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Healthcare Reform News Update for August 8, 2017

Healthcare Reform News Update for August 8, 2017

Anthem Exits More Marketplaces, BCBS Enters At-Risk Counties

Health insurer Anthem Inc announced Monday that it will no longer offer individual marketplace plans in Nevada and almost half of Georgia. However, the company’s Nevada exit does not create more counties without ACA options.

Meanwhile, Blue Cross and Blue Shield of Georgia will offer marketplace plans to 85 counties that would have had no ACA options in 2018 following Anthem’s exit. The insurance company will enter these counties after reaching an agreement with the state insurance commissioner.

A Look at Maine’s Medicaid Waiver

Maine has applied for a Medicaid waiver that includes:

  • Work requirements
  • Mandatory premiums ranging from $10-40
  • Asset Testing: The asset test would be $5,000, though some argue the tests are unlawful.

Within the application, Maine states it is attempting to “preserve limited financial resources…[and] promote financial independence and transitions to employer-sponsored or other commercial health insurance.”

Healthcare Reform News Update for August 7, 2017

Senate Republicans Open Up to Bipartisan Healthcare Reform Ideas

Senate Majority Leader Mitch McConnell (R-KY) said Saturday that he is open to a bipartisan attempt to stabilize the individual marketplace. Other Republicans are also considering bipartisan ideas to reform Obamacare. Senator Thom Tillis (R-NC) said, “We have got a destabilized market where insurance rates are going to go up 20, 30, 40 percent next year. Anything that we can do to prevent that and the damage that that will have on people who need health care I think is something I have to look at.”

Molina Wins $52 Million in Obamacare Lawsuit

The U.S. Court of Federal Claims ruled Friday that the government owes Molina $52 million for payments the health insurer should have received under the risk corridor program. This temporary program established under Obamacare “was intended to promote accurate premiums in the early years of the exchanges (2014 through 2016) by discouraging insurers from setting premiums high in response to uncertainty about who will enroll and what they will cost.” According to the court’s opinion, “The government is liable for its breach of a statutory and contractual obligation to make full annual payments to insurers who participated in the risk corridor program.”

This Insurance Company’s Failure May Cause a Spike in Premiums

Recently, Penn Treaty American Corp., of Allentown, Pa., and two of its subsidiaries were forced to liquidate. It’s estimated that the parent company had $4 billion in claims liabilities but only $700 million in assets. The long-term care company’s implosion means that other companies have to “help pay off the company’s claims and protect policyholders through groups known as state guarantee associations.”

These industry assessments are usually based on market share, meaning larger insurers pay more. Health insurance companies that have to foot the bill may pass costs onto consumers, charging premium surcharges.

Healthcare Reform News Update for August 3, 2017 

Six GOP Governors Move to Alter Medicaid

Republican governors in Arizona, Arkansas, Indiana, Kentucky, Maine, and Wisconsin have drafted plans that would modify the eligibility requirements for Medicaid enrollees in their states. Under some plans, employment requirements and drug testing for recipients would be introduced.

Molina Exits 2 Marketplaces, Eliminates Jobs

After significant second-quarter losses, Molina is exiting ACA marketplaces in Utah and Wisconsin. Molina’s exit in Wisconsin could leave one county without marketplace coverage options. Additionally, the company will increase premium rates in its remaining service areas in 2018 and eliminate around 1,500 jobs in an effort to save $300-$400 million by late next year.

BCBS of North Carolina Lowers Requested Rate Increase for ACA Plans

Blue Cross and Blue Shield of North Carolina announced Wednesday that it has lowered its requested rate increase for 2018 ACA plans from 22.9 percent to 14.1 percent. The company is the only healthcare insurer that offers ACA plans in the state. Brian Tajlili, director of actuarial and pricing services for BCBS of North Carolina, wrote this on the company’s website blog yesterday: “The individual market in North Carolina has become less volatile. […]We have gotten a better handle on the anticipated medical costs of people covered in this group which has made it easier for us to estimate the necessary price of our ACA health plans.”

Healthcare Reform News Update for August 2, 2017

Senate Will Hold Bipartisan Hearings to Stabilize Insurance Marketplace

The Senate’s Committee on Health, Education, Labor and Pensions will hold bipartisan hearings on ways to stabilize the Affordable Care Act marketplaces for 2018, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced Tuesday. Hearings are scheduled to start the first week of September. The committee will hear from ACA customers, governors, healthcare experts, insurance commissioners, and insurance companies.

The goal is to act by September 27, when health insurance companies must sign contracts to sell plans within the marketplace for 2018.

Democratic State Attorneys General Gain Right to Defend CSR Payments

A U.S. appeals court granted 16 attorneys general’s motion Tuesday to defend cost-sharing reduction (CSR) subsidy payments. Now, Democrats who want to uphold CSR payments have “the power to block a settlement or appeal a ruling blocking the payments.”

The court approved the motion because the attorneys general had displayed “a substantial risk that an injunction requiring termination of the payments at issue here…would lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the states will have to provide health care. In addition, state-funded hospitals will suffer financially when they are unable to recoup costs from uninsured, indigent patients for whom federal law requires them to provide medical care.”

Sanders Begins ‘Medicare for All’ Campaign

Senator Bernie Sanders (I-VT) has started his campaign for “Medicare for All”, a single-payer healthcare plan, with digital ads to gather voters’ support. The ads will direct supporters to Sanders’ website, where they can sign on to his bill. Sanders is currently finalizing the bill and creating a campaign strategy.

Sanders is also proposing a new rule for pricing on federally funded prescriptions. Sanders’ proposal would force “pharmaceutical companies to set reasonable prices for drugs developed using research funded by federal research dollars.”

States Expecting Premium Rate Increases, Decreases, and Coverage Changes

IncreasesInsurance companies across the nation are raising premium rates as a result of the continued marketplace uncertainty. Covered California, for example, is expected to see an average rate increase of 12.5 percent. However, California’s increase is dwarfed by other states’ average increases. Premium rate increase requests of 20 percent, 30 percent, and even 50 percent for marketplace plans are being submitted to state insurance commissions.

Decreases: Going against the curve toward high rate increases, Alaska’s individual marketplace filed for a premium rate decrease of about 22 percent for 2018.

Coverage Changes: Anthem is exiting 16 regions in California’s Affordable Care Act marketplace for 2018. Anthem Blue Cross of California President Brian Ternan said in a statement, “The market for these plans has become unstable. And with federal rules and guidance changing, it’s no longer possible for us to offer some of those plans.”

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