The Scoop: health insurance news – February 24, 2021

In this edition

Idaho is final state to open COVID-related enrollment window

Before we delve into this week’s news, a reminder that enrollment is now open for 2021 individual/family health insurance in every state except Idaho – but Idaho’s enrollment period will start on Monday. Uninsured people have another opportunity to sign up for coverage, and in most states, people who already have coverage can use this window as an opportunity to switch to a different plan if it would better meet their needs.

The Biden administration and the states that run their own exchanges are also pouring a great deal of money into marketing and outreach during this period, in an effort to reach the millions of uninsured Americans who don’t yet know about the coverage and financial assistance available to them via the marketplace or Medicaid. In most states, the enrollment window continues through May 15, but there are several states with different deadlines.

Bills under consideration in Maryland, California would connect unemployment applicants with health coverage

California S.B. 644, introduced last week, would help to connect unemployed California residents with health coverage resources, starting in July 2022. Under the terms of the legislation, the California Employment Development Department (EDD) would provide Covered California (the state-run exchange) with contact information for people who apply for programs administered by the EDD, including unemployment benefits, state disability, paid family leave, etc. Covered California would then reach out to these individuals, determine whether they’re eligible for Medi-Cal or premium subsidies, and help them get enrolled in coverage if they choose to do so.

In Maryland, a similar bill (H.B. 1002) would allow people seeking unemployment benefits to consent to having their contact information and other relevant information shared with Maryland Health Connection (the state-run exchange) and the Maryland Department of Health. These agencies could then determine whether the resident would be eligible for financial assistance with their health insurance, and help them enroll in coverage. Maryland already has an “easy enrollment” program that connects residents with the health insurance exchange via their tax returns; H.B.1002 would expand the outreach to include people dealing with the loss of a job.

DOJ asks Supreme Court to cancel hearing in Medicaid work requirement case

On Monday, the Department of Justice asked the Supreme Court to scrap the oral arguments that are scheduled to be heard next month in a case to determine the legality of Medicaid work requirements. The case focuses on the work requirements in Arkansas and New Hampshire, but it would have ramifications for work requirements that the Trump administration approved in several other states as well.

Work requirements are not currently in effect in any state, and would not be compatible with the current rules that allow states to receive additional COVID-related federal Medicaid funding, on the condition that enrollees’ coverage not be terminated during the pandemic emergency period. But some states, including Arkansas, hope to eventually reimpose a Medicaid work requirement.

The Biden administration notified states earlier this month that the Medicaid work requirements that were approved over the last few years are now being reconsidered. Arkansas, which had the previous administration’s support in the work requirement lawsuit, filed a brief asking the Supreme Court to ignore the Department of Justice’s request and continue with the scheduled oral arguments next month. But Arkansas officials have also said that they will not seek reapproval for the work requirement when the current waiver expires at the end of this year, and are instead considering a work incentive program that would provide private coverage to people who participate in the program, and traditional Medicaid to those who don’t.

Virginia lawmakers head to conference committee over reinsurance funding

Virginia lawmakers have been working on a bill to create a reinsurance program in the state. But as has been the case in some other states that have considered reinsurance programs, there’s disagreement over how to cover the state’s portion of the funding.

The measure passed by Virginia’s House of Delegates earlier this month called for an assessment on individual/family and large group health plans in the state (but not small-group plans), set at 1% of the prior year’s premium revenue. But the Senate has proposed funding the state’s share of the reinsurance program – estimated at $40 to $60 million – from general fund revenues, without the need for an assessment on health insurers.

The two chambers are taking the measure into a conference committee, and have until March 1 to come to an agreement. Assuming they do reach an agreement, the reinsurance program is slated to take effect in 2023 – but it’s possible that the conference committee could work out an arrangement that allows it to take effect in 2022 instead. (Most other states that have established reinsurance programs have had them up and running by the plan year immediately following the enactment of legislation to start the program.)

Iowa, Kentucky Houses approve bills limiting insulin cost-sharing; other states consider similar bills

Yesterday, Kentucky’s House of Representatives voted unanimously to pass H.B. 95, which would require state-regulated health plans to cap cost-sharing for insulin at $30/month, starting in 2022. The measure now heads to Kentucky’s Senate for further consideration. A similar bill – but with a cost-sharing limit of $100/month – passed in Iowa’s House of Representatives earlier this month.

A bill that would cap insulin cost-sharing at $50/month was introduced in California’s Senate last week. And although Illinois was one of the states that enacted legislation last year to cap insulin cost-sharing at $100/month, a new bill was introduced in the Illinois House last week that would lower that cap to $30/month. West Virginia also enacted a $100/month cap last year, but a new bill was introduced this month in West Virginia’s Senate that would lower the cap to $25/month.

In 2019, Colorado became the first state to enact legislation to limit cost-sharing for insulin. Several other states enacted similar legislation last year, and several more had already begun considering bills to limit cost-sharing for insulin earlier this year.

South Dakota becomes fifth state to allow non-insurance Farm Bureau health plans

South Dakota Gov. Kristi Noem signed a bill last week that will allow the South Dakota Farm Bureau to offer health plans that will not be considered health insurance, and that will be specifically exempt from state and federal insurance laws and regulations. Tennessee, Kansas, Iowa, and Indiana already allow this type of plan to be sold.

South Dakota Farm Bureau noted that its plans to partner with a third-party administrator to offer the new plans. SDFB does intend to cover the Affordable Care Act’s essential health benefits, but it’s expected that that plan will use medical underwriting as a mechanism to keep costs down.

Oscar Health to become publicly traded company, with 31 million shares for sale next week

Oscar Health has filed to become a publicly traded company, with stock sales expected to begin next week. Oscar plans to offer 31 million shares, priced at $32 – $34 per share, potentially raising a billion dollars in the initial public offering. Shares will trade on the NY Stock Exchange under the ticker symbol OSCR.

Oscar offers health plans in 18 states this year. They have more than half a million members, most of whom are enrolled in individual/family plans obtained via the health insurance marketplaces. Although most insurers in the individual market struggled with losses in the early years of ACA implementation, many of them have since become profitable. But Oscar’s losses have continued to mount, despite steady expansion into new states and expansion into the Medicare Advantage market last year.

Senate committee hearings focus on HHS Secretary nominee Xavier Becerra

The Senate Health Committee held a hearing yesterday with California Attorney General Xavier Becerra, President Biden’s nominee to lead the Department of Health and Human Services. Another hearing takes place today, with the Senate Committee on Finance. The committees will then make a recommendation to the rest of the Senate, and the nomination will be sent to the full Senate for debate and a confirmation vote. If Becerra is confirmed, he would be the first Latino Secretary of Health and Human Services.

Becerra was previously in the U.S. House of Representatives from 1993 to 2017. He voted for the Affordable Care Act in 2009/10 and then voted to protect it numerous times over the ensuing years. Becerra became California’s Attorney General in 2017, taking over from Kamala Harris when she was elected to the Senate. He led numerous legal battles against the Trump administration, and some Senate Republicans have expressed opposition to his nomination.

Democrats and the White House have expressed confidence that Becerra will be confirmed. With the 50-50 split in the Senate, Becerra could be confirmed on a party-line vote, with Vice President Kamala Harris casting the tie-breaking vote. But moderate West Virginia Democrat Joe Manchin has indicated that he’s undecided on Becerra’s nomination. There are, however, moderate Republicans who may support Becerra’s confirmation.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – February 24, 2021 appeared first on healthinsurance.org.

The Scoop: health insurance news – February 17, 2021

In this edition

COVID-related enrollment window starts in most states

Although open enrollment ended two months ago in most of the country, a new one-time enrollment opportunity is available for 2021 coverage. Uninsured Americans nationwide have access to this enrollment window, and in most states, it can also be used by people who want to pick a different plan or switch from off-exchange to on-exchange coverage.

This enrollment window – a response to the ongoing COVID emergency – is now underway nationwide, with the exception of Idaho, which announced on Monday that a special enrollment period would begin March 1. In almost every state, the enrollment period continues through May 15, although there are seven state-run exchanges that have – for now – different end dates:

If you’re not yet enrolled in health coverage for 2021, or if you’re enrolled in something like a short-term plan, Farm Bureau plan, or health care sharing ministry plan, this enrollment window – which does not require a qualifying event – is an opportunity to secure real health insurance coverage for the rest of the year.

And keep an eye on the COVID relief legislation that Congress is considering. It could end up providing enrollees with much larger and more widely available premium subsidies, making it particularly important that people get enrolled in on-exchange coverage before the end of this enrollment window.

CMS notifies states that Medicaid work requirements are being reconsidered

Last week, the Biden administration began notifying states with approved Medicaid work requirements that CMS is considering withdrawing the approval for these programs. The letters were sent to Arizona, Arkansas, Georgia, Indiana, Nebraska, New Hampshire, Ohio, South Carolina, Utah, and Wisconsin, and clarify that CMS “has preliminarily determined that allowing work and other community engagement requirements to take effect … would not promote the objectives of the Medicaid program.”

There are currently no Medicaid work requirements in effect. Some have been overturned by the courts, some have been postponed voluntarily by the states, and others have been suspended or postponed due to the COVID pandemic and the ban on coverage terminations that states are required to adhere to in order to receive enhanced federal Medicaid funding during the pandemic. The Supreme Court will hear oral arguments next month in Arkansas v. Gresham, to determine whether the Trump administration’s approval of a Medicaid work requirement in Arkansas was lawful.

CMS also sent a letter (see Michigan’s here) last week to states that currently operate 1115 waivers, rescinding a previous letter that former CMS Administrator Seema Verma sent to states in early January. Verma’s letter had stated that if CMS were to terminate or withdraw approval for part or all of a state’s 1115 waiver, there would be a nine-month delay before the changes took effect.

South Dakota legislature passes bill to allow sale of Farm Bureau plans

Last week, we told you about a bill in South Dakota that would allow the state to join Tennessee, Kansas, Iowa, and Indiana in allowing Farm Bureau (or other agricultural organizations domiciled in the state for at least 25 years) to sell medically underwritten health plans that would specifically not be considered health insurance and thus would be exempt from insurance laws and regulations, including state laws as well as the Affordable Care Act’s rules.

The bill had already passed the Senate at that point, and has since passed in the South Dakota House as well. It’s now under consideration by GOP Gov. Kristi Noem, who consistently voted against the Affordable Care Act during her time in Congress.

There are other states where Farm Bureau partners with health insurers to offer ACA-compliant health insurance (Michigan is an example), and the Nebraska Farm Bureau partners with Medica to offer guaranteed-issue short-term health insurance during a limited annual enrollment period. But these approaches are not the same as allowing an agricultural organization to offer products that are specifically not considered health insurance.

Kansas Senate legislation would allow short-term health plans in Kansas to follow federal rules

Kansas is one of the states where the rules for short-term health plans are more restrictive than the current federal rules. But S.B. 199, introduced last week in the Kansas Senate, would change that. Kansas currently limits short-term health plans to a single renewal, which means their total duration cannot exceed 24 months. S.B. 199 would allow short-term health plans in Kansas to have total durations of up to 36 months – in line with current federal rules. The Biden administration may roll back the Trump-era rules for short-term plans, however, which would eventually make more relaxed state rules moot.

Aetna plans to rejoin exchanges for 2022

CVS Health/Aetna plans to offer health coverage in at least some health insurance exchanges during the open enrollment period that starts this November, although the insurer has not yet provided details in terms of where it will participate. Aetna had previously offered coverage in some exchanges, but had exited all of them by the end of 2017, and has not participated since. CVS/Aetna opting back into the exchanges would continue the trend that has been ongoing in 2019, 2020, and 2021, with insurers joining or rejoining the exchanges, after numerous insurers – including Aetna – left the exchanges in 2017 and 2018.

Aetna’s previous exit from the health insurance exchanges happened before the company was acquired by CVS. But the exit was controversial, and linked to the Department of Justice’s decision to block a merger between Humana and Aetna. Here’s what David Anderson wrote about this in 2016, and Charles Gaba has put together a timeline of Aetna’s 2016 decision-making process.

Washington state Senate committee approves legislation to ensure coverage of gender-affirming healthcare

Washington state lawmakers are considering S.B. 5313, which would require state-regulated health plans to provide non-discriminatory coverage for medically necessary gender-affirming care. Insurers would not, for example, be able to deny coverage for services needed by transgender members, such as facial feminization, breast reductions, breast implants, etc. by classifying them as cosmetic procedures.

The bill was overwhelmingly approved last week by the Washington Senate’s Committee on Health and Long Term Care.

Rhode Island legislation would create commission to consider single-payer health program

Legislation was introduced in Rhode Island last week that calls for the creation of a special legislative committee tasked with “a comprehensive study to determine the pros and cons of implementing a single-payer (health coverage) program in Rhode Island.” The legislation notes that an “improved Medicare-for-all type single-payer program” would be in the state’s best interest. There are not currently any states that have single-payer health coverage systems, although there are others that are considering similar studies.

Medicaid buy-in legislation introduced in West Virginia

Legislation has been introduced in several states this year that would create Medicaid buy-in programs. With the introduction of H.B. 2241, West Virginia is the latest state where lawmakers are considering this possibility. The idea is to create a public option program by allowing residents – who would not otherwise be eligible for Medicaid – to purchase Medicaid coverage as an alternative to purchasing private health insurance. There are not yet any states where Medicaid buy-in programs have been enacted; Nevada has come the closest, but the Medicaid buy-in legislation that lawmakers passed in 2017 was vetoed by Nevada’s governor.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – February 17, 2021 appeared first on healthinsurance.org.

The Scoop: health insurance news – February 10, 2021

In this edition

COVID-related enrollment window starts Monday in most states

In every state except Connecticut, Idaho, and Vermont, a COVID-related enrollment window will be open by next week. (In a few states, they’re already open.) During these enrollment windows, consumers can sign up for ACA-compliant health coverage without a qualifying event.

In most states, the enrollment window applies to anyone eligible to use the marketplace, including people who are already enrolled and want to make a plan change. But some of the state-run exchanges are limiting eligibility to only people who are currently uninsured, or to people who aren’t already enrolled through the exchange. And some states are extending the COVID-related enrollment window to off-exchange plans as well, although financial assistance is never available outside the exchange.

If you’re uninsured or know someone who is, this is an opportunity to have coverage in place for the rest of 2021, with an effective date as early as March 1. Millions of uninsured Americans are eligible for premium subsidies substantial enough to cover the full cost of at least some plans in the marketplace. And Congress is considering COVID relief measures (described below) that would make coverage even more affordable.

House committees propose health insurance provisions as part of COVID package

The House Ways and Means Committee unveiled a set of nine COVID relief proposals this week. Subtitle G, related to “promoting economic security,” includes several important health insurance provisions:

  • For 2021 and 2022, the normal rules for the percentage of income a person is expected to pay for on-exchange health insurance would be modified to be much more generous. People with income up to 150 percent of the federal poverty level would pay nothing for the benchmark plan. And nobody would pay more than 8.5 percent of their income, including people who earn over 400 percent of the poverty level (and are currently not eligible for a premium tax credit at all, regardless of how much of their income they have to pay for health coverage).
  • For 2020 only, excess premium tax credits would not have to be repaid to the IRS. This is something that several insurance commissioners from around the country suggested to President Biden before he took office. Premium subsidy reconciliation can catch people off guard at the best of times — and 2020 was a particularly complicated year.
  • People receiving unemployment benefits in 2021 would receive a premium tax credit that would fully cover the cost of the benchmark plan.

The House Energy and Commerce Committee also published its proposed COVID relief measures this week, including a provision that would provide additional financial incentives for the states to expand Medicaid eligibility if they haven’t already. There are still a dozen states that haven’t expanded Medicaid.

Under current rules, if and when they expand eligibility, the federal government will cover 90 percent of the cost for the newly eligible population, and will continue to fund the rest of the state’s Medicaid program at the state’s normal matching rate (varies from 50 percent to about 76 percent, depending on the state). But under the committee’s legislative proposal relating to Medicaid, states that newly expand Medicaid would get an additional 5 percent federal funding match for their whole Medicaid program, for the first two years of Medicaid expansion.

The committees will markup these proposals this week, and a floor vote in the House on the final COVID relief legislation is planned for later this month.

Virginia House bill would implement reinsurance program in 2023

Legislation was introduced in Virginia last month to create a reinsurance program in the state. Last week, the Virginia House of Delegates passed the bill by a wide margin, and a Virginia Senate committee unanimously agreed to consider the bill during a special session that starts today.

If it’s passed and signed into law, the legislation calls for the state to submit a 1332 waiver proposal to the federal government by January 2022, and for the reinsurance program to be implemented by January 2023. (This is a fairly long timeline. We’ve seen several states implement reinsurance programs over the last few years, often with the program in place for the plan year immediately following the passage of the legislation that authorized it.)

Montana House passes bill to prohibit abortion coverage for exchange plans

Last week, we told you about a bill in Montana’s House that would prohibit on-exchange health plans in Montana from covering abortion services. On Friday, the bill passed in the House by a wide margin, and mostly along party lines. (Four Democrats voted yes, while one Republican voted no.) It’s now with the Montana Senate’s Judiciary Committee for further review. Montana is currently among the minority of states where abortion coverage can be provided under on-exchange plans and at least some plans do offer this coverage.

South Dakota Senate passes legislation to allow non-insurance Farm Bureau health plans

South Dakota’s Senate passed S.B.87 last week, which would allow a nonprofit agricultural organization, domiciled in the state for at least 25 years, to offer non-insurance health benefits to its members. The legislation, which was proposed by South Dakota Farm Bureau, would specifically exempt such health plans from insurance laws or oversight. Tennessee, Kansas, Iowa, and Indiana already allow Farm Bureau health plans to be sold with similar rules. (The plans are not considered health insurance and are thus not subject to insurance laws or regulations.)

The bill is now with the South Dakota House of Representatives, where the Agriculture and Natural Resources Committee approved it 11-1 this week, sending it to a vote on the House floor. The American Cancer Society has expressed strong opposition to the bill, noting that the proposed non-insurance health plans “have the potential of segmenting the insurance market, driving up premiums and making it harder for South Dakotans who live with serious or chronic disease to find health insurance.”

State lawmakers introduce Medicaid buy-in legislation

The concept of Medicaid buy-in as a way of establishing a public option has been debated for several years. Nevada lawmakers passed a Medicaid buy-in bill in 2017, but it was vetoed by the governor. Similar legislation was considered in New Mexico in 2019, but did not pass. (United States of Care has an extensive list of the actions that various states considered in 2019 related to Medicaid buy-in programs.)

This year, lawmakers in several states have introduced various forms of Medicaid buy-in legislation:

  • Georgia: S.B. 83/H.B. 214 would create a Medicaid buy-in program that would be available to anyone not otherwise eligible for Medicaid, Medicare, or PeachCare for Kids (Georgia’s CHIP).
  • Iowa: S.F. 220 would create a buy-in program for the Hawk-i program (Iowa’s CHIP). It would allow families to purchase coverage for their kids (and young adults up to age 26) through the program if their household income is too high to meet the normal eligibility guidelines. (Currently, 302 percent of the federal poverty level.) The plan would be available through Iowa’s marketplace and could be used with premium tax credits and cost-sharing reductions for eligible enrollees.
  • Oklahoma: H.B. 1808 would create a Medicaid buy-in program in the state. The bill would alter the existing Oklahoma statute that directs the state to create a Medicaid buy-in program for people with disabilities if funds become available. The funding aspect is key; Oklahoma has not yet created a Medicaid buy-in program for people with disabilities. But another bill was introduced in Oklahoma last week, calling for the removal of the “if funds become available” language in the existing statute.
  • South Carolina: H. 3573 would create a Medicaid buy-in program that would be available to people who are not eligible for premiums tax credits under the ACA, Medicaid, Medicare, or affordable employer-sponsored coverage.
  • Tennessee: S.B. 418/H.B. 602 would create a Medicaid buy-in program that would be available to people who are not eligible for premium tax credits, affordable employer-sponsored coverage, Medicaid, or Medicare. (The wording of the Tennessee legislation is very similar to the South Carolina legislation).

Biden administration puts Trump-era association health plan rule appeal on hold

In 2018, the Trump administration relaxed the rules for association health plans (AHPS), allowing self-insured people to join AHPs, as well as small groups that share only a common geographical location. The rules would also have allowed for the creation of these associations for the sole purpose of offering health insurance, without any other business purpose. These rules were soon challenged in court, and vacated by a judge in 2019. The Trump administration appealed the decision, and oral arguments in the appeal were heard by the D.C. Circuit Court in November 2019.

But a ruling had not yet been handed down by the time the Biden administration took office, and the new administration soon asked the court to stay the appeal. The court granted that request this week, so the appeal is on hold while the new leadership at the Department of Labor reviews the case, with status reports due every two months.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – February 10, 2021 appeared first on healthinsurance.org.

 

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