be weighted more heavily in determining MA and Part D Star Ratings.
- “Look-alike” Dual Eligible Special Needs Plans (D-SNPs) will be phased out. Look-alike plans have similar levels of enrollment qualifications as D-SNPs but do not have the federal regulatory and state-contracting requirements applicable to D-SNPs.
Healthcare Reform News Update for May 13, 2020
Kaiser: More Than 30% Newly Uninsured Eligible for Subsidized ACA Plans
Of the estimated 27 million Americans who have lost employer-sponsored health coverage due to the coronavirus (COVID-19) pandemic, approximately 31.11% are eligible for subsidized coverage for an Affordable Care Act plan, according to a new study released today by the Kaiser Family Foundation.
The study, which spans March 1 through May 2, estimates how many of those who lost employer-sponsored coverage plans will be eligible for other available coverage options. According to the analysis:
- 8.4 million (or 31.11%) are eligible for subsidized ACA plans,
- 5.7 million (or 21.11%) are not eligible for subsidized ACA plans. Of this number:
- 3.7 million (or 13.7%*) earn too much to qualify for subsidies;
- 1.3 million (or 4.81%*) can go on a family member’s plan;
- 530,000 (or 1.96%*) do not meet citizenship or immigration requirements;
- 150,00 (less than 1%*) fall into a “coverage gap” in states that have not expanded Medicaid through the ACA.
- 12.7 million (or 47.04%) are eligible for Medicaid, including 6.1 million (22.6%) children who qualify for CHIP coverage.
* This is the percentage of the 27 million Americans who have lost employer-sponsored health coverage.
UnitedHealth Group to Expand ACA Plan Availability for 2021
Beginning in 2021, UnitedHealth Group will offer Affordable Care Act plans in more states—its first expansion in four years.
The company currently offers ACA plans in Massachusetts, Nevada, and New York. The company will expand into Maryland next year; more states are expected to be announced.
IRS Gives Employer Health Plans Flexibility in Enrollment, FSA Accounts
Companies now have the option to offer changes to coverage plans outside their standard enrollment period, including cancellations, adding family members, or switching plans, according to the Internal Revenue Service (IRS).
This new guidance for employer-sponsored health plans was released Tuesday in response to the coronavirus (COVID-19).
The IRS will also allow employers to offer mid-year enrollment in flexible spending accounts (FSAs), alter the amount employees can set aside for these accounts, and expand rollover exception rules.
Companies are not required to provide the new options to employees. But, these options give human resource departments flexibility when making coverage decisions.
Healthcare Reform News Update for May 7, 2020
UnitedHealth Group, Cigna Offer Discounts, Relief in Response to COVID-19
Two of country’s largest health insurers, UnitedHealth Group and Cigna, have announced new measures in response to the coronavirus (COVID-19) pandemic.
UnitedHealth Group’s assistance includes:
- Employer and individual health plans. The company will issue premium credits ranging from 5% to 20% in June.
- Medicare Advantage plans. All cost-sharing for specialist and primary care will be waived through September.
- AARP Medicare Supplement plans. The company will provide both new and renewal premium price stability and support.
UnitedHealth is also expanding its Housing+Health and homeless support programs.
Express Scripts, a Cigna company, is offering its Parachute RxSM discount program to any American who has lost coverage due to COVID-19 for a limited time. The program provides generic drugs capped at $25 for a 30-day supply and brand-name drugs capped at $75 for a 30-day supply.
The Parachute RxSM program covers over 40 brand-name drugs and thousands of generic medication used mostly commonly to treat conditions such as asthma, diabetes, glaucoma, heart disease, migraine, non-opioid pain management, reproductive health, seizures, and thyroid conditions. Users can have drugs delivered from the Express Scripts Pharmacy or pick up at them up one of the 50,000 participating retail pharmacy locations.
Medicare Allows Special Enrollment Period for Those Affected by COVID-19
The Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries can sign up for new coverage until June 30 if they were unable to sign up previously due to the coronavirus (COVID-19) pandemic.
This Special Enrollment Period (SEP) is available to residents of all states, tribes, territories, and the District of Columbia. Beneficiaries do not have to provide proof that they were affected by the pandemic-related emergency.
Healthcare Reform News Update for May 6, 2020
Humana Waives Medicare Advantage Cost-sharing for 2020
Humana is waiving all copays, coinsurance, and deductibles for all in-network primary care, behavioral health, and telehealth visits for its Medicare Advantage customers for the remainder of 2020.
In addition, the company is sending a safety kit that includes masks and health advice information to its Medicare Advantage members to help them see their healthcare providers safely.
Last month, Humana waived all out-of-pocket expenses for coronavirus (COVID-19) treatments. The company says that this latest measure is intended to help ease financial burdens, support member safety, reopen the healthcare system, and boost the economy.
Healthcare Reform News Update for April 29, 2020
COVID-19 Is Causing Medicare Part B Enrollment Delays
Seniors transitioning from employer coverage to Medicare Part B medical insurance are likely to encounter wait times more than twice as long as normal due to coronavirus (COVID-19) office closures.
With many workers furloughed or laid off, Social Security has seen an increase in applications for Medicare Part B, which covers outpatient services such as lab tests, from workers who continued working past age 65. Many Medicare issues can be handled online. But moving from employer coverage to Medicare Part B requires contacting Social Security personnel, who are currently working from home.
Most recently, the increase in Part B applications has led to average hold times of 45 minutes. However, wait times could be up to 90 minutes for the agency’s national 800 number, according to the Social Security Administration’s website. Previously, the average was 20 minutes.
Acknowledging the delays, Social Security teamed up with the Centers for Medicare and Medicaid Services (CMS) to streamline the application process by temporarily waiving some signature requirements and creating a dedicated fax number for applications.
Healthcare Reform News Update for April 28, 2020
Supreme Court Upholds $12 Billion in Government ACA Risk Corridor Payments
The U.S. Supreme Court ruled Monday that the federal government owes up to $12 billion in payments to insurance companies who participated in the Affordable Care Act’s temporary risk corridor program that ran from 2014 to 2016.
When the ACA was enacted, the government promised to reimburse insurers that enrolled at-risk customers. The costs were higher than anticipated, and Congress later voted to ban the payments.
The court said the congressional restrictions did not liberate the government from its original agreement to fund the program. The decision was an 8-1 ruling, with Justice Samuel Alito dissenting.
Healthcare Reform News Update for April 17, 2020
KFF: Consumers Projected to Receive an Average $420 Each in ACA Rebates
Premium rebates from Affordable Care Act plans are estimated to be an average $420 per customer this year, according to a new report from the Kaiser Family Foundation.
The analysis estimates that insurers will pay a record-high $1.97 billion in rebates to individuals who were enrolled in rebate-eligible plans in 2019. The ACA requires insurance companies to send rebates when they spend less than 80% of their premium income on claims and quality improvement over a three-year period.
This year the data is based on insurer financial data from 2017 to 2019 when premiums dramatically increased due to marketplace uncertainties and the repeal of the ACA’s individual mandate.
Rebates will be paid later this year either as a lump sum or as a premium credit.
Healthcare Reform News Update for April 15, 2020
Covered California Signs Up 58,400 in Coronavirus Special Enrollment Period
Approximately 58,400 California residents enrolled in Affordable Care Act plans in the first three weeks of a Special Enrollment Period created in response to the coronavirus (COVID-19), according to data released by Covered California, the state’s health insurance exchange.
The initial data includes residents who signed up in the three weeks between March 20 and April 10. The SEP continues through June 30 and is open to uninsured Californians who meet the eligibility requirements.
Healthcare Reform News Update for April 13, 2020
CMS: Insurers Must Provide Free COVID-19 Antibody Tests
Insurance companies are required to provide antibody tests for the coronavirus (COVID-19) to policyholders with no out-of-pocket costs, according to new guidance released by the Trump administration on Saturday.
The free antibody tests will be used to detect those with immunity against the virus and help determine how many Americans were infected with the virus but experienced little or no symptoms.
Health experts believe that extensive antibody testing is integral to easing social distancing protocols and will enable employees to go back to their workplaces faster.
It’s not clear whether uninsured Americans will be eligible for free antibody tests.
Healthcare Reform News Update for April 10, 2020
Trump Administration Bans Surprise Bills for COVID-19 Patients
Hospitals and doctors that accept funding from the $2 trillion stimulus bill are barred from charging insured patients for out-of-network costs incurred while receiving treatment for the coronavirus (COVID-19), according to the Trump administration.
Individuals covered by individual plans, employer plans, and government programs will not receive these “surprise” medical bills. Plans for how costs for uninsured COVID-19 patients will be handled have not yet been announced.
Previously, co-pays and deductibles for testing were waived, and many insurance companies have also waived out-of-pocket costs for in-network treatment.
Healthcare Reform News Update for April 2, 2020
ACA Enrollment Remains Steady for Third Consecutive Year
Enrollment in Affordable Care Act plans has stayed steady for the third year in a row with 11.4 million Americans signed up for 2020 plans, according to a report issued Wednesday by the Trump administration.
The report also included data on the 38 states that use the federal exchange:
- 87% of enrollees received subsidies.
- The average monthly premium for 2020 plans before subsidies is $595, a 3% drop compared to 2019.
- The average monthly premium for subsidized plans is $89, a $2 increase compared to 2019.
- The average deductible for enrollees who don’t qualify for cost-sharing reductions is $5,316, a 4% increase compared to 2019.
Health Care Services Corp Opens Special Enrollment for Fully Insured Group Plans
Due to the coronavirus (COVID-19) outbreak, Health Care Services Corporation announced a Special Enrollment Period for its fully insured group plans through April 30.
The company, which runs Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, is allowing employees who did not opt in to their group plans to enroll themselves and dependents in coverage. Currently enrolled employees may also add eligible dependents and spouses to their existing plans.
The special enrollment is for medical/pharmacy and dental coverage only and will be effective April 1.
UnitedHealthcare, Anthem Waive COVID-19 Treatment Cost-Sharing
UnitedHealthcare, Anthem, and two regional insurance companies have announced that they will waive cost-sharing for coronavirus (COVID-19) treatment.
UnitedHealthcare will waive out-of-pocket costs for its Medicare Advantage, fully insured group plans and Medicaid plans. The company is also working with self-funded employers who would like to offer the benefit.
Anthem will cover out-of-pocket costs through May 31 for individuals, Medicare Advantage and Medicaid enrollees, and fully insured employer plans. The company has also encouraged its self-funded plans to offer the benefit.
Healthcare Reform News Update for April 1, 2020
States on Federal ACA Exchange Will Not Launch Special Enrollment Period
The Trump administration will not open the federal Affordable Care Act exchange for a Special Enrollment Period (SEP) in response to the coronavirus (COVID-19) outbreak.
Recently, 11 states and the District of Columbia, which run their own ACA exchanges, launched coronavirus-related SEPs, allowing previously uninsured residents to enroll in health insurance plans. Health insurance companies and Democratic lawmakers had expected President Donald Trump to follow suit, opening an SEP for the 38 states that use the federal healthcare exchange.
A White House official said that the administration is “exploring other options.”
Americans who have lost their jobs and health coverage due to the coronavirus can still enroll in ACA plans. Unemployment, along with other life events such as moving and marriage, qualifies individuals for an SEP.
Healthcare Reform News Update for March 31, 2020
Federal Ruling Allows Medicare Patients to Challenge Hospital Observation Status
Medicare patients can now appeal hospital-mandated status changes that characterize them under “observation” status instead of “inpatient,” according to a March 24 ruling by a federal judge.
The decision, part of a class action lawsuit, is important because it could protect some Medicare beneficiaries from large out-of-pocket costs. Medicare Part A does not pay for costs associated with hospitalization or post-acute skilled nursing stays unless the patient has been admitted as an inpatient.
U.S. District Judge Michael Shea said patients should be allowed to challenge decisions that essentially strip them of their Medicare Part A benefits. His decision applies to Medicare beneficiaries from 2009 forward.
The ruling does not apply to patients who were initially placed into hospital “observation” status and were never admitted as inpatients.
The Centers for Medicare and Medicaid Services (CMS) is reviewing the ruling; the Department of Health and Human Services (HHS) has until late May to appeal the decision.
Healthcare Reform News Update for March 30, 2020
Cigna, Humana Waive Out-of-Pocket Costs for COVID-19 Treatment
Health insurers Cigna and Humana will not require policyholders to make out-of-pocket payments for treatment related to the coronavirus (COVID-19).
The companies’ decision will affect all fully insured health policies for employer-sponsored, individual, and Medicare Advantage customers. Self-insured employers are encouraged to waive deductibles and copays but can opt out if they choose.
Cigna’s waived payments are in effect through May 31. Humana has not set an end date and will evaluate the policy as needed.
Healthcare Reform News Update for March 23, 2020
More States Address Coronavirus With ACA Special Enrollments
Due to the coronavirus outbreak, health insurance exchanges in Minnesota, Vermont, and California have created or adjusted special enrollment periods, during which uninsured residents can enroll in coverage.
Minnesota’s MNsure exchange has opened a special enrollment period (SEP) from March 23 to April 21. Coverage will start on April 1 for all enrollees.
Vermont Health Connect’s SEP began Friday and runs until April 17. Enrollees can choose to start their coverage on either April 1 or May 1, no matter when they’ve enrolled.
California’s Covered California exchange extended its current SEP to June 30. Coverage will begin the first day of the month following enrollment. Policies will cover all medically necessary screening and testing for COVID-19 at no charge to enrollees, including telehealth and in-person doctor visits.
George Forbids Health Insurers From Cancelling Policies During Coronavirus Outbreak
Georgia Insurance Commissioner John King has banned insurance companies from cancelling health insurance policies for nonpayment during the coronavirus pandemic. The directive is in effect until further notice.
Healthcare Reform News Update for March 20, 2020
10 State ACA Exchanges Open SEPs in Response to COVID-19
Ten states that run their own Affordable Care Act exchanges have opened Special Enrollment Periods (SEPs) in response to the coronavirus outbreak.
Uninsured residents in the following states and the District of Columbia can enroll in ACA plans from now until the deadlines listed below:
- California – April 30
- Colorado – April 3
- Connecticut – April 2
- Maryland – April 15
- Massachusetts – April 25
- Nevada – April 15
- New York – April 15
- Rhode Island – April 15
- Washington – April 8
- The District of Columbia – June 15
California and the District of Columbia previously opened SEPs due to other factors, but uninsured residents concerned about COVID-19 expenses have the opportunity to sign up now.
State-run exchanges in Idaho, Minnesota, and Vermont have not created SEPs. The federal ACA exchange running the remaining 38 states also has not announced an SEP.
Healthcare Reform News Update for March 19, 2020
CMS Allows Catastrophic ACA Plans to Provide Pre-Deductible COVID-19 Coverage
Insurance providers can cover COVID-19 treatment and testing for patients with Affordable Care Act catastrophic plans before the deductible is met and without requiring cost-sharing.
The Centers for Medicare & Medicaid Services made the announcement Wednesday in the release of COVID-19-related FAQs, which clarify catastrophic plan coverage for coronavirus diagnosis and treatment.
The guidance noted that “the exact coverage details and cost-sharing amounts for individual services may vary by plan, and some plans may require prior authorization before these services are covered.”
Blue Shield of California to Provide Digital COVID-19 Triage Tool to Hospitals
A new digital tool from Blue Shield of California will allow its in-network hospitals to provide patients up-to-date COVID-19 triage and advice from their websites.
The result of a partnership with GYANT, the COVID-19 Screener and Emergency Response Assistant (SERA) tool will enable participating providers to manage patient demand by:
- asking basic questions,
- directing users to the appropriate site for care,
- and providing the latest guidance from the Centers for Disease Control and Prevention and the World Health Organization.
For hospitals that may not have the capacity to create an online patient tool, SERA can be deployed and customized within 48 hours to meet a facility’s needs. It will be offered to hospitals free of charge for three months.
CMS Advises Delay of Non-Essential Procedures
The Centers for Medicare & Medicaid Services recommended Wednesday that all elective surgeries and non-essential medical, surgical, and dental procedures be delayed during the COVID-19 pandemic.
CMS Administrator Seema Verma said personal protective equipment, beds, ventilators, and the healthcare workforce should be preserved for COVID-19 care during this critical time.
The final decision about proceeding with non-essential procedures will be given at the local level by clinicians, patients, hospitals, and state and local health departments.
Healthcare Reform News Update for March 18, 2020
CMS Expands Medicare Telehealth Services Amid COVID-19 Spread
The Trump administration is temporarily expanding Medicare telehealth services to limit the vulnerable senior population’s exposure to–or spreading of–the coronavirus.
All Medicare beneficiaries may use services such as FaceTime or Skype to connect with a healthcare professional by phone or video conference for treatment or diagnosing purposes. This also includes cases unrelated to COVID-19, said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. Previously, only seniors living in rural areas had access to telehealth.
The service will be available for Medicare patients to connect with physicians, nurse practitioners, clinical psychologists and social workers in a variety of settings–including nursing homes and hospital outpatient departments–at no additional cost.
Healthcare Reform News Update for March 13, 2020
Massachusetts Allows Special Insurance Sign-Up Period Due to Coronavirus
Residents of Massachusetts without insurance will be allowed to sign up for coverage through Massachusetts’ Health Connector Affordable Care Act exchange until April 25. This special enrollment period comes in response to the spread of the coronavirus.
Last week, the Massachusetts Division of Insurance announces that insurance companies are required to cover the cost of coronavirus testing and treatment, including waiving copayments and deductibles.
Healthcare Reform News Update for March 12, 2020
High-Deductible Plans Allowed to Offer Free Coronavirus Care
The Internal Revenue Service confirmed that employers can waive the out-of-pocket costs for the testing and treatment of COVID-19 for employees on high-deductible plans, even if they have not met the minimum deductible.
Prior to the guidance, employers were concerned that waiving cost-sharing for testing or treatment for the coronavirus would affect their plans’ statuses as high-deductible health plans. Losing this status would then make the plans ineligible for use with a health savings account.
Even with cost-sharing for testing waived, patients may still be responsible for out-of-pocket costs related to doctor visits or treatment.
CMS Pilot Program to Lower Medicare Part D Insulin Costs by 66%
The CMS’ Center for Medicare & Medicaid Innovation will test a program for Medicare Part D enhanced plans that will cap out-of-pocket costs for insulin at $35 a month.
The Part D Senior Savings Model could potentially save beneficiaries in participating plans an average of $446 per year. The savings would apply to a broad set of formulary insulins, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins.
The goal of the Part D Senior Savings Model is to enable consistent, predictable access to medications to help improve the total cost of care for those with diabetes. The department predicts that the program could save the government more than $250 million during a five-year period, in large part due to drug companies paying additional discounts.
The pilot program will begin January 1, 2021, with participating insurers.
MA & Part D Plans Encouraged to Waive Costs for Coronavirus
The Centers for Medicare and Medicaid Services (CMS) has issued guidance to insurance companies on the out-of-pocket costs of coronavirus testing and treatment for seniors with Medicare Advantage or Medicare Part D plans.
CMS outlined some of the options available to insurance providers, including:
- Waiving cost-sharing for COVID-19 testing
- Waiving cost-sharing for COVID-19 treatment received in doctors’ offices, emergency rooms, and telehealth services
- Eliminating prior authorization requirements
- Waiving drug refill limits
- Lifting drug delivery restrictions
- Expanding telehealth access
The Trump administration has previously said that Medicare would cover a COVID-19 vaccine if it is developed.
Healthcare Reform News Update for March 11, 2020
California Orders Christian Healthcare Ministries Group to Cease Operations in State
State insurance regulators in California served a cease-and-desist order to a Christian healthcare ministries group on Tuesday, accusing it of misleading consumers and offering health coverage without state approval.
Trinity HealthShare and Aliera, the entities that run and sell the health plans, respectively, offer health sharing plans that do not qualify as insurance and don’t meet the requirements of the Affordable Care Act. California estimates that up to 11,000 might belong to their plans.
The companies are expected to contest the action, claiming that they offer lower-cost alternatives to residents who can’t afford traditional insurance.
Insurers & Lawmakers Address Free Coronavirus Testing for Self-Funded Employers
Insurers and Congress moved this week to extend free conoravirus testing to those on self-funded employer plans. Most large insurance companies have previously announced that they will waive out-of-pocket costs for fully insured employer, Medicare Advantage, Medicaid, and ACA plans.
Cigna automatically signed up all its self-funded clients for the benefit this week, giving them 10 days to opt out if they choose to. Meanwhile, House Reps. Diana DeGette (D-CO) and Donna Shalala (D-FL) introduced legislation that would require insurers to cover 100 percent of coronavirus testing costs.
Until now, the Centers for Disease Control and Prevention has conducted and covered most testing. As more tests become available, private labs are expected to start billing insurance companies.
Healthcare Reform News Update for March 10, 2020
Trump Administration Rules Will Allow More Electronic Access to Health Records
Federal officials announced finalized rules that will make it easier for patients to retrieve their health records electronically from healthcare providers and insurance companies.
The new rules would require health providers to make data available free of charge to patients in a standardized format, which could then be downloaded onto smartphones. Standardized data could help public health agencies more efficiently analyze the safety and effectiveness of medications or the spread of contagions such as coronavirus. It could also make it easier for technology companies to use the data to develop artificial intelligence and other software tools.
To address concerns over privacy and security, the rules require developers to verify to plans to protect medical data. Consumers must be warned about programs that do not meet privacy standards and will be provided with clear information about how their information will be used by third parties.
The new rules also prevent hospitals, health insurers, and vendors of electronic health records from blocking access to patient data. Most of the new data provisions will go into effect by 2022.
Healthcare Reform News Update for March 6, 2020
New Hampshire Joins Defense in ACA Supreme Court Case
Republican New Hampshire Governor Chris Sununu announced that the state will join 17 others in defending the Affordable Care Act in a case recently taken up by the Supreme Court.
Sununu said he believed that repealing the ACA without a replacement healthcare plan would not benefit New Hampshire residents.
Healthcare Reform News Update for March 3, 2020
Supreme Court Will Hear ACA Appeal
The Supreme Court announced Monday that it will take up a case against the Affordable Care Act brought about by Republican attorneys general. The case argues that the repeal of the individual mandate invalidates the entire law.
The decision marks the third time that the Supreme Court will hear a challenge to the ACA. The justices upheld the law in two previous cases.
The justices did not specify a timeline, but they will likely hear the case this fall with a decision expected in 2021.
Healthcare Reform News Update for February 20, 2020
California Increases New ACA Enrollment 41%
The increase is a result of the individual mandate and expansion of subsidies to middle-income residents. Nearly 32,000 additional Californians qualified under the new subsidy levels, which lowered middle-income premiums by an average of $504 a month.
So far, there have been 1.5 million enrollments for 2020 ACA plans in California. That number will rise with the addition of a special enrollment period that ends April 30.
Healthcare Reform News Update for February 19, 2020
New Special Enrollment Period in CA Extends ACA Signups Through April 30
The state’s ACA exchange created the special enrollment period for Californians who were not aware of the state’s recently enacted individual mandate penalty or new tax subsidies that extended the number of people who qualified.
Residents who sign up through March 31 will not pay a penalty. Those who sign up in April will pay a pro-rated penalty of one-third the total annual fine.
Healthcare Reform News Update for February 6, 2020
CMS Proposes Changes for Medicare Advantage & Part D Plans
The Centers for Medicare and Medicaid Services released proposed rule changes for Medicare Advantage and Medicare Part D prescription drug plans on Wednesday. Some of the proposals include:
- Increasing Medicare Advantage rates by 0.93% for 2021
- Allowing those with end-stage renal disease on dialysis to enroll in Medicare Advantage
- Enabling consumers to view real-time direct drug price comparisons between formulary options
- Adding a second specialty drug tier to formularies for “preferred” medications
- Revising the star ratings system to account for patient feedback.
CMS will accept comments on the proposed changes until Friday, March 6.
Healthcare Reform News Update for February 4, 2020
Republican Lawmakers Ask Supreme Court to Wait on ACA Case Review
The Trump administration and coalition of Republican-led states filed a petition with the Supreme Court, asking it to hold off on reviewing the case against the Affordable Care Act until it works its way through the lower courts.
Last month, the Supreme Court decided not to expedite the case, but the possibility of discussing it by the end of February remains. The filing argues that taking up the case during the current session would be premature.
Justices are expected to respond to the request before the end of the month.
Humana and Private Equity Firm to Develop More Medicare-centric Primary Care Centers
Health insurer Humana and private equity firm Welsh, Carson, Anderson & Stow have formed a joint venture to develop payor-agnostic primary care centers that focus on treating seniors.
The clinics will be managed by Humana’s Partners in Primary Care and will more than double the number of its care centers over the next three years. Currently, it runs 47 facilities in Florida, Kansas, Missouri, North Carolina, South Carolina, and Texas.
Healthcare Reform News Update for January 28, 2020
Medicare Approves Coverage of Next Generation Sequencing Tests for Cancer Patients
Medicare will now cover diagnostic laboratory tests that use next-generation sequencing (NGS) for enrollees with inherited ovarian and breast cancers, The Centers for Medicare & Medicaid Services announced. The new tests will help determine the most effective treatments for patients with advanced cancers and their candidacy for clinical trials.
Healthcare Reform News Update for January 22, 2020
Analysis: Medicare Advantage Can Save Enrollees 40% More Than Fee-For-Service Plans
Out-of-pocket costs for Medicare beneficiaries with Medicare Advantage plans can be nearly 40 percent less than those with Original Medicare and supplement plans, according to new research sponsored by UnitedHealth Group (UHG).
Research from the Milliman consulting firm compared annual healthcare costs for enrollees with Medicare Advantage with drug coverage; enrollees with Original Medicare and a Part D plan, and enrollees with Original Medicare, a Part D plan and a Medicare Supplement plan.
The analysis found that those with Medicare Advantage plans with prescription drug coverage typically spent $1,477 less annually than those enrolled in Original Medicare and a Part D plan, and $2,328 less than those with Original Medicare, a Part D plan, and a Medicare Supplement Plan F.
UHG claims that over a lifetime, Medicare Advantage plans could save beneficiaries between $50,000 and $85,000.
Medicare to Cover Acupuncture for Chronic Low Back Pain
Medicare will now pay for acupuncture treatments for beneficiaries with chronic low back pain, CMS announced on Tuesday. Coverage includes up to 12 sessions over three months and an additional 8 sessions if symptoms improve.
The decision is part of an effort to increase the number options for non-opioid pain management.
Healthcare Reform News Update for January 21, 2020
Supreme Court Declines to Fast-Track ACA Case
The Supreme Court announced today that it will not review a legal challenge to the Affordable Care Act in its current term, which ends in June. The court did not state whether or not it will review the case in the future.
A coalition of Democrats had asked the Supreme Court to expedite a hearing after a federal appeals court sent the case back to the lower court judge who ruled that the ACA was unconstitutional.
Supreme Court to Review ACA Birth Control Exemption
The Supreme Court will consider whether employers can use religious reasons to opt out of the Affordable Care Act’s requirement to cover birth control.
Federal judges have blocked new Trump administration rules that would allow more types of employers to claim exemptions from the requirement to provide no-cost birth control on religious or moral grounds.
Healthcare Reform News Update for January 17, 2020
ACA Silver Plan Premiums Decreased in 31 States for 2020
Premiums for the lowest-priced Affordable Care Act silver plans dropped in 31 states in 2020, according to a new study by the Urban Institute.
Researchers found that rates rose significantly between 2017 and 2018, but stabilized in 2019. In 2020, premiums for the lowest-priced silver plans decreased an average of 3.5 percent. The overall average premium for the lowest-priced silver plans in 2020 is $426.
The study found that states with higher average premiums for the lowest-priced silver plan usually had less competition. Wyoming has the highest average 2020 premium at $871; Minnesota has the lowest at $298.
The report suggests that increased participation in the ACA exchanges in 2019 and 2020 show that insurers believe that the marketplace is stable and potentially profitable.
Healthcare Reform News Update for January 16, 2020
Study: ACA Helped Narrow Racial Gaps in Health Coverage Access
The Affordable Care Act has reduced racial and ethnic disparities in access to insurance coverage, according to a new study from The Commonwealth Fund.
The study found that the health law’s Medicaid expansion led to historic reductions in uninsured rates. However, progress has stalled since 2016, and the overall rate has started to climb. Other findings include:
- The gap between uninsured black adults and uninsured white adults fell from 9.9 percentage points in 2013 to 5.8 percentage points in 2018.
- The gap between uninsured Hispanic adults and uninsured white adults fell from 25.7 percentage points in 2013 to 16.3 percentage points in 2018.
- Racial disparities narrowed in both expansion states and nonexpansion states. However, expansion states had greater access to care for all three groups with fewer racial differences between them.
- Black adults in expansion states had as good or better coverage rates as white adults in nonexpansion states.
- 46% of black working-age adults reside in the 15 nonexpansion states.
- The uninsured rate for black adults has risen by .7 percentage points since 2016, while the uninsured rate for white adults has risen by .5 percentage points.
Healthcare Reform News Update for January 13, 2020
Trump Administration Wants Supreme Court ACA Hearing Delayed
A Supreme Court fast-track review on the Affordable Care Act’s constitutionality would be premature, according to separate filings from the Trump administration and a coalition of Republican attorneys general.
The 5th Circuit Court of Appeals struck down the ACA’s individual mandate but has requested clarification from a lower court on whether the entire law should be repealed.
Democratic lawmakers have asked the Supreme Court to take up the case before its term ends in June. Republicans argue that the lower-court case needs to be decided prior to a Supreme Court review.
Healthcare Reform News Update for January 10, 2020
Kansas Proposal Sets Path for ACA Medicaid Expansion & Reinsurance Program
Kansas Governor Laura Kelly and state Senate Majority Leader Jim Denning announced a bipartisan proposal that expands Medicaid under the Affordable Care Act and creates a reinsurance program to help lower private insurance premiums.
Expanding Medicare would cover as many as 150,000 additional residents who earn up to $138% of the federal poverty level. A surcharge on hospitals will help cover the state’s costs. The proposal sets a start date of January 1, 2021.
The proposal is expected to pass in the legislature, which convenes next week.
Healthcare Reform News Update for January 8, 2020
ACA Medicaid Expansion Slows Health Decline in Southern States
The expansion of Medicaid helped those in Southern states by making declines in health status 1.8 percentage points less likely, according to a new study published in Health Affairs.
The study focused on twelve Southern states and compared those that have accepted the Affordable Care Act’s allowance for the expansion of Medicaid and those that have not. People in the states where Medicaid was expanded have a higher probability of maintaining their baseline health status.
Healthcare Reform News Update for January 7, 2020
ACA Market Remained Stable Despite Repeal of Individual Mandate
The Affordable Care Act’s individual insurance market remained relatively stable and profitable in 2019 even without the individual mandate penalty, according to a new study by the Kaiser Family Foundation (KFF).
KFF points to the following key measure to demonstrate the marketplace’s stability:
- A modest growth in claims costs
- A decrease in hospitalizations
- The decrease in 2020 premiums by 2-3 percent on average
- Steady enrollment in 2020 plans
Supreme Court Requests Quick Response from ACA Opponents
Opponents of the Affordable Care Act have until this Friday to respond to a request made by Democrats to expedite the challenge to an appeals court’s decision on the constitutionality of the Affordable Care Act, according to the Supreme Court.
The Supreme Court has not yet announced if it will hear the case.
Healthcare Reform News Update for January 6, 2020
Democratic Attorneys General Ask Supreme Court to Review ACA Court Ruling
A coalition of 20 states, Democratic members of the House, and Washington D.C. have asked the Supreme Court to fast-track a review of a lower court’s decision to declare the Affordable Care Act unconstitutional.
The petition requests a hearing and decision by this summer, arguing that uncertainty regarding the ACA could impact the future of the nation’s healthcare system.
Healthcare Reform News Update for January 2, 2020
Costs for over 200 Prescriptions Drugs Expected to Rise in 2020
Pharmaceutical companies are expected to increase the cost of over 200 medications in the U.S. beginning in 2020. These include treatments for cancer, rheumatoid arthritis, respiratory issues, and more. The price increases are expected to all stay below 10%, most likely due to pressure from politicians and patients.
Risk Adjustment Payments Program Upheld in U.S. Appeals Court
A U.S. appeals court maintained that a risk adjustment payments program implemented under the Affordable Care Act is valid, leaving the program in effect. This reversed a lower-court ruling that led to a suspension in payments.
The risk adjustment payments program pays insurance companies who cover sicker and high-risk patients, including those with pre-existing conditions, with funds collected from insurers that enroll low-risk patients. Removing this program could have led to increased premiums and healthcare market disturbances.
Healthcare Reform News Update for December 23, 2019
2020 ACA Enrollment Remains Steady With 8.3 Million Signups
Enrollment in Affordable Care Act health insurance plans remained consistent for 2020 with 8.3 million people signing up for coverage on the federal exchange, according to preliminary data from the Centers for Medicare and Medicaid Services.
This is a slight downturn from last year. However, the final number will be released once national totals, which include enrollments from state-run exchanges, are released.
The 2020 signups include 2 million first-time enrollees, an increase of 36,000 compared to last year.
CMS Finalizes Rules on Abortion Billing & Oversight of Tax Credit Eligibility
The Centers for Medicare and Medicaid Services finalized a new rule that requires Affordable Care Act plans to send a separate bill to enrollees for the share of their premium that funds abortion coverage, which is prohibited from public funding.
The rule includes additional procedures for state-based exchanges to ensure that they correctly identify consumers who are eligible for tax credits and cost-sharing reduction subsidies. It also requires exchanges to conduct “data matching” at least twice a year for subsidized enrollees. This helps exchanges ensure they are pinpointing people who’ve become eligible for other coverage that might change their eligibility for federal subsidies.
The rule takes effect June 27, 2020.
Senate Passes Government Spending Package
President Donald Trump is expected to sign the bill to avoid a government shutdown.
Healthcare Reform News Update for December 19, 2019
Federal Appeals Court Strikes Down ACA’s Individual Mandate
A U.S. Court of Appeals decided on Wednesday that the part of the Affordable Care Act that required Americans to have health coverage or pay a penalty is unconstitutional.
However, the rest of the law remains in limbo. The appeals court sent the case back to the judge who originally declared the entire ACA unconstitutional asked him to provide more specific recommendations for the remaining parts of the law. The panel also asked him to consider a Justice Department proposal to overturn the entire ACA, but only in the 18 states that filed the lawsuit against it.
California Attorney General Xavier Becerra, who is defending the ACA in court, announced that he will appeal the decision to the Supreme Court immediately.
The ruling does not affect the current implementation of the law or the coverage for consumers who have ACA plans.
Medicare Suspends Data Sharing Tool Over Technical Error
The Centers for Medicare and Medicaid announced that it has temporarily shut down access to Blue Button 2.0 due to a coding error that may have exposed beneficiaries’ data.
The Blue Button data sharing tool allows Medicare enrollees to share claims data with third-party applications. The error may have unintentionally sent protected health information to the wrong user or to the wrong Blue Button 2.0 app. Any data exposure was limited to Blue Button beneficiaries or developers; the information was not compromised by outside entities.
CMS said that the issue has affected fewer than 10,000 users and 30 authorized apps.
Access to Blue Button 2.0 will remain closed until the issue is resolved.
Healthcare Reform News Update for December 18, 2019
House Passes Government Spending Package That Removes 3 ACA Taxes
The House voted Tuesday to pass a $1.4 trillion government spending package that includes the permanent repeal of three Affordable Care Act taxes.
The bill would repeal:
- the “Cadillac tax” on high-cost employer plans that has never gone into effect,
- a 2.3% excise tax on the sale of medical devices, and
- the health insurance tax that was scheduled to be reinstated in 2021.
Also included in the package are provisions that will block the Trump administration from ending auto-enrollment or outlawing the practice of “silver loading,” which is when insurers raise ACA premiums for benchmark silver plans to boost tax subsidy payments for consumers.
The Senate will vote on the bill later this week.
Maryland ACA Enrollments Reach Four-Year High
More people signed up for a Maryland’s state-run Affordable Care Act marketplace plan this season than in any of the past three years, with enrollments reaching 215,150.
Signups increased in 20 of 24 state jurisdictions with a 1% total increase over last year.
Premiums for 2020 health plans decreased by an average of 10%.
Healthcare Reform News Update for December 17, 2019
Five State-Run ACA Exchanges Extend Enrollment Deadlines
The signup deadlines for several states that run their own Affordable Care Act marketplaces have been extended.
- California: Residents now have until December 20 to sign up for coverage beginning January 1. Coverage for signups made between December 21 and January 31 will begin February 1.
- Connecticut: The deadline for coverage has been extended to January 15. Coverage for signups made between December 16 and January 15 will begin February 1.
- District of Columbia: Residents now have until December 18 to sign up for coverage that begins January 1. Coverage for signups completed between December 19 and January 15 begin February 1. Coverage for signups made between January 16 and January 31 begins March 1.
- Nevada: Residents who started their enrollment application by December 15 have until December 20 to complete it.
- Washington: Residents now have until December 30 to sign up for coverage that starts February 1.
The Centers for Medicare and Medicaid Services (CMS) announced yesterday that the Open Enrollment deadline dates in most states have been extended to December 18.
Healthcare Reform News Update for December 16, 2019
ACA Enrollment Deadline Extended to December 18
The deadline for signing up for coverage on the federal Affordable Care Act marketplace has been extended to December 18, according to the Centers for Medicare and Medicaid Services (CMS).
Due to a rush of last-minute enrollments, website glitches, and call center delays, some people experienced difficulties in signing up.
CMS noted that enrollees who have left their contact information with the government call center do not need to reapply during this extension; a representative will follow up with them later this week.
First-Time ACA Enrollment Increases 16% in California
Covered California, the state-run Affordable Care Act marketplace, has enrolled more than 130,000 California residents who signed up for the first time during this year’s Open Enrollment Period—a 16% increase from last year. Also, more than 1.13 million Californians have renewed their coverage for 2020.
Under the state’s recent subsidy expansion, around 23,000 California residents in the 400-600% range of the federal poverty level have qualified for assistance with paying their premiums.
California’s new premium assistance guideline helps families who earn up to 600% of the federal poverty level. For example, a family of four with an annual household income up to $154,500 would be eligible for premium-payment help.
The enrollment deadline is January 31 in California, which is one of several states with extended Open Enrollment dates.
Healthcare Reform News Update for December 12, 2019
2020 ACA Enrollment Down Compared to Last Year
Health insurance enrollment on the federal Affordable Care Act exchange is down by 6% as compared to last year, according to Centers for Medicare and Medicaid Services.
Approximately 3.9 million Americans have enrolled in a 2020 ACA plan during the first six weeks of the Open Enrollment Period. This is a decrease of about 250,000 from the same time frame last year.
Open Enrollment ends Dec. 15 in most states. However, some states have chosen to extend Open Enrollment deadlines.
Healthcare Reform News Update for December 11, 2019
Kaiser: 28% of Uninsured Americans Qualify for $0 Bronze ACA Coverage
Because of “silver loading,” 4.7 million uninsured Americans qualify for a $0 premium bronze Affordable Care Act plan in 2020 once subsidies are applied, according to a new Kaiser Family Foundation analysis.
The number represents 28% of the total 16.7 uninsured individuals in the country. That’s slightly higher than last year when 27%, or 4.2 million, uninsured consumers qualified for a $0 premium bronze plan.
The analysis shows that over half of these eligible consumers live in Texas, Florida, North Carolina and Georgia.
Silver loading involves raising the premiums of benchmark silver ACA plans, which enables subsidized consumers to receive higher tax credit amounts allowing them to purchase a plan on the marketplace. In some instances, the tax credit exceeds the price of a bronze plan, triggering a $0 per month premium.
Report: IRS Push to Increase Health Coverage Saved 700 Lives
A letter sent by the Internal Revenue Service in 2016 to 3.9 million Americans without health insurance increased sign-ups and helped show that health coverage leads to fewer deaths, according to a working paper by three U.S. Department of Treasury economists.
Due to budgetary reasons, a mailing that encouraged people to sign up for coverage was sent to only a portion of the 4.5 million Americans who paid a fine for being uninsured. Approximately 600,000 people did not receive the letter. This created a randomized controlled trial, allowing Treasury Department researchers to compare the results.
For every 1,648 person between the ages of 45 and 64 who received the letter, one fewer death occurred, according to the analysis. The study estimates that the letter may have saved up to 700 lives.
Healthcare Reform News Update for December 10, 2019
Poll: Medical Costs Are Causing Americans to Delay Care for ‘Serious’ Conditions
One in four Americans say they or a family member decided to postpone treatment for a serious medical condition in 2019 because of the cost, according to a new Gallup poll. The percentage is the highest recorded since Gallup began asking the question in 1991.
Other findings from the poll include:
- 8% of respondents said they or a family member delayed treatment for less serious conditions because of cost.
- 36% of households with less than $40,000 in annual income reported delaying treatment because of cost–an increase of 13% compared to 2018.
- Delaying care for those with pre-existing conditions rose 13% compared to last year.
- Throughout the past 18 years, there has been a 50% increase in the percentage of respondents who have delayed care due to cost.
- The increase in delaying care did not appear to be caused by changes in insurance status, as the percentage of those uninsured remained steady.
Supreme Court Hears ACA Risk Corridor Case
Oral arguments over the Affordable Care Act’s risk corridor program will be heard in the Supreme Court today.
The temporary program touted reimbursement payments to insurance companies to help increase participation in the initial ACA marketplace and mitigate any losses they may incur. Republicans in Congress reduced the amount of funds available by $12 billion, calling the payments a “taxpayer-funded bailout” for insurers.
Insurance companies are suing the federal government to reinstate the full payments.
Healthcare Reform News Update for December 5, 2019
Hospital Groups Sue Trump Administration Over Price Transparency Rule
Four hospital groups have filed a lawsuit over a Trump administration rule that requires hospitals to publish the rates they negotiate with insurers.
The groups argue that the rule violates the First Amendment, would cause confusion with consumers regarding their out-of-pocket costs, and would be an administrative burden. They also claim that the Department of Health and Human Services does not have the legal authority to enforce the rule.
The suit was filed Wednesday by the American Hospital Association, Association of American Medical Colleges, the Children’s Hospital Association, and the Federation of American Hospitals.
Healthcare Reform News Update for December 4, 2019
Study: Silver-Loading, CSR Cut Reduced ACA Premiums in Rural Areas
Subsidized Affordable Care Act enrollees who live in rural areas have more affordable plan options due to the elimination of cost-sharing reduction (CSR) payments than those who live in urban areas, according to analysis by Health Affairs.
After the Trump administration stopped CSR payments in 2017, some insurers responded with “silver-loading” or “silver-switching” strategies, which lowered premiums for subsidized enrollees. The study found that rural areas were more affected by the results of these actions.
The average premium for subsidized rural ACA enrollees was lowered from $288 in 2017 to $157 in 2018, a 45.5% decrease. For urban dwellers, the reduction was 34.5%, from $275 to $180.
One reason for the disparity is that rural areas have more flexibility to set premiums when there are fewer insurers available.
Humana Will Offer Remote Monitoring Services to At-Risk Medicare Advantage Enrollees
Humana is partnering with health technology company Philips on two programs that will offer remote monitoring services to Medicare Advantage members who are at high risk of hospital readmissions.
Humana will offer Philips’ Lifeline medical alert service to members who are at risk for falls and a suite of remote monitoring tools to members with severe congestive heart failure.
The initiatives are intended to provide at-risk members with 24/7 access to care, increase support after a hospital stay, and encourage prevention.
Healthcare Reform News Update for December 3, 2019
Study: Most Medicare Beneficiaries Are Keeping Their Current Plans
Most Medicare Beneficiaries with Medicare Advantage prescription drug plans (MA-PDs) and Part D stand-alone prescription plans (PDPs) do not switch to different plans during the Open Enrollment Period, according to a new analysis from the Kaiser Family Foundation.
The study shows that during Open Enrollment in 2016, 8% of MA-PD enrollees switched to new 2017 plans and 10% of PDP enrollees switched to new 2017 plans.
For all the Open Enrollment periods between 2007 and 2016, enrollees who switched to new plans ranged from 6% to 11% for MA-PD enrollees and 10% to 13% for PDP enrollees.
The reluctance to change plans could be attributed to several factors. But previous analysis showed that 45% of Medicare beneficiaries never review or compare their options, and 35% said it is “very difficult” or “somewhat difficult” to compare plans.
Healthcare Reform News Update for December 2, 2019
Blue Cross of Idaho Introduces ‘Enhanced’ Short-Term Health Insurance
Beginning January 1, Blue Cross of Idaho will offer new comprehensive short-term health plans to state residents.
Called “Access” plans, the coverage is expected to be up to 40% less than plans sold on the Affordable Care Act marketplace. However, unlike ACA plans, enrollees who are sicker can be charged higher premiums, and people with pre-existing conditions could have a waiting period of up to 12 months.
There will be three Access plans with differing deductibles and out-of-pocket maximums. Some features of the plans include:
- Plans last up to 364 days and are renewable up to 36 months.
- The ACA’s 10 essential benefits, including maternity care and prescription drugs, are covered.
- Preventive care is covered before having to meet the deductible.
- No copays for children who receive diagnostic tests with the family doctor.
- The first 10 primary care doctor visits for adults are covered prior to meeting the deductible.
- No copay for the first six mental health visits.
Deductibles for the plans range from $2,500 to $10,000 for individuals and from $5,000 to $20,000 for families.
UnitedHealthcare Opens Medicare Service Centers in Walgreens Stores
UnitedHealthcare will open service centers for Medicare beneficiaries in Walgreens stores in Las Vegas, Phoenix, Cleveland, Denver, and Memphis beginning in January.
The service centers will provide information about Medicare coverage options and the ability for enrollees of the company’s Medicare Advantage plans to schedule their annual wellness visits.
Healthcare Reform News Update for November 22, 2019
Kaiser: More Insurance Companies Are Participating in the 2020 ACA Marketplace
The 2020 ACA marketplace will have increased participation, with consumers in 18 states gaining a total of 26 new insurers and an additional 54 insurance companies expanding their service areas within states, according to a new analysis from the Kaiser Family Foundation.
Additional findings about 2020 ACA participation include:
- Each state will have an average of 4.5 insurers, compared to 4 in 2019.
- 67% of enrollees can choose from three or more insurers, compared to 58% in 2019.
- 668 counties will add at least one insurer, while 18 counties will lose an insurer.
- Counties in metro areas will average 2.6 insurers; non-metro counties will average 2.
- 10% of enrollees have access to just one ACA insurer, the lowest percentage since 2016.
Medicare Plan Finder Tool Can Misdirect Consumers to Higher-Cost Plans
A feature in the new plan finder tool on the Medicare.gov website may be causing some beneficiaries to unintentionally choose higher-cost coverage.
The tool, used by 60 million Medicare recipients, automatically displays the lowest-premium plan at the top of the page. However, the tool does not take into consideration other out-of-pocket expenses such as copays and prescription drug costs. If a user doesn’t take extra steps to filter the results, the plan with the lowest total annual cost may not be the first one shown.
Critics of the new tool say that the wrong choice could cost beneficiaries thousands of dollars per year.
Medicare is testing different methods, such as a pop-up, to direct consumers’ attention to total costs.
Healthcare Reform News Update for November 21, 2019
Week 3 ACA Enrollment Down 1.5% From Last Year
During the first three weeks of the Affordable Care Act’s Open Enrollment Period, 737,352 people signed up for coverage, which is 1.5% less than the same period last year.
So far, nearly 1.7 million people have enrolled in 2020 ACA plans in the 38 states that use the federal exchange. Only Mississippi has seen an increase in enrollment compared to last year’s sign-ups.
Senators Say Trump Administration Is Driving ACA Shoppers to Short-Term Plans
Some consumers shopping for Affordable Care Act plans on the federal exchange are being redirected to third-party websites that promote enrollment in short-term health plans.
Nearly two dozen Senate Democrats, led by New Hampshire Senator Jeanne Shaheen, sent a letter to the Centers of Medicare and Medicaid Services voicing concern that the Trump administration is steering consumers away from ACA plans.
Short-term plans often have lower premiums than ACA plans but do not provide comprehensive coverage, such as protections for pre-existing conditions, maternity care, prescription drug coverage and emergency room service.
Healthcare Reform News Update for November 18, 2019
Trump Administration Proposes New Insurance Price Transparency Rules
The Trump administration on Friday released a new proposal that would require insurance companies to provide price and cost-sharing information to consumers before services are performed.
The Transparency in Coverage proposal would enable participants, beneficiaries and enrollees to:
- Access personalized out-of-pocket cost information for all covered services through an online tool or a printed copy, if requested.
- See the rates their insurance company has negotiated with in-network providers and the allowed amounts for out-of-network providers.
- Share the cost savings received by their insurance company.
The proposal builds on its newly finalized transparency rules for hospitals “to ensure consumers are empowered with the information they need to make informed health care decisions,” according to a statement by the Centers for Medicare and Medicaid Services.
Healthcare Reform News Update for November 14, 2019
2020 ACA Enrollment Down From Last Year
Sign-ups for 2020 Affordable Care Act plans on Healthcare.gov during the first two weeks of the open enrollment period (OPE) were 20 percent lower than last year.
Around 932,000 people enrolled in an ACA plan on the federal exchange during the first nine days, whereas 1.18 million enrolled during the first ten days of the 2019 season, according to The Centers for Medicare and Medicaid Services.
There were 244,928 new enrollees, an increase from last year, and over 680,000 renewing consumers. The totals do not include those who signed up in states that operate their own insurance exchanges.
Google Healthcare Data Project Incites Federal Investigation
The Department of Health and Human Services’ Office for Civil Rights has opened an investigation regarding the healthcare data collection partnership between Google and Ascension.
The federal probe will investigate whether the initiative is compliant with federal patient privacy laws.
Both companies have stated that the mass collection of patient data meets all HIPAA regulations regarding data privacy, security, and usage.
“We are happy to cooperate with any questions about the project,” said Tariq Shaukat, Google Cloud’s president of industry products and solutions.
Healthcare Reform News Update for November 12, 2019
Google to Store & Analyze Healthcare Records for Millions of Patients
Google’s deal with medical system Ascension allows the tech company to collect and analyze the medical data, such as lab results, doctor diagnoses, and hospitalization records, of millions of Americans.
Google said in a blog post that patient data would not be combined with any of its consumer information.
The companies are in “early testing” for optimizing Ascension’s data. Ascension claims its goal for the partnership is to use artificial intelligence to help improve clinical effectiveness and patient safety.
Ascension operates 150 hospitals and more than 50 senior living facilities in 21 states.
Healthcare Reform News Update for November 11, 2019
Original Medicare Premiums and Deductibles to Increase in 2020
Original Medicare monthly premiums, deductibles, and copayments will in increase in 2020, the Centers for Medicare and Medicaid announced on Friday.
Medicare Part B premiums will rise nearly 7 percent, increasing from $135.50 to $144.60 for beneficiaries who earn up to $87,000 per year. The Part B outpatient deductible will rise from $185 to $198.
Medicare Part A rates will also increases. Inpatient hospital deductibles will jump from $1,364 to $1,408, an increase of $44. Coinsurance for the 61st through the 90th day in the hospital will rise from $341 per day to $352.
Healthcare Reform News Update for November 7, 2019
Federal Judge Voids Trump Administration Conscience Rule
A federal court on Wednesday struck down a Trump administration rule that allowed healthcare providers to refuse to cover or perform services on religious or moral grounds.
U.S. District Judge Paul Engelmayer said the “conscience” rule was “arbitrary and capricious,” conflicted with federal laws, and would threaten funding for noncompliant providers including hospitals, clinics, and universities.
The law was scheduled to go into effect November 22.
Technical Glitch Causes ACA Enrollment Decline in First Two Days
During the first two days of the Affordable Care Act Open Enrollment Period, 177,082 people signed up for coverage, according to the Centers for Medicare and Medicaid Services (CMS).
Of those who signed up, nearly 49,000 were new enrollees.
Enrollment was down compared to the 371,676 people who enrolled during the first three days of 2018. CMS attributes the lower numbers to technical issues on the federal government website.
Healthcare Reform News Update for November 6, 2019
Buttigieg Campaign Highlights Plan to Reduce Hospital Bills
Presidential candidate Pete Buttigieg’s plan to lower hospital prices places a limit on how much hospitals would receive from insurance companies for services performed by out-of-network providers.
Buttigieg’s “Medicare For All Who Want It” plan puts a cap on out-of-network costs at twice the amount that Medicare pays for the same service. The expectation is that the limit will lower patients’ medical bills by influencing price negotiations between insurance companies and hospitals.
This approach addresses the rise of hospital prices at four times faster than physician prices and prevents hospitals from “pricing irresponsibly,” according to Buttigieg’s website.
Report: Number of MA Plans With Supplemental Benefits Increases Significantly
Medicare Advantage plans offering expanded supplemental benefits grew from 102 in 2019 to 364 in 2020, according to a new study from Milliman and the Better Medicare Alliance.
Some of the benefits that will become more available in 2020 are therapeutic massage, in-home support services, adult day health services, home-based palliative care, and support for caregivers of beneficiaries. In 2019, no plans offered more than one of these services; in 2020, 116 plans include more than one.
Healthcare Reform News Update for November 5, 2019
Georgia Governor Proposes Partial ACA Medicaid Expansion
Georgia Governor Brian Kemp (R.) has proposed a limited expansion of Medicaid that would provide health coverage to low-income residents who spend 80 hours per month working, volunteering, or attending job training.
The plan, called Georgia Pathways, would be available to residents with an income at or under 100% of the federal poverty level, which is around $12,490 a year for an individual. That’s below the 138% federal poverty level requirement in the Affordable Care Act, which is around $17,236 per year for an individual.
Although 408,000 Georgia citizens will be eligible for Medicaid under the expansion, only about 52,000 would be enrolled in the program after five years, according to Kemp’s office.
The proposal requires approval from the Trump administration before it can be implemented.
Survey: Majority of Seriously Ill Medicare Beneficiaries Incur Financial Difficulties
Over half of all Medicare enrollees who are seriously ill face financial hardships as a result of medical bills, according to a new survey published in “Health Affairs.”
Drug costs are the leading cause of financial exposure, with hospital bills, ambulance rides, and emergency visits also cited.
Other findings include:
- More than a third said they used all or most of their savings to pay medical bills.
- 30% said prescription drugs were their major hardship.
- 27% were contacted by a collection agency.
- 25% said the costs were a major burden on their families.
- 23% could not pay for basics, including housing, food, and utilities.
The study describes seriously ill patients as those who have conditions that require two or more hospital stays and have visited more than three doctors. Heart disease, cancer, and diabetes were the most common illnesses.
Healthcare Reform News Update for November 4, 2019
Analysis: State Reinsurance Programs Reduced ACA Premiums by Almost 17%
The 12 states that implemented reinsurance programs lowered Affordable Care Act plan premiums by an average of 16.9% in the first year of operation, according to a new analysis from Avalere Health.
Maryland had the highest decline in premiums its first year with a 43.4% reduction in 2019. Rhode Island’s program had the least effect on premiums with a 5.9% reduction for 2020 plans.
The analysis also found that the reinsurance programs cost states an average of $53.7 million per year.
Healthcare Reform News Update for October 31, 2019
Number of Uninsured Children Increases to 4.1 Million
The number of U.S. children without health insurance passed 4 million in 2018, according to a new report from the Georgetown University Center for Children and Families.
Before hitting 5% in 2017, the rate of uninsured children had not increased since 2008. The jump to 5.2% in 2018 makes it in the second year of increases in a row.
States that have not implemented the Affordable Care Act’s Medicaid expansion were more likely to have a high percentage of uninsured children. Texas had the largest rate at 11.2%, while West Virginia saw the greatest percentage increase in the number of insured kids.
Researchers cited several reasons for the uptick in uninsured children, including confusion over the Trump administration’s attempt to repeal the Affordable Care Act; the elimination of the ACA’s individual mandate; and the crackdown on immigration.
The analysis is based on data from the U.S. Census Bureau American Community Survey.
Senate Resolution to Block ACA Opt-Out Rules Fails to Pass
A Senate Democratic resolution to block waivers that allow states to opt out of Affordable care Act requirements failed to pass on Wednesday.
The new Trump administration waivers allow states to sell cheaper, less-comprehensive health insurance coverage that doesn’t fully meet ACA standards, including pre-existing condition protections.
Healthcare Reform News Update for October 28, 2019
Medicare Advantage Choices Reach Highest Level in a Decade
The average Medicare beneficiary will be able to choose from 28 Medicare Advantage plans offered by seven different insurance carriers in 2020, according to new analysis by the Kaiser Family Foundation. Availability varies by location.
In total, there will be 3,148 Medicare Advantage plans available nationwide, up from 2,734 in 2019. HMOs account for 64% of all plans offered.
Other findings include:
- More special needs plan will be available in 2020 than in any other year.
- Twenty-four percent of Medicare users will be able to choose between plans offered by 10 or more companies, while 4% will only be able to choose from plans offered by two or fewer.
- Metropolitan counties will average 31 plans per beneficiary, whereas non-metropolitan counties will average 16 plans.
- Ninety-seven percent of beneficiaries have access to extra benefits, like dental, vision, fitness, and hearing.
- There are 13 new insurers entering the market in 2020 and one insurer leaving, with a total of over 100 companies offering Medicare Advantage plans.
Healthcare Reform News Update for October 25, 2019
Judge: Government Owes $1.6 Billion in ACA Subsidies
The federal government was ordered this week to pay almost 100 health insurance companies a total of $1.6 billion in unpaid Affordable Care Act cost-sharing reduction payments.
In February, U.S. Court of Federal Claims Judge Margaret Sweeney ruled in favor of a class-action suit that challenged the Trump administration’s decision to end the payments at the end of 2017. As part of the ruling, Sweeney asked insurers to file reports on the subsidy amounts they were owed for 2017 and 2018.
The amounts owed to individual companies range from the tens of thousands to $220.3 million.
The government is expected to appeal the ruling.
Healthcare Reform News Update for October 22, 2019
2020 ACA Benchmark Plan Premiums Decline
Monthly premiums for 2020 Affordable Care Act benchmark plans sold on the federal exchange will be 4% less on average than this year’s, according to the Centers for Medicare & Medicaid Services.
CMS also reported that the number of insurers offering ACA plans will increase by 20 carriers for a total of 175 plan sponsors on the federal exchange.
CMS Administrator Seema Verma shared the following additional information:
- The average monthly premium for a 27-year-old with an income 150% of the federal poverty level will be $52.
- The average monthly unsubsidized silver plan premium for a 27-year-old will be $374.
- States with average monthly premium decreases of 10% or more include: Delaware, Montana, Nebraska, North Dakota, Oklahoma, and Utah.
- States with average monthly premium increases of 10% or more include: Indiana, New Jersey, and Louisiana.
- Wyoming will have the highest average monthly premiums; New Mexico will have the lowest.
- Only Delaware and Wyoming will have a single ACA insurer, which is down from five states this year.
- Average silver plan deductibles are increasing from $4,471 to $4,604.
Healthcare Reform News Update for October 21, 2019
Arizona Postpones Medicaid Work Requirement
The state of Arizona will delay the implementation of the planned Medicare work requirement and other program changes. State officials notified the Center for Medicare and Medicaid Services on October 17 via a letter.
The requirement was intended to begin in 2020, but ongoing litigation and an “evolving national landscape” has made Arizona hold off on any major amendments to their Medicaid program.
The proposed work requirement would make Medicaid recipients between the ages of 18 and 49 report at least 80 hours of work, schooling, volunteer community service, job training, or job hunting per month to receive benefits.
Healthcare Reform News Update for October 14, 2019
More 2020 Medicare Plans Receive Higher Star Ratings
The Centers for Medicare & Medicaid Services (CMS) released Medicare star ratings for 2020, which shows an increase in the number of plans rated four stars or higher.
Some of the star-rating results:
- 52.4% of 2020 Medicare Advantage plans with drug coverage received at least four stars, a 6.7% increase over 2019 plans.
- The average star rating for 2020 Medicare Advantage plans with prescription drug coverage is 4.16 (compared to 4.06 in 2019).
- Higher-rated plans get a larger share of enrollments; MA-PD plans rated 4 stars or higher are on track to have 81.1% of members (compared to 75.3% in 2019).
- Enrollment in Medicare Part D plans that received at least four stars is estimated to grow from 5.6% in 2019 to 27.6 in 2020.
- 2020 Part D plans received an average star rating of 3.5 (compared to 3.34 in 2019).
CMS awarded five stars to 23 individual plans, including offerings from CVS Health, Humana, UnitedHealth Group, and Kaiser Foundation Health Plan.
Healthcare Reform News Update for October 4, 2019
Trump Signs Executive Order to Expand Medicare Advantage Plans
President Donald Trump issued an executive order Thursday that directs the Department of Health and Human Services (HHS) to develop regulations that will encourage Medicare Advantage plans to offer innovative services and benefits.
Medicare Advantage plans are offered by private insurance companies and serve as an alternative to Original Medicare, which is managed by the federal government.
The order asks HHS to develop proposals that will:
- Expand access to Medicare medical savings accounts.
- Ensure that Original Medicare is not promoted over Medicare Advantage plans
- Allow plans to offer access to telehealth services.
- Change the payment model that will allow beneficiaries receive savings or rebates for seeking high-quality care.
- Modify Original Medicare fee-for-service payments to more closely reflect prices paid for Medicare Advantage and private plans.
- Allow nurse practitioners and medical assistants to practice at the top of their licenses.
- Streamline approval, coverage, and coding processes for medical devices.
Healthcare Reform News Update for October 2, 2019
Cigna Rolls out Its Largest Medicare Advantage Expansion to Date
Cigna is launching its first Medicare Advantage PPO plans in 43 counties and expanding HMO plans into 37 new counties for 2020 plan year. The company is also offering both types of Medicare Advantage plans in Colorado for the first time.
Cigna’s new Medicare Advantage PPO plans will be available in select counties in Alabama, Colorado, Delaware, Georgia, Illinois, North Carolina, Pennsylvania, and Tennessee.
The company’s Medicare Advantage HMO plans are expanding into new counties in Arkansas, Colorado, Florida, Illinois, Kansas, Missouri, New Jersey, North Carolina, and South Carolina.
According to Cigna, most plans will include vision and dental benefits, access to fitness centers and remote access to doctors. In addition, select plans will offer additional benefits that target the social determinants of health, such as:
- an adult day care allowance,
- acupuncture allowance,
- transportation, and
- fall prevention programs.
Healthcare Reform News Update for October 1, 2019
CMS Announces 10-State Pilot Wellness Program for ACA Marketplace
Ten states will soon offer health-contingent wellness programs in the individual market as part of the Centers for Medicare & Medicaid Services (CMS) pilot program.
Participating states will be able offer residents lower premiums or other incentives if they achieve certain health outcomes. However, states must also offer alternative programs for those whose medical conditions would keep them from participating.
To be a part of the program, states must show that the wellness program won’t result in coverage losses or increase costs for the federal government.
Deceptive “Trumpcare” Ads Tout Non-existent Insurance Plans
Web ads offering low-cost “Trumpcare” insurance plans are taking advantage of consumer confusion, according to Axios. No official “Trumpcare” exists, and these advertised plans offer minimal coverage.
The ads offer health insurance plans for $59 or less, but refer to short-term plans or fixed indemnity plans do not offer comprehensive coverage and do not comply with ACA regulations. Buyers of these plans could be left financially vulnerable if they experience serious illness or injury.
Alignment Healthcare Expands California Medicare Advantage Offerings
Alignment Healthcare announced that it will double its Medicare Advantage coverage in California for 2020.
The company will offer plans in eight new counties in Sacramento and the Bay area. If approved by regulators, the expansion
Healthcare Reform News Update for September 27, 2019
New Consumer Survey Measures Open Enrollment Preparedness
A new UnitedHealthcare survey published this week gauges consumer preparedness for the upcoming Open Enrollment season.
Some of the key findings include:
- 75% of overall respondents felt prepared, but there were generational differences.
- 44% of Gen-Z respondents felt prepared compared to 69% of Millennials, 84% of Gen-Xers, and 78% of Baby Boomers.
- 36% said they spend less than one hour shopping for plan, 27% spend one to three hours, and 23% spend more than three hours.
- 77% said having vision and dental coverage options is important.
- 54% check if their current doctors are included in a plan’s network.
Healthcare Reform News Update for September 26, 2019
2020 Medicare Advantage Plans Add New Benefit Options
Next year, Medicare Advantage plans will have the ability to add new benefits that focus on preventive care for people with chronic diseases or certain health issues.
New supplemental benefits include services such as transportation to a nutritionist, carpet cleaning to prevent asthma attacks, or food for a service animal. Many plans will also cover telemedicine visits with doctors and other health professionals.
The new benefits are part of an effort by the government and insurance companies to keep enrollees healthy.
The new benefit options will be available only for Medicare Advantage plans, not Original Medicare, and coverage will vary from plan to plan.
Healthcare Reform News Update for September 25, 2019
Medicare Advantage Rates Hit Lowest Point in 13 Years
Premiums for 2020 Medicare Advantage plans will be the lowest since 2007, according to the Centers for Medicare and Medicaid Services.
Plan premiums for 2020 will be 14.4% lower than those for 2019, with the average monthly premium set for $23 per month compared to last year’s $26.87.
In addition, the average number of Medicare Advantage plans available per county will increase from 33 to 39. CMS also expects enrollment in Medicare Advantage plans to increase 9.9% for a total of 24.4 million enrollees.
Healthcare Reform News Update for September 24, 2019
Study: Removing ACA Auto-enrollment Could Increase Dropped Coverage
Eliminating the option to automatically re-enroll in an Affordable Care Act plan could increase the number of people who drop their insurance coverage by 30%, according to a new study in JAMA Internal Medicine.
It’s possible that the Centers for Medicare & Medicaid Services is considering this route. Researchers cited the Trump administration’s request in January for public comments on removing the auto-enrollment option.
The analysis is narrowed to California residents who had ACA plans with insurers that exited the marketplace.
It compares Californians who could automatically re-enroll in coverage after their insurer’s exit to those who could not. Over 51% of people with auto-enrollment continued their coverage compared to 21.5% of those who did not have the option.
However, the study authors said their sample size is too small to predict whether the results would be similar if the elimination of auto-enrollment was due to policy changes instead of insurer exits.
Medicare Double Bills 411,000 Part B Direct Payments
Due to a processing error, the Centers for Medicare and Medicaid Services deducted Medicare Part B premiums twice for approximately 411,0000 beneficiaries who pay through the department’s Easy Pay system.
CMS says that “approximately 20% of the duplicated transactions have been returned by financial institutions, and if the remaining duplications are not returned by Wednesday, Sept. 25, Treasury’s Bureau of Fiscal Service will begin to reverse the remaining transactions to complete the reimbursement.”
Any overdraft of fees resulting from the error should be waived by the financial institution.
Healthcare Reform News Update for September 20, 2019
Maryland Reinsurance Plan Helps 2020 ACA Premiums Drop
Premium rates for Maryland Affordable Care Act plans will be 10.3 percent lower on average in 2020, making it the second year in a row that premiums have declined. According to insurance regulators, the drop is primarily due to the reinsurance plan state leaders created in 2018.
CareFirst BlueCross BlueShield’s HMO plan premium will decline by 14.7 percent; its PPO plan premium will decline by 1.45 percent. Premiums for Kaiser Permanente’s plan will drop by 5 percent on average.
Healthcare Reform News Update for September 16, 2019
Premium Increases Lower Than Requested for Connecticut 2020 ACA Plans
State officials in Connecticut approved lower premium increases for 2020 Affordable Care Act plans than the ones requested by the insurance carriers.
Carriers cited rising medical costs, an older insured population and the federal Health Insurance Tax (HIT) as reasons for requesting premium increases. Lawmakers, concerned about the compounding of percentage increases each year, pushed back and approved reduced premium increases for individual plans.
Below are the percentage hikes as requested and approved for plans sold on the state’s ACA exchange.
Requested Average Increase
Approved Average Increase
Anthem Health Plans
ConnectiCare Benefits, Inc.
Anthem Health Plans
ConnectiCare Benefits, Inc.
Healthcare Reform News Update for September 13, 2019
Massachusetts 2020 ACA Plan Premiums Will Increase 4%
Insurance coverage for 2020 Affordable Care Act plans in Massachusetts will rise an average of 4%, according to state officials.
The average unsubsidized silver plan premium for a 42-year-old resident will be $473 per month.
The Massachusetts Health Connector exchange will include nine insurance companies offering 56 different health plans for individuals and families.
Healthcare Reform News Update for September 11, 2019
Kaiser: MLR Rebates Will Reach a Record High in 2019
Health insurance companies will pay out a record-high total of $1.3 billion in medical loss ratio (MLR) rebates to 2019 Affordable Care Act plan enrollees, according to a new analysis from the Kaiser Family Foundation.
Insurer MLR payouts are as follows, according to the report:
- $743.3 million in the individual market, an average of $270 per member
- $250 million in the small business market, an average of $1,180 per employer
- $284.1 million in the large business market, an average of $10,650 per employer
This is the largest MLR rebate total since the $1.1 billion payout in 2012.
The MLR limits the amount of premium costs insurers can spend on overhead expenses, such as administrative costs, marketing, and profit. Companies exceeding the limits must issue rebates to consumers in the form of premium credits or checks.
Report: Number of Privately Insured Americans Held Steady in 2018
The percentage of people covered by private health insurance remained statistically the same between 2017 and 2018, according to a new report from the U.S. Census Bureau.
In 2018, 67.3% of Americans purchased private health insurance plans through employers, directly from insurance companies, or through TRICARE. This is a 0.4% decrease from 2017.
The overall uninsured rate increased slightly from 7.9% to 8.5%, mostly due to a decrease in Medicaid participants.
Other findings include:
- The percentage of people with Medicare coverage grew from 17.4% to 17.8%.
- The percentage of uninsured children increased from 4.9% to 5.5%.
- States with the largest percentage of uninsured residents were Texas (17.7%), Oklahoma (14.2%), Georgia (13.7%) and Florida (13%).
Healthcare Reform News Update for September 5, 2019
Minnesota Shortens ACA Enrollment Period for 2020
This year, Minnesotans will have 20 fewer days to enroll in individual health plans on MNsure, the state’s Affordable Care Act exchange. The enrollment period for 2020 plans will run from Nov. 1 to Dec. 23, with coverage beginning on Jan. 1.
In past years, residents could sign up for ACA plans in late December and early January for coverage that began on Feb. 1.
According to MNsure, the revised enrollment period will help ensure that consumers have coverage for the entire year in 2020.
Healthcare Reform News Update for August 30, 2019
Maine to Adopt State-Run ACA Exchange
Maine plans to create a state-run Affordable Care Act exchange beginning in 2021, Governor Janet Mills (D) announced Thursday.
The new state-based marketplace intends to use the federal government’s enrollment platform before moving to a fully state-run system. Legislation to authorize the exchange will be introduced next year.
The shift would give the state more control to help consumers and small employers, Mills says.
Trump Administration Rejects Idaho’s ACA Medicaid Expansion Request
Health and Human Services (HHS) denied Idaho’s Affordable Care Act waiver request to expand its Medicaid program.
HHS said the state’s waiver application was incomplete and did not demonstrate that the program would be cost neutral.
Governor Brad Little (R), who was “surprised and disappointed” by the decision, intends to resubmit the waiver with additional information.
Healthcare Reform News Update for August 28, 2019
Rhode Island Gains Approval for Reinsurance Program
Health and Human Services has approved Rhode Island’s Affordable Care Act waiver application to create a new reinsurance pool.
The program is expected to lower premiums for 2020 ACA health plans by 5.9% and increase enrollment by about 1 percent.
Healthcare Reform News Update for August 23, 2019
CMS Publishes ACA Plan Star Ratings
While some major plans ranked below the national average, over 63 percent of Affordable Care Act plans received above average star ratings in new data published by the Centers for Medicare and Medicaid Services,
The average rating for ACA plans in the five-star system was 3.8 stars. The percentage of plans in each ratings category are:
- One star: 1.5 percent
- Two stars: 3.6 percent
- Three stars: 36.2 percent
- Four stars: 45.1 percent
- Five stars: 18.5 percent
The ratings are based on 38 different measures, including medical care quality management, member experience, and plan administration.
ACA Helped Reduce Racial Coverage Gaps
The Affordable Care Act helped lower racial and ethnic disparities in insurance coverage, according to new analysis from Commonwealth Fund.
Between 2013 and 2017, the coverage gap between blacks and whites fell from 11 percentage points to 5.3. During the same period, the gap between Hispanics and non-Hispanic whites dropped from 25.4 percentage points to 16.6.
In states that implemented ACA Medicaid expansion, the coverage gap for Hispanics declined by over 18 percentage points. For states that did not expand the program, the gap was reduced by 6.9 percent.
Oscar Health Plans to Offer ACA Plans in Additional States for 2020
Oscar Health announced that it will offer Affordable Care Act plans in six new states and 12 new markets to in 2020.
New markets include:
- Florida, including Miami, Tampa, Ocala, and Daytona
- Philadelphia, PA
- Denver, CO
- Richmond, VA
- Atlanta, GA
- Kansas City, MI and KS
- Houston, TX
The company will also expand its services in Dallas-Fort Worth, TX and Western Michigan.
Plan details will be available after regulatory approval.
Healthcare Reform News Update for August 21, 2019
New Medicare Advantage Plan Launched for Chicago Area
Health2047 is launching a new Medicare Advantage plan in 2020 geared toward helping traditionally underserved seniors.
Zing Health, available in Cook County, will use local teams to coordinate with physicians and hospitals in order to help improve access to care.
Healthcare Reform News Update for August 20, 2019
CMS Announces Updates to Hospital Star Ratings for 2021
The way hospital star ratings are determined will change beginning in 2021, according to the Centers for Medicare and Medicaid Services.
The agency will finalize the changes after a public listening session and the formation of a technical expert panel.
In the meantime, CMS will refresh the ratings on the Hospital Compare website in early 2020 using the current methodology.
Alignment Healthcare to Expand Presence in California
Alignment Healthcare announced that its Medicare Advantage plans will be available in more California counties in 2020, doubling from eight to 16.
The company will increase its offerings from 10 health maintenance organization (HMO) plan to 22 HMO and preferred provider organization (PPO) plans.
Healthcare Reform News Update for August 16, 2019
2020 ACA Exchanges to Include CMS Star Quality Ratings
Plans sold on the 2020 Affordable Care Act exchange will display their quality star ratings to help improve transparency and quality, the Centers for Medicare and Medicaid announced yesterday.
The five-star system is based on enrollee opinions on in-network healthcare providers, the care they received, customer service, and overall experience with the health plan.
The national rollout of the quality star ratings comes after pilot programs in Virginia, Wisconsin, Michigan, Montana, and New Hampshire.
Study: Uninsured Rate Rose Between 2016-2017
Between 2016 and 2017, the uninsured rate rose for the first time since 2013, when the Affordable Care Act went into effect, with 700,000 people losing health coverage, according to a new study from The Urban Institute
The study shows that the uninsured rate fell every year between 2013 and 2016, with 18.5 million people gaining coverage. The uninsured rate then increased from 10% in 2016 to 10.2% in 2017. The increase was concentrated primarily in states that did not enact ACA Medicaid expansion.
Some of the findings:
- The uninsured rate remained stable at 7.6% for Medicaid expansion states.
- The uninsured rate for the states that did not expand Medicaid increased from 13.7% to 14.3%.
- Coverage losses mostly affected non-Hispanic white people, black people, people with some college, and those living in the South and Midwest.
Healthcare Reform News Update for August 14, 2019
States See Increase in ACA Marketplace Insurers
The average number of state insurers on the Affordable Care Act marketplace is rising slightly from 3.5 this year to four in 2020, according to the Kaiser Family Foundation.
Greater stability in the ACA marketplace has enabled insurers to expand into new counties and/or new states for 2020 plans.
- In California, 87% of enrollees will have three or more carriers to choose from for 2020 plans. Anthem Blue Cross, Blue Shield of California, and Chinese Community Health Plan are all expanding into new counties.
- Anthem will expand its coverage in Virginia.
- Centene will enter into new markets.
- Bright Health will expand into six additional states.
- Oscar will begin offering coverage in Colorado, Pennsylvania, Virginia, and additional areas in New York and Texas.
The following states will have eight or more insurers in 2020: California, Massachusetts, Michigan, New York, Ohio, Texas, and Wisconsin.
The states with only one insurer for 2020 are Alaska, Delaware, Mississippi, and Wyoming.
Healthcare Reform News Update for August 13, 2019
ACA Exchanges Lost 2.5 Million Unsubsidized Enrollees from 2016 to 2018
Unsubsidized Affordable Care Act exchange enrollees declined by 40 percent between 2016 and 2018, a loss of 2.5 million customers, according to a new report from the Centers for Medicare & Medicaid Services.
The loss of more than a million customers in 2017 and 1.2 million customers in 2018 corresponded to premium hikes of 21 percent and 26 percent, respectively, in those years.
The number of subsidized enrollees during the same period rose slightly with a 4 percent increase.
Healthcare Reform News Update for August 8, 2019
Medicare Will Cover CAR T-cell Cancer Therapy
Medicare will now cover CAR T-cell gene therapy when it is provided in healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies program, according the Centers for Medicare & Medicaid Services.
These types of therapies use a patient’s own immune system to combat certain types of lymphoma and leukemia. CMS said it will also approve the therapy for additional uses when recommended by CMS-approved medical guidelines.
Healthcare Reform News Update for August 7, 2019
New Survey Shows Consumer Neutrality on Medicare for All Plans
Close to half of adults surveyed neither support nor oppose Medicare for All and other healthcare expansion proposals, according to a new study on consumer attitudes.
Urban Institute surveyed respondents on their opinions regarding access to care, costs, and other factors. The survey differs from other recent polls in that it offered respondents the option to remain neutral, instead of being forced into giving an opinion.
Some of the findings include:
- 40.7% of respondents neither support nor oppose Medicare for All.
- 45% of respondents neither support nor oppose a public option plan.
- Young adults, nonwhite and Hispanic adults and those with low incomes were more likely to support than oppose Medicare for All. Those with higher incomes were more likely to oppose.
- 29.8% of all respondents support Medicare for All.
- 27.8% of all respondents oppose Medicare for All.
- Medicare for All Supporters list universal coverage and affordability as important factors influencing their support. Opponents list higher taxes, wait times, and quality of care as their top concerns.
Healthcare Reform News Update for August 1, 2019
Senate to Vote on ACA Waiver Requirements
Democratic senators will force a vote over the Trump administration’s decision to make it easier for states to apply for Affordable Care Act waivers.
The new rule gives states the ability to offer tax subsidies for plans that fall short of ACA requirements, including plans that fail to protect people with pre-existing conditions.
The resolution is not expected to pass the Republican-controlled Senate.
Colorado ACA Reinsurance Program Approved
The Centers for Medicare & Medicaid Services on Wednesday approved Colorado’s request to run an Affordable Car Act reinsurance program beginning next year.
The program is projected to increase 2020 enrollment by 3% and lower premiums by 16%.
Healthcare Reform News Update for July 31, 2019
2020 Medicare Part D Premiums Expected to Decrease
The Centers for Medicare & Medicaid Services has projected that premiums for 2020 Medicare Part D prescription drug plans will decline for the third year in a row.
The average Part D premiums will be $30 per month, which is 13.5% less than in 2017, according to a CMS press release issued Tuesday. The price reduction will save enrollees roughly $1.9 billion in premium costs.
CMS attributed several cost-cutting measures for the price reduction, including:
- elimination of the “gag clause,”
- reducing out-of-pocket costs for biosimilar products, and
- requiring explanation of benefit notices to include price increases and lower-cost therapeutic alternatives.
Pilot Program Enables Medicare Providers Access to Patient Claims Data
The Centers for Medicare & Medicaid Services is launching a new pilot program called Data at the Point of Care that gives healthcare providers direct access to claims data for their Medicare patients.
CMS’s Blue Button computer interface will help physicians and clinicians easily access and assess a patient’s medical history.
“This data gives them more information about their patients, so they are better able to impact their care, and it allows them to do the analysis about their patient population,” said CMS Administrator Seema Verma.
The pilot program is scheduled to begin in September. Medicare beneficiaries will be automatically included in the program unless they contact Medicare to opt out.
Healthcare Reform News Update for July 30, 2019
Latest Kaiser Poll Shows Bipartisan Support for ACA Provisions
A majority of Americans prefer that the Affordable Care Act’s provisions remain in place and that future healthcare measures build on the existing law, rather than be replaced with a Medicare for All plan, according to a new Kaiser Family Foundation poll.
A majority of both Republican and Democratic respondents believed that it’s “very important” to maintain key provisions of the ACA, including protections for people with pre-existing conditions and pregnant women, no-cost preventive services, no annual or lifetime limits, and keeping young adults on their parents’ plan up to age 26.
Among Democrats, 55% favor expanding the ACA, and 39% prefer a Medicare for All approach.
Support for Medicare for All plans decreased from April, with Democratic support slipping from 80% to 72%, and Republican support dropping from 27% to 15%.
Among Democrats, 55% favor expanding the ACA, and 39% prefer a Medicare for All approach.
Other findings include:
- 65% favor a public option plan that would compete with private health insurance plans. However, views shifted when presented with arguments both for and against the approach.
- 83% have a favorable opinion of Medicare.
- 76% have a favorable opinion of employer health plans.
- Medicare, Medicaid, and employer coverage are viewed more favorably than individual health plans. But a majority rate their own coverage positively, whether they have private or public coverage.
Trump Administration Rejects Utah’s Partial ACA Medicaid Expansion
The Centers for Medicare and Medicaid Services denied Utah’s request to partially expand its Medicaid program under the Affordable Care Act.
Under the ACA, residents earning 138% of the federal poverty level (FPL) are eligible for the program. Utah’s plan would expand Medicaid only to those making up to 100% of the FPL.
CMS said it does not plan to approve funding for any state that implements limited enrollment.
Healthcare Reform News Update for July 25, 2019
Bright Health Expands Into 13 New Markets for 2020
Bright Health announced that it will double its locations in 2020 by expanding into 13 new markets in seven states for Affordable Care Act health plans and Medicare Advantage plans.
If approved by regulators, the new markets will increase the company’s availability to a total of 22 markets in 12 states.
New Bright Health plan locations for ACA plans include:
- Colorado: Summit County
- Florida: Jacksonville, Orlando, Palm Beach, Tampa
- North Carolina: Charlotte, Winston-Salem
- Nebraska: Statewide
- Oklahoma: Oklahoma City
- South Carolina: Greenville
New Bright Health plan locations for Medicare Advantage plans include:
- Florida: Orlando, Palm Beach
- Illinois: Chicago
- Nebraska: Omaha
- Ohio: Cleveland
- South Carolina: Greenville
- Tennessee: Memphis
Report: Medicare Could Save $57M By Providing Free Home-Delivered Meals
Medicare could save about $57 million per year by providing free meals to recently hospitalized seniors, according to a new report from the Bipartisan Policy Center.
By analyzing data from seniors with multiple chronic conditions, the study found that providing meals for one week after a hospitalization could prevent nearly 10,000 hospital readmissions every year.
The meals would cost approximately $101 million, but Medicare would save more than $158 million in payments for return hospital stays.
Currently, some Medicare Advantage plans cover meal-service delivery. The report recommends that lawmakers add the benefit to Original Medicare in limited circumstances.
Healthcare Reform News Update for July 24, 2019
Senate Committee Announces Plan to Overhaul Medicare Part D
The Senate Finance Committee announced its bipartisan legislation designed to lower drug costs.
The proposal, called The Prescription Drug Pricing Reduction Act, would overhaul Medicare Part D in significant ways, including:
- Putting a cap on drug prices, which would keep drug makers from raising prices above the rate of inflation.
- Lowering the threshold that activates the catastrophic phase for Medicare Part D users from more than $8,000 to $3,100 by 2022.
- Revising the catastrophic coverage drug payment model so that insurance companies pay 60 percent of the costs, and the government and drug makers each pay 20 percent.
The proposal is projected to save Medicare beneficiaries $27 billion in out-of-pocket costs and $5 billion in premiums over 10 years.
Committee leaders Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) said that the committee plans to vote on the legislation on Thursday.
Healthcare Reform News Update for July 22, 2019
Federal Judge Backs Expansion of Short-Term Plans
A federal judge upheld the Trump administration’s expansion of short-term health insurance plans, which don’t meet Affordable Care Act standards.
U.S. District Judge Richard Leon said that extending the duration of the plans from three to 12 months with the ability to renew for up to 36 months would have minimal “potential negative impact” to enrollment in ACA plans.
The Association for Community Affiliated Plans argued against the extension and said it planned to appeal.
Healthcare Reform News Update for July 18, 2019
Coverage for Chronic Disease Treatments Expanded for High-Deductible Plans
The Trump administration announced new guidance, effective immediately, that gives chronically ill patients with high-deductible plans access to coverage for certain services before they meet their deductible amounts.
The Internal Revenue Service, Treasury Department, and Health and Human Services reclassified 14 services as preventive treatments for conditions such as asthma, congestive heart failure, and diabetes. Some of the services patients can now access without a deductible include insulin, glucometers, inhalers, blood pressure monitors, beta-blockers, statins, and antidepressants.
The guidance was in response to an executive order from President Donald Trump to expand the use of health savings accounts paired with high-deductible plans to fund care for the chronically ill.
Premiums for Michigan 2020 ACA Plans Are Expected to Drop
Proposed rates for 2020 Affordable Care Act plans in Michigan will drop. This is a reversal from the rate increases insurance companies have requested in past years.
Only two of the state’s nine ACA insurers requested rate hikes. Molina Healthcare requested the largest decrease of almost 9 percent.
ACA insurer rate decrease requests include:
- Molina Healthcare: -8.8%
- Blue Cross Blue Shield: -7.7%
- McLaren Health Plan: -5.9%
- Meridian Health Plan: -3.6%
- Blue Care Network: -1.2%
- Total Health Care USA: -0.6%
- Priority Health: -0.1%
ACA insurer rate increase requests include:
- Physicians Health Plan: 0.6% increase
- Oscar Insurance: 8.3% increase
Oscar Health Will Offer Medicare Advantage Plans
Oscar Health announced Wednesday that it will enter the Medicare Advantage market in 2020 with plans available in New York City and Houston.
In New York, the company is offering plans in partnership with Montefiore Health System. In Houston, the company is pairing with several regional providers including Houston Methodist, HCA Houston Healthcare, and St. Joseph Medical Center.
Pending approval by regulators, the plans will be available during Open Enrollment this fall.
Healthcare Reform News Update for July 17, 2019
House Will Vote to Repeal ACA’s Cadillac Tax
The U.S. House of Representatives is expected to pass a bill today that will repeal the Affordable Care Act’s never-implemented “Cadillac tax” on high-cost employer-sponsored health plans.
The measure imposes a 40% excise tax on plans that exceed $11,200 for individuals and $30,150 for families. It’s currently scheduled to begin in 2022.
The bill is sponsored by Representative Joe Courtney (D-CT) and 367 co-sponsors. The Senate’s companion bill, the Middle Class Health Benefits Tax Repeal Act of 2019, has 42 signers.
Surprise Billing Proposal Could Save More Than $7B
Legislation in the Senate to eliminate surprise medical bills would save the federal government $7.6 billion over 10 years, according to the Congressional Budget Office.
The CBO projects that the proposal would increase spending by $18.7 billion and raise revenue by $26.2 billion. Savings would come from tax subsidies paid out for Affordable Care Act plans and a 1% reduction in employer plan premiums.
Details of surprise billing legislation are still being deliberated in House and Senate committees.
Healthcare Reform News Update for July 16, 2019
Medicare Considering Covering Acupuncture for Back Pain
A new Medicare proposal would cover acupuncture for beneficiaries with chronic low-back pain as an alternative to opioid treatments, which can become addictive.
Health and Human Services Secretary Alex Azar announced Monday that the coverage would apply only to patients enrolled in clinical trials or other CMS-approved studies. The agency would then use results of those trials to determine further acupuncture coverage options.
CMS is gathering public input before finalizing the proposal.
Healthcare Reform News Update for July 15, 2019
Appeals Court Blocks Trump Administration’s Exemptions to ACA Contraception Rules
The 3rd U.S. Circuit Court of Appeals upheld a decision to block the Trump administration from “allowing employers with moral and religious objections” to deny birth control coverage mandated by the Affordable Care Act.
The ACA requires that employer-sponsored health plans include birth control coverage with no copays. In 2017, President Trump signed an executive order encouraging federal agencies to expand “conscience-based objections” to the mandate.
The panel of three judges sided with Democratic state attorneys general from Pennsylvania and New Jersey who argued that the new exemption rules contained “serious substantive problems.”
Connecticut ACA Insurers Propose Rate Increases for 2020 Plans
Anthem and ConnectiCare, the two insurance companies on Connecticut’s state healthcare exchange, have proposed premium increases for individual Affordable Care Act plans in 2020.
Anthem has requested an average 15.2 percent rate increase for individual plans sold on and off the exchange and an average 14.8 percent rate increase for small group health plans.
ConnectiCare requested a 4.9 percent rate increase for individual plans sold on and off the exchange.
The companies attributed rising healthcare costs, the aging population, and the newly reinstated Health Insurance Tax (HIT) as factors in their proposals.
Healthcare Reform News Update for July 12, 2019
Cancer Patients Face Substantial Financial Burden
A recent study from the Centers for Disease Control and Prevention shows that the annual out-of-pocket expenses for cancer survivors is increasing with 25 percent experiencing problems paying their bills and 34 percent worried about their costs.
Average out-of-pocket spending for cancer survivors is $1,000 per year compared to $622 per year for people who’ve never had cancer. And those costs are growing. Even with health insurance in place, cancer patients incur an additional financial burden from things such as traveling to treatment and being away from work.
Other findings from the study:
- Out-of-pocket expenses were highest among cancer survivors ages 18-64 and those who were unemployed.
- Cancer survivors ages 40-49 reported the highest percentage of “material or psychological financial hardship.”
- A higher percentage of minority racial/ethnic cancer survivors reported “material or psychological financial hardship.”
- “Cancer survivors [are] more likely to be older, female, non-Hispanic white, married, privately insured,” full-time employees, more educated, and have more chronic conditions compared to people who’ve never had cancer.
Narrow Medicare Advantage Networks Limit Access for Some Enrollees
Finding a doctor in a Medicare Advantage (MA) plan network can be difficult for many enrollees, especially if they live in rural areas.
Government audits have found that nearly half of the entries in MA directories had incorrect addresses, phone numbers, or doctors who were not accepting new patients. The American Journal of Managed Care found that a Google search for participating doctors could be more accurate than using a plan’s directory.
A Kaiser Family Foundation study from 2017 found that MA plans included “46 percent of all physicians in a county, on average.” Access to psychiatrists is the most restricted, with 23 percent in a county’s plan on average, followed by cardiothoracic surgeons, neurosurgeons, plastic surgeons, and radiation oncologists.
Rural beneficiaries can be especially burdened by narrow MA networks. A study of California MA plans showed that some enrollees in rural areas lived over 100 miles from in-network specialists.
Healthcare Reform News Update for July 10, 2019
Appeals Judges Question Validity of ACA’s Individual Mandate
A panel of three federal appeals court judges pressed the state attorneys general defending the Affordable Care Act on Tuesday over whether the law remains constitutional without its individual mandate penalty.
In the two hours of oral arguments, two Republican-appointed judges appeared skeptical about the constitutionality of the individual mandate. Judge Kurt Engelhardt suggested that severing the tax penalty from the ACA should be the job of Congress rather than the courts.
The two judges also questioned whether either side of the lawsuit had any legal standing to initially challenge the ACA or appeal the lower-court’s decision.
Carolyn Dineen King, the only Democratic-appointed judge, did not ask questions during the hearing.
The judges did not indicate when they would issue their ruling, but it is expected in the coming months.
California 2020 ACA Premiums Show Record Low Increases
Proposed premium increases for 2020 ACA plans in California are the lowest in the state exchange’s history, with an average hike of 0.8%, officials said. That’s down from an average increase of nearly 9% for 2019 plans and a five-year average increase of 8.4%.
Proposed bronze plan rates will increase an average of 5.7%, and silver plans will decrease an average of 4.3%.
Covered California Executive Director Peter Lee said the rate stabilizations were due to new state-funded tax credits to middle-class enrollees and a new state penalty imposed on uninsured residents.
All of the state’s 11 ACA insurers will return for 2020, and Anthem Blue Cross will expand into the Central Coast, parts of the Central Valley, Los Angeles County and the Inland Empire.
Minnesota 2020 ACA Premiums Show Modest Increase
Proposed 2020 ACA premiums in Minnesota show only slight increases compared to this year’s rates.
Proposed average individual rate changes for the state’s four ACA insurers are as follows:
- Medica: down 1.4%
- UCare: up 0.3%
- HealthPartners: up 2.1%
- Blue Cross HMO: up 4.8%
In the state’s small group market, the proposed rate increases were between 3 and 6%.
Final rates are scheduled to be released in early October.
Healthcare Reform News Update for July 9, 2019
Federal Appeals Court Hearing on ACA Constitutionality Begins Today
The 5th U.S. Circuit Court of Appeals will hear oral arguments today on whether a lower court ruling that declared the Affordable Care Act unconstitutional should be overturned.
The ACA is being challenged by 18 Republican-led states. The three-judge panel will also decide whether the coalition of Democratic states and the U.S. House of Representatives have standing to intervene in the case after the Trump administration declined to defend the health law.
It’s unclear when the panel will make its ruling. However, it’s expected that the case will ultimately be decided by the Supreme Court.
Connecticut Enacts Mental Health Parity Bill
Connecticut Governor Ned Lamont signed a bill into law that will require insurance providers to submit annual reports to state insurance commissioners, detailing their coverage of mental health and substance abuse services.
The new law intends to hold insurers accountable for complying with state and federal laws that mandate equal access to mental and physical health services.
Healthcare Reform News Update for July 8, 2019
Medicare Coverage Expanded for Blood Pressure Monitoring Devices
The Centers for Medicare & Medicaid Services (CMS) has extended coverage of Ambulatory Blood Pressure Monitoring (ABPM) devices to Medicare beneficiaries who have suspected abnormal low blood pressure readings while in a doctor’s office.
Previously, Medicare covered ABPM devices only for patients with suspected “white coat hypertension,” which occurs when a patient’s blood pressure is elevated due to anxiety associated with a clinical setting. The 24-hour monitoring device is now also approved for “masked hypertension,” the inverse of “white coat hypertension,” which causes patients to have lower-than-normal blood pressure readings while in a clinical setting.
The new rule also lowers the definition of hypertension from a reading of 140/90 to 130/80 “to align with the latest society recommendations regarding the diagnostic criteria.”
Healthcare Reform News Update for July 3, 2019
Federal Appeals Court Denies ACA Lawsuit Postponement
The 5th U.S. Circuit Court of Appeals rejected a request from Republican state attorneys general to delay oral arguments in the case to strike down the Affordable Care Act.
The lawyers had asked for a 20-day delay to file briefs relating to questions on whether the Democratic-led states defending the ACA have legal standing to intervene. The court allowed a two-day delay and will hear the case July 9 as scheduled.
Pennsylvania Will Switch to State-based ACA Exchange for 2021 Plans
Pennsylvania Governor Tom Wolf signed legislation Tuesday implementing a state-based Affordable Care Act exchange that’s expected to begin with next year’s Open Enrollment for 2021 plans.
The law also includes a new state reinsurance fund, which could help reduce premiums by as much as 10 percent, state officials say.
The Department of Health and Human Services must approve the law before it can be enacted.
Poll: Majority Support Medicare for All if Healthcare Providers Remain
A majority of voters would back a Medicare for All plan if they could keep their preferred doctors and hospitals, according to a new Morning Consult/Politico survey.
Of those surveyed, 55% of respondents backed a single-payer system that would reduce the role of private insurance companies but allow them to keep their healthcare providers.
But 46% were in favor when told the role of private insurers would be reduced, and 53% approved when not given any specifics about insurers or doctors.
The poll found that general support for a Medicare for All system comes from 77% of Democrats, 27% of Republicans and 50% of Independents.
Healthcare Reform News Update for June 27, 2019
Court Questions Democrats’ Right to Defend ACA
The U.S. Court of Appeals for the 5th Circuit has asked whether the Democrat-led House of Representatives or Democratic states have the legal right to appeal the ruling that struck down the Affordable Care Act.
It’s possible that the panel could toss out the appeal on procedural grounds if it decides that the opposing side does not have the authority to appeal U.S. District Judge Reed O’Connor’s decision to declare the ACA unconstitutional.
A three-judge panel requested that both sides of the lawsuit provide written arguments. Oral arguments will begin on July 9.
Senate Committee Approves Surprise Billing Package
The Senate health committee approved its healthcare package, called the Lower Health Care Costs Act, which includes a cap on how much providers can bill for out-of-network care.
Before approval, an amendment was added to the legislation. The change requires insurers to reveal all physicians and hospitals in their networks so patients can see all available options before choosing a plan.
Committee Chairman Lamar Alexander (R-TN) said that the bill will likely have more revisions before a vote in August.
Healthcare Reform News Update for June 26, 2019
New Study Shows 14% Increase in Out-of-Pocket Healthcare Costs
In 2018, out-of-pocket costs for inpatient services increased 14% over the previous year, according to a report from TransUnion Healthcare.
TransUnion tracked deductible and co-pay costs for patients with commercial insurance, Medicare Advantage, Traditional Medicare, and those who self-pay to find the annual averages.
2018 Average Out-of-Pocket Cost
2017 Average Out-of-Pocket Cost
In addition, the study found that 59% of patients had out-of-pocket expenses between $501 and $1,000, compared to 39% in 2017. Patients with expenses of $500 or less drop from 49% in 2017 to 36% in 2018.
Healthcare Reform News Update for June 25, 2019
Supreme Court to Rule on ACA Risk Corridor Suit
The Supreme Court agreed to hear a case that will decide if insurers are owed $12 billion in government payments from the Affordable Care Act’s risk corridor program.
The program was created to help offset potential financial losses during the initial years of the ACA. Insurers with lower-than-expected costs would pay into the program, and those with heavy-than-expected costs would be reimbursed from this fund.
In 2014, Congress required the program to be budget-neutral and limited payments, which insurers say lead to a shortfall.
President Signs Executive Order on Healthcare Pricing Transparency
President Trump signed an executive order on Monday that will require hospitals and insurance companies to publicly disclose their negotiated pricing.
The order is meant to increase price transparency through five policies:
- Providers must disclose the prices for insurers and patients in an easy-to-read format.
- Providers and insurance must provide patients with the estimated out-of-pocket costs before they receive care.
- Agencies must propose ways to simplify and improve quality measures across all healthcare programs.
- Researchers must gain increased access to healthcare claims information, stripped of individual details.
- The Treasury Department must look for ways to expand how health savings accounts can be used.
Before the changes can be implemented, government agencies, including Health and Human Services and the Treasury Department, must determine a rule-making process and work out the details of how the president’s plan will be executed.
California Lawmakers Approve State Individual Mandate
The California Legislature voted to impose a tax on residents who do refuse to purchase health insurance.
The penalty will go into effect on January 1, 2020, if the bill becomes law. The state will use the funds collected from the tax to provide insurance premium subsidies to middle-income Californians who earn up to six times the federal poverty limit.
The bill is expected to be signed by Governor Gavin Newsom.
Healthcare Reform News Update for June 20, 2019
Senate Committee to Propose Pay Cap for Surprise Medical Bills
The Senate health committee has come to decision on how its bipartisan healthcare package will help patients with surprise medical bills. Patients often face these unexpectedly-high bills after receiving care from a provider that isn’t in their insurance network.
To combat these charges, panel leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) will include a “benchmark” system as part of their new healthcare bill. The benchmark system will cap charges for out-of-network care based on a plan’s median in-network rate for an area.
The announcement came right before a new Kaiser Family Foundation study found that 1 in 6 insured Americans have been affected by surprise bills after a hospital stay.
The committee expects to vote on the legislation next week.
Healthcare Reform News Update for June 14, 2019
New Rule Allows Workers to Use HRAs to Purchase Health Insurance Plans
The Trump administration has issued a new rule that will enable employees of small businesses to use tax-free health reimbursement accounts (HRAs) to purchase individual health insurance plans.
Previously, employers could set up tax-deductible HRAs to help reimburse workers for out-of-pocket medical expenses.
Beginning January 1, 2020, small employers who do not offer group health insurance can set up HRAs that workers can use to purchase ACA-compliant plans on the individual market.
Employers who offer group insurance can set up an “excepted benefit” HRA that can be used to purchase short-term health insurance plans that don’t comply with the ACA. These HRAs will be limited to $1,800 per year.
White House officials said provisions have been created to block employers from using the new rule to send only their oldest and/or sickest employers to the individual marketplace.
The rule change will provide coverage to an estimated 800,000 people who currently do not have health insurance, according to the Trump administration.
Healthcare Reform News Update for June 13, 2019
House Committee Debates Medicare for All Proposals
For the first time, the House Ways and Means Committee held a hearing on the various Democratic proposals for universal healthcare.
The discussion, held Wednesday with a panel of healthcare experts and advocates, primarily served as a platform for partisan debate. Republicans were united in the belief that Medicare for All measures would cost too much, raise taxes and dilute the quality of healthcare. Democrats remain split on what type of public plans to support and whether the Affordable Care Act could be used to move those proposals forward.
Lawmakers from both parties agreed that the current healthcare system needs to be revised so that more people can have access to quality care and affordable coverage.
Healthcare Reform News Update for June 7, 2019
250K Medicare Beneficiaries Could Be Impacted by Error
At least 250,000 Medicare beneficiaries enrolled in Medicare Advantage and Medicare Part D plans could receive bills for five months of coverage due to a “processing error” within the Social Security Administration.
This error has caused some beneficiaries to be dropped from their coverage due to nonpayment.
In a notice to beneficiaries, the Department of Health and Human Services disclosed that some enrollees have not had premiums deducted from their Social Security benefit checks since February. The error has been corrected and payments will be resumed beginning this month or in July.
Insurance companies will bill customers for any shortfalls. Members will have at least two months to pay the premiums that were missed. Payment plans can be set up for beneficiaries who need them.
Neither the SSA or Medicare have said how the glitch occurred, which plans were affected, or the total amount of premiums that will need to be paid retroactively.
Healthcare Reform News Update for June 5, 2019
Medicare for All Hearing Set for Next Week
The House Ways and Means Committee has scheduled a Medicare for All hearing for June 12. It will be the first time the measure is examined by a panel that oversees healthcare issues.
The House version of the proposal is sponsored by Rep. Pramila Jayapal (D-WA) and currently has 110 Democratic cosponsors.
This hearing could encourage the House Energy and Commerce Committee, which also has control over healthcare issues, to consider the Medicare for All proposal.
Healthcare Reform News Update for June 4, 2019
Premiums for 2020 ACA Plans Trend Toward Modest Increases
States have just begun to release rate filings for 2020 Affordable Care Act plans, and so far the modest premium rate increases indicate that the market remains stable.
Some of the proposed average rate changes by state include:
- Maryland: 2.9 percent decrease
- Washington: less than 1 percent increase
- New York: 8.4 percent increase
- Vermont: 13 percent increase
Increases in premiums for 2020 are attributed to 4 to 8 percent increase in medical costs and the return of the ACA’s health insurance tax.
New Poll Shows Nearly Half of Country Struggles With Paying Medical Expenses
A national survey released by Monmouth University shows that 45% of Americans have difficulty paying out-of-pocket medical expenses, and 40% have trouble paying their health insurance premiums.
In addition, the report found that 49 percent of adults believe that access to health insurance plays a significant role in their decision to pursue a new job opportunity, with 20% saying that the need to keep their employer-sponsored plan prevented them from pursuing a new job opportunity in the past 10 years.
Other poll findings:
- 46 percent say that their health care costs have increased over the past two years.
- 27 percent say that a family member did not seek medical care in the past two years because of the costs.
- 52 percent of people who earn less than $50,000 a year say it is difficult for them to pay out-of-pocket medical expenses.
Minnesota Will Continue ACA Reinsurance Program
Legislators in Minnesota voted to extend the Minnesota Premium Security Plan, the state’s reinsurance program, which has helped stabilize ACA premium rates.
The program’s initial $542 million appropriation has not been exhausted, so its continuation will not require additional funds.
Committee Starts Talks to Expand Long-Term Care in MedSupp Plans
The House Ways and Means Committee has reached out to the National Association of Insurance Commissioners for recommendations on how to expand long-term care benefits for Medicare Supplement plans.
Committee Chair Richard Neal (D-MA) wrote to NAIC President Eric Cioppa asking for ideas on how a federal policy could be crafted to “provide some relief” to families without causing adverse selection. Neal requested suggestions on lifetime and daily caps, waiting periods, eligibility requirements, and enrollment forecasts.
Healthcare Reform News Update for June 3, 2019
Studies Link ACA to Reduced Racial Gap in Cancer Care & Earlier Ovarian Cancer Diagnosis
New research suggests that the Affordable Care Act improved the racial disparities in cancer treatment and helped women with ovarian cancer get diagnosed earlier.
Before the implementation of the ACA, African Americans were 4.8 percent less likely than white patients to begin treatment for advanced cancers within a month of diagnosis. A new study shows that today, 49.6 percent of black patients receive treatment within 30 days, compared to 50.3 percent of white patients, in the states were Medicaid has been expanded under the ACA.
A second study found that since the ACA became law, more women with ovarian cancer have begun receiving treatment within one month of diagnosis.
The studies were presented at a meeting of the American Society of Clinical Oncology on Sunday.
California Governor Proposes Health Insurance Subsidies for Middle-Class
Governor Gavin Newsom has asked California state legislators to provide tax subsidies for middle class residents that would help pay the premiums on Affordable Care Act health plans. The proposal would affect an estimated 850,000 residents.
If approved, individuals who earn between $50,000 and $75,000, and families who earn between $103,000 and $154,500, would receive tax credits of $144 per month on average.
The proposal also provides some additional tax credits for individuals and families who earn between 200% and 400% of the federal poverty level.
The subsidies would be funded by a tax penalty on state residents who do not have insurance coverage, much like the original federal mandate that was recently removed from the ACA.
Healthcare Reform News Update for May 28, 2019
Senate Committee Proposes Bipartisan Fix for Healthcare Costs, Billing
The Health, Education, Labor and Pensions Committee released a draft bill last week aimed at lowering out-of-pocket costs and reforming other healthcare issues such as surprise billing and prescription drug pricing.
The proposal from Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) includes three
suggestions to stop the practice of surprise billing:
- Require that all hospital providers, as well as corresponding labs and diagnostic tests, be “in network.”
- Use outside arbitration to resolve disputed charges higher than $750.
- Establish a standard benchmark for physician pay.
Consumer protections in the draft legislation include a requirement that patients receive “good-faith” estimates of out-of-pocket costs within two days of a request and receive their full bills within 30 days of a procedure.
To lower drug costs, the patent process would be revised to make it faster and easier for generic drugs to be available.
The draft legislation also addresses hospital and insurer contracts, vaccine education, grants to improve maternal mortality rates, and measures to improve cybersecurity.
Alexander said that he expects a Senate vote on the bill in July.
Proposed HHS Rule Reverses ACA Transgender Protections
The Trump administration has proposed a rule that would roll back Affordable Care Act protections for transgender individuals.
The Department of Health and Human Services (HHS) says the ACA’s definition of sex discrimination is too broad, and the change makes regulations more consistent with other agencies.
Critics of the proposal say the rule would impact the treatment of both LGBTQ and female patients. Legal challenges are expected when the final rule is released.
ACA Lawsuit Hearing Date Set
The 5th Circuit Court of Appeals has slated July 9 as the hearing date for Judge Reed O’Connor’s ruling that the Affordable Care Act is unconstitutional.
O’Connor ruled that the Affordable Care Act became unconstitutional in 2017 when Congress eliminated the tax penalty for not having health insurance.
Healthcare Reform News Update for May 17, 2019
House Passes Bill That Strengthens ACA Measures
The Democrat-led House passed a package of healthcare bills designed to lower drug prices and strengthen the Affordable Care Act on Thursday.
The bills’ ACA changes include:
- Restoring $100 million in funding for the open enrollment period navigator program
- Reversing the Trump administration’s expansion of short-term health insurance plans
- Funding for states to create their own online healthcare exchanges
Other provisions in the legislation address lowering prescription drug prices by increasing the availability of generic alternatives.
Though Republicans are in favor the drug-pricing measures, the changes to the ACA are expected to prevent the bill’s passage in the GOP-led Senate.
Bipartisan Senators Create Legislation on Surprise Medical Bills
A bipartisan senate coalition introduced legislation to protect patients from unexpected out-of-pocket medical costs. The surprise bills can occur when a patient receives care from a medical provider who is not in their insurance network.
The bill would take the patient out of price disputes between out-of-network healthcare providers and insurance companies.
Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), and Maggie Hassan (D-NH) propose that insurers automatically pay out-of-network providers approximately the same rate as in-network providers. Instead of billing patients the difference in cost, hospitals, specialty physicians and insurers would use arbitration to settle any disputes with the pay rate proposed.
Trump Administration Releases Final Rule for Medicare Drug Pricing
The Centers for Medicare and Medicaid Services (CMS) released a final rule Thursday aimed at lowering costs and improving price transparency for prescription drugs.
Stipulations in the rule include:
- Medicare Part D plans will continue to cover drugs in six “protected classes,” including antidepressants and immunosuppressants.
- Medicare Advantage plans are allowed to use “step therapy” for Part B drugs, which requires the use of a lower-cost medication before trying a more expensive one.
- Pharmacists may disclose when Part D drugs can be purchased at a lower cost out-of-pocket than through their insurance.
Also, beginning in 2021:
- The Part D explanation of benefits beneficiaries receive will include a notice of price hikes and any low-cost therapeutic alternatives.
- Each Part D plan will use at least one electronic benefit tool that works with electronic health records.
CMS did not implement some rules it had proposed last fall, including allowing insurance companies to drop a medication from its formulary if the price soared or was a new formulation of an existing single-source drug.
Healthcare Reform News Update for May 14, 2019
Washington Creates Country’s First State-Run, Long-Term Care Benefit Program
A first-of-its-kind program that will help state residents offset the costs of long-term care became a law on Monday when Washington Governor Jay Inslee signed the new bill.
Beginning in 2025, participants will receive a $100-per-day allowance that can be used for nursing home fees, in-home assistance, and reimbursement for family caretakers, up to a lifetime maximum of $36,500, indexed to inflation. To receive the funds, residents must need help with at least three “activities of daily living,” such as bathing, eating, and dressing.
The program will be funded through a payroll tax that starts in 2022. Employees will pay 0.58 percent of their income into a state fund. Workers will have to pay the premium for at least 500 hours per year for three of the previous six years, or for a total of 10 years (with at least five of those paid without interruption), in order to be eligible for the benefit.
Residents who have long-term care insurance policies are exempt from paying the tax. Those who are self-employed can opt to pay into the program, but it’s not required.
Healthcare Reform News Update for May 13, 2019
Washington to Become First State With a Public Healthcare Option
Washington will establish the country’s first universally available public insurance option when Governor Jay Inslee signs the legislation today.
The public option, called Cascade Care, is a hybrid insurance model: the state will create the terms of the plans and private insurance companies will administer the day-to-day operations, such as enrollment and claims payments.
Premiums are expected to be up to 10 percent lower than comparable private insurance coverage. The reduced costs are made possible by capping payments to healthcare providers at 160 percent of federal Medicare rates.
The set of tiered plans will available by 2021 and will be offered to all Washington residents, regardless of income.
Uninsured in Maryland Will Get Help via State Income Tax Returns
Maryland residents will soon be able to see if they qualify for free or low-cost insurance after filing their taxes, as Governor Larry Hogan is scheduled to sign a bill today that will alter the state’s income tax form.
If the new checkbox on the form is selected, Maryland’s healthcare exchange will determine if the tax filer is eligible for help with insurance.
Residents who qualify for Medicaid will be automatically enrolled. Those who qualify for Affordable Care Act plans will be contacted by the exchange.
Healthcare Reform News Update for May 10, 2019
House Passes Bill Strengthening Pre-Existing Condition Protections
The House voted to overturn a new Trump administration waiver program that weakens the Affordable Care Act’s pre-existing condition protections.
The waiver allows states to offer low-cost, low-coverage policies that can deny coverage to people with pre-existing conditions or charge them more for the same policy.
House Republicans said the waivers promote state flexibility and expand consumer healthcare choices.
The bill its not expected to clear the Republican-led Senate.
Study: Employer Plans Pay 241% More Than Medicare
Hospitals charged private employer-sponsored plans 240% more on average than what they billed Medicare, according to a new RAND Corp. study on healthcare pricing.
Researchers compared payment rates for 1,600 hospitals in 25 states. The charges represent the negotiated allowed amounts between hospitals and health plans.
Some of the findings include:
- The price disparity has increased from 2015, when it was 236%.
- The difference between Medicare and employer plans ranged from 150% to over 400%.
- If employer plans were charged the same as Medicare during the study period. It would have reduced health spending by $7.7 billion.
- The price difference was higher for outpatient care (293%) than for inpatient care (204%).
The study also recommends measures that employers could take to help reduce the disparity, including:
- pressuring their health plan to base pricing on Medicare rates
- encouraging state or federal policy intervention as a way to readjust “negotiating leverage between hospitals and employer health plans”
Healthcare Reform News Update for May 8, 2019
Study: 2018 Brought Record Financial Performance for ACA Insurers
Last year was the most profitable year for Affordable Care Act plans since they were made available, according to the Kaiser Family Foundation’s recently published analysis of 2018 individual market performance.
The data also show that “financial results suggest the market is still stable and sustainable.”
Some of the report’s findings also include:
- Insurers are expected to owe rebates totaling almost $800 million to consumers as a result of not meeting the medical loss ratio threshold.
- Insurers are regaining profitability, but the Trump administration’s proposed changes to the ACA make predictions for the future uncertain.
- Premium increases combined with modest growth in medical expense claims helped fuel improvements in financial performance.
- The premium increases for 2017 plans were a necessary one-time market correction adjustment due to a “sicker-than-expected risk pool.”
- Premium increases in 2018 were mostly “compensating for policy uncertainty and the termination of cost-sharing subsidy payments.”
- Premiums in 2019 decreased partly because 2018 premiums “were higher than necessary to cover claims costs.”
Poverty Threshold Changes Would Affect ACA Premium Tax Subsidies
The Trump administration has proposed changes to how the poverty level is determined, which would influence the number of consumers eligible for premium tax credits on Affordable Care Act health plans.
Currently, the poverty level is determined by the consumer price index. The Office of Management and Budget is considering a different measure called “chained CPI” that raises the poverty level at a slower rate. This means fewer Americans would qualify for services that are based on their incomes.
To qualify for the ACA premium tax credit, an enrollee’s estimated income must fall between 100% and 400% of the federal poverty level.
Critics of the plan say the change would cause harm to low-income workers who would be stripped of benefits they are currently eligible for.
The administration notes that the poverty threshold has not changed in 40 years and “is worth re-evaluating.”
Bipartisan Senators Ask Trump Administration to Defend the ACA
Senators Susan Collins (R-ME) and Joe Manchin (D-WV) wrote a letter to Attorney General William Barr asking that the Trump administration stop its attempt to dismantle the Affordable Care Act in federal court.
The senators said Congress’ repeal of the individual mandate was not a move to invalidate the entire health law and that the administration’s position would cause 133 million Americans to lose their health coverage.
Healthcare Reform News Update for May 7, 2019
Study: Medicare Advantage Beneficiaries Spend Less
People who switch to Medicare Advantage plans spend less on average and use fewer services than traditional Medicare beneficiaries—even before they enroll in Medicare Advantage, according to a new study from the Kaiser Family.
In the study, researchers compared the “average traditional Medicare spending and use of services in 2015 among beneficiaries who switched to Medicare Advantage plans in 2016 with those who remained in traditional Medicare that year, after adjusting for health risk.”
Those who switched spent $1,253 less on average in 2015, according to the analysis.
The spending difference remained, regardless of age, gender, or health condition. Medicare Advantage users with dual-eligibility also spent less prior to their switch to Medicare Advantage.
The findings suggest that the Centers for Medicare and Medicaid Services (CMS) could be overpaying MA plans by billions of dollars per year because the department bases its payments on spending by those on traditional Medicare.
In addition, the results question whether the care management strategies of Medicare Advantage plans are responsible for the lower spending of enrollees.
Healthcare Reform News Update for May 2, 2019
Trump Administration Formally Files To Strike Down Entire ACA
The Trump administration filed its support of overturning the entire Affordable Care Act with the Fifth Circuit Court of Appeals this Wednesday. The administration, along with a coalition of Republican-led states, are asking the court to uphold U.S. District Court Judge Reed O’Connor’s ruling that the ACA became invalid when the individual mandate was repealed.
Previously, the Justice Department’s held the position that some provisions of the law should continue to stand, including Medicaid expansion, premium tax subsidies and health insurance markets. The administration has since reconsidered.
In the legal filing, Justice Department stated that “the remaining provisions of the ACA should not be allowed to remain in effect — again, even if the government might support some individual positions as a policy matter.”
California Attorney General Xavier Becerra, who leads the group of 21 Democratic states defending the ACA, said, “Our legal coalition will vigorously defend the law and the Americans President Trump has abandoned.”
Oral arguments in the case are expected to begin in July.
CBO Report Highlights Complexities of a Medicare for All System
The Congressional Budget Office released a report on Wednesday that analyzes the “opportunities and risks” of creating a Medicare for All type of healthcare system like those proposed by some Democratic lawmakers and presidential candidates.
Instead of cost estimates, “Key Design Components and Considerations for Establishing a Single-Payer Health Care System” lays out the positive and negative outcomes that lawmakers and consumers could face if current system were revised.
The report outlines ways in which Congress could address issues that may arise with a single-payer system, such as:
- Funding the system
- Plan oversight
- The role of private insurance providers
- Management of provider rates and prescription drugs
The analysis suggests drawbacks of single-payer healthcare could include longer wait times and decreased access to care. New taxes would also have to be established for income, payroll, or consumption to help pay for the system.
Benefits of a single-payer system, according to the report, include costs savings from administrative streamlining, and a greater focus on preventive care and increasing the nation’s health as a whole.
Other considerations for legislators include whether or not to pay for undocumented immigrants and long-term care services, and what strategies should be used to maintain costs.
Democrats Reintroduce Compromise Medicare Expansion Proposal
Democratic Representatives Rosa DeLaura of Connecticut and Jan Schakowsky of Illinois presented their plan for expanding healthcare coverage on Wednesday. The Medicare for America Act is considered a more moderate approach than a single-payer models like Medicare for All.
The plan debuted last year, but now has 16 cosponsors.
The proposal would maintain employer-based health plans, but employees would have the option to enroll in Medicare coverage. Consumers who have coverage though Affordable Care Act plans, Medicaid, Medicare and CHIP would all transition to the newly expanded Medicare plans.
Premiums for the plans would be based on income, but cost would be capped at 8 percent of monthly pay. Tax subsidies would be provided to those with low-incomes. There would be no deductibles to be met before coverage begins.
CMS Seeks New Ideas for State ACA Waivers
The Centers for Medicare & Medicaid Services and the Treasury Department has issued a call for ways to improve the system states use to ask for exceptions to Affordable Care Act regulations.
“Ultimately, the goal here is to see states develop new waiver concepts and submit waiver applications that improve their health insurance markets,” said CMS Administrator Seema Verma via a blog post.
Healthcare Reform News Update for May 1, 2019
President Trump Asks Senator to Restart Bipartisan ACA Stabilization Deal
President Trump asked Senator Patty Murray (D-WA) on Tuesday to renew her efforts to create a bipartisan bill that would help stabilize the Affordable Care Act.
Murray’s previous proposal with Senator Lama Alexander (R-TN) stalled last year after legislators could not agree on modifications to the Hyde Amendment, which concerns abortion funding restrictions. At the time, the president waivered in his support of the bill.
Murray said through an aide that she is willing to try again, and that she is ready to work with either Democrats or Republicans to roll back any sabotage to the ACA and make healthcare more affordable.
Alexander remains firm on the issue that derailed the initial bill. “I was extremely disappointed our legislation didn’t become law. If Democrats are willing to modify their position on the Hyde Amendment and renew their interest in Alexander-Murray, I would welcome the opportunity to discuss it,” he said.
Medicare for All Bill Receives First Congressional Hearing
The first public congressional discussion on Medicare for All was held on Wednesday in front of the House Rules Committee. The hearing centered on a bill from Representative Pramila Jayapal (D-WA), which has over 100 Democratic co-sponsors.
Speakers included healthcare providers, a conservative economist, liberal activists with disparate opinions on how a single-payer system would operate, and Ady Barkan, a supporter with Lou Gehrig’s disease who described his struggles with exorbitant out-of-pocket costs.
Jayapal’s bill currently lacks support from centrist Democrats and would not be able to pass in the Republican-controlled Senate. However, she and other advocates were positive about gaining a hearing. “This was the first step, it’s a big step, but we’re on our way. Medicare for All is possible. It is reasonable. It can move forward, and I think it should,” said the Chairman of the Rules Committee Jim McGovern (D-MA.).
Republicans remained skeptical about Medicare for All efforts. Representative Tom Cole (R-OK), the ranking Republican on the committee, said that supporters have “not told us how much this massive new program would cost, who would pay for it and how much taxes would have to go up.”
Additional hearings on Medicare for All were confirmed during Wednesday’s discussion: one for The House Budget Committee and another for the House Ways and Means Committee.
Healthcare Reform News Update for April 30, 2019
Florida Senate Approves New Standards for State Health Plans
On Thursday, the Florida senate passed a health benefits package that could define new standards for health insurance in the state if the Affordable Care Act is removed. The bills address pre-existing condition protections, association plans, short-term health plans, and essential health benefits.
The package will allow insurance companies to offer plans that limit or deny coverage for people with pre-existing conditions, as long as policies without these restrictions are actively marketed. No limits would be set on the differences in premiums for the two types of plans, which means that the state would allow insurance companies to charge those with pre-existing conditions higher rates.
The package will also allow association health plans and three-year short-term plans to be sold in the state. Part of the package allows for the defining of a new list of essential health benefits.
Senators who sponsored the package said that they believed the new standards will help in lowering premiums.
Healthcare Reform News Update for April 25, 2019
New Poll Shows Americans Concerned About Drug Costs and Pre-Existing Condition Protections
Americans believe the top healthcare priorities for Congress should be lowering prescription drug costs, pre-existing condition protections, and protecting people from surprise medical bills, according to a new Kaiser Family Foundation poll released Wednesday. The poll gathered opinion data on the Affordable Care Act, healthcare concerns and future healthcare legislation.
While 54% of Americans do not want the Affordable Care Act overturned, opinions are split between political parties. Of Republicans, 73% support striking down the entire ACA. Conversely, 83% of Democrats are against eliminating the ACA. However, a majority of Democrats, Republicans, and Independents (67%) believe the government should require health insurance plans to cover a designated set of benefits and pre-existing conditions.
In addition, a majority of respondents are worried that they or a family member could lose, or not be able to afford, coverage if the Supreme Court overturns the ACA or pre-existing condition protections.
Other findings from the poll include:
- Nearly six in 10 Americans (56%) support a Medicare-for-all plan.
- More than half (52%) of Democrats prefer a focus on improving and protecting the ACA over passing a Medicare-for-all plan.
- Only 26% of Americans believe low-cost, short-term plans without required coverage or pre-existing condition protections should be allowed.
- Four in 10 insured families (41%) received an unexpected medical bill over the last two years.
Healthcare Reform News Update for April 23, 2019
Two Republican Bills Address Pre-Existing Condition Protections
Two similar bills introduced by Republican legislators seek to protect patients with pre-existing conditions in the event that the Affordable Care Act is struck down. Senator Thom Tillis of North Carolina and Representative Greg Walden of Oregon have authored similar proposals.
The bills would prohibit insurance companies from denying coverage on the basis of health status, but they are missing some of the protections available under the current law. Insurance companies would be allowed to charge women higher premiums and put lifetime limits on benefits.
Democrats say that the bills fall short in their promise to protect insurance beneficiaries. “You could theoretically buy insurance if you have a pre-existing condition, but it is very deceptive because the bill will still allow insurers to set premiums based on health status.” said Representative Frank Pallone Jr. (D-NY) chairman of the Energy and Commerce Committee.
CMS Announces New Medicare Payment Models for Primary Care Practices
Health and Human Services Secretary Alex Azar on Monday announced two new voluntary Medicare programs for primary care physicians that will reward practices based on their patients’ health improvements instead of the traditional fee-for-service payments.
The initiative will “move [the nation] toward a system where providers are paid for outcomes rather than procedures, and free up doctors to focus on the patients in front of them, rather than the paperwork we send them,” Azar said.
The CMS Primary Cares initiative, set to launch in 2020, contains new payment models where physicians and hospitals assume varying levels of financial responsibility for reducing costs and improving services.
The first model, aimed at small, primary-care practices, gives two payment options that include a flat monthly fee per patient, with bonuses and penalties based on patients’ health.
Larger practices and health systems have three payment options within this initiative:
- The “Professional Option:” Providers would receive a fixed monthly payment and assume 50% of the financial risk.
- The “Global Option:” Providers would assume the full risk of the cost of caring for patients.
- The “Geographic Option:” Health systems or insurance plans take on the full risk for the primary care cost for communities within a specific region.
CMS Primary Cares was designed to promote new technologies such as telehealth and remote patient monitoring. “Providers will have greater flexibility to spend these resources how they want, allowing them to come up with innovative ways to care for patients — and receive significant savings if they keep patients healthier than expected,” Azar said.
Azar said he expects around one-fourth of primary care practices to sign up for CMS Primary Cares.
Medicare and Social Security Funds Face Uncertainty
A new report from the board of trustees for Medicare forecast that the Medicare Supplementary hospital insurance fund will be depleted by 2026, which is the same date projected last year.
In addition, costs for the Medicare Supplementary Medical Insurance (SMI) fund, which covers drug cost in Part B and D, are expected to grow gradually from 2.1 percent of gross domestic product in 2018 to about 3.7 percent of GDP in 2038. However, trustees report that the fund will be sufficiently financed by general revenues and beneficiary premiums.
Social Security also faces an uncertain financial future, as its total cost is predicted to exceed its total income in 2020, which will be the first time it’s happened since 1982.
The report requests that legislators “take action sooner rather than later to address these shortfalls, so that a broader range of solutions can be considered and more time will be available to phase in changes while giving the public adequate time to prepare.”
Healthcare Reform News Update for April 22, 2019
Congressional Budget Office Revises its Insurance Estimate Model
The Congressional Budget Office announced that it will change how it estimates the financial impact of new health insurance legislation, beginning with its budget projections later this spring. The new model will consider consumer and employer preferences.
The revisions were made to address Republican criticism of how the nonpartisan agency makes estimates, specifically regarding the repeal of the Affordable Care Act and its individual mandate.
“The new model better captures underlying relationships among individuals, families, employment, income, and insurance coverage because it incorporates new data and includes refinements in modeling insurance choices,” said CBO Director Keith Hall.
Kansas Governor Allows Farm Bill to Pass
The Kansas Farm Bureau will be allowed to offer health coverage that does not meet Affordable Care Act standards, as Governor Laura Kelly declined to block the law.
The new association health plan is not considered insurance, so it will be exempt from state and federal insurance regulations. It does not include protections for people with pre-existing conditions, nor does it include the ACA’s ten essential benefits, such as coverage for prescription drugs, maternity care, or mental health services.
In a statement, Kelly mentioned reservations about the law, but chose not to block it as a demonstration or compromise. “I believe the potential risks of this legislation can be mitigated if they are coupled with a stable, secure, proven health care option: Medicaid expansion,” said Kelly.
Healthcare Reform News Update for April 19, 2019
Changes to 2020 ACA Plans Announced by CMS
The Centers for Medicare and Medicaid Services (CMS) released its finalized rule for 2020 Affordable Care Act health plans on Thursday.
The agency will reduce user fees to plans on the federal exchange from 3.5 percent of premiums to 3 percent. User fees for plans sold on state exchanges will drop from 3 percent to 2.5 percent.
CMS Administrator Seema Verma said in the announcement that “The rule issued today will give consumers immediate premium relief for 2020 by reducing the federal exchange user fees thanks to successful efforts to improve the efficiency of the exchange. At CMS, we have improved the operations of the exchange to deliver a better consumer experience at a lower cost.”
- raising the maximum out-of-pocket limit to $8,150 for individuals and $16,300 for families and increase of by 3.16 percent,
- slightly decreasing the amount subsidized enrollees are required to contribute toward benchmark silver plans to 8.24 percent, and
- allowing insurers to block drug manufacturer coupons from applying to annual out-of-pocket limits if a generic version of the drug is available.
Healthcare Reform News Update for April 18, 2019
Colorado Pushes Forward on Government-Run Insurance Option
The Colorado Senate moved closer to the creation of a state public-option health insurance plan by endorsing a study that will examine the impact of such a plan.
The proposed bill asks state agencies to present recommendations for a healthcare plan in November that could compete with plans available on Colorado’s Affordable Care Act exchange in 2021.
Supporters of the measure say the public-option plan would reduce premiums in areas that have some of the highest costs in the nation.
Republican Senator Jim Smallwood, an opponent of the bill, suggests that instead of creating competition, a public healthcare option would cause private insurers to abandon the Colorado market.
Connecticut House Passes Pre-Existing Condition Protections for Short-Term Plans
A bill to protect consumers with pre-existing conditions from being denied coverage or charged more for short-term health insurance plans was passed by the Connecticut House of Representatives.
According to the Kaiser Family Foundation, approximately 522,000 Connecticut citizens under 65 have a pre-existing condition.
The bill is opposed by the Connecticut Conference of Municipalities, which stated that the measure would raise insurance premiums for municipal employers. However, analysts with the Office of Fiscal Analysis say the bill has no financial impact on the state.
Healthcare Reform News Update for April 11, 2019
Bernie Sanders Debuts Revamped Medicare for All Bill
Senator Bernie Sanders (I-VT) debuted an updated version of his Medicare for All bill on Wednesday with the support of 14 Democratic cosponsors.
In his proposal, Sanders calls for replacing private insurance with a single-payer, government-run system with no premiums or deductibles. Certain services would come with small copays, and copays for brand-name prescription would be capped at $200. This new version of the proposal adds coverage for long-term care.
“The American people are increasingly clear: They want a health care system which guarantees healthcare to all Americans as a right,” said Sanders.
Sanders did not outline how the program would be funded, but did offer general suggestions.
In response, White House press secretary Sarah Huckabee Sanders called the plan a “total government takeover of health care that would actually hurt seniors, eliminate private health insurance for 180 million Americans, and cripple our economy and future generations with unprecedented debt.”
Healthcare Reform News Update for April 10, 2019
House Democrats Seek Justification for ACA Lawsuit Strategy
Democratic House committee chairmen are insisting that the Trump administration reveal documents and information that explain why the Department of Justice came to the decision to not defend the Affordable Care Act in the lawsuit against it.
The five committees involved have sent letters to the White House, the Justice Department, and Health and Human Services, requesting the legal justification for the administration’s decision to seek the elimination of the healthcare law. They also request that the DOJ allow four of its attorneys to testify.
Judiciary chairman Jerry Nadler (D-NY) told reporters on Tuesday that “The Judiciary committee will hold those responsible for this complete abdication of the department’s legal duty. They are in contempt of the law in the way they are carrying out their intentions.”
During testimony in front of a House appropriations subcommittee on Tuesday, Attorney General William Barr defended the administration’s strategy. “When we face a legal question, we try to base our answer on the law. If you think it’s such an outrageous position, you have nothing to worry about. Let the courts do their job,” he said.
Wisconsin Allowed to Withdraw From Remaining ACA Lawsuit
The 5th District Court of Appeals has agreed to dismiss Wisconsin from the appeal of the Affordable Care Act ruling that declared the healthcare law unconstitutional.
Last week, the court allowed the state to withdraw from two related cases. This latest court decision removes Wisconsin from all the federal lawsuits filed against the ACA.
ACA Medicaid Expansion Approved in Idaho
Idaho Governor Brad Little signed voter-approved legislation to expand Medicaid to approximately 90,000 residents by covering those earning up to 138 percent of the federal poverty level.
The bill also includes requests for two federal waivers. One requires Medicaid recipients to be employed in order to receive benefits. The other will allow Medicaid-eligible residents to stay on the state’s health insurance exchange instead of moving to the government plan.
Expanded Medicaid coverage is created via provisions of the ACA. Idaho is the 37th state to adopt the expansion.
Healthcare Reform News Update for April 9, 2019
ACA Lawsuit Timeline May Be Accelerated
The Department of Justice filed a motion to begin oral arguments in the appeal of a lower-court ruling against the Affordable Care Act the week of July 8. The Democrat-led opposition defending the law did not oppose the DOJ’s request.
Healthcare Reform News Update for April 8, 2019
Kansas Lawmakers Approve Bill That Permits Farm Bureau Health Plan
Both the Kansas House and Senate passed a Republican-backed bill that allows the Farm Bureau to offer health coverage that doesn’t meet Affordable Care Act provisions.
Because the plans would not be considered insurance, people with pre-existing conditions could be refused coverage or have to pay more than other enrollees.
The Farm Bureau estimates that 42,000 Kansas residents who currently have no healthcare or who have problems affording an ACA plan would enroll in the new lower-cost option.
Democratic Governor Laura Kelly has not announced if she will sign the legislation.
Trump Administration Plans Future Healthcare Policy at Camp David Meeting
Acting White House Chief of Staff Mick Mulvaney met with White House aides and administration officials at Camp David on Saturday to discuss President Trump’s plan to replace the Affordable Care Act with a Republican option.
Attendees included Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma.
Mulvaney stressed that he’d like to see a proposal in place to put in front of voters prior to the 2020 elections. “I do think you’ll see a plan here fairly shortly,” he said.
Healthcare Reform News Update for April 3, 2019
Plan to Postpone ACA Replacement Came From Senate Majority Leader
Senate Majority Leader Mitch McConnell (R-KY) said that it was his consultation that prompted President Trump to announce that a Republican replacement to the Affordable Care Act would not occur until after the 2020 elections.
“We had a good conversation yesterday afternoon and I pointed out to him the Senate Republicans’ view on dealing with comprehensive healthcare reform with a Democratic House of Representatives,” said McConnell on Monday.
Instead of attempting to repeal and replace the ACA, McConnell said that Republican senators would focus on trying to lower prescription drug prices and other less comprehensive measures.
Wisconsin Withdraws From Two ACA Lawsuits
A federal judge granted permission for Wisconsin to drop out of two lawsuits against the Affordable Care Act at the request of Wisconsin Attorney General Josh Kaul.
The first lawsuit argues that the entirety of the ACA is unconstitutional. A federal Judge’s ruling that declared the ACA unconstitutional is currently being heard in a U.S. Appeals court, where Wisconsin is still party to the case. The state has also requested to be removed from the appeal and is awaiting a decision.
The second lawsuit challenges the ACA’s protections for transgender individuals and women seeking abortion. Arizona, Kentucky, Nebraska, and Mississippi continue to be listed as plaintiffs in that case.
Healthcare Reform News Update for April 2, 2019
President Moves Republican ACA Replacement Plan to After 2020
In a series of three tweets, President Trump said that a Republican replacement for the Affordable Care Act would be put up for a vote after the 2020 elections.
“The Republicans…are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare,” said Trump on Monday night. “Vote will be taken right after the Election when Republicans hold the Senate & win…back the House.”
GOP Attorneys General in Two States Ask Court to Uphold ACA
Republican attorneys general in Ohio and Montana filed a brief in the 5th U.S. Circuit Court of Appeals arguing that the federal judge that ruled that the Affordable Care Act unconstitutional was incorrect.
Dave Yost of Ohio and Timothy Fox of Montana say they support the elimination of the mandate, but believe that “…the District Court’s ruling is wrong, and its errors threaten harm to millions of people.”
As part of the appeal process, the court will review the ruling that declared that the elimination of the ACA’s individual mandate means the entire law should be struck down.
Healthcare Reform News Update for April 1, 2019
Senators to Debut Revised “Medicare X” Plan
Democratic Senators Tim Kaine (VA) and Michael Bennet (CO) will introduce a new “Medicare X” healthcare plan next week, which would create a public health insurance option.
The proposal retains employer health plans, but also allows consumers to purchase Medicare plans through the individual or small-business ACA exchanges.
“180 million people in America get their insurance through an employer-based plan and Medicare X gives people the opportunity to decide whether they want to stay on that plan,” said Bennet.
Features of the Medicare X plan include:
- access to the Medicare network of doctors,
- the ACA’s essential benefits, such as maternity and newborn care,
- the establishment of a federal reinsurance program to keep premiums down, and
- tax credits for higher-income Americans.
The plan would be gradually phased in over a five-year period, beginning in rural areas, then nationwide, and lastly to small businesses.
The proposal has no Republican cosponsors, although Bennet and Kaine are optimistic about the idea catching on.
House Resolution Criticizes President’s Position on ACA Lawsuit
The House will vote this week on a resolution that denounces President Trump’s decision to support a lawsuit that would eliminate the Affordable Care Act in its entirety.
The effort is led by Rep. Colin Allred (D-TX). According to the resolution, Trump has publicly claimed to support protections for those with pre-existing conditions while ordering the Department of Justice to “actively pursue the destruction” of the ACA and its protections in federal court.
Mick Mulvaney, the president’s acting chief of staff, said on Sunday that no Americans would lose healthcare coverage, even if the ACA is struck down. Currently, no replacement healthcare law has been proposed.
Republican Senator Asks Attorney General to Reverse ACA Decision
Sen. Susan Collins (R-ME) has sent a letter to Attorney General William Barr asking that he reverse the Department of Justice’s decision to support the removal of the Affordable Care Act.
“Rather than seeking to have the courts invalidate the ACA, the proper route for the administration to pursue would be to propose changes to the ACA or to once again seek its repeal,” Collins writes in the letter. “The administration should not attempt to use the courts to bypass Congress.”
In addition, Collins criticizes the DOJ’s refusal to defend the healthcare law in court. “The administration should reconsider its decision and defend the remainder of the ACA,” wrote Collins.
Healthcare Reform News Update for March 29, 2019
Federal Judge Rejects Association Health Plan Expansion
U.S. District Judge John D. Bates on Thursday blocked the Trump administration’s attempt to expand access to association health plans (AHPs).
The new rule enabled groups of employers, including the self-employed, to create associations to form health plans that are not required to meet all Affordable Care Act requirements.
Bates said the Trump administration’s final rule was an “end-run around the ACA” and “stretches the definition of ‘employer’” under the Employee Retirement Income Security Act (ERISA).
Since expanding AHPs, around 30 associations have formed and are scheduled to begin on Jan. 1, 2020. An appeal of Bates’ ruling is expected. If successful, the appeal could allow the plans to continue.
Insurers Request Change to Out-of-Pocket Limits for Grandfathered ACA Plans
Insurance groups have asked the Centers for Medicare and Medicaid Services (CMS) to allow them to increase out-of-pocket charges for grandfathered ACA plans.
The change would take into account the increase in prescription drug prices. The new methodology is needed because “prescription drug inflation exceeds medical inflation,” according to The American Benefits Council.
Instead of calculating out-of-pocket charges based on the Consumer Price Index’s medical inflation numbers, insurers would like to base them on CMS’ “average per enrollee private health insurance premiums for the National Health Expenditure Accounts.”
An increase in deductibles and maximum out-of-pocket limits would affect approximately 1 million people who are enrolled in lower-cost grandfathered ACA plans, which don’t provide the law’s 10 essential health benefits.
Healthcare Reform News Update for March 28, 2019
Republican Lawmakers Pressed to Create an ACA Replacement Plan
Following the Department of Justice’s decision to argue for the elimination of the Affordable Care Act, President Trump has put pressure on Republicans to create replacement legislation.
“If the Supreme Court rules that Obamacare is out, we’ll have a plan that is far better than Obamacare,” President Trump said during an event on Wednesday.
The DOJ’s decision took some lawmakers by surprise and created some concern about its timing. “Repealing the entire law — or knocking it down in the court system with no plan to address the impasse — leaves millions of Americans in harm’s way, and they didn’t do anything. We owe it to the American people to have a solid plan in place before that occurs,” said Rep. Tom Reed (R-NY).
According to Marc Short, Vice President Pence’s chief of staff, “the president will be putting forward plans this year that we hope to introduce into Congress.”
A few Republican members of Congress spoke to the president about creating new legislation, including. Senator John Barrasso (R-WY). “He wants to preserve people being able to get their insurance through work . . . and focused on people with preexisting conditions. He is 100 percent committed to ensuring that people with pre-existing conditions get covered, and I understand that . . . and the president is also focused on lowering the cost of drugs,” said Barrasso.
Senator Susan Collins (R-ME) is drafting a letter to the Trump administration, arguing against the DOJ’s decision. “I believe that he’s sort of got the cart before the horse, that you need to have a plan for what a replacement would be that would improve upon the ACA,” she said. “There are some very important, good provisions of the ACA that have helped expand health insurance for low-income Americans . . . I would not want to see those abandoned.”
Republicans believe that the legal battle at the center of the issue could take up to a year to go through the court system, so they have some time to consolidate disparate ideas into a single GOP plan.
Senate Democrats Move to Block DOJ Funds for ACA Lawsuit
Senate Minority Leader Charles Schumer (D-NY) said on Wednesday that he will try to force a vote on a measure that would block the Department of Justice from using federal funds in the lawsuit against the Affordable Care Act. The measure would be part of an amendment to the disaster aid bill currently being considered in the Senate.
The move would force Republicans to go on record regarding their support of DOJ’s declaration that the ACA should be struck down in its entirety, including its protections of people with pre-existing conditions.
“It will very simply prohibit the Department of Justice from using any funding to litigate the downfall of the ACA in the Circuit Court,” said Schumer. “Let’s see if all of our Republican colleagues who have said they don’t want to take away protections for pre-existing conditions. Let’s see how our Republican colleagues will vote on this.”
Healthcare Reform News Update for March 27, 2019
House Dems Reveal New Healthcare Package to Expand Coverage
Speaker of the House Nancy Pelosi (D-Calif.) on Tuesday presented a legislation package designed to stabilize the Affordable Care Act marketplace.
The package will “strengthen protections for pre-existing conditions, reverse the GOP’s healthcare sabotage, and lower Americans’ health costs,” according to Pelosi.
Some of the legislation’s proposals include:
- Rolling back the Trump administration’s expansion of short-term health plans
- Tightening state innovation waiver guidelines
- Expanding tax subsidy eligibility rules
- Re-establishing a federal reinsurance program
- Restoring outreach and funding for the Annual Enrollment Period
House Democrats expect to begin putting sections of the package up for votes individually beginning in May.
Centene’s Purchase of WellCare to Create Large Share of ACA Enrollees
Health insurer Centene announced today that it will buy WellCare Health Plans, which also provides government and ACA health insurance, for $17.3 billion.
If approved, the merger will cover almost 9 million people with ACA plans and 13 million Medicare Advantage and Medicaid enrollees.
Healthcare Reform News Update for March 26, 2019
Department of Justice Agrees With Ruling to Nullify ACA
In a two-sentence legal filing to the 5th U.S. Circuit Court of Appeals, the U.S. Department of Justice on Monday affirmed a district court judge’s December ruling to eliminate the Affordable Care Act.
The agency says it agrees with U.S. District Judge Reed O’Connor’s decision that the repeal of the ACA’s individual mandate invalidated the entire law. The DOJ’s brief stated: “With the amount of the tax set at zero, the remaining minimum coverage provision becomes simply precatory—precisely as the amending Congress intended. It is no more constitutionally objectionable than the ‘sense of the Congress’ resolutions that Congress often adopts.”
Prior to this position, the Trump administration showed support for some ACA provisions, including protections for people with pre-existing conditions and Medicaid expansion.
Shortly after O’Connor’s ruling, a coalition of Democratic attorneys general appealed it. The law remains in place while the case moves through the court system.
The DOJ must file a full brief within 30 days.
CMS: State ACA Enrollment Rises, Federal Enrollment Dips Slightly
States running their own healthcare exchanges are maintaining enrollment levels better than the federal exchange, according to 2019 enrollment data released Tuesday by the Centers for Medicare and Medicaid Services (CMS).
In 2019, 11.4 million Americans enrolled in ACA plans. That is a 2.6 percent overall decrease from 2018. States that run their own exchanges saw a 1 percent increase in enrollment, while states on the federal exchange dropped 3.8 percent.
Regarding the report, CMS Administrator Seema Verma tweeted: “Steady enrollment through (the) exchanges, confirming another successful enrollment period at a time when premiums are stabilizing after years of substantial increases.”
Healthcare Reform News Update for March 25, 2019
New Jersey Will Operate a State ACA Exchange Starting in 2021
New Jersey will establish its own health insurance marketplace beginning in 2021. Governor Phil Murphy sent a letter to the Trump administration on Friday declaring that the state would no longer be using the federal exchange to enroll participants in Affordable Care Act insurance.
The move away from the federal exchange will allow the state to extend its open enrollment period. The break from the marketplace is a continuation of Murphy’s efforts to support several provisions of the law, including the creation of a state reinsurance program and a state individual mandate.
Murphy said funding for the state exchange would come from redirecting its current federal exchange user fee, which is a 3.5 percent assessment on insurance premiums.
New Study Confirms $30 Billion Cost for Federal Reinsurance Program
A national reinsurance program would cost $30.1 billion over three years, according to a new study published in the Journal of Health Care Organization, Provision and Financing last week. The findings align closely with the $10 billion per year supporters of the program are asking from Congress.
A reinsurance program helps protect insurers from its highest-use enrollees, and would cost the federal government $9.5 billion in 2020, or $30.1 billion from 2020-2022.
The study reviewed data from the 2007-2016 Medical Expenditure Panel Survey and state demographic and health insurance coverage data from the 2015-2017 Current Population Survey Annual Social and Economic Supplement.
A recent report conducted by Georgetown University’s Center on Health Insurance Reforms found that state reinsurance programs in Alaska, Minnesota and Oregon have helped stabilize the states’ ACA insurance marketplaces.
Healthcare Reform News Update for March 12, 2019
Trump’s Budget Proposal Slashes Spending for Medicaid and other HHS Programs
The White House proposed a $4.7 trillion budget for 2020 on Monday. Included in the budget request is a 12 percent cut to Health and Human Services funding.
The “Budget for a Better America” proposal endorses repealing the Affordable Care Act and converting the law’s funding into state block grants. The proposal also calls for a ban on exchange plans that do not require customer to pay a premium.
The new budget would cut Medicaid funding by almost $1.5 trillion over nine years and repeal the ACA’s expansion of the program. Medicare spending would be reduced by roughly $845 billion over 10 years.
The president’s budget is expected to be rejected by Congress.
Healthcare Reform News Update for March 7, 2019
CMS Requests Recommendations for Selling Health Insurance Across State Lines
The Centers for Medicare & Medicaid Services (CMS) has asked the public for suggestions on how to facilitate the sale of health insurance plans across state lines.
The Affordable Care Act includes a provision that allows such sales through state agreements called “healthcare choice compacts.” However, few states have passed legislation that would take advantage of the opportunity.
CMS Administrator Seema Verma said in a statement that “Americans are in desperate need of more affordable health insurance options. Eliminating the barriers to selling health insurance coverage across state lines could help provide access to a more competitive and affordable health insurance market.”
While campaigning, President Trump said that interstate sales could be one way to help improve the ACA. However, the American Academy of Actuaries reported that premiums are determined by the cost of local care, not where the policies are sold, so savings would be limited.
CMS will accept public comments on the issue for the next 60 days.
Healthcare Reform News Update for March 5, 2019
Kaiser Study: ACA Affordability Most Challenging for Middle-Income Earners
A new study of ACA premiums released by the Kaiser Family Foundation highlights the financial burden placed on middle-class, older consumers who earn too much to receive tax subsidies.
The report speaks to the “subsidy cliff,” the point where people earning over 400 percent of the federal poverty level no longer qualify for tax credits. The cliff is especially hard on people over 50, whose premiums are allowed to be up to three times higher than younger enrollees.
On average, a subsidized ACA premium for a 40-year-old who makes $45,000 per year is $227. For a 50-year-old who makes $50,000, the same plan without a subsidy is $340. Plan premiums vary widely based on location.
“For older people living in very high-premium counties, the affordability gap is much more stark,” according to the report. “In the 28 Nebraska counties with the highest premiums, a 60-year-old making $45,000 would pay nothing in monthly premiums and the same person making $50,000 would pay $1,314 (32% of income) for the lowest-cost plan.”
Healthcare Reform News Update for March 1, 2019
BCBS Association Asks Congress to Stabilize ACA Markets
The Blue Cross and Blue Shield Association submitted a legislative proposal on Thursday designed to stabilize the Affordable Care Act exchanges. The suggestions focus on expanding eligibility for tax subsidies and encouraging younger consumers to sign up for coverage.
“We think this is a pragmatic, incremental step,” said Justine Handelman, the association’s senior vice president in the Office of Policy and Representation. “We believe it’s important to build on what’s working.
The proposal asks Congress to:
- Add age as a factor for determining eligibility for premium tax subsidies.
- Ensure that higher-income enrollees do not pay more than 12% of their income on premiums.
- Resume cost-sharing reduction (CSR) payments to insurers.
- Allow people who earn between 200 percent and 300 percent of the federal poverty level to have 80 percent of their healthcare costs paid from CSR funds.
- Delay the resumption of the health insurance tax scheduled for next year.
- Increase outreach funding for the open enrollment period from $10 million per year to $160 per year.
The association says that the plan would lower premiums by an average of 33 percent and increase enrollment by 4.2 million consumers, but cost more than $10 billion annually.
Healthcare Reform News Update for February 28, 2019
Centrist Democrats Ask for Revival of ACA Stabilization Talks
A group of 101 moderate House Democrats has called for a bipartisan effort to help stabilize the Affordable Care Act marketplace.
On Wednesday, two hours after progressives in the party held a press conference announcing a new Medicare for all proposal, the centrist New Democrat Coalition unveiled its plans to revive last year’s talks to lower ACA premiums and stop the Trump administration’s proposals that “sabotage” the law.
In a letter to key committee leaders, the group wrote to urge those committees “to deliver on the promises made to our constituents by prioritizing strengthening the ACA and continuing the path toward universal affordable coverage.”
The coalition said it promotes:
- reducing ACA premiums via a national reinsurance program,
- increasing premium assistance,
- reinstituting insurer subsidies that were canceled in 2017, and
- discussing a public option where consumers could buy in to Medicare coverage.
HHS Secretary Azar Pushes Plan for ACA Subsidies to Fund HSAs
Health and Human Services Secretary Alex Azar promoted the concept of depositing Affordable Care Act tax subsidies into health savings accounts (HSAs) to pay for insurance premiums and other out-of-pocket expenses.
“This is just one possible way to help use insurance design to drive value by empowering patients as consumers of healthcare,” Azar said during a meeting of the National Association of Health Underwriters. “Plans with HSAs, especially funded HSAs, can protect Americans from the risk of catastrophic healthcare costs while encouraging them to be price-conscious consumers.”
The Trump administration is also considering a proposal that would redefine preventive services. The change would allow those on high-deductible health plans use HSA funds to pay for items like insulin.
Healthcare Reform News Update for February 27, 2019
Progressive Democrats Unveil Far-reaching Medicare for All Bill
Rep. Pramila Jayapal (D-WA) introduced an ambitious Medicare for All proposal today that would move all Americans to Medicare plans, entrusting private insurers only with supplemental coverage.
The Medicare for All Act of 2019 has over 100 House cosponsors, most of whom are progressive Democrats. It would transition consumers to a government-run plan over two years, revise how healthcare providers are reimbursed, and eliminate the requirement for premiums, deductibles, or copays in order to receive care.
“Americans are literally dying because they can’t afford insulin or they can’t get the cancer treatment they need,” said Jayapal. “There are some things that should not be provided through the for-profit market.”
House Speaker Nancy Pelosi has not endorsed the health-care plan. Without support from centrist House Democrats, the bill may not come up for a vote.
Insurance industry lobbying groups have come out against Medicare for All proposals. “The vast majority of Americans are satisfied with the coverage they have today. They have choice and control over their coverage, options, and treatment,” said America’s Health Insurance Plans in a statement.
Healthcare Reform News Update for February 21, 2019
CMS Projects 5.5% Annual Rise in Healthcare Spending Over the Next Decade
The Centers for Medicare and Medicaid Services projects that government spending on healthcare will increase an average of 5.5 percent annually over the next 10 years.
The department’s Office of the Actuary projected that healthcare spending will exceed $5.9 trillion in 2027, representing 19.4 percent of the gross national product, according to a CMS report released Wednesday.
The CMS analysis also projected the following:
- In 2027, 47 percent of healthcare costs will be paid by federal, state, and local governments—an increase from the current 45 percent.
- Nearly half of the increase in personal healthcare spending will be from price increases for outpatient drugs, hospitals, and physicians. Another cause is the transition of baby boomers from private insurance plans to Medicare.
- Spending increases over the next decade will include 4.8 percent for private insurance, 5.5 percent for Medicaid, and 7.4 percent for Medicare.
The report also projects that the repeal of the Affordable Care Act’s individual mandate will increase the uninsured population from 29.9 million in 2018 to 31.2 million this year.
Healthcare Reform News Update for February 15, 2019
House Democrats Allowed to Defend ACA in Federal Lawsuit
A federal appeals court ruled on Thursday to allow House Democrats to join 16 Democratic states and the District of Columbia in defending the Affordable Care Act in a lawsuit filed by 20 Republican attorneys general.
The Trump administration has declined to defend the healthcare law in the case. In his ruling, Circuit Judge Leslie Southwick said, “In the absence of any other federal governmental party in the case presenting a complete defense to the Congressional enactment at issue, this court may benefit from the participation by the House.”
The case has been in appeal since a federal district judge in Texas ruled the ACA unconstitutional. Southwick declined the Democrats’ request to expedite the appeal.
Healthcare Reform News Update for February 14, 2019
New Bill Proposes Selling Medicare to People Age 50 to 65 on ACA Exchanges
Congressional Democrats introduced a new bill on Wednesday that would allow anyone over 50 to buy Medicare plans on the health insurance marketplace. Plans would include Medicare Part A, Part B, Part D prescription plans and Medicare Advantage plans.
Sponsors of the “Medicare at 50” bill said that the premiums from the new enrollees will pay for the plan, and those premiums would cost an estimated 40% less than gold plans on the exchanges. Enrollees would also be eligible for Affordable Care Act tax credits and cost-sharing subsidies.
Supporters say that the plan will lower ACA plan premiums by removing the older enrollees from the risk pool, and also lower Medicare premiums through the addition of younger, healthier enrollees.
The Federation of American Hospitals criticized the bill, saying low Medicare margins makes the higher reimbursements they receive from private insurers necessary in order to provide quality care.
House Committee Proposes Four Bills to Combat Recent Changes to ACA
The House Energy and Commerce Committee held hearings on four separate bills on Wednesday that would reverse or revise some of the recent changes by the Trump administration to the Affordable Care Act.
- A bill by Anna Eshoo (D-CA) would require insurers to put consumer warnings on their short term health plans, bringing attention to the fact they offer limited benefits and provide no protections for pre-existing conditions.
- A bill by Kathy Castor (D-FL) would completely cancel the recent expansion of short-term health plans, which extended their duration up to 12 months and allowed renewal for up to three years.
- A bill by Ann Kuster (D-NH) would revoke the ability for states to seek waivers that would allow customers to use the ACA’s tax subsidies to pay for plans that do not meet ACA requirements.
- A bill by Lisa Blunt Rochester (D-DE) would restore ACA navigator and marketing program funds that the Trump administration cut by 90 percent.
Healthcare Reform News Update for February 12, 2019
Utah Lawmakers Decrease Voter-Backed ACA Medicaid Expansion
On Monday, Utah Governor Gary Herbert signed legislation that shrinks an Affordable Care Act Medicaid expansion measure approved by voters in November.
The voter-passed expansion would have covered 150,000 residents with incomes up to 138% of the federal poverty level. The new legislation cuts the eligibility number nearly in half, covering an estimated 90,000 residents with incomes of up to 100% of the poverty level and adds employment conditions.
Before implementation, the state must file waivers with the Trump administration to approve the partial Medicaid expansion. If the waivers are rejected, the measure would revert back to one resembling the voter-approved version.
Healthcare Reform News Update for February 8, 2019
White House Report Says ACA Changes Don’t ‘Sabotage’ Law
A new report from the White House’s Council of Economic Advisors claims that the Trump administration’s changes to the Affordable Care Act help increase effectiveness and don’t damage the overall law.
The report reviews the administration’s extension of short-term health plans, increased availability of association plans, and the repeal of the individual mandate.
“These reforms do not ‘sabotage’ the ACA but rather provide a more efficient focus of tax-funded care to those in need,” says the report.
The report acknowledges that some consumers may drop their ACA coverage due to the newly available alternatives, but argues that the federal exchange will continue to stay afloat due to premium subsidies received by nearly 90 percent of enrollees.
The Republican-lead lawsuit against the ACA is not addressed. However, the report’s analysis concerning the individual mandate repeal could have some bearing on case, as it contradicts the plaintiffs’ arguments that the penalty is central to the law.
The report says that “removing the tax penalty and opening up more affordable options was able to save taxpayer dollars, give families more choice, without destabilizing the exchanges.”
New Poll Shows Majority Want Private Insurance Option in ‘Medicare for All’ Plans
A new Hill-HarrisX survey on universal healthcare coverage found that 87 percent of respondents preferred a healthcare system that includes private plans.
When registered voters were asked about the government’s role in healthcare:
- 32 percent said they preferred a government-run system that included an option to purchase private, supplemental coverage.
- 26 percent said they preferred the “public option” system, where government insurance is available to all, but there is still the option to use private insurance instead.
- 15 percent said they preferred that the government remove itself from paying for healthcare.
- 14 percent said they preferred to keep the current system.
- 13 percent said they preferred a totally government-run system with no private plans available.
Healthcare Reform News Update for February 7, 2019
House Democrats Plan Hearings on Proposals to Overturn Recent Healthcare Changes
In a meeting of the House Energy and Commerce Subcommittee on Wednesday, House Democrats announced they will hold hearings next week concerning proposals that address Trump administration changes that affect the Affordable Care Act.
The subcommittee plans to review legislation that would:
- Overturn new rules that expand short-term health plans
- Restore funding for outreach efforts during the open enrollment period
- Invalidate guidance that makes it easier for states to receive exemption waivers
Any legislation of this nature initiated and passed by the House will face tough battle in the Republican-led Senate.
Bipartisan Senators Question Medical Industry on ‘Surprise Billing’ Practices
A bipartisan group of six senators sent letters to insurance industry and medical groups on Tuesday asking about their balanced billing practices, which can lead to surprise out-of-pocket costs for consumers.
The letter requested information from hospitals regarding:
- the percentage of specialists they outsource,
- the percentage of patients who receive specialty treatment at an in-network hospital that is billed as out-of-network, and
- the increase of patient spending on emergency care.
Insurers were asked to disclose what they pay for out-of-network care compared to average in-network rates and Medicare rates.
“We want to protect patients from costly surprise bills while preventing undue disruption in the health care system,” said the senators in the letter. “To meet this goal, it is critical that we receive additional data and more complete feedback in order to refine and inform our legislative proposal.”
Healthcare Reform News Update for February 4, 2019
Judge Dismisses Lawsuit Maryland Filed to Protect the ACA
Late last week, a Maryland federal judge dismissed a lawsuit from the state that demanded the Trump administration cease its perceived “sabotage” of the Affordable Care Act and declare it constitutional.
The plaintiffs in the case used the administration’s halting of cost-sharing reduction payments, the Department of Justice’s decision to not defend the law in a current lawsuit, and President Trump’s own comments as evidence that law was in danger of not being enforced.
U.S. District Judge Ellen Lipton Hollander called the lawsuit speculative and a “request for an advisory opinion.”
“The president’s profound disdain for the ACA cannot be seriously disputed,” wrote Hollander. “But, the state’s allegations do not create a plausible inference of a substantial or certainly impending risk that the Trump administration will cease enforcement of part or all of the ACA. Neither the president’s zealous attempts to repeal the statute, nor his derisive comments about it, support an inference that he will fail to enforce the law.”
Healthcare Reform News Update for January 31, 2019
Consumers Searching for Coverage Directed to Short-Term Plans That Lack ACA Protections
A new study by Georgetown University’s Center on Health Insurance Reforms found that the those searching for health insurance online last fall were often directed to websites and brokers that sell short-term plans that do not meet Affordable Care Act consumer protection requirements.
In their report, the researchers noted that “lead-generating sites that point consumers to short-term plans or other non–ACA compliant insurance products were the most common search result in every state, representing more than half of all search results before and during open enrollment.”
The search results and the lead-generation led the researchers to two web brokers: Agilehealthinsurance.com and eHealthinsurance.com. Agilehealthinsurance.com only sells non-ACA compliant plans. Ehealthinsurance.com sells short-term plans, ACA-compliant plans and other coverage, but appeared in the search results half as often as agilehealthinsurance.com.
The research team analyzed the top four results, including paid ads, for the search terms “cheap health insurance,” “Obamacare,” “ACA enroll,” and “short-term health insurance.” The study investigated online marketing practices in Colorado, Florida, Idaho, Maine, Minnesota, Missouri, Texas and Virginia in the weeks before and during the ACA’s open enrollment period in November and December.
Researchers also created a profile of a subsidy-eligible 29-year-old female and interacted with six brokers. Half of the brokers recommended ACA-compliant plans, while the remaining three recommended non-ACA compliant coverage, even after learning the consumer was eligible for tax credits.
Sabrina Corlette, the lead author of the study said that “it was disturbing, but not unexpected, to find such a high proportion of misleading ads and come-ons. That raises the risk that consumers could be duped into buying health insurance that they think offers comprehensive and secure coverage, but does not.”
Late last year, the Trump administration extended the term limits of short-term plans from three to 12 months. The low-cost plans are not required to cover consumers with preexisting conditions and do not have to cover services such as maternity care, prescription drugs, or mental health care. Tax subsidies are not available for these plans.
“These plans are different, and consumers do need to know what they are purchasing, which is why we now require more robust warnings about the limits of these plans than before,” said Seema Verma, the administrator of the Centers for Medicare & Medicaid Services.
New Study Shows ACA Did Not Reduce Employer Health Insurance
A new study from the University of Minnesota found that launch of the Affordable Care Act did not cause a reduction in employer-sponsored health insurance plans. Researchers reviewed federal data before and after the law’s implementation and found that employer coverage was mostly unaffected.
The study found “no evidence that employer offers, takeup rates, or out-of-pocket premiums paid by workers changed signiﬁcantly” due to the launch of the ACA or Medicaid expansions.
Jean Abraham, a professor of health care administration at the University of Minnesota, said that company coverage may not have changed for several reasons, including the desire to attract higher-income employees who aren’t eligible for subsidies or Medicaid, the ACA’s employer mandate, and the uncertain future of the individual insurance marketplace.
New California ACA Sign-ups Drop Significantly
Covered California, the state’s Affordable Care Act insurance exchange, announced that the number of consumers who renewed their ACA plans in 2019 increased by 7.5 percent, but new enrollees dropped by 23.7 percent.
For 2019, there were 295,980 new enrollees, compared to 388,344 last year. Total ACA enrollment in California dipped slightly to 8.4 million, down from roughly 8.7 million last year.
Covered California officials say that the drop in new enrollments is due primarily to the Trump administration’s repeal of the ACA’s individual mandate, which required individuals to have health insurance coverage or pay a fine.
California’s recently elected governor has called for a state individual mandate, which will have to be approved by the state’s legislature.
Healthcare Reform News Update for January 25, 2019
Wisconsin Governor’s Attempt to Withdraw From ACA Lawsuit Denied
Newly elected Wisconsin Governor Tony Evers’ request to leave the 20-state lawsuit against the Affordable Care Act was rejected by the state’s attorney general.
Attorney General Josh Kaul said in a letter to Evers that the state’s department of justice “does not have statutory authority to withdraw the State from the ACA litigation absent approval from the Joint Committee on Finance.”
The ability to withdraw the state from lawsuits was taken from the governor and given to the Joint Finance Committee last month in legislation signed by the previous governor, Scott Walker. Kaul has asked this committee to withdraw from the lawsuit.
Healthcare Reform News Update for January 24, 2019
Uninsured Rate at Highest Level Since ACA Implementation
In the fourth quarter of 2018, the number of uninsured Americans was at its highest point since the Affordable Care Act went into effect four years prior, according to a new survey from Gallup.
The overall uninsured rate was at 13.7 percent, compared to 13.4 percent in the first quarter of 2014. Groups with the fastest-growing uninsured rates were women, young adults, and those with a lower-income. The data shows that in the fourth quarter of 2018:
- 21.6 percent of adults under the age of 35 were uninsured.
- 19.6 percent of Americans in the South were uninsured
- 19.1 percent of adults in households making between $24,000 and $48,000 per year were uninsured.
The uninsured rate is still lower than the peak rate of 18 percent, which occurred in 2013 before the ACA was launched.
Gallup cited several factors that could have contributed to the rise in the uninsured rate, including higher premiums, slashed advertising funds, the elimination of cost-sharing reduction subsidies, negative political rhetoric and the repeal of the ACA’s individual mandate.
Colorado to Have New State Office Devoted to Healthcare Costs
Jared Polis, the newly elected governor of Colorado, signed an executive order on Wednesday to create The Office of Saving People Money on Health Care.
The office will focus on lowering the costs of insurance, hospital stays, and prescription drugs. It will also tackle price transparency and efficiency improvements.
“So right now, cost is a barrier to access. By reducing costs we’ll help businesses, we’ll help the state, we’ll help the health care system, and, most importantly, we’ll help the patients,” said Lt. Gov. Dianne Primavera, who will oversee the office.
President Trump Addresses His Concern Over Surprise Medical Bills
On Wednesday, President Trump asked administration officials to investigate how to eliminate surprise medical bills.
In a White House round-table discussion with Health Secretary Alex Azar, Labor Secretary Alex Acosta, and guests who have been hit with exorbitant out-of-network costs, President Trump vowed to tackle the issue.
“The healthcare system too often harms people with some unfair surprises … medical bills and the like. We’re going to stop all of it, and it’s very important to me,” he said.
Healthcare Reform News Update for January 23, 2019
Kaiser Poll Shows Fluctuating Support for Medicare for All Plans
A new poll released by the Kaiser Family Foundation shows mixed support for Medicare for All plans, with approval varying depending on the information provided.
The poll showed that 56 percent of respondents indicated they supported a national health plan like Medicare for All when initially asked. However, support increased when respondents were told that the program would:
- Guarantee health insurance as a right. (71 percent)
- Eliminate premiums and out-of-pocket costs. (67 percent)
Support for a Medicare for All plan decreased when respondents were told that the plan could:
- Require more taxes. (37 percent)
- Lead to delays in treatment. (26 percent)
The poll also found that 77 percent of Americans support Medicare buy-in plans for people aged 50-64, and 74 percent support optional Medicare buy-in plans for people of any age.
Healthcare Reform News Update for January 22, 2019
Trump Administration Proposes Changes to Out-of-Pocket Limit Calculations
Patients on Affordable Care Act plans could face higher costs if they use brand-name prescription drugs when generics are available, if the proposed changes from the Trump Administration go into effect.
The proposal would allow insurers to only credit the price of a generic drug in a patient’s annual cost-sharing limits, even if the patient purchased the brand-name version. For example, if a patient pays a $30 co-pay to fill a prescription for a brand-name drug when a $10 generic is available, only $10 will be applied toward the patient’s annual out-of-pocket limit.
Similarly, the value of coupons or other cost-lowering assistance from drug manufacturers for brand-name drugs would not count toward the out-of-pocket limit if generics are available.
“The availability of a coupon may cause physicians and beneficiaries to choose an expensive brand-name drug when a less expensive and equally effective generic or other alternative is available,” said the Trump administration.
Critics, including representatives from the AIDS Institute, the National Multiple Sclerosis Society, and the Diabetes Patient Advocacy Coalistion (DPAC), say that the proposal harms patients with conditions that require expensive treatments. These patients often rely on coupons and copay assistance for both brand-name and generic drugs.
“In theory, copay coupons could encourage people to take higher-priced drugs. In reality, people use them to get the medicines that their doctors prescribe, despite astronomically high deductibles,” said Leyla Mansour-Cole, the policy director of DPAC.
Healthcare Reform News Update for January 18, 2019
Trump Administration Proposes Raising ACA Premiums, Cutting Exchange Fees
On Thursday, the Centers for Medicare and Medicaid Services issued proposed rule changes to the Affordable Care Act that would slightly increase premiums and reduce fees for insurers using the exchange.
CMS says that the proposed rule changes detailed in the 331 page document reflect the Trump Administration’s aim to lower premiums for enrollees and reduce the regulatory burden on insurance companies.
Some of the proposals include:
- Increasing premiums by approximately 1 percent to improve the formula that calculates ACA tax subsidies.
- Lowering insurers’ ACA exchange user fees by .5 percent beginning in 2020 to help them reduce premiums.
- Possibly ending the practice of “silver-loading,” where insurers hike premiums only on silver-level plans in order to increase the ACA tax subsidy amounts available to enrollees.
- Requiring insurance companies that offer plans with abortion coverage to offer “mirror” plans that don’t cover those services.
- Allowing Congress to create a way to fund cost-sharing reduction payments, which the Trump administration halted in 2017.
- Increasing the annual cost-sharing limit by 3.8 percent for individuals and families.
- Allowing higher-income consumers to qualify for a special enrollment period if their income level decreases and becomes low enough to be eligible for a premium tax subsidy.
The document says that the proposals would save an estimated $900 million per year on tax subsidies, but also estimates an enrollment decrease of 100,000. The proposal is currently open for public comment.
Healthcare Reform News Update for January 15, 2019
Judge Issues National Block on New Contraception Rules
Pennsylvania District Court Judge Wendy Beetlestone issued a nationwide block on a Trump administration rule that would allow more companies to opt out of providing free birth control coverage to employees.
The ruling came one day after a California judge made a similar ruling that applied to 13 states and the District of Columbia.
Beetlestone said that the new rules went beyond the scope of the Affordable Care Act, which she said specifically prohibits the U.S. Department of Health Human Services from allowing these kind of exceptions. Beetlestone also said the rules would put the burden on states to pay for birth control and could result in 70,500 women losing contraception coverage.
It’s likely that the Department of Justice will appeal the ruling. “Religious organizations should not be forced to violate their mission and deeply held beliefs,” it said in a statement.
Healthcare Reform News Update for January 14, 2019
Judge Blocks Changes to ACA Contraception Rules in 13 States
The Trump administration’s decision to expand employer exemptions to the Affordable Care Act’s birth control rules has been blocked from taking effect in 13 states and the District of Columbia.
The new policy, scheduled to go into effect today, allows more companies to opt out of providing no-cost birth control on religious or moral grounds.
Washington D.C., California and 12 other plaintiffs requested an injunction to keep the new rules from going into place while a lawsuit against them moves through the courts. U.S. Judge Haywood Gilliam sided with the plaintiffs, saying that the new rules could cause a “substantial number” of women to lose birth control coverage. However, his decision applies only to the plaintiffs who filed the suit, not nationwide.
Gilliam’s ruling applies to California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia.
ACA Lawsuit Appeal Suspended Due to Government Shutdown
U.S. Court of Appeals Judge Leslie Southwick has temporarily halted the appeal of the Affordable Care Act lawsuit due to the partial government shutdown.
Attorneys for the Department of Justice are unable to work until the government is reopened. They requested that the proceedings be paused so upcoming deadlines would not be missed.
Healthcare Reform News Update for January 11, 2019
Bipartisan Bill Filed to Eliminate ACA Health Insurance Tax on Insurers
Senators Kyrsten Sinema (D-AZ), John Barrasso (R-WY), and Cory Gardner (R-CO) filed legislation on Thursday to repeal the Affordable Care Act’s health insurance tax, saying that its implementation would raise premiums.
The tax, which is levied on health insurers, has been delayed numerous times but is currently scheduled to go into effect next year.
Healthcare Reform News Update for January 10, 2019
House Passes Measure to Intervene in ACA Lawsuit
The House passed a measure 235-192 to legally intervene in the lawsuit aiming to strike down the Affordable Care Act. All Democrats and three Republicans voted their support on Wednesday.
Last week, a similar intervention measure was passed as part of a broad rules package. Yesterday’s vote isolated the issue so that the Democratic majority could put Republicans on record as voting against the ACA and its protections for Americans with pre-existing medical conditions. During the midterm campaigns, many Republicans promised to protect insurance coverage for people with pre-existing conditions.
“A campaign is part of forming a government, and no issue resonated with the American people in the last election like the issue of pre-existing conditions,” said House Ways and Means Committee Chairman Richard E. Neal (D-MA).
Healthcare Reform News Update for January 9, 2019
Democratic Lawmakers in CA, WA & NYC Announce New Health Insurance Programs
The Democratic governors of California and Washington and the mayor of New York City have all started their 2019 terms with proposals for major health insurance initiatives.
In California, Governor Gavin Newsom began his first day in office with proposals that would: create a state individual mandate that requires residents to purchase insurance or pay a penalty; expand Affordable Care Act tax subsidy eligibility to people above the 400% poverty limit; and allow undocumented young adults up to age 26 to be covered by Medicaid.
In Washington, Governor Jay Inslee said that he will introduce a bill for a state public health insurance option for all residents on its state healthcare exchange. “Under the Obama administration and the Affordable Care Act, Washington was able to make tremendous progress in expanding coverage and start bringing down costs in our health care system. Under the Trump administration, all that progress is at risk,” said Inslee.
In New York City, Mayor Bill de Blasio announced he will expand the city’s low-income healthcare program to an additional 600,000 uninsured, including undocumented immigrants. The “NYC Care” plan will provide residents access to physicians and hospitals at reduced cost or no cost, depending on ability to pay. The program will begin the Bronx this summer and roll out citywide by 2021.
Democratic Congress Members Seek Answers Regarding New Short-term Insurance Rules
Democratic lawmakers in the House and Senate have sent a letter to the Trump administration about its decision to expand the length of short-term insurance plans from three to 12 months and allow renewals for up to three-year renewability. This is the third letter sent to the administration asking for additional information about the short-term plans’ economic analysis.
“We believe allowing for renewal or extension of short-term policies for up to 36 months is contrary to law, and that the creation of an entirely unregulated parallel market competing against the market for Qualified Health Plans goes against Congressional intent in enacting the comprehensive consumer protections embodied in the Affordable Care Act,” they said in the letter.
The administration believes that the short-term plans are a good alternative for healthy individuals looking for lower-cost insurance. The plans do not follow the Affordable Care Act restrictions, which means they can omit some health services and deny coverage of pre-existing conditions.
Committee Chairman Asks for Single-Payer Healthcare Budget Report
House Budget Committee Chairman John Yarmuth (D-KY) has requested Congressional Budget Office (CBO) analysis of single-payer healthcare proposals.
“The House Budget Committee will soon schedule hearings to review potential ways to achieve affordable, high-quality health care coverage for everyone, including Medicare for All. To begin that work, I have requested that the Congressional Budget Office provide a report on the design considerations that policymakers should consider in developing proposals to establish a single-payer system in the United States,” said Yarmuth in a statement.
Healthcare Reform News Update for January 8, 2019
ACA Individual Mandate Repeal Could Set Back Insurance Coverage Gains
A new study found that the repeal of the Affordable Care Act’s penalty for not having insurance could reverse the recent increases in coverage for Hispanics, younger Americans, the healthy, those with a lower income.
The study, published earlier this week in the journal Health Affairs, is based on a 2017 survey of 3,000 California residents. Nineteen percent of respondents said that they would not have purchased health insurance in 2017 if there was no penalty.
Findings in the study include:
- 31 percent of Hispanics said they would not buy a health plan if there was no mandate.
- 22 percent of people with no chronic conditions would not have purchased a plan if there was no tax penalty.
- Men age 18 – 30 were twice as likely to drop health coverage than those over 50 in absence of a penalty.
- Premiums would have increased by an estimated 4 to 7 percent if all those who said they would not keep health insurance without the tax penalty dropped their coverage.
The elimination of the individual mandate went into effect on January 1. The penalty still applies to those who went without health coverage in 2018.
“Especially for lower-income consumers who are potentially eligible for subsidies, it’s really important to try to understand how eliminating the penalty might affect their choices,” said Vicki Fung, assistant professor of medicine at Harvard Medical School and lead author of the study.
Poll Shows Strong Democratic Support for Public-Option Healthcare Plans
A new Harvard/Politico poll shows that 71 percent of Americans support a Medicare buy-in option for people under 65. Of these respondents, 83 percent are Democrats and 60 percent are Republicans.
A public health insurance option that would compete with private insurance companies is supported by 65 percent of respondents (70 percent Democrats and 51 percent Republicans).
Other findings from the poll:
- 91 percent support protections for people with pre-existing conditions.
- 68 percent support providing health insurance through a taxpayer-funded, national plan
- 36 percent were not aware of the repeal of the ACA’s individual mandate.
- 92 percent ranked addressing the high prices of prescription drugs as extremely important.
Healthcare Reform News Update for January 4, 2019
2019 Federal ACA Exchange Enrollment Falls Slightly
Final data from CMS shows that 8.4 million people signed up on the healthcare.org site during the 2019 Open Enrollment Period, a 3.8 percent decrease from last year.
Additional data from the report:
- There were 6.3 million returning enrollees, an increase of 0.9 percent from 2018.
- There were a little less than 2.1 million new enrollees, which is about a 15.8 percent decrease from 2018.
- Florida, Hawaii, Mississippi, Oklahoma, Utah, and Wyoming increased their number of enrollees.
- Virginia had the largest decrease in enrollees at 18 percent, presumably due to the state’s expansion of Medicaid to 400,000 residents.
CMS says it will release a report that includes state exchange enrollment figures in March.
Democratic Attorneys General Appeal ACA Decision
A coalition of 17 Democratic states on Thursday filed to appeal a federal judge’s decision declaring the Affordable Care Act unconstitutional. The lawsuit will now go to the 5th U.S. Circuit Court of Appeals in Louisiana.
Led by California Attorney General Xavier Becerra, the attorneys general expect a decision within a year. Last week, Judge Reed O’Conner ruled that the ACA will remain in place during the court process.
Medicare for All to Get Hearings from House Democrats
House Democrats plan to hold hearings on universal healthcare legislation after House Speaker Nancy Pelosi (D-CA) gave her support.
Representative Pramila Jayapal (D-WA), the sponsor of the Medicare for All proposal, expects to release a bill this month and hold hearings in a number of committees.
“It’s a huge step forward to have the speaker’s support,” she said.
Maine’s new Governor Orders ACA Medicaid Expansion
Janet Mills, the newly installed governor of Maine, called on state health officials to move ahead with implementing Affordable Care Act Medicaid expansion that was approved by voters over a year ago.
The state’s previous governor, Paul LePage, blocked expansion efforts, saying the program was not adequately funded. Mills has asked the state Department of Health and Human Services to work with lawmakers to find a method of “sustainable” funding.
Healthcare Reform News Update for January 3, 2019
New Democratic House to Vote Next Week on Defending ACA in Lawsuit
The House of Representatives plans to hold a vote next week on whether to defend the Affordable Care Act in the federal lawsuit that’s set to be heard in the appellate court.
Last week, the federal judge who ruled that the ACA as invalid allowed the appeals process to proceed. The law continues to be in effect while it moves through the appeal process.
The new House Democratic majority intends for the vote to put pressure on Republicans, who campaigned on their support of pre-existing conditions protections as currently outlined in the ACA. “Republicans who survived the election on their tardy promises to protect pre-existing conditions will have to explain why they have once again been complicit in trying to strike down those life-saving protections,” said a spokesman for House Speaker Nancy Pelosi (D-CA).
Though legal experts on both sides do not expect the ruling against the ACA to be upheld, President Trump predicted yesterday that the Supreme Court will side with the decision. “We should win at the Supreme Court, where this case will go. When we do, we will sit down with the Democrats and we will come up with great healthcare,” he said.
Insurance Lobbying Groups Ask for Changes to Proposed HRA Rule
America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association warned the Trump administration that allowing the use of HRA funds to purchase short-term insurance plans could weaken the individual market and raise premium rates.
In October, the Centers for Medicare and Medicaid Services announced a proposed rule that would allow employees to use money in HRA accounts to buy insurance from the individual marketplace beginning in 2020.
The Blues Cross and Blue Shield association cautioned that also allowing employees to use the HRA funds for short-term plan insurance plans that do not adhere to the ACA requirements “runs the risk of upending the individual market and dramatically increasing costs.”
Both groups also recommended that implementation of the rule be delayed until at least 2021 to help ensure effective administration.
Healthcare Reform News Update for January 2, 2019
ACA Remains in Effect While Appeal Efforts Move Forward
U.S. Judge Reed O’Connor finalized his decision against the Affordable Care Act and allowed the case to go the 5th U.S. Circuit Court of Appeals. The law continues to remain in place as it goes through the appeal process.
In his order, O’Connor said that his stay of the law will prevent Americans from facing “great uncertainty” and that he was confident that the appellate court will side with his ruling.
Colorado Legislators to Propose State Public Health Insurance Option
Two lawmakers in Colorado will propose bills that would establish the country’s first state-run, public health insurance option.
Rep. Dylan Roberts will introduce a bill that will create the infrastructure to create the program and gain approval from the federal government. Sen. Kerry Donovan’s bill will set up a pilot program to offer the option to counties with limited insurance choices and high premiums.
The program would offer Colorado residents the option to purchase an insurance plan from the state. “This is not free insurance. You’re still going to pay a monthly premium,” said Roberts.
The lawmakers believe that the program could increase competition and reduce overall premiums for residents.
Healthcare Reform News Update for December 26, 2018
Republicans Urge Judge to Allow Appeal on ACA Ruling
U.S. District Judge Reed O’Connor ruled that the Affordable Care Act was unconstitutional on December 14, and the Democratic attorneys general defending the law vowed to immediately appeal the decision. On Friday, the Republican attorneys general who originally filed the lawsuit asked O’Connor to move forward with the appeal process.
The Republicans said that they hoped the 5th U.S. Circuit Court of Appeals, and potentially the Supreme Court, will uphold O’Connor’s ruling so that states would be able to regulate their own individual insurance marketplaces.
“When that happens, the states will be able to enact policies and regulations accomplishing what the ACA promised but could never provide: affordable health insurance for all Americans,” they wrote.
Currently, the ACA remains the rule of the land while the appeal process continues.
Healthcare Reform News Update for December 20, 2018
ACA Enrollment Stays Relatively Steady
Total enrollment for 2019 health insurance plans on the Affordable Care Act federal exchange is currently 8.5 million, which is 4 percent lower than last year. The data does not yet include enrollees who signed up within three hours before the deadline or those who were put on a waitlist. The final tally is due next week.
During the final week of open enrollment, 4.3 million people signed up for insurance, which is 318,000 more than the final week in 2017.
States that run their own healthcare exchanges have mostly seen an increase in enrollees:
- New York has already exceeded last year’s numbers with over 1 million enrollees. Sign-up continues until January 31.
- Maryland has seen a 2 percent increase in enrollment.
- Colorado and Minnesota have seen a 5 percent increase in enrollment.
- Washington has seen a 10 percent decrease in enrollment.
Senate Democrats’ ACA Resolution Blocked
A resolution drafted by Senate Democrats to intervene in the federal lawsuit against the Affordable Care Act was blocked by Senator John Barrasso (R-WY).
The resolution requested unanimous consent for the Senate’s legal counsel to defend the ACA in court. Last week, a federal judge ruled that the law was unconstitutional, but this decision is in the process of being appealed.
Barrasso claims that the resolution was a political ploy. “Regardless of what happens in this legal process, we look to protect people with pre-existing conditions,” Barrasso said.
Democrats argued that the best way to protect those with pre-existing conditions is to defend the law and its provisions.
“If people say we all have sympathy and empathy for people with pre-existing conditions, if you want to protect then … at least allow us to move forward on a unanimous consent so we can fight and have a fighting chance, as this thing will be appealed to the higher courts,” said Senator Joe Manchin (D-WV).
Healthcare Reform News Update for December 18, 2018
State AGs Ask Federal Judge for Clarification on ACA Ruling
A coalition of 17 Democratic attorneys general have asked Judge Reed O’Connor to clarify ambiguities surrounding his ruling that declared the Affordable Care Act unconstitutional. They’ve requested that O’Connor either issue a stay on the motion pending appeal or an order that declares that the law is still in effect.
Lead by California’s Xavier Becerra, the coalition said that the ruling caused confusion about the current state of the law. It is unclear what will occur on January 1, which is when the repeal of the individual mandate goes into effect. They also requested that O’Connor certify his opinion so that it can be appealed.
“The district court’s ruling poses a dangerous threat to the healthcare of millions of Americans. We’re asking the court to make clear that the ACA is still the law and ensure that all Americans can continue to access affordable healthcare under it,” Becerra said in a statement.
A spokesperson for the Department of Health and Human Services said on Monday that it “will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision.”
Healthcare Reform News Update for December 17, 2018
Judge Rules ACA Unconstitutional, 2019 Enrollment Unaffected
U.S. District Judge Reed O’Connor ruled the Affordable Care Act unconstitutional, siding with 20 Republican lawmakers who said that the repeal of the individual mandate, which imposed a penalty on the uninsured, invalidated the entire law.
The 17 Democrat attorneys general who defended the law plan to appeal the ruling, and the case is expected to ultimately be decided by the Supreme Court.
O’Connor’s decision does not impact 2019 health insurance policies, nor does it immediately affect areas that are guided by the law, such as Medicare, Medicaid, prescription drugs, and public health policies.
“There is no impact to current coverage or coverage in a 2019 plan,” said Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, in a tweet.
White House press secretary Sarah Sanders also confirmed the law’s continued enforcement. “We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place,” she said in a statement.
House Democrats, who will be the majority party beginning in 2019, promised to fight the ruling. “We will take immediate action in the new Congress to intervene in this case and appeal this decision. House Democrats will do whatever it takes to make sure the protections enshrined in the Affordable Care Act endure,” the House Ways and Means Committee Democrats said in a statement.
Senate Minority Leader Chuck Schumer (D-NY) also promised to take action. In an interview, Schumer said he plans to push for a vote to have the Senate to intervene in the case.
California Extends Insurance Enrollment Deadline
Covered California, the state’s Affordable Care Act healthcare exchange, announced that it has extended the deadline to purchase an insurance policy that will start on January 1.
The new enrollment schedule:
- Residents who enroll by Friday, December 21 will have coverage that begins January 1.
- Residents who enroll between December 22 and January 15 will have coverage that begins February.
“We have seen tens of thousands of people flood into Covered California over the past week, and we want to make sure everyone can start the new year off right by being covered,” said Covered California’s Executive Director Peter Lee in a statement.
Healthcare Reform News Update for December 14, 2018
Vox Analyzes 8 Democrat Universal Health Care Proposals
The idea of creating a “Medicare-for-all” healthcare system has become a major issue for many in Congress, especially with Democrats taking over the House in 2019. However, lawmakers differ on the solution. There are currently six different universal health care bills in Congress and two proposals from Democratic think-tanks.
Vox reporters researched these eight plans, spoke to their authors, and published their analysis yesterday. Here are the plans and some of Vox’s findings about them:
- Sen. Bernie Sanders’ (I-VT) Medicare-for-all bill: This Senate bill guarantees that every American has health coverage with no premiums. Employer-sponsored insurance would be eliminated. Income taxes would have to increase. All expenses would be covered, but prescriptions might have copayments.
- Rep. Premila Jayapal (D-WA) and the House Progressive Caucus’ Medicare-for-all bill: This House bill is similar to Sanders’ proposal. Some of the provisions may be currently under revision to more align with Sanders’ version.
- Rep. Jan Schakowsky (D-IL) and Sen. Sheldon Whitehouse’s (D-RI) CHOICE Act: This bill would make enrollment into a Medicare expansion plan optional. Enrollees would pay premiums. Employer-sponsored plans would still be available, but small businesses could opt-in to the Medicare plan. Income taxes would not need to be increased. Plans would cover between 60 and 80 percent of expected medical expenses.
- Sen. Michael Bennet (D-CO), Sen. Brian Higgins (D-NY) and Sen. Tim Kaine’s (D-VA) Medicare X: This is similar to the CHOICE Act, but plans would be available in two tiers: one covers 70 percent of medical expenses, the other covers 80 percent.
- Sen. Jeff Merkley (D-OR) and Sen. Chris Murphy’s (D-CT) Choose Medicare Act: This is also similar to the CHOICE Act, but employees could only opt-in if their employers allow it. Plans would cover 80 percent of medical expenses.
- Sen. Brian Schatz (D-HI) and Rep. Ben Ray Lujan’s (D-NM) Medicaid Buy-in bill: This plan would give residents in all 50 states the option to buy-in to a Medicaid program. States would determine the premiums, copayments, and deductibles. Employer-sponsored plans would still be available. Income taxes would not be increased.
- The Center for American Progress’ Medicare Extra for All proposal: The proposal guarantees that every American has health coverage, with higher-income enrollees paying premiums. Employer-sponsored plans would still be available, but employers will have the option to stop offering coverage and instead pay a payroll tax roughly equivalent to what they currently spend on health insurance. Income taxes would be increased.
- The Urban Institute’s Healthy America proposal: This plan doesn’t set universal coverage standards, but hopes to reduce the number of uninsured by 16 million in its first year. A new market would be established that combines Medicaid and ACA enrollees. Employer-sponsored plans would be available and untouched. Premiums would be a maximum of 8.5 percent of income. Plans would cover 80 percent of medical expenses.
All plans include government regulation of healthcare prices. While the Democrats do not believe they will pass Medicare-for-all with this Congress, they do believe that now is the time for working out the plans and building support.
Healthcare Reform News Update for December 13, 2018
Sign-ups For ACA Plans Down by 11.7%
Around 930,000 people enrolled in an Affordable Care Act health insurance plan on the federal exchange during the sixth week of open enrollment. It was the busiest week yet, but enrollments continue to lag behind last year.
So far, around 4.1 million people have signed up for 2019 ACA plans, which is down 11.7 percent from the same time period in 2018.
Florida continues to have the highest enrollment numbers, with over 999,000 people signed up for coverage to date.
Healthcare Reform News Update for December 12, 2018
New Study Show 4.2 Million Could Purchase ACA Health Plans for $0
A new analysis by the Kaiser Family Foundation found that 4.2 million people without insurance are eligible for $0 premium bronze plans on the Affordable Care Act exchange.
Bronze plans with a $0 premium are available to enrollees who qualify for subsidies that equal or exceed the price of the plan. The study finds that of the 15.9 million Americans without insurance, 27 percent are eligible for the plans.
Availability of $0 plans varies by location. Only 5 percent of uninsured consumers in Washington and Indiana have access to the plans; however, more than 45 percent have access in Delaware, Iowa, Nebraska, and Utah.
The study also suggests that premiums are not the only expense enrollees should take into account. The average deductible for 2019 bronze plans is $6,258, while silver plan deductibles range from $239 to $3,169. Those who qualify for subsidies can purchase silver plans for $20 to $130 per month, depending on income.
ACA Signups Spiked on Monday
With the enrollment period in its last week, the Affordable Care Act’s healthcare.gov site received its highest traffic on Monday.
Due to the high volume, some users were placed into a “waiting room” to help the website adjust.
According to the Centers for Medicare and Medicaid Services, enrollees who call to enroll may be asked to leave their contact information and wait for a callback. Those that do may not be contacted before the December 15, but they will still be eligible for coverage that begins on January 1.
Judge Upholds Religious Groups’ Position Against ACA Birth Control Mandate
A federal judge issued an order this week that blocks the federal government from forcing religious groups to cover contraception-related drugs, devices, and related counseling as required in the Affordable Care Act.
Judge Philip Brimmer sided with the plaintiffs, six religious colleges and organizations that requested a permanent injunction against the mandate. The government did not fight against the lawsuit.
Healthcare Reform News Update for December 11, 2018
Groups Call for Legislation Tackling Surprise Medical Bills
Nine organizations sent a joint letter to Congress on Monday that called for federal legislation to protect consumers from surprise medical bills issued by to out-of-network providers.
Although several states have passed laws to prevent patients from receiving unexpected charges while inadvertently visiting an out-of-network doctor or facility, there are no federal protections.
The nine organizations represent health insurance, employers, and consumer groups. They asked lawmakers to stop providers from billing a patient for medical costs not covered by insurance when the choice of provider is not the patient’s fault. However, they also stressed that any new laws should not cause a rise in insurance premiums or deter providers from joining a health plan’s network.
The groups include Blue Cross and Blue Shield Association, America’s Health Insurance Plans, the National Business Group on Health, Consumers Union, American Benefits Council, The ERISA Industry Committee, Families USA, the National Association of Health Underwriters, and the National Retail Federation.
CEOs from the American Hospital Association responded, blaming inadequate provider networks as a major cause of surprise medical bills.
Obama Urges Americans to Enroll in ACA Plans
Former President Barack Obama posted a video on Twitter Monday in which he encourages the uninsured to enroll in Affordable Care Act plans.
The post received over 500,000 views within the first hour it was released.
As he has in past years, Obama stressed the importance of health insurance and signing up before Saturday’s deadline.
Blue Shield of California to Limit Out-of-State Coverage
Beginning January 1, Blue Shield of California will cut back on its out-of-state coverage for members with individual health plans.
The plans will continue to cover out-of-state emergency services, urgent care, and some limited primary care. The company said it will work with member who currently use out-of-state providers and will allow telephone consultations with out-of-state physicians.
“We’re trying to focus on affordability and part of that is focusing on our provider network in California. We’re able to manage our costs better,” said Blue Cross Spokesperson Amanda Wardell.
The change will only affect members in California with individual health plans, not those with employer or Medicare plans.
Healthcare Reform News Update for December 10, 2018
ACA Risk-adjustment Program to Continue Normal Operations
A final rule was issued by The Centers for Medicare and Medicaid (CMS) that allows normal operation of the Affordable Care Act’s risk-adjustment program to continue for the 2018 benefit year.
The risk-adjustment program moves money from health insurance plans with healthier enrollees to plans with sicker, more expensive enrollees. The rule comes during ongoing litigation regarding the formula the CMS uses to determine insurance companies’ payment responsibilities. Currently, the CMS uses a statewide average premium in the methodology instead of an insurer’s own premium.
“Today’s final rule continues our commitment to provide certainty regarding this important program, to give insurers the confidence they need to continue participating in the markets, and, ultimately, to guarantee that consumers have access to better coverage options,” CMS Administrator Seema Verma said in a statement.
House Reps Ask for Details on Administration’s Pre-existing Conditions Stance
Four Democratic House Representatives have sent a letter to President Trump’s administration looking for explanations concerning its decision to not defend Affordable Care Act’s pre-existing condition protections in court.
Frank Pallone Jr. (D-NJ), Richard Neal (D-MA), Bobby Scott (D-VA) and Jerrold Nadler (D-NY) addressed the letter to Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma.
The lawmakers requested any analysis the administration may have performed to determine its position, and details of how the administration will respond if the protections are eliminated.
“In declining to defend these provisions, the Trump Administration is seeking to invalidate these critical patient protections, and once again subject millions of Americans with preexisting conditions to the discrimination they faced before the ACA,” the letter said.
Healthcare Reform News Update for December 7, 2018
Enrollment for 2019 ACA Plans Fall Behind Last Year By 11%
With one week left in the Affordable Care Act’s 2019 open enrollment period, the total number sign-ups continue to trail behind to last year.
The first five weeks of enrollment saw 3.2 million enrollments, compared to 3.6 million last year—a drop of 11 percent. New customer sign-ups are down 17 percent.
Industry experts cite several reason for the drop, including:
- the repeal of the individual mandate,
- funding cuts for advertising and enrollment assistance, and
- a shorter first week of enrollment.
Healthcare Reform News Update for December 6, 2018
Majority of 2019 ACA Plans Have Narrow Provider Networks
New analysis from consulting firm Avalere shows that 72 percent of 2019 Affordable Care Act plans sold on the federal exchange have narrow provider networks. A plan with a narrow provider network only covers the care members receive from a small list of approved providers.
The number of narrow-network plans remained steady compared to last year. In 2018, 73 percent of plans had a narrow network.
Of all plans on the 2019 ACA exchange:
- 53 percent are narrow-network HMO plans
- 19 percent are narrow-network EPO plans
- 21 percent are broad-network PPO plans
- 6 percent are broad-network point-of-service plans
Chris Sloan, a director at Avalere, said that the trend toward lower-cost narrow networks is expected to continue. “Narrow network doesn’t mean it’s bad, or that patients in the network are getting sub-quality care. You can have a narrow network that’s great and that’s high quality,” he said.
Insurers prefer the narrow-network plans because they help control enrollee spending and keep premiums lower. Critics argue that provider directory inaccuracies could leave patients with unexpectedly large medical bills and that the lack of choice may also require members to drive long distances to receive care.
Reinsurance Plan in Minnesota Could Lose $100M in Funding
Minnesota lawmakers will debate the future of its reinsurance program after the estimate for federal funding was reduced from $183.9 million to $84 million. The estimate is based on the amount of premium tax credits the federal government would have paid out to residents if this waiver-based program was not in place.
The program helps insurers cover the costs of residents with the highest medical bills, and has helped the state lower the growth rate of premiums over the last two years.
Healthcare Reform News Update for November 30, 2018
New CMS State Waiver Concepts Expand Use of ACA Tax Subsidies
The Centers for Medicare & Medicaid Services (CMS) recently issued four state Affordable Care Act waiver concepts to “promote more affordable, flexible health insurance coverage options.”
The concepts allow states to bypass current ACA regulations and suggest alternate uses of tax credit subsidy programs. Any state programs developed using the waivers must be approved by the CMS and are are required to meet the law’s “guardrails” of comprehensiveness, affordability, coverage, and federal deficit neutrality.
The state concepts suggested include:
- Setting up “account-based subsidies.” States could use federal ACA subsidies to create accounts that work much like health savings accounts. Residents could then use the funds in the account to pay for health insurance premiums or out-of-pocket expenses.
- Adopting “state-specific premium assistance.” These state-administered plans could adjust the way subsidies are distributed in an attempt to attract young, healthy consumers and help individuals whose higher income makes them ineligible for federal tax credits.
- Creating “adjusted plan options” that allow tax subsidies to be used for non-ACA marketplace plans, short-term plans, association health plans or catastrophic plans.
- Forming “risk stabilization strategies” to help insurers pay medical bills for patients with high healthcare costs. Suggestions from CMS include reinsurance programs and high-risk pools.
CMS also encouraged states to “couple waiver concepts with other ideas” to meet the needs of their residents.
Critics of the concepts point out that the measures: might fall under legislative rule and need to go through Congress before being implemented; could create rules that vary widely by state; and could harm consumers with “skimpy” coverage that’s not required to include pre-existing condition protections.
Healthcare Reform News Update for November 29, 2018
ACA Enrollment Continues to Trail Last Year’s Numbers
About 350,000 fewer people have signed up for healthcare on the federal exchange compared the same period last year.
In the first four weeks of open enrollment, over 2.4 million people have signed up for ACA plans, a drop from nearly 2.8 million in 2017. The numbers only include enrollments through the national federal exchange and do not yet include automatic renewals.
A new Kaiser Family Foundation poll suggests that one reason for the drop could be lack of awareness. According to the survey:
- About 69 percent of Americans who purchase individual plans did not know that enrollment ends on December 15 for most states.
- Only 25 percent of respondents are aware of seeing any ACA-related advertising.
Some state exchanges are seeing an increase in ACA signups. For example, New York is currently 10 percent above last year’s enrollment figures, with 36,000 new enrollees and 870,000 renewals.
Number of Uninsured Children Increased for First Time Since 2008
A new report by Georgetown University’s Center for Children and Families shows that the number of uninsured children in the country rose by 276,000 in 2017. This increase follows almost a decade of steady decline.
In 2017, there were 3.9 million uninsured children in the U.S., compared to 3.6 million in 2016. Some findings from the study include:
- Texas leads in the nation in the number of uninsured children with 835,000, or 1 in 5, going without coverage.
- Other marked increases occurred in South Dakota (from 4.7 percent to 6.2 percent), Utah (from 6 percent to 7.3 percent), and Florida (from 6.6 percent to 7.3 percent).
- States that have not implemented ACA Medicare expansion increased the uninsured rate by triple the rates of states that have.
- The rate of uninsured children among Hispanics was 7.8 percent, 4.9 percent among whites and 4.6 percent among blacks overall.
The study suggests that one reason for the increase could be that 25 percent of minors in the country have a parent who is an immigrant; these parents might avoid enrollment for fear of deportation.
Healthcare Reform News Update for November 28, 2018
State ACA Reinsurance Programs Successful in Lowering Premiums
The first three states to implement Affordable Care Act reinsurance programs were able to stabilize their markets and boost enrollment, according to a study by Georgetown University’s Center on Health Insurance Reforms.
Alaska, Minnesota and Oregon implemented the programs last year, which reimburse insurers for eligible high-cost claims. The study found that in 2018:
- Alaska lowered average rates 26 percent compared to 2017.
- Minnesota reduced its rates by 11.3 percent.
- Oregon rates fluctuated, but are an estimated 6 percent lower than what they would have been if the program had not been implemented.
The study also found that the programs did not attract additional insurers to the state ACA exchanges. Alaska and Minnesota retained the same number of insurers; Oregon saw a decrease.
Illinois Limits Short-Term Health Insurance to Six Months
Illinois Governor Bruce Rauner vetoed a bill that limited short-term health insurance to six months, but the state legislature overrode his decision on Tuesday.
The bill was drafted in response to new rules from the Trump administration, which allow customers to stay on short-term plans for up to twelve months and renew them for up to three years. However, consumer advocates say these cheaper plans provide less comprehensive coverage, don’t include pre-existing condition protections, and expose consumers to higher out-of-pocket costs than insurance plans covered by ACA regulations.
Illinois joins several states, such as California, New York, New Jersey, and Washington, that have limited or banned the new, expanded short-term plans.
California Uninsured Projected to Increase Drastically Without State Intervention
The number of uninsured Californians could increase by 800,000 in five years if the state fails to expand coverage, according to a report by the UC Berkeley Labor Center and UCLA Center for Health Policy Research.
The report projects there will be 4.4 million uninsured Californians in 2023, which would represent 12.9 percent of the population.
The number of uninsured residents is projected to increase primarily due to the repeal of the Affordable Care Act’s individual mandate, which levied a penalty against people without coverage.
The report says that policies such as a state individual mandate, state-funded financial assistance, and expansion of the Medi-Cal program could help keep people from dropping their coverage.
“Unless the state takes action, the number of uninsured will start creeping back up. Our uninsured rate did go down significantly because of the ACA, and we’re estimating it could climb up. But the state does have some policy options and policy levers it could pull to try to get to universal coverage,” said Miranda Dietz, the lead author of the report.
Healthcare Reform News Update for November 26, 2018
ACA 2019 Benchmark Plan Premiums Decrease, Choices Increase
Nineteen states are seeing lower premiums for 2019 Affordable Care Act benchmark silver plans compared to last year, with many areas also experiencing an increase in the number of insurers.
Premiums for the cheapest available plans have been reduced by 10 percent on average for more than half of the counties that use the federal health exchange. Nationally, premiums for the average benchmark silver plan decreased about one percent.
Tennessee leads the country in reducing benchmark premiums, with an average 26 percent decrease. In 2018, a 40-year-old Tennessee resident paid $743 on average for a benchmark plan; this year it’s $548. Competition has also increased; over 82 percent of Tennessee counties had only one insurer selling ACA plans in 2018. For 2019, it’s under 52 percent.
Arizona is another newly competitive market. In 2018, the Phoenix area had a single insurer selling ACA plans. For 2019, that insurer has lowered its most affordable silver plan by 12 percent and is joined by three competitors.
ACA Enrollment Down on Federal Exchange, Up on Some State Exchanges
In the first three weeks of the Affordable Care Act’s open enrollment period, over 1.9 million people have signed up for 2019 coverage on the federal exchange. That is down from 2.3 million last year.
Though enrollment has lagged on the federal exchange, several state exchanges have seen increases compared to 2018 sign ups. Minnesota is up 6.9 percent with almost 98,000 enrollments during the first two weeks of open enrollment. Colorado is up 13.1 percent with around 25,600 enrollees during the first two weeks of open enrollment.
Other details on Week 3 of the federal exchange enrollment:
- 748,244 total households selected plans (down 6.3 percent from last year)
- 566,250 households renewed coverage (down 2.1 percent from last year)
- 181,994 households purchased plans for the first time (down 17.4 percent from last year)
Healthcare Reform News Update for November 20, 2018
House Democrats Plan to Investigate DOJ’s Decision Over ACA Lawsuit
When Democrats take over the House in January, they plan to investigate why the Department of Justice Department declined to defend the Affordable Care Act in federal court, according to Rep. Jerrold Nadler (D-NY).
Twenty Republican-governed states have sued the federal government in an attempt to end the ACA. In June, the DOJ refused to defend the healthcare law in the suit.
Nadler, the expected upcoming chair of the House Judiciary Committee, sent a letter to acting Attorney General Matthew Whitaker, asking him to respond to letters previously sent to former attorney general Jeff Sessions about the decision.
“This committee expects to examine the department’s refusal to defend a duly enacted federal statute, the abrupt resignation of veteran department employees and an apparent determination by this administration to undermine affordable healthcare coverage for millions,” Nadler wrote.
Maryland Lawmakers to Propose State Individual Mandate
Some legislators in Maryland are backing a plan that would require state residents to be covered by health insurance or pay a fine.
Unlike the federal individual mandate that was repealed earlier this year, the state proposal would enable the uninsured to use the fine amount as down payment on a health insurance policy sold on the state’s Affordable Care Act exchange.
“Our ‘down-payment plan’ helps get the uninsured to contribute. They get the care they need while we shrink uncompensated care, holding down insurance costs for everyone,” said state Democratic representative Joseline Peña-Melnyk in a radio ad.
Passage of the bill is uncertain, as Governor Larry Hogan has expressed his disapproval. “While we are always open to ideas to make healthcare more accessible and affordable for Marylanders, the governor favors incentives over penalties,” said Amelia Chassé, a spokeswoman for Hogan.
Connecticut ACA Exchange to Oppose New Abortion Billing Proposal
The Trump administration’s proposal to require separate billing for abortion coverage is being challenged by Connecticut’s Affordable Care Act exchange.
Access Health CT will submit public comment to protest, with lawmakers arguing that the regulation would be a burden on insurance companies. “This proposed rule will impact our carriers…and we are committed to helping our carriers in any way we can,” said James Michel, CEO of Access Health CT.
The proposal was introduced earlier this month by the Centers for Medicare & Medicaid, who said that separate billing would ensure that no federal funds would be used to pay for abortion services.
Healthcare Reform News Update for November 16, 2018
Over 20 Million More Americans Insured Since Passage of the ACA
There are now 20.1 million fewer Americans without health insurance than when the Affordable Care Act was enacted in 2010, according to data released by the Centers for Disease Control and Prevention.
Findings in the data include:
- In the first half of 2018, there were 28.5 million uninsured Americans, compared to 48.6 in 2010.
- About 70 percent of adults age 18-64 are currently covered by private health insurance. Four percent of the insured (almost 8 million people) purchased plans on an ACA exchange.
- Most likely to be insured are adults aged 25-34; only 16.5 percent do not have coverage.
- States that have expanded Medicaid coverage have an average uninsured rate of 9.1 percent, compared to 18.1 percent for states that have not.
House Democrats Split on Medicare for All
Democrats, soon to be the majority in the House of Representatives, are debating whether to vote on legislation regarding single-payer insurance coverage.
Progressives, such as Raúl Grijalva of Arizona and Pramila Jayapal of Washington, are pushing to introduce a revised bill in January.
Centrists, including Ron Kind of Wisconsin and Frank Pallone Jr. of New Jersey, believe that a vote is not realistic since a bill would not get through the Republican-controlled Senate.
“I’ve always been an advocate for Medicare for all or single-payer, but I just don’t think that the votes would be there for that, so I think our priority has to be stabilizing the Affordable Care Act, preventing the sabotage that the Trump administration has initiated,” said Pallone.
Healthcare Reform News Update for November 15, 2018
Insurance Company Participation in ACA Marketplace is Rising
New analysis from the Kaiser Family Foundation finds that more insurance companies are participating in the Affordable Care Act’s 2019 Health Insurance Marketplace than in 2018.
After reviewing data by state and county, their findings show that:
- For 2019, 608 counties are gaining at least one insurance company, while only five counties are losing an insurer.
- Approximately 17% of enrollees have only one insurer in their county for 2019; dropping from 26% in 2018.
- There are four insurers per state on average in 2019, compared to 3.5 in 2018. The highest average was six per state in 2015.
- Alaska, Delaware, Mississippi, Nebraska, and Wyoming each have only one insurer for 2019.
- California, New York, and Wisconsin have over ten insurers for 2019.
ACA Signups Continue Slow Start
Signups for Affordable Care Act plans during the early weeks of open enrollment trail last year by about 300,000 people.
During the first ten days of enrollment, about 1.2 million people have signed up for ACA plans, compared to the estimated 1.5 million who signed up during a similar period last year.
An industry analyst from the Kaiser Family Foundation says it’s too soon to predict whether the slow start indicates an overall reduction in ACA enrollment.
Healthcare Reform News Update for November 14, 2018
Expansion of Short-term Health Plans Getting Push-back From States
Delaware is the latest state to initiate new rules on short-term health insurance policies in response to new federal government regulations. State officials announced that the coverage period will be limited to three months.
The new regulations from the Trump administration increase the maximum duration of short-term plans from three months to 364 days and allow consumers to renew plans for up to 36 months. Worried about the plans’ exemption from ACA minimum standards and their potential to create marketplace instability, state regulators have begun responding with rules of their own.
Other recent state responses to short-term plans:
- Vermont requires that the plans cover all ten ACA essential benefits.
- California has banned their sale.
- Washington limits the coverage period to three months, prohibits renewals, and bans their sale during the ACA open enrollment period if coverage will begin in the upcoming year.
Some states, including New York, Massachusetts, New Jersey, South Carolina, Hawaii, and Michigan have existing regulations that limit or ban the sale of the plans.
Healthcare Reform News Update for November 13, 2018
New Association Health Plans Provide Comprehensive Coverage
New association health plans (AHPs) offered by farmer-owned cooperative Land O’Lakes in Nebraska, several Nevada chambers of commerce, and the National Restaurant Association are offering benefits comparable to Affordable Care Act plans for premiums up to 35 percent lower.
The plans are able to offer lower premiums because of several factors, including their ability to set premiums based on gender and industry, which is not allowed with ACA plans. The current plans are not charging people with pre-existing conditions higher rates or denying them coverage.
“AHPs can offer comprehensive coverage and still be cheaper than marketplace plans if they either serve a population that is less costly than the average of the marketplace and/or they somehow are able to pay less for services,” said Katherine Hempstead, a health insurance coverage director for the Robert Wood Johnson Foundation.
Those who qualify for tax subsidies may still be able to purchase comparable plans for less on the ACA exchange than with the AHPs. However, Bruce Ramge, insurance director for Nebraska, claims the plans “will offer another really good choice for individuals who either don’t receive a subsidy and cannot afford coverage on the exchange, or for some reason prefer not to purchase that coverage.”
Some states, fearing that the expansion of AHPs will destabilize the market or lead to increased fraud, have issued new rules and guidance limiting their scope. Democratic attorneys general in 11 states and the District of Columbia filed a lawsuit to block the new Trump Administration rule that allows the expansion of AHPs; the case is still pending.
Healthcare Reform News Update for November 9, 2018
New Democratic House Majority Could Quickly Move to Defend ACA Protections
House Democrats could soon intervene in a lawsuit that attacks the Affordable Care Act and its protections for people with pre-existing conditions.
Using its power as the soon-to-be majority, Democrats may have the House vote on a measure to step in and defend the ACA’s constitutionality. If passed, the measure would not require approval by the Senate or President Trump.
A spokesman for House Democratic Leader Nancy Pelosi said that “the new Democratic House Majority will move swiftly to defend the vital protections for people with people with pre-existing conditions still under legal assault by the GOP.”
The lawsuit was brought by GOP-led states arguing the legality of the ACA. The Trump administration declined to defend the law. The judge’s ruling is expected soon, though the decision is likely to be appealed.
Healthcare Reform News Update for November 8, 2018
Democratic House Majority Will Change Congress’ Healthcare Agenda
The results of the midterm elections last Tuesday will give Democrats the majority in the House of Representatives in 2019, which dramatically alters political healthcare priorities.
In a news conference on Wednesday, Senate Majority Leader Mitch McConnell (R-KY) remarked that Affordable Care Act repeal and replace efforts are over. “I think it is very obvious that a Democratic House is not going to be interested in that,” he said. Instead, McConnell believes that addressing drug prices will be on the agenda.
Democratic leader Nancy Pelosi also said that they “will take real, very strong legislative action” on drug prices. Democrats had made healthcare a primary issue in their campaigns. “Healthcare was on the ballot, and healthcare won,” said Pelosi.
President Trump also weighed in, saying he thinks that bipartisan efforts to improve healthcare is possible. “We want to do something on healthcare; they want to do something on healthcare. There are a lot of great things that we can do together.”
With repeal and replace efforts tabled, the next healthcare clash between Democrats and Republicans— and a certain topic in the 2020 presidential election—will be the issue of Medicare for All. Progressive Democrats have increasingly supported the idea of expanding Medicare to all working-age Americans, but Republicans claim it will harm Medicare for seniors.
First Week of ACA Open Enrollment Lags Behind Last Year’s
During the first three days of the open enrollment period, about 371,700 signed up for insurance through the Affordable Care Act federal exchange. That’s a slower start compared to the first four days of last year’s enrollment period, which saw 601,500 signups.
According to the Centers for Medicare and Medicaid Services, approximately 75 percent of the enrollees had previously purchased an ACA policy, and the remaining were new consumers.
The enrollment period for 2019 ACA plans this year is November 1 through December 15.
New Rules for Employer Contraception Coverage Issued by Trump Administration
On Wednesday, the Department of Health and Human Services issued two new rules that will expand the types of businesses that are allowed to deny birth control coverage to employees due to religious or moral objections.
HHS officials said in a statement that the Affordable Care Act does not include a contraception requirement and that it does “not require the government to violate religious or moral objections to providing or purchasing such coverage.”
Currently, only churches, religious orders, and organizations that received financial support from religious organizations could be exempted from contraception coverage. The new rules add nonprofit organizations, small businesses, and individuals that morally object to providing contraceptive services.
Publicly-traded companies and government entities will not be allowed to claim the exemption.
HMS estimates that the new exemption rules will affect around 200 employers and potentially 6,400 women. However, civil liberty groups and women’s rights advocates have argued that the number is higher.
CMS Proposes Separate, Add-on Billing for ACA Plans That Cover Abortion
The Trump administration has proposed a rule that would require insurers to identify and issue a separate surcharge to enrollees on any Affordable Care Act plan that covers abortion.
The ACA requires that plans on the exchange charge an additional surcharge if elective abortions were covered. Insurers are currently allowed to include the surcharge in monthly premiums—a provision granted under the Obama administration.
The new proposed rule states that “individual market exchange issuers must determine the amount of, and collect, from each enrollee, a ‘separate payment’ for an amount equal to the actuarial value of the coverage for abortions for which public funding is prohibited, which must be no less than $1 per enrollee per month.”
The rule would affect individual market insurers operating in 24 states and the District of Columbia.
Healthcare Reform News Update for November 7, 2018
Insurers Lose Appeal Over ACA Risk-Corridor Program Payments
Insurers looking to collect part of $12.3 billion in risk-corridor payments faced a serious setback when the U.S. Court of Appeals for the Federal Circuit declined to rehear a petition in a 9-2 ruling. The petition was filed by Moda Health Plan and Illinois’ Land of Lincoln Mutual Health Insurance Co., who are looking to collect Affordable Care Act program subsidy payments from the U.S. Department of Health and Human Services.
The risk-corridor program was created for the early years of the ACA. The intent was for insurance companies who were successful on the ACA exchange to help cover the losses of companies who were not.
In 2017, Moda initially won its case seeking $214 million in payments, but the judgement was overturned by an appellate court earlier this year. That ruling stated that the government doesn’t have to make the $12.3 billion in payments because of budget-neutrality requirements, which means that the government cannot pay out more than it made through the program.
Any future recourse will have to be heard by the U.S. Supreme Court.
Medicaid Expansion Approved in Three States
Voters in Utah, Nebraska, and Idaho have voted to expand their Medicaid programs in accordance with the Affordable Care Act. The measures will extend coverage for low-income residents, which could include 150,000 people in Utah, 90,000 people in Nebraska, and 62,000 in Idaho.
Judge Shuts Down Insurer Selling Deceptive Plans
A federal judge ordered a Florida insurance company to temporarily shut down after the Federal Trade Commission (FTC) discovered that it allegedly made more than $100 million selling “TrumpCare” plans. The plans were marketed as comprehensive, government-sponsored insurance, but in reality did not provide many of the benefits promised.
According to the FTC, Simple Health Plans enrolled tens of thousands of people through deceptive websites that falsely claimed their plans covered pre-existing conditions and prescription drugs. The sites also featured logos for insurance companies that were not affiliated with the plans. Customers were charged an enrollment fee and premiums that ranged from $40 to $500 per month for what amounted to a medical discount program.
“Many consumers were misled into thinking they had purchased comprehensive health insurance, but when they needed to rely on that insurance, they learned they had none of the promised benefits,” said the director of the FTC’s Bureau of Consumer Protection, Andrew Smith.
In actuality, the plans sold by the Simple Health provided $50 per visit to a physician (capped at three per year); a $100 maximum per day benefit for hospitalization; and a maximum total benefit of $3,200 per person, per year, and only if the beneficiary was hospitalized for 30 days.
Healthcare Reform News Update for October 29, 2018
ACA Navigator Cuts Cause Some Areas to Go Without Them
Funding for Affordable Care Act Navigator programs has been cut by more than 70 percent this year, which has left almost one-third of the counties who participate in the federal exchange without insurance counselors, reported the New York Times.
Last year, the Trump administration cut the funding for the program from $63 million to $36 million. This year, the budget is $10 million. Centers for Medicare and Medicaid Services Administrator Seema Verma said the cutbacks were appropriate since consumers are now more aware of the program and other sources of help are available.
Effects of the cuts include:
- 797 counties out of 2,400 do not have navigators available.
- Some cities, including Cleveland and Dallas, will have no navigators.
- All of Michigan outside the Detroit metro area is without navigators.
- Only 45 of 254 Texas counties have navigator coverage.
Iowa, Montana, and New Hampshire will have no navigator programs because they did not apply for funding.
Judge Requests That Insurers Drop Short-Term Plan Challenge
Federal Judge Richard Leon of the United States District Court for the District of Columbia asked the Association for Community Affiliated Plans (ACAP) to withdraw its request to block the rule that allows the expansion of short-term health insurance policies.
The ACAP claims that the low-cost plans, which don’t include the ACA’s consumer protection provisions, could cause the loss of at least 10,000 enrollees and a financial loss of up to $100 million for insurance companies selling ACA-compliant plans on the individual market exchanges. Leon was skeptical of the estimates, noting that there is currently no data to support the ACAP’s claim.
Charles Rothfeld, counsel for ACAP, argued that “the purpose of this rule is to create an alternative insurance market to compete with the ACA. The more you draw out young and healthy people, the more it becomes economically impossible to cover people with pre-existing conditions.”
Leon disagreed, saying that the short-term plans help consumers “fill in a gap, as opposed to forcing them to choose between no insurance and the ACA.”
Leon said that the group’s request came too late to make a ruling prior to the start of the open enrollment period on November 1. He said he could have an opinion early next year if ACAP backs out of its request for a preliminary injunction and instead seeks a trial.
Healthcare Reform News Update for October 25, 2018
Report: Millions Could Lose Coverage if ACA is Deemed Unconstitutional
More than 15 million people could lose their health insurance or face rate hikes due to pre-existing conditions, age, or gender if a federal judge rules in favor of a Trump administration-backed lawsuit to declare the Affordable Care Act unconstitutional, according to a report from Democrats on the House Oversight Committee.
The lawsuit was filed by 20 GOP state attorneys general and seeks to overturn the ACA, including its protections for people with pre-existing conditions. Attorney General Jeff Sessions chose not to defend the law “with the approval of the President of the United States.”
The report examined Americans who receive their coverage from the individual insurance market. The findings showed that, if the lawsuit succeeds:
- More than 10 million people could lose their insurance or face rate hikes due to lack of consumer protections. Of this group, more than 4.8 million could be denied coverage due to the severity of their pre-existing condition.
- More than 9 million women who rely on the individual market for insurance could face gender discrimination.
Poll Shows Majority of Young Americans Support Single-Payer Healthcare
Sixty-nine percent of U.S. residents between the ages of 15 and 34 support a single-payer healthcare system, according to a new poll by The Associated Press-NORC Center for Public Affairs Research and MTV.
Eighty-eight percent of Democratic respondents and 40 percent of Republican respondents said they support the government-run system.
In addition, 62 percent of voting-age respondents said that healthcare is a very important issue for the midterm elections next month, making it the most popular issue for young Americans.
Healthcare Reform News Update for October 23, 2018
CMS Expands ACA Subsidies to Cover Short-Term & AHP Plans
States will soon be able to use federal funding to subsidize premiums for short-term health insurance plans and association health plans, the Trump administration announced on Monday. Affordable Care Act restrictions previously prevented the use of waivers for these plans as they do not include the law’s consumer protections.
CMS Administrator Seema Verma said that the change gives states more flexibility and give consumers more choices. Consumers will still be able to purchase ACA plans with the subsidies, which do not deny coverage for people with pre-existing conditions or charge them higher premiums.
The approach allows states “to provide consumers plan options that best meet their needs, while at the same time ensuring that those with pre-existing conditions retain access to the same coverage as today,” Verma said.
Verma also said that states could apply for waivers that would increase subsidy amounts for young adults to encourage them to sign up for health insurance. Additional waivers will be announced in the near future, she said.
States must first apply for the waivers, so the expanded subsidies won’t be available to consumers until 2020.
Critics of the change say that drawing the younger, healthy customers away to the cheaper, less-comprehensive plans may increase the premiums for individuals who need the protections provided in the ACA marketplace insurance plans.
Trump Administration Expands Employer HRA Rules
Proposed expanded options for health reimbursement arrangements (HRAs) used by small-to-midsized companies were announced by the Trump administration.
The new regulations will allow employees to use funds in their HRAs to purchase their own individual health coverage. Companies could also allow workers to use HRAs to pay for optional benefits, such as dental insurance. The new rules would allow workers to be reimbursed up to $1,800 in premiums, as long as the company also offers traditional employer-sponsored coverage.
Trump administration officials say the move will increase the number of Americans who have insurance. Opponents say it would shift less-healthy, higher-risk workers off employer plans and into the public marketplace and undermine traditional employer-provided coverage.
ACA “Family Glitch” Solution Could be Midterm Issue
The outcome of next month’s elections could determine how the “family glitch” of the Affordable Healthcare Act is addressed, according to Kaiser Health News.
The issue relates to how eligibility for insurance premium subsidies is calculated. In order to be eligible, individuals must not have access to “affordable” coverage through their employer or their spouse’s employer. The ACA calculates “affordable coverage” based on the rates for a single family member rather than the whole family, which can result in a denial of subsidies. This means some families can’t afford to cover spouses or children using an employer plan or an ACA Marketplace plan.
If Democrats overtake Republicans in the midterms, analysts believe they may try to revise the calculations, though doing so could increase federal spending by as much as $10 billion. Republicans are more likely to suggest the use of lower-cost, lower-coverage options, such as short-term or association plans.
Healthcare Reform News Update for October 18, 2018
Senate Majority Leader May Restart ACA Repeal and Replace Efforts
On Wednesday, Senate Majority Leader Mitch McConnell said that Republicans might try to rekindle their attempts to repeal the Affordable Care Act if they prevail in next month’s midterm elections.
Attempts to dismantle the healthcare law failed to pass last year, which McConnell called “the one disappointment of this Congress from a Republican point of view.” McConnell said that if Senate Republicans “had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks … We’re not satisfied with the way Obamacare is working.”
In the interview with Reuters, McConnell also said that he believes that the long-term drivers of national debt are social programs like Social Security and Medicare.
Democratic lawmakers such as Senate Minority Leader Chuck Schumer shot back at McConnell’s statements. “If Republicans retain the Senate they will do everything they can to take away families’ health care and raise their costs. Americans should take Senator McConnell at his word,” said Schumer.
Healthcare Tops Midterm Election Concerns
A new Kaiser Family Foundation survey shows that healthcare continues to be the main issue for voters in the upcoming midterm elections.
Over seventy percent of respondents said that healthcare was “very important” in their election decisions, with nearly 40 percent of Democrats and 15 percent of Republicans saying it was their most important issue.
Healthcare Reform News Update for October 17, 2018
CMS Chief Says ‘Medicare For All” Would Harm Physician Networks
In a speech to insurers on Tuesday, Medicare and Medicaid Services Administrator Seema Verma warned that Democratic “Medicare for all” proposals “would decimate physician networks, creating a permanent physician shortage.”
Verma pointed out that Medicare covers only 80 percent of physicians’ expenses on average, which could cause doctors to exit the program and leave patients struggling to find care. Without private insurance patients to offset Medicare patients, “there is no relief valve for physicians facing up to 40 percent payment cuts,” she said.
Creating a single-payer healthcare system has become a campaign issue during the midterm elections. However, Verma says that she will deny waivers to any state that tries to implement such a program.
2019 ACA Plans in Virginia to Increase 9%
State regulators in Virginia announced on Tuesday that 2019 premiums for individual plans sold on the Affordable Care Act marketplace will rise about 9 percent on average, somewhat less than the 13 percent predicted earlier this year.
The increase is significantly less than last year, which saw an average spike in premiums of 69 percent, creating some of the highest rates in the country. For 2019, fewer counties have only a single provider, which contributed to more competitive rates.
Healthcare Reform News Update for October 12, 2018
Premiums for 2019 ACA Silver Plans Will Drop for the First Time
For the first time since the Affordable Care Act has been in effect, average premiums for benchmark silver plans will decrease by 1.5 percent in 2019.
Centers for Medicare and Medicaid Services Administrator Seema Verma credits the Trump administration for the rate drop. She says measures taken, such as the repeal of the individual mandate and the expansion of short-term plans, have helped stabilize the market.
Other insurance experts say that the decrease is a price correction. Average premiums increased 37 percent last year, which helped increase profits for insurance companies.
Only ACA silver plans will see an average premium decrease. Overall, average rates will increase slightly for 2019 ACA policies.
Healthcare Reform News Update for October 11, 2018
President Trump Criticizes ‘Medicare for All’ in Controversial Op-Ed
In an Oct. 10 opinion article for USA Today, President Trump attacked Democrats for proposing to expand Medicare to all Americans.
The president wrote that an expansion of the healthcare program “means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised,” and that “the Democrats’ plan also would mean the end of choice for seniors over their own healthcare decisions.”
The article was criticized for a number of inaccurate claims, including health insurance premium rates, Medicare revenue numbers, and inaccess to physicians.
Senator Bernie Sanders (I-VT) stated that the op-ed piece was dishonest. “Bottom line is he’s trying to frighten seniors and suggest that Medicare for all would cut back the benefits they have. The truth is it would expand the benefits that they have,” said Sanders to reporters.
Centene Expands ACA Offerings for 2019
Centene Corporation announced on Wednesday that it will expand the reach of its health plans sold on the Health Insurance Marketplace under its Ambetter brand.
The company will enter four new markets in 2019: Pennsylvania, North Carolina, South Carolina, and Tennessee. It will also expand the number of counties it sells to in Florida, Georgia, Indiana, Kansas, Missouri, and Texas.
Healthcare Reform News Update for October 10, 2018
Maintenance Schedule for ACA Website Unchanged From Last Year’s
The Centers for Medicare and Medicaid Services is planning to shut down the healthcare.gov website for maintenance a maximum of 60 hours during the 2019 Affordable Care Act open enrollment period.
The maintenance schedule is the same as last year’s. The site may not be available for sign-ups from midnight to noon ET each Sunday during the enrollment period, except for Dec. 9, the final Sunday. Last year, the website’s actual maintenance downtime totaled 21.5 hours.
For most states, the open enrollment period is Nov. 1 through Dec. 15.
Senate Vote Fails to Overturn New Short-Term Health Plans
A resolution presented by Senate Democrats to prevent the expansion of short-term health insurance plans narrowly lost by a 50-50 vote. Senator Susan Collins of Maine was the only Republican to vote in favor of the measure.
The Democrats oppose new rules that allow these plans to deny coverage to people with pre-existing conditions and do not require them to cover the Affordable Care Act’s ten essential benefits, including maternity care, prescription drugs, and mental health care. They believe the plans hurt consumers and provide sub-par coverage.
Republicans say the plans provide consumers with more choices and lower-cost alternatives to ACA plans.
The legislation was sponsored by Senator Tammy Baldwin (D-WI) and was supported by all 49 members of the Senate Democratic Caucus.
Healthcare Reform News Update for October 8, 2018
2019 ACA Premiums in Illinois & Ohio See Modest Increases
Finalized insurance rates for 2019 Affordable Care Act plans in Illinois and Ohio will rise by single digits.
In Illinois, premiums for silver plans will increase by 4 percent on average. Bronze and gold plans will rise by 6 percent. Jennifer Hammer, director of the Illinois Department of Insurance says that rates for many plans will decrease.
In Ohio, overall premiums will increase by 6.3 percent on average. In addition, residents will have more choices. The number of insurers offering plans in the state has risen from eight to 10. Only 16 counties will have a single insurer, down from 42 this year.
ACA Rate Increases for 2018 Plans Drove Record Insurer Profitability
A new Kaiser Family Foundation study of Affordable Care Act financial performance shows that insurance companies in the individual market experienced their highest levels of profitability in the first six months of 2018 since passage of the health law.
Policy changes from the Trump administration, including the cancelation of cost-sharing subsidy payments, contributed to significant premium increases in 2018. Some of these rate hikes resulted in overpricing and larger profits. Subsequently, rates for 2019 plans are projected to increase modestly and, in some cases, even decrease.
The study results showed that “despite significant challenges, the individual market remains stable and insurers are generally profitable.”
Healthcare Reform News Update for October 5, 2018
New Iowa Farm Bureau Health Benefit Plans Will Not Protect Pre-Existing Conditions
People with pre-existing conditions could be denied coverage or pay higher premiums under the new “health benefit plans” available on November 1 from Iowa’s Farm Bureau.
The plans do not meet the requirements of the Affordable Care Act. As such, the plans are not considered insurance and will not be regulated by the Iowa Insurance Division.
Applicants will be questioned about 16 conditions, including blood pressure, mental health, reproductive and pulmonary disorders, and others. Positive responses will require the submission of detailed explanations about treatments, medications, and current status.
Farm Bureau Vice President Steve Kammeyer confirmed that some people could be charged more or declined coverage, but did not say which conditions would trigger those outcomes.
The plans lack the ACA’s consumer protections, but will cover maternity services, mental health care, addiction treatment, and prescription drugs. Because the plans don’t meet federal requirements, they are expected to cost less than plans sold on the ACA exchange.
Senators Ask CBO to Test Health Insurance Simulation Model
The Congressional Budget Office (CBO) has received a request from Republican members of the Senate Budget Committee to test its health insurance simulation model using outside validation. The lawmakers want to ensure that the model correctly estimates Affordable Care Act spending and enrollment.
The senators argue that the CBO used faulty data last year and overestimated the number of ACA enrollees who would lose coverage if the health law was repealed. They believe that a test could help “determine whether the agency’s estimate would have been closer to the actual, observed amounts since (the ACA’s) enactment,” according to a letter written by the committee, led by Chair Mike Enzi (R-WY).
“This type of real-world testing not only could serve to validate the model, but would help further the goal of developing a new model that is capable of producing more accurate estimates for Members of Congress and the public,” the letter states.
Colorado 2019 ACA Plans Rise 5.6 Percent for Individuals
The Colorado Division of Insurance announced that 2019 ACA premiums will increase 5.6 percent on average for individuals.
Specifically, individual gold plans will increase 3.8 percent, silver plans will increase nearly 12 percent, and bronze plans will increase by less than 1 percent.
Coloradans who qualify for premium tax credits will see a premium decrease of 24 percent on average if they continue with their current plan, but have the potential to reduce their rates up to 50 percent if they switch to the lowest-cost plan in the same tier.
For small businesses, the market rates will increase 7.28 percent on average.
Employee Healthcare Deductibles Double Over Past Decade
The Kaiser Family Foundation annual employer health benefits survey shows that deductibles for employer health plans have more than doubled since 2008.
The average deductible for an employer plan in 2018 is $1,573, compared to $735 in 2008. In addition, more employer plans include a deductible. In 2018, 85 percent of plans include deductibles, compared to 59 percent a decade ago.
Other findings from the employer-plan survey:
- 2018 premiums rose 3 percent for individuals
- 2018 premiums rose 5 percent for families
Healthcare Reform News Update for October 3, 2018
2019 ACA Individual Premiums in Minnesota Drop Dramatically
State officials in Minnesota announced that premiums for 2019 Affordable Care Act benchmark plans for individuals will decrease by as much as 22 percent, one of the largest drops in the country.
“On average, rates are going down in the individual market because of lower utilization rates, lower costs per service, Minnesota’s reinsurance program, and a strong Minnesota economy,” said Minnesota Commerce Commissioner Jessica Looman.
For the small group market in Minnesota, rates are expected to increase between 3 and 12 percent.
House Republicans Vow to Uphold Protections for Pre-existing Conditions
On Tuesday, Representative Pete Sessions (R-Texas) introduced a nonbinding resolution with several Republican cosponsors that supports insurance protections for people with pre-existing medical conditions.
“To cement these protections, I proudly introduced this resolution to ensure that patients with pre-existing conditions are protected from the erroneously high costs and the limited options they are experiencing now,” said Sessions.
Sessions and other House Republicans have been criticized by Democratic counterparts for their past support of repealing the Affordable Care Act, including the law’s pre-existing condition protections. The issue has become a frequent midterm election talking point.
Covered California Begins its ACA Renewal Period
On Monday, California began its annual renewal period for residents who currently have coverage under the state’s ACA health exchange, Covered California.
Those looking to renew can reduce their premiums up to 6.9 percent by choosing the lowest-cost health plan in their tier, according to Covered California. “Healthcare is local, and the price of coverage varies by health plan and region, so consumers will be encouraged to shop when they renew this fall,” said Covered California Executive Director Peter V. Lee.
The renewal period for Covered California continues through January 15. The enrollment period for new enrollees begins October 15.
Healthcare Reform News Update for October 2, 2018
Michigan Business Groups Form Association Health Plan
The Small Business Association of Michigan and MichBusiness have joined forces to TranscendAHP, a new association health plan (AHP).
The nonprofit Transcend AHP is expected to offer 10 plans from Blue Cross Blue Shield of Michigan and Blue Care Network to its combined membership of around 52,000 small-business owners. Other associations and chambers of commerce will also be eligible to join.
AHPs are not required to meet Affordable Care Act standards, including protections for people with preexisting conditions and essential health benefits such as maternity care, mental health care, and prescription drugs. Critics say the plans leave enrollees underinsured.
The Trump administration defends its new AHP rules, saying the lower-cost plans help keep businesses competitive. “Many of our laws make healthcare coverage more expensive for small businesses than large companies. Association Health Plans are about more choice, more access, and more coverage,” said Department of Labor Secretary Alexander Acosta in a statement.
Healthcare Reform News Update for September 28, 2018
HHS Secretary Touts 2% Drop in 2019 ACA Silver Plan Premiums
Premiums for benchmark silver plans sold on the national Affordable Care Act exchange will decrease by 2 percent in most states next year, said Health and Human Services Secretary Alex Azar.
The number of insurers selling ACA plans will increase for the first time since 2015, he said.
Azar credited President Donald Trump for the news, saying that he “has proven better at managing it than the president who wrote the law.” As examples, he referred to the expansion of consumer healthcare choices and increased marketplace efficiency.
In addition, Azar criticized single-payer health plans as too expensive for taxpayers and unfair to seniors. “The main thrust of ‘Medicare for All’ is giving you a new government plan and taking away your other choices.”
Healthcare Reform News Update for September 27, 2018
Democrats Hope for ACA Battle With Trump Administration
Congressional Democrats say that if they overpower Republicans in the midterm elections this November, they will work to defend the Affordable Care Act and “undo” some changes to the law made by the Trump administration.
“I think healthcare will be one of the very first things that we address,” said Illinois Representative Jan Schakowsky. “There’s a lot of fear out there, and we need to calm people who are so afraid they’re going to lose their healthcare or not be able to afford their healthcare. I think that will be a big agenda item.” Schakowsky said she would like to make the efforts bipartisan.
“What they’ve done is try to dismantle [the ACA] through the regulatory process,” said Massachusetts Representative Richard Neal. “I think if we were so lucky as to be the majority, I think we would certainly be in the position to stop that.”
If Democrats become the majority party in power, they would be able to:
- conduct investigations.
- issue subpoenas.
- inquire officials over measures such as the expansion of short-term health plans and association health plans.
- question the cutting of funds for navigator programs.
2019 Healthcare Premiums for Federal Employees to Increase 1.5%
Federal employees and retirees will pay 1.5 percent more on average for their health insurance premiums in 2019. It’s the smallest increase for the program since 1995.
Considered the largest employer-sponsored health insurance program in the nation, the Federal Employees Health Benefits Program comprises 265 local health maintenance organizations and 16 nationwide plans.
Healthcare Reform News Update for September 25, 2018
California Challenges Trump Administration’s ACA-exempt Insurance Options
Jerry Brown, governor of California, has signed a healthcare package that includes bills banning the Trump administration’s new healthcare options that don’t meet the requirements of the Affordable Care Act.
The bills in the package include:
- A ban on the Trump administration’s short-term insurance plans that can be extended up to 36 months and do not include essential benefits coverage such as maternity care, mental health, and prescription drugs.
- A ban on association health plans, which can exempt people with pre-existing conditions.
- The creation of a council that will conduct a feasibility study on a state public option healthcare plan.
- Prohibiting the state from applying for a waiver that would require Medicaid enrollees to show proof of employment.
- Requiring that health plans spend at least 80 percent of premium revenue on healthcare.
Healthcare Reform News Update for September 24, 2018
Maryland 2019 ACA Premiums Will Decrease by 13.2%
State insurance regulators in Maryland finalized dramatically lower rates for 2019 plans sold on the Affordable Care Act than originally requested by insurance companies. The new premiums will be lower by 13.2 percent on average due to a recently approved state reinsurance program.
In May, CareFirst Blue Cross and Blue Shield and Kaiser Foundation Health Plans, Maryland’s two ACA insurers, requested rate increases that averaged 30.2 percent. Instead, the reinsurance program enabled the state to “lessen the significant burden” of rising costs, said Maryland Insurance Commissioner Al Redmer.
Finalized rates for 2019 ACA plans in Maryland include:
- A 17 percent decrease for CareFirst HMO plans.
- An 11.1 percent decrease for CareFirst’s two PPO plans.
- An average 7.4 percent decrease for Kaiser’s HMO plans.
State officials also project that the lower rates will increase 2019 ACA enrollment by 5 percent.
Bipartisan Senators Move to Eliminate Surprise Out-of-Network Costs
Last week, a group of six bipartisan senators created draft legislation to protect patients with insurance from extra charges from doctors and hospitals that are not in the insurance company’s network.
Often called “surprise bills,” the charges stem from non-network emergency room doctors who work in network facilities. Patients receive bills from the non-network provider that are over their deductible or co-pay limits.
The proposed bill tackles three areas:
- Patients would pay only the out-of-pocket amount required on their plan for out-of-network emergency room doctors who work in out-of-network hospitals. Any additional “balance billing” payments would come from the insurance company.
- Patients would pay only what is required for out-of-network doctors who work at in-network emergency rooms.
- Emergency room patients in non-network facilities would be notified in writing that any follow-up treatments could include non-network charges unless they go to an in-network hospital.
“No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency,” said Tom Carper (D-DE), one of the sponsors of the bill. “The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider.”
Healthcare Reform News Update for September 17, 2018
Trump Administration Sued Over New Short-Term Health Plan Rules
A group of seven healthcare organizations filed a lawsuit Friday against the Trump administration, seeking to block implementation of short-term health insurance plans that do not meet Affordable Care Act requirements.
The short-term plans, scheduled to be available October 2, are not required to cover people with existing conditions or the 10 essential health benefits available with ACA plans.
The lawsuit argues that the extension of the plans from three months to 12 months with the ability to renew up to three years does not meet the definition of “short term” and that the agencies did not disclose the extension in its proposed rule.
The suit also alleges the plans are harmful to those with pre-existing conditions and puts them “into a loophole that would permit the creation of a parallel individual insurance market consisting of plans that are not subject to the ACA’s consumer protection standards. This result cannot be reconciled with the text, structure, or purpose of the ACA.”
The Department of Health and Human Services (HHS) defended its position in a statement from a spokesperson: “Short-Term Limited Duration plans are an important option for people in certain circumstances, and the Trump administration is committed to delivering greater access to more affordable choices to the men and women left out by Obamacare.”
Plaintiffs in the suit include: the National Alliance on Mental Illness, the American Psychiatric Association, Little Lobbyists, Association for Community Affiliated Plans, Mental Health America, AIDS United, and National Partnership for Women & Families.
Healthcare Reform News Update for September 14, 2018
Maryland Attorney General Sues Trump Administration Over ACA
Brian Frosh, Maryland’s attorney general, has filed a lawsuit in U.S. District Court against the Trump administration, asserting that it is attempting to “sabotage” the Affordable Care Act and move people away from its health coverage.
Frosh is looking for a declaratory judgment that the ACA is constitutional and that further measures to dismantle the law must stop. The lawsuit says repealing the ACA would cause “immediate and long-term harm” to Maryland.
“We are taking action to protect and ensure healthcare coverage for every Marylander and all Americans,” Frosh said in a statement.
2019 ACA Premiums in CA, MA & CT Could Rise an Average of 4%
Proposed premiums for 2019 Affordable Care Act plans in California, Massachusetts and Connecticut will rise an average of 4 percent.
Covered California says small businesses will receive rate increases that average 4.6 percent.
Premiums for Massachusetts’ Connector plans will increase an average of 4.7 percent.
Connecticut premiums will rise an average of 2.72 percent for individuals and 3.14 percent for small-group coverage.
Rates will be finalized before the Open Enrollment Period later this fall.
Healthcare Reform News Update for September 13, 2018
ACA Navigators Asked to Do More With Less Funding
The Center for Medicare and Medicaid Services (CMS) announced Wednesday the 39 navigator programs that will share $10 million in funding to promote and enroll consumers into healthcare plans.
CMS Administrator Seema Verma said the 2019 program kicks off a “new direction.” Instead of exclusively enrolling uninsured residents in ACA plans, grantees are encouraged to enroll them in association health plans, short-term plans, Medicaid, and CHIP.
“This new direction will increase accountability and ensure the grants are effective in helping consumers find health coverage that meets their needs,” she said. Verma also encourages navigators to rely more heavily on volunteers and partnerships with other organizations.
These are drastic cuts compared to last year’s grants of $36 million to 90 organizations. Overall, navigators have been cut 84 percent since 2016.
2018 Tax Returns Won’t Require Proof to Claim ACA Hardship Exemption
Individuals who have opted out of healthcare coverage in 2018 will not have to provide documentation or a written explanation on their 2018 tax return to claim a hardship exemption.
Late last year, Congress repealed the individual mandate that required uninsured Americans to pay a fine. However, the change does not go into effect until 2019. For this year, the penalty is $695 or 2.5 percent of overall income, whichever is higher.
Taxpayers can avoid the penalty via the hardship exemption under some circumstances, including bankruptcy, homelessness, or a natural disaster. CMS’ new guidance requests that people who are eligible for the exemption retain all paperwork as proof in the event of an audit, but it does not need to be included with their tax form.
Census: Uninsured Rate Steady Between 2016 to 2017
The number of uninsured Americans in 2017 was 28.5 million people or 8.8 percent, the same as in 2016, according to new data from the Census Bureau.
The numbers have remained steady after the Affordable Care Act significantly reduced the uninsured rate in 2014.
Healthcare Reform News Update for September 12, 2018
CBO: House Bill Revising ACA Employer Regulations Would Cost Over $51 Billion
A bill proposed by House Republicans to change provisions of the Affordable Care Act as it relates to employers will cost the federal government $51.6 billion over the next 10 years, according to a Congressional Budget Office (CBO) report.
The bill, titled the Save America’s Workers Act, seeks to postpone or repeal several portions of the ACA. Lawmakers will meet tomorrow to prepare the package for a vote.
Some of the bill’s proposals and the CBO’s estimated costs include:
- Retroactively suspending the employer mandate penalty from 2015 to 2019. The CBO estimates this will cost $25.9 billion over the next decade.
- Increasing the full-time hours per week required for workers to receive mandatory employer-paid health coverage from the current 30 hours to 40 hours. The CBO estimates this measure will cost $9.8 billion through 2028.
- Postpone the start date of the “Cadillac tax” on high-cost health benefits packages to 2023. The CBO estimates this to cost $15.5 billion.
Healthcare Reform News Update for September 10, 2018
New Jersey 2019 ACA Premiums Could Decrease by 9.3%
Rates for 2019 Affordable Care Act health plans in New Jersey are expected to fall by an average of 9.3 percent, Governor Phil Murphy announced Friday.
Murphy attributed the decrease to a reinsurance program approved last month and the passage of a state individual mandate requiring all residents to have health insurance or pay a penalty.
Final rates will be announced prior to the Open Enrollment Period this fall.
Healthcare Reform News Update for September 6, 2018
Montana Health Prevails in $5.3 Million CSR Payment Lawsuit
Montana Health Co-op won its case in the first lawsuit against the Trump administration’s decision to cut off cost-sharing reduction (CSR) payments to insurers.
U.S. Court of Federal Claims Judge Elaine Kaplan decided the government was in violation of an Affordable Care Act provision. Through the provision, the government must reimburse insurance companies for decreasing low-income enrollees’ out-of-pocket medical expenses associated with ACA plans.
The government argued it had a right to eliminate the payments because funds were never set aside specifically for CSR reimbursement.
“The statutory language clearly and unambiguously imposes an obligation on the Secretary of HHS to make payments to health insurers that have implemented cost-sharing reductions on their covered plans as required by the ACA,” Kaplan said in her order.
Montana Health was seeking $5.3 million in unpaid CSR payments. Several similar lawsuits by other healthcare organizations are currently in progress.
Federal Judge Hears Arguments on Overturning ACA
U.S. District Court Judge Reed O’Connor said he would make a ruling as soon as possible in the lawsuit filed by 20 Republican attorneys general to strike down the Affordable Care Act. The plaintiffs argued Wednesday that last year’s repeal of the individual mandate nullified the entire healthcare law.
The Trump administration chose not to defend the ACA, so a group of Democratic attorneys general have stepped in to argue for the law. They say overturning the ACA would cause tens of millions of Americans to lose their health coverage.
Lawyers representing the Justice Department asked O’Connor to postpone a decision until after the Open Enrollment Period to prevent confusion. “The last thing we want is for chaos in the market,” said Brett Shumate, an attorney for the Justice Department.
2019 ACA Premium Rates to Drop Slightly in New Mexico
Premiums for 2019 health plans sold on New Mexico’s Affordable Care Act exchange are expected to decrease an average of 1 percent.
Requested rates for Molina Health Care could decrease an average of 6 percent, Blue Cross and Blue Shield requested that rates remain unchanged from this year, and Christus Health Plan has asked for rates 4 percent higher than in 2018.
Final rates will be announced by state regulators before the Open Enrollment Period begins November 1.
Healthcare Reform News Update for September 5, 2018
Poll Shows Most Americans Favor Pre-Existing Conditions Protections
A new Kaiser Family Foundation poll found that 72 percent of respondents believe that it’s “very important” that insurance companies do not charge higher premiums to people with pre-existing conditions, and 75 percent do not want people denied coverage due to their medical history.
Other findings in the poll:
- 41% are “very worried” that they or a relative could lose coverage if pre-existing conditions protections are overturned.
- 52% of respondents are “very worried” that they or a relative would have to pay more because of a pre-existing condition.
- 60% of respondents say they or a family member have a pre-existing condition.
- 67% are either “somewhat worried” or “very worried” about unexpected medical bills.
- 50% of overall respondents have a favorable view of the Affordable Care Act. (77% of Democrats are favorable; 22% of Republicans are favorable.)
Healthcare Reform News Update for September 4, 2018
Analysis: Overall 2019 ACA Premiums Could Increase up to 4%
Premiums for 2019 healthcare plans sold on the Affordable Care Act marketplace are expected to increase by less than 4 percent nationwide, according to an analysis by Charles Gaba of ACASignups.net.
While a few states such as Kentucky and Connecticut will experience increases of 12 percent, other states such as Tennessee and New Hampshire will see declines, according to the findings.
Gaba also found that the Trump administration’s actions prevented additional drops in premium costs. Eliminating the individual mandate penalty, dropping cost-sharing reduction (CSR) payments, and offering “skimpy” short-term insurance have contributed to weakening the marketplace.
Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, agrees that rates will rise modestly. She also points out that insurance companies selling ACA policies are expanding into new markets.
“The news about the marketplace this year is very good, both in terms of the premium increase and extent of carrier participation,” Hempstead said.
Court Fight Over Legality of ACA Begins Wednesday
A group of Republican state attorneys general will present their oral arguments September 5 for a preliminary injunction to halt enforcement of the Affordable Care Act. U.S. District Judge Reed O’Connor will determine if the law should be put on hold while their case proceeds.
The Republicans, led by Texas’ Ken Paxton, claim the ACA became unconstitutional last year when Congress eliminated the individual mandate penalty. Democratic attorneys general led by Xavier Becerra of California disagree.
Healthcare Reform News Update for August 30, 2018
Senate Democrats Move to Overturn New Short-Term Health Insurance Rule
Senator Tammy Baldwin (D-WI) introduced legislation to force a vote to block a Trump administration rule that expands short-term health insurance plans from three months to one year.
The plans fall short of Affordable Care Act protections for people with pre-existing conditions and don’t require essential benefits such as prescription drugs, maternity care, and mental health coverage.
In a statement, Baldwin called the plans “junk insurance” and said that they “could increase costs and reduce access to quality coverage for millions, force premium increases on older Americans, and harm people with pre-existing conditions.”
The bill would require the support of two Republicans to pass in the Senate. Passage in the House is unlikely, as the Republican majority has shown strong support for the extension, saying that the plans are a cost-effective alternative for consumers who aren’t able to afford comprehensive health coverage.
Healthcare Reform News Update for August 29, 2018
ACA Has Helped Reduce Number of Uninsured by 58%
The number of uninsured dropped from 29.3 million in 2017 to 28.3 million the first quarter of 2018, according to new data from the Centers for Disease Control and Prevention show.
That compares to 48.6 million uninsured in 2010, prior to the enactment of the Affordable Care Act—a 58.2 percent reduction.
Other findings in the data show:
- There are 12.5 percent Americans between the ages of 18 and 64 who remain uninsured.
- In Arkansas, Louisiana, Oklahoma, and Texas, almost 25 percent of adults are uninsured.
- Twenty percent of insured adults are covered by public plans, while 70 percent are covered by private plans.
- More than 95 percent of children are insured by either public or private plans.
- The number of people under age 65 covered by ACA plans in 2018 is 9.7 million, about 1 million fewer people than last year.
NY & MN to Receive $465.5 Million in Lost Low-Income ACA Funds
The Centers for Medicare and Medicaid Services (CMS) will pay New York and Minnesota a combined $468.5 million in response to funding losses for Affordable Care Act programs to 822,000 low-income residents.
The two states created Basic Health Programs under the ACA for people who earned too much for Medicaid but not enough to receive federal subsidies to purchase plans on the healthcare exchange. After the Trump administration cut off funding for cost-sharing payments, the programs lost funds.
The states prevailed in a lawsuit against the administration earlier this year and received a combined $168.2 million as an interim payment. The finalized payment of $422,206,235 to New York and $46,276,090 to Minnesota compensates for the cost-sharing payment losses.
Healthcare Reform News Update for August 28, 2018
CMS Approves Opioid Addiction Treatments for 2020 Illinois ACA Plans
Beginning in 2020, Affordable Care Act plans sold in Illinois must cover the treatment and prevention of opioid addiction.
The Centers for Medicare and Medicaid Services (CMS) on Monday approved the state’s request to expand the required medical services for Illinois ACA plans.
Plans will cover prescriptions for the opioid overdose antidote naloxone, telepsychiatry services for addiction and mental health issues, and alternative therapies for chronic pain.
New CA Coalition Will Fight Single-Payer Healthcare
California-based business and healthcare organizations have joined forces as a coalition to oppose single-payer healthcare initiatives.
The coalition, Californians Against the Costly Disruption of Our Health Care, believes the estimated $400 billion per year needed to pay for a single-payer system would be too costly to maintain.
The group will urge state legislators to propose alternative bills, including the expansion of health insurance subsidies, opening Medi-Cal to undocumented adult residents, and requiring all Californians to have health coverage.
Healthcare Reform News Update for August 27, 2018
GOP-Backed Bill Offers ACA Pre-Existing Condition Protections; Critics Call It a ‘Mirage’
In response to a lawsuit challenging the legality of the Affordable Care Act, Senator Thom Tillis (R-NC) and 10 Senate Republican co-signers have introduced a bill to preserve the law’s protections for people with pre-existing conditions.
The lawsuit was filed by 20 Republican state attorneys general and will be heard by a federal judge next month.
The proposed bill would require insurance companies to cover all individuals regardless of health status and ensure that premiums are not revised based on health.
But some critics believe the bill creates a loophole that enables insurance companies to revive the kinds of activities that prompted ACA talks in the first place. The bill holds insurers to guaranteeing access to coverage on the individual market; however, insurance companies could still use exclusions to limit coverage for pre-existing conditions and related ailments.
“If the goal is to protect people with pre-existing conditions, the bill is a bit of a mirage,” said Larry Levitt, senior vice president for health reform at the bipartisan Kaiser Family Foundation.
Healthcare Reform News Update for August 24, 2018
Georgia Sees First-Time Decrease in ACA Premiums
Two of Georgia’s Affordable Care Act plan providers, Blue Cross Blue Shield of Georgia and Alliant Health Plans, are proposing 2019 rate decreases that together average 5.15 percent. This is the first time since the implementation of the health law that the state has seen a rate reduction.
Georgia’s two other ACA carriers, Ambetter and Kaiser Permanente, have proposed rate increases that together average around 12 percent. The increases are significantly lower than 2018 plans, which saw rates rise 50 percent, one of the nation’s steepest premium hikes.
Finalized rates will be announced prior to the Open Enrollment Period, which begins in November.
Maine Court Orders Implementation of ACA Medicaid Expansion
Maine’s Supreme Court ruled Thursday that Republican Governor Paul LePage’s administration must implement the state’s voter-mandated Medicaid expansion—even if they continue fighting the plan in court.
LePage, who is opposed to the expansion, has attempted to block the measure. Thursday’s ruling denied LePage’s latest request to delay implementation. The ruling also lifted a temporary stay and sent the case back to Superior Court.
Healthcare Reform News Update for August 23, 2018
Report Critiques Trump Administration’s First ACA Signup Year
The nonpartisan Government Accountability Office has released a report that examines how the Trump administration managed the 2018 Affordable Care Act Open Enrollment Period and makes recommendations for improvements.
The report credits Health and Human Services (HHS) for improving the reliability of the federal enrollment site and reducing call center wait times.
However, the following areas are lacking and need addressing, according to the watchdog group:
- HHS did not set enrollment targets as it had during the Obama administration.
- HHS used “unreliable” data to justify a 40 percent cut to the Navigator programs.
- Television advertising was proven to be the most effective method to help enroll consumers. However, the Trump administration slashed the entire budget.
The report also found that states using the government site for enrollments had a 5 percent reduction, while states that run their own exchanges maintained enrollment levels. It also confirmed that the Trump administration’s discontinuation of cost-sharing reduction (CSR) payments contributed to “substantial increases” in premiums.
Tennessee 2019 ACA Premiums Get Decreases
Most premiums for Affordable Care Act plans in Tennessee will be noticeably lower for 2019.
BlueCross BlueShield of Tennessee has requested decreasing its rates an average of 14.8 percent, and Cigna has requested decreasing its rates an average of 12.9 percent. Oscar Health has requested increases that average between 7.2 percent and 10.84 percent. Rates will be finalized by September 25.
In addition, the state will have two new insurers selling ACA plans, Bright Health and Celtic Insurance.
Healthcare Reform News Update for August 22, 2018
Maryland Reinsurance Program Gains Approval
The Trump administration has consented to a federal waiver for a state reinsurance program, Maryland lawmakers said.
The bipartisan-supported plan will take tax revenue imposed on insurance companies and use it to subsidize the most expensive claims sold on Maryland’s Affordable Care Act marketplace.
The reinsurance program will eliminate the predicted 40 percent increase in 2019 ACA premiums for more than 200,000 enrollees and ensure that CareFirst BlueCross BlueShield continues to sell ACA plans in the state.
Delaware ACA Premiums to Rise 3%, Small Groups Get Rebates
Affordable Care Act plans for individuals in Delaware will see premium increases of 3 percent on average in 2019. Highmark Blue Cross Blue Shield of Delaware, the only insurer offering ACA plans in the state, asked regulators for a 5.7 percent increase.
State regulators also announced that, due to an excess of administrative fees, Highmark will provide $5 million in rebates to small group market members.
Study: Ohio ACA Medicaid Expansion Reduced Uninsured by 50%
Ohio’s expansion of Medicaid through the Affordable Care Act has cut the number of uninsured by half since the program began four years ago, according to an independent study conducted by Ohio’s Department of Medicaid.
The study also found that:
- Emergency room visits were reduced by 17 percent.
- Enrollees seeking primary care physicians increased by 10 percent.
- Ninety-six percent of enrollees with opioid addiction sought treatment.
- Thirty-seven percent of smokers kicked the habit.
The expansion has enabled 653,000 residents to gain health coverage, though some state lawmakers believe the costs are not sustainable.
Healthcare Reform News Update for August 21, 2018
Trump Administration Will Distribute $8.6 Million to States for Healthcare Initiatives
The Centers for Medicare and Medicaid Services (CMS) will award $8.6 million in unspent Affordable Care Act funding to 30 states and the District of Columbia to help stabilize their insurance exchanges.
The two-year grants range from $225,000 to $290,000 and can be used to expand consumers’ healthcare options. All states that applied for the funds received them.
The grant funds come from money set aside as part of the Affordable Care Act for states to review health insurance proposals.
In a statement, CMS Administrator Seema Verma said, “These grants build on CMS’s ongoing efforts to give states the tools and flexibility they need to help people struggling to afford the year-over-year premium increases caused by Obamacare regulations. We recognize that states are in the best position to assess the needs of their consumers and develop innovative measures to ensure access to affordable health coverage. These grants make yet another down payment on our work to enhance states’ ability to stabilize and improve their respective health insurance markets.”
California Bill Would Ban Short-Term Health Insurance
California’s Legislature has approved a bill that bans short-term health insurance from being sold in the state.
Governor Jerry Brown must sign off on the bill for it to become law. If signed, the law will become effective January 1, 2019.
The Trump Administration expanded short-term insurance availability rules earlier this month, allowing consumers to maintain policies for up to three years. The plans cost less than comprehensive Affordable Care Act plans. However, the plans fail to cover essential benefits and can limit or deny policies to people with pre-existing conditions. States have the flexibility to alter the new regulations.
New Jersey, Massachusetts, and New York have also restricted or banned short-term health plans.
Three Groups in Nevada to Offer Association Health Plans
Three chambers of commerce in Clark County, Nevada, are the first small business groups in the country to take advantage of the Trump administration’s new rules for association health plans.
The groups will offer plans beginning September 1 to 2,000 small businesses that have 10 or fewer employees.
The plans are not required to meet the Affordable Care Act’s essential health benefit requirements or other consumer protections, such as accepting people with pre-existing conditions.
ACA Medicaid Expansion Fought in 3 States, Helps LA Cut Uninsured Rate by 50%
Maine, Nebraska, and Kentucky are working to sort out how, or if, they will expand Medicaid availability though the Affordable Care Act. Meanwhile, Louisiana’s expansion lowered the number of uninsured in the state by half.
- Though Maine voters have approved ACA Medicaid expansion in the state, Governor Paul LePage’s administration has not been clear on whether it intends to enforce it. The state’s high court will decide whether the state will accept Medicaid applications.
- In Nebraska, a petition to put ACA Medicaid expansion on the November ballot has collected enough signatures. However, the proposal is being challenged in court. The hearing is set for early next week.
- Kentucky Governor Matt Bevin lost his legal battle over the requirement that Medicaid recipients be employed to receive benefits. Ultimately, the legality of the plan is likely to be determined in a separate case filed in Washington, D.C.
- Louisiana’s Medicaid expansion program dropped the uninsured rate from 22.7 percent in 2015 to 11.4 percent in 2017, according to a new survey.
Healthcare Reform News Update for August 17, 2018
Nevada Will Switch to a State-Run ACA Healthcare Exchange
Nevada Health Link, the state’s insurance marketplace, will open its own state exchange in 2020 to sell Affordable Care Act plans.
Nevada Health Link cited lowering costs as the main consideration. For example, the state exchange will cost about $5.1 million to run in 2020 compared to $13.2 million to lease the federal exchange website.
In a statement, Nevada Health Link Executive Director Heather Korbulic said, “This transition will save Nevada more than $18 million for the duration of the contract, offer a better consumer experience and provide the Marketplace with timely and efficient access to data that will improve marketing efforts.”
Trump Administration Approves NJ Reinsurance Program
The Centers for Medicare and Medicaid Services (CMS) has approved New Jersey’s reinsurance plan.
The program will help insurance companies pay for their sickest enrollees. Partial funding will be provided through revenue from the state’s new law that fines residents without health insurance.
The state estimates that the program will lower 2019 ACA premiums by up to 15 percent.
Massachusetts ACA Premiums to Rise 4.2%
Rates for 2019 Affordable Care Act plans in Massachusetts are expected to rise an average of 4.2 percent. Some premiums will decrease, while others will increase from about 2 percent to 13 percent, depending on the plan.
Massachusetts Health Connector, the state’s insurance exchange, will finalize the rates next month.
Healthcare Reform News Update for August 8, 2018
2019 ACA Premiums in New Hampshire Could Drop an Average of 6.7%
The three health insurers in New Hampshire that sell Affordable Care Act coverage have proposed an average 6.75 percent premium reduction for 2019 plans.
Several factors are responsible for the rate drop, including the expansion of Medicaid, which moved low-income New Hampshire residents from ACA plans into the Medicaid program.
Rates for the Ambetter, Anthem, and Harvard Pilgrim ACA plans will be finalized by state regulators before the Open Enrollment Period begins in November.
Healthcare Reform News Update for August 7, 2018
Nevada 2019 ACA Premiums Could Increase an Average of 1.9%
Health insurance companies in Nevada have proposed increasing premiums for 2019 Affordable Care Act plans an average of 1.9 percent, the lowest rate increase in the history of the law.
Both SilverSummit and Health Plan of Nevada will continue to sell ACA plans in the state, with SilverSummit increasing its offerings from four to six plans in every county.
Final rates will be approved by state regulators in October.
Healthcare Reform News Update for August 3, 2018
Senate Democrats Try to Block Short-Term Health Plans
In response to the Trump administration’s new final rule on short-term healthcare plans, Senate Democrats are planning to introduce a resolution to upend it. However, the measure to overturn the rule is unlikely to pass since the legislation would need to be signed by President Donald Trump.
The lawmakers say that, since the plans are not required to cover people with pre-existing conditions or adhere to the Affordable Care Act’s essential benefits, the plans are “nothing short of junk insurance.”
“We cannot let the Trump administration rewrite the rules on the guaranteed healthcare protections that people depend on because no family should be forced to choose between helping a loved one get better or going bankrupt,” said Tammy Baldwin (D-WI), one of the senators leading the measure.
Senate Minority Leader Charles Schumer (D-NY) will force a vote under the Congressional Review Act, which means Republicans will be unable to block it.
“This is an issue the American people should know where everyone stands,” Schumer said. “Let them, instead of saying they’re for it, actually do something to preserve pre-existing conditions.”
Study: NY Single-Payer Bill Could Lower Costs for Most Residents
A New York bill to create a state single-payer health plan could lower out-of-pocket medical costs for residents earning less than $290,000 but would significantly raise taxes on those who earn more, according to an analysis from the Rand Corporation and the New York State Health Foundation.
The bill proposes expanding healthcare to all New York residents with no copays or deductibles.
The plan would need to raise $139 billion in additional taxes to fund the program, which could be funded with a three-tiered tax income bracket ranging from low-earning families paying 6.1 percent and high-earners paying 18.3 percent, according to the study.
Though taxes would be increased, those earning less than $290,000 would have reduced medical costs. For example, a person who earns up to $185,200 would pay about $3,000 less per year.
To be enacted, the bill would need to be approved by a Republican-controlled state Senate and receive a waiver from the Centers for Medicare and Medicaid Services (CMS), neither of which is likely.
Healthcare Reform News Update for August 2, 2018
Four Cities Sue Trump for Undermining the ACA
The cities of Chicago, Columbus, Cincinnati, and Baltimore filed a lawsuit today in Maryland federal court against President Donald Trump, claiming he has not faithfully executed the Affordable Care Act, which is in violation of the Constitution.
The complaint charges that Trump “waged a relentless effort to use executive action alone to undermine and, ultimately, eliminate the law,” according to a draft of the lawsuit obtained by NBC News.
The suit cites measures such as the expansion of association plans, attempt to eliminate cost-sharing reduction payments, reduction of funds for navigator programs, reducing the Open Enrollment Period, and urging the court to remove pre-existing condition protections.
The lawsuit seeks to stop practices that allow ACA exchanges to strip tax credits from enrollees with no notification, increase oversight of brokers, and strengthen oversight of the law.
“The overall picture here is one of sabotage that drives up the rates of uninsured and underinsured and leaves cities and counties holding the bag,” said Adam Grogg, senior counsel at Democracy Forward and the lead litigator in the lawsuit.
2019 ACA Premiums in Missouri to Rise Less Than 6%
Insurance companies in Missouri have requested premium increases for small group and individual plans that average just under 6 percent for 2019 ACA plans.
Ambetter, Centene, Cigna and Medica will all return to the Missouri ACA marketplace. There will be coverage available in every county.
Final rates are expected to be approved by state regulators next month.
Molina May Re-Enter Utah, Wisconsin ACA Marketplaces
Health insurance company Molina is weighing a return to selling Affordable Care Act plans in Utah and Wisconsin. The company left both states this year and is currently studying the profitability of coming back.
Company CEO Joseph Zubretsky said a decision would be made by the end of the summer.
Senate Fails to Stop DC Individual Mandate Funding
Senator Ted Cruz (R-TX) failed in his attempt to include an amendment to a funding bill that would have barred the District of Columbia from using money to impose an individual health insurance mandate. The senate voted 54-44 to table the provision.
Healthcare Reform News Update for August 1, 2018
Trump Administration Allows 12-Month Short-Term Plans
The Trump administration released a final rule today on new short-term health insurance policies, which will go into effect in October.
The rule extends the current 90 days of coverage up to 12 months, and policies have the option to be renewable for a maximum of three years.
Premiums for the short-term policies could cost half as much as comprehensive coverage. However, these policies have the choice to skirt many Affordable Care Act provisions, such as coverage for maternity care, prescription drugs, or mental health care. These plans can also set annual and lifetime caps on benefits, deny coverage, or charge more for people with pre-existing conditions.
“We make no representation that it’s equivalent coverage,” said James Parker, a senior adviser to Health and Human Services Secretary Alex Azar. “These policies will not necessarily cover the same benefits or extend coverage to the same degree, but what we do know is that there are individuals today who have been priced out of coverage because of the way the ACA has been implemented and the effects that it’s had on the market.”
Critics fear the availability of the plans could cause ACA premiums to rise due to lower enrollment. An analysis by lobbying group America’s Health Insurance Plans estimates a 1.7 percent increase next year due to the short-term plan expansion.
The administration estimates that about 600,000 people will enroll in a short-term plan next year. Of that 600,000, officials estimate between 100,000 and 200,000 people will switch from ACA plans to enroll in short-term options.
Plans could be available in about 60 days but first must be approved by insurance regulators.
Report: Individual Insurance Enrollment Dropped by 12%
Enrollment in individual health insurance policies declined by 12 percent to 14.4 million in the first quarter of 2018 as compared to 2017, according to a new analysis from the Kaiser Family Foundation.
The study indicates that Affordable Care Act premium increases for unsubsidized enrollees was a key factor in the decrease, with 38 percent of people who were not eligible for subsidies dropping their coverage.
Even with the drop-off, overall enrollment in plans sold on the ACA exchanges continues to be stable, with 10.6 million enrolled compared to 10.3 million this time last year.
North Carolina Insurer to Reduce 2019 ACA Premiums by 4.1%
Blue Cross and Blue Shield of North Carolina has proposed lowering its premium rates for 2019 Affordable Care Act plans by 4.1 percent.
The company cited several factors in its decision, including a $120 million reduction in healthcare costs from newly negotiated hospital and doctor agreements, the suspension of the health insurance tax, and proceeds from last year’s federal income tax cut.
There are about 475,000 North Carolina residents enrolled in the company’s ACA plans.
Healthcare Reform News Update for July 31, 2018
NY Governor Requests Denial of Some ACA Premium Increases
New York Governor Andrew Cuomo has asked the state’s Department of Financial Services to reject any portion of Affordable Care Act premium increases attributed to the repeal of the individual mandate.
Premium increase requests for 2019 plans in New York average 24 percent, of which half is credited to the elimination of the ACA provision that required individuals to have health coverage or face a penalty.
“If we allowed that rate increase to go through, it would be hundreds of millions of dollars as a bonanza to the private insurance companies. It would increase the cost to normal hardworking families. We’re not going to let it happen,” Cuomo said at a rally on Monday. He added that “insurance premiums must be based on actual cost, and not political manipulations.”
Cuomo said the current proposed rates would raise premiums an average of $1,500 for each enrollee.
Maine Gains OK for Reinsurance Program
The Centers for Medicare and Medicaid Services approved Maine’s request to establish a reinsurance program to help stabilize Affordable Care Act insurers in the state.
CMS’ decision comes one day after approving a similar request from Wisconsin. The two states join Minnesota, Alaska, Oregon, and Hawaii with approved reinsurance programs.
New Jersey 2019 ACA Premiums to Rise 5.8%
Premiums for 2019 ACA plans in New Jersey are expected to rise an average of 5.8 percent.
Insurance requests in the state ranged from an increase of 0.8 percent to 9.2 percent. Governor Phil Murphy said the state’s individual mandate law prevented much higher price hikes.
Rates will be finalized prior to the open enrollment period this fall.
Healthcare Reform News Update for July 30, 2018
Analysis: Sanders’ Single-Payer Plan Could Cost $32.6 Trillion
Vermont Senator Bernie Sanders’ “Medicare for All” healthcare plan would increase government spending by $32.6 trillion over a decade, according to an analysis by the libertarian Mercatus Center at George Mason University in Virginia.
Sanders’ plan would cover all Americans with no copays or deductibles. Tax increases would be required to replace premium costs that are currently paid by consumers and employers.
The plan could lower prescription costs by $846 billion over 10 years and administration costs by $1.6 trillion, according to the report. However, spending would rise due to:
- Covering almost 30 million people who are currently uninsured,
- Requiring no out-of-pocket costs, and
- Including dental, vision and hearing coverage.
If corporate and individual income taxes were doubled, it would still not be enough to pay for the plan, according to the analysis.
Sanders calls the report a “misleading and biased” response to the growing popularity of a single-payer system. “If every major country on earth can guarantee health care to all, and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States cannot do the same,” he said in a statement.
Trump Administration Approves Wisconsin Reinsurance Program
The Centers for Medicare & Medicaid Services (CMS) on Sunday approved Wisconsin Governor Scott Walker’s reinsurance program.
Called the Health Care Stability Plan, the $200 million program will lower insurance rates for Affordable Care Act plans by providing government funds to insurance companies for their most expensive enrollees.
The plan is expected to lower 2019 ACA premiums by 3.5 percent.
Healthcare Reform News Update for July 27, 2018
Trump Administration Sued Over Association Health Plans
Attorneys general for 11 states and the District of Columbia have sued to block the Trump Administration’s regulation that expands access to association health plans (AHPs).
AHPs enable small businesses and groups to join together to purchase health insurance. The coverage does not have to meet the requirements of the Affordable Care Act, so the premiums are lower, but the plans do not cover essential benefits such as prescription drugs, maternity care, or mental health.
According to the complaint, the rule “upends a decades-old understanding of a foundational employee benefits law for the purpose of exempting a significant portion of the health insurance market from the Affordable Care Act’s consumer protections.”
The complaint also contends that the rule “increases the risk of fraud and harm to consumers, requires states to redirect significant enforcement resources to curb those risks, and jeopardizes state efforts to protect their residents through stronger regulation.”
The lawsuit is signed by the attorneys general of California, Delaware, District of Columbia Kentucky, Maryland, New Jersey, New York, Massachusetts, Oregon, Pennsylvania, Virginia and Washington.
HHS Secretary Criticizes ACA in Speech to Conservative Organization
Health and Human Services (HHS) Secretary Alex Azar spoke out against the Affordable Care Act on Thursday in a speech to the conservative Heritage Foundation.
Azar said the healthcare law was an example of government overreach that caused consumers to pay higher prices and “imposed a new tax or regulation, or sometimes both, on just about every moving part in our healthcare system.”
Azar believes the healthcare exchanges, in particular, have failed to attract younger enrollees, placing a financial burden on the older people left behind.
“The only factor keeping the individual markets alive is the tens of billions in subsidies supplied directly to insurers each year. The fundamental flaw of the Affordable Care Act is that it narrowed the competition for insurance options and laid down heavy-handed controls on the prices that could be charged,” he said.
Azar also shared his disapproval of the ACA’s Medicaid expansion, saying the federal government now pays more for the expansion population than it does for those who traditionally qualified for benefits. He said the Trump administration will support work requirements for beneficiaries who are neither disabled nor have children.
Healthcare Reform News Update for July 26, 2018
CMS Administrator Rejects Single-Payer Healthcare System
In a speech delivered Wednesday, Centers for Medicare and Medicaid Services Administrator Seema Verma said that a government-run, “Medicare for all” healthcare system would not work and she would likely deny states seeking waivers for single-payer programs.
Verma believes expanding Medicare would drain funding and put seniors at risk. “Ideas like ‘Medicare for all’ would only serve to hurt and divert focus from seniors,” she said.
Kaiser Poll: Pre-Existing Condition Protections Top Healthcare Concerns
A candidate’s position on continuing protections for people with pre-existing conditions is the leading healthcare concern for the majority of voters, with 63 percent of respondents ranking it their “most important” or “very important” healthcare issue, according to a new poll from the Kaiser Family Foundation. The topic ranked high with both Democrats and Republicans.
Other healthcare findings in the poll:
- 64 percent would oppose the Supreme Court overturning pre-existing condition protections.
- 51 percent of residents in states that have not expanded Medicaid would support expansion efforts.
- 56 percent of respondents believe President Donald Trump and his administration are trying to make the Affordable Care Act fail (with 47 percent saying it is a bad thing).
- 58 percent hold Trump and Republicans in Congress responsible for any future problems with the ACA.
House Passes Bill to Delay ACA Health Insurance Tax
The House on Wednesday passed a bill to extend the delay of the Affordable Care Act’s health insurance tax for 2020 and 2021. The tax was previously suspended for 2019.
The bill also expands eligibility for ACA catastrophic plans and expands eligibility and use of health savings accounts (HSAs).
Healthcare Reform News Update for July 25, 2018
Trump Administration Will Resume ACA Risk-Adjustment Payments
Centers for Medicare and Medicaid Services (CMS) issued a final rule Tuesday to restart the Affordable Care Act’s risk-adjustment payments to insurance companies.
Risk-adjustment payments are made by insurance companies with healthier enrollees to help offset companies with sicker enrollees. This process helps stabilize the marketplace. Earlier this month, the department halted the $10.4 billion program due to a federal judge’s ruling.
Halting the payments set off fears that the move would increase 2019 premiums or cause some insurance companies to leave the ACA exchanges.
“This rule will restore operation of the risk-adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation,” said CMS Administrator Seema Verma in a statement. “Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today. Alleviating concerns in the market helps to protect consumer choices.”
ACA Critic Paul Mango to Serve Trump Administration in CMS Role
Paul Mango, a strong critic of the Affordable Care Act, has been appointed chief principal deputy administrator and chief of staff at the Centers for Medicare and Medicaid Services (CMS).
Mango, a former Pennsylvania gubernatorial candidate, previously worked on healthcare issues for consulting firm McKinsey & Company.
“I have known Paul for more than 10 years and look forward to having his support as we deliver on President Trump’s agenda and execute on our strategy on behalf of the American people,” said CMS Administrator Seema Verma in a statement.
House Passes Bill to Repeal ACA Medical Device Tax
The house voted Tuesday to repeal a 2.3 percent tax on medical devices. The vote garnered support from both Democrats and Republicans.
The tax has been delayed twice, but the current bill would make the repeal permanent. It is uncertain whether or not the bill will be taken up in the Senate.
GOP Senators Push to Repeal DC’s Individual Mandate Penalty
Six Republican senators, led by Ted Cruz (R-TX), have introduced an amendment to an appropriations bill that would prevent the District of Columbia from using federal funds to impose a penalty on residents who don’t have health insurance. Last week, the House passed the amendment in a spending bill.
Healthcare Reform News Update for July 24, 2018
House to Vote on ACA Revisions, HSA Expansion
The House will vote this week on several Republican-backed healthcare measures, including:
- Allowing ACA premium tax subsidies to fund off-exchange health plans, including catastrophic coverage.
- Permanently repealing the Affordable Care Act’s medical device tax.
- Delaying the ACA health insurance tax.
- Expanding eligibility and use of health savings accounts (HSAs).
If approved, the measure would cost $92 billion over 10 years, according to Congressional Budget Office (CBO) estimates.
PA Insurers Lower 2019 ACA Rate Proposals
Pennsylvania insurance companies have reduced their rate requests for 2019 Affordable Care Act plans from an average increase of 4.9 percent to an average increase of 1 percent.
The state cited several factors for the change, “including lower insurer expenses for cost-sharing reduction payments covering deductibles, co-payments, and co-insurance for lower income customers, the department lowered the amount of a standardized factor.”
The state will finalize the rates prior to the Open Enrollment Period later this year.
Healthcare Reform News Update for July 23, 2018
Payment Structure for Medicare Office Visits Could Change
The Trump administration would like to change the way doctors charge Medicare patients for office visits beginning in 2019 by establishing one set rate for new patients and a lower set rate for established patients.
Medicare patients are currently billed between $76 and $211 for new patients and between $45 and $148 for established patients, depending on the complexity of the service. The Trump administration has proposed a set rate of about $135 for new patients and about $93 for established patients.
Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), says the change would help lessen doctors’ paperwork, giving them more time with patients. She says the change would help fulfill the president’s promise to “cut the red tape of regulation.”
Critics of the proposal say it could increase the risk of fraud and would result in a patient with a cold being charged the same as a patient with Stage 4 cancer. In addition, they fear that physicians in more specialized fields, such as dermatology and rheumatology, would be underpaid and that many could stop taking Medicare patients.
The proposal has the potential to affect the broader healthcare community, as private insurance companies often mirror Medicare rules.
The administration’s proposal is expected to be published in the Federal Register on Friday with a public comment period scheduled through September 10.
Connecticut 2019 ACA Premiums Could Rise 12.3%
Proposed health insurance premiums for 2019 Affordable Care Act plans in Connecticut will rise an average of 12.3 percent, with requests ranging from a 10.9 percent reduction from CTCare Benefits Inc. to an increase of 31 percent from Anthem Health Plans.
Final rates will be announced this fall after a review by state insurance regulators.
Healthcare Reform News Update for July 20, 2018
CMS May Restart of Risk-Adjustment Payments
The Centers for Medicare and Medicaid Services (CMS) sent an interim final rule to the Office of Management and Budget on Wednesday that is likely to enable the agency to resume billions in Affordable Care Act risk-adjustment payments.
The rule, titled “Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act,” could go into effect immediately. The contents of the rule will not be disclosed until it has been reviewed.
CMS stopped payments to the program last week due to conflicting legal rulings. The payments, which totaled $10.4 billion in 2017, go from insurance companies with heathier enrollees to those with sicker enrollees. This process helps balance the marketplace. Insurance companies feared that halting the payments could trigger premium increases.
Removing Pre-Existing Condition Protections Will Hurt States Challenging ACA the Most
Almost half of the states that have launched a legal challenge against the Affordable Care Act would be negatively impacted the most if protections for people with pre-existing conditions were eliminated, according to an analysis by the Kaiser Family Foundation.
A coalition of 20 Republican-led states filed a lawsuit in February challenging the legality of the ACA and its provision that people with pre-existing conditions can get health coverage without being charged higher premiums.
The study found that nine of the states in the lawsuit have residents with the country’s highest rates of pre-existing conditions among adults under 65. For example, West Virginia has the country’s highest rates with 36 percent of its population — or 1 in 3 adults under 65 — who would qualify as having a pre-existing condition.
“These states have been opposed to the ACA from the beginning. They’re hurting their most vulnerable citizens,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research.
Studies have shown that, prior to the Affordable Care Act, between 27 percent and 50 percent of adults under 65 had at least one pre-existing condition.
Poll: Half of Americans Believe Healthcare is More Expensive in 2018
Nearly half the country finds that healthcare is more difficult to afford than last year, according to a new poll by Democratic messaging firm Navigator Research.
Respondent opinions mostly transcended party affiliation with 54 percent of Democrats and 46 percent of Republicans saying it’s more difficult to afford prescription drugs, insurance premiums, and doctor visits this year as compared to last year.
The poll also showed that 78 percent of respondents believe the government should do more to make healthcare more affordable.
California 2019 ACA Premiums to Increase 8.7%
Affordable Care Act health plans sold on California’s healthcare exchange, Covered California, will rise an average of 8.7 percent in 2019, ending the double-digit increases seen in the state the previous two years. Covered California singled out the repeal of the individual mandate penalty as the reason for the increases.
All 11 insurance companies that sell ACA plans in the state will return next year. Rates are subject to review by state regulators before becoming final this fall.
House Passes Two Measures Blocking D.C.’s Individual Mandate
House Republicans passed measures on Thursday that would repeal the District of Columbia’s requirement that all residents have health insurance coverage.
Democratic Mayor Muriel E. Bowser was against the decision, saying the House ignored the wishes of residents.
The measure was introduced by Representative Gary Palmer (R-AL) who said in a statement that “individuals should be allowed to make their own decisions about the type of insurance they want to purchase without being subjected to punishment from the government. The D.C. individual mandate would restrict patient choice and force people to purchase insurance that they may not need, desire, or be able to afford.”
Healthcare Reform News Update for July 19, 2018
Association Health Plans Get Tepid Reception From Key Business Group
The National Federation of Independent Business (NFIB), which has lobbied for almost 20 years for association health plans, says the new insurance initiative allowing them is impractical for its membership.
The Trump administration will allow the plans to be sold beginning September 1. The NFIB objects to the rule that businesses can join together to purchase health insurance only if they share an industry or are within the same state.
“We can’t set up an AHP under the new rules any more than [we] could under the old rules,” said NFIB Spokesman Adam Temple.
Other trade groups such as the National Retail Federation and the National Association of Realtors have also voiced concerns about the new rules and have no intentions of setting up AHPs in the near future.
House Democrats Form New Medicare for All Caucus
Democrats in the House are launching a new caucus today that will focus on endorsing single-payer healthcare.
The Medicare for All Caucus will comprise approximately 60 Democratic members led by Representatives Pramila Jayapal (WA), Debbie Dingell (MI), and Keith Ellison (MN).
Healthcare Reform News Update for July 18, 2018
States: ‘Silver Loading’ ACA Plans Helped Subsidized Consumers
Eighteen states and the District of Columbia have asked a judge to put their lawsuit concerning the Trump administration’s cuts to Affordable Care Act subsidies on hold.
The states filed suit last year after President Donald Trump ended government payments to insurance companies that provided discounts to low-income consumers. As a workaround to counter the payment cutoffs, insurance companies raised premiums on silver plans. That move helped trigger increased tax credits for subsidized enrollees.
The states say that the workaround was successful in protecting lower-income consumers from premium increases. According to the filing, the decision “provided some stability to help ensure a functioning insurance market.”
The states are requesting a hold instead of dropping the suit entirely in the event the administration disallows the “silver loading” workaround.
Idaho Voters Will Decide on ACA Medicaid Expansion in November
Idaho residents will vote on expanding Medicaid through the Affordable Care Act in November, after a petition included enough signatures to put the measure on the ballot.
If approved, the expansion will enable 62,000 additional residents to qualify for coverage.
Healthcare Reform News Update for July 17, 2018
Lawmakers Press HHS to Restart ACA Risk Adjustment Payments
In a letter to HHS, Democrats on Congress’s healthcare committee asked the department to reconsider. “We ask that you take immediate action to reverse this destructive decision that will further destabilize the individual and small group markets that millions of Americans rely on for health insurance,” according to the letter.
The letter was signed by Democratic Representatives Frank Pallone Jr. (NJ), Richard Neal (MA), Bobby Scott (VA), and Senators Patty Murray (WA) and Ron Wyden (OR).
House Ways and Means Committee Chairman Kevin Brady (R-TX) said he is working with HHS officials to restart the payments. “The administration wants to restore those payments, so we’re looking at ways that we can help them do that,” he said.
Risk insurance payments are collected from insurance companies with healthier enrollees to help companies with sicker enrollees cover costs. Last week, the Trump administration suspended the payments citing a court ruling.
Healthcare Reform News Update for July 16, 2018
Colorado’s 2019 ACA Premiums Could See Average Increase of 5.94%
In Colorado, health insurance companies have requested to raise rates on 2019 Affordable Care Act plans by an average of 5.94 percent.
Broken down by plan type, the state filings reflected an average increase of:
- 6.85 percent for gold plans.
- 12.3 percent for silver plans.
- 0.9 percent for bronze plans.
All seven insurance companies that sell ACA plans in Colorado will remain on the exchange in 2019, and every county will have at least one insurer. Final rates will be announced prior to this fall’s open enrollment period.
Healthcare Reform News Update for July 13, 2018
House Committee Approves ACA Employer Mandate, Tax Credit Bills
Two bills advanced by the House Ways and Means Committee on Thursday address several provisions of the Affordable Care Act.
The first bill suspends ACA employee mandate penalties through 2019 and delays implementation of the “Cadillac tax” on high-deductible employee-sponsored health plans until 2022. The bill is sponsored by representatives Devin Nunes (R-CA) and Mike Kelly (R-PA).
The second bill would allow individuals to use ACA tax credits to purchase health plans not sold on the ACA exchanges. It will also allow people over the age of 30 to purchase catastrophic plans. The bill is sponsored by Peter Roskam (R-IL) and Michael Burgess (R-TX).
Healthcare Reform News Update for July 12, 2018
Bright Health Increases ACA Reach Into 9 New Markets
Startup insurer Bright Health announced that it will sell Affordable Care Act plans in nine additional markets in 2019, upping its reach to 12 markets in six states.
The company’s health plans are currently available in Colorado, Phoenix, and Birmingham, Alabama. New markets include:
- New York City
- Tucson, Arizona
- Cincinnati, Springfield, Toledo, and Youngstown, Ohio
- Knoxville, Nashville, and Memphis, Tennessee
Healthcare Reform News Update for July 11, 2018
ACA Navigator Program Funding Reduced to $10 Million
The Centers for Medicare and Medicaid Services (CMS) announced Tuesday that it will cut funding for the Affordable Care Act navigator program reducing it to $10 million.
Last year, the Trump administration slashed the federal grants for the program from $62.5 million to $36 million.
Each of the 34 states that use the federal ACA exchange will be awarded a minimum of $100,000 to help residents sign up for health coverage. In addition to promoting the government’s healthcare website, CMS says that it wants navigators to raise awareness of the association health plans and short-term plans that provide coverage for up to 12 months.
CMS Administrator Seema Verma said, “it’s time for the navigator program to evolve, which is why we are announcing a new direction for the program today.”
The agency says that the program’s sign-up performance in the past has been disappointing. After the 84 percent funding cut since 2016, navigators enrolled less than 1 percent of all ACA enrollees. Insurance agents and brokers signed up 42 percent.
Healthcare Reform News Update for July 10, 2018
Analysis: Insurance Companies Could Expand Into More ACA Exchanges
More insurance companies might sell Affordable Care Act plans in 2019, according to projections from a new analysis by the Robert Wood Johnson Foundation.
The analysis points to several factors that could increase the number of companies selling health plans on the exchanges:
- No insurers have announced that they are exiting any ACA markets.
- Profits are improving for plans sold on the ACA exchanges.
- Insurers have announced ACA expansions in Arizona, Florida, Iowa, Maine, Michigan, New Mexico, North Carolina, Ohio, Oklahoma, Tennessee, Utah, Virginia, and Wisconsin.
- More insurers have announced expansions compared to last year. Oscar, Bright Health, Medica, and Wellmark have announced expansions. Anthem is also expected to enter new markets.
The analysis was prepared prior to last weekend’s announcement by the Trump administration that it will suspend risk-adjustment payments to insurance companies. That decision, plus a lawsuit that questions the validity of the ACA, could potentially upset market stability, raise premiums, and affect insurers’ confidence to enter new markets.
Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute, addressed the issue. “There seems to be a little more confidence in the sustainability of the ACA market. It remains to be seen whether underserved rural areas will get more competition and choice next year. But with the administration’s risk-adjustment decision and the Texas lawsuit, we’re not out of the woods yet,” she said.
Maine ACA Medicaid Expansion Blocked by State House Lawmakers
The Maine House was unable to get the votes necessary to override Republican Governor Paul LePage’s veto of a bill that funded a voter-approved expansion of Medicaid. The bill would have garnered more than $500 million in federal funds and $60 million in state funds to more than 70,000 low-income residents.
A hearing next week before the Maine Supreme Judicial Court will determine how and if the state can implement the voter-approved expansion without funding approved by the Legislature.
Healthcare Reform News Update for July 9, 2018
Trump Administration Suspends ACA Risk Adjustment Payments
Citing conflicting court rulings, the Centers for Medicare & Medicaid Services (CMS) announced Saturday that it will halt $10.4 billion in risk adjustment payments to insurers until legal issues are resolved.
The Affordable Care Act’s risk adjustment program takes payments from insurers with healthier customers and redistributes that money to companies with sicker enrollees. A court in Massachusetts upheld the risk adjustment payments; however, a New Mexico court decided in February that the rules were unfair.
A statement from CMS Administrator Seema Verma said that the “ruling prevents CMS from making further collections or payments under the risk adjustment program. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold.”
Verma’s statement also noted that the agency is “seeking a quick resolution to the legal issues raised and will inform stakeholders of any update to the status of collections or payments at an appropriate future date.”
Insurance trade groups say that halting the payments will cause premiums to increase this fall.
Insurance trade group America’s Health Insurance Plans said the following in a statement: “This decision comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own.”
“Risk adjustment is a mandatory program under federal law. Without a quick resolution … this action will significantly increase 2019 premiums for millions of individuals and small business owners. … It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most,” said Blue Cross Blue Shield Association President Scott Serota.
Democratic lawmakers and ACA advocates, including House Energy and Commerce Committee Representative Frank Pallone (D-NJ), say the decision is one more step in the Trump administration’s plan to sabotage the healthcare law.
Healthcare Reform News Update for July 6, 2018
Nebraska Voters Could Have ACA Medicaid Expansion on Fall Ballot
Advocacy group Insure the Good Life garnered more than 135,000 signatures to allow Nebraskans the chance to vote for expanding Medicaid through provisions of the Affordable Care Act.
The petition included about 60 percent more signatures than required to qualify for the ballot. If enacted, the measure would insure approximately 90,000 people in Nebraska who earn up to $16,753 for a single person or $34,638 for a family of four.
Nebraska Governor Pete Ricketts opposes Medicaid expansion, and previous proposals have failed in the state’s predominately Republican legislature over the past six years.
Election officials have until mid-August to review the signatures collected and certify the ballot initiative.
Healthcare Reform News Update for July 5, 2018
Number of Brokers, Agents Selling ACA Coverage Drops Almost 25%
Insurance agent and broker participation in Affordable Care Act enrollment decreased by 24.8 percent in 2018, according to a report released by the Centers for Medicare & Medicaid Services (CMS) earlier this week.
Currently, 42 percent of ACA enrollees receive help through insurance agents or brokers. Last year, 65,300 agents and brokers helped Americans sign up for coverage. This year, the number dropped to 49,100.
According to CMS, the drop is due to several factors, including fewer insurance companies offering ACA plans, high premiums for people without subsidies, and limited commissions.
In 2016, the agency issued guidance to insurance companies to be consistent in their commission structures by the first of this year to help encourage agent and broker participation. Groups representing agents and brokers claim that it has not happened.
“Without a viable compensation structure for agents and brokers, it may be difficult for CMS to improve or stabilize agent and broker retention and achieve significant enrollment gains, leaving consumers with diminished access to insurance specialists willing to help them in their local communities,” according to the CMS report.
Vermont Prepares to Regulate Association Plans
Vermont will regulate association health plans that could be available in the state as soon as September, said Michael Pieciak, commissioner of the Vermont Department of Financial Regulation.
Last month the Department of Labor announced the expansion of the plans to the self-employed and a larger swath of small businesses. The plans are able to skirt many of the Affordable Care Act essential benefits, including mental health services, maternity care, and prescription drugs.
Pieciak said Monday that his department “aims to craft regulations that ensure Vermonters are protected and well-served by these health plans. In the past, similar plans that operated in other states were poorly run, and many were fraudulent.”
Healthcare Reform News Update for July 3, 2018
Percentage of 2018 ACA Enrollees Who Keep Plans Rises Slightly
The Centers for Medicare and Medicaid Services (CMS) released enrollment data Monday for 2018 Affordable Care Act Plans.
According to the report, 10.6 million of the 11.8 million who signed up for ACA plans paid their first month’s premium.
Almost 1.1 million, or about 9 percent, dropped their coverage as of February 2018. That percentage is lower than in 2017, when 1.9 million of 12.2 million enrollees—about 15.5 percent—dropped their coverage.
Enrollees without subsidized coverage dropped their coverage at a much higher rate than those with subsidies. From 2016 to 2017, only 3 percent of subsidized enrollees dropped coverage. In that same time frame, 20 percent of those without subsidized coverage dropped their plans.
Other findings in the study:
- The percentage of people who receive tax subsidies rose from 84 percent in 2017 to 87 percent in 2018.
- Cost-sharing reduction (CSR) subsidies were provided to 53 percent of enrollees.
- The average monthly premium before subsidies is $597, which is 27 percent higher than in 2017.
- The average tax credit is $520 per month, which is 39 percent higher than in 2017.
Healthcare Reform News Update for July 2, 2018
Trump Administration Could Slash Funding for ACA Outreach Groups
The Department of Health and Human Services (HHS) has made an initial proposal to cut funding for Affordable Care Act navigator groups from $36 million to $10 million, though the final funding amount has not been announced.
Navigators help consumers, especially those with limited English skills and citizens in rural areas, understand and find ACA plans. The groups have yet to receive any information from HHS on their funding levels for the upcoming open enrollment period.
Last year, the Trump administration reduced funding for navigators from $63 million to the current $36 million, asserting that the outreach programs were ineffective. Democratic lawmakers said the reduction was designed to sabotage the healthcare law.
Oregon 2019 ACA Premiums to Increase up to 10%
In Oregon, individual premiums will increase between 5 and 10 percent next year, according to preliminary rate decisions for 2019 Affordable Care Act plans issued Friday by state insurance regulators. Small group insurance plans will experience rate changes from a 4 percent drop to a 9.4 percent increase.
The relatively small increases are credited to the state’s reinsurance program. Final rates are expected to be announced by the end of the month.
Kentucky’s Medicaid Work Requirement Struck Down
U.S. District Judge James E. Boasberg on Friday blocked Kentucky’s new requirement that all Medicaid recipients have jobs. The decision, which is likely to be appealed, could reduce the number of states that expand their Medicaid programs through the Affordable Care Act.
Kentucky’s work requirement was the first of its kind in the country. It required 80 hours of work, job training, education, or volunteer service per month for nondisabled enrollees. Exemptions included pregnant women, full-time students, primary caregivers, and those considered medically frail.
Arkansas, Indiana, and New Hampshire have also passed Medicaid work requirements, and seven additional states have federal approvals pending. It’s unclear if Boasberg’s ruling applies to them as well.
Healthcare Reform News Update for June 27, 2018
Poll: Most Americans Back Pre-Existing Condition Protections
Majorities of Republicans, Democrats, and independents say it’s “very important” to retain the Affordable Care Act’s protections for people with pre-existing conditions, according to a Kaiser Family Foundation poll released today.
The poll asked 1,492 adults whether insurance companies should deny coverage based on someone’s medical history and whether those with pre-existing conditions should pay higher premiums. Currently, the ACA prohibits these practices. However, the Trump administration, in a legal challenge, recently said it would not defend these provisions.
Eighty-eight percent of Democrats, 58 percent of Republicans, and 77 percent of independents responded that it is “very important” that insurance companies cannot deny coverage because of a person’s medical history.
Similarly, 85 percent of Democrats, 58 percent of Republicans, and 70 percent of independents, responded that it is “very important” that health insurance companies cannot charge sick people more.
Medica Expands ACA Coverage to Oklahoma and Kansas City
In Missouri, the company will expand into Cass, Clay, Jackson and Platte counties. This year, the company sold policies only in Johnson and Wyandotte counties.
Proposed pricing for Medica’s ACA plans in both states will be available at a later date.
Healthcare Reform News Update for June 26, 2018
Smaller Insurers Expanding ACA Marketplace Coverage
Some smaller health insurance companies are planning to increase their presence on the Affordable Care Act marketplace for 2019, despite a decline in ACA carriers across the country in recent years.
Last week, Oscar Health announced its growth into three states and three new markets in existing states. Now, Bright Health has determined it will expand into Tennessee, and Presbyterian Healthcare is returning to the ACA marketplace to sell plans in New Mexico.
“It’s still early, but we haven’t seen any exits, and we are certainly seeing new insurers enter markets and expand where they are doing business,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “If not for the still significant political and legal uncertainty, we’d be seeing a very robust market right now.”
Seven states will gain ACA plan choices next year, but premiums will be higher. Rates will increase from an average of $642 per month this year to $740 in 2019.
Healthcare Reform News Update for June 25, 2018
2019 ACA Premiums Could Rise by 8.2% in Ohio
Insurance companies in Ohio have submitted proposed rates for 2019 health plans sold on the Affordable Care Act marketplace.
If approved by state regulators, premiums will rise an average of 8.2 percent. Last year, premium increases averaged 20 percent.
Ohio’s Department of Insurance also noted that residents in every county will have access to ACA coverage from at least one insurance company.
Healthcare Reform News Update for June 21, 2018
NY, MA Will Fight Trump Administration Over AHPs
The Democratic attorneys general for New York and Massachusetts will file a lawsuit against the Trump administration over its recent rule to expand access to lower-cost association health plans (AHPs).
The rule, finalized Tuesday, will allow self-employed individuals to join AHPs. In addition, the plans will not have to provide the 10 essential health benefits required under the Affordable Care Act, including emergency care, prescription drugs, and maternity care.
New York Attorney General Barbara Underwood and Massachusetts Attorney General Maura Healey say that the decision will “invite fraud, mismanagement, and deception.”
“We believe the rule, as proposed, is unlawful and would lead to fewer critical consumer health protections,” they said in a statement.
Kaiser Estimates ACA Eligibility Among the Uninsured
The Kaiser Family Foundation released an analysis that provides national and state-by-state estimates of how many uninsured Americans are eligible for Affordable Care Act healthcare coverage.
Of the 27.5 million nonelderly uninsured people in the country in 2016, the analysis found that:
- 54 percent are eligible for coverage via Medicaid or subsidized ACA coverage
- 28 percent are eligible for premium tax credits for ACA plans
- 16 percent are adults eligible for Medicaid
- 10 percent are children either eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
Oscar Health ACA Plans Expand Into 3 New States
Oscar Health is expanding its coverage area and will sell Affordable Care Act plans in Florida, Arizona, and Michigan in 2019. The company will also serve three new metropolitan areas in Ohio, Tennessee, and Texas, where it already offers insurance. In total, the company will sell 2019 ACA coverage in nine states.
Currently, there are 240,000 people signed up for Oscar plans, which is more than double last year’s enrollment.
Healthcare Reform News Update for June 20, 2018
Trump Administration Releases Final Rule on Association Health Plans
The Trump administration on Tuesday announced its finalized rules on expanding access to association health plans (AHPs).
AHPs allow small businesses to purchase health insurance across state lines at a lower cost. The new rules permit self-employed individuals to join AHPs, which will not be required to offer some essential health benefits outlined in the Affordable Care Act (ACA).
The plans can’t set premium rates based on pre-existing conditions, but they can vary rates based on age, occupation, or place of business.
“You’re going to save massive amounts of money and have much better health care. It’s going to cost you much less,” Trump said in a speech to the National Federation of Independent Business.
Labor Secretary Alexander Acosta said the plans could be available to millions of new enrollees as soon as September 1.
“As the cost of insurance for small businesses has been increasing, the percentage of small businesses offering health care coverage has been dropping substantially,” Acosta said. “Today, the Trump administration helps level the playing field between large companies and small businesses.”
Critics believe AHPs are “junk health insurance” and will cause healthy people to leave ACA plans, destabilizing the ACA marketplace. Some point out that, in the past, similar plans committed insurance fraud; therefore, more protections should be put in place.
As a reaction to the expected decrease in enrollment, the Congressional Budget Office (CBO) projects 2019 ACA premiums to rise by 2 to 3 percent.
Conservative Policymakers Release New ACA Repeal and Replace Plan
A coalition of conservative groups, led by the Heritage Foundation, the Galen Institute, and former Senator Rick Santorum (R-PA), unveiled a new plan Tuesday to repeal and replace the Affordable Care Act.
The plan states: “After efforts to repeal and replace Obamacare fell short last year, many in Congress seem resigned to accepting the status quo or even willing to bail out and prop up the program. But Obamacare is broken, can’t be fixed, and continues to do great harm.”
Proposals in the plan include eliminating the ACA’s essential health benefits and providing block grants to states instead of the current use of insurance subsidies and Medicaid expansion.
The plan is not expected to pass in Congress this year, as lawmakers have other priorities.
Healthcare Reform News Update for June 19, 2018
Report: ACA Helped Reduce Number of Uninsured Children
Uninsured children in the U.S. dropped by 2.2 million after the enactment of the Affordable Care Act in 2014, according to a study from the State Health Access Data Assistance Center (SHADAC).
The study compared insurance coverage from 2013 to 2016 overall and by individual factors such as income, race/ethnicity, and education levels.
The largest reduction of children without insurance was from families that were low-income, Hispanic, and non-white. Children in families with low education levels also benefitted.
The study examined coverage at the national and state levels, and the results include individual data for each state. For example, Georgia saw a decrease of more than 85,000 uninsured children, and Texas lowered the rate of uninsured children by 23.1 percent during the study period.
Bipartisan Governors Pledge Support for ACA Consumer Protections
A bipartisan group of nine governors issued a joint statement Monday speaking out against a Trump administration decision that could jeopardize access to healthcare for people with a history of medical problems.
In a recent legal brief, the Justice Department said it will no longer defend the portion of the Affordable Care Act that relates to pre-existing conditions.
“We’re asking the Administration to reverse their decision and instead work with Congress and Governors on bipartisan solutions to protect coverage and lower health care costs for all Americans, all while protecting those with preexisting conditions,” according to the statement.
Governors from the following states signed the statement: Colorado, Ohio, Alaska, Pennsylvania, Nevada, Montana, Maryland, Washington, and North Carolina.
Younger People Willing to Trade Privacy for Lower Premiums
The majority of people between 18 and 34 would be willing to share their social media information in exchange for lower health insurance premiums, according to a recent poll by software company MuleSoft Inc.
When 8,000 global respondents were asked if they’d be “happy for insurers to use third-party data” from sources such as Facebook, Fitbits, and smart-home devices to lower insurance costs, here’s how the age groups answered:
- 18–34: 62 percent said yes
- 35–54: 45 percent said yes
- 55-plus: 27 percent said yes
The survey also found spit opinions on digital offerings from insurance companies with 58 percent saying the systems don’t work adequately, and 56 percent saying they would drop their provider if the digital service was poor.
Maine Governor Continues to Fight ACA Medicaid Expansion
A Maine judge denied a motion filed by Republican Governor Paul LePage to delay the voter-approved expansion of Medicaid under the Affordable Care Act. Superior Court Justice Michaela Murphy said LePage’s administration must file the paperwork to begin the process. The governor said he would also fight this latest order.
Healthcare Reform News Update for June 18, 2018
2019 ACA Premiums to Rise in Washington DC, Fall in Minnesota
Health insurance companies in the District of Columbia and Minnesota have filed their premium rate requests for 2019 Affordable Care Act plans.
In D.C., the average request increases premiums about 15 percent compared to 2018 plans. In Minnesota, the rates are reduced about 12 percent on average.
Minnesota’s rate reductions are due to the state’s new reinsurance program, which offsets 80 percent of annual medical claim costs between $50,000 and $250,000 for individuals.
Actual rates will be finalized by insurance regulators before the annual enrollment period this fall.
Healthcare Reform News Update for June 15, 2018
Federal Court: Government Doesn’t Have to Pay ACA Risk Corridor Payments
A federal appellate court ruled Thursday that that the U.S. government does not owe health insurers over $12 billion sought in unpaid Affordable Care Act risk corridor funds.
Because Congress made the risk corridor payments budget neutral, the three-judge court agreed that the government could not tap other sources of money to pay for insurers’ losses.
The temporary risk corridor program was set up in the early years of the ACA for insurance companies that were making a profit to help companies that were struggling. However, too many insurers requested risk corridor money, and too few paid into the fund.
Healthcare Groups Oppose Justice Department’s ACA Decision
Eleven friend-of-the-court briefs have been filed by a variety of interested parties regarding the Justice Department’s decision not to defend some Affordable Care Act provisions, including protections for people with pre-existing conditions. All but one brief is against the decision.
Groups opposed to the decision represent insurance companies, medical schools, hospitals, and patient advocacy. The one brief filed in favor of the Trump administration’s position was from a coalition of gun-owner’s groups and the conservative organization Citizens United.
Healthcare Reform News Update for June 14, 2018
Actuary Group: Government Policies Are Driving ACA Premium Increases
Affordable Care Act premium hikes are being caused primarily from the increase of healthcare costs and policy changes from the Trump administration, according to a report released by the American Academy of Actuaries on Wednesday.
“The individual market, which had shown signs of stabilizing, now faces a potential deterioration of the risk pool due to policy changes that reduce incentives for healthy individuals to enroll in ACA marketplace plans. This deterioration and other factors could drive premiums higher for 2019,” said Cori Uccello, the group’s senior health fellow.
According to the report, national policy changes driving the increases include the:
- Repeal of the individual mandate.
- Extension of short-term insurance plans.
- Wider availability of association plans.
Healthcare actions by individual states are also a factor in the expected premium increases. In addition, policy changes are affecting insurance company assumptions for 2019 plans.
The group found that healthcare costs for 2019 are projected to rise between 5 to 8 percent.
House Democrats Question HHS & CMS Leaders About ACA Protections
A letter from House Democratic lawmakers to Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma asks if they were involved in the Justice Department’s decision to not defend central protections of the Affordable Care Act, including those for people with pre-existing conditions.
Signed by several ranking members of House committees, the letter asks about the existence of any analysis that may have been conducted that could have affected the decision and if they had plans to address any confusion the decision may cause.
“In declining to defend these protections in the Texas v. United States lawsuit, the Trump Administration is seeking to invalidate these critical patient protections, and once again subject tens of millions of Americans with pre-existing conditions to the discrimination they faced before the ACA,” the lawmakers wrote.
Healthcare Reform News Update for June 13, 2018
Azar, McConnell Affirm Support of Pre-Existing Condition Safeguards
Health and Human Services Secretary Alex Azar told the Senate Health, Education, Labor, and Pensions Committee he believes that the Affordable Care Act’s protections for people with pre-existing conditions should be maintained.
Azar said the Justice Department’s position that the law’s protections should be nullified is “a constitutional position … not a policy position.” When asked if he would urge the administration to revise its opinion, Azar said, “we do believe in finding solutions on the matter of pre-existing conditions and the matter of affordability, regardless of the litigation.”
Senate Majority Leader Mitch McConnell (R-KY) on Tuesday also expressed his support of the protections. “Everybody I know in the Senate — everybody — is in favor of maintaining coverage for pre-existing conditions. There is no difference in opinion about that whatsoever,” he said.
Healthcare Reform News Update for June 11, 2018
California AG & AHIP to Fight Government’s ACA Case
California Attorney General Xavier Becerra and the insurance company lobbying group America’s Health Insurance Plans (AHIP) have separately made statements that they will defend the Affordable Care Act against measures taken by the Trump administration.
The Justice Department on Thursday requested that a federal court invalidate some provisions of the law, including the individual mandate and protections for pre-existing conditions. Becerra is leading an effort by several Democratic attorneys general to defend the ACA in the case.
“It’s, simply put, an attack on the healthcare that millions of Americans have come to count on […],” Becerra said about the Justice Department’s decision.
AHIP announced Friday that it would file an amicus brief to provide specifics on the damage that could come from invalidating the ACA measures.
“Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” AHIP said in a statement.
KFF Tracks 2019 ACA Premium Changes
As it’s done since 2014, the Kaiser Family Foundation is monitoring and compiling insurance company filing information for next year’s Affordable Care Act plan premiums.
The analysis displays 2019 proposed premium rates for a major city in each state. The charts provide rates for a 40-year-old nonsmoker for the lowest-cost bronze plan and the second-lowest cost silver plan, which is used to determine subsidy rates. In addition, a tracker shows the number of insurance companies offering ACA plans in each state and the average difference in rates compared to 2018.
KFF will update the information as it becomes publicly available.
Healthcare Reform News Update for June 8, 2018
Trump Administration Reviewing ACA Consumer Protections, Individual Mandate
The Justice Department told a federal court Thursday that it would no longer defend key parts of the Affordable Care Act, including provisions that protect people with pre-existing conditions, saying they are part of an unconstitutional scheme.
In a brief filed in a Texas federal court, the department said the individual mandate was unconstitutional. It also said that the protections for people with pre-existing conditions should be eliminated.
The brief said that other portions of the law, including Medicaid expansion, health insurance marketplaces, and premium subsidies could remain as-is.
If a federal court agrees with the Justice Department, ACA consumer protections could be abolished. Any court rulings regarding the brief could take months to decide.
NC Farm Bureau Requests Association Health Plan
Following the lead of groups in Tennessee and Iowa, the North Carolina Farm Bureau has asked the state Senate to approve an association health plan that does not meet Affordable Care Act consumer protections.
Details of the plan have not been released, but the president of the bureau said premiums would vary based on an enrollee’s pre-existing conditions or medical history.
VA Governor Signs Medicaid Expansion Bill
Virginia Governor Ralph Northam (D) signed a bill into law Thursday allowing about 400,000 low-income residents to enroll in Medicaid, making it the 33rd state to do so under the Affordable Care Act.
“As a doctor and a public servant, I believe making sure all Virginians have the access to the care they need to be healthy and productive is both a moral and economic imperative,” said Northam.
Medicare Advantage Plans Could Skirt Chronic Care Act Benefits
Insurance companies that offer Medicare Advantage plans may not offer new benefits outlined in the Chronic Care Act to avoid enrolling seniors with fragile health conditions, according to a new analysis in the New England Journal of Medicine.
The new law expands nonmedical services that MA plans can cover, such as scooters, grab bars, hearing aids, and personal care services. The analysis warns that insurance companies may fail to offer these extra benefits to keep costlier, severely ill seniors from joining the plans.
Representatives from insurance companies dispute the analysis. For example, they say the authors did not take into consideration Medicare Advantage Dual Eligible Special Need Plans (D-SNPs), which enroll chronically ill beneficiaries.
“The argument being made by these authors is speculative and does not recognize some of the important realities of the Medicare Advantage program,” said AHIP spokesperson Cathryn Donaldson.
Healthcare Reform News Update for June 7, 2018
HHS to Allow Insurance Companies to Practice ‘Silver Loading’
Health and Human Services Secretary Alex Azar said Wednesday that his department will continue to allow insurance companies to practice “silver loading” for 2019 Affordable Care Act policies.
During a hearing before the House Education and Workforce Committee, Azar said banning silver loading was not possible for 2019 because it would “require regulations, which simply couldn’t be done in time.”
Silver loading raises the premiums of midlevel silver plans, which causes subsidy rates to rise accordingly. The practice can lower the out-of-pocket costs for enrollees eligible for tax subsidies, in some cases making low-level bronze plan premiums $0 per month. However, the practice increases the amount the government pays and can make premium prices for higher-income enrollees a burden.
Healthcare Reform News Update for June 6, 2018
Medicare Financials Worsening Due Partly to ACA Mandate Repeal
Medicare program trustees said Tuesday that Medicare Part A, which covers inpatient hospital stays, could run out of money by 2026, three years sooner than estimated a year ago.
In their annual report, trustees said Medicare’s insurance trust fund for hospital expenses is not sufficiently financed because of lower payroll taxes, Social Security tax cuts, the repeal of the Affordable Care Act’s individual mandate penalties, and the repeal of an ACA board responsible for overseeing spending.
The repeal of the individual mandate is expected to increase the number of uninsured Americans, which could leave hospitals with increased rates of uncompensated care. A Medicare fund helps hospitals with high numbers of uninsured patients cover those costs.
Treasury Secretary Steven Mnuchin says that efforts by the Trump administration will help reduce the financial outlook for both Medicare and Social Security. “Robust economic growth will help to ensure their lasting stability,” he said.
Medicare Part B, which covers doctor visits and outpatient care, is expected to remain solvent.
ACA’s Risk Adjustment Program Affects Plan Rates for Low-, High-Risk Insurers
Because of the way the Affordable Care Act’s risk adjustment program is structured, insurance companies that don’t anticipate a large drop in ACA plan enrollment for 2019 are proposing premium increases.
The risk adjustment program requires plans with low-risk younger, healthier enrollment to help offset plans with older, sicker members.
The Trump administration’s repeal of the ACA’s individual mandate is expected to cause low-risk people to drop their coverage. With fewer enrollees in the plan, insurance companies that pay into the risk adjustment plan will either have to increase their risk adjustment dollars or pay less into the system, which in turn affects high-risk plans.
“Even if any given insurer doesn’t actually expect their members to dis-enroll, they still have to raise premiums because this is a community-rated market,” said Erin Trish, a health policy professor at the University of Southern California.
Senate Democrat Vows to Force Healthcare Votes in August
After Senate Majority Leader Mitch McConnell (R-KY) canceled a scheduled August recess, Senate Majority Leader Chuck Schumer (D-NY) announced that he wants to use that time to put five Democratic-backed healthcare proposals up for a vote.
In a letter to McConnell, Schumer wrote, “We believe this previously unscheduled session time can be put to good use to finally help Americans secure the affordable health care the President and Congressional Republicans have thus far failed to deliver.”
Healthcare Reform News Update for June 5, 2018
New York, Washington Propose 2019 Double-Digit ACA Premium Hikes
Health insurance companies in New York and Washington have submitted double-digit rate hike requests for 2019 plans sold on the Affordable Care Act exchanges.
Fourteen insurers in New York have asked state regulators to raise rates an average of 24 percent due to the repeal of the ACA’s individual mandate. State regulators estimate that premium requests would have increased 12 percent without the repeal.
In Washington, rate hikes averaged 19.08 percent, citing the Trump administration’s recent proposals for short-term insurance and association plans as the cause.
The rate requests must be approved by the states prior to being implemented.
Judge Orders Maine Governor to Implement ACA Medicaid Expansion
In November, Maine voters approved the expansion of Medicaid through the Affordable Care Act, but Republican Governor Paul LePage has delayed implementation. A state judge on Monday gave LaPage a deadline of June 11 to submit details to the federal government.
The expansion would provide 70,000 low-income residents with health coverage.
Healthcare Reform News Update for June 4, 2018
Business Coalition Objects to IRS’s Handling of ACA Employer Mandate
Business trade groups, including the U.S. Chamber of Commerce and the National Retail Association, have sent a letter to the Trump administration objecting to the Internal Revenue Service’s tactics in collecting assessments for the Affordable Care Act’s employer mandate.
The coalition believes the IRS has not followed due process requirements in collecting approximately $4.3 billion in 2015 taxes. The letter states that the assessments should be suspended due to the “cost, complexity and confusion surrounding compliance with the employer mandate.”
More than 30,000 employers owe taxes due to the ACA regulation mandating that companies with 50 or more full-time employees provide health insurance, according to the IRS.
Texas Insurance Company Delays New ER Payment Policy
Blue Cross and Blue Shield of Texas will delay its new emergency room payment policy for 60 days while the state’s insurance department seeks clarification on how the company’s process will be implemented.
The company plans to charge its 500,000 HMO plan members 100 percent of ER costs if it’s determined that the visit was not related to a serious or life-threatening condition.
Texas Insurance Commissioner Kent Sullivan requested information on the company’s denial process, patient appeal rights, and communication methods to new members.
Medicare Beneficiaries Paying More for Brand-Name Drugs
Throughout a five-year period, Medicare beneficiaries decreased their Part D brand-name prescriptions by 17 percent but spent 40 percent more in out-of-pocket costs due to rising prices, according to a new report released today by the Health and Human Services inspector general’s office.
Between 2011 and 2015, the annual cost of brand-name drugs rose on average from $161 to $225. These costs will continue to rise, according to the report.
Other findings include:
- Costs for the top 200 most-prescribed medications increased more than double the rate of other drugs.
- From 2011 to 2015, Medicare beneficiaries with out-of-pocket drug expenses of more than $2,000 doubled to 7.3 percent.
- During the five-year period studied, spending for brand-name drugs rose from $58 billion to $102 billion, an increase of 77 percent.
- Manufacturer rebates had little impact in slowing the increase in costs.
Healthcare Reform News Update for May 31, 2018
NJ Governor Signs State Individual Health Insurance Mandate
New Jersey Governor Phil Murphy has enacted an individual mandate law that requires all state residents to have health insurance or pay a penalty.
Similar to the recently repealed Affordable Care Act individual mandate, the state’s penalty is 2.5 percent of household income or $2,085 per person, whichever is higher. The maximum penalty will be the average annual cost of a bronze plan. Residents who cannot afford health coverage could receive a hardship exemption determined by the state treasurer.
The law goes into effect January 1, 2019. The expected $90 to $100 million collected in penalties from the law will be used to fund a state reinsurance program.
The new law is the second state individual mandate in the country. Massachusetts enacted its law in 2006.
Virginia to Enact ACA Medicaid Expansion
The Virginia legislature voted Wednesday to expand Medicaid to as many as 400,000 residents under the Affordable Care Act. The state becomes the 33rd to adopt the program.
Virginia’s program includes a work requirement and a mandate that enrollees who earn wages over the federal poverty line must pay more out-of-pocket for medical services.
Majority of Healthcare Groups Critical of President’s Insurance Proposals
More than 95 percent of healthcare groups oppose two recent proposals from the Trump administration, according to a Los Angeles Times’ analysis of comments submitted to federal agencies.
More than 300 groups representing patients, consumers, physicians, nurses, hospitals, clinics, and insurance companies have left public comments in letters filed with federal agencies about proposed rules to expand short-term coverage plans and loosen association health plan regulations.
The review found that:
- 95% of healthcare groups left comments critical of the association health plan proposal.
- 98% of groups left comments critical of the short-term health plan extension.
- 25 state officials submitted critical comments about one or both of the proposals.
- Six state insurance officials submitted positive comments about one or both of the proposals.
Healthcare Reform News Update for May 25, 2018
Bipartisan Bill Proposes Delay of ACA’s Health Insurance Tax Until 2021
A bill introduced Thursday by bipartisan House members proposes to delay the Affordable Care Act’s health insurance tax until 2021.
The tax was enacted in 2014, but it was suspended last year and for 2019. Insurance companies are required to pay the tax for this year.
A delay of the tax could help prevent premium increases of up to 2.8 percent; however, it could also lead to a decrease in federal revenue by $144.7 billion over 10 years.
Healthcare Reform News Update for May 24, 2018
CBO Report: ACA Premiums, Number of Uninsured to Rise Through 2028
The Congressional Budget Office (CBO) issued a report Wednesday projecting a 15 percent rise in silver plan premiums and an additional 3 million uninsured people next year. The report projects continued increases through 2028, with premiums rising about 7 percent each year and the number of uninsured rising to 35 million people.
The increases are due to the repeal of the Affordable Care Act’s individual mandate and other alterations of the law by the Trump administration, according to the report.
The CBO also estimates the total cost of subsidies for ACA health plans and other individual health coverage will be $55 billion this year.
Healthcare Reform News Update for May 22, 2018
CDC Survey: 2017 Uninsured Rate Remained Steady at 9.1%
In 2017, the uninsured rate remained flat at 9.1 percent, which is just over 29 million people, according to a new survey from the Centers for Disease Control and Prevention (CDC).
Although the overall numbers were statistically unchanged from the end of the Obama administration into the beginning of President Donald Trump’s presidency, some groups are seeing a rise in not having insurance coverage. The CDC’s data show that:
- The middle-class uninsured rate rose to 8.2 percent possibly due to rising premiums and no subsidized coverage.
- Uninsured rates rose to an average of 19 percent in states that did not expand Medicaid coverage per the Affordable Care Act.
The survey also found a rise in the use of high-deductible health plans with almost 44 percent of insured Americans with deductibles that are at least $1,300 for individuals and $2,600 for families.
Healthcare Reform News Update for May 21, 2018
Four Healthcare Bills in Virginia Rejected by Governor
Virginia Governor Ralph Northam (D) on Friday vetoed four separate pieces of healthcare legislation that he said would destabilize the marketplace.
The vetoed bills sought to establish association plans, create nonprofit “benefits consortiums,” allow the purchase of short-term policies for up to a year, and allow more people to purchase catastrophic health plans.
In each of his veto statements, Northam said, “this legislation would place consumers at risk of being underinsured and would fragment Virginia’s federal marketplace risk pool, leading to rapidly increasing premiums.”
Northam would prefer to lower healthcare costs by expanding Medicaid to the state’s low-income adults. In each veto statement, he said, “we are fortunate to have a better opportunity to expand healthcare to people who need it and make it more affordable for all Virginians.”
Maryland Reinsurance Program Delayed
A $462 million reinsurance program proposal created by Maryland has been delayed, and acceptance is uncertain due to a disagreement from the two insurance companies that sell plans on the state’s Affordable Care Act exchange.
Kaiser Permanente of the Mid-Atlantic States claims that the reinsurance plan would favor CareFirst BlueCross BlueShield through “double dipping” the reinsurance program and a separate federal risk adjustment plan.
The state’s ACA marketplace, The Maryland Health Benefit Exchange, has asked for an independent analysis, which will not be complete until June 30. This poses a problem for the state as the deadline to file an application with the Centers for Medicare & Medicaid Services is May 31.
Healthcare Reform News Update for May 18, 2018
Insurance Companies Selling ACA Plans Received Highest Profits in 2017
Companies selling individual health plans on the Affordable Care Act marketplace posted their strongest financial year in 2017, according to a new Kaiser Family Foundation report.
The findings are based on two different financial indicators:
- The average share of health premiums paid out in claims fell to 82 percent in 2017. In 2016, it was 96 percent. In 2015, it was 103 percent.
- Average premiums collected in excess of claims were $79 in 2017 per member per month, compared to $14 in 2016 and $9 in 2015.
The analysis indicates that future profitability is unclear. “These new data from 2017 offer further evidence that insurers in the individual market are regaining profitability, even as political and policy uncertainty, repeal of the individual mandate penalty as part of tax reform legislation, and proposed regulations to expand loosely-regulated short-term insurance plans cloud expectations for the future,” according to the analysis.
CMS Rejects Ohio’s Plan to Nullify ACA Individual Mandate
The Centers for Medicare & Medicaid Services (CMS) has denied Ohio’s request to eliminate the Affordable Care Act’s provision that all residents have health care coverage.
In a letter to the state’s Department of Insurance, CMS said the state failed to provide an alternate program that was equivalent to ACA coverage and did not provide a reason for the request.
Congress repealed the tax penalty for not having tax coverage in December, but the requirement for having insurance still remains part of the law.
The state is reviewing CMS’ position and is working to develop potential responses.
California ACA Premiums Expected to Rise 11%
Covered California, the state’s ACA marketplace, released estimates Thursday projecting that 2019 individual plan premiums will rise 11 percent and enrollment will drop 12 percent. Actual premium increase amounts will be announced in July.
The state has the largest ACA enrollment in the country with 2.4 million people, including 1.3 million who receive subsidies.
Healthcare Reform News Update for May 17, 2018
Federal Judge Allows Democratic States to Proceed in ACA Lawsuit
A federal judge has granted California Attorney General Xavier Becerra and 16 other attorneys general from Democratic states the right to intervene in a lawsuit filed in Texas that seeks to eliminate the Affordable Care Act.
“Today’s ruling allows us to protect the health and wellbeing of these Americans by defending affordable access to healthcare,” Becerra said. “Before the Affordable Care Act, Americans had shorter lives and paid twice as much for their healthcare as other developed countries. The passage of the ACA was the first step toward fixing that problem. We must continue to move forward, not backward.”
The lawsuit was filed in February by Republican attorneys general who argue that the repeal of the ACA’s individual mandate made the law unconstitutional.
Graham Continues ACA Repeal and Replace Efforts
Senator Lindsey Graham (R-SC) said Wednesday that he is continuing his efforts to put together a bill to repeal and replace the Affordable Care Act.
Graham’s new bill is expected to contain components from his failed effort last year that gives block grant money to states instead of subsidies or Medicaid expansion.
“I haven’t given up. Will there be another effort to replace Obamacare with a state-centric plan? I hope so,” he said.
VT Governor Signs Bill to Allow Drugs From Canada
Republican Governor Phil Scott of Vermont signed first-of-its-kind legislation on Wednesday to allow importing prescription drugs from Canada.
The law allows Canadian drug wholesalers to sell their products to wholesalers in Vermont. Other states permit individuals, but not wholesalers, to import prescription drugs. Before being enacted, the law must first be certified by the Department of Health and Human Services.
Both President Donald Trump’s administration and drug companies have voiced their opposition to the legislation.
Healthcare Reform News Update for May 16, 2018
Expanded Short-Term Health Plans Could Cost Government $1.2 Billion
President Donald Trump’s proposal to increase short-term health plans to 12 months would attract more consumers and cost up to seven times more than previously estimated, according to an independent study conducted by Medicare’s chief actuary Paul Spitalnic.
Originally, the Trump administration estimated that the plans would enroll a few hundred thousand consumers and cost between $96 million and $168 million a year. However, the plan could increase federal spending by $1.2 billion next year, Spitalnic believes.
Spitalnic estimated that premiums for the short-term plans would average $340 per month compared to $600 for unsubsidized silver plans sold on the Affordable Care Act exchanges. The lower cost of the plans would attract people who don’t need all the essential benefits, which would lead to “relatively less healthy” people in the ACA marketplaces.
The study also found that “skimpy” short-term plans would cover 50 percent of enrollee costs, compared to 70 percent for ACA silver plans.
Oregon ACA Plans Request 8% Average Increase
Oregon’s seven insurance companies that sell Affordable Care Act plans have requested premium changes for 2019 that would raise costs an average of 8 percent.
The increases range from Regence BlueCross and BlueShield’s 5 percent hike to HealthNet’s request of 16.3 percent. PacificSource is the only company asking for a decrease, requesting 10 percent lower premiums due to lower-than-expected costs.
Oscar ACA Plans to Expand Into More States
Oscar Insurance Corp. announced that it will begin to sell Affordable Care Act plans in Arizona and at least three additional states for 2019 enrollment. Due to incomplete state filings, Oscar CEO Mario Schlosser was not able to name the other markets it will enter.
“We feel comfortable that the risk pool will remain comfortable, and that we can roll out the blueprint for expansion that we have in more areas,” Schlosser said.
This year, Oscar enrolled 240,000 people in ACA plans, up from 90,000 in 2017.
Healthcare Reform News Update for May 15, 2018
Survey: Number of Uninsured Americans Rises to 15.5%
About 15.5 percent of Americans between 19 and 64 are uninsured in 2018, up from 12.7 percent in 2016, according to a new Commonwealth Fund tracking survey. That’s 4 million people who have dropped coverage between the two years.
Specific findings in the survey include:
- Texas leads the nation in uninsured residents with 4.5 million without insurance. That number includes nearly 700,000 uninsured children.
- States that have not implemented the Affordable Care Act’s Medicaid expansion have seen a rise in uninsured residents from 16.1 percent in 2016 to 21.9 percent this year.
- About 20 percent of people in the South are currently uninsured.
- About 5 percent of adults are expected to drop coverage in 2019 due to the repeal of the ACA’s individual mandate.
HHS Considers Plans to Reduce Medicare Drug Prices
Health and Human Services Secretary Alex Azar announced that he is studying a plan to help lower the cost of prescription drugs for Medicare beneficiaries.
Azar wants to simplify the way Medicare pays for some expensive drugs by having them paid through Part D instead of Part B.
“We believe there are more private sector entities equipped to negotiate these better deals in Part B, and we want to let them do it. More broadly, the President has called for me to merge Medicare Part B drug payments into Part D, where negotiation has been so successful,” Azar said.
A pilot program could be used to roll out the new plan, but no details have been released.
Medica Doubles ACA Enrollment Numbers
Health insurance company Medica increased the number of people enrolled in plans it sells on the Affordable Care Act marketplace from 91,000 in 2017 to 196,479 in 2018. Most of the increase came from Iowa and Nebraska, where it is currently the only choice on the state exchange.
Maryland’s Expanded Medicare All-Payer Model Approved
The Centers for Medicare & Medicaid Services (CMS) approved Maryland’s requests to expand its unique all-payer model.
The state requires Medicare payers to charge the same rate for all hospitals. The new model will include nonhospital community providers such as long-term care and mental health facilities.
The new model is expected to save Medicare $1 billion by 2023.
Healthcare Reform News Update for May 14, 2018
Up to 10% of ACA Enrollees Could Switch to Association Health Plans
Enrollment in Affordable Care Act plans could drop anywhere from 3 to 10 percent due to people switching to less-expensive association health plans (AHPs), according to a new study released Friday by The Actuary magazine.
The study analyzed two scenarios based on how association plans could be implemented by the U.S. Department of Labor. In both scenarios, the analysis showed that:
- healthier people are more likely to switch to association health plans.
- the cost of ACA premiums would rise as a result.
The first scenario projects a 3 percent drop in ACA enrollment if self-employed individuals are allowed to opt in to AHPs. In this instance, enrollees would be subject to strict verification requirements and could not be excluded due to health status.
The second scenario projects a 10 percent drop in ACA enrollment if self-employed AHP enrollees could be excluded based on health status and the regulations preempt some state regulatory authority.
Healthcare Reform News Update for May 11, 2018
HHS Secretary Defends 12-Month Short-Term Insurance Plans
During a Senate budget hearing Thursday, Health and Human Services (HHS) Secretary Alex Azar reiterated his support of short-term insurance plans that can be purchased for up to 12 months.
The lower-cost plans do not require the Affordable Care Act’s 10 essential benefits nor are they required to cover pre-existing conditions.
Azar said that the plans “may not be the right option for everybody” but are better than being uninsured. “If we start making them the equivalent of the Affordable Care Act, we’ll end up with the same pricing regime [and the problem of unaffordable insurance won’t be solved],” he said.
NY and MN Settle Lawsuit Over ACA’s Basic Health Programs
Officials in New York and Minnesota have settled a lawsuit against Health and Human Services (HHS) over its decision to cut funding for the states’ Basic Health Programs, which insure residents whose income is above the Medicaid threshold, but below 200 percent of the poverty level.
HHS will pay $151.9 million to New York and $17.3 million to Minnesota by May 14.
“We are gratified that the federal government has agreed to make this interim payment,” Acting New York Attorney General Barbara Underwood said in a statement. “We hope and expect that, in the coming weeks, we’ll reach agreement with the federal government on a payment formula for the program, so that we can resolve this matter fairly and appropriately for all New Yorkers.”
HHS stopped funding the programs in December 2017 as part of the decision to stop cost-sharing reduction (CSR) payments to insurance companies. Funding for the Basic Health Programs is partially determined by CSR subsidy amounts.
The Basic Health Programs were established by the Affordable Care Act and cover 800,000 low-income people in New York and Minnesota, the only states that operate the programs.
Healthcare Reform News Update for May 10, 2018
CMS to Update Online Medicare Plan Finder Tool
At the urging of patient advocates, the Centers for Medicare & Medicaid Services (CMS) will update its Medicare Plan Finder tool to make it easier for consumers to navigate.
“CMS is undertaking several consumer-friendly improvements for Medicare Open Enrollment so that people with Medicare can make an informed choice between original Medicare and Medicare Advantage,” said CMS Administrator Seema Verma.
Some of the new features will include:
- A mobile out-of-pocket cost calculator for prescription drugs
- A simplified login process
- A webchat option
The improvements will be ready by the 2019 enrollment period, which begins October 15, Verma said.
GOP Senators Try to Accelerate ACA State Waiver Process
Republican Senators Lamar Alexander (TN) and Susan Collins (ME) are in discussions with CMS Administrator Seema Verma about expediting the process for states to obtain Affordable Care Act innovation waivers to establish reinsurance programs.
Insurance companies are beginning to request premium increases for 2019 plans, and reinsurance programs can help balance the increases, but getting approval in time is a factor.
“Obviously most of what we proposed to do has to be done with legislation, but [Verma] might have some flexibility to change things,” Alexander said.
Healthcare Reform News Update for May 9, 2018
CMS Hopes to Improve Services in Rural Areas
The Centers for Medicare & Medicaid Services (CMS) unveiled a new rural healthcare strategy Tuesday that addresses how its policies affect rural providers and communities.
The department wants to alleviate disparities by:
- Loosening telehealth regulations
- Reaching out to rural providers to increase awareness of CMS programs
- Pinpointing the policies that work best for the 60 million people who live in rural areas
“This administration clearly understands that one of the keys to ensuring that those who call rural America home are able to achieve their highest level of health is to advance policies and programs that address their unique healthcare needs,” said CMS Administrator Seema Verma.
The document did not contain any specific policy measures.
Senator Working With Trump Administration on ACA Flexibility
After failing in a bipartisan effort with Senator Patty Murray (D-WA) to help stabilize the Affordable Care Act marketplace and lower premiums, Senator Lamar Alexander (R-TN) is now in talks with the Trump administration for solutions.
In a recent letter to supporters, Alexander said that he is working with the president’s officials to find “other administrative actions they can take to give states more flexibility to help lower health insurance premiums, especially for the 9 million working Americans in the individual market who do not receive a federal subsidy.”
In a separate statement, Murray expressed her disappointment with Alexander’s partisan efforts.
Healthcare Reform News Update for May 8, 2018
CMS Hires Contractor to Validate Medicare Beneficiary Addresses
The Centers for Medicare & Medicaid Services (CMS) has signed an emergency $5.5 million contract with a vendor to help ensure that the new Medicare ID cards are mailed to the correct beneficiaries.
A data vulnerability revealed that some addresses may not be accurate. West Publishing Corp. has been tapped to track down beneficiaries and ensure that the cards are not misdirected.
CMS has planned to mail new cards to approximately 60 million Medicare enrollees by April 2019.
Maryland Insurers Request 2019 ACA Rate Hikes of up to 91%
Two health insurance companies in Maryland have sent requests to the state for double-digit premium increases on 2019 plans sold on the Affordable Care Act marketplace.
CareFirst BlueCross BlueShield has asked for an increase of 18.5 percent for its HMO plans and a hike of 91.4 percent for its PPO plans. Kaiser Permanente has proposed an overall 37.4 percent increase.
The companies cite several Trump administration policies that may cause healthy people to drop their coverage, including the repeal of the individual mandate, intentions to allow short-term plans to extend the maximum period to 12 months, and the approval of “skimpier” health plans that do not meet all ACA regulations.
State regulators must approve the increases by the annual enrollment period in November before they can go into effect.
House Farm Bill Includes Establishment of Association Health Plan
The House version of a massive farm bill includes $65 million in loans and grants to help organizations create association health plans for ranchers, farmers, and other agribusiness.
The bill proposes that, beginning in 2019, the secretary of Agriculture could issue up to 10 loans of no more than $15 million each to existing agricultural associations. Due to changes from the Trump administration, the plans would not have to offer the Affordable Care Act’s 10 essential health benefits.
The bill was approved by the House Committee on Agriculture last month but is currently waiting consideration on the House floor.
Healthcare Reform News Update for May 7, 2018
Virginia Insurance Companies Ask for Double-Digit Premium Increases
Two insurance companies in Virginia have requested significant premium rate hikes for their 2019 Affordable Care Act health plans, citing the repeal of the individual mandate as the primary reason.
Cigna has asked for an average premium increase of 15 percent for its 103,264 Virginia enrollees. CareFirst BlueCross BlueShield is seeking a 64 percent hike for its 4,500 enrollees.
However, Optima Health has asked for a 5 percent decrease for 2019 ACA premiums. The remaining four state insurers participating in ACA exchanges have yet to file rate requests.
Healthcare Reform News Update for May 3, 2018
Price Explains Support for ACA Individual Mandate Repeal
Former Health and Human Services Secretary Tom Price said that comments he made at Tuesday’s World Health Care Congress were taken out of context. At the event, Price said the repeal of the Affordable Care Act’s individual mandate would increase insurance premiums and destabilize the marketplace.
“Repealing the individual mandate was exactly the right thing to do. Forcing Americans to buy something they don’t want undermines individual liberty as well as free markets. The only fair and effective way to bring down health-care costs is to allow markets to create more choices for consumers and small businesses,” Price said in a statement on Wednesday.
Healthcare Reform News Update for May 2, 2018
Former HHS Secretary Criticizes ACA Individual Mandate Repeal
Tom Price, former secretary of Health and Human Services, said Tuesday that the repeal of the Affordable Care Act’s individual mandate will drive up premiums and damage marketplace stability.
“[…] There are many, and I’m one of them, who believes that that actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently, that drives up the cost for other folks within that market,” he said.
Price’s remarks during the World Health Care Congress are a reversal from his previous position during his time in the Trump administration, where he pushed for a repeal of the law and its individual mandate.
CMS Concerned About Medicaid Work Requirements in Non-Expansion States
Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said Tuesday that she’s worried about some people losing coverage if Medicaid work requirements are approved in states that have not expanded Medicaid under the Affordable Care Act.
Verma is concerned about a “subsidy cliff.” This would happen if a person earns enough to make them ineligible for Medicaid but not enough to receive a subsidy for a marketplace plan, causing them to be uninsured.
“Because there is no tax credit for them to move on to the exchanges, what happens to those individuals? We need to figure out a pathway, a bridge to self-sufficiency,” Verma said.
Work permit waivers in Arkansas, Indiana, and Kentucky have been approved. Kansas, Maine, Mississippi, Utah, and Wisconsin are currently seeking waivers, with other states expected to follow soon.
Healthcare Reform News Update for May 1, 2018
ACA Medicaid Expansion an Issue in Maine, Idaho, and Virginia
Several of the 18 states that have not expanded Medicaid through the Affordable Care Act are now either putting the measure up for ballot votes or creating legislation. Under the ACA, Medicaid expansion provides insurance coverage to adults earning up to 138 percent of the federal poverty level, which is $16,800 for an individual and $34,600 for a family of four.
The topic has been raised this week in Maine, Idaho, and Virginia:
- In Maine, supporters of the Affordable Care Act filed a lawsuit against the Maine Department of Health and Human Services to force it to implement a law that was approved by voters in November. Republican Governor Paul LePage refuses to expand Medicaid services to the 80,000 residents that qualify, despite 59 percent of voters approving the measure.
- An activist group in Idaho has collected enough signatures to put the measure on the ballot in this fall’s election. Similar efforts are underway in Nebraska and Utah.
- In Virginia, the state legislature is working on an expansion bill that includes a work requirement for eligible enrollees. Arkansas, Indiana, and Kentucky have previously been granted approval to require that Medicaid beneficiaries be employed.
Healthcare Reform News Update for April 30, 2018
House Democrat Proposes Changes to ACA Enrollment
Representative Ami Bera (D-CA) has unveiled two healthcare bills that would change how and when people sign up for individual insurance.
Bera’s first bill proposes reducing uninsured rates by providing states with grants to test a system that would automatically enroll consumers into Affordable Care Act health plans or Medicaid. Enrollees would have 60 days to opt out.
“Reducing complexity and making non-enrollment the onerous choice has been found to be both popular and effective. Opt-out enrollment in retirement plans boosted participation rates to 90 percent from just 33 percent using traditional enrollment,” according to Bera’s office.
His second bill moves the end of the open enrollment period to April 15, lining up with the deadline to file taxes. Bera thinks consumers would be more willing to sign up in spring rather than the busy holiday season.
Healthcare Reform News Update for April 27, 2018
CMS Extends Renewal of Transitional Health Plans
The Centers for Medicare and Medicaid Services (CMS) has allowed an extension for transitional health plans through December 31, 2019.
Transitional plans were available to individuals and small groups prior to the enactment of the Affordable Care Act (ACA) and do not comply with all of the law’s regulations. These “grandmothered” lower-cost plans were initially allowed to continue coverage in 2014 and have received three prior extensions.
There are currently about 1 million enrollees in transitional plans, and moving these consumers to ACA plans would help lower premiums, experts say. Since transitional plans base their premium costs on health status, they often attract healthier Americans, which increases the premiums of plans sold on the ACA marketplace.
States are allowed to discontinue the transitional plans, but many lawmakers fear that doing so would cause consumers to cancel their health coverage.
20 States Ask Court to Invalidate the Affordable Care Act
A coalition of 20 states, led by the attorneys general of Texas and Wisconsin, has asked a federal court to temporarily overturn Affordable Care Act regulations.
The coalition filed its original suit in February. The suit argues that, when Congress repealed the penalty for being uninsured, it invalidated the overall law. That lawsuit has been challenged by 16 Democratic governors.
This latest filing asks the court to grant a preliminary injunction while the larger suit proceeds.
Healthcare Reform News Update for April 26, 2018
California Marketplace Director Calls on HHS to Restore ACA Outreach Funds
Peter Lee, the executive director of California’s state-run Affordable Care Act marketplace, has requested that Health and Human Services (HHS) reinstate the previous funding levels for advertising and outreach for the ACA’s open enrollment period.
In a letter to HHS Secretary Alex Azar on Wednesday, Lee warned that the 90 percent cut to funding by the department last year will be a factor in higher health insurance premiums for ACA plans.
“The reality is clear: If the federal government maintains the current cuts in marketing and outreach, premiums will be higher than necessary, consumers will be hurt as a result, and taxpayers will pay the price by supporting higher [than] necessary subsidies,” Lee wrote.
Throughout the past two years, enrollment for ACA plans on the national marketplace declined by 9 percent overall, and first-time enrollees decreased by 40 percent. For state-run ACA marketplaces, which maintained their outreach funding levels, enrollment remained steady.
Healthcare Reform News Update for April 24, 2018
Insurance, Hospital Groups Weigh in on Short-Term Health Plans
Associations representing insurance companies and hospitals have sent comments to Health and Human Services Secretary Alex Azar about the department’s plan to extend short-term health insurance plans to 12 months.
America’s Health Insurance Plans, a leading industry lobbying group, warned that the extension would curtail access to affordable comprehensive coverage and raise premiums for those with pre-existing conditions. “Policies that disproportionately draw healthy consumers away from the individual market, like expanding access to short-term plans, will likely have an even more devastating effect on affordability, choice, and competition,” the organization said.
Alliance of Community Health Plans believes short-term plans should remain capped at their existing 90-day limit and an extension would destabilize the individual health insurance marketplace. Association for Community Affiliated Plans also expressed concern that the plans would harm consumers and warned that, in the past, coverage has been rescinded for some beneficiaries who try to file substantial claims.
Some insurance companies, such as Aetna, Agile Health Insurance, and The IHC Group, are generally in favor of the proposal but request some consumer protections, including:
- Allowing plans to be in effect until the next open enrollment period
- Prohibiting the practice of denying claims based on pre-existing conditions more than a year old
- Limiting policy rescissions to occurrences when enrollees omit information on applications
- Creating a minimum coverage guarantee
- Allowing state insurance departments to create a standardized policy that would be effective in several states
Healthcare Reform News Update for April 23, 2018
Judge Grants Class-Action Status to Insurance Companies in CSR Lawsuit
Judge Margaret Sweeney of the U.S. Court of Federal Claims has allowed insurance companies to sue the federal government as a class concerning its failure to pay cost-sharing reduction (CSR) payments.
The request for class-action status came from Common Ground Healthcare Cooperative. If the group is successful in court, the government could be responsible for billions in back payments of CSR bills.
The government argued that a class-action suit was not appropriate because damages to individual companies would vary since many insurers raised premiums to offset the CSR payment cutoff.
It’s expected that the government will appeal the decision.
Healthcare Reform News Update for April 20, 2018
Wisconsin Seeks a Federal Waiver for Reinsurance Program
Wisconsin has requested a waiver from the federal government for a state reinsurance program, which will help insurance companies pay for the most expensive claims.
The $200 million program is expected to help lower premiums for the state’s Affordable Care Act health plans by 5 percent in 2019, which is a significant reversal from this year’s increase of 44 percent.
Currently, Wisconsin has more than 202,000 residents enrolled in ACA plans with premiums averaging $751 a month. With the reinsurance program, premiums are projected to average $710.
“We feel very, very positive about our ability to get an approval and do so on a timely basis,” said Wisconsin Governor Scott Walker.
Healthcare Reform News Update for April 19, 2018
Senate Democrats Propose New Healthcare Option
Senators Chris Murphy (D-CT) and Jeff Merkley (D-OR), along with eight Democratic cosponsors, introduced an expanded public option healthcare proposal on Wednesday.
The Choose Medicare Act is a compromise idea that borrows measures from “Medicare for all” proposals and builds on existing measures of the Affordable Care Act.
The proposal gives consumers and businesses the choice to use private health insurance coverage or Medicare-based coverage. It also increases ACA subsidy amounts and includes people with higher income levels than current requirements allow.
CA Hospitals Must Continue ACA Charity Care Obligations
Three hospitals in California have been ordered to pay millions of dollars in lump-sum payments to local nonprofit organizations after state Attorney General Xavier Becerra declined their requests to be relieved from Affordable Care Act charity obligations.
The hospitals argued that insurance gains under the ACA last year overrode the law’s requirement to provide free or discounted care (or other charity donations) in exchange for tax breaks.
Senators Request Justification for Risk Corridor Decisions
The ranking Democrats of the Senate finance and health committees have asked Health and Human Services Secretary Alex Azar to explain the department’s sudden decision to stop making risk-corridor payments to insurance companies on the ACA marketplace.
Ron Wyden (D-OR) and Patty Murray (D-WA) have requested the disclosure of:
- The accounting practices used to rationalize the decision.
- Why the department believes it no longer has “unfunded obligations” to the insurance companies.
- Whether federal accounting standards or Office of Management and Budget (OMB) guidance was used as justification.
“The Trump administration’s approach to funding the risk-corridors program amounts to budgetary whiplash, leaving many unanswered questions about its ability to be good financial stewards of taxpayer funds,” Wyden and Murray wrote.
An HHS spokesperson responded that the department “has updated its accounting of the risk-corridor program to reflect the fact that there is no obligation to make payments beyond the amounts collected from insurers under the program.”
Healthcare Reform News Update for April 17, 2018
Utah Likely to Include ACA Medicaid Expansion on Ballot
Organizers in Utah have collected enough signatures to put an Affordable Care Act expansion of Medicaid initiative on the state’s election ballot this fall. The advocacy group Utah Decides Healthcare needed more than 113,000 signatures; it gathered more than 165,000.
If passed by voters, the measure will allow 150,000 Utah residents who make 138 percent of the federal poverty level to enroll in Medicaid with no enrollment caps.
Utah lawmakers are also working on a “partial expansion” proposal that would include a work requirement and limit enrollment to residents who make up to 100 percent of the poverty level, which is about $25,000 for a four-person family. The proposal would cover 60,000 people. CMS’ approval of the measure is unclear, since the ACA requires the full 138 percent.
Healthcare Reform News Update for April 16, 2018
New Jersey Legislature Approves 3 State Healthcare Stabilization Initiatives
Late last week, New Jersey lawmakers passed three healthcare bills to address rising costs and consumer protections, including a state individual mandate penalty.
The bills awaiting Governor Phil Murphy’s signature include:
- A requirement that most New Jersey residents have health insurance, or pay a fine of either 2.5 percent of their household income or $695 per adult and $347.50 per child, whichever is greater. This law would be the first of its kind since President Donald Trump signed the tax bill late last year that included a repeal of the Affordable Care Act’s individual mandate.
- A reinsurance plan that helps insurance companies cover the most expensive healthcare claims.
- An out-of-network consumer protection measure that requires healthcare providers to disclose whether they are in a patient’s insurance network and discuss the patient’s out-of-pocket costs prior to an appointment. It also includes extensive reporting and transparency requirements for insurance companies.
Congressional Lawmakers Decry Short-Term Insurance Proposal
The top Democrats of five House and Senate committees have asked the Trump administration to scrap its proposed rule to increase the availability of short-term health insurance plans from three months to 12 months.
The short-term plans do not include consumer protections currently included in plans sold on the Affordable Care Act exchanges, including equal premiums for those with pre-existing conditions, as well as coverage for mental health care and prescription drugs.
“This proposed rule would expand the availability of discriminatory, deceptive, and insufficient plans … that deceive consumers into thinking they are covered for major medical expenses and is yet another attempt to sabotage the health care markets on which millions rely for coverage,” wrote Democratic Representatives Richard Neal (MA) and Bobby Scott (VA) and Senators Ron Wyden (OR) and Patty Murray (WA).
Healthcare Reform News Update for April 13, 2018
Poll: Slim Majority Favors a Single-Payer Government Program
A new Washington Post-Kaiser Family Foundation poll shows that 51 percent of Americans are in favor of the government creating a single-payer national health plan.
Democrats are more strongly in favor of a single-payer program, with 74 percent supporting it, compared to nearly 20 percent of Republicans. A majority of Independents support the program, with 54 percent saying they favor the program.
This latest poll mirrors a similar one last year that showed a 53 percent majority supporting a single-payer program.
Healthcare Reform News Update for April 10, 2018
ACA Rules for States Relaxed, New Individual Mandate Exemptions Added
President Donald Trump’s administration has taken steps to weaken Affordable Care Act rules on state insurance standards and provide exemptions to the law’s individual mandate.
Under the final rule issued by the Centers for Medicare and Medicare Services (CMS), states will have more control over individual health plan coverage. States will be allowed to:
- Have more flexibility in how they choose their essential health benefits (EHB)-benchmark plan. From CMS’s press release: “Instead of being limited to 10 options, states will now be able to choose from the 50 EHB-benchmark plans used for the 2017 plan year in other states or select specific EHB categories, such as drug coverage or hospitalization, from among the categories used for the 2017 plan year in other states.”
- Request “reasonable adjustments” to the medical loss ratio formula (MLR) if it could help stabilize the state’s healthcare exchange. The MLR is the amount an insurance company spends on medical claims compared with income from premiums.
- Require state regulators to review premium increases of 15 percent or more. Previously, the threshold was 10 percent.
The administration also added two retroactive exemptions to the rule that requires all Americans to have health insurance coverage. The mandate was repealed late last year, but the penalty is in effect until 2019.
Exemptions will be available to people living in areas where only one insurer is selling ACA health plans. They will also extend to those who oppose abortion but live in places where the only available plan covers abortion services.
Sixteen Attorneys General File to Defend ACA from Texas Lawsuit
A group of attorneys from 15 states and the District of Columbia have filed a motion to intervene in a Texas lawsuit that claims the Affordable Care Act has become invalid since the individual mandate’s repeal.
Led by California Attorney General Xavier Becerra, the motion states that eliminating the law would cause “immediate and irreparable harm” to residents of their states.
“We’re taking this action to protect the health and financial security of millions of people in our country, as well as billions of dollars of federal funds that go to our states to make sure that we can afford the healthcare that our families need,” Becerra said.
CBO Predicts Rise in Some ACA Premiums
The premiums for ACA silver plans will increase by 34 percent for 2019 plans, due mostly to the repeal of the individual mandate and the cutoff of cost-sharing reduction (CSR) payments to insurance companies, according to a new estimate from the Congressional Budget Office (CBO). The CBO also expects federal subsidies to rise 21 percent in response to the premium increases. It projects that, after 2019, subsidies will rise by 5 percent per year for the next decade.
Healthcare Reform News Update for April 6, 2018
Maryland Tackles Measures to Stabilize State ACA Exchange
Maryland Governor Larry Hogan (R) has expressed his support for legislation that will establish a reinsurance program and keep premiums down for plans on the Maryland Health Care Exchange.
Hogan signed the bipartisan reinsurance bill Thursday, which will require a federal waiver before being enacted.
A separate bill, passed by the legislature Thursday, will enable the state to use $380 million that insurance companies no longer pay in federal taxes to help keep insurance premiums from rising on the state’s healthcare exchange throughout the next year. Hogan is expected to sign the bill next week.
Insurance Companies May Lose Profitability Due to CSR Elimination
Due to the way the Affordable Care Act calculates risk adjustment, smaller health insurance companies that sell plans on the marketplace could hit a profitability snag. The problem stems from the Trump administration’s elimination of cost-sharing reduction (CSR) payments late last year.
The lack of CSRs caused those costs to be placed into the middle-tier silver plans, creating higher premiums for those plans, a process called “silver-loading.” It also made smaller companies take on a larger share of risk.
Since tax credits are based on the price of silver plans, enrollees who qualified for subsidies were able to purchase bronze plans for a low or even $0 premium. These higher-risk enrollees could cause insurance companies to lose money when it comes time for risk-adjustment payment transfers.
Healthcare Reform News Update for April 4, 2018
Signups for 2018 ACA Plans Take a Dip
CMS Administrator Seema Verma announced Tuesday that 11.8 million people signed up for 2018 plans on the Affordable Care Act marketplace. The total is roughly 400,000 fewer than last year, a much smaller number than predicted before the enrollment period began in November.
Other enrollment information released by the department includes:
- Of all signups, 27 percent were new enrollees.
- The average premium for those signing up on the federal exchange before tax subsidies were applied was $621 compared to $476 for 2017.
- Of all enrollees, 7 percent chose gold plans, 29 percent chose bronze plans, and 63 percent chose silver plans.
- A majority, 83 percent, of enrollees qualified for tax subsidies.
The federal exchange saw a reduction in signups, and states with their own marketplaces remained equal to last year’s, according to the report.
Ohio Asks for ACA Individual Mandate Waiver
Ohio is the first state to seek a waiver for the Affordable Care Act’s individual mandate.
Even though Congress repealed the penalty for not having insurance late last year, the requirement that all Americans have health coverage is still in effect, the state’s insurance director said.
Approval of the waiver has the potential to reduce health insurance premiums for residents.
CMS Expands Medicare Advantage Coverage
This week, the Centers for Medicare & Medicaid Services (CMS) announced its plan to expand products and services covered by Medicare Advantage plans.
The department has revised its definition of “primarily health-related” benefits to help Medicare Advantage enrollees lead more independent lives. Some of the new services could include minor home modifications such as grab bars, transportation to and from medical appointments, and home-delivered meals.
A prescription is not needed for the new covered services, but they must be “medically appropriate” and recommended by a healthcare provider. Coverage will vary depending on the plan.
Healthcare Reform News Update for April 3, 2018
Poll: Most ACA Enrollees Are Satisfied With Their Plan
Most people who have purchased their health plan on the Affordable Care Act exchange like their insurance coverage but fear that the marketplace is “collapsing,” according to a Kaiser Family Foundation poll released Tuesday.
Findings from the poll include:
- 61 percent of marketplace enrollees are satisfied with their insurance choice
- 53 percent think the ACA marketplace is collapsing
- 19 percent are aware that the individual mandate was repealed but is currently still in effect
- 34 percent said the mandate was the main reason for purchasing health insurance
- 90 percent of those with a nongroup plan said they would still purchase insurance without the mandate
- 58 percent of ACA enrollees say they are worried about a lack of available insurance coverage in the future
Georgia Bill Mandates Commissions for Health Plans
A new law in Georgia makes it mandatory for all insurance companies to pay commissions to agents and brokers for virtually all health insurance plans, including those sold on the Affordable Care Act marketplace.
The law does not provide specific amounts for commissions or require commissions for individual plans sold during ACA special enrollment periods.
The law was created in response to the falling number of agents and brokers selling ACA plans. The number of brokers registered for the federal ACA exchange is down 31 percent from last year and 50 percent from 2015.
Healthcare Reform News Update for March 29, 2018
Iowa Governor to Sign Legislation for Alternatives to ACA Health Plans
On Tuesday, Iowa lawmakers approved a bill that will allow the state to sell two new types of cheaper health plans that do not meet some requirements of the Affordable Care Act. Governor Kim Reynolds (R) is expected to sign it.
The legislation includes:
- Association health plans for small businesses and the self-employed.
- Benefit plans sold through a partnership between the Iowa Farm Bureau and Wellmark Blue Cross and Blue Shield. These plans are not health insurance and will not be required to comply with state or federal insurance regulations.
Neither of the plans will include the ACA’s essential health benefits such as maternity care, mental health care, substance abuse treatment, or equal premium charges for those with pre-existing conditions.
The Trump administration has not indicated whether it will challenge the state’s law.
Premiums for Minnesota State Exchange Plans Reduced by 15 Percent
New research from the Urban Institute found that 2018 insurance premiums on MNsure, Minnesota’s state healthcare exchange, are 15 percent lower than last year’s.
Researchers found that the average silver plan on the MNsure marketplace for a 40-year-old nonsmoker was $365 for 2018 compared to $429 in 2017. The reduction was primarily due to the state’s enactment of a reinsurance program in 2017.
“Last year, [Minnesota] premiums were significantly above the national average,” said Erik Wengle, an Urban Institute researcher. “With the addition of reinsurance payments, that has come down to significantly below the national average.”
Healthcare Reform News Update for March 27, 2018
Poll: Healthcare Remains Primary Concern for Majority of Americans
For the fifth continuous year, healthcare is a top concern for a majority of Americans, according to a new Gallup poll conducted March 1-8.
When asked about the cost and availability of healthcare:
- 55 percent worry about the topic “a great deal.”
- 23 percent worry “a fair amount.”
- 23 percent worry “only a little” or “not at all.”
The poll included 14 additional issues. Other top-ranking worries include crime and violence, government spending, and the availability of firearms.
Healthcare Reform News Update for March 23, 2018
Majority Whip Plans to Put ACA Stabilization Bill Up for Vote
Senate Majority Whip John Cornyn (R-TX) said Thursday that “there will be a vote” on an Affordable Care Act stabilization bill that was removed from the omnibus spending package.
Lawmakers are at odds over abortion language within the legislation. Republications support new ACA funding aimed at lowering premiums that would add abortion restrictions, which Democrats oppose.
It’s not clear whether the bill would be added to the spending package as an amendment or if it would be presented as a stand-alone measure.
Washington State Expands Reproductive Health Coverage
Washington Governor Jay Inslee signed the state’s Reproductive Parity Act into law, which expands Affordable Care Act provisions for maternity, contraception, and abortion access.
The new law requires insurance companies to provide abortion coverage if they also cover maternity care. It also ensures that there are no out-of-pocket costs for any form of contraception.
The law will “make sure that women have access to the full spectrum of healthcare they need without cost barriers or stigma,” Inslee said.
Healthcare Reform News Update for March 22, 2018
ACA Stabilization Left Out of Spending Package
The bipartisan plan to help stabilize the Affordable Care Act marketplace was dropped from Congress’ $1.3 trillion spending package. The effort stalled due to disagreements between lawmakers over abortion language and auto-renewal of short-term health plans.
Advocacy group America’s Health Insurance Plans was disappointed by the decision. “In every other market, state and federal leaders have supported healthy markets that deliver better affordability and care,” the group said in a statement. “Through employer-provided coverage, Medicare Advantage, and Medicaid-managed care, nearly 300 million Americans see the value that insurance providers bring to improve health, access, and financial security. Americans who rely on the individual market deserve the same access to stable and affordable comprehensive coverage.”
The package includes new ACA oversight provisions:
- Congressional committees must be notified by CMS before any ACA-related data or grants are released.
- The president’s administration must “publish ACA-related spending by category since its inception” and publicly release the personnel and processes required to execute, manage, or enforce ACA rules.
Also included was the provision that continues the ban on risk corridor payments to insurance companies.
Healthcare Reform News Update for March 21, 2018
Warren Proposes New Bill to Increase ACA Affordability, Reliability
Senator Elizabeth Warren (D-MA) submitted a new bill Wednesday that intends to help healthcare plans on the Affordable Care Act marketplace be more affordable and reliable.
The legislation, titled the Consumer Health Insurance Protection Act, would work with the current healthcare system to improve the efficiency of both individual and employer-sponsored coverage. Some provisions in the bill include:
- Enabling more people to qualify for premium subsidies.
- Capping premiums at 8.5 percent of income.
- Basing premium subsidies on the cost of gold plans.
- Capping out-of-pocket costs for prescriptions at $250 per month for private plans.
- Requiring private insurance companies to spend 85 percent of premium dollars on insurance claims.
- Barring insurance companies from dropping enrollee coverage during their course of treatment.
- Increasing funding for ACA outreach and education.
- Requiring that insurance companies cover the 10 essential benefits as outlined in the ACA.
- Reinstating cost-sharing reduction (CSR) payments.
- Requiring insurance companies that bid on public healthcare plans in areas of the country with limited competition to also offer plans on the ACA marketplace.
The bill is co-sponsored by senators Kamala Harris (D-CA), Maggie Hassan (D-NH), Kirsten Gillibrand (D-NY), (Tammy Baldwin (D-WI), and Bernie Sanders (I-VT). It has also been endorsed by liberal groups Families USA, Public Citizen, Consumers Union, and Community Catalyst.
The Congressional Budget Office has not yet estimated how much the bill would cost.
Healthcare Reform News Update for March 20, 2018
Chances Dwindle for ACA Stabilization Inclusion in Funding Bill
The inclusion of restored cost-sharing reduction (CSR) payments in Congress’ $1.3 trillion omnibus spending package, which would keep the government from another shutdown, is uncertain due to last-minute negations.
Senators Patty Murray (D-WA) and Lamar Alexander (R-TN) hoped to include the measure, which will help stabilize the Affordable Care Act marketplace, in the spending package. President Donald Trump on Monday voiced his support for the provision.
Lawmakers are at odds over abortion language. Republicans want to include expanded Hyde Amendment restrictions to prohibit federal funding for abortions. Democrats say that doing so would restrict access for many low-income women.
“One of the regrets we have about the negotiation is that we thought there’d be a chance to have a health piece, like ‘reinsurance,’” Pelosi said on Thursday.
The spending bill needs to be finalized by Friday to avoid a government shutdown. Without the stabilization measures, ACA health insurance premiums are expected to rise significantly for 2019 plans.
Healthcare Reform News Update for March 19, 2018
Virginia Debating ACA Expansion of Medicaid
Virginia may include a proposal to expand Medicaid under the Affordable Care Act during a special session for a budget agreement that begins April 11. The state is one of 18 that has not enacted the expansion.
The issue became possible after November’s election of Democratic Governor Ralph Northam and the flipping of 15 state House seats to Democrats. However, Republicans who are against the expansion continue to be a slim majority of 51 to 49.
Second Liberal Group Comes Out Against CSR Funding
Liberal advocacy group Families USA has said it opposes the proposal in Congress to fund the Affordable Care Act’s cost-sharing reduction (CSR) subsidies. The announcement comes after last week’s analysis from liberal group The Center on Budget and Policy Priorities showed the funding would raise premium subsidies.
“Enacting the new proposal from Senator Lamar Alexander (R-TN) will be worse for consumers than if Congress does nothing at all to stabilize the individual insurance market. If this is the best package members can produce, we encourage Congress to reject it,” Families USA wrote.
Report: Most Blue Cross Plans Saw ACA Profitability in 2017
For the first time in four years, most Blue Cross Blue Shield plans saw profitability on the Affordable Care Act marketplace, according to a new Politico analysis of financial filings.
The study showed that:
- Of 29 regional Blue plans, all but eight earned money from ACA plans.
- On average, the plans spent 80 percent of premium revenue on medical costs, down 12 from the previous year.
- Health Care Service Corporation improved its premium revenue versus medical cost percentage 18.5 percent; Blue Cross Blue Shield of North Carolina improved by 10 percent.
- The 29 regional plans had 4.5 million ACA enrollees in 2017, which comprised one-fifth of the total marketplace enrollment.
Insurance companies caution that analyzing financial performance of a single year can be misleading and that a variety of factors can upend the statistics for 2018, including the repeal of the individual mandate and the possible expansion of non-compliant short-term plans.
Healthcare Reform News Update for March 16, 2018
Idaho Lawmakers Discuss State Health Plans with Washington Officials
Idaho Insurance Commissioner Dean Cameron and Idaho Senator Jim Risch met with officials from the Trump administration on Wednesday to discuss the state’s plan to sell lower-cost health insurance plans that do not meet the requirements of the Affordable Care Act.
Centers for Medicare and Medicaid Services Administrator Seema Verma denied the state’s proposal last week on legal grounds, suggesting that the plans be sold instead as short-term health insurance plans. Cameron has opposed the idea.
Cameron said he will “see what areas we can further adjust and decide how and when to submit that to Ms. Verma.” One possibility, he said, is providing discounts to healthy enrollees because charging people with preexisting conditions higher premiums goes against ACA rules.
Healthcare Reform News Update for March 15, 2018
Senators’ Revamped Stabilization Bill Will Lower Premiums by 10 Percent
Senators Lamar Alexander (R-TN) and Susan Collins (D-ME) have revised their Affordable Care Act stabilization package in hopes that it will be included in next week’s omnibus funding bill. If enacted, it will reduce premiums by 10 percent in 2019 and 20 percent in 2020 and 2021, according to an estimate from the Congressional Budget Office.
The new stabilization package includes:
- Three years of funding for ACA cost-sharing reduction (CSR) subsidies
- $30 billion for three years of federal reinsurance and invisible high-risk programs
- Expansion of catastrophic plans to people 30 years old and older
- Increased ability for states to design their own health plans
- Streamlining the process for states to implement their own plans
- A “requirement that funds not be used for plans that cover abortions”
It’s unclear whether the new package has enough support to pass.
New Poll Shows Americans Shifting ACA Responsibility
A new Morning Consult/Politico poll of nearly 2,000 registered voters, shows that 44 percent of Americans hold former President Obama responsible for the state of the Affordable Care Act, which is down from 50 percent compared with a poll conducted in October. Twenty-eight percent of respondents held President Trump accountable, which is comparable to the October poll.
Other findings from the poll:
- 49 percent of respondents support the concept of single-payer healthcare
- 50 percent of respondents believe “that the nation spends too little on healthcare”
Healthcare Reform News Update for March 13, 2018
Conservative Coalition Asks Congress to Deny ACA Stabilization Efforts
A group of 15 conservative organizations asked Congress on Monday to reject a “bailout” of the Affordable Care Act (ACA) in the upcomng omnibus spending bill.
The group is against including cost-sharing reduction (CSR) and reinsurance payments in the government funding bill that needs to be passed by March 23 to avoid a government shutdown.
“Lawmakers should fulfill their longstanding promise of repealing and replacing Obamacare, not setting the dangerous precedent of bailing it out,” wrote the coalition that includes Americans for Prosperity, Club for Growth, and Heritage Action
Premera Blue Cross Commits to Washington State and Alaska
Citing a refund made possible by the new tax law, health insurance company Premera Blue Cross announced that it will continue to provide coverage on the Affordable Care Act (ACA) marketplace in Washington state and Alaska in 2019.
The company committed to offering health insurance to any counties in Washington that lack an insurance company on the state’s ACA marketplace. It also pledged to “ensure continued stability” in Alaska where it is the only health insurance company on the ACA marketplace.
“This refund has given us an unexpected opportunity to reach beyond our own company to further address the critical health care needs of the communities where we live and work. I am especially pleased to continue our commitment to the individual market and build stability for families in Washington and Alaska,” said Premera Blue Cross CEO Jeff Roe in a statement.
Judge Strikes Down Challenge to ACA Birth Control Exemptions
U.S. District Judge Nathaniel Gorton rejected a lawsuit that challenged the Trump administration’s easing of Affordable Care Act (ACA) contraception rules.
Massachusetts Attorney General Maura Healy filed the suit, hoping to overturn rules that allow businesses and nonprofits to claim religious or moral objections in providing birth control.
In his decision, Gorton cited a new Massachusetts law that requires all employer health plans to cover contraception with no co-pays, saying that it prevents companies from taking advantage of the exemptions and that women in the state were less likely to be affected by the federal law.
Healthcare Reform News Update for March 12, 2018
Liberal Group Says Funding CSRs Would Hurt Subsidized ACA Enrollees
A new analysis from the liberal group The Center on Budget and Policy Priorities says that funding the Affordable Care Act’s cost-sharing reduction (CSR) subsidies in Congress’s upcoming omnibus spending bill would “do more harm than good.”
When President Trump cut off the CSR funding late last year, insurance companies raised premiums on ACA health insurance plans to make up for the loss of funding. Because of a “quirk” in the law’s structure, the increased premiums made the plans more affordable for lower-income Americans by increasing premium subsidy amounts (premium tax credits). According to the analysis, resuming CSR funding would reduce the premium subsidies and increase costs for subsidized enrollees.
The group believes that lower-income enrollees would be better served by blocking the Trump administration’s call to create “skimpier, cheaper” short-term health plans, which could draw people away from ACA-compliant plans.
Idaho Governor to Continue Talks About Non-Compliant Health Plans
Idaho Governor Butch Otter said on Friday that the Trump administration’s rebuke of the state’s plan to provide health insurance that does not meet Affordable Care Act requirements was not a rejection.
“In fact, we consider the letter an invitation from CMS to continue discussing the specifics of what can and cannot be included in state-based plans,” said Otter in a statement with the
lieutenant governor and state insurance commissioner.
“Idaho’s proposal would allow [insurance companies] to sell plans that charge people with pre-existing conditions more, which is barred by ObamaCare, and not cover all of the health services required under the health law.” However, in her letter, CMS Administrator Seema Verma offered the state another way to do this: short-term health plans.
Healthcare Reform News Update for March 9, 2018
Trump Administration Rejects Idaho’s State-Based Health Plans
Idaho’s plan to allow stripped-down, low-cost health insurance that does not meet the requirements of the Affordable Care Act is unlawful, said Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma in a letter to the state’s Republican Governor C.L. “Butch” Otter.
In the letter sent Thursday, Verma said that, since the health plans do not meet the minimum ACA standards, the federal agency would have to enforce the law, which would pull regulatory authority away from the state and fine insurance companies up to $100 per day for every resident enrolled in a noncompliant plan.
Verma listed eight areas where the plans did not meet legal standards, such as failing to cover the 10 essential health benefits; charging customers more based on age, location, or history; and discriminating against people with pre-existing conditions.
With some modifications, the proposed plans could be legally issued as short-term plans.
Study: ACA Premiums Could Increase Up to 94%in 3 Years
Insurance premiums could rise for individual plans on the Affordable Care Act marketplace between 35 and 94 percent by 2021, according to a new study from Covered California, the state’s healthcare exchange.
The study found that the primary factor in the increase was the repeal of the individual mandate, which imposed a penalty on Americans without health coverage. Other causes include a shorter open enrollment period and the president’s recent plan to extend “skimpy” short-term plans.
“The effect is going to be: The individual market will be poor people who get subsidies and sick people who buy no matter what. And the middle class will be priced out of insurance in about a third of America,” said Covered California’s Executive Director Peter V. Lee.”
Florida Bill Would Broaden Eligibility for Healthcare Ministries
The Florida Legislature passed a bill Wednesday aimed at increasing enrollment in healthcare sharing ministries.
Participation in the ACA-exempt programs is currently limited to people who share the same religious beliefs. The new bill, if signed by Republican Governor Rick Scott, would expand eligibility to include people who hold the same ethical beliefs.
Trump Proposes Eliminating CSR Reimbursements for 2017
The White House urged Congress on Thursday to pass legislation that doesn’t authorize cost-sharing reduction (CSR) payments and reinsurance for 2017—even though insurers contributed to the program.
The request states that insurers should pay back any excess money paid out by the government before President Donald Trump cut off the payments late last year.
The proposed legislation asserts that “… there is no obligation under this act or any other act, including the Patient Protection and Affordable Care Act, to make payments on or after October 1, 2017 for purposes of reconciling any such cost-sharing reduction payments made for benefit years 2016 or 2017.”
The proposal also makes clear that insurers are still obligated to make CSR payments to their low-income enrollees.
HHS Secretary Touts Healthcare Options
The Trump administration would do what it can “within the law” to allow insurers to sell health plans that don’t meet Affordable Care Act rules, Health and Human Services (HHS) Secretary Alex Azar said Thursday.
Speaking at a conference sponsored by America’s Health Insurance Plans, Azar said he wants to ensure that consumers have choices in their healthcare decisions.
“More broadly, we are committed to using the flexibilities we have within the law to allow insurers to offer competitive products that work for consumers. We know the layers of regulation imposed by the Affordable Care Act have made this almost impossible. Consistent with the law, we want to work with you to open up new affordable and flexible options,” he said.
Healthcare Reform News Update for March 8, 2018
GOP Senator Proposes Splitting ACA Individual Marketplace
Senator John Barrasso (R-WY) has authored a new bill that would essentially divide the individual Affordable Care Act marketplace into two separate exchanges.
Barrasso’s plan would create non-ACA compliant, short-term plans that last as long as 364 days and give enrollees the option of guaranteed renewability. Premiums would be allowed to go up if the enrollee became more expensive to insure.
Critics of the plan say it would create a parallel marketplace, with healthier people moving to the cheaper, “skimpier” short-term plans and sicker people staying with ACA policies. Since the ACA plans are not allowed to discriminate based on risk, the premiums on ACA plans could then go up significantly.
New Analysis Charts Outperformance of State-Run ACA Marketplaces
The 17 states that run their own Affordable Care Act marketplaces perform better than the federal marketplace, according to a new analysis from The Commonwealth Fund. The data review found that state-run marketplaces have:
- Lower projected premiums ($633 per month vs. $526 per month) for the individual market.
- Lower projected medical claims ($478 per month vs. $419 per month).
- A lower portion of premiums going to medical claims rather than overhead (20.2 percent vs. 24.7 percent).
- A lower percentage of cost increases in 2018 compared to 2017.
- A lower percentage of rate increases year over year.
State Attorneys General Demand Hearing on Association Plans
A coalition of 17 Democratic state attorneys general has sent a formal comment letter to the Labor Department asking for public hearings on the Trump administration’s plans to expand association health plans.
The administration’s proposal would allow groups to purchase cheaper health plans that don’t meet the requirements of the Affordable Care Act, including coverage of essential health benefits such as maternity care, prescription drugs, and mental health care.
The coalition, led by attorneys general Eric Schneiderman of New York and Maura Healey of Massachusetts, said the measure undermines protections in the ACA.
The proposal “is nothing more than an unlawful end run around the consumer protections enshrined in the Affordable Care Act, part of President Trump’s continued efforts to sabotage the ACA,” Schneiderman said.
Changes to Dodd-Frank Could Affect Medicare Insurance Agents
Three sections of a proposed change to the Dodd-Frank Act, called the “Economic Growth, Regulatory Relief, and Consumer Protection Act” bill, could change some reporting requirements for Medicare insurance agents.
The three sections of the bill would:
- Possibly provide federal legal protection if the agent reports suspicious financial abuse of seniors to authorities.
- Require insurers to provide training and credential tracking if they want their agents to report suspicions of elder abuse.
- Make available annual reports from the federal government about international insurance regulatory developments.
Healthcare Reform News Update for March 7, 2018
White House Would Back ACA Stabilization With Conservative Changes
The Trump administration would support efforts to stabilize the Affordable Care Act, but only if measures backed by conservatives are included, according to a memo issued by the White House.
The memo includes support for renewing cost-sharing reduction (CSR) payments and states that all efforts need to be “life-protected,” which prevents government funds from being used for abortions.
“Although congressional efforts to provide taxpayer money to prop up the exchanges is understandable, any such efforts must also provide relief to middle-class families harmed by the law and protect life,” the memo states.
The document specified three policies that the administration wants to pursue, including:
- Extending “skimpier” short-term health plans, which Trump previously proposed, and allowing them to be renewed with no health underwriting.
- Expanding access to health savings accounts.
- Allowing insurers to charge older people as much as five times more than younger people (the current ratio is three to one).
OMB Analysis: CSR Funding Would Lower Premiums Up to 20%
Funding Obamacare’s cost-sharing reduction (CSR) subsidies would lower premiums by 15 to 20 percent, significantly more than a reinsurance program, according to an analysis by the Office of Management and Budget.
The analysis found that reinsurance would reduce premiums by 1 percent for every $1 billion spent on the program.
“We project funding CSRs would have a greater impact on reducing premiums than any of the reinsurance funding levels that have been proposed, and would have more bang for the buck in terms of federal spending,” according to the analysis.
Health Coalition Urges Congress to Include ACA Stabilization in Funding Bill
A group made up of healthcare providers and insurers has asked congressional lawmakers to include funds for stabilizing the Affordable Care Act in an omnibus spending package scheduled for later this month.
“Congress has an important opportunity to act and reduce premiums for consumers for 2019, but time is running short. We urge you to take immediate action to advance bipartisan legislation that includes both premium reduction/reinsurance and funding for CSR benefits as part of the March 23rd omnibus appropriations,” the group said.
The coalition includes America’s Health Insurance Plans, the American Hospital Association, and the American Medical Association.
Healthcare Reform News Update for March 6, 2018
Federal Appeals Court Revisits Cost-Sharing Reduction Settlement
The D.C. Circuit Court of Appeals is calling into question a settlement deal over cost-sharing reduction (CSR) subsidy payments to insurers under the Affordable Care Act.
The settlement agreement said that House Republicans, the Trump administration, and liberal states would not cite a previous ruling by U.S. District Court Judge Rosemary Collyer in any future case. Collyer ruled in 2016 that the Obama administration did not have the authority to make the CSR payments because Congress did not properly fund them.
On Monday, the federal court panel issued an order to pursue further briefing in the case. The order questioned the legality of overturning part of the lower-court order.
Healthcare Reform News Update for March 5, 2018
Congressman Wants Immediate Repeal of ACA Individual Mandate
Representative Mark Meadows (R-NC), chairman of the conservative House Freedom Caucus, is calling for the immediate repeal of the Affordable Care Act’s individual mandate.
Currently, the penalty for not having health insurance is in effect until 2019. Meadows would like to eliminate the penalty for 2017 and 2018 tax returns.
“Unfortunately, many Americans believe the mandate to be immediately repealed and no longer in effect, but will be surprised to learn that it still applies for both 2017 and 2018 tax returns. Congress must resolve this,” Meadows wrote in a letter to a House Appropriations Committee subpanel.
Healthcare Reform News Update for March 2, 2018
California Could Lose 18% of ACA Marketplace Enrollees Next Year
Without the Affordable Care Act’s individual mandate, 18 percent of California residents with Covered California marketplace health plans could drop their coverage, according to a new survey by Harvard Medical School researchers.
Without a penalty for being uninsured, healthier residents are more likely to go without coverage. The loss of these enrollees could raise premiums by 12 to 16 percent next year.
“While California would continue to have a stable individual market, and we have the reserves and flexibility to adjust for this impact, the impacts would be real and significant for California’s consumers,” said Peter Lee, Covered California’s executive director.
Healthcare Reform News Update for March 1, 2018
Association Plans Could Bump 4.3 Million Off ACA Coverage
The Trump administration’s plan to expand association health plans could cause between 2.4 million and 4.3 million people to switch from ACA marketplace plans to association plans by 2022, according to a study by Avalere Health.
The study also found that the association plans would cause:
- A premium increase for ACA marketplace plans by as much as 4 percent.
- Between 130,000 to 140,000 people to become uninsured by 2022 due to high premiums.
- Between 1.7 million and 3.2 million people to exit the small group market.
- 700,000 to 1.2 million people to leave the individual market.
Premiums for the association plans could be up to $10,800 lower than the individual market and up to $4,100 lower than the small group market.
“Changes that allow or incentivize healthier individuals to exit the individual and small group market to pursue other, sometimes non-ACA-compliant coverage offerings, could lead to higher costs for those sicker, less healthy individuals and groups who remain behind in the ACA-regulated markets,” the study states.
Wisconsin Governor Signs Reinsurance Bill
Wisconsin Governor Scott Walker (R) signed a bill Tuesday that will allow the state to apply for a federal waiver to help stabilize its health insurance marketplace though a reinsurance program.
The program would cover 80 percent of medical claims between $50,000 and $250,000, which would help lower premiums for healthier residents by 13 percent in 2019 and 12 percent in 2020.
“Our Health Care Stability Plan is our solution to Washington’s failure; we want to provide health care stability and lower premiums for Wisconsin,” Walker said.
GOP Lawmakers Consider Budget Procedure for ACA Funds
Republican leaders in the House are considering a complex budget maneuver to help pay for Affordable Care Act funds—a controversial move as many conservatives see the action as a “bailout.”
The two-step plan would direct the Congressional Budget Office (CBO) to take cost-sharing reduction (CSR) payments out of its baseline for projected federal spending. It would then use the savings from the first step to pay for reinsurance programs. The move would help lower premiums and, subsequently, reduce the cost of government subsidies for health insurance.
Supporters of the plan say it would fund reinsurance programs without having to create a budget for it. But conservative lawmakers call the move a budgetary “gimmick.”
ACA Popularity Reaches Record High
A recent poll by the Kaiser Family Foundation shows that 54 percent of Americans approve of the Affordable Care Act, the highest rating since the group began its monthly poll in 2010.
In addition, only 13 percent of respondents were aware that the repeal of the individual mandate goes into effect in 2019. Others were either unaware of the repeal or unclear on when it will be implemented.
Health Agents Meet With Washington Legislators
Over 700 members of the National Association of Health Underwriters are attending a conference in Washington, D.C., this week. The group plans to lobby lawmakers on a number of topics including stabilizing subsidy programs, protecting the group health premium tax exclusion, and addressing Affordable Care Act agent compensation rules.
Healthcare Reform News Update for February 27, 2018
20 States Sue to End Affordable Care Act
A lawsuit filed against the federal government by 20 states claims that the Affordable Care Act is now unconstitutional.
The lawsuit, led by the attorneys general of Texas and Wisconsin, states that the ACA is invalid without the individual mandate tax penalty for not having coverage, which was repealed last year.
“The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional. With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all,” said Texas Attorney General Ken Paxton.
Healthcare Reform News Update for February 26, 2018
Report: Short-Term Policy Expansion Will Raise Premiums
The Trump administration’s proposal to extend short-term health plans that fall short of Affordable Care Act regulations will increase premiums for traditional plans, according to analysis by the Urban Institute.
Rates would rise by 18 percent in in the 43 states that allow less-comprehensive short-term plans, according to the study. It also projects that 2.5 million Americans would drop their marketplace plans to switch to the short-term plans, compared to the 100,000 to 200,000 predicted by the Trump administration.
Iowa Group Plans to Offer Non-ACA Compliant Plans
A bill currently under review in Iowa would allow the Iowa Farm Bureau Federation to offer low-cost health insurance that doesn’t meet ACA requirements.
The Farm Bureau would partner with Wellmark Blue Cross and Blue Shield to provide members a with a plan that could charge higher premiums for those with pre-existing conditions.
The plan would be available to any Iowa resident who pays the Farm Bureau’s $55 annual dues. The group says that around 28,000 current members would be eligible to enroll.
Trump Touts Efforts to ‘Wipe Out’ ACA
President Donald Trump said his administration’s actions on healthcare, such as eliminating the individual mandate and allowing skimpy “short-term plans,” are gradually chipping away at the Affordable Care Act.
Trump made these comments at the Conservative Political Action Conference on Friday.
“I think we may be better off the way we’re doing it, piece by piece, Obamacare is just being wiped out. The individual mandate essentially wipes it out, so I think we may be better off. And people are getting great healthcare plans, and we’re not finished yet,” Trump said.
Healthcare Reform News Update for February 23, 2018
State Leaders Propose Plan for Healthcare Improvements
A bipartisan group of governors will unveil a plan to help improve the nation’s healthcare system today at a National Press Club event.
Their plan includes a variety of suggestions to improve affordability, stability, and flexibility for states, including:
- Restoring insurer subsidies.
- Increasing outreach for the Affordable Care Act marketplace’s open enrollment period.
- Implementing reinsurance programs.
- Streamlining regulations.
- Cutting Medicaid costs.
The governors included in the event are John Kasich (R-OH), John Hickenlooper (D-CO), and Bill Walker (I-AK).
Democratic Lawmakers Question Idaho Insurance Commissioner
Four democratic members of the congressional committee that oversees healthcare have sent a letter to Idaho Insurance Commissioner Dean Cameron about the state’s intention to sell health plans that fall short of Affordable Care Act regulations.
Senators Patty Murray of Washington, Ron Wyden of Oregon, and representatives Frank Pallone, Jr. of New Jersey and Richard Neal of Massachusetts requested a staff briefing on the state’s plan.
The letter states: “We strongly oppose efforts that result in higher costs and undermine consumer protections that are guaranteed by federal law that protect women, people with pre-existing conditions, and others facing discrimination in access to health care, and therefore request an explanation of how the Idaho Department of Insurance will regulate insurance plans being sold in the individual market that are not compliant with federal law.”
Healthcare Reform News Update for February 22, 2018
Policy Group Releases Plan for New Type of Universal Health Coverage
Liberal think tank Center for American Progress has proposed a new government health plan called Medicare Extra for All that would allow individuals and employers to enroll but would also preserve employer and insurer coverage.
Medicare Extra would be based on the existing Medicare payment system. Companies and individuals could choose to continue with their current health coverage or enroll in the proposed plan.
Here’s a look at some of Medicare Extra’s features:
- Open to all U.S. citizens and lawful residents
- Free services would include preventive care, treatment for chronic disease, and generic prescription drugs
- Dental, vision, hearing, and long-term care would be covered
- Premiums would be determined based on income
- Current Medicare Advantage enrollees would continue to have similar coverage, renamed Medicare Choice
Center for American Progress did not include cost estimates for the program but recognized that implementation would require tax increases.
States Consider Reinsurance Plans
Wisconsin and Maryland are making efforts to set up reinsurance plans to help stabilize the Affordable Care Act marketplace in their respective states.
This week, Wisconsin lawmakers approved a plan that would allow the state to apply for a federal waiver to obtain reinsurance funds to help insurers with their most expensive claims. Governor Scott Walker called the action a “market-driven solution that will lower premiums.”
In Maryland, lawmakers held hearings this week to discuss their own bill to apply for reinsurance funds. “We’re looking this year at stabilizing the exchange, because, as you know, if we don’t do something, it’s going to blow completely up,” said State Senator Thomas Middleton.
Healthcare Reform News Update for February 21, 2018
Companies Receiving Penalty Notices for ACA Violations
For the first time, the Internal Revenue Service is sending notices to hundreds of companies that have violated the Affordable Care Act’s provision requiring they provide health coverage for their employees.
Companies with more than 50 full-time employees face fines for failing to comply with the law in 2015, the first year the mandate was applied. The penalty can reach between $2,000 to $3,000 per employee, depending on a variety of factors.
Some affected companies are fighting back against the penalty, saying that it is invalid because they never received a legally required warning.
Healthcare Reform News Update for February 20, 2018
Trump Proposal Expands ‘Skimpy’ Short-Term Plans to 12 Months
The Trump administration said Tuesday that it wants to extend the limits of lower-cost short-term plans that do not include the consumer protections built in to the Affordable Care Act.
The proposal expands the availability of so-called “skimpy” plans from three months to 12. Unlike ACA marketplace plans, these short-term options can refuse coverage due to pre-existing conditions and cap payout amounts, which could leave those covered with large out-of-pocket costs.
Opponents of the plans say consumers may not be aware of their limited benefits. Supporters say the plans offer the uninsured more affordable coverage options to people who don’t qualify for ACA subsidies.
“The status quo is failing too many Americans who face skyrocketing costs and fewer and fewer choices,” Health and Human Services Secretary Alex Azar said in a statement. “The Trump Administration is taking action so individuals and families have access to quality, affordable healthcare that works for them.”
The proposal will be open for comments from the public until April 23.
Trump Administration Appeals Judge’s Birth Control Decision
Lawyers for the U.S. Department of Justice have appealed a decision that blocked Trump administration changes to the Affordable Care Act, which allowed more employers to opt-out of offering no-cost birth control to women.
U.S. District Judge Haywood Gilliam blocked the ACA changes in December. On Friday, lawyers filed a notice of appeal saying that it was unclear if the law would cause women to lose no-cost contraception coverage.
Healthcare Reform News Update for February 16, 2018
Lawmakers Closer to Drafting an ACA Stabilization Bill
Senators Susan Collins (R-ME) and Lamar Alexander (R-TN) met with House Energy and Commerce Committee Chairman Greg Walden (R-OR) on Thursday to try to reconcile Affordable Care Act stabilization proposals.
The lawmakers compared a reinsurance bill by Alexander and Collins to one proposed by Representative Ryan Costello (R-PA). They hope to include the resulting ACA stabilization measure in an omnibus funding bill due next month.
HHS Secretary to Review Idaho State-Based Health Plans
Health and Human Services (HHS) Secretary Alex Azar said Thursday that he would examine Idaho’s acceptance of health plans that do not meet the standards set in the Affordable Care Act.
“We’ll be looking at that very carefully and measure it up against the standards of the law,” he said. Azar also said he believes that the plans are a “cry for help” for more affordable coverage.
Azar added that it was too early for him to know what actions he might take.
Healthcare Reform News Update for February 15, 2018
Alex Azar Asserts Compliance With ACA Regulations
Department of Health and Human Services (HHS) Secretary Alex Azar told a congressional panel Wednesday that he will comply with the Affordable Care Act as long as it remains federal law.
Azar’s comment was in response to a question about Idaho’s divisive decision to allow insurers to sell plans that don’t meet ACA requirements. Critics of the state’s proposal say the measure goes against consumer protections built into the law and that the plans should be scrapped.
“I’m not aware that our opinions or views have been solicited,” Azar said. “There are rules, and there’s a rule of law that we need to enforce.”
Healthcare Reform News Update for February 14, 2018
Idaho’s First Non-ACA-Compliant Healthcare Plans Filed
Blue Cross of Idaho is the first insurer to file health plans under a controversial Idaho executive order allowing insurance companies to sell plans that don’t meet the requirements of the Affordable Care Act.
On Tuesday, the insurer submitted five non-ACA-compliant plans that it expects to sell this spring. Called “state-based” plans, they could be approved next month. The plans are geared toward the state’s 110,000 uninsured middle-class residents, many of whom earn too much to qualify for subsidies to purchase ACA plans.
Once approved, the plans will be sold on the state’s exchange, Your Health Idaho. The plans include:
- Coverage of all the essential health benefits outlined by the ACA.
- Deductibles from $2,000 to $10,000.
- Maternity care in four of the plans.
- $0 copay for preventative care.
- Narrow networks with heavy penalties for non-network services.
- Large out-of-pocket maximums.
- $1 million limit on claims per year.
Proposed premiums for the state-based plans for a 21-year-old on a $4,000 deductible plan would range from $89.91 to $242.79, compared to $237.60 for an ACA plan. A family of four could pay from $435.58 to $1,176.24, compared to $933.05 for an ACA plan.
Budget Deal Includes Medicare Advantage Reforms
The Bipartisan Budget Act approved by President Donald Trump last week includes multiple reforms to Medicare Advantage (MA) plans. Some of the provisions include:
- Permanent reauthorization of Dual Eligible Special Needs Plans (D-SNPs).
- The availability of telehealth services.
- Expansion of supplemental benefits such as grab bars and wheelchair ramps.
- Giving all 50 states the ability to reduce or eliminate copayments or waive the deductible for high-value services for patients with certain chronic conditions.
The legislation has fewer reforms for traditional Medicare but did provide a two-year extension of the Independence at Home program and added telehealth availability.
House Speaker Wants ‘Incremental’ Healthcare Reform
Paul Ryan (R-WI) said Tuesday that “incremental entitlement reform” would be a more effective way of passing healthcare legislation than the sweeping repeal-and-replace measures of past years.
Ryan did not specify what actions he’d like to address but noted the recent repeal of the Affordable Care Act’s individual mandate and last week’s budget deal that raised premiums for high-earning Medicare beneficiaries.
One healthcare reform measure currently under discussion by House Republicans is repealing or delaying the ACA’s employer mandate. House Ways and Means Committee Chairman Kevin Brady (R-TX) said he wants to ensure that businesses with 50 employees or more are not imposed fines or punitive measures retroactively for not offering health coverage throughout the past three years.
Trump’s Budget Proposal Funds ACA Program
Even though President Donald Trump’s budget request includes the repeal of the Affordable Care Act, it provides more than $800 million in mandatory appropriations to fund its risk corridor program.
The risk corridor plan is a fund that was established in 2014 to pay insurers for heavy losses during the first years of the ACA’s implementation.
Senator Marco Rubio (R-FL), a long-time critic of the risk corridor plan, demonstrated his disapproval of the proposal Tuesday in a series of tweets. “It’s unacceptable that programs that matter to #Florida could see cuts while the gov’t continues to bail out private insurers to protect them from consequences of #Obamacare,” he tweeted.
Oregon Bill Makes Healthcare a Right
Oregon’s House of Representatives passed a bill Tuesday to create a constitutional amendment, stating “it is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable healthcare as a fundamental right.”
If passed by the state’s Senate and then approved by voters, the legislation would be the first of its kind in the country.
Critics of the bill say there are no funds to support such a measure, and it could make the state vulnerable to lawsuits.
Healthcare Reform News Update for February 13, 2018
White House Pushes Elimination of ACA in Budget Proposal
The budget request, released by the White House on Monday, proposes replacing the Affordable Care Act with a series of block grants to states.
The request says that the budget “supports a two-part approach to repealing and replacing Obamacare,” based on the failed Graham-Cassidy bill from 2017. Repealing the ACA could save more than $90 billion over 10 years, according to the proposal.
Most lawmakers in Congress have not been supportive of continued efforts this year to eliminate the law.
Other healthcare-related cuts in the president’s budget include:
- $69.5 billion in Medicare payments over 10 years to hospitals for “uncompensated care”
- $22 billion from Medicare Advantage plans
- $48 billion in Medicare payments over 10 years to teaching hospitals
The budget also includes a proposal to create a limit on Medicare out-of-pocket drug costs.
Budget Act Will Raise Medicare Premiums for High-Income Earners
The Bipartisan Budget Act passed late last week includes a provision that will raise Medicare premiums for the wealthiest beneficiaries by 5 percent.
Beginning in 2019, individuals who earn $500,000 or more and couples who earn $750,000 or more will pay 85 percent of Part B and Part D premiums. The income threshold will be frozen until 2028.
Healthcare Reform News Update for February 12, 2018
Medicare Part D Coverage Gap to Close in 2019
President Donald Trump signed a budget deal February 9 including a provision that will close the Medicare “donut hole” in 2019, a year earlier than previously scheduled.
Beginning next year, Medicare Part D beneficiaries will pay 25 percent of the cost of prescription drugs after they reach the coverage gap, which is currently $3,750. This year, enrollees will pay 35 percent of brand-name drugs’ overall cost and 44 percent for generic drugs.
Since the enactment of the Affordable Care Act in 2010, the law has gradually reduced the financial responsibility for Medicare beneficiaries who have reached the Part D coverage gap.
Under the new law, drug manufacturers will pay 70 percent of drug costs for beneficiaries in the coverage gap beginning in 2019 compared to the current 50 percent.
Once out-of-pocket costs reach $5,000, beneficiaries are eligible for catastrophic coverage and won’t pay more than 5 percent of prescription drug costs.
Healthcare Reform News Update for February 8, 2018
Murray Asks for Additions to ACA Stabilization Bill
Senator Patty Murray (D-WA) is advocating for renegotiations on an Affordable Care Act stabilization bill that would significantly expand subsidies, helping more people afford health insurance.
Currently, the bill Murray drafted with Senator Lamar Alexander (R-TN) restores cost-sharing reduction (CSR) payments that President Donald Trump canceled last year. Murray wants to continue to restore CSR payments, but she also wants to make subsidies more generous and expand eligibility requirements to offset expected premium increases due to the repeal of the individual mandate.
Also, Murray is asking to restore outreach and funding for ACA enrollment and to prevent the sale of “skinny” insurance plans.
2018 ACA Signups Show ‘Remarkable Stability’
Almost 11.8 million Americans enrolled in Affordable Care Act plans during this year’s Open Enrollment Period, which is a 3.7 percent drop from 2017, according to a new report released by the National Academy for State Health Policy (NASHP).
“For the first time we now have the full national picture of how the individual marketplaces did this year, and it is a picture of remarkable stability,” said NASHP Executive Director Trish Riley.
Although states on the federal health exchange saw enrollment drop by 5.3 percent, eight of the 12 states that run their own health exchanges showed an increase in enrollment. Some state findings from the NASHP report include:
- Florida and California continue to have the most enrollees with 1.7 million and 1.5 million, respectively.
- Rhode Island had the highest increase in enrollment at 12.1 percent.
- Arizona had the largest decline in enrollment at 15.6 percent.
- California enrollment fell 2.3 percent overall but saw an increase in new enrollees.
“Despite all the uncertainty and challenges we have seen, particularly for consumers living in states supported by state-based marketplaces, we see millions of Americans continuing to benefit from the coverage they get in the individual market,” Riley said.
Healthcare Reform News Update for February 7, 2018
House Bill Cuts $2.85 Billion From ACA Public Health Fund
The House’s proposed short-term funding bill cuts $2.85 billion over 10 years from the Affordable Care Act’s Prevention and Public Health Fund to help pay for other healthcare programs.
The cut is opposed by public health groups who say it could hamper the activities of the Centers for Disease Control and Prevention (CDC), including vaccination, anti-smoking, and lead-poisoning prevention efforts.
A spokesperson for Energy and Commerce Committee Republicans said the funds will be used for public health efforts such as special diabetes programs and community health centers. In addition, the spokesperson said that funding for the Prevention and Public Health Fund will remain at the current levels of around $1 billion per year as the cuts only affect planned future increases.
More Than 1.6 Million Enroll in Centene ACA Plans
Health insurer Centene Corporation had more than 1.6 million people enroll in plans it sells on the Affordable Care Act marketplace for 2018, making it the leading ACA carrier. The company increased its enrollments from last year by more than 640,000.
Healthcare Reform News Update for February 6, 2018
Blue Cross Blue Shield Backs Reinsurance Efforts
The Blue Cross Blue Shield Association said Monday that there is an “urgent need” for lawmakers to stabilize the Affordable Care Act’s marketplace, especially by dedicating funding to reinsurance.
Citing data from consulting firm Oliver Wyman, the health insurance group said that $15 billion in reinsurance funding, combined with cost-sharing reduction (CSR) payments, could lower next year’s silver plan premiums by 17 percent.
Association officials said these measures would more than offset expected premium increases caused by the repeal of the ACA’s individual mandate late last year.
Healthcare Reform News Update for February 5, 2018
New York Health Exchange Reaches 4.3 Million Signups
New York’s state-run Affordable Care Act marketplace signed up a record number of enrollees during this year’s Open Enrollment Period, which ended January 31 for the state.
More than 4.3 million New Yorkers signed up for coverage, an increase of 700,000 from 2017.
Healthcare Reform News Update for February 1, 2018
House GOP Softens Position on Reinsurance Proposal
Some key Republicans in the House have expressed interest in supporting reinsurance, which represents a shift from the party’s previous resistance to Affordable Care Act (ACA) stabilization efforts.
A proposal from Representative Ryan Costello (R-PA) to provide funding in 2019 and 2020 has been gaining support from other Republican colleagues, including House Energy and Commerce Committee Chairman Greg Walden (OR) and Cathy McMorris Rodgers (WA).
“If it lowers premiums, I’m willing to listen to any ideas,” said Mark Meadows (R-NC), chairman of the House Freedom Caucus.
The measure is expected to be discussed during this week’s GOP retreat in West Virginia.
Healthcare Reform News Update for January 30, 2018
Pro-ACA Group Launches Ads Targeting GOP Lawmakers
The Affordable Care Act advocacy group Save My Care is releasing television ads this week that are critical of Republican efforts to repeal the law.
The ads claim that the failed bills GOP lawmakers proposed would have increased health insurance premiums and left millions of people without coverage. They will run in West Virginia, where Congressional Republicans are holding a retreat, in addition to Washington D.C., Maine, and Alaska.
Leslie Dach, Save My Care’s campaign chairman, hopes the ads will remind lawmakers to act. “It’s time to listen to what Americans demand, move on from repeal and sabotage, and work on bipartisan solutions that keep and improve on the Affordable Care Act,” he said in a press release.
Azar Sworn in as HHS Secretary
Alex Azar was sworn in Monday to lead the Department of Health and Human Services.
“As our new secretary, Alex will continue to implement the administrative and regulatory changes needed to ensure that our citizens get the affordable high-quality care that they deserve,” President Donald Trump said at a White House ceremony honoring Azar.
Azar was confirmed last week in a 55-43 Senate vote.
Open Enrollment Period Ends Tomorrow for 3 Exchanges
California, New York, and Washington D.C. will end their Open Enrollment Periods at midnight January 31.
California’s state exchange has signed up about 1.2 million residents renewing their policies and 342,000 new enrollees. New York will enroll 2.1 million people. And the Washington D.C. exchange says its poised to match last year’s numbers.
Healthcare Reform News Update for January 29, 2018
Trump Administration Sued Over Cuts to ACA Plans
The attorneys general for New York and Minnesota have sued the Trump administration for cutting off more than $1 billion in annual federal funding for state Affordable Care Act plans that cover almost 1 million low-income residents.
The Department of Health and Human Services (HHS) announced December 21 that it would not pay the $266 million to New York or $32 million to Minnesota for their Basic Health Program plans in the first quarter. The cuts represent more than 25 percent of the overall funding to the programs and $1.2 billion over one year.
The states are the only two that participate in the Basic Health Program, which provides low out-of-pocket plans with premiums of $0 to $80 per month. New York has 700,000 enrollees.
“The abrupt decision to cut these vital funds is a cruel and reckless assault on New York’s families,” said New York Attorney General Eric Schneiderman.
Healthcare Reform News Update for January 26, 2018
Two Reinsurance Bills Vie for Congressional Support
Two rival reinsurance bills — one with only GOP support in the House, the other with bipartisan support in the Senate — are complicating ACA stabilization efforts.
The House version, sponsored by Representatives Ryan Costello (R-PA) and Collin Peterson (D-MN), will cost $30 billion over three years at the discretion of the secretary of Health and Human Services. It consolidates a federal reinsurance program and includes retroactive funding of cost-sharing reduction (CSR) payments for 2017 and funding for 2019.
The Senate bipartisan version, sponsored by Senators Susan Collins (R-ME) and Bill Nelson (D-FL), uses 1332 wavers to give states a $2.25 billion pool every two years to fund their own reinsurance programs.
Costello says his approach has the advantage of “speed, efficiency, and certainty,” because obtaining waivers can be uncertain. Collins says the waivers will ultimately benefit states more.
Costello and Collins have discussed the proposals, and talks are ongoing. It’s unclear which proposal has more support from lawmakers.
Warren Calls for ACA Supporters to ‘Go on Offense’
Senator Elizabeth Warren (D-MA) in a Thursday speech called for supporters of the Affordable Care Act to be more aggressive over healthcare issues in response to Republican efforts to repeal the law.
“We need to do more than play defense,” she said at a conference held by Families USA, a liberal healthcare advocacy group. “I believe it is time for us to go on offense.”
Warren spoke about building on the ACA’s fundamentals, including creating a public health insurance option and expanding Medicare eligibility. She also criticized insurance carriers and said the government needs to “hold America’s insurance companies accountable.”
Healthcare Not Priority for Battleground Voters
Even though healthcare is a top issue for voters nationwide, it lags behind the economy, North Korea, and immigration as a priority for voters in states with competitive political races, according to a recent poll from the Kaiser Family Foundation.
Nationwide, healthcare is the top issue for 29 percent of voters, followed by the economy and immigration. For the 13 states with congressional or gubernatorial races, 21 percent of voters choose healthcare as the priority.
The poll also found that 50 percent of voters were not aware that the ACA’s individual mandate had been repealed. The same percentage said they supported the ACA.
Healthcare Reform News Update for January 25, 2018
Azar Confirmed as Health & Human Services Secretary
Former Eli Lilly executive Alex Azar was confirmed Wednesday as the new secretary for the Department of Health and Human Services (HHS) in a 55-43 Senate vote.
Azar previously served the department as general counsel and then as deputy secretary under former President George W. Bush. “He understands the process, and he knows the levers and how you make it work and where the potential roadblocks are,” said former HHS Secretary Mike Leavitt.
Azar has four main objectives for the department:
- help contain prescription drug prices
- make health insurance more affordable and accessible
- continue working to make Medicare payments based on quality—not quantity
- tackle the opioid addiction epidemic
Idaho to Allow Sale of Non-ACA-Compliant Health Insurance
Idaho revealed a plan Wednesday that would allow the sale of health insurance that does not meet the consumer protections established under the Affordable Care Act. It’s the first state to do so without prior federal approval.
The director of the Idaho Department of Insurance says the plan is necessary to make cheaper insurance available to more people. But the legality of the measure is being questioned by healthcare experts.
Under Idaho’s guidelines, the new, cheaper plans could:
- Deny coverage for pre-existing conditions for up to 12 months
- Exclude pediatric dental coverage and vision care
- Charge people more based on where they live, health history, and age
- Charge consumers separate out-of-pocket maximums for different services
Insurers in the state would continue to have ACA-compliant marketplace plans available.
Trump Administration Seeks to Expand Individual Mandate Exemptions
The Affordable Care Act’s individual mandate was repealed last month, but it doesn’t go into effect until 2019. In response, the Trump administration is exploring ways for more consumers to qualify for exemptions on 2018 tax returns.
The Centers for Medicare and Medicaid Services (CMS) is creating guidance to expand hardship exemptions but has yet to finalize or publish the details.
Ted Cruz Continues Fight to Repeal ACA
Senator Ted Cruz (R-TX) on Wednesday said he is still working to repeal the Affordable Care Act this year.
Cruz said he has been “speaking with a wide number of senators” about repeal efforts and is trying to get enough support for an effort to pass.
“I don’t think leadership is interested in going down this road again until we can get 50 votes, and so we need to do the hard work of bringing the rest of the conference together. I think we’re still quite close,” he said.
Healthcare Reform News Update for January 24, 2018
ACA Tax Delays Will Cost $31.3 Billion
The postponement of three Affordable Care Act taxes in the stopgap spending bill, which ended the three-day government shutdown, will reduce federal revenue by $31.3 billion over 10 years, according to the Joint Committee on Taxation.
- Delaying the medical device tax will cost $3.8 billion.
- Postponing the Cadillac tax will cost $14.8 billion.
- Deferring the health insurance tax will cost $12.7 billion.
HHS Nominee Advanced by Senate
Alex Azar, President Donald Trump’s nominee to lead the Department of Health and Human Services (HHS), won Senate approval Tuesday in a 54-43 vote. Final confirmation is expected today. Azar is a former Eli Lilly executive.
Healthcare Reform News Update for January 23, 2018
Stopgap Bill Includes 3 ACA Tax Delay Extensions
The bill that reopened the federal government today includes three measures that affect the Affordable Care Act.
The “Extension of Continuing Appropriations Act, 2018″ (ECAA) bill will delay:
- the start date of the ACA’s Cadillac tax through 2022.
- the health insurance tax through 2019.
- the medical device tax through 2019.
The Congressional Budget Office (CBO) has estimated that the three taxes represent $12.7 billion in federal revenue.
California Marketplace Enrollment Up 7 Percent
Covered California, the state’s ACA marketplace, has signed up about 342,000 healthcare enrollees since Open Enrollment began November 1. That’s a 7 percent increase compared to the same time last year.
“The demand — as well as the need — for health insurance is as strong today as it was when we first began offering coverage five years ago,” said Peter V. Lee, Covered California’s executive director, in a statement.
Enrollment will continue for the state through January 31.
ACA Stabilization Bills Still Alive in Congress
Senator Susan Collins (R-ME) remains optimistic about bipartisan legislation created to help lower premiums and stabilize the Affordable Care Act marketplace.
Collins expects the measures to be included in an omnibus bill due for a vote within the next few weeks.
“Our negotiations with the House are going very, very well. The deadline slipped but the policy is what is important,” she said.
Healthcare Reform News Update for January 18, 2018
Azar Moves to Full Confirmation for HHS Secretary
The Senate Finance Committee voted 15-12 to advance Alex Azar’s nomination to head the Department of Health and Human Services (HHS). All committee Republicans voted for Azar; Tom Carper (DE) was the only Democrat voting in support of the nominee.
Azar was an HHS official during the George W. Bush administration and is a former executive for pharmaceutical company Eli Lilly. Azar has said he intends to cut back the Affordable Care Act through new regulations and help stem the rise of drug prices.
A confirmation date has not been scheduled, but lawmakers expect a vote by the end of the month.
GOP Plans for ACA Taxes Unveiled
Republican lawmakers introduced measures Tuesday to suspend or delay some ACA taxes as part of the efforts to avoid a government shutdown.
The proposals include delaying the health insurance tax (HIT) for one year and a two-year delay on the medical device tax and the Cadillac tax on high-cost insurance plans. It also included a six-year reauthorization of the Children’s Health Insurance Program (CHIP).
Opponents have asked to suspend the HIT tax retroactively for 2018, saying it would lower premium costs. “While we welcome the suspension of the health insurance tax (HIT) in 2019, small businesses need help now. It’s critical that policymakers provide urgent relief and much-needed certainty by suspending the tax immediately for 2018 and 2019,” said Elena Tompkins, executive director of Stop the HIT, a coalition representing small-business owners.
Healthcare Reform News Update for January 16, 2018
Uninsured Americans Grew to 12.2 Percent Last Year
After years of decline due to the Affordable Care Act, the number of Americans who do not have health insurance rose to 12.2 percent in 2017, compared to 10.9 percent at the end of 2016, according to a new national survey from Gallup.
This is the first time in nine years where there was not a year-over-year decrease in the number of uninsured.
About 3.2 million Americans lost coverage in 2017. Especially affected were young adults, blacks, Latinos, and households making less than $36,000 a year. The majority of the newly uninsured had previously purchased individual insurance, rather than receiving group coverage from an employer, Medicare, or Medicaid.
It’s expected that the Trump administration’s efforts to weaken portions of the Affordable Care Act, such as repealing the individual mandate, could continue to impact the number of uninsured. “It seems likely that the uninsured rate will rise further in the years ahead,” according to the report.
Republican Leaders Hope to Eliminate ACA Employer Mandate
House Republicans Devin Nunes (CA) and Mike Kelly (PA) have introduced a bill that would suspend the Affordable Care Act’s mandate that employers offer healthcare to employees, canceling penalties that would be imposed for any year from 2015 to 2018.
“The employer mandate is a job-killer, a wage-killer, and a business-killer,” said Representative Kelly.
Currently, if an employer does not offer minimum essential coverage to full-time employees, the business is subject to a penalty of $2,260 per year for each employee in excess of 30. It’s estimated that businesses will pay $12 billion in penalties in 2018.
Democrats oppose repealing the employer mandate saying that the measure has not harmed businesses since the law’s implementation in 2010.
Healthcare Reform News Update for January 12, 2018
ACA Exchange Carrier Faces Lawsuit
A class-action lawsuit claiming inadequate access to doctors was filed Thursday in a federal court against Centene, one of the largest insurance carriers on the federal healthcare exchange.
Centene sells Ambetter plans in more than 15 states and insures 1.4 million people. In some areas of the country, the company is the only provider available on the exchange.
The lawsuit alleges that Centene falsified its network of doctors and that patients have trouble finding providers who accept the plans. “Centene misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers — some of whom have specifically asked to be removed — as participants in their networks and by listing nurses and other non-physicians as primary care providers.”
The company said it was not aware of the lawsuit until Thursday. According to a spokesperson, “We believe our networks are adequate. We work in partnership with our states to ensure our networks are adequate and our members have access to high quality healthcare.”
House Chairman Hopes ACA Cadillac Tax Will Be Eliminated
House Ways and Means Committee Chairman Kevin Brady (R-TX) said there is a chance that a repeal of the Affordable Care Act’s “Cadillac tax” could be included as part of the government funding measure under negotiation in Congress. Currently, the tax will not go into effect until 2020.
The Cadillac tax imposes a 40 percent excise tax on employer-funded health insurance plans that cost more than $10,200 for individuals and $27,500 for families.
Healthcare Reform News Update for January 11, 2018
Internal Document Discloses Trump Administration’s ACA Strategy
An internal Trump administration document recently obtained by Senator Bob Casey (D-PA) outlines 10 actions that Health and Human Services (HHS) planned to implement via executive authority to make changes to the Affordable Care Act.
The March 23, 2017, document says the measures would “improve the individual and small group markets most harmed by Obamacare.”
Casey called the list “sabotage” of the ACA. “The primary problem here is government officials, government agencies, were taking steps that would lead to fewer people having coverage and erecting barriers to people having coverage,” Casey said.
The document was used during a meeting with House GOP lawmakers in March, including House Speaker Paul Ryan (R-WI).