The Scoop: health insurance news – February 10, 2021

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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.

The Scoop: health insurance news – February 3, 2021

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Special enrollment periods underway (or soon to be underway) in most states

White House

An executive order signed by President Biden has authorized a COVID-related special enrollment period on HealthCare.gov. The SEP will run from February 15 to May 15.

Last week, the Biden administration announced a special enrollment period for HealthCare.gov, which will run from February 15 to May 15. This window will allow anyone eligible to use the marketplace to enroll or make a plan change, without needing a qualifying event.

The SEP applies in the 36 states that use HealthCare.gov, but 12 of the other 15 state-run exchanges have also announced similar enrollment windows — some of which are already underway:

These state-run exchanges are taking a mixed approach to this enrollment window, with some allowing anyone to enroll, and others limiting it to only people who are currently uninsured. There are only three other states that run their own exchange platforms but have not yet announced COVID-related special enrollment periods: Connecticut, Idaho, and Vermont.

House, Senate legislation would make ACA premium subsidies more generous

Democrats in Congress have long been considering various proposals to enhance the ACA’s premium subsidies and make more robust coverage more affordable. Last month, Rep. Lauren Underwood (D-Ill.) introduced the Health Care Affordability Act (H.R. 369) and Sen. Mark Warner (D-Va.) introduced the Health Care Improvement Act of 2021. Both bills include the basic health care provisions that President Biden has proposed as part of his American Recovery Plan.

One of the most important aspects of these pieces of legislation is a fundamental change in the formula for calculating premium subsidies. Under these bills, the subsidies would become more generous, allowing more Americans to purchase coverage with minimal or zero premiums, and capping premiums at no more than 8.5 percent of income, regardless of a household’s income. At ACA Signups, Charles Gaba has created graphics that will help you visualize after-subsidy premiums as a percentage of income under the status quo versus H.R. 369, as well as a previous piece of federal legislation and California’s state-based subsidy system.

Maryland legislation would create young-adult subsidy pilot program

A bill (H.B. 780) introduced last week in Maryland calls for the state to create a pilot program that would provide state-funded premium subsidies to young adults with fairly low incomes. The legislation calls for the state to use $10,000,000 per year in 2022 and 2023 to provide additional premium assistance to people between the ages of 18 and 41, with incomes between 133 percent and 140 percent of the poverty level.

The ACA already provides federal premium subsidies for people at this income level, but the subsidies aren’t as strong for young people as they are for older enrollees. The pilot program would be designed to make net premiums more affordable and boost enrollment for this demographic.

Minnesota legislation calls for transition to HealthCare.gov

Minnesota H.F. 536 – introduced on Monday – calls for the state to transition away from MNsure as of 2022 and start utilizing HealthCare.gov instead. The measure is not likely to pass in the Minnesota House, given the Democratic majority in that chamber and the lawmakers’ general support for MNsure.

In 2017, former Gov. Mark Dayton vetoed a bill that would have transitioned the state to HealthCare.gov, and MNsure has continued to be a successful state-run exchange ever since.

Over the first few years the exchanges were in operation, several states shifted from their own enrollment platforms to HealthCare.gov (although Idaho took the opposite approach, switching from HealthCare.gov to their own platform as of the 2015 plan year). But the opposite trend has been ongoing for the last couple of years, with Nevada, Pennsylvania, and New Jersey all switching away from HealthCare.gov and operating their own exchange platforms, and other states planning to follow suit over the next few years. (You can see a full timeline of all the changes here.)

Minnesota bill would require more robust coverage of outpatient mental health treatment

Minnesota H.F. 415 and S.F. 377 – both introduced last week – would require major medical plans regulated by the state of Minnesota (ie, individual and fully-insured group plans, but not self-insured group plans) to cover a member’s first four outpatient mental health visits each year with cost-sharing that doesn’t exceed $25 per visit.

There’s no mention of an exclusion for HSA-qualified high-deductible health plans (HDHP), but that would need to be added to the legislation in order to allow HSA-compliant plans to continue to be available in Minnesota. IRS rules do not allow HDHPs to pay for services like mental health care until the member has met their deductible.

Washington legislation would create state-based premium subsidies

Washington state’s Cascade Care program, including standardized plans and public option plans, is underway this year. But part of the original 2019 Cascade Care legislation called for the state to develop a plan to provide state-based premium subsidies to people earning up to 500 percent of the poverty level.

Legislation to get the ball rolling on that did not advance in last year’s session, but a new bill was introduced last week with a similar intent. S.B. 5377 calls for the state to provide premium subsidies to people with income up to 500 percent of the poverty level (and possibly a cost-sharing assistance program), as long as they’re enrolled in the lowest-cost Bronze, Silver, or Gold standardized plan available in their area. Washington’s exchange conducted a detailed analysis of various approaches to state-based premium subsidy programs last year; their report includes a recommendation that the state-funded premium subsidies be provided as a fixed-dollar amount.

S.B. 5377 also addresses some aspects of the state’s existing public option program, including participation requirements for hospitals and surgical facilities, as well as a reduction in the reimbursement rate for hospitals (currently set at 160 percent of Medicare rates, but it would decline to 135 percent of Medicare rates under S.B. 5377, leading to lower premiums for enrollees).

Mississippi and Kentucky consider extending postpartum Medicaid coverage

Mississippi lawmakers are considering S.B. 2799, which would make a variety of changes to the state’s Medicaid program, including an extension of postpartum Medicaid coverage. Under current rules, a woman in Mississippi who qualifies for Medicaid due to pregnancy is eligible for 60 days of postpartum Medicaid coverage after the baby is born, but S.B. 2799 would extend that to 12 months (during the COVID pandemic, postpartum Medicaid coverage does not terminate after 60 days, due to the current rules that prevent states from terminating Medicaid coverage for any enrollees unless they move out of the state or request a coverage termination). Medicaid covers nearly two-thirds of all births in Mississippi — the highest proportion in the nation.

The Kentucky House Democratic Women’s Caucus has created a plan they’re calling the Kentucky Maternal and Infant Health Project, comprised of 21 proposed bills that would address a wide range of issues. Among them is a measure that would extend postpartum Medicaid coverage from 60 days to 12 months. The proposal also calls for pregnancy to be considered a qualifying event, which is currently only the case in New York, Connecticut, and DC.

Montana legislative committee advances bill to prohibit abortion coverage for on-exchange plans

Last week we told you about legislation in Arizona, Texas, and Virginia that would remove state rules that prohibit abortion coverage on health plans that are sold in the exchange/marketplace in those states. Montana lawmakers are considering the opposite approach, however, with H.B. 229. The bill, which was approved by the House Judiciary Committee last week, would prohibit abortion coverage on plans sold in the Montana exchange. The only exception would be in cases where the mother’s life is in danger.

Montana is currently one of a minority of states where there is no ban on abortion coverage for on-exchange plans, and at least one insurer does offer plans that include abortion coverage.

More states consider bills that would cap out-of-pocket costs for insulin

Last year, several states enacted legislation to cap consumers’ out-of-pocket costs for insulin. Other states are considering similar bills this year, including Montana ($35/month cap), Tennessee ($100/month cap), New Jersey ($50/month cap), and New York ($30/month cap; New York already passed a bill last year that limits out-of-pocket costs for insulin, but the cap is $100. The new legislation would reduce that to $30 instead).

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 3, 2021 appeared first on healthinsurance.org.

The Scoop: health insurance news – January 13, 2021

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Open enrollment for 2021 health plans will end in five states on Friday

Open enrollment for individual/family health plans ended a month ago in most of the country, but it’s still underway in ten states and Washington, DC. In five of those states, there are only a few days left. Open enrollment ends this Friday, January 15, in five states:

Residents in those states can currently enroll in a plan with a February 1 start date. But after Friday, enrollment in those states will only be possible for people who experience a qualifying event (and most qualifying events require that the person already had minimum essential coverage within the prior 60 days).

Exchange enrollment has already surpassed last year’s total

As of January 12, confirmed enrollment in individual market plans via the exchanges stood at 11.5 million, according to Charles Gaba of ACA Signups. And open enrollment is still ongoing in ten states and Washington, DC (plus a special enrollment period for uninsured Maryland residents). What’s more, four states – Idaho, New York, Rhode Island, and Vermont – haven’t yet reported any of their enrollment data for 2021 plans.

Last year, when all was said and done, enrollment reached 11.4 million, so it’s already surpassed the 2020 total – the first time since 2016 that year-over-year enrollment has grown during the open enrollment period. Once open enrollment closes in all states and final data are reported, Gaba projects that this year’s enrollment will exceed 12 million.

HHS extends COVID public health emergency through mid-April

Last week, HHS Secretary Alex Azar announced that the COVID-19 public health emergency was being extended for another 90 days, through April 21, 2021. The ongoing public health emergency – which was first declared in January 2020 and extended several times since then – plays a key role in various rules related to health insurance coverage.

For the duration of the emergency period, for example, most health insurance plans must cover the cost of COVID testing and vaccines without cost-sharing. States will continue to receive additional federal matching funds for Medicaid through June 2021, and cannot disenroll people from their Medicaid programs during the COVID emergency period, unless the person moves out of state or requests a coverage termination. The public health emergency also expands access to telehealth and reduces reporting burdens for hospitals.

Tennessee’s Medicaid block grant waiver approved

In November 2019, Tennessee submitted a waiver proposal to CMS, seeking approval to transition to a block grant funding approach for the state’s Medicaid program. Last week the Trump administration announced that the state’s proposal had been approved for 10 years, with the extended timeframe intended to “reduce administrative burden and allow the state sufficient time to evaluate its innovative approach.” Instead of the open-ended matching system that the federal government uses with the rest of the states, Tennessee will have an annual spending cap, which can grow if enrollment grows, but which will not adjust to keep up with increasing healthcare spending.

In its approval letter, the Trump administration repeatedly touts the flexibility that the block grant waiver will provide for Tennessee. But block grants for Medicaid funding have been widely panned by public health experts, and are strongly opposed by leading patient advocacy groups due to the potential for reduced benefits, increased costs for enrollees, reductions in payments to providers, and state budget shortfalls.

Although the incoming Biden administration can make changes to 1115 waivers via a review process, Margo Sanger-Katz reported last week that CMS has sent letters to all 45 states that have active waivers, asking them to sign contracts that would make it harder for a new administration to terminate waivers “on a political whim.”

CMS auditing hospitals for compliance with new price transparency requirements

The hospital price transparency rule that CMS finalized in late 2019 took effect on January 1. It requires hospitals to “provide clear, accessible pricing information online” for 300 “shoppable” services, in both machine-readable and consumer-friendly formats. And the pricing information has to include payer-specific negotiated rates, which is much more useful than hospital “chargemaster” rates that don’t really reflect the amounts that payers and consumers actually pay.

There is widespread anecdotal evidence that compliance is spotty thus far (and the maximum annual penalty for non-compliance would only amount to about $100,000, which is equal to about four hospital admissions), but CMS is currently conducting an audit of some hospitals to determine whether they’re in compliance with the new rule. Hospital compliance is expected to ramp up in the coming weeks, but a lot remains to be seen in terms of how much impact the transparency rules will actually have on consumer decision-making.

Legislation in Minnesota would expand MinnesotaCare, create a public option

HF11, sponsored by Rep. Jennifer Shultz (DFL, District 7A), was introduced in Minnesota last week, calling for various changes to the MinnesotaCare program that would allow more people to enroll. MinnesotaCare is a Basic Health Program, which provides coverage to people who aren’t eligible for Medicaid and who have household incomes of up to 200 percent of the poverty level.

HF11 would extend MinnesotaCare eligibility to undocumented immigrants, and would also eliminate the “family glitch” for MinnesotaCare eligibility. HF11 would also create a public option, via MinnesotaCare buy-in, for people with income above 200 percent of the poverty level, with a sliding fee scale for premiums. The legislation would also allow small employers to buy into the MinnesotaCare program as a means of providing coverage for their employees.

Rep. Shultz published an op-ed in the Minnesota Reformer last week, outlining her goals for health care reform and the incremental steps that Minnesota could take to make coverage and care more accessible and affordable in the state.

Utah Insurance Department proposes new minimum standards for short-term health plans

The Utah Insurance Department has proposed new minimum standards for short-term health insurance coverage, including a benefit cap of at least $1 million, copayments/coinsurance that can’t exceed 50 percent of covered charges, and various inpatient and outpatient services that would have to be covered. But the three benefit categories that are most commonly excluded on short-term plans – outpatient prescription drugs, mental health care, and maternity care – are not among the mandated benefits that the Department has proposed. The Department is accepting public comments on the proposal until March 3.

BCBS Association suspends contributions to members of Congress who voted to reject electoral college results

Last Friday, the Blue Cross Blue Shield Association announced that it was suspending political contributions “to lawmakers who voted to undermine our democracy,” referring to the members who challenged the electoral college results from the November presidential election. Numerous other companies have followed suit, including Disney and Wal-Mart, but the Blue Cross Blue Shield Association was the first major healthcare group to take this step. Others have since announced similar decisions, including PhRMA, and to a lesser degree, Cigna. The Blue Cross Blue Shield Association represents the 36 independent Blue Cross Blue Shield insurers that operate across the country, insuring more than 107 million Americans.

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 – January 13, 2021 appeared first on healthinsurance.org.

The Scoop: health insurance news – December 23, 2020

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Open enrollment continues in 11 states, Washington, DC

Although open enrollment for 2021 individual and family health insurance ended last week in most states, and ended last night in Minnesota, open enrollment is still ongoing in 11 states and Washington, DC, with the following enrollment deadlines:

Enrollment up 6.6% for 2021 in states that use HealthCare.gov

Last Friday, CMS published preliminary enrollment data for the 36 states that used HealthCare.gov during the open enrollment period that ended last week. Across those 36 states, a total of 8.23 million people enrolled in private plans through HealthCare.gov. As Charles Gaba notes, that’s a 6.6 percent increase over last year, after we account for the fact that Pennsylvania and New Jersey are now running their own exchange platforms and will report their enrollment numbers separately. (Both also have ongoing enrollment periods, as noted above.)

As detailed by Andrew Sprung, private-plan enrollment via the exchange in states that have not expanded Medicaid is about 10 percent higher for 2021 than it was for 2020, while enrollment is slightly lower in states that have expanded Medicaid. Sprung offers several explanations for this, including the fact that many who lost their incomes in 2020 have transitioned to Medicaid, which is more likely to be an available option in states that have expanded Medicaid. Sprung has also tracked the significant increase in the number of people covered by Medicaid this year.

Trump administration finalizes rule changes for grandfathered group plans

Earlier this month, the Trump administration finalized new rules for grandfathered group health plans. The rule change is essentially the same as the changes that the administration proposed in July, but the effective date has been pushed out to mid-June 2021, as opposed to the originally proposed effective date of 30 days after the rules were finalized.

Under the new rules, grandfathered group plans that are HSA-qualified will be able to make cost-sharing increases necessary to retain their HSA-qualified status, even if the increases exceed the limits that would otherwise have applied to grandfathered plans. (This situation has not yet arisen, but if it does in the future, the rule change will allow these plans to keep both their HSA-qualified status and their grandfathered status.) And the new rules will also allow grandfathered group plans to increase their cost-sharing amounts by a larger threshold than previously permitted, with allowable cost-sharing expected to be about 3 percentage points higher under the new rule.

Congress passes legislation to protect consumers from surprise balance billing

The surprise balance billing legislation that we told you about last week was included in the Consolidated Appropriations Act, 2021, which passed earlier this week with strong bipartisan support in both the House and Senate. President Trump was widely expected to sign it as soon as it reached his desk, but he cast doubt on that via Twitter on Tuesday night, expressing displeasure at some aspects of the legislation. Trump didn’t say that he would veto the bill, but the video he shared on Twitter indicated that the current bill is no longer a sure thing.

In its current form, the massive bill includes government funding for the first three quarters of 2021, extensive COVID-19 relief, and numerous other provisions, including strong consumer protections against surprise balance billing that will take effect in January 2022. As the Kaiser Family Foundation’s Larry Levitt explains in this Twitter thread, the new legislation provides strong consumer protections, and – assuming it does get signed into law – will result in consumers having to pay just their normal in-network cost-sharing when they receive emergency care or unknowingly receive care from an out-of-network provider at an in-network facility.

Protections against surprise balance billing for ground ambulance charges are not included in the legislation, despite the fact that ambulance rides often result in surprise balance billing. But the legislation does call for a commission that will study ground ambulance charges in hopes of incorporating additional consumer protections in a future piece of legislation.

Congresses passes legislation to make health insurers subject to federal antitrust laws

The Competitive Health Insurance Reform Act of 2020 – H.R.1418 – passed in the Senate last night and is now headed to President Trump’s desk (it was passed by the House in September). Under the terms of this legislation, health insurance companies will be subject to federal antitrust laws, reversing a 75-year-old exemption that was granted in 1945 via the McCarran-Ferguson Act.

Sens. Steve Daines (R-Montana) and Patrick Leahy (D-Vermont) shepherded the bipartisan bill through the Senate. In announcing the passage of the bill, Daines noted that it “will ensure that health insurance issuers are subject to the same federal antitrust laws prohibiting unfair trade practices, such as price-fixing and collusion, as virtually every other industry in our economy.” The rest of the McCarran-Ferguson Act – which gives states the right to regulate their insurance markets — is unchanged by H.R.1418.

Ohio enacts legislation to end ‘fail first’ drug requirements for stage 4 cancer treatment

This week, Ohio Gov. Mike DeWine signed a new law prohibiting Ohio health insurance plans from imposing “fail first” requirements on drug coverage for people with stage 4 cancer. S.B.252 prohibits insurers from requiring these patients to try a cheaper medication first and then only cover another medication if the first did not work. These “fail first” requirements are often imposed on newer, cutting-edge therapies that tend to be more expensive than older medications, but Ohio’s legislation stems from the fact that time is of the essence with metastatic cancer.

Delaware proposal calls for increased investment in primary care

Delaware’s Insurance Commissioner, Trinidad Navarro, and the state’s Office of Value-Based Health Care Delivery have published a report that outlines proposals for improving access to primary care in the state without increasing healthcare costs. The report calls for health insurers in Delaware to increase their investments in primary care while decreasing price growth for some other services, including hospital care, and to transition to a value-based payment model instead of a fee-for-service model. The state is accepting public comments on the report until January 25, 2021.

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 – December 23, 2020 appeared first on healthinsurance.org.

The Scoop: health insurance news – December 2, 2020

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Open enrollment ends in 13 days in most states

In most of the United States, open enrollment for individual/family health plans is scheduled to end in just 13 days – on December 15. If you haven’t yet figured out your health coverage for next year, now’s the time to get that done!

open enrollment 2021

Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.

In 10 states and Washington, DC, the end of open enrollment has been extended, with deadlines that vary by state and continue well into January in some cases.

There are four other states (Connecticut, Idaho, Maryland, and Vermont) that run their own enrollment platforms and thus have the option to extend open enrollment if they choose to do so, although it’s still scheduled to end on December 15 in each of those states. In the rest of the country, the federal government runs the exchange and has control over the timing of open enrollment, currently slated to end December 15.

Oregon’s bipartisan congressional delegation asks HHS to extend open enrollment

Oregon’s entire bipartisan congressional delegation sent a letter to HHS this week, asking the federal government to extend the open enrollment period on HealthCare.gov. Oregon, like most of the rest of the country, relies on the HealthCare.gov enrollment platform, which means the state is unable to extend the enrollment deadline on its own.

The Oregon lawmakers pointed out that the COVID pandemic and this year’s devastating wildfires in Oregon are making it harder for people to enroll in health coverage for 2021 in a timely manner. They’re asking HHS to grant some extra flexibility by giving people until the end of December – instead of December 15 – to enroll in a health plan for 2021.

Washington Healthplanfinder accepting public comments on standardized plan designs for 2022

Washington State rolled out standardized plans in the individual market for the first time this fall. For the last month, some consumers in the state have been enrolling in these plans for 2021 coverage, but Washington’s exchange has already done much of the work to complete the standardized plan designs for 2022. They have publicized the draft plan designs, and are accepting public comments on the proposed plan designs through December 29. Comments can be emailed to standardplans@wahbexchange.org.

Delaware fines insurers nearly $600,000 for mental health parity violations

Delaware’s recently re-elected insurance commissioner, Trinidad Navarro, has imposed nearly $600,000 in fines for mental healthy parity violations by health insurers in the state. The Delaware Department of Insurance conducted a review of all four of the state’s major health insurers, checking for compliance with state and federal mental health parity requirements. (In general, the plan requirements and benefits provided for mental healthcare cannot be any more strict than the requirements and benefits that apply to other medical care.)

After finding “thousands” of violations, Delaware regulators worked with the insurers to remedy the problems and create more equitable access to mental health coverage and care in the state.

Proposed health insurance rule changes include waiver allowing states to eliminate exchanges

Last week, CMS published the proposed Notice of Benefit and Payment Parameters for 2022 (summary available here). Many aspects of the ACA were left up to HHS/CMS to implement and require ongoing adjustments, so CMS issues this rulemaking guidance each year. There’s a 30-day public comment period, and it appears that the Trump administration is hoping to finalize the proposed rules before the Biden administration takes over on January 20, 2021.

The proposed benefit and payment parameters cover a wide range of issues, as is always the case. But the following proposals are the ones that are most likely to directly affect you and your health insurance coverage:

  • Allow states to eliminate their exchanges: This is generally considered the most dramatic change that CMS has proposed for 2022, and it’s very similar to the waiver approval that it granted to Georgia last month. If finalized, this rule change would allow states to eliminate their central exchange (HealthCare.gov or a state-run exchange) and switch to a system of direct enrollment via brokers, agents, and insurers. Many people already enroll in on-exchange plans via the enhanced direct enrollment pathway, utilizing a third party’s website instead of the exchange website. But there are widespread concerns that consumers will fall through the cracks in states that opt to abandon their exchange platforms altogether – potentially having to visit multiple websites in order to get comprehensive information, not being able to learn about their eligibility for programs like Medicaid and CHIP, or being sold lesser quality coverage, such as short-term health insurance.
  • Maximum out-of-pocket increasing to $9,100: Under the ACA, health plans that aren’t grandfathered or grandmothered (or excepted from ACA rules altogether) must cap in-network out-of-pocket costs for their enrollees. But this cap changes each year, under a formula that has evolved over time. This year, the maximum out-of-pocket for a single person was $8,150. Next year, it will be $8,550. And for 2022, CMS has proposed a maximum out-of-pocket limit of $9,100. (The family cap is always double the individual amount.) Many plans will continue to have lower out-of-pocket caps, although catastrophic plans have the maximum allowable out-of-pocket exposure, as do most bronze plans.
  • More flexible SEP for people who lose eligibility for premium subsidies: Under current rules, a person who is receiving a premium subsidy (premium tax credit) qualifies for a special enrollment period if they become ineligible for that premium subsidy mid-year (either due to an income change or a change in household size), but they’re limited to picking a different plan at the same metal level as the plan they already have. CMS is proposing a more flexible special enrollment period that would also allow the option of switching to a plan at a lower metal level in order to give people the opportunity to reduce their monthly premiums as much as possible. Here are all the details.
  • New SEP when employer terminates contributions to COBRA premiums: In some cases, employers subsidize the cost of COBRA benefits for a certain period of time – this has been particularly common this year amid the widespread layoffs that stemmed from the COVID pandemic. When that subsidy ends, the full cost of the COBRA coverage can be unaffordable, but there’s not technically a special enrollment period for this situation, as it’s not among the official triggering events. CMS notes that people enrolling through HealthCare.gov have been granted a loss-of-coverage SEP in this situation, but the proposed rule change would add this as an official qualifying event for individual market coverage, making it applicable nationwide, both on-exchange and off-exchange.
  • New affordability threshold for catastrophic plan eligibility: People who are 30 and older can only buy a catastrophic plan if they have a hardship/affordability exemption from the exchange, indicating that the lowest-cost metal-level plan available to them would cost more than a certain percentage of their income. In 2020, that threshold is 8.24 percent. For 2022, CMS has proposed an increase to 8.47 percent.
  • MLR rebates: Earlier this year, to address the COVID pandemic, CMS issued guidance that allowed insurance companies to issue medical loss ratio (MLR) rebates earlier than usual. CMS is proposing a rule change that would essentially make this year’s relaxed rules permanent, allowing insurers the option to prepay MLR rebates rather than waiting until the fall to issue them.

At Health Affairs, Katie Keith has three detailed articles about the proposed benefit and payment parameters: One addressing rules related to the health insurance exchanges, a second addressing the MLR rules, and a third addressing the rules related to risk adjustment.

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 – December 2, 2020 appeared first on healthinsurance.org.

The Scoop: health insurance news – November 25, 2020

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Open enrollment for 2021 health plans: Under 3 weeks remaining

If you or a loved one is in need of health insurance, or if you’re already enrolled in an individual-market (non-group) health plan, open enrollment is currently underway nationwide, and we’re past the half-way point. Enrollment started more than three weeks ago, and we now have under three weeks remaining.

open enrollment 2021

Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.

Open enrollment is an opportunity for people to newly enroll in health coverage – regardless of medical history or prior coverage – and it also allows people who are already enrolled to actively compare their available options for 2021 and select a different plan if it would serve them better.

(Even if the current plan is still the best choice, this is always a better approach than simply letting the plan auto-renew without checking the other options.)

Still have questions? Read our extensive overview of open enrollment.

Enrollments have surpassed 3 million nationwide

As of November 21, nearly 2.4 million people in 36 states had enrolled in coverage for 2021 through HealthCare.gov. A few of the state-run exchanges (used in Washington, DC, and the other 14 states) have also published enrollment updates:

According to Charles Gaba – who’s tracking enrollments nationwide – enrollment stood at more than 3 million as of November 25, including several hundred thousand enrollees in state-based exchanges whose coverage has been auto-renewed for 2021. (These individuals still have an opportunity to pick a different plan if they choose to do so). Gaba’s tally includes the states that use HealthCare.gov as well as the handful of state-run exchanges that have reported enrollment data, but most of the state-run exchanges have not yet made their enrollment data public.

The daily enrollment pace via HealthCare.gov is higher than it was during the same time period last year, and that appears to be the case in the state-run exchanges as well. But we aren’t yet seeing a significant surge in enrollment that might be expected given the job losses and associated coverage losses caused by the COVID pandemic. However, enrollment in Medicaid has grown significantly this year, thanks to the ACA’s Medicaid expansion guidelines that allow people in most states to enroll in Medicaid if their income drops to under 138% of the poverty level, even if it was higher than that earlier in the year.

Get Covered 2021 coalition seeks to slow the spread of COVID, get uninsured Americans enrolled in coverage

Get Covered 2021 launched last week as a broad coalition of organizations with a two-part goal: keeping Americans safe amid the COVID pandemic, and spreading awareness about available health insurance options and the financial assistance that can make health coverage much more affordable than it would otherwise be. “Get Covered” is a reminder of the importance of wearing a mask to slow the spread of COVID, as well as the importance of having health insurance coverage.

Get Covered 2021 is chaired by Carrie Banahan, who directs Kynect in Kentucky, Peter Lee, who directs Covered California, and Joshua Peck, co-founder of Get America Covered. The Get Covered 2021 coalition includes 15 state-run marketplaces and numerous national health care and consumer advocacy organizations.

KFF finds 40% of Americans eligible for free 2021 health coverage

A new analysis published this week by KFF finds that about 40% of uninsured Americans are eligible for free or nearly free health coverage for 2021. About a quarter of the uninsured are eligible for Medicaid, which is free in most states and has nominal premiums in a few states. And another 16% are eligible for premium subsidies in the exchange that are substantial enough to allow them access to at least one private plan that would have no premiums at all.

The free private plans are generally Bronze plans, although there are free Gold plans available in some areas. Selecting the free plans is not always the best option – some of these individuals will be better off with a Silver plan that includes cost-sharing reductions, even if they have to pay a higher monthly premium. But enrolling in free health coverage is certainly a far better option than remaining uninsured for the coming year.

Maine healthcare organization to gather signatures for universal coverage initiative on 2022 ballot

Three years ago, Maine made history when the state became the first to have Medicaid expansion approved via a ballot measure passed by voters; several other states have since followed suit. Now Maine Healthcare Action – a nonprofit focused on universal healthcare in Maine – has announced that it will begin gathering signatures in 2021 for another ballot measure, which would direct the legislature to create a universal health coverage system for the people of Maine by 2024.

In order to get the measure on the 2022 ballot, 63,067 valid signatures are needed, although advocates are hoping to gather at least 80,000. They will have a year in which to get enough signatures to get the measure on the 2022 ballot.

Healthcare sharing ministry fined $1 million by Washington, cease-and-desist order upheld

For well over a year, Washington Insurance Commissioner Mike Kreidler has been seeking a $1 million fine against healthcare sharing ministry Aliera Healthcare, Inc. Kreidler had ordered the company to stop issuing memberships in Washington in the spring of 2019. (Other states have also stepped in to issue cease-and-desist orders for Aliera.)

Aliera had appealed Kreidler’s cease-and-desist order, but it was upheld earlier this month. And this week, Aliera was ordered to pay the $1 million fine, although the company has 90 days to appeal that as well.

Appellate court hears Oscar suit challenging Florida Blue exclusive broker requirements

Last fall, we told you about a lawsuit involving Oscar and Florida Blue, stemming from Florida Blue’s requirement that brokers who offer their products refrain from offering products from any other insurance company. This is far from the norm; brokers in most states are allowed – and generally encouraged – to become appointed with a variety of insurance companies, in order to offer their clients a broad selection of plans from which to choose.

Oscar sued, alleging that Florida Blue’s exclusive broker requirement amounts to coercion and unfair market practices, but a judge sided with Florida Blue last September. Last week, the case was argued in front of a three-judge panel for the 11th Circuit Court of Appeals in Atlanta, but it’s not yet known when the judges will issue a ruling on the case.

Brookings Institution paper analyzes strategies for reducing healthcare costs

The Brookings Institution’s Matt Fiedler has published a new paper that analyzes various options for reducing healthcare costs, including capping out-of-network prices, capping both in-network and out-of-network prices, and creating a public option. Start with Fiedler’s Twitter thread about this, and then dig into the summaries and the paper itself.

The short story? It’s complicated and there are numerous pitfalls to avoid, but there are strategies that could successfully lower healthcare prices.

Nevada health exchange director discusses increased enrollment

This week, Megan Messerly of the Nevada Independent interviewed Heather Korbulic, the executive director of Nevada’s health insurance exchange (Nevada Health Link). Korbulic and Messerly cover a wide range of topics, including increased enrollment during special enrollment periods earlier this year, the increased plan availability during the current open enrollment period, and the potential impact of the pending Supreme Court ruling on the ACA.

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 – November 25, 2020 appeared first on healthinsurance.org.

The Scoop: health insurance news – November 18, 2020

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Early open enrollment data indicate individual-market enrollment is trending higher than last year

Open enrollment for individual/family health insurance has been underway nationwide since the start of November. It continues for nearly another month – through December 15 in most states – although the state-run exchanges in Washington, DC and ten states have extended enrollment deadlines.

open enrollment 2021

Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.

As of November 7, total enrollment via HealthCare.gov (the exchange in 36 states) had reached 818,635. As Charles Gaba explains here, the daily enrollment pace is trending about 20 percent higher than last year, although we obviously only have a short segment of data thus far.
CMS typically publishes weekly enrollment data throughout the open enrollment period. The state-run exchanges tend to have more sporadic updates on their enrollment progress, but some have started to publicize data:

All three states also have tens of thousands of current enrollees whose coverage will be auto-renewed if they don’t select a new plan for 2021.
Got questions about open enrollment? Our comprehensive guide has answers. And Kaiser Family Foundation has an excellent overview of why this year’s open enrollment period is so important, written by Cynthia Cox, Karen Pollitz, and Daniel McDermott.

Trump administration relaxes Medicaid rules for additional COVID funding

Earlier this month, the Trump administration published an interim final rule to update earlier rulemaking related to the COVID pandemic. The new rules took effect immediately, but public comments are being accepted through January 4.
We’ve covered this in more detail here, but the takeaway point is that the new rule allows states to reduce Medicaid benefits during the COVID pandemic (within certain constraints) without losing the additional federal Medicaid funding that states have been receiving as a result of the pandemic. Families USA, a consumer advocacy group, has criticized the fact that this new rule will allow states to reduce Medicaid benefits in the midst of a global health crisis.
States are still not allowed to make their Medicaid eligibility requirements any more strict than they were at the start of 2020, so Medicaid work requirements would still be a no-go for states receiving the additional federal Medicaid funding. There are several states where Medicaid work requirements have been approved but are not yet in effect. For the time being, this will continue to be the case.

Healthcare emerges as key battle issue in Georgia run-off

Sen. Kelly Loeffler, R-Georgia, is campaigning to keep her Senate seat during a runoff election scheduled for January 5, and healthcare has emerged as a key issue in the race. Loeffler has long expressed opposition to the Affordable Care Act, while her Democratic opponent, Raphael Warnock, has called for the ACA to be strengthened and improved, supports a public option, and has long pushed for Georgia to accept federal funding to expand access to Medicaid under the ACA.
Last week, Loeffler unveiled her own healthcare reform proposal, which is a compilation of various pieces of legislation that she has sponsored or co-sponsored, as well as several additional ideas.
Loeffler’s proposal states that it would “ensure Americans with pre-existing conditions are protected,” but gives few details about how that would be accomplished. She calls for the expansion of health savings accounts and a “one-time federal tax credit toward HSA contributions for low-income families with pre-existing conditions,” but does not clarify how big that tax credit would be, or exactly how eligibility for it would be determined. The proposal also calls for the creation of “Guaranteed Coverage Plans to help cover patients with pre-existing conditions,” but does not provide any details on how such plans would work.
Loeffler’s proposal also calls for the passage of a bill she introduced last spring, which would codify the Trump administration’s relaxed rules for short-term health plans into federal law. In nearly all cases, short-term health plans do not provide coverage for pre-existing health conditions.

HRSA proposes ACA plans cover no-cost counseling aimed at preventing obesity in women age 40-60

Under the Affordable Care Act, all non-grandfathered health insurance plans are required to cover a wide range of preventive services with no cost-sharing (ie, no deductible, copay, or coinsurance). This includes services for all adults, as well as services that are specific to children and to women.
The Health Resources and Services Administration – responsible for determining which benefits must be provided at no cost to women – is currently collecting public feedback on its recommendation to add coverage for counseling aimed at preventing obesity in women age 40-60. The proposed recommendation calls for this counseling service to be added to the women’s preventive health care guidelines – meaning that non-grandfathered health plans would have to cover it without any cost-sharing. The counseling would be provided to women with both normal-weight and overweight women, with an aim of helping them maintain their body weight or prevent future weight gain.
If the recommendation is adopted by HRSA, non-grandfathered health plans would have to start covering the no-cost obesity prevention counseling. But there’s a one-year delay, as new preventive care rules take effect for plan years that start on or after one year after a recommendation is issued. Comments on the new recommendation can be submitted here, through December 9, 2020.

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 – November 18, 2020 appeared first on healthinsurance.org.

 

Maddox Insurance Agency

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Licensed in Tennessee, Mississippi & Arkansas

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