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Below is a summary of recent events to help you stay current on healthcare reform news all in one place. To make your voice heard on these issues, visit OurCareBill.org, a non-partisan movement that lets you share your opinion on healthcare legislation with friends, family, and even Washington D.C.!
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 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).
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.
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 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 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.
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 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.
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.
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.
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.
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.
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.
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 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.
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.
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 November 1, 2019
Georgia Governor Requests Changes to State ACA Marketplace
Georgia Governor Brian Kemp announced that he will request federal waivers for a two-part plan to alter the state’s Affordable Care Act health insurance marketplace.
Kemp said the proposed changes, called Georgia Access, would help lower premiums and give the state greater control over federal healthcare subsidies.
The first waiver would establish a state reinsurance program.
The second waiver would enable residents to sign up for coverage directly through insurance providers or broker websites instead of using healthcare.gov. Enrollees would also gain the ability to use federal tax subsidies to purchase lower cost, less comprehensive short-term and association plans. Only plans that include pre-existing condition protections would be available.
New Survey: Premiums Are Primary Factor in Consumer Healthcare Shopping
A new poll by Morning Consult shows that consumers consider premiums as the most important factor when selecting a healthcare plan, especially shoppers who are uninsured.
The survey showed that 36 percent of uninsured adult shoppers said premiums were the most important consideration compared to 24 percent of all adult shoppers.
Other factors were significantly less of a priority, including copay amounts (13 percent of all adults and 13 percent of uninsured adults) and deductibles (8 percent of all adults and 5 percent of uninsured adults).
For consumers age 29 and under, coverage for prescription drugs is the most important factor in choosing a plan, with 20 percent saying it’s their top consideration. Premiums and copays were less important with 17 percent of younger shoppers saying they were primary concerns.
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 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 16, 2019
Federal Judge Strikes Down ACA Nondiscrimination Rule
A federal judge overturned an Affordable Care Act rule that banned discrimination against anyone based on sex, gender identity, or termination of pregnancy.
The provision requires insurers and doctors to provide transgender patients the same “medically necessary” treatments and services they would provide other patients.
Judge Reed O’Conner said the rule violates the Religious Freedom Restoration Act and issued a nationwide injunction against its enforcement. O’Connor is the same judge who recently ruled that the entire ACA healthcare law as unconstitutional.
The decision is expected to be appealed.
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.
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 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.
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 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 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 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
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
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 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.
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 8, 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 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 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.
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.
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.
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 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.
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.