Insurance Healthcare Reform News Update for February, 2018. A lawsuit filed against the federal government by 20 states claims that the Affordable Care Act is now unconstitutional. The lawsuit, led by the attorneys general of Texas and Wisconsin, states that the ACA is invalid without the individual mandate tax penalty for not having coverage, which was repealed last year.
20 States Sue to End Affordable Care Act
“The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional. With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all,” said Texas Attorney General Ken Paxton.
Healthcare Reform News Update for February 26, 2018
Report: Short-Term Policy Expansion Will Raise Premiums
The Trump administration’s proposal to extend short-term health plans that fall short of Affordable Care Act regulations will increase premiums for traditional plans, according to analysis by the Urban Institute.
Rates would rise by 18 percent in in the 43 states that allow less-comprehensive short-term plans, according to the study. It also projects that 2.5 million Americans would drop their marketplace plans to switch to the short-term plans, compared to the 100,000 to 200,000 predicted by the Trump administration.
Iowa Group Plans to Offer Non-ACA Compliant Plans
A bill currently under review in Iowa would allow the Iowa Farm Bureau Federation to offer low-cost health insurance that doesn’t meet ACA requirements.
The Farm Bureau would partner with Wellmark Blue Cross and Blue Shield to provide members a with a plan that could charge higher premiums for those with pre-existing conditions.
The plan would be available to any Iowa resident who pays the Farm Bureau’s $55 annual dues. The group says that around 28,000 current members would be eligible to enroll.
Trump Touts Efforts to ‘Wipe Out’ ACA
President Donald Trump said his administration’s actions on healthcare, such as eliminating the individual mandate and allowing skimpy “short-term plans,” are gradually chipping away at the Affordable Care Act.
Trump made these comments at the Conservative Political Action Conference on Friday.
“I think we may be better off the way we’re doing it, piece by piece, Obamacare is just being wiped out. The individual mandate essentially wipes it out, so I think we may be better off. And people are getting great healthcare plans, and we’re not finished yet,” Trump said.
Healthcare Reform News Update for February 23, 2018
State Leaders Propose Plan for Healthcare Improvements
A bipartisan group of governors will unveil a plan to help improve the nation’s healthcare system today at a National Press Club event.
Their plan includes a variety of suggestions to improve affordability, stability, and flexibility for states, including:
- Restoring insurer subsidies.
- Increasing outreach for the Affordable Care Act marketplace’s open enrollment period.
- Implementing reinsurance programs.
- Streamlining regulations.
- Cutting Medicaid costs.
The governors included in the event are John Kasich (R-OH), John Hickenlooper (D-CO), and Bill Walker (I-AK).
Democratic Lawmakers Question Idaho Insurance Commissioner
Four democratic members of the congressional committee that oversees healthcare have sent a letter to Idaho Insurance Commissioner Dean Cameron about the state’s intention to sell health plans that fall short of Affordable Care Act regulations.
Senators Patty Murray of Washington, Ron Wyden of Oregon, and representatives Frank Pallone, Jr. of New Jersey and Richard Neal of Massachusetts requested a staff briefing on the state’s plan.
The letter states: “We strongly oppose efforts that result in higher costs and undermine consumer protections that are guaranteed by federal law that protect women, people with pre-existing conditions, and others facing discrimination in access to health care, and therefore request an explanation of how the Idaho Department of Insurance will regulate insurance plans being sold in the individual market that are not compliant with federal law.”
Healthcare Reform News Update for February 22, 2018
Policy Group Releases Plan for New Type of Universal Health Coverage
Liberal think tank Center for American Progress has proposed a new government health plan called Medicare Extra for All that would allow individuals and employers to enroll but would also preserve employer and insurer coverage.
Medicare Extra would be based on the existing Medicare payment system. Companies and individuals could choose to continue with their current health coverage or enroll in the proposed plan.
Here’s a look at some of Medicare Extra’s features:
- Open to all U.S. citizens and lawful residents
- Free services would include preventive care, treatment for chronic disease, and generic prescription drugs
- Dental, vision, hearing, and long-term care would be covered
- Premiums would be determined based on income
- Current Medicare Advantage enrollees would continue to have similar coverage, renamed Medicare Choice
Center for American Progress did not include cost estimates for the program but recognized that implementation would require tax increases.
States Consider Reinsurance Plans
Wisconsin and Maryland are making efforts to set up reinsurance plans to help stabilize the Affordable Care Act marketplace in their respective states.
This week, Wisconsin lawmakers approved a plan that would allow the state to apply for a federal waiver to obtain reinsurance funds to help insurers with their most expensive claims. Governor Scott Walker called the action a “market-driven solution that will lower premiums.”
In Maryland, lawmakers held hearings this week to discuss their own bill to apply for reinsurance funds. “We’re looking this year at stabilizing the exchange, because, as you know, if we don’t do something, it’s going to blow completely up,” said State Senator Thomas Middleton.
Healthcare Reform News Update for February 21, 2018
Companies Receiving Penalty Notices for ACA Violations
For the first time, the Internal Revenue Service is sending notices to hundreds of companies that have violated the Affordable Care Act’s provision requiring they provide health coverage for their employees.
Companies with more than 50 full-time employees face fines for failing to comply with the law in 2015, the first year the mandate was applied. The penalty can reach between $2,000 to $3,000 per employee, depending on a variety of factors.
Some affected companies are fighting back against the penalty, saying that it is invalid because they never received a legally required warning.
Healthcare Reform News Update for February 20, 2018
Trump Proposal Expands ‘Skimpy’ Short-Term Plans to 12 Months
The Trump administration said Tuesday that it wants to extend the limits of lower-cost short-term plans that do not include the consumer protections built in to the Affordable Care Act.
The proposal expands the availability of so-called “skimpy” plans from three months to 12. Unlike ACA marketplace plans, these short-term options can refuse coverage due to pre-existing conditions and cap payout amounts, which could leave those covered with large out-of-pocket costs.
Opponents of the plans say consumers may not be aware of their limited benefits. Supporters say the plans offer the uninsured more affordable coverage options to people who don’t qualify for ACA subsidies.
“The status quo is failing too many Americans who face skyrocketing costs and fewer and fewer choices,” Health and Human Services Secretary Alex Azar said in a statement. “The Trump Administration is taking action so individuals and families have access to quality, affordable healthcare that works for them.”
The proposal will be open for comments from the public until April 23.
Trump Administration Appeals Judge’s Birth Control Decision
Lawyers for the U.S. Department of Justice have appealed a decision that blocked Trump administration changes to the Affordable Care Act, which allowed more employers to opt-out of offering no-cost birth control to women.
U.S. District Judge Haywood Gilliam blocked the ACA changes in December. On Friday, lawyers filed a notice of appeal saying that it was unclear if the law would cause women to lose no-cost contraception coverage.
Healthcare Reform News Update for February 16, 2018
Lawmakers Closer to Drafting an ACA Stabilization Bill
Senators Susan Collins (R-ME) and Lamar Alexander (R-TN) met with House Energy and Commerce Committee Chairman Greg Walden (R-OR) on Thursday to try to reconcile Affordable Care Act stabilization proposals.
The lawmakers compared a reinsurance bill by Alexander and Collins to one proposed by Representative Ryan Costello (R-PA). They hope to include the resulting ACA stabilization measure in an omnibus funding bill due next month.
HHS Secretary to Review Idaho State-Based Health Plans
Health and Human Services (HHS) Secretary Alex Azar said Thursday that he would examine Idaho’s acceptance of health plans that do not meet the standards set in the Affordable Care Act.
“We’ll be looking at that very carefully and measure it up against the standards of the law,” he said. Azar also said he believes that the plans are a “cry for help” for more affordable coverage.
Azar added that it was too early for him to know what actions he might take.
Healthcare Reform News Update for February 15, 2018
Alex Azar Asserts Compliance With ACA Regulations
Department of Health and Human Services (HHS) Secretary Alex Azar told a congressional panel Wednesday that he will comply with the Affordable Care Act as long as it remains federal law.
Azar’s comment was in response to a question about Idaho’s divisive decision to allow insurers to sell plans that don’t meet ACA requirements. Critics of the state’s proposal say the measure goes against consumer protections built into the law and that the plans should be scrapped.
“I’m not aware that our opinions or views have been solicited,” Azar said. “There are rules, and there’s a rule of law that we need to enforce.”
Healthcare Reform News Update for February 14, 2018
Idaho’s First Non-ACA-Compliant Healthcare Plans Filed
Blue Cross of Idaho is the first insurer to file health plans under a controversial Idaho executive order allowing insurance companies to sell plans that don’t meet the requirements of the Affordable Care Act.
On Tuesday, the insurer submitted five non-ACA-compliant plans that it expects to sell this spring. Called “state-based” plans, they could be approved next month. The plans are geared toward the state’s 110,000 uninsured middle-class residents, many of whom earn too much to qualify for subsidies to purchase ACA plans.
Once approved, the plans will be sold on the state’s exchange, Your Health Idaho. The plans include:
- Coverage of all the essential health benefits outlined by the ACA.
- Deductibles from $2,000 to $10,000.
- Maternity care in four of the plans.
- $0 copay for preventative care.
- Narrow networks with heavy penalties for non-network services.
- Large out-of-pocket maximums.
- $1 million limit on claims per year.
Proposed premiums for the state-based plans for a 21-year-old on a $4,000 deductible plan would range from $89.91 to $242.79, compared to $237.60 for an ACA plan. A family of four could pay from $435.58 to $1,176.24, compared to $933.05 for an ACA plan.
Budget Deal Includes Medicare Advantage Reforms
The Bipartisan Budget Act approved by President Donald Trump last week includes multiple reforms to Medicare Advantage (MA) plans. Some of the provisions include:
- Permanent reauthorization of Dual Eligible Special Needs Plans (D-SNPs).
- The availability of telehealth services.
- Expansion of supplemental benefits such as grab bars and wheelchair ramps.
- Giving all 50 states the ability to reduce or eliminate copayments or waive the deductible for high-value services for patients with certain chronic conditions.
The legislation has fewer reforms for traditional Medicare but did provide a two-year extension of the Independence at Home program and added telehealth availability.
House Speaker Wants ‘Incremental’ Healthcare Reform
Paul Ryan (R-WI) said Tuesday that “incremental entitlement reform” would be a more effective way of passing healthcare legislation than the sweeping repeal-and-replace measures of past years.
Ryan did not specify what actions he’d like to address but noted the recent repeal of the Affordable Care Act’s individual mandate and last week’s budget deal that raised premiums for high-earning Medicare beneficiaries.
One healthcare reform measure currently under discussion by House Republicans is repealing or delaying the ACA’s employer mandate. House Ways and Means Committee Chairman Kevin Brady (R-TX) said he wants to ensure that businesses with 50 employees or more are not imposed fines or punitive measures retroactively for not offering health coverage throughout the past three years.
Trump’s Budget Proposal Funds ACA Program
Even though President Donald Trump’s budget request includes the repeal of the Affordable Care Act, it provides more than $800 million in mandatory appropriations to fund its risk corridor program.
The risk corridor plan is a fund that was established in 2014 to pay insurers for heavy losses during the first years of the ACA’s implementation.
Senator Marco Rubio (R-FL), a long-time critic of the risk corridor plan, demonstrated his disapproval of the proposal Tuesday in a series of tweets. “It’s unacceptable that programs that matter to #Florida could see cuts while the gov’t continues to bail out private insurers to protect them from consequences of #Obamacare,” he tweeted.
Oregon Bill Makes Healthcare a Right
Oregon’s House of Representatives passed a bill Tuesday to create a constitutional amendment, stating “it is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable healthcare as a fundamental right.”
If passed by the state’s Senate and then approved by voters, the legislation would be the first of its kind in the country.
Critics of the bill say there are no funds to support such a measure, and it could make the state vulnerable to lawsuits.
Healthcare Reform News Update for February 13, 2018
White House Pushes Elimination of ACA in Budget Proposal
The budget request, released by the White House on Monday, proposes replacing the Affordable Care Act with a series of block grants to states.
The request says that the budget “supports a two-part approach to repealing and replacing Obamacare,” based on the failed Graham-Cassidy bill from 2017. Repealing the ACA could save more than $90 billion over 10 years, according to the proposal.
Most lawmakers in Congress have not been supportive of continued efforts this year to eliminate the law.
Other healthcare-related cuts in the president’s budget include:
- $69.5 billion in Medicare payments over 10 years to hospitals for “uncompensated care”
- $22 billion from Medicare Advantage plans
- $48 billion in Medicare payments over 10 years to teaching hospitals
The budget also includes a proposal to create a limit on Medicare out-of-pocket drug costs.
Budget Act Will Raise Medicare Premiums for High-Income Earners
The Bipartisan Budget Act passed late last week includes a provision that will raise Medicare premiums for the wealthiest beneficiaries by 5 percent.
Beginning in 2019, individuals who earn $500,000 or more and couples who earn $750,000 or more will pay 85 percent of Part B and Part D premiums. The income threshold will be frozen until 2028.
Healthcare Reform News Update for February 12, 2018
Medicare Part D Coverage Gap to Close in 2019
President Donald Trump signed a budget deal February 9 including a provision that will close the Medicare “donut hole”in 2019, a year earlier than previously scheduled.
Beginning next year, Medicare Part D beneficiaries will pay 25 percent of the cost of prescription drugs after they reach the coverage gap, which is currently $3,750. This year, enrollees will pay 35 percent of brand-name drugs’ overall cost and 44 percent for generic drugs.
Since the enactment of the Affordable Care Act in 2010, the law has gradually reduced the financial responsibility for Medicare beneficiaries who have reached the Part D coverage gap.
Under the new law, drug manufacturers will pay 70 percent of drug costs for beneficiaries in the coverage gap beginning in 2019 compared to the current 50 percent.
Once out-of-pocket costs reach $5,000, beneficiaries are eligible for catastrophic coverage and won’t pay more than 5 percent of prescription drug costs.
Healthcare Reform News Update for February 8, 2018
Murray Asks for Additions to ACA Stabilization Bill
Senator Patty Murray (D-WA) is advocating for renegotiations on an Affordable Care Act stabilization bill that would significantly expand subsidies, helping more people afford health insurance.
Currently, the bill Murray drafted with Senator Lamar Alexander (R-TN) restores cost-sharing reduction (CSR) payments that President Donald Trump canceled last year. Murray wants to continue to restore CSR payments, but she also wants to make subsidies more generous and expand eligibility requirements to offset expected premium increases due to the repeal of the individual mandate.
Also, Murray is asking to restore outreach and funding for ACA enrollment and to prevent the sale of “skinny” insurance plans.
2018 ACA Signups Show ‘Remarkable Stability’
Almost 11.8 million Americans enrolled in Affordable Care Act plans during this year’s Open Enrollment Period, which is a 3.7 percent drop from 2017, according to a new report released by the National Academy for State Health Policy (NASHP).
“For the first time we now have the full national picture of how the individual marketplaces did this year, and it is a picture of remarkable stability,” said NASHP Executive Director Trish Riley.
Although states on the federal health exchange saw enrollment drop by 5.3 percent, eight of the 12 states that run their own health exchanges showed an increase in enrollment. Some state findings from the NASHP report include:
- Florida and California continue to have the most enrollees with 1.7 million and 1.5 million, respectively.
- Rhode Island had the highest increase in enrollment at 12.1 percent.
- Arizona had the largest decline in enrollment at 15.6 percent.
- California enrollment fell 2.3 percent overall but saw an increase in new enrollees.
“Despite all the uncertainty and challenges we have seen, particularly for consumers living in states supported by state-based marketplaces, we see millions of Americans continuing to benefit from the coverage they get in the individual market,” Riley said.
Healthcare Reform News Update for February 7, 2018
House Bill Cuts $2.85 Billion From ACA Public Health Fund
The House’s proposed short-term funding bill cuts $2.85 billion over 10 years from the Affordable Care Act’s Prevention and Public Health Fund to help pay for other healthcare programs.
The cut is opposed by public health groups who say it could hamper the activities of the Centers for Disease Control and Prevention (CDC), including vaccination, anti-smoking, and lead-poisoning prevention efforts.
A spokesperson for Energy and Commerce Committee Republicans said the funds will be used for public health efforts such as special diabetes programs and community health centers. In addition, the spokesperson said that funding for the Prevention and Public Health Fund will remain at the current levels of around $1 billion per year as the cuts only affect planned future increases.
More Than 1.6 Million Enroll in Centene ACA Plans
Health insurer Centene Corporation had more than 1.6 million people enroll in plans it sells on the Affordable Care Act marketplace for 2018, making it the leading ACA carrier. The company increased its enrollments from last year by more than 640,000.
Healthcare Reform News Update for February 6, 2018
Blue Cross Blue Shield Backs Reinsurance Efforts
The Blue Cross Blue Shield Association said Monday that there is an “urgent need” for lawmakers to stabilize the Affordable Care Act’s marketplace, especially by dedicating funding to reinsurance.
Citing data from consulting firm Oliver Wyman, the health insurance group said that $15 billion in reinsurance funding, combined with cost-sharing reduction (CSR) payments, could lower next year’s silver plan premiums by 17 percent.
Association officials said these measures would more than offset expected premium increases caused by the repeal of the ACA’s individual mandate late last year.
Healthcare Reform News Update for February 5, 2018
New York Health Exchange Reaches 4.3 Million Signups
New York’s state-run Affordable Care Act marketplace signed up a record number of enrollees during this year’s Open Enrollment Period, which ended January 31 for the state.
More than 4.3 million New Yorkers signed up for coverage, an increase of 700,000 from 2017.
Healthcare Reform News Update for February 1, 2018
House GOP Softens Position on Reinsurance Proposal
Some key Republicans in the House have expressed interest in supporting reinsurance, which represents a shift from the party’s previous resistance to Affordable Care Act (ACA) stabilization efforts.
A proposal from Representative Ryan Costello (R-PA) to provide funding in 2019 and 2020 has been gaining support from other Republican colleagues, including House Energy and Commerce Committee Chairman Greg Walden (OR) and Cathy McMorris Rodgers (WA).
“If it lowers premiums, I’m willing to listen to any ideas,” said Mark Meadows (R-NC), chairman of the House Freedom Caucus.
The measure is expected to be discussed during this week’s GOP retreat in West Virginia.