Healthcare Reform News Update

Stay up-to-date on Healthcare Reform.

Below is a summary of recent events to help you stay current on healthcare reform news all in one place. To make your voice heard on these issues, visit,  a non-partisan movement that lets you share your opinion on healthcare legislation with friends, family, and even Washington D.C.!

Healthcare Reform News Update for December 14, 2018

Vox Analyzes 8 Democrat Universal Health Care Proposals

The idea of creating a “Medicare-for-all” healthcare system has become a major issue for many in Congress, especially with Democrats taking over the House in 2019. However, lawmakers differ on the solution. There are currently six different universal health care bills in Congress and two proposals from Democratic think-tanks.

Vox reporters researched these eight plans, spoke to their authors, and published their analysis yesterday. Here are the plans and some of Vox’s findings about them:

  1. Sen. Bernie Sanders’ (I-VT) Medicare-for-all bill: This Senate bill guarantees that every American has health coverage with no premiums. Employer-sponsored insurance would be eliminated. Income taxes would have to increase. All expenses would be covered, but prescriptions might have copayments.
  2. Rep. Premila Jayapal (D-WA) and the House Progressive Caucus’ Medicare-for-all bill: This House bill is similar to Sanders’ proposal. Some of the provisions may be  currently under revision to more align with Sanders’ version.
  3. Rep. Jan Schakowsky (D-IL) and Sen. Sheldon Whitehouse’s (D-RI) CHOICE Act: This bill would make enrollment into a Medicare expansion plan optional. Enrollees would pay premiums. Employer-sponsored plans would still be available, but small businesses could opt-in to the Medicare plan. Income taxes would not need to be increased. Plans would cover between 60 and 80 percent of expected medical expenses.
  4. Sen. Michael Bennet (D-CO), Sen. Brian Higgins (D-NY) and Sen. Tim Kaine’s (D-VA) Medicare X: This is similar to the CHOICE Act, but plans would be available in two tiers: one covers 70 percent of medical expenses, the other covers 80 percent.
  5. Sen. Jeff Merkley (D-OR) and Sen. Chris Murphy’s (D-CT) Choose Medicare Act: This is also similar to the CHOICE Act, but employees could only opt-in if their employers allow it. Plans would cover 80 percent of medical expenses.
  6. Sen. Brian Schatz (D-HI) and Rep. Ben Ray Lujan’s (D-NM) Medicaid Buy-in bill: This plan would give residents in all 50 states the option to buy-in to a Medicaid program. States would determine the premiums, copayments, and deductibles. Employer-sponsored plans would still be available. Income taxes would not be increased.
  7. The Center for American Progress’ Medicare Extra for All proposal: The proposal guarantees that every American has health coverage, with higher-income enrollees paying premiums. Employer-sponsored plans would still be available, but employers will have the option to stop offering coverage and instead pay a payroll tax roughly equivalent to what they currently spend on health insurance. Income taxes would be increased.
  8. The Urban Institute’s Healthy America proposal: This plan doesn’t set universal coverage standards, but hopes to reduce the number of uninsured by 16 million in its first year. A new market would be established that combines Medicaid and ACA enrollees. Employer-sponsored plans would be available and untouched. Premiums would be a maximum of 8.5 percent of income. Plans would cover 80 percent of medical expenses.

All plans include government regulation of healthcare prices. While the Democrats do not believe they will pass Medicare-for-all with this Congress, they do believe that now is the time for working out the plans and building support.

Healthcare Reform News Update for December 13, 2018

Sign-ups For ACA Plans Down by 11.7%

Around 930,000 people enrolled in an Affordable Care Act health insurance plan on the federal exchange during the sixth week of open enrollment. It was the busiest week yet, but enrollments continue to lag behind last year.

So far, around 4.1 million people have signed up for 2019 ACA plans, which is down 11.7 percent from the same time period in 2018.

Florida continues to have the highest enrollment numbers, with over 999,000 people signed up for coverage to date.

Healthcare Reform News Update for December 12, 2018

New Study Show 4.2 Million Could Purchase ACA Health Plans for $0

A new analysis by the Kaiser Family Foundation found that 4.2 million people without insurance are eligible for $0 premium bronze plans on the Affordable Care Act exchange.

Bronze plans with a $0 premium are available to enrollees who qualify for subsidies that equal or exceed the price of the plan. The study finds that of the 15.9 million Americans without insurance, 27 percent are eligible for the plans.

Availability of $0 plans varies by location. Only 5 percent of uninsured consumers in Washington and Indiana have access to the plans; however, more than 45 percent have access in Delaware, Iowa, Nebraska, and Utah.

The study also suggests that premiums are not the only expense enrollees should take into account. The average deductible for 2019 bronze plans is $6,258, while silver plan deductibles range from $239 to $3,169. Those who qualify for subsidies can purchase silver plans for $20 to $130 per month, depending on income.

ACA Signups Spiked on Monday

With the enrollment period in its last week, the Affordable Care Act’s site received its highest traffic on Monday.

Due to the high volume, some users were placed into a “waiting room” to help the website adjust.

According to the Centers for Medicare and Medicaid Services, enrollees who call to enroll may be asked to leave their contact information and wait for a callback. Those that do may not be contacted before the December 15, but they will still be eligible for coverage that begins on January 1.

Judge Upholds Religious Groups’ Position Against ACA Birth Control Mandate

A federal judge issued an order this week that blocks the federal government from forcing religious groups to cover contraception-related drugs, devices, and related counseling as required in the Affordable Care Act.

Judge Philip Brimmer sided with the plaintiffs, six religious colleges and organizations that requested a permanent injunction against the mandate. The government did not fight against the lawsuit.

Healthcare Reform News Update for December 11, 2018

Groups Call for Legislation Tackling Surprise Medical Bills

Nine organizations sent a joint letter to Congress on Monday that called for federal legislation to protect consumers from surprise medical bills issued by to out-of-network providers.

Although several states have passed laws to prevent patients from receiving unexpected charges while inadvertently visiting an out-of-network doctor or facility, there are no federal protections.

The nine organizations represent health insurance, employers, and consumer groups. They asked lawmakers to stop providers from billing a patient for medical costs not covered by insurance when the choice of provider is not the patient’s fault. However, they also stressed that any new laws should not cause a rise in insurance premiums or deter providers from joining a health plan’s network.

The groups include Blue Cross and Blue Shield Association, America’s Health Insurance Plans, the National Business Group on Health, Consumers Union, American Benefits Council, The ERISA Industry Committee, Families USA, the National Association of Health Underwriters, and the National Retail Federation.

CEOs from the American Hospital Association responded, blaming inadequate provider networks as a major cause of surprise medical bills.

Obama Urges Americans to Enroll in ACA Plans

Former President Barack Obama posted a video on Twitter Monday in which he encourages the uninsured to enroll in Affordable Care Act plans.

The post received over 500,000 views within the first hour it was released.

As he has in past years, Obama stressed the importance of health insurance and signing up before Saturday’s deadline.

Blue Shield of California to Limit Out-of-State Coverage

Beginning January 1, Blue Shield of California will cut back on its out-of-state coverage for members with  individual health plans.

The plans will continue to cover out-of-state emergency services, urgent care, and some limited primary care. The company said it will work with member who currently use out-of-state providers and will allow telephone consultations with out-of-state physicians.

“We’re trying to focus on affordability and part of that is focusing on our provider network in California. We’re able to manage our costs better,” said Blue Cross Spokesperson Amanda Wardell.

The change will only affect members in California with individual health plans, not those with employer or Medicare plans.

Healthcare Reform News Update for December 10, 2018

ACA Risk-adjustment Program to Continue Normal Operations

A final rule was issued by The Centers for Medicare and Medicaid (CMS) that allows normal operation of the Affordable Care Act’s risk-adjustment program to continue for the 2018 benefit year.

The risk-adjustment program moves money from health insurance plans with healthier enrollees to plans with sicker, more expensive enrollees. The rule comes during ongoing litigation regarding the formula the CMS uses to determine insurance companies’ payment responsibilities. Currently, the CMS uses a statewide average premium in the methodology instead of an insurer’s own premium.

“Today’s final rule continues our commitment to provide certainty regarding this important program, to give insurers the confidence they need to continue participating in the markets, and, ultimately, to guarantee that consumers have access to better coverage options,” CMS Administrator Seema Verma said in a statement.

House Reps Ask for Details on Administration’s Pre-existing Conditions Stance

Four Democratic House Representatives have sent a letter to President Trump’s administration looking for explanations concerning its decision to not defend Affordable Care Act’s pre-existing condition protections in court.

Frank Pallone Jr. (D-NJ), Richard Neal (D-MA), Bobby Scott (D-VA) and Jerrold Nadler (D-NY) addressed the letter to Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma.

The lawmakers requested any analysis the administration may have performed to determine its position, and details of how the administration will respond if the protections are eliminated.

“In declining to defend these provisions, the Trump Administration is seeking to invalidate these critical patient protections, and once again subject millions of Americans with preexisting conditions to the discrimination they faced before the ACA,” the letter said.

Healthcare Reform News Update for December 7, 2018

Enrollment for 2019 ACA Plans Fall Behind Last Year By 11%

With one week left in the Affordable Care Act’s 2019 open enrollment period, the total number sign-ups continue to trail behind to last year.

The first five weeks of enrollment saw 3.2 million enrollments, compared to 3.6 million last year—a drop of 11 percent. New customer sign-ups are down 17 percent.

Industry experts cite several reason for the drop, including:

  • the repeal of the individual mandate,
  • funding cuts for advertising and enrollment assistance, and
  • a shorter first week of enrollment.

Healthcare Reform News Update for December 6, 2018

Majority of 2019 ACA Plans Have Narrow Provider Networks

New analysis from consulting firm Avalere shows that 72 percent of 2019 Affordable Care Act plans sold on the federal exchange have narrow provider networks. A plan with a narrow provider network only covers the care members receive from a small list of approved providers.

The number of narrow-network plans remained steady compared to last year. In 2018, 73 percent of plans had a narrow network.

Of all plans on the 2019 ACA exchange:

  • 53 percent are narrow-network HMO plans
  • 19 percent are narrow-network EPO plans
  • 21 percent are broad-network PPO plans
  • 6 percent are broad-network point-of-service plans

Chris Sloan, a director at Avalere, said that the trend toward lower-cost narrow networks is expected to continue. “Narrow network doesn’t mean it’s bad, or that patients in the network are getting sub-quality care. You can have a narrow network that’s great and that’s high quality,” he said.

Insurers prefer the narrow-network plans because they help control enrollee spending and keep premiums lower. Critics argue that provider directory inaccuracies could leave patients with unexpectedly large medical bills and that the lack of choice may also require members to drive long distances to receive care.

Reinsurance Plan in Minnesota Could Lose $100M in Funding

Minnesota lawmakers will debate the future of its reinsurance program after the estimate for federal funding was reduced from $183.9 million to $84 million. The estimate is based on the amount of premium tax credits the federal government would have paid out to residents if this waiver-based program was not in place.

The program helps insurers cover the costs of residents with the highest medical bills, and has helped the state lower the growth rate of premiums over the last two years.

Healthcare Reform News Update for November 30, 2018

New CMS State Waiver Concepts Expand Use of ACA Tax Subsidies

The Centers for Medicare & Medicaid Services (CMS) recently issued four state Affordable Care Act waiver concepts to “promote more affordable, flexible health insurance coverage options.”

The concepts allow states to bypass current ACA regulations and suggest alternate uses of tax credit subsidy programs. Any state programs developed using the waivers must be approved by the CMS and are are required to meet the law’s “guardrails” of comprehensiveness, affordability, coverage, and federal deficit neutrality.

The state concepts suggested include:

  1. Setting up “account-based subsidies.” States could use federal ACA subsidies to create accounts that work much like health savings accounts. Residents could then use the funds in the account to pay for health insurance premiums or out-of-pocket expenses.
  2. Adopting “state-specific premium assistance.” These state-administered plans could adjust the way subsidies are distributed in an attempt to attract young, healthy consumers and help individuals whose higher income makes them ineligible for federal tax credits.
  3. Creating “adjusted plan options” that  allow tax subsidies to be used for non-ACA marketplace plans, short-term plans, association health plans or catastrophic plans.
  4. Forming “risk stabilization strategies” to help insurers pay medical bills for patients with high healthcare costs. Suggestions from CMS include reinsurance programs and high-risk pools.

CMS also encouraged states to “couple waiver concepts with other ideas” to meet the needs of their residents.

Critics of the concepts point out that the measures: might fall under legislative rule and need to go through Congress before being implemented; could create rules that vary widely by state; and could harm consumers with “skimpy” coverage that’s not required to include pre-existing condition protections.

Healthcare Reform News Update for November 29, 2018

ACA Enrollment Continues to Trail Last Year’s Numbers

About 350,000 fewer people have signed up for healthcare on the federal exchange compared the same period last year.

In the first four weeks of open enrollment, over 2.4 million people have signed up for ACA plans, a drop from nearly 2.8 million in 2017. The numbers only include enrollments through the national federal exchange and do not yet include automatic renewals.

A new Kaiser Family Foundation poll suggests that one reason for the drop could be lack of awareness. According to the survey:

  • About 69 percent of Americans who purchase individual plans did not know that enrollment ends on December 15 for most states.
  • Only 25 percent of respondents are aware of seeing any ACA-related advertising.

Some state exchanges are seeing an increase in ACA signups. For example, New York is currently 10 percent above last year’s enrollment figures, with 36,000 new enrollees and 870,000 renewals.

Number of Uninsured Children Increased for First Time Since 2008

A new report by Georgetown University’s Center for Children and Families shows that the number of uninsured children in the country rose by 276,000 in 2017. This increase follows almost a decade of steady decline.

In 2017, there were 3.9 million uninsured children in the U.S., compared to 3.6 million in 2016. Some findings from the study include:

  • Texas leads in the nation in the number of uninsured children with 835,000, or 1 in 5, going without coverage.
  • Other marked increases occurred in South Dakota (from 4.7 percent to 6.2 percent), Utah (from 6 percent to 7.3 percent), and Florida (from 6.6 percent to 7.3 percent).
  • States that have not implemented ACA Medicare expansion increased the uninsured rate by triple the rates of states that have.
  • The rate of uninsured children among Hispanics was 7.8 percent, 4.9 percent among whites and 4.6 percent among blacks overall.

The study suggests that one reason for the increase could be that 25 percent of minors in the country have a parent who is an immigrant; these parents might avoid enrollment for fear of deportation.

Healthcare Reform News Update for November 28, 2018

State ACA Reinsurance Programs Successful in Lowering Premiums

The first three states to implement Affordable Care Act reinsurance programs were able to stabilize their markets and boost enrollment, according to a study by Georgetown University’s Center on Health Insurance Reforms.

Alaska, Minnesota and Oregon implemented the programs last year, which reimburse insurers for eligible high-cost claims. The study found that in 2018:

  • Alaska lowered average rates 26 percent compared to 2017.
  • Minnesota reduced its rates by 11.3 percent.
  • Oregon rates fluctuated, but are an estimated 6 percent lower than what they would have been if the program had not been implemented.

The study also found that the programs did not attract additional insurers to the state ACA exchanges. Alaska and Minnesota retained the same number of insurers; Oregon saw a decrease.

Illinois Limits Short-Term Health Insurance to Six Months

Illinois Governor Bruce Rauner vetoed a bill that limited short-term health insurance to six months, but the state legislature overrode his decision on Tuesday.

The bill was drafted in response to new rules from the Trump administration, which allow customers to stay on short-term plans for up to twelve months and renew them for up to three years. However, consumer advocates say these cheaper plans provide less comprehensive coverage, don’t include pre-existing condition protections, and expose consumers to higher out-of-pocket costs than insurance plans covered by ACA regulations.

Illinois joins several states, such as California, New York, New Jersey, and Washington, that have limited or banned the new, expanded short-term plans.

California Uninsured Projected to Increase Drastically Without State Intervention

The number of uninsured Californians could increase by 800,000 in five years if the state fails to expand coverage, according to a report by the UC Berkeley Labor Center and UCLA Center for Health Policy Research.

The report projects there will be 4.4 million uninsured Californians in 2023, which would represent 12.9 percent of the population.

The number of uninsured residents is projected to increase primarily due to the repeal of the Affordable Care Act’s individual mandate, which levied a penalty against people without coverage.

The report says that policies such as a state individual mandate, state-funded financial assistance, and expansion of the Medi-Cal program could help keep people from dropping their coverage.

“Unless the state takes action, the number of uninsured will start creeping back up. Our uninsured rate did go down significantly because of the ACA, and we’re estimating it could climb up. But the state does have some policy options and policy levers it could pull to try to get to universal coverage,” said Miranda Dietz, the lead author of the report.

Healthcare Reform News Update for November 26, 2018

ACA 2019 Benchmark Plan Premiums Decrease, Choices Increase

Nineteen states are seeing lower premiums for 2019 Affordable Care Act benchmark silver plans compared to last year, with many areas also experiencing an increase in the number of insurers.

Premiums for the cheapest available plans have been reduced by 10 percent on average for more than half of the counties that use the federal health exchange. Nationally, premiums for the average benchmark silver plan decreased about one percent.

Tennessee leads the country in reducing benchmark premiums, with an average 26 percent decrease. In 2018, a 40-year-old Tennessee resident paid $743 on average for a benchmark plan; this year it’s $548. Competition has also increased; over 82 percent of Tennessee counties had only one insurer selling ACA plans in 2018. For 2019, it’s under 52 percent.

Arizona is another newly competitive market. In 2018, the Phoenix area had a single insurer selling ACA plans. For 2019, that insurer has lowered its most affordable silver plan by 12 percent and is joined by three competitors.

ACA Enrollment Down on Federal Exchange, Up on Some State Exchanges

In the first three weeks of the Affordable Care Act’s open enrollment period, over 1.9 million people have signed up for 2019 coverage on the federal exchange. That is down from 2.3 million last year.

Though enrollment has lagged on the federal exchange, several state exchanges have seen increases compared to 2018 signups. Minnesota is up 6.9 percent with almost 98,000 enrollments during the first two weeks of open enrollment. Colorado is up 13.1 percent with around 25,600 enrollees during the first two weeks of open enrollment.

Other details on week 3 of the federal exchange enrollment:

  • 748,244 total households selected plans (down 6.3 percent from last year)
  • 566,250 households renewed coverage (down 2.1 percent from last year)
  • 181,994 households purchased plans for the first time (down 17.4 percent from last year)

Healthcare Reform News Update for November 20, 2018

House Democrats Plan to Investigate DOJ’s Decision Over ACA Lawsuit

When Democrats take over the House in January, they plan to investigate why the Department of Justice Department declined to defend the Affordable Care Act in federal court, according to Rep. Jerrold Nadler (D-NY).

Twenty Republican-governed states have sued the federal government in an attempt to end the ACA. In June, the DOJ refused to defend the healthcare law in the suit.

Nadler, the expected upcoming chair of the House Judiciary Committee, sent a letter to acting Attorney General Matthew Whitaker, asking him to respond  to letters previously sent to former attorney general Jeff Sessions about the decision.

“This committee expects to examine the department’s refusal to defend a duly enacted federal statute, the abrupt resignation of veteran department employees and an apparent determination by this administration to undermine affordable healthcare coverage for millions,” Nadler wrote.

Maryland Lawmakers to Propose State Individual Mandate

Some legislators in Maryland are backing a plan that would require state residents to be covered by health insurance or pay a fine.

Unlike the federal individual mandate that was repealed earlier this year, the state proposal would enable the uninsured to use the fine amount as down payment on a health insurance policy sold on the state’s Affordable Care Act exchange.

“Our ‘down-payment plan’ helps get the uninsured to contribute. They get the care they need while we shrink uncompensated care, holding down insurance costs for everyone,” said state Democratic representative Joseline Peña-Melnyk in a radio ad.

Passage of the bill is uncertain, as Governor Larry Hogan has expressed his disapproval. “While we are always open to ideas to make healthcare more accessible and affordable for Marylanders, the governor favors incentives over penalties,” said Amelia Chassé, a spokeswoman for Hogan.

Connecticut ACA Exchange to Oppose New Abortion Billing Proposal

The Trump administration’s proposal to require separate billing for abortion coverage is being challenged by Connecticut’s Affordable Care Act exchange.

Access Health CT will submit public comment to protest, with lawmakers arguing that the regulation would be a burden on insurance companies. “This proposed rule will impact our carriers…and we are committed to helping our carriers in any way we can,” said James Michel, CEO of Access Health CT.

The proposal was introduced earlier this month by the Centers for Medicare & Medicaid, who said that separate billing would ensure that no federal funds would be used to pay for abortion services.

Healthcare Reform News Update for November 16, 2018

Over 20 Million More Americans Insured Since Passage of the ACA

There are now 20.1 million fewer Americans without health insurance than when the Affordable Care Act was enacted in 2010, according to data released by the Centers for Disease Control and Prevention.

Findings in the data include:

  • In the first half of 2018, there were 28.5 million uninsured Americans, compared to 48.6 in 2010.
  • About 70 percent of adults age 18-64 are currently covered by private health insurance. Four percent of the insured (almost 8 million people) purchased plans on an ACA exchange.
  • Most likely to be insured are adults aged 25-34; only 16.5 percent do not have coverage.
  • States that have expanded Medicaid coverage have an average uninsured rate of 9.1 percent, compared to 18.1 percent for states that have not.

House Democrats Split on Medicare for All

Democrats, soon to be the majority in the House of Representatives, are debating whether to vote on legislation regarding single-payer insurance coverage.

Progressives, such as Raúl Grijalva of Arizona and Pramila Jayapal of Washington, are pushing to introduce a revised bill in January.

Centrists, including Ron Kind of Wisconsin and Frank Pallone Jr. of New Jersey, believe that a vote is not realistic since a bill would not get through the Republican-controlled Senate.

“I’ve always been an advocate for Medicare for all or single-payer, but I just don’t think that the votes would be there for that, so I think our priority has to be stabilizing the Affordable Care Act, preventing the sabotage that the Trump administration has initiated,” said Pallone.

Healthcare Reform News Update for November 15, 2018

Insurance Company Participation in ACA Marketplace is Rising

New analysis from the Kaiser Family Foundation finds that more insurance companies are participating in the Affordable Care Act’s 2019 Health Insurance Marketplace than in 2018.

After reviewing data by state and county, their findings show that:

  • For 2019, 608 counties are gaining at least one insurance company, while only five counties are losing an insurer.
  • Approximately 17% of enrollees have only one insurer in their county for 2019; dropping from 26% in 2018.
  • There are four insurers per state on average in 2019, compared to 3.5 in 2018. The highest average was six per state in 2015.
  • Alaska, Delaware, Mississippi, Nebraska, and Wyoming each have only one insurer for 2019.
  • California, New York, and Wisconsin have over ten insurers for 2019.

ACA Signups Continue Slow Start

Signups for Affordable Care Act plans during the early weeks of open enrollment trail last year by about 300,000 people.

During the first ten days of enrollment, about 1.2 million people have signed up for ACA plans, compared to the estimated 1.5 million who signed up during a similar period last year.

An industry analyst from the Kaiser Family Foundation says it’s too soon to predict whether the slow start indicates an overall reduction in ACA enrollment.

Healthcare Reform News Update for November 14, 2018

Expansion of Short-term Health Plans Getting Push-back From States

Delaware is the latest state to initiate new rules on short-term health insurance policies in response to new federal government regulations. State officials announced that the coverage period will be limited to three months.

The new regulations from the Trump administration increase the maximum duration of short-term plans from three months to 364 days and allow consumers to renew plans for up to 36 months. Worried about the plans’ exemption from ACA minimum standards and their potential to create marketplace instability, state regulators have begun responding with rules of their own.

Other recent state responses to short-term plans:

  • Vermont requires that the plans cover all ten ACA essential benefits.
  • California has banned their sale.
  • Washington limits the coverage period to three months, prohibits renewals, and bans their sale during the ACA open enrollment period if coverage will begin in the upcoming year.

Some states, including New York, Massachusetts, New Jersey, South Carolina, Hawaii, and Michigan have existing regulations that limit or ban the sale of the plans.

Healthcare Reform News Update for November 13, 2018

New Association Health Plans Provide Comprehensive Coverage

New association health plans (AHPs) offered by farmer-owned cooperative Land O’Lakes in Nebraska, several Nevada chambers of commerce, and the National Restaurant Association are offering benefits comparable to Affordable Care Act plans for premiums up to 35 percent lower.

The plans are able to offer lower premiums because of several factors, including their ability to set premiums based on gender and industry, which is not allowed with ACA plans. The current plans are not charging people with pre-existing conditions higher rates or denying them coverage.

“AHPs can offer comprehensive coverage and still be cheaper than marketplace plans if they either serve a population that is less costly than the average of the marketplace and/or they somehow are able to pay less for services,” said Katherine Hempstead, a health insurance coverage director for the Robert Wood Johnson Foundation.

Those who qualify for tax subsidies may still be able to purchase comparable plans for less on the ACA exchange than with the AHPs. However, Bruce Ramge, insurance director for Nebraska, claims the plans “will offer another really good choice for individuals who either don’t receive a subsidy and cannot afford coverage on the exchange, or for some reason prefer not to purchase that coverage.”

Some states, fearing that the expansion of AHPs will destabilize the market or lead to increased fraud, have issued new rules and guidance limiting their scope. Democratic attorneys general in 11 states and the District of Columbia filed a lawsuit to block the new Trump Administration rule that allows the expansion of AHPs; the case is still pending.

Healthcare Reform News Update for November 9, 2018

New Democratic House Majority Could Quickly Move to Defend ACA Protections

House Democrats could soon intervene in a lawsuit that attacks the Affordable Care Act and its protections for people with pre-existing conditions.

Using its power as the soon-to-be majority, Democrats may have the House vote on a measure to step in and defend the ACA’s constitutionality. If passed, the measure would not require approval by the Senate or President Trump.

A spokesman for House Democratic Leader Nancy Pelosi said that “the new Democratic House Majority will move swiftly to defend the vital protections for people with people with pre-existing conditions still under legal assault by the GOP.”

The lawsuit was brought by GOP-led states arguing the legality of the ACA. The Trump administration declined to defend the law. The judge’s ruling is expected soon, though the decision is likely to be appealed.

Healthcare Reform News Update for November 8, 2018

Democratic House Majority Will Change Congress’ Healthcare Agenda

The results of the midterm elections last Tuesday will give Democrats the majority in the House of Representatives in 2019, which dramatically alters political healthcare priorities.

In a news conference on Wednesday, Senate Majority Leader Mitch McConnell (R-KY) remarked that Affordable Care Act repeal and replace efforts are over. “I think it is very obvious that a Democratic House is not going to be interested in that,” he said. Instead, McConnell believes that addressing drug prices will be on the agenda.

Democratic leader Nancy Pelosi also said that they “will take real, very strong legislative action” on drug prices. Democrats had made healthcare a primary issue in their campaigns. “Healthcare was on the ballot, and healthcare won,” said Pelosi.

President Trump also weighed in, saying he thinks that bipartisan efforts to improve healthcare is possible. “We want to do something on healthcare; they want to do something on healthcare. There are a lot of great things that we can do together.”

With repeal and replace efforts tabled, the next healthcare clash between Democrats and Republicans— and a certain topic in the 2020 presidential election—will be the issue of Medicare for All. Progressive Democrats have increasingly supported the idea of expanding Medicare to all working-age Americans, but Republicans claim it will harm Medicare for seniors.

First Week of ACA Open Enrollment Lags Behind Last Year’s

During the first three days of the open enrollment period, about 371,700 signed up for insurance through the Affordable Care Act federal exchange. That’s a slower start compared to the first four days of last year’s enrollment period, which saw 601,500 signups.

According to the Centers for Medicare and Medicaid Services, approximately 75 percent of the enrollees had previously purchased an ACA policy, and the remaining were new consumers.

The enrollment period for 2019 ACA plans this year is November 1 through December 15.

New Rules for Employer Contraception Coverage Issued by Trump Administration

On Wednesday, the Department of Health and Human Services issued two new rules that will expand the types of businesses that are allowed to deny birth control coverage to employees due to religious or moral objections.

HHS officials said in a statement that the Affordable Care Act does not include a contraception requirement and that it does “not require the government to violate religious or moral objections to providing or purchasing such coverage.”

Currently, only churches, religious orders, and organizations that received financial support from religious organizations could be exempted from contraception coverage. The new rules add nonprofit organizations, small businesses, and individuals that morally object to providing contraceptive services.

Publicly-traded companies and government entities will not be allowed to claim the exemption.

HMS estimates that the new exemption rules will affect around 200 employers and potentially 6,400 women. However, civil liberty groups and women’s rights advocates have argued that the number is higher.

CMS Proposes Separate, Add-on Billing for ACA Plans That Cover Abortion

The Trump administration has proposed a rule that would require insurers to identify and issue a separate surcharge to enrollees on any Affordable Care Act plan that covers abortion.

The ACA requires that plans on the exchange charge an additional surcharge if elective abortions were covered. Insurers are currently allowed to include the surcharge in monthly premiums—a provision granted under the Obama administration.

The new proposed rule states that “individual market exchange issuers must determine the amount of, and collect, from each enrollee, a ‘separate payment’ for an amount equal to the actuarial value of the coverage for abortions for which public funding is prohibited, which must be no less than $1 per enrollee per month.”

The rule would affect individual market insurers operating in 24 states and the District of Columbia.

Healthcare Reform News Update for November 7, 2018

Insurers Lose Appeal Over ACA Risk-Corridor Program Payments

Insurers looking to collect part of $12.3 billion in risk-corridor payments faced a serious setback when the U.S. Court of Appeals for the Federal Circuit declined to rehear a petition in a 9-2 ruling. The petition was filed by Moda Health Plan and Illinois’ Land of Lincoln Mutual Health Insurance Co., who are looking to collect Affordable Care Act program subsidy payments from the U.S. Department of Health and Human Services.

The risk-corridor program was created for the early years of the ACA. The intent was for insurance companies who were successful on the ACA exchange to help cover the losses of companies who were not.

In 2017, Moda initially won its case seeking $214 million in payments, but the judgement was overturned by an appellate court earlier this year. That ruling stated that the government doesn’t have to make the $12.3 billion in payments because of budget-neutrality requirements, which means that the government cannot pay out more than it made through the program.

Any future recourse will have to be heard by the U.S. Supreme Court.

Medicaid Expansion Approved in Three States

Voters in Utah, Nebraska, and Idaho have voted to expand their Medicaid programs in accordance with the Affordable Care Act. The measures will extend coverage for low-income residents, which could include 150,000 people in Utah, 90,000 people in Nebraska, and 62,000 in Idaho.

Judge Shuts Down Insurer Selling Deceptive Plans

A federal judge ordered a Florida insurance company to temporarily shut down after the Federal Trade Commission (FTC) discovered that it allegedly made more than $100 million selling “TrumpCare” plans. The plans were marketed as comprehensive, government-sponsored insurance, but in reality did not provide many of the benefits promised.

According to the FTC, Simple Health Plans enrolled tens of thousands of people through deceptive websites that falsely claimed their plans covered pre-existing conditions and prescription drugs. The sites also featured logos for insurance companies that were not affiliated with the plans. Customers were charged an enrollment fee and premiums that ranged from $40 to $500 per month for what amounted to a medical discount program.

“Many consumers were misled into thinking they had purchased comprehensive health insurance, but when they needed to rely on that insurance, they learned they had none of the promised benefits,” said the director of the FTC’s Bureau of Consumer Protection, Andrew Smith.

In actuality, the plans sold by the Simple Health provided $50 per visit to a physician (capped at three per year); a $100 maximum per day benefit for hospitalization; and a maximum total benefit of $3,200 per person, per year, and only if the beneficiary was hospitalized for 30 days.

Healthcare Reform News Update for October 29, 2018

ACA Navigator Cuts Cause Some Areas to Go Without Them

Funding for Affordable Care Act Navigator programs has been cut by more than 70 percent this year, which has left almost one-third of the counties who participate in the federal exchange without insurance counselors, reported the New York Times.

Last year, the Trump administration cut the funding for the program from $63 million to $36 million. This year, the budget is $10 million. Centers for Medicare and Medicaid Services Administrator Seema Verma said the cutbacks were appropriate since consumers are now more aware of the program and other sources of help are available.

Effects of the cuts include:

  • 797 counties out of 2,400 do not have navigators available.
  • Some cities, including Cleveland and Dallas, will have no navigators.
  • All of Michigan outside the Detroit metro area is without navigators.
  • Only 45 of 254 Texas counties have navigator coverage.

Iowa, Montana, and New Hampshire will have no navigator programs because they did not apply for funding.

Judge Requests That Insurers Drop Short-Term Plan Challenge

Federal Judge Richard Leon of the United States District Court for the District of Columbia asked the Association for Community Affiliated Plans (ACAP) to withdraw its request to block the rule that allows the expansion of short-term health insurance policies.

The ACAP claims that the low-cost plans, which don’t include the ACA’s consumer protection provisions, could cause the loss of at least 10,000 enrollees and a financial loss of up to $100 million for insurance companies selling ACA-compliant plans on the individual market exchanges. Leon was skeptical of the estimates, noting that there is currently no data to support the ACAP’s claim.

Charles Rothfeld, counsel for ACAP, argued that “the purpose of this rule is to create an alternative insurance market to compete with the ACA. The more you draw out young and healthy people, the more it becomes economically impossible to cover people with pre-existing conditions.”

Leon disagreed, saying that the short-term plans help consumers “fill in a gap, as opposed to forcing them to choose between no insurance and the ACA.”

Leon said that the group’s request came too late to make a ruling prior to the start of the open enrollment period on November 1. He said he could have an opinion early next year if ACAP backs out of its request for a preliminary injunction and instead seeks a trial.

Healthcare Reform News Update for October 25, 2018

Report: Millions Could Lose Coverage if ACA is Deemed Unconstitutional

More than 15 million people could lose their health insurance or face rate hikes due to pre-existing conditions, age, or gender if a federal judge rules in favor of a Trump administration-backed lawsuit to declare the Affordable Care Act unconstitutional, according to a report from Democrats on the House Oversight Committee.

The lawsuit was filed by 20 GOP state attorneys general and seeks to overturn the ACA, including its protections for people with pre-existing conditions. Attorney General Jeff Sessions chose not to defend the law “with the approval of the President of the United States.”

The report examined Americans who receive their coverage from the individual insurance market. The findings showed that, if the lawsuit succeeds:

  • More than 10 million people could lose their insurance or face rate hikes due to lack of consumer protections. Of this group, more than 4.8 million could be denied coverage due to the severity of their pre-existing condition.
  • More than 9 million women who rely on the individual market for insurance could face gender discrimination.

Poll Shows Majority of Young Americans Support Single-Payer Healthcare

Sixty-nine percent of U.S. residents between the ages of 15 and 34 support a single-payer healthcare system, according to a new poll by The Associated Press-NORC Center for Public Affairs Research and MTV.

Eighty-eight percent of Democratic respondents and 40 percent of Republican respondents said they support the government-run system.

In addition, 62 percent of voting-age respondents said that healthcare is a very important issue for the midterm elections next month, making it the most popular issue for young Americans.

Healthcare Reform News Update for October 23, 2018

CMS Expands ACA Subsidies to Cover Short-Term & AHP Plans

States will soon be able to use federal funding to subsidize premiums for short-term health insurance plans and association health plans, the Trump administration announced on Monday. Affordable Care Act restrictions previously prevented the use of waivers for these plans as they do not include the law’s consumer protections.

CMS Administrator Seema Verma said that the change gives states more flexibility and give consumers more choices. Consumers will still be able to purchase ACA plans with the subsidies, which do not deny coverage for people with pre-existing conditions or charge them higher premiums.

The approach allows states “to provide consumers plan options that best meet their needs, while at the same time ensuring that those with pre-existing conditions retain access to the same coverage as today,” Verma said.

Verma also said that states could apply for waivers that would increase subsidy amounts for young adults to encourage them to sign up for health insurance. Additional waivers will be announced in the near future, she said.

States must first apply for the waivers, so the expanded subsidies won’t be available to consumers until 2020.

Critics of the change say that drawing the younger, healthy customers away to the cheaper, less-comprehensive plans may increase the premiums for individuals who need the protections provided in the ACA marketplace insurance plans.

Trump Administration Expands Employer HRA Rules

Proposed expanded options for health reimbursement arrangements (HRAs) used by small-to-midsized companies were announced by the Trump administration.

The new regulations will allow employees to use funds in their HRAs to purchase their own individual health coverage. Companies could also allow workers to use HRAs to pay for optional benefits, such as dental insurance. The new rules would allow workers to be reimbursed up to $1,800 in premiums, as long as the company also offers traditional employer-sponsored coverage.

Trump administration officials say the move will increase the number of Americans who have insurance. Opponents say it would shift less-healthy, higher-risk workers off employer plans and into the public marketplace and undermine traditional employer-provided coverage.

ACA “Family Glitch” Solution Could be Midterm Issue

The outcome of next month’s elections could determine how the “family glitch” of the Affordable Healthcare Act is addressed, according to Kaiser Health News.

The issue relates to how eligibility for insurance premium subsidies is calculated. In order to be eligible, individuals must not have access to “affordable” coverage through their employer or their spouse’s employer. The ACA calculates “affordable coverage” based on the rates for a single family member rather than the whole family, which can result in a denial of subsidies. This means some families can’t afford to cover spouses or children using an employer plan or an ACA Marketplace plan.

If Democrats overtake Republicans in the midterms, analysts believe they may try to revise the calculations, though doing so could increase federal spending by as much as $10 billion. Republicans are more likely to suggest the use of lower-cost, lower-coverage options, such as short-term or association plans.

Healthcare Reform News Update for October 18, 2018

Senate Majority Leader May Restart ACA Repeal and Replace Efforts

On Wednesday, Senate Majority Leader Mitch McConnell said that Republicans might try to rekindle their attempts to repeal the Affordable Care Act if they prevail in next month’s midterm elections.

Attempts to dismantle the healthcare law failed to pass last year, which McConnell called “the one disappointment of this Congress from a Republican point of view.” McConnell said that if Senate Republicans “had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks … We’re not satisfied with the way Obamacare is working.”

In the interview with Reuters, McConnell also said that he believes that the long-term drivers of national debt are social programs like Social Security and Medicare.

Democratic lawmakers such as Senate Minority Leader Chuck Schumer shot back at McConnell’s statements. “If Republicans retain the Senate they will do everything they can to take away families’ health care and raise their costs. Americans should take Senator McConnell at his word,” said Schumer.

Healthcare Tops Midterm Election Concerns

A new Kaiser Family Foundation survey shows that healthcare continues to be the main issue for voters in the upcoming midterm elections.

Over seventy percent of respondents said that healthcare was “very important” in their election decisions, with nearly 40 percent of Democrats and 15 percent of Republicans saying it was their most important issue.

Healthcare Reform News Update for October 17, 2018

CMS Chief Says ‘Medicare For All” Would Harm Physician Networks

In a speech to insurers on Tuesday, Medicare and Medicaid Services Administrator Seema Verma warned that Democratic “Medicare for all” proposals “would decimate physician networks, creating a permanent physician shortage.”

Verma pointed out that Medicare covers only 80 percent of physicians’ expenses on average, which could cause doctors to exit the program and leave patients struggling to find care. Without private insurance patients to offset Medicare patients, “there is no relief valve for physicians facing up to 40 percent payment cuts,” she said.

Creating a single-payer healthcare system has become a campaign issue during the midterm elections. However, Verma says that she will deny waivers to any state that tries to implement such a program.

2019 ACA Plans in Virginia to Increase 9%

State regulators in Virginia announced on Tuesday that 2019 premiums for individual plans sold on the Affordable Care Act marketplace will rise about 9 percent on average, somewhat less than the 13 percent predicted earlier this year.

The increase is significantly less than last year, which saw an average spike in premiums of 69 percent, creating some of the highest rates in the country. For 2019, fewer counties have only a single provider, which contributed to more competitive rates.

Healthcare Reform News Update for October 12, 2018

Premiums for 2019 ACA Silver Plans Will Drop for the First Time

For the first time since the Affordable Care Act has been in effect, average premiums for benchmark silver plans will decrease by 1.5 percent in 2019.

Centers for Medicare and Medicaid Services Administrator Seema Verma credits the Trump administration for the rate drop. She says measures taken, such as the repeal of the individual mandate and the expansion of short-term plans, have helped stabilize the market.

Other insurance experts say that the decrease is a price correction. Average premiums increased 37 percent last year, which helped increase profits for insurance companies.

Only ACA silver plans will see an average premium decrease. Overall, average rates will increase slightly for 2019 ACA policies.

Healthcare Reform News Update for October 11, 2018

President Trump Criticizes ‘Medicare for All’ in Controversial Op-Ed

In an Oct. 10 opinion article for USA Today, President Trump attacked Democrats for proposing to expand Medicare to all Americans.

The president wrote that an expansion of the healthcare program “means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised,” and that “the Democrats’ plan also would mean the end of choice for seniors over their own healthcare decisions.”

The article was criticized for a number of inaccurate claims, including health insurance premium rates, Medicare revenue numbers, and inaccess to physicians.

Senator Bernie Sanders (I-VT) stated that the op-ed piece was dishonest. “Bottom line is he’s trying to frighten seniors and suggest that Medicare for all would cut back the benefits they have. The truth is it would expand the benefits that they have,” said Sanders to reporters.

Centene Expands ACA Offerings for 2019

Centene Corporation announced on Wednesday that it will expand the reach of its health plans sold on the Health Insurance Marketplace under its Ambetter brand.

The company will enter four new markets in 2019: Pennsylvania, North Carolina, South Carolina, and Tennessee. It will also expand the number of counties it sells to in Florida, Georgia, Indiana, Kansas, Missouri, and Texas.

Healthcare Reform News Update for October 10, 2018

Maintenance Schedule for ACA Website Unchanged From Last Year’s

The Centers for Medicare and Medicaid Services is planning to shut down the website for maintenance a maximum of 60 hours during the 2019 Affordable Care Act open enrollment period.

The maintenance schedule is the same as last year’s. The site may not be available for sign-ups from midnight to noon ET each Sunday during the enrollment period, except for Dec. 9, the final Sunday. Last year, the website’s actual maintenance downtime totaled 21.5 hours.

For most states, the open enrollment period is Nov. 1 through Dec. 15.

Senate Vote Fails to Overturn New Short-Term Health Plans

A resolution presented by Senate Democrats to prevent the expansion of short-term health insurance plans narrowly lost by a 50-50 vote. Senator Susan Collins of Maine was the only Republican to vote in favor of the measure.

The Democrats oppose new rules that allow these plans to deny coverage to people with pre-existing conditions and do not require them to cover the Affordable Care Act’s ten essential benefits, including maternity care, prescription drugs, and mental health care. They believe the plans hurt consumers and provide sub-par coverage.

Republicans say the plans provide consumers with more choices and lower-cost alternatives to ACA plans.

The legislation was sponsored by Senator Tammy Baldwin (D-WI) and was supported by all 49 members of the Senate Democratic Caucus.

Healthcare Reform News Update for October 8, 2018

2019 ACA Premiums in Illinois & Ohio See Modest Increases

Finalized insurance rates for 2019 Affordable Care Act plans in Illinois and Ohio will rise by single digits.

In Illinois, premiums for silver plans will increase by 4 percent on average. Bronze and gold plans will rise by 6 percent. Jennifer Hammer, director of the Illinois Department of Insurance says that rates for many plans will decrease.

In Ohio, overall premiums will increase by 6.3 percent on average. In addition, residents will have more choices. The number of insurers offering plans in the state has risen from eight to 10. Only 16 counties will have a single insurer, down from 42 this year.

ACA Rate Increases for 2018 Plans Drove Record Insurer Profitability

A new Kaiser Family Foundation study of Affordable Care Act financial performance shows that insurance companies in the individual market experienced their highest levels of profitability in the first six months of 2018 since passage of the health law.

Policy changes from the Trump administration, including the cancelation of cost-sharing subsidy payments, contributed to significant premium increases in 2018. Some of these rate hikes resulted in overpricing and larger profits. Subsequently, rates for 2019 plans are projected to increase modestly and, in some cases, even decrease.

The study results showed that “despite significant challenges, the individual market remains stable and insurers are generally profitable.”

Healthcare Reform News Update for October 5, 2018

New Iowa Farm Bureau Health Benefit Plans Will Not Protect Pre-Existing Conditions

People with pre-existing conditions could be denied coverage or pay higher premiums under the new “health benefit plans” available on November 1 from Iowa’s Farm Bureau.

The plans do not meet the requirements of the Affordable Care Act. As such, the plans are not considered insurance and will not be regulated by the Iowa Insurance Division.

Applicants will be questioned about 16 conditions, including blood pressure, mental health, reproductive and pulmonary disorders, and others. Positive responses will require the submission of detailed explanations about treatments, medications, and current status.

Farm Bureau Vice President Steve Kammeyer confirmed that some people could be charged more or declined coverage, but did not say which conditions would trigger those outcomes.

The plans lack the ACA’s consumer protections, but will cover maternity services, mental health care, addiction treatment, and prescription drugs. Because the plans don’t meet federal requirements, they are expected to cost less than plans sold on the ACA exchange.

Senators Ask CBO to Test Health Insurance Simulation Model

The Congressional Budget Office (CBO) has received a request from Republican members of the Senate Budget Committee to test its health insurance simulation model using outside validation. The lawmakers want to ensure that the model correctly estimates Affordable Care Act spending and enrollment.

The senators argue that the CBO used faulty data last year and overestimated the number of ACA enrollees who would lose coverage if the health law was repealed. They believe that a test could help “determine whether the agency’s estimate would have been closer to the actual, observed amounts since (the ACA’s) enactment,” according to a letter written by the committee, led by Chair Mike Enzi (R-WY).

“This type of real-world testing not only could serve to validate the model, but would help further the goal of developing a new model that is capable of producing more accurate estimates for Members of Congress and the public,” the letter states.

Colorado 2019 ACA Plans Rise 5.6 Percent for Individuals

The Colorado Division of Insurance announced that 2019 ACA premiums will increase 5.6 percent on average for individuals.

Specifically, individual gold plans will increase 3.8 percent, silver plans will increase nearly 12 percent, and bronze plans will increase by less than 1 percent.

Coloradans who qualify for premium tax credits will see a premium decrease of 24 percent on average if they continue with their current plan, but have the potential to reduce their rates up to 50 percent if they switch to the lowest-cost plan in the same tier.

For small businesses, the market rates will increase 7.28 percent on average.

Employee Healthcare Deductibles Double Over Past Decade

The Kaiser Family Foundation annual employer health benefits survey shows that deductibles for employer health plans have more than doubled since 2008.

The average deductible for an employer plan in 2018 is $1,573, compared to $735 in 2008. In addition, more employer plans include a deductible. In 2018, 85 percent of plans include deductibles, compared to 59 percent a decade ago.

Other findings from the employer-plan survey:

  • 2018 premiums rose 3 percent for individuals
  • 2018 premiums rose 5 percent for families

Healthcare Reform News Update for October 3, 2018

2019 ACA Individual Premiums in Minnesota Drop Dramatically

State officials in Minnesota announced that premiums for 2019 Affordable Care Act benchmark plans for individuals will decrease by as much as 22 percent, one of the largest drops in the country.

“On average, rates are going down in the individual market because of lower utilization rates, lower costs per service, Minnesota’s reinsurance program, and a strong Minnesota economy,” said Minnesota Commerce Commissioner Jessica Looman.

For the small group market in Minnesota, rates are expected to increase between 3 and 12 percent.

House Republicans Vow to Uphold Protections for Pre-existing Conditions

On Tuesday, Representative Pete Sessions (R-Texas) introduced a nonbinding resolution with several Republican cosponsors that supports insurance protections for people with pre-existing medical conditions.

“To cement these protections, I proudly introduced this resolution to ensure that patients with pre-existing conditions are protected from the erroneously high costs and the limited options they are experiencing now,” said Sessions.

Sessions and other House Republicans have been criticized by Democratic counterparts for their past support of repealing the Affordable Care Act, including the law’s pre-existing condition protections. The issue has become a frequent midterm election talking point.

Covered California Begins its ACA Renewal Period

On Monday, California began its annual renewal period for residents who currently have coverage under the state’s ACA health exchange, Covered California.

Those looking to renew can reduce their premiums up to 6.9 percent by choosing the lowest-cost health plan in their tier, according to Covered California. “Healthcare is local, and the price of coverage varies by health plan and region, so consumers will be encouraged to shop when they renew this fall,” said Covered California Executive Director Peter V. Lee.

The renewal period for Covered California continues through January 15. The enrollment period for new enrollees begins October 15.

Healthcare Reform News Update for October 2, 2018

Michigan Business Groups Form Association Health Plan

The Small Business Association of Michigan and MichBusiness have joined forces to TranscendAHP, a new association health plan (AHP).

The nonprofit Transcend AHP is expected to offer 10 plans from Blue Cross Blue Shield of Michigan and Blue Care Network to its combined membership of around 52,000 small-business owners. Other associations and chambers of commerce will also be eligible to join.

AHPs are not required to meet Affordable Care Act standards, including protections for people with preexisting conditions and essential health benefits such as maternity care, mental health care, and prescription drugs. Critics say the plans leave enrollees underinsured.

The Trump administration defends its new AHP rules, saying the lower-cost plans help keep businesses competitive. “Many of our laws make healthcare coverage more expensive for small businesses than large companies. Association Health Plans are about more choice, more access, and more coverage,” said Department of Labor Secretary Alexander Acosta in a statement.

Healthcare Reform News Update for September 28, 2018

HHS Secretary Touts 2% Drop in 2019 ACA Silver Plan Premiums

Premiums for benchmark silver plans sold on the national Affordable Care Act exchange will decrease by 2 percent in most states next year, said Health and Human Services Secretary Alex Azar.

The number of insurers selling ACA plans will increase for the first time since 2015, he said.

Azar credited President Donald Trump for the news, saying that he “has proven better at managing it than the president who wrote the law.” As examples, he referred to the expansion of consumer healthcare choices and increased marketplace efficiency.

In addition, Azar criticized single-payer health plans as too expensive for taxpayers and unfair to seniors. “The main thrust of ‘Medicare for All’ is giving you a new government plan and taking away your other choices.”

Healthcare Reform News Update for September 27, 2018

Democrats Hope for ACA Battle With Trump Administration

Congressional Democrats say that if they overpower Republicans in the midterm elections this November, they will work to defend the Affordable Care Act and “undo” some changes to the law made by the Trump administration.

“I think healthcare will be one of the very first things that we address,” said Illinois Representative Jan Schakowsky. “There’s a lot of fear out there, and we need to calm people who are so afraid they’re going to lose their healthcare or not be able to afford their healthcare. I think that will be a big agenda item.” Schakowsky said she would like to make the efforts bipartisan.

“What they’ve done is try to dismantle [the ACA] through the regulatory process,” said Massachusetts Representative Richard Neal. “I think if we were so lucky as to be the majority, I think we would certainly be in the position to stop that.”

If Democrats become the majority party in power, they would be able to:

  • conduct investigations.
  • issue subpoenas.
  • inquire officials over measures such as the expansion of short-term health plans and association health plans.
  • question the cutting of funds for navigator programs.

2019 Healthcare Premiums for Federal Employees to Increase 1.5%

Federal employees and retirees will pay 1.5 percent more on average for their health insurance premiums in 2019. It’s the smallest increase for the program since 1995.

Considered the largest employer-sponsored health insurance program in the nation, the Federal Employees Health Benefits Program comprises 265 local health maintenance organizations and 16 nationwide plans.

Healthcare Reform News Update for September 25, 2018

California Challenges Trump Administration’s ACA-exempt Insurance Options

Jerry Brown, governor of California, has signed a healthcare package that includes bills banning the Trump administration’s new healthcare options that don’t meet the requirements of the Affordable Care Act.

The bills in the package include:

  • A ban on the Trump administration’s short-term insurance plans that can be extended up to 36 months and do not include essential benefits coverage such as maternity care, mental health, and prescription drugs.
  • A ban on association health plans, which can exempt people with pre-existing conditions.
  • The creation of a council that will conduct a feasibility study on a state public option healthcare plan.
  • Prohibiting the state from applying for a waiver that would require Medicaid enrollees to show proof of employment.
  • Requiring that health plans spend at least 80 percent of premium revenue on healthcare.

Healthcare Reform News Update for September 24, 2018

Maryland 2019 ACA Premiums Will Decrease by 13.2%

State insurance regulators in Maryland finalized dramatically lower rates for 2019 plans sold on the Affordable Care Act than originally requested by insurance companies. The new premiums will be lower by 13.2 percent on average due to a recently approved state reinsurance program.

In May, CareFirst Blue Cross and Blue Shield and Kaiser Foundation Health Plans, Maryland’s two ACA insurers, requested rate increases that averaged 30.2 percent. Instead, the reinsurance program enabled the state to “lessen the significant burden” of rising costs, said Maryland Insurance Commissioner Al Redmer.

Finalized rates for 2019 ACA plans in Maryland include:

  • A 17 percent decrease for CareFirst HMO plans.
  • An 11.1 percent decrease for CareFirst’s two PPO plans.
  • An average 7.4 percent decrease for Kaiser’s HMO plans.

State officials also project that the lower rates will increase 2019 ACA enrollment by 5 percent.

Bipartisan Senators Move to Eliminate Surprise Out-of-Network Costs

Last week, a group of six bipartisan senators created draft legislation to protect patients with insurance from extra charges from doctors and hospitals that are not in the insurance company’s network.

Often called “surprise bills,” the charges stem from non-network emergency room doctors who work in network facilities. Patients receive bills from the non-network provider that are over their deductible or co-pay limits.

The proposed bill tackles three areas:

  • Patients would pay only the out-of-pocket amount required on their plan for out-of-network emergency room doctors who work in out-of-network hospitals. Any additional “balance billing” payments would come from the insurance company.
  • Patients would pay only what is required for out-of-network doctors who work at in-network emergency rooms.
  • Emergency room patients in non-network facilities would be notified in writing that any follow-up treatments could include non-network charges unless they go to an in-network hospital.

“No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency,” said Tom Carper (D-DE), one of the sponsors of the bill. “The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider.”

Healthcare Reform News Update for September 17, 2018

Trump Administration Sued Over New Short-Term Health Plan Rules

A group of seven healthcare organizations filed a lawsuit Friday against the Trump administration, seeking to block implementation of short-term health insurance plans that do not meet Affordable Care Act requirements.

The short-term plans, scheduled to be available October 2, are not required to cover people with existing conditions or the 10 essential health benefits available with ACA plans.

The lawsuit argues that the extension of the plans from three months to 12 months with the ability to renew up to three years does not meet the definition of “short term” and that the agencies did not disclose the extension in its proposed rule.

The suit also alleges the plans are harmful to those with pre-existing conditions and puts them “into a loophole that would permit the creation of a parallel individual insurance market consisting of plans that are not subject to the ACA’s consumer protection standards. This result cannot be reconciled with the text, structure, or purpose of the ACA.”

The Department of Health and Human Services (HHS) defended its position in a statement from a spokesperson: “Short-Term Limited Duration plans are an important option for people in certain circumstances, and the Trump administration is committed to delivering greater access to more affordable choices to the men and women left out by Obamacare.”

Plaintiffs in the suit include: the National Alliance on Mental Illness, the American Psychiatric Association, Little Lobbyists, Association for Community Affiliated Plans, Mental Health America, AIDS United, and National Partnership for Women & Families.

Healthcare Reform News Update for September 14, 2018

Maryland Attorney General Sues Trump Administration Over ACA

Brian Frosh, Maryland’s attorney general, has filed a lawsuit in U.S. District Court against the Trump administration, asserting that it is attempting to “sabotage” the Affordable Care Act and move people away from its health coverage.

Frosh is looking for a declaratory judgment that the ACA is constitutional and that further measures to dismantle the law must stop. The lawsuit says repealing the ACA would cause “immediate and long-term harm” to Maryland.

“We are taking action to protect and ensure healthcare coverage for every Marylander and all Americans,” Frosh said in a statement.

2019 ACA Premiums in CA, MA & CT Could Rise an Average of 4%

Proposed premiums for 2019 Affordable Care Act plans in California, Massachusetts and Connecticut will rise an average of 4 percent.

Covered California says small businesses will receive rate increases that average 4.6 percent.

Premiums for Massachusetts’ Connector plans will increase an average of 4.7 percent.

Connecticut premiums will rise an average of 2.72 percent for individuals and 3.14 percent for small-group coverage.

ates will be finalized before the Open Enrollment Period later this fall.

Healthcare Reform News Update for September 13, 2018

ACA Navigators Asked to Do More With Less Funding

The Center for Medicare and Medicaid Services (CMS) announced Wednesday the 39 navigator programs that will share $10 million in funding to promote and enroll consumers into healthcare plans.

CMS Administrator Seema Verma said the 2019 program kicks off a “new direction.” Instead of exclusively enrolling uninsured residents in ACA plans, grantees are encouraged to enroll them in association health plans, short-term plans, Medicaid, and CHIP.

“This new direction will increase accountability and ensure the grants are effective in helping consumers find health coverage that meets their needs,” she said. Verma also encourages navigators to rely more heavily on volunteers and partnerships with other organizations.

These are drastic cuts compared to last year’s grants of $36 million to 90 organizations. Overall, navigators have been cut 84 percent since 2016.

2018 Tax Returns Won’t Require Proof to Claim ACA Hardship Exemption

Individuals who have opted out of healthcare coverage in 2018 will not have to provide documentation or a written explanation on their 2018 tax return to claim a hardship exemption.

Late last year, Congress repealed the individual mandate that required uninsured Americans to pay a fine. However, the change does not go into effect until 2019. For this year, the penalty is $695 or 2.5 percent of overall income, whichever is higher.

Taxpayers can avoid the penalty via the hardship exemption under some circumstances, including bankruptcy, homelessness, or a natural disaster. CMS’ new guidance requests that people who are eligible for the exemption retain all paperwork as proof in the event of an audit, but it does not need to be included with their tax form.

Census: Uninsured Rate Steady Between 2016 to 2017

The number of uninsured Americans in 2017 was 28.5 million people or 8.8 percent, the same as in 2016, according to new data from the Census Bureau.

The numbers have remained steady after the Affordable Care Act significantly reduced the uninsured rate in 2014.

Healthcare Reform News Update for September 12, 2018

CBO: House Bill Revising ACA Employer Regulations Would Cost Over $51 Billion

A bill proposed by House Republicans to change provisions of the Affordable Care Act as it relates to employers will cost the federal government $51.6 billion over the next 10 years, according to a Congressional Budget Office (CBO) report.

The bill, titled the Save America’s Workers Act, seeks to postpone or repeal several portions of the ACA. Lawmakers will meet tomorrow to prepare the package for a vote.

Some of the bill’s proposals and the CBO’s estimated costs include:

  • Retroactively suspending the employer mandate penalty from 2015 to 2019. The CBO estimates this will cost $25.9 billion over the next decade.
  • Increasing the full-time hours per week required for workers to receive mandatory employer-paid health coverage from the current 30 hours to 40 hours. The CBO estimates this measure will cost $9.8 billion through 2028.
  • Postpone the start date of the “Cadillac tax” on high-cost health benefits packages to 2023. The CBO estimates this to cost $15.5 billion.

Healthcare Reform News Update for September 10, 2018

New Jersey 2019 ACA Premiums Could Decrease by 9.3%

Rates for 2019 Affordable Care Act health plans in New Jersey are expected to fall by an average of 9.3 percent, Governor Phil Murphy announced Friday.

Murphy attributed the decrease to a reinsurance program approved last month and the passage of a state individual mandate requiring all residents to have health insurance or pay a penalty.

Final rates will be announced prior to the Open Enrollment Period this fall.

Healthcare Reform News Update for September 6, 2018

Montana Health Prevails in $5.3 Million CSR Payment Lawsuit

Montana Health Co-op won its case in the first lawsuit against the Trump administration’s decision to cut off cost-sharing reduction (CSR) payments to insurers.

U.S. Court of Federal Claims Judge Elaine Kaplan decided the government was in violation of an Affordable Care Act provision. Through the provision, the government must reimburse insurance companies for decreasing low-income enrollees’ out-of-pocket medical expenses associated with ACA plans.

The government argued it had a right to eliminate the payments because funds were never set aside specifically for CSR reimbursement.

“The statutory language clearly and unambiguously imposes an obligation on the Secretary of HHS to make payments to health insurers that have implemented cost-sharing reductions on their covered plans as required by the ACA,” Kaplan said in her order.

Montana Health was seeking $5.3 million in unpaid CSR payments. Several similar lawsuits by other healthcare organizations are currently in progress.

Federal Judge Hears Arguments on Overturning ACA

U.S. District Court Judge Reed O’Connor said he would make a ruling as soon as possible in the lawsuit filed by 20 Republican attorneys general to strike down the Affordable Care Act. The plaintiffs argued Wednesday that last year’s repeal of the individual mandate nullified the entire healthcare law.

The Trump administration chose not to defend the ACA, so a group of Democratic attorneys general have stepped in to argue for the law. They say overturning the ACA would cause tens of millions of Americans to lose their health coverage.

Lawyers representing the Justice Department asked O’Connor to postpone a decision until after the Open Enrollment Period to prevent confusion. “The last thing we want is for chaos in the market,” said Brett Shumate, an attorney for the Justice Department.

2019 ACA Premium Rates to Drop Slightly in New Mexico

Premiums for 2019 health plans sold on New Mexico’s Affordable Care Act exchange are expected to decrease an average of 1 percent.

Requested rates for Molina Health Care could decrease an average of 6 percent, Blue Cross and Blue Shield requested that rates remain unchanged from this year, and Christus Health Plan has asked for rates 4 percent higher than in 2018.

Final rates will be announced by state regulators before the Open Enrollment Period begins November 1.

Healthcare Reform News Update for September 5, 2018

Poll Shows Most Americans Favor Pre-Existing Conditions Protections

A new Kaiser Family Foundation poll found that 72 percent of respondents believe that it’s “very important” that insurance companies do not charge higher premiums to people with pre-existing conditions, and 75 percent do not want people denied coverage due to their medical history.

Other findings in the poll:

  • 41% are “very worried” that they or a relative could lose coverage if pre-existing conditions protections are overturned.
  • 52% of respondents are “very worried” that they or a relative would have to pay more because of a pre-existing condition.
  • 60% of respondents say they or a family member have a pre-existing condition.
  • 67% are either “somewhat worried” or “very worried” about unexpected medical bills.
  • 50% of overall respondents have a favorable view of the Affordable Care Act. (77% of Democrats are favorable; 22% of Republicans are favorable.)

Healthcare Reform News Update for September 4, 2018

Analysis: Overall 2019 ACA Premiums Could Increase up to 4%

Premiums for 2019 healthcare plans sold on the Affordable Care Act marketplace are expected to increase by less than 4 percent nationwide, according to an analysis by Charles Gaba of

While a few states such as Kentucky and Connecticut will experience increases of 12 percent, other states such as Tennessee and New Hampshire will see declines, according to the findings.

Gaba also found that the Trump administration’s actions prevented additional drops in premium costs. Eliminating the individual mandate penalty, dropping cost-sharing reduction (CSR) payments, and offering “skimpy” short-term insurance have contributed to weakening the marketplace.

Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, agrees that rates will rise modestly. She also points out that insurance companies selling ACA policies are expanding into new markets.

“The news about the marketplace this year is very good, both in terms of the premium increase and extent of carrier participation,” Hempstead said.

Court Fight Over Legality of ACA Begins Wednesday

A group of Republican state attorneys general will present their oral arguments September 5 for a preliminary injunction to halt enforcement of the Affordable Care Act. U.S. District Judge Reed O’Connor will determine if the law should be put on hold while their case proceeds.

The Republicans, led by Texas’ Ken Paxton, claim the ACA became unconstitutional last year when Congress eliminated the individual mandate penalty. Democratic attorneys general led by Xavier Becerra of California disagree.

Healthcare Reform News Update for August 30, 2018

Senate Democrats Move to Overturn New Short-Term Health Insurance Rule

Senator Tammy Baldwin (D-WI) introduced legislation to force a vote to block a Trump administration rule that expands short-term health insurance plans from three months to one year.

The plans fall short of Affordable Care Act protections for people with pre-existing conditions and don’t require essential benefits such as prescription drugs, maternity care, and mental health coverage.

In a statement, Baldwin called the plans “junk insurance” and said that they “could increase costs and reduce access to quality coverage for millions, force premium increases on older Americans, and harm people with pre-existing conditions.”

The bill would require the support of two Republicans to pass in the Senate. Passage in the House is unlikely, as the Republican majority has shown strong support for the extension, saying that the plans are a cost-effective alternative for consumers who aren’t able to afford comprehensive health coverage.

Healthcare Reform News Update for August 29, 2018

ACA Has Helped Reduce Number of Uninsured by 58%

The number of uninsured dropped from 29.3 million in 2017 to 28.3 million the first quarter of 2018, according to new data from the Centers for Disease Control and Prevention show.

That compares to 48.6 million uninsured in 2010, prior to the enactment of the Affordable Care Act—a 58.2 percent reduction.

Other findings in the data show:

  • There are 12.5 percent Americans between the ages of 18 and 64 who remain uninsured.
  • In Arkansas, Louisiana, Oklahoma, and Texas, almost 25 percent of adults are uninsured.
  • Twenty percent of insured adults are covered by public plans, while 70 percent are covered by private plans.
  • More than 95 percent of children are insured by either public or private plans.
  • The number of people under age 65 covered by ACA plans in 2018 is 9.7 million, about 1 million fewer people than last year.

NY & MN to Receive $465.5 Million in Lost Low-Income ACA Funds

The Centers for Medicare and Medicaid Services (CMS) will pay New York and Minnesota a combined $468.5 million in response to funding losses for Affordable Care Act programs to 822,000 low-income residents.

The two states created Basic Health Programs under the ACA for people who earned too much for Medicaid but not enough to receive federal subsidies to purchase plans on the healthcare exchange. After the Trump administration cut off funding for cost-sharing payments, the programs lost funds.

The states prevailed in a lawsuit against the administration earlier this year and received a combined $168.2 million as an interim payment. The finalized payment of $422,206,235 to New York and $46,276,090 to Minnesota compensates for the cost-sharing payment losses.

Healthcare Reform News Update for August 28, 2018

CMS Approves Opioid Addiction Treatments for 2020 Illinois ACA Plans

Beginning in 2020, Affordable Care Act plans sold in Illinois must cover the treatment and prevention of opioid addiction.

The Centers for Medicare and Medicaid Services (CMS) on Monday approved the state’s request to expand the required medical services for Illinois ACA plans.

Plans will cover prescriptions for the opioid overdose antidote naloxone, telepsychiatry services for addiction and mental health issues, and alternative therapies for chronic pain.

New CA Coalition Will Fight Single-Payer Healthcare

California-based business and healthcare organizations have joined forces as a coalition to oppose single-payer healthcare initiatives.

The coalition, Californians Against the Costly Disruption of Our Health Care, believes the estimated $400 billion per year needed to pay for a single-payer system would be too costly to maintain.

The group will urge state legislators to propose alternative bills, including the expansion of health insurance subsidies, opening Medi-Cal to undocumented adult residents, and requiring all Californians to have health coverage.

Healthcare Reform News Update for August 27, 2018

GOP-Backed Bill Offers ACA Pre-Existing Condition Protections; Critics Call It a ‘Mirage’

In response to a lawsuit challenging the legality of the Affordable Care Act, Senator Thom Tillis (R-NC) and 10 Senate Republican co-signers have introduced a bill to preserve the law’s protections for people with pre-existing conditions.

The lawsuit was filed by 20 Republican state attorneys general and will be heard by a federal judge next month.

The proposed bill would require insurance companies to cover all individuals regardless of health status and ensure that premiums are not revised based on health.

But some critics believe the bill creates a loophole that enables insurance companies to revive the kinds of activities that prompted ACA talks in the first place. The bill holds insurers to guaranteeing access to coverage on the individual market; however, insurance companies could still use exclusions to limit coverage for pre-existing conditions and related ailments.

“If the goal is to protect people with pre-existing conditions, the bill is a bit of a mirage,” said Larry Levitt, senior vice president for health reform at the bipartisan Kaiser Family Foundation.

Healthcare Reform News Update for August 24, 2018

Georgia Sees First-Time Decrease in ACA Premiums

Two of Georgia’s Affordable Care Act plan providers, Blue Cross Blue Shield of Georgia and Alliant Health Plans, are proposing 2019 rate decreases that together average 5.15 percent. This is the first time since the implementation of the health law that the state has seen a rate reduction.

Georgia’s two other ACA carriers, Ambetter and Kaiser Permanente, have proposed rate increases that together average around 12 percent. The increases are significantly lower than 2018 plans, which saw rates rise 50 percent, one of the nation’s steepest premium hikes.

Finalized rates will be announced prior to the Open Enrollment Period, which begins in November.

Maine Court Orders Implementation of ACA Medicaid Expansion

Maine’s Supreme Court ruled Thursday that Republican Governor Paul LePage’s administration must implement the state’s voter-mandated Medicaid expansion—even if they continue fighting the plan in court.

LePage, who is opposed to the expansion, has attempted to block the measure. Thursday’s ruling denied LePage’s latest request to delay implementation. The ruling also lifted a temporary stay and sent the case back to Superior Court.

Healthcare Reform News Update for August 23, 2018

Report Critiques Trump Administration’s First ACA Signup Year

The nonpartisan Government Accountability Office has released a report that examines how the Trump administration managed the 2018 Affordable Care Act Open Enrollment Period and makes recommendations for improvements.

The report credits Health and Human Services (HHS) for improving the reliability of the federal enrollment site and reducing call center wait times.

However, the following areas are lacking and need addressing, according to the watchdog group:

  • HHS did not set enrollment targets as it had during the Obama administration.
  • HHS used “unreliable” data to justify a 40 percent cut to the Navigator programs.
  • Television advertising was proven to be the most effective method to help enroll consumers. However, the Trump administration slashed the entire budget.

The report also found that states using the government site for enrollments had a 5 percent reduction, while states that run their own exchanges maintained enrollment levels. It also confirmed that the Trump administration’s discontinuation of cost-sharing reduction (CSR) payments contributed to “substantial increases” in premiums.

Tennessee 2019 ACA Premiums Get Decreases

Most premiums for Affordable Care Act plans in Tennessee will be noticeably lower for 2019.

BlueCross BlueShield of Tennessee has requested decreasing its rates an average of 14.8 percent, and Cigna has requested decreasing its rates an average of 12.9 percent. Oscar Health has requested increases that average between 7.2 percent and 10.84 percent. Rates will be finalized by September 25.

In addition, the state will have two new insurers selling ACA plans, Bright Health and Celtic Insurance.

Healthcare Reform News Update for August 22, 2018

Maryland Reinsurance Program Gains Approval

The Trump administration has consented to a federal waiver for a state reinsurance program, Maryland lawmakers said.

The bipartisan-supported plan will take tax revenue imposed on insurance companies and use it to subsidize the most expensive claims sold on Maryland’s Affordable Care Act marketplace.

The reinsurance program will eliminate the predicted 40 percent increase in 2019 ACA premiums for more than 200,000 enrollees and ensure that CareFirst BlueCross BlueShield continues to sell ACA plans in the state.

Delaware ACA Premiums to Rise 3%, Small Groups Get Rebates

Affordable Care Act plans for individuals in Delaware will see premium increases of 3 percent on average in 2019. Highmark Blue Cross Blue Shield of Delaware, the only insurer offering ACA plans in the state, asked regulators for a 5.7 percent increase.

State regulators also announced that, due to an excess of administrative fees, Highmark will provide $5 million in rebates to small group market members.

Study: Ohio ACA Medicaid Expansion Reduced Uninsured by 50%

Ohio’s expansion of Medicaid through the Affordable Care Act has cut the number of uninsured by half since the program began four years ago, according to an independent study conducted by Ohio’s Department of Medicaid.

The study also found that:

  • Emergency room visits were reduced by 17 percent.
  • Enrollees seeking primary care physicians increased by 10 percent.
  • Ninety-six percent of enrollees with opioid addiction sought treatment.
  • Thirty-seven percent of smokers kicked the habit.

The expansion has enabled 653,000 residents to gain health coverage, though some state lawmakers believe the costs are not sustainable.

Healthcare Reform News Update for August 21, 2018

Trump Administration Will Distribute $8.6 Million to States for Healthcare Initiatives

The Centers for Medicare and Medicaid Services (CMS) will award $8.6 million in unspent Affordable Care Act funding to 30 states and the District of Columbia to help stabilize their insurance exchanges.

The two-year grants range from $225,000 to $290,000 and can be used to expand consumers’ healthcare options. All states that applied for the funds received them.

The grant funds come from money set aside as part of the Affordable Care Act for states to review health insurance proposals.

In a statement, CMS Administrator Seema Verma said, “These grants build on CMS’s ongoing efforts to give states the tools and flexibility they need to help people struggling to afford the year-over-year premium increases caused by Obamacare regulations. We recognize that states are in the best position to assess the needs of their consumers and develop innovative measures to ensure access to affordable health coverage. These grants make yet another down payment on our work to enhance states’ ability to stabilize and improve their respective health insurance markets.”

California Bill Would Ban Short-Term Health Insurance

California’s Legislature has approved a bill that bans short-term health insurance from being sold in the state.

Governor Jerry Brown must sign off on the bill for it to become law. If signed, the law will become effective January 1, 2019.

The Trump Administration expanded short-term insurance availability rules earlier this month, allowing consumers to maintain policies for up to three years. The plans cost less than comprehensive Affordable Care Act plans. However, the plans fail to cover essential benefits and can limit or deny policies to people with pre-existing conditions. States have the flexibility to alter the new regulations.

New Jersey, Massachusetts, and New York have also restricted or banned short-term health plans.

Three Groups in Nevada to Offer Association Health Plans

Three chambers of commerce in Clark County, Nevada, are the first small business groups in the country to take advantage of the Trump administration’s new rules for association health plans.

The groups will offer plans beginning September 1 to 2,000 small businesses that have 10 or fewer employees.

The plans are not required to meet the Affordable Care Act’s essential health benefit requirements or other consumer protections, such as accepting people with pre-existing conditions.

ACA Medicaid Expansion Fought in 3 States, Helps LA Cut Uninsured Rate by 50%

Maine, Nebraska, and Kentucky are working to sort out how, or if, they will expand Medicaid availability though the Affordable Care Act. Meanwhile, Louisiana’s expansion lowered the number of uninsured in the state by half.

  • Though Maine voters have approved ACA Medicaid expansion in the state, Governor Paul LePage’s administration has not been clear on whether it intends to enforce it. The state’s high court will decide whether the state will accept Medicaid applications.
  • In Nebraska, a petition to put ACA Medicaid expansion on the November ballot has collected enough signatures. However, the proposal is being challenged in court. The hearing is set for early next week.
  • Kentucky Governor Matt Bevin lost his legal battle over the requirement that Medicaid recipients be employed to receive benefits. Ultimately, the legality of the plan is likely to be determined in a separate case filed in Washington, D.C.
  • Louisiana’s Medicaid expansion program dropped the uninsured rate from 22.7 percent in 2015 to 11.4 percent in 2017, according to a new survey.

Healthcare Reform News Update for August 17, 2018

Nevada Will Switch to a State-Run ACA Healthcare Exchange

Nevada Health Link, the state’s insurance marketplace, will open its own state exchange in 2020 to sell Affordable Care Act plans.

Nevada Health Link cited lowering costs as the main consideration. For example, the state exchange will cost about $5.1 million to run in 2020 compared to $13.2 million to lease the federal exchange website.

In a statement, Nevada Health Link Executive Director Heather Korbulic said, “This transition will save Nevada more than $18 million for the duration of the contract, offer a better consumer experience and provide the Marketplace with timely and efficient access to data that will improve marketing efforts.”

Trump Administration Approves NJ Reinsurance Program

The Centers for Medicare and Medicaid Services (CMS) has approved New Jersey’s reinsurance plan.

The program will help insurance companies pay for their sickest enrollees. Partial funding will be provided through revenue from the state’s new law that fines residents without health insurance.

The state estimates that the program will lower 2019 ACA premiums by up to 15 percent.

Massachusetts ACA Premiums to Rise 4.2%

Rates for 2019 Affordable Care Act plans in Massachusetts are expected to rise an average of 4.2 percent. Some premiums will decrease, while others will increase from about 2 percent to 13 percent, depending on the plan.

Massachusetts Health Connector, the state’s insurance exchange, will finalize the rates next month.

Healthcare Reform News Update for August 8, 2018

2019 ACA Premiums in New Hampshire Could Drop an Average of 6.7%

The three health insurers in New Hampshire that sell Affordable Care Act coverage have proposed an average 6.75 percent premium reduction for 2019 plans.

Several factors are responsible for the rate drop, including the expansion of Medicaid, which moved low-income New Hampshire residents from ACA plans into the Medicaid program.

Rates for the Ambetter, Anthem, and Harvard Pilgrim ACA plans will be finalized by state regulators before the Open Enrollment Period begins in November.

Healthcare Reform News Update for August 7, 2018

Nevada 2019 ACA Premiums Could Increase an Average of 1.9%

Health insurance companies in Nevada have proposed increasing premiums for 2019 Affordable Care Act plans an average of 1.9 percent, the lowest rate increase in the history of the law.

Both SilverSummit and Health Plan of Nevada will continue to sell ACA plans in the state, with SilverSummit increasing its offerings from four to six plans in every county.

Final rates will be approved by state regulators in October.

Healthcare Reform News Update for August 3, 2018

Senate Democrats Try to Block Short-Term Health Plans

In response to the Trump administration’s new final rule on short-term healthcare plans, Senate Democrats are planning to introduce a resolution to upend it. However, the measure to overturn the rule is unlikely to pass since the legislation would need to be signed by President Donald Trump.

The lawmakers say that, since the plans are not required to cover people with pre-existing conditions or adhere to the Affordable Care Act’s essential benefits, the plans are “nothing short of junk insurance.”

“We cannot let the Trump administration rewrite the rules on the guaranteed healthcare protections that people depend on because no family should be forced to choose between helping a loved one get better or going bankrupt,” said Tammy Baldwin (D-WI), one of the senators leading the measure.

Senate Minority Leader Charles Schumer (D-NY) will force a vote under the Congressional Review Act, which means Republicans will be unable to block it.

“This is an issue the American people should know where everyone stands,” Schumer said. “Let them, instead of saying they’re for it, actually do something to preserve pre-existing conditions.”

Study: NY Single-Payer Bill Could Lower Costs for Most Residents

A New York bill to create a state single-payer health plan could lower out-of-pocket medical costs for residents earning less than $290,000 but would significantly raise taxes on those who earn more, according to an analysis from the Rand Corporation and the New York State Health Foundation.

The bill proposes expanding healthcare to all New York residents with no copays or deductibles.

The plan would need to raise $139 billion in additional taxes to fund the program, which could be funded with a three-tiered tax income bracket ranging from low-earning families paying 6.1 percent and high-earners paying 18.3 percent, according to the study.

Though taxes would be increased, those earning less than $290,000 would have reduced medical costs. For example, a person who earns up to $185,200 would pay about $3,000 less per year.

To be enacted, the bill would need to be approved by a Republican-controlled state Senate and receive a waiver from the Centers for Medicare and Medicaid Services (CMS), neither of which is likely.

Healthcare Reform News Update for August 2, 2018

Four Cities Sue Trump for Undermining the ACA

The cities of Chicago, Columbus, Cincinnati, and Baltimore filed a lawsuit today in Maryland federal court against President Donald Trump, claiming he has not faithfully executed the Affordable Care Act, which is in violation of the Constitution.

The complaint charges that Trump “waged a relentless effort to use executive action alone to undermine and, ultimately, eliminate the law,” according to a draft of the lawsuit obtained by NBC News.

The suit cites measures such as the expansion of association plans, attempt to eliminate cost-sharing reduction payments, reduction of funds for navigator programs, reducing the Open Enrollment Period, and urging the court to remove pre-existing condition protections.

The lawsuit seeks to stop practices that allow ACA exchanges to strip tax credits from enrollees with no notification, increase oversight of brokers, and strengthen oversight of the law.

“The overall picture here is one of sabotage that drives up the rates of uninsured and underinsured and leaves cities and counties holding the bag,” said Adam Grogg, senior counsel at Democracy Forward and the lead litigator in the lawsuit.

2019 ACA Premiums in Missouri to Rise Less Than 6%

Insurance companies in Missouri have requested premium increases for small group and individual plans that average just under 6 percent for 2019 ACA plans.

Ambetter, Centene, Cigna and Medica will all return to the Missouri ACA marketplace. There will be coverage available in every county.

Final rates are expected to be approved by state regulators next month.

Molina May Re-Enter Utah, Wisconsin ACA Marketplaces

Health insurance company Molina is weighing a return to selling Affordable Care Act plans in Utah and Wisconsin. The company left both states this year and is currently studying the profitability of coming back.

Company CEO Joseph Zubretsky said a decision would be made by the end of the summer.

Senate Fails to Stop DC Individual Mandate Funding

Senator Ted Cruz (R-TX) failed in his attempt to include an amendment to a funding bill that would have barred the District of Columbia from using money to impose an individual health insurance mandate. The senate voted 54-44 to table the provision.

Healthcare Reform News Update for August 1, 2018

Trump Administration Allows 12-Month Short-Term Plans

The Trump administration released a final rule today on new short-term health insurance policies, which will go into effect in October.

The rule extends the current 90 days of coverage up to 12 months, and policies have the option to be renewable for a maximum of three years.

Premiums for the short-term policies could cost half as much as comprehensive coverage. However, these policies have the choice to skirt many Affordable Care Act provisions, such as coverage for maternity care, prescription drugs, or mental health care. These plans can also set annual and lifetime caps on benefits, deny coverage, or charge more for people with pre-existing conditions.

“We make no representation that it’s equivalent coverage,” said James Parker, a senior adviser to Health and Human Services Secretary Alex Azar. “These policies will not necessarily cover the same benefits or extend coverage to the same degree, but what we do know is that there are individuals today who have been priced out of coverage because of the way the ACA has been implemented and the effects that it’s had on the market.”

Critics fear the availability of the plans could cause ACA premiums to rise due to lower enrollment. An analysis by lobbying group America’s Health Insurance Plans estimates a 1.7 percent increase next year due to the short-term plan expansion.

The administration estimates that about 600,000 people will enroll in a short-term plan next year. Of that 600,000, officials estimate between 100,000 and 200,000 people will switch from ACA plans to enroll in short-term options.

Plans could be available in about 60 days but first must be approved by insurance regulators.

Report: Individual Insurance Enrollment Dropped by 12%

Enrollment in individual health insurance policies declined by 12 percent to 14.4 million in the first quarter of 2018 as compared to 2017, according to a new analysis from the Kaiser Family Foundation.

The study indicates that Affordable Care Act premium increases for unsubsidized enrollees was a key factor in the decrease, with 38 percent of people who were not eligible for subsidies dropping their coverage.

Even with the drop-off, overall enrollment in plans sold on the ACA exchanges continues to be stable, with 10.6 million enrolled compared to 10.3 million this time last year.

North Carolina Insurer to Reduce 2019 ACA Premiums by 4.1%

Blue Cross and Blue Shield of North Carolina has proposed lowering its premium rates for 2019 Affordable Care Act plans by 4.1 percent.

The company cited several factors in its decision, including a $120 million reduction in healthcare costs from newly negotiated hospital and doctor agreements, the suspension of the health insurance tax, and proceeds from last year’s federal income tax cut.

There are about 475,000 North Carolina residents enrolled in the company’s ACA plans.

Healthcare Reform News Update for July 31, 2018

NY Governor Requests Denial of Some ACA Premium Increases

New York Governor Andrew Cuomo has asked the state’s Department of Financial Services to reject any portion of Affordable Care Act premium increases attributed to the repeal of the individual mandate.

Premium increase requests for 2019 plans in New York average 24 percent, of which half is credited to the elimination of the ACA provision that required individuals to have health coverage or face a penalty.

“If we allowed that rate increase to go through, it would be hundreds of millions of dollars as a bonanza to the private insurance companies. It would increase the cost to normal hardworking families. We’re not going to let it happen,” Cuomo said at a rally on Monday. He added that “insurance premiums must be based on actual cost, and not political manipulations.”

Cuomo said the current proposed rates would raise premiums an average of $1,500 for each enrollee.

Maine Gains OK for Reinsurance Program

The Centers for Medicare and Medicaid Services approved Maine’s request to establish a reinsurance program to help stabilize Affordable Care Act insurers in the state.

CMS’ decision comes one day after approving a similar request from Wisconsin. The two states join Minnesota, Alaska, Oregon, and Hawaii with approved reinsurance programs.

New Jersey 2019 ACA Premiums to Rise 5.8%

Premiums for 2019 ACA plans in New Jersey are expected to rise an average of 5.8 percent.

Insurance requests in the state ranged from an increase of 0.8 percent to 9.2 percent. Governor Phil Murphy said the state’s individual mandate law prevented much higher price hikes.

Rates will be finalized prior to the open enrollment period this fall.

Healthcare Reform News Update for July 30, 2018

Analysis: Sanders’ Single-Payer Plan Could Cost $32.6 Trillion

Vermont Senator Bernie Sanders’ “Medicare for All” healthcare plan would increase government spending by $32.6 trillion over a decade, according to an analysis by the libertarian Mercatus Center at George Mason University in Virginia.

Sanders’ plan would cover all Americans with no copays or deductibles. Tax increases would be required to replace premium costs that are currently paid by consumers and employers.

The plan could lower prescription costs by $846 billion over 10 years and administration costs by $1.6 trillion, according to the report. However, spending would rise due to:

  • Covering almost 30 million people who are currently uninsured,
  • Requiring no out-of-pocket costs, and
  • Including dental, vision and hearing coverage.

If corporate and individual income taxes were doubled, it would still not be enough to pay for the plan, according to the analysis.

Sanders calls the report a “misleading and biased” response to the growing popularity of a single-payer system. “If every major country on earth can guarantee health care to all, and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States cannot do the same,” he said in a statement.

Trump Administration Approves Wisconsin Reinsurance Program

The Centers for Medicare & Medicaid Services (CMS) on Sunday approved Wisconsin Governor Scott Walker’s reinsurance program.

Called the Health Care Stability Plan, the $200 million program will lower insurance rates for Affordable Care Act plans by providing government funds to insurance companies for their most expensive enrollees.

The plan is expected to lower 2019 ACA premiums by 3.5 percent.

Healthcare Reform News Update for July 27, 2018

Trump Administration Sued Over Association Health Plans

Attorneys general for 11 states and the District of Columbia have sued to block the Trump Administration’s regulation that expands access to association health plans (AHPs).

AHPs enable small businesses and groups to join together to purchase health insurance. The coverage does not have to meet the requirements of the Affordable Care Act, so the premiums are lower, but the plans do not cover essential benefits such as prescription drugs, maternity care, or mental health.

According to the complaint, the rule “upends a decades-old understanding of a foundational employee benefits law for the purpose of exempting a significant portion of the health insurance market from the Affordable Care Act’s consumer protections.”

The complaint also contends that the rule “increases the risk of fraud and harm to consumers, requires states to redirect significant enforcement resources to curb those risks, and jeopardizes state efforts to protect their residents through stronger regulation.”

The lawsuit is signed by the attorneys general of California, Delaware, District of Columbia Kentucky, Maryland, New Jersey, New York, Massachusetts, Oregon, Pennsylvania, Virginia and Washington.

HHS Secretary Criticizes ACA in Speech to Conservative Organization

Health and Human Services (HHS) Secretary Alex Azar spoke out against the Affordable Care Act on Thursday in a speech to the conservative Heritage Foundation.

Azar said the healthcare law was an example of government overreach that caused consumers to pay higher prices and “imposed a new tax or regulation, or sometimes both, on just about every moving part in our healthcare system.”

Azar believes the healthcare exchanges, in particular, have failed to attract younger enrollees, placing a financial burden on the older people left behind.

“The only factor keeping the individual markets alive is the tens of billions in subsidies supplied directly to insurers each year. The fundamental flaw of the Affordable Care Act is that it narrowed the competition for insurance options and laid down heavy-handed controls on the prices that could be charged,” he said.

Azar also shared his disapproval of the ACA’s Medicaid expansion, saying the federal government now pays more for the expansion population than it does for those who traditionally qualified for benefits. He said the Trump administration will support work requirements for beneficiaries who are neither disabled nor have children.

Healthcare Reform News Update for July 26, 2018

CMS Administrator Rejects Single-Payer Healthcare System

In a speech delivered Wednesday, Centers for Medicare and Medicaid Services Administrator Seema Verma said that a government-run, “Medicare for all” healthcare system would not work and she would likely deny states seeking waivers for single-payer programs.

Verma believes expanding Medicare would drain funding and put seniors at risk. “Ideas like ‘Medicare for all’ would only serve to hurt and divert focus from seniors,” she said.

Kaiser Poll: Pre-Existing Condition Protections Top Healthcare Concerns

A candidate’s position on continuing protections for people with pre-existing conditions is the leading healthcare concern for the majority of voters, with 63 percent of respondents ranking it their “most important” or “very important” healthcare issue, according to a new poll from the Kaiser Family Foundation. The topic ranked high with both Democrats and Republicans.

Other healthcare findings in the poll:

  • 64 percent would oppose the Supreme Court overturning pre-existing condition protections.
  • 51 percent of residents in states that have not expanded Medicaid would support expansion efforts.
  • 56 percent of respondents believe President Donald Trump and his administration are trying to make the Affordable Care Act fail (with 47 percent saying it is a bad thing).
  • 58 percent hold Trump and Republicans in Congress responsible for any future problems with the ACA.

House Passes Bill to Delay ACA Health Insurance Tax

The House on Wednesday passed a bill to extend the delay of the Affordable Care Act’s health insurance tax for 2020 and 2021. The tax was previously suspended for 2019.

The bill also expands eligibility for ACA catastrophic plans and expands eligibility and use of health savings accounts (HSAs).

Healthcare Reform News Update for July 25, 2018

Trump Administration Will Resume ACA Risk-Adjustment Payments

Centers for Medicare and Medicaid Services (CMS) issued a final rule Tuesday to restart the Affordable Care Act’s risk-adjustment payments to insurance companies.

Risk-adjustment payments are made by insurance companies with healthier enrollees to help offset companies with sicker enrollees. This process helps stabilize the marketplace. Earlier this month, the department halted the $10.4 billion program due to a federal judge’s ruling.

Halting the payments set off fears that the move would increase 2019 premiums or cause some insurance companies to leave the ACA exchanges.

“This rule will restore operation of the risk-adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation,” said CMS Administrator Seema Verma in a statement. “Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today. Alleviating concerns in the market helps to protect consumer choices.”

ACA Critic Paul Mango to Serve Trump Administration in CMS Role

Paul Mango, a strong critic of the Affordable Care Act, has been appointed chief principal deputy administrator and chief of staff at the Centers for Medicare and Medicaid Services (CMS).

Mango, a former Pennsylvania gubernatorial candidate, previously worked on healthcare issues for consulting firm McKinsey & Company.

“I have known Paul for more than 10 years and look forward to having his support as we deliver on President Trump’s agenda and execute on our strategy on behalf of the American people,” said CMS Administrator Seema Verma in a statement.

House Passes Bill to Repeal ACA Medical Device Tax

The house voted Tuesday to repeal a 2.3 percent tax on medical devices. The vote garnered support from both Democrats and Republicans.

The tax has been delayed twice, but the current bill would make the repeal permanent. It is uncertain whether or not the bill will be taken up in the Senate.

GOP Senators Push to Repeal DC’s Individual Mandate Penalty

Six Republican senators, led by Ted Cruz (R-TX), have introduced an amendment to an appropriations bill that would prevent the District of Columbia from using federal funds to impose a penalty on residents who don’t have health insurance. Last week, the House passed the amendment in a spending bill.

Healthcare Reform News Update for July 24, 2018

House to Vote on ACA Revisions, HSA Expansion

The House will vote this week on several Republican-backed healthcare measures, including:

  • Allowing ACA premium tax subsidies to fund off-exchange health plans, including catastrophic coverage.
  • Permanently repealing the Affordable Care Act’s medical device tax.
  • Delaying the ACA health insurance tax.
  • Expanding eligibility and use of health savings accounts (HSAs).

If approved, the measure would cost $92 billion over 10 years, according to Congressional Budget Office (CBO) estimates.

PA Insurers Lower 2019 ACA Rate Proposals

Pennsylvania insurance companies have reduced their rate requests for 2019 Affordable Care Act plans from an average increase of 4.9 percent to an average increase of 1 percent.

The state cited several factors for the change, “including lower insurer expenses for cost-sharing reduction payments covering deductibles, co-payments, and co-insurance for lower income customers, the department lowered the amount of a standardized factor.”

The state will finalize the rates prior to the Open Enrollment Period later this year.

Healthcare Reform News Update for July 23, 2018

Payment Structure for Medicare Office Visits Could Change

The Trump administration would like to change the way doctors charge Medicare patients for office visits beginning in 2019 by establishing one set rate for new patients and a lower set rate for established patients.

Medicare patients are currently billed between $76 and $211 for new patients and between $45 and $148 for established patients, depending on the complexity of the service. The Trump administration has proposed a set rate of about $135 for new patients and about $93 for established patients.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), says the change would help lessen doctors’ paperwork, giving them more time with patients. She says the change would help fulfill the president’s promise to “cut the red tape of regulation.”

Critics of the proposal say it could increase the risk of fraud and would result in a patient with a cold being charged the same as a patient with Stage 4 cancer. In addition, they fear that physicians in more specialized fields, such as dermatology and rheumatology, would be underpaid and that many could stop taking Medicare patients.

The proposal has the potential to affect the broader healthcare community, as private insurance companies often mirror Medicare rules.

The administration’s proposal is expected to be published in the Federal Register on Friday with a public comment period scheduled through September 10.

Connecticut 2019 ACA Premiums Could Rise 12.3%

Proposed health insurance premiums for 2019 Affordable Care Act plans in Connecticut will rise an average of 12.3 percent, with requests ranging from a 10.9 percent reduction from CTCare Benefits Inc. to an increase of 31 percent from Anthem Health Plans.

Final rates will be announced this fall after a review by state insurance regulators.

Healthcare Reform News Update for July 20, 2018

CMS May Restart of Risk-Adjustment Payments

The Centers for Medicare and Medicaid Services (CMS) sent an interim final rule to the Office of Management and Budget on Wednesday that is likely to enable the agency to resume billions in Affordable Care Act risk-adjustment payments.

The rule, titled “Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act,” could go into effect immediately. The contents of the rule will not be disclosed until it has been reviewed.

CMS stopped payments to the program last week due to conflicting legal rulings. The payments, which totaled $10.4 billion in 2017, go from insurance companies with heathier enrollees to those with sicker enrollees. This process helps balance the marketplace. Insurance companies feared that halting the payments could trigger premium increases.

Removing Pre-Existing Condition Protections Will Hurt States Challenging ACA the Most

Almost half of the states that have launched a legal challenge against the Affordable Care Act would be negatively impacted the most if protections for people with pre-existing conditions were eliminated, according to an analysis by the Kaiser Family Foundation.

A coalition of 20 Republican-led states filed a lawsuit in February challenging the legality of the ACA and its provision that people with pre-existing conditions can get health coverage without being charged higher premiums.

The study found that nine of the states in the lawsuit have residents with the country’s highest rates of pre-existing conditions among adults under 65. For example, West Virginia has the country’s highest rates with 36 percent of its population — or 1 in 3 adults under 65 — who would qualify as having a pre-existing condition.

“These states have been opposed to the ACA from the beginning. They’re hurting their most vulnerable citizens,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research.

Studies have shown that, prior to the Affordable Care Act, between 27 percent and 50 percent of adults under 65 had at least one pre-existing condition.

Poll: Half of Americans Believe Healthcare is More Expensive in 2018

Nearly half the country finds that healthcare is more difficult to afford than last year, according to a new poll by Democratic messaging firm Navigator Research.

Respondent opinions mostly transcended party affiliation with 54 percent of Democrats and 46 percent of Republicans saying it’s more difficult to afford prescription drugs, insurance premiums, and doctor visits this year as compared to last year.

The poll also showed that 78 percent of respondents believe the government should do more to make healthcare more affordable.

California 2019 ACA Premiums to Increase 8.7%

Affordable Care Act health plans sold on California’s healthcare exchange, Covered California, will rise an average of 8.7 percent in 2019, ending the double-digit increases seen in the state the previous two years. Covered California singled out the repeal of the individual mandate penalty as the reason for the increases.

All 11 insurance companies that sell ACA plans in the state will return next year. Rates are subject to review by state regulators before becoming final this fall.

House Passes Two Measures Blocking D.C.’s Individual Mandate

House Republicans passed measures on Thursday that would repeal the District of Columbia’s requirement that all residents have health insurance coverage.

Democratic Mayor Muriel E. Bowser was against the decision, saying the House ignored the wishes of residents.

The measure was introduced by Representative Gary Palmer (R-AL) who said in a statement that “individuals should be allowed to make their own decisions about the type of insurance they want to purchase without being subjected to punishment from the government. The D.C. individual mandate would restrict patient choice and force people to purchase insurance that they may not need, desire, or be able to afford.”

Healthcare Reform News Update for July 19, 2018

Association Health Plans Get Tepid Reception From Key Business Group

The National Federation of Independent Business (NFIB), which has lobbied for almost 20 years for association health plans, says the new insurance initiative allowing them is impractical for its membership.

The Trump administration will allow the plans to be sold beginning September 1. The NFIB objects to the rule that businesses can join together to purchase health insurance only if they share an industry or are within the same state.

“We can’t set up an AHP under the new rules any more than [we] could under the old rules,” said NFIB Spokesman Adam Temple.

Other trade groups such as the National Retail Federation and the National Association of Realtors have also voiced concerns about the new rules and have no intentions of setting up AHPs in the near future.

House Democrats Form New Medicare for All Caucus

Democrats in the House are launching a new caucus today that will focus on endorsing single-payer healthcare.

The Medicare for All Caucus will comprise approximately 60 Democratic members led by Representatives Pramila Jayapal (WA), Debbie Dingell (MI), and Keith Ellison (MN).

Healthcare Reform News Update for July 18, 2018

States: ‘Silver Loading’ ACA Plans Helped Subsidized Consumers

Eighteen states and the District of Columbia have asked a judge to put their lawsuit concerning the Trump administration’s cuts to Affordable Care Act subsidies on hold.

The states filed suit last year after President Donald Trump ended government payments to insurance companies that provided discounts to low-income consumers. As a workaround to counter the payment cutoffs, insurance companies raised premiums on silver plans. That move helped trigger increased tax credits for subsidized enrollees.

The states say that the workaround was successful in protecting lower-income consumers from premium increases. According to the filing, the decision “provided some stability to help ensure a functioning insurance market.”

The states are requesting a hold instead of dropping the suit entirely in the event the administration disallows the “silver loading” workaround.

Idaho Voters Will Decide on ACA Medicaid Expansion in November

Idaho residents will vote on expanding Medicaid through the Affordable Care Act in November, after a petition included enough signatures to put the measure on the ballot.

If approved, the expansion will enable 62,000 additional residents to qualify for coverage.

Healthcare Reform News Update for July 17, 2018

Lawmakers Press HHS to Restart ACA Risk Adjustment Payments

Congressional Democrats and a House GOP chairman on Monday addressed reinstating the $10.4 billion in risk adjustment program payments that Health and Human Services (HHS) recently suspended.

In a letter to HHS, Democrats on Congress’s healthcare committee asked the department to reconsider. “We ask that you take immediate action to reverse this destructive decision that will further destabilize the individual and small group markets that millions of Americans rely on for health insurance,” according to the letter.

The letter was signed by Democratic Representatives Frank Pallone Jr. (NJ), Richard Neal (MA), Bobby Scott (VA), and Senators Patty Murray (WA) and Ron Wyden (OR).

House Ways and Means Committee Chairman Kevin Brady (R-TX) said he is working with HHS officials to restart the payments. “The administration wants to restore those payments, so we’re looking at ways that we can help them do that,” he said.

Risk insurance payments are collected from insurance companies with healthier enrollees to help companies with sicker enrollees cover costs. Last week, the Trump administration suspended the payments citing a court ruling.

Healthcare Reform News Update for July 16, 2018

Colorado’s 2019 ACA Premiums Could See Average Increase of 5.94%

In Colorado, health insurance companies have requested to raise rates on 2019 Affordable Care Act plans by an average of 5.94 percent.

Broken down by plan type, the state filings reflected an average increase of:

  • 6.85 percent for gold plans.
  • 12.3 percent for silver plans.
  • 0.9 percent for bronze plans.

All seven insurance companies that sell ACA plans in Colorado will remain on the exchange in 2019, and every county will have at least one insurer. Final rates will be announced prior to this fall’s open enrollment period.

Healthcare Reform News Update for July 13, 2018

House Committee Approves ACA Employer Mandate, Tax Credit Bills

Two bills advanced by the House Ways and Means Committee on Thursday address several provisions of the Affordable Care Act.

The first bill suspends ACA employee mandate penalties through 2019 and delays implementation of the “Cadillac tax” on high-deductible employee-sponsored health plans until 2022. The bill is sponsored by representatives Devin Nunes (R-CA) and Mike Kelly (R-PA).

The second bill would allow individuals to use ACA tax credits to purchase health plans not sold on the ACA exchanges. It will also allow people over the age of 30 to purchase catastrophic plans. The bill is sponsored by Peter Roskam (R-IL) and Michael Burgess (R-TX).

Healthcare Reform News Update for July 12, 2018

Bright Health Increases ACA Reach Into 9 New Markets

Startup insurer Bright Health announced that it will sell Affordable Care Act plans in nine additional markets in 2019, upping its reach to 12 markets in six states.

The company’s health plans are currently available in Colorado, Phoenix, and Birmingham, Alabama. New markets include:

  • New York City
  • Tucson, Arizona
  • Cincinnati, Springfield, Toledo, and Youngstown, Ohio
  • Knoxville, Nashville, and Memphis, Tennessee

Healthcare Reform News Update for July 11, 2018

ACA Navigator Program Funding Reduced to $10 Million

The Centers for Medicare and Medicaid Services (CMS) announced Tuesday that it will cut funding for the Affordable Care Act navigator program reducing it to $10 million.

Last year, the Trump administration slashed the federal grants for the program from $62.5 million to $36 million.

Each of the 34 states that use the federal ACA exchange will be awarded a minimum of $100,000 to help residents sign up for health coverage. In addition to promoting the government’s healthcare website, CMS says that it wants navigators to raise awareness of the association health plans and short-term plans that provide coverage for up to 12 months.

CMS Administrator Seema Verma said, “it’s time for the navigator program to evolve, which is why we are announcing a new direction for the program today.”

The agency says that the program’s sign-up performance in the past has been disappointing. After the 84 percent funding cut since 2016, navigators enrolled less than 1 percent of all ACA enrollees. Insurance agents and brokers signed up 42 percent.

Healthcare Reform News Update for July 10, 2018

Analysis: Insurance Companies Could Expand Into More ACA Exchanges

More insurance companies might sell Affordable Care Act plans in 2019, according to projections from a new analysis by the Robert Wood Johnson Foundation.

The analysis points to several factors that could increase the number of companies selling health plans on the exchanges:

  • No insurers have announced that they are exiting any ACA markets.
  • Profits are improving for plans sold on the ACA exchanges.
  • Insurers have announced ACA expansions in Arizona, Florida, Iowa, Maine, Michigan, New Mexico, North Carolina, Ohio, Oklahoma, Tennessee, Utah, Virginia, and Wisconsin.
  • More insurers have announced expansions compared to last year. Oscar, Bright Health, Medica, and Wellmark have announced expansions. Anthem is also expected to enter new markets.

The analysis was prepared prior to last weekend’s announcement by the Trump administration that it will suspend risk-adjustment payments to insurance companies. That decision, plus a lawsuit that questions the validity of the ACA, could potentially upset market stability, raise premiums, and affect insurers’ confidence to enter new markets.

Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute, addressed the issue. “There seems to be a little more confidence in the sustainability of the ACA market. It remains to be seen whether underserved rural areas will get more competition and choice next year. But with the administration’s risk-adjustment decision and the Texas lawsuit, we’re not out of the woods yet,” she said.

Maine ACA Medicaid Expansion Blocked by State House Lawmakers

The Maine House was unable to get the votes necessary to override Republican Governor Paul LePage’s veto of a bill that funded a voter-approved expansion of Medicaid. The bill would have garnered more than $500 million in federal funds and $60 million in state funds to more than 70,000 low-income residents.

A hearing next week before the Maine Supreme Judicial Court will determine how and if the state can implement the voter-approved expansion without funding approved by the Legislature.

Healthcare Reform News Update for July 9, 2018

Trump Administration Suspends ACA Risk Adjustment Payments

Citing conflicting court rulings, the Centers for Medicare & Medicaid Services (CMS) announced Saturday that it will halt $10.4 billion in risk adjustment payments to insurers until legal issues are resolved.

The Affordable Care Act’s risk adjustment program takes payments from insurers with healthier customers and redistributes that money to companies with sicker enrollees. A court in Massachusetts upheld the risk adjustment payments; however, a New Mexico court decided in February that the rules were unfair.

A statement from CMS Administrator Seema Verma said that the “ruling prevents CMS from making further collections or payments under the risk adjustment program. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold.”

Verma’s statement also noted that the agency is “seeking a quick resolution to the legal issues raised and will inform stakeholders of any update to the status of collections or payments at an appropriate future date.”

Insurance trade groups say that halting the payments will cause premiums to increase this fall.

Insurance trade group America’s Health Insurance Plans said the following in a statement: “This decision comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own.”

“Risk adjustment is a mandatory program under federal law. Without a quick resolution … this action will significantly increase 2019 premiums for millions of individuals and small business owners. … It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most,” said Blue Cross Blue Shield Association President Scott Serota.

Democratic lawmakers and ACA advocates, including House Energy and Commerce Committee Representative Frank Pallone (D-NJ), say the decision is one more step in the Trump administration’s plan to sabotage the healthcare law.

Healthcare Reform News Update for July 6, 2018

Nebraska Voters Could Have ACA Medicaid Expansion on Fall Ballot

Advocacy group Insure the Good Life garnered more than 135,000 signatures to allow Nebraskans the chance to vote for expanding Medicaid through provisions of the Affordable Care Act.

The petition included about 60 percent more signatures than required to qualify for the ballot. If enacted, the measure would insure approximately 90,000 people in Nebraska who earn up to $16,753 for a single person or $34,638 for a family of four.

Nebraska Governor Pete Ricketts opposes Medicaid expansion, and previous proposals have failed in the state’s predominately Republican legislature over the past six years.

Election officials have until mid-August to review the signatures collected and certify the ballot initiative.

Healthcare Reform News Update for July 5, 2018

Number of Brokers, Agents Selling ACA Coverage Drops Almost 25%

Insurance agent and broker participation in Affordable Care Act enrollment decreased by 24.8 percent in 2018, according to a report released by the Centers for Medicare & Medicaid Services (CMS) earlier this week.

Currently, 42 percent of ACA enrollees receive help through insurance agents or brokers. Last year, 65,300 agents and brokers helped Americans sign up for coverage. This year, the number dropped to 49,100.

According to CMS, the drop is due to several factors, including fewer insurance companies offering ACA plans, high premiums for people without subsidies, and limited commissions.

In 2016, the agency issued guidance to insurance companies to be consistent in their commission structures by the first of this year to help encourage agent and broker participation. Groups representing agents and brokers claim that it has not happened.

“Without a viable compensation structure for agents and brokers, it may be difficult for CMS to improve or stabilize agent and broker retention and achieve significant enrollment gains, leaving consumers with diminished access to insurance specialists willing to help them in their local communities,” according to the CMS report.

Vermont Prepares to Regulate Association Plans

Vermont will regulate association health plans that could be available in the state as soon as September, said Michael Pieciak, commissioner of the Vermont Department of Financial Regulation.

Last month the Department of Labor announced the expansion of the plans to the self-employed and a larger swath of small businesses. The plans are able to skirt many of the Affordable Care Act essential benefits, including mental health services, maternity care, and prescription drugs.

Pieciak said Monday that his department “aims to craft regulations that ensure Vermonters are protected and well-served by these health plans. In the past, similar plans that operated in other states were poorly run, and many were fraudulent.”

Healthcare Reform News Update for July 3, 2018

Percentage of 2018 ACA Enrollees Who Keep Plans Rises Slightly

The Centers for Medicare and Medicaid Services (CMS) released enrollment data Monday for 2018 Affordable Care Act Plans.

According to the report, 10.6 million of the 11.8 million who signed up for ACA plans paid their first month’s premium.

Almost 1.1 million, or about 9 percent, dropped their coverage as of February 2018. That percentage is lower than in 2017, when 1.9 million of 12.2 million enrollees—about 15.5 percent—dropped their coverage.

Enrollees without subsidized coverage dropped their coverage at a much higher rate than those with subsidies. From 2016 to 2017, only 3 percent of subsidized enrollees dropped coverage. In that same time frame, 20 percent of those without subsidized coverage dropped their plans.

Other findings in the study:

  • The percentage of people who receive tax subsidies rose from 84 percent in 2017 to 87 percent in 2018.
  • Cost-sharing reduction (CSR) subsidies were provided to 53 percent of enrollees.
  • The average monthly premium before subsidies is $597, which is 27 percent higher than in 2017.
  • The average tax credit is $520 per month, which is 39 percent higher than in 2017.

Healthcare Reform News Update for July 2, 2018

Trump Administration Could Slash Funding for ACA Outreach Groups

The Department of Health and Human Services (HHS) has made an initial proposal to cut funding for Affordable Care Act navigator groups from $36 million to $10 million, though the final funding amount has not been announced.

Navigators help consumers, especially those with limited English skills and citizens in rural areas, understand and find ACA plans. The groups have yet to receive any information from HHS on their funding levels for the upcoming open enrollment period.

Last year, the Trump administration reduced funding for navigators from $63 million to the current $36 million, asserting that the outreach programs were ineffective. Democratic lawmakers said the reduction was designed to sabotage the healthcare law.

Oregon 2019 ACA Premiums to Increase up to 10%

In Oregon, individual premiums will increase between 5 and 10 percent next year, according to preliminary rate decisions for 2019 Affordable Care Act plans issued Friday by state insurance regulators. Small group insurance plans will experience rate changes from a 4 percent drop to a 9.4 percent increase.

The relatively small increases are credited to the state’s reinsurance program. Final rates are expected to be announced by the end of the month.

Kentucky’s Medicaid Work Requirement Struck Down

U.S. District Judge James E. Boasberg on Friday blocked Kentucky’s new requirement that all Medicaid recipients have jobs. The decision, which is likely to be appealed, could reduce the number of states that expand their Medicaid programs through the Affordable Care Act.

Kentucky’s work requirement was the first of its kind in the country. It required 80 hours of work, job training, education, or volunteer service per month for nondisabled enrollees. Exemptions included pregnant women, full-time students, primary caregivers, and those considered medically frail.

Arkansas, Indiana, and New Hampshire have also passed Medicaid work requirements, and seven additional states have federal approvals pending. It’s unclear if Boasberg’s ruling applies to them as well.

Healthcare Reform News Update for June 27, 2018

Poll: Most Americans Back Pre-Existing Condition Protections

Majorities of Republicans, Democrats, and independents say it’s “very important” to retain the Affordable Care Act’s protections for people with pre-existing conditions, according to a Kaiser Family Foundation poll released today.

The poll asked 1,492 adults whether insurance companies should deny coverage based on someone’s medical history and whether those with pre-existing conditions should pay higher premiums. Currently, the ACA prohibits these practices. However, the Trump administration, in a legal challenge, recently said it would not defend these provisions.

Eighty-eight percent of Democrats, 58 percent of Republicans, and 77 percent of independents responded that it is “very important” that insurance companies cannot deny coverage because of a person’s medical history.

Similarly, 85 percent of Democrats, 58 percent of Republicans, and 70 percent of independents, responded that it is “very important” that health insurance companies cannot charge sick people more.

Medica Expands ACA Coverage to Oklahoma and Kansas City

Health insurer Medica announced that it will sell 2019 Affordable Care Act coverage in all 77 counties in Oklahoma and add four additional counties in the Kansas City, Missouri, area.

In Missouri, the company will expand into Cass, Clay, Jackson and Platte counties. This year, the company sold policies only in Johnson and Wyandotte counties.

Proposed pricing for Medica’s ACA plans in both states will be available at a later date.

Healthcare Reform News Update for June 26, 2018

Smaller Insurers Expanding ACA Marketplace Coverage

Some smaller health insurance companies are planning to increase their presence on the Affordable Care Act marketplace for 2019, despite a decline in ACA carriers across the country in recent years.

Last week, Oscar Health announced its growth into three states and three new markets in existing states. Now, Bright Health has determined it will expand into Tennessee, and Presbyterian Healthcare is returning to the ACA marketplace to sell plans in New Mexico.

“It’s still early, but we haven’t seen any exits, and we are certainly seeing new insurers enter markets and expand where they are doing business,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “If not for the still significant political and legal uncertainty, we’d be seeing a very robust market right now.”

Seven states will gain ACA plan choices next year, but premiums will be higher. Rates will increase from an average of $642 per month this year to $740 in 2019.

Healthcare Reform News Update for June 25, 2018

2019 ACA Premiums Could Rise by 8.2% in Ohio

Insurance companies in Ohio have submitted proposed rates for 2019 health plans sold on the Affordable Care Act marketplace.

If approved by state regulators, premiums will rise an average of 8.2 percent. Last year, premium increases averaged 20 percent.

Ohio’s Department of Insurance also noted that residents in every county will have access to ACA coverage from at least one insurance company.

Healthcare Reform News Update for June 21, 2018

NY, MA Will Fight Trump Administration Over AHPs

The Democratic attorneys general for New York and Massachusetts will file a lawsuit against the Trump administration over its recent rule to expand access to lower-cost association health plans (AHPs).

The rule, finalized Tuesday, will allow self-employed individuals to join AHPs. In addition, the plans will not have to provide the 10 essential health benefits required under the Affordable Care Act, including emergency care, prescription drugs, and maternity care.

New York Attorney General Barbara Underwood and Massachusetts Attorney General Maura Healey say that the decision will “invite fraud, mismanagement, and deception.”

“We believe the rule, as proposed, is unlawful and would lead to fewer critical consumer health protections,” they said in a statement.

Kaiser Estimates ACA Eligibility Among the Uninsured

The Kaiser Family Foundation released an analysis that provides national and state-by-state estimates of how many uninsured Americans are eligible for Affordable Care Act healthcare coverage.

Of the 27.5 million nonelderly uninsured people in the country in 2016, the analysis found that:

  • 54 percent are eligible for coverage via Medicaid or subsidized ACA coverage
  • 28 percent are eligible for premium tax credits for ACA plans
  • 16 percent are adults eligible for Medicaid
  • 10 percent are children either eligible for Medicaid or the Children’s Health Insurance Program (CHIP)

Oscar Health ACA Plans Expand Into 3 New States

Oscar Health is expanding its coverage area and will sell Affordable Care Act plans in Florida, Arizona, and Michigan in 2019. The company will also serve three new metropolitan areas in Ohio, Tennessee, and Texas, where it already offers insurance. In total, the company will sell 2019 ACA coverage in nine states.

Currently, there are 240,000 people signed up for Oscar plans, which is more than double last year’s enrollment.

Healthcare Reform News Update for June 20, 2018

Trump Administration Releases Final Rule on Association Health Plans

The Trump administration on Tuesday announced its finalized rules on expanding access to association health plans (AHPs).

AHPs allow small businesses to purchase health insurance across state lines at a lower cost. The new rules permit self-employed individuals to join AHPs, which will not be required to offer some essential health benefits outlined in the Affordable Care Act (ACA).

The plans can’t set premium rates based on pre-existing conditions, but they can vary rates based on age, occupation, or place of business.

“You’re going to save massive amounts of money and have much better health care. It’s going to cost you much less,” Trump said in a speech to the National Federation of Independent Business.

Labor Secretary Alexander Acosta said the plans could be available to millions of new enrollees as soon as September 1.

“As the cost of insurance for small businesses has been increasing, the percentage of small businesses offering health care coverage has been dropping substantially,” Acosta said. “Today, the Trump administration helps level the playing field between large companies and small businesses.”

Critics believe AHPs are “junk health insurance” and will cause healthy people to leave ACA plans, destabilizing the ACA marketplace. Some point out that, in the past, similar plans committed insurance fraud; therefore, more protections should be put in place.

As a reaction to the expected decrease in enrollment, the Congressional Budget Office (CBO) projects 2019 ACA premiums to rise by 2 to 3 percent.

Conservative Policymakers Release New ACA Repeal and Replace Plan

A coalition of conservative groups, led by the Heritage Foundation, the Galen Institute, and former Senator Rick Santorum (R-PA), unveiled a new plan Tuesday to repeal and replace the Affordable Care Act.

The plan states: “After efforts to repeal and replace Obamacare fell short last year, many in Congress seem resigned to accepting the status quo or even willing to bail out and prop up the program. But Obamacare is broken, can’t be fixed, and continues to do great harm.”

Proposals in the plan include eliminating the ACA’s essential health benefits and providing block grants to states instead of the current use of insurance subsidies and Medicaid expansion.

The plan is not expected to pass in Congress this year, as lawmakers have other priorities.

Healthcare Reform News Update for June 19, 2018

Report: ACA Helped Reduce Number of Uninsured Children

Uninsured children in the U.S. dropped by 2.2 million after the enactment of the Affordable Care Act in 2014, according to a study from the State Health Access Data Assistance Center (SHADAC).

The study compared insurance coverage from 2013 to 2016 overall and by individual factors such as income, race/ethnicity, and education levels.

The largest reduction of children without insurance was from families that were low-income, Hispanic, and non-white. Children in families with low education levels also benefitted.

The study examined coverage at the national and state levels, and the results include individual data for each state. For example, Georgia saw a decrease of more than 85,000 uninsured children, and Texas lowered the rate of uninsured children by 23.1 percent during the study period.

Bipartisan Governors Pledge Support for ACA Consumer Protections

A bipartisan group of nine governors issued a joint statement Monday speaking out against a Trump administration decision that could jeopardize access to healthcare for people with a history of medical problems.

In a recent legal brief, the Justice Department said it will no longer defend the portion of the Affordable Care Act that relates to pre-existing conditions.

“We’re asking the Administration to reverse their decision and instead work with Congress and Governors on bipartisan solutions to protect coverage and lower health care costs for all Americans, all while protecting those with preexisting conditions,” according to the statement.

Governors from the following states signed the statement: Colorado, Ohio, Alaska, Pennsylvania, Nevada, Montana, Maryland, Washington, and North Carolina.

Younger People Willing to Trade Privacy for Lower Premiums

The majority of people between 18 and 34 would be willing to share their social media information in exchange for lower health insurance premiums, according to a recent poll by software company MuleSoft Inc.

When 8,000 global respondents were asked if they’d be “happy for insurers to use third-party data” from sources such as Facebook, Fitbits, and smart-home devices to lower insurance costs, here’s how the age groups answered:

  • 18–34: 62 percent said yes
  • 35–54: 45 percent said yes
  • 55-plus: 27 percent said yes

The survey also found spit opinions on digital offerings from insurance companies with 58 percent saying the systems don’t work adequately, and 56 percent saying they would drop their provider if the digital service was poor.

Maine Governor Continues to Fight ACA Medicaid Expansion

A Maine judge denied a motion filed by Republican Governor Paul LePage to delay the voter-approved expansion of Medicaid under the Affordable Care Act. Superior Court Justice Michaela Murphy said LePage’s administration must file the paperwork to begin the process. The governor said he would also fight this latest order.

Healthcare Reform News Update for June 18, 2018

2019 ACA Premiums to Rise in Washington DC, Fall in Minnesota

Health insurance companies in the District of Columbia and Minnesota have filed their premium rate requests for 2019 Affordable Care Act plans.

In D.C., the average request increases premiums about 15 percent compared to 2018 plans. In Minnesota, the rates are reduced about 12 percent on average.

Minnesota’s rate reductions are due to the state’s new reinsurance program, which offsets 80 percent of annual medical claim costs between $50,000 and $250,000 for individuals.

Actual rates will be finalized by insurance regulators before the annual enrollment period this fall.

Healthcare Reform News Update for June 15, 2018

Federal Court: Government Doesn’t Have to Pay ACA Risk Corridor Payments

A federal appellate court ruled Thursday that that the U.S. government does not owe health insurers over $12 billion sought in unpaid Affordable Care Act risk corridor funds.

Because Congress made the risk corridor payments budget neutral, the three-judge court agreed that the government could not tap other sources of money to pay for insurers’ losses.

The temporary risk corridor program was set up in the early years of the ACA for insurance companies that were making a profit to help companies that were struggling. However, too many insurers requested risk corridor money, and too few paid into the fund.

Healthcare Groups Oppose Justice Department’s ACA Decision

Eleven friend-of-the-court briefs have been filed by a variety of interested parties regarding the Justice Department’s decision not to defend some Affordable Care Act provisions, including protections for people with pre-existing conditions. All but one brief is against the decision.

Groups opposed to the decision represent insurance companies, medical schools, hospitals, and patient advocacy. The one brief filed in favor of the Trump administration’s position was from a coalition of gun-owner’s groups and the conservative organization Citizens United.

Healthcare Reform News Update for June 14, 2018

Actuary Group: Government Policies Are Driving ACA Premium Increases

Affordable Care Act premium hikes are being caused primarily from the increase of healthcare costs and policy changes from the Trump administration, according to a report released by the American Academy of Actuaries on Wednesday.

“The individual market, which had shown signs of stabilizing, now faces a potential deterioration of the risk pool due to policy changes that reduce incentives for healthy individuals to enroll in ACA marketplace plans. This deterioration and other factors could drive premiums higher for 2019,” said Cori Uccello, the group’s senior health fellow.

According to the report, national policy changes driving the increases include the:

  • Repeal of the individual mandate.
  • Extension of short-term insurance plans.
  • Wider availability of association plans.

Healthcare actions by individual states are also a factor in the expected premium increases. In addition, policy changes are affecting insurance company assumptions for 2019 plans.

The group found that healthcare costs for 2019 are projected to rise between 5 to 8 percent.

House Democrats Question HHS & CMS Leaders About ACA Protections

A letter from House Democratic lawmakers to Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma asks if they were involved in the Justice Department’s decision to not defend central protections of the Affordable Care Act, including those for people with pre-existing conditions.

Signed by several ranking members of House committees, the letter asks about the existence of any analysis that may have been conducted that could have affected the decision and if they had plans to address any confusion the decision may cause.

“In declining to defend these protections in the Texas v. United States lawsuit, the Trump Administration is seeking to invalidate these critical patient protections, and once again subject tens of millions of Americans with pre-existing conditions to the discrimination they faced before the ACA,” the lawmakers wrote.

Healthcare Reform News Update for June 13, 2018

Azar, McConnell Affirm Support of Pre-Existing Condition Safeguards

Health and Human Services Secretary Alex Azar told the Senate Health, Education, Labor, and Pensions Committee he believes that the Affordable Care Act’s protections for people with pre-existing conditions should be maintained.

Azar said the Justice Department’s position that the law’s protections should be nullified is “a constitutional position … not a policy position.” When asked if he would urge the administration to revise its opinion, Azar said, “we do believe in finding solutions on the matter of pre-existing conditions and the matter of affordability, regardless of the litigation.”

Senate Majority Leader Mitch McConnell (R-KY) on Tuesday also expressed his support of the protections. “Everybody I know in the Senate — everybody — is in favor of maintaining coverage for pre-existing conditions. There is no difference in opinion about that whatsoever,” he said.

Healthcare Reform News Update for June 11, 2018

California AG & AHIP to Fight Government’s ACA Case

California Attorney General Xavier Becerra and the insurance company lobbying group America’s Health Insurance Plans (AHIP) have separately made statements that they will defend the Affordable Care Act against measures taken by the Trump administration.

The Justice Department on Thursday requested that a federal court invalidate some provisions of the law, including the individual mandate and protections for pre-existing conditions. Becerra is leading an effort by several Democratic attorneys general to defend the ACA in the case.

“It’s, simply put, an attack on the healthcare that millions of Americans have come to count on […],” Becerra said about the Justice Department’s decision.

AHIP announced Friday that it would file an amicus brief to provide specifics on the damage that could come from invalidating the ACA measures.

“Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” AHIP said in a statement.

KFF Tracks 2019 ACA Premium Changes

As it’s done since 2014, the Kaiser Family Foundation is monitoring and compiling insurance company filing information for next year’s Affordable Care Act plan premiums.

The analysis displays 2019 proposed premium rates for a major city in each state. The charts provide rates for a 40-year-old nonsmoker for the lowest-cost bronze plan and the second-lowest cost silver plan, which is used to determine subsidy rates. In addition, a tracker shows the number of insurance companies offering ACA plans in each state and the average difference in rates compared to 2018.

KFF will update the information as it becomes publicly available.

Healthcare Reform News Update for June 8, 2018

Trump Administration Reviewing ACA Consumer Protections, Individual Mandate

The Justice Department told a federal court Thursday that it would no longer defend key parts of the Affordable Care Act, including provisions that protect people with pre-existing conditions, saying they are part of an unconstitutional scheme.

In a brief filed in a Texas federal court, the department said the individual mandate was unconstitutional. It also said that the protections for people with pre-existing conditions should be eliminated.

The brief said that other portions of the law, including Medicaid expansion, health insurance marketplaces, and premium subsidies could remain as-is.

If a federal court agrees with the Justice Department, ACA consumer protections could be abolished. Any court rulings regarding the brief could take months to decide.

NC Farm Bureau Requests Association Health Plan

Following the lead of groups in Tennessee and Iowa, the North Carolina Farm Bureau has asked the state Senate to approve an association health plan that does not meet Affordable Care Act consumer protections.

Details of the plan have not been released, but the president of the bureau said premiums would vary based on an enrollee’s pre-existing conditions or medical history.

VA Governor Signs Medicaid Expansion Bill

Virginia Governor Ralph Northam (D) signed a bill into law Thursday allowing about 400,000 low-income residents to enroll in Medicaid, making it the 33rd state to do so under the Affordable Care Act.

“As a doctor and a public servant, I believe making sure all Virginians have the access to the care they need to be healthy and productive is both a moral and economic imperative,” said Northam.

Medicare Advantage Plans Could Skirt Chronic Care Act Benefits

Insurance companies that offer Medicare Advantage plans may not offer new benefits outlined in the Chronic Care Act to avoid enrolling seniors with fragile health conditions, according to a new analysis in the New England Journal of Medicine.

The new law expands nonmedical services that MA plans can cover, such as scooters, grab bars, hearing aids, and personal care services. The analysis warns that insurance companies may fail to offer these extra benefits to keep costlier, severely ill seniors from joining the plans.

Representatives from insurance companies dispute the analysis. For example, they say the authors did not take into consideration Medicare Advantage Dual Eligible Special Need Plans (D-SNPs), which enroll chronically ill beneficiaries.

“The argument being made by these authors is speculative and does not recognize some of the important realities of the Medicare Advantage program,” said AHIP spokesperson Cathryn Donaldson.

Healthcare Reform News Update for June 7, 2018

HHS to Allow Insurance Companies to Practice ‘Silver Loading’

Health and Human Services Secretary Alex Azar said Wednesday that his department will continue to allow insurance companies to practice “silver loading” for 2019 Affordable Care Act policies.

During a hearing before the House Education and Workforce Committee, Azar said banning silver loading was not possible for 2019 because it would “require regulations, which simply couldn’t be done in time.”

Silver loading raises the premiums of midlevel silver plans, which causes subsidy rates to rise accordingly. The practice can lower the out-of-pocket costs for enrollees eligible for tax subsidies, in some cases making low-level bronze plan premiums $0 per month. However, the practice increases the amount the government pays and can make premium prices for higher-income enrollees a burden.

Healthcare Reform News Update for June 6, 2018

Medicare Financials Worsening Due Partly to ACA Mandate Repeal

Medicare program trustees said Tuesday that Medicare Part A, which covers inpatient hospital stays, could run out of money by 2026, three years sooner than estimated a year ago.

In their annual report, trustees said Medicare’s insurance trust fund for hospital expenses is not sufficiently financed because of lower payroll taxes, Social Security tax cuts, the repeal of the Affordable Care Act’s individual mandate penalties, and the repeal of an ACA board responsible for overseeing spending.

The repeal of the individual mandate is expected to increase the number of uninsured Americans, which could leave hospitals with increased rates of uncompensated care. A Medicare fund helps hospitals with high numbers of uninsured patients cover those costs.

Treasury Secretary Steven Mnuchin says that efforts by the Trump administration will help reduce the financial outlook for both Medicare and Social Security. “Robust economic growth will help to ensure their lasting stability,” he said.

Medicare Part B, which covers doctor visits and outpatient care, is expected to remain solvent.

ACA’s Risk Adjustment Program Affects Plan Rates for Low-, High-Risk Insurers

Because of the way the Affordable Care Act’s risk adjustment program is structured, insurance companies that don’t anticipate a large drop in ACA plan enrollment for 2019 are proposing premium increases.

The risk adjustment program requires plans with low-risk younger, healthier enrollment to help offset plans with older, sicker members.

The Trump administration’s repeal of the ACA’s individual mandate is expected to cause low-risk people to drop their coverage. With fewer enrollees in the plan, insurance companies that pay into the risk adjustment plan will either have to increase their risk adjustment dollars or pay less into the system, which in turn affects high-risk plans.

“Even if any given insurer doesn’t actually expect their members to dis-enroll, they still have to raise premiums because this is a community-rated market,” said Erin Trish, a health policy professor at the University of Southern California.

Senate Democrat Vows to Force Healthcare Votes in August

After Senate Majority Leader Mitch McConnell (R-KY) canceled a scheduled August recess, Senate Majority Leader Chuck Schumer (D-NY) announced that he wants to use that time to put five Democratic-backed healthcare proposals up for a vote.

In a letter to McConnell, Schumer wrote, “We believe this previously unscheduled session time can be put to good use to finally help Americans secure the affordable health care the President and Congressional Republicans have thus far failed to deliver.”

Healthcare Reform News Update for June 5, 2018

New York, Washington Propose 2019 Double-Digit ACA Premium Hikes

Health insurance companies in New York and Washington have submitted double-digit rate hike requests for 2019 plans sold on the Affordable Care Act exchanges.

Fourteen insurers in New York have asked state regulators to raise rates an average of 24 percent due to the repeal of the ACA’s individual mandate. State regulators estimate that premium requests would have increased 12 percent without the repeal.

In Washington, rate hikes averaged 19.08 percent, citing the Trump administration’s recent proposals for short-term insurance and association plans as the cause.

The rate requests must be approved by the states prior to being implemented.

Judge Orders Maine Governor to Implement ACA Medicaid Expansion

In November, Maine voters approved the expansion of Medicaid through the Affordable Care Act, but Republican Governor Paul LePage has delayed implementation. A state judge on Monday gave LaPage a deadline of June 11 to submit details to the federal government.

The expansion would provide 70,000 low-income residents with health coverage.

Healthcare Reform News Update for June 4, 2018

Business Coalition Objects to IRS’s Handling of ACA Employer Mandate

Business trade groups, including the U.S. Chamber of Commerce and the National Retail Association, have sent a letter to the Trump administration objecting to the Internal Revenue Service’s tactics in collecting assessments for the Affordable Care Act’s employer mandate.

The coalition believes the IRS has not followed due process requirements in collecting approximately $4.3 billion in 2015 taxes. The letter states that the assessments should be suspended due to the “cost, complexity and confusion surrounding compliance with the employer mandate.”

More than 30,000 employers owe taxes due to the ACA regulation mandating that companies with 50 or more full-time employees provide health insurance, according to the IRS.

Texas Insurance Company Delays New ER Payment Policy

Blue Cross and Blue Shield of Texas will delay its new emergency room payment policy for 60 days while the state’s insurance department seeks clarification on how the company’s process will be implemented.

The company plans to charge its 500,000 HMO plan members 100 percent of ER costs if it’s determined that the visit was not related to a serious or life-threatening condition.

Texas Insurance Commissioner Kent Sullivan requested information on the company’s denial process, patient appeal rights, and communication methods to new members.

Medicare Beneficiaries Paying More for Brand-Name Drugs

Throughout a five-year period, Medicare beneficiaries decreased their Part D brand-name prescriptions by 17 percent but spent 40 percent more in out-of-pocket costs due to rising prices, according to a new report released today by the Health and Human Services inspector general’s office.

Between 2011 and 2015, the annual cost of brand-name drugs rose on average from $161 to $225. These costs will continue to rise, according to the report.

Other findings include:

  • Costs for the top 200 most-prescribed medications increased more than double the rate of other drugs.
  • From 2011 to 2015, Medicare beneficiaries with out-of-pocket drug expenses of more than $2,000 doubled to 7.3 percent.
  • During the five-year period studied, spending for brand-name drugs rose from $58 billion to $102 billion, an increase of 77 percent.
  • Manufacturer rebates had little impact in slowing the increase in costs.

Healthcare Reform News Update for May 31, 2018

NJ Governor Signs State Individual Health Insurance Mandate

New Jersey Governor Phil Murphy has enacted an individual mandate law that requires all state residents to have health insurance or pay a penalty.

Similar to the recently repealed Affordable Care Act individual mandate, the state’s penalty is 2.5 percent of household income or $2,085 per person, whichever is higher. The maximum penalty will be the average annual cost of a bronze plan. Residents who cannot afford health coverage could receive a hardship exemption determined by the state treasurer.

The law goes into effect January 1, 2019. The expected $90 to $100 million collected in penalties from the law will be used to fund a state reinsurance program.

The new law is the second state individual mandate in the country. Massachusetts enacted its law in 2006.

Virginia to Enact ACA Medicaid Expansion

The Virginia legislature voted Wednesday to expand Medicaid to as many as 400,000 residents under the Affordable Care Act. The state becomes the 33rd to adopt the program.

Virginia’s program includes a work requirement and a mandate that enrollees who earn wages over the federal poverty line must pay more out-of-pocket for medical services.

Majority of Healthcare Groups Critical of President’s Insurance Proposals

More than 95 percent of healthcare groups oppose two recent proposals from the Trump administration, according to a Los Angeles Times’ analysis of comments submitted to federal agencies.

More than 300 groups representing patients, consumers, physicians, nurses, hospitals, clinics, and insurance companies have left public comments in letters filed with federal agencies about proposed rules to expand short-term coverage plans and loosen association health plan regulations.

The review found that:

  • 95% of healthcare groups left comments critical of the association health plan proposal.
  • 98% of groups left comments critical of the short-term health plan extension.
  • 25 state officials submitted critical comments about one or both of the proposals.
  • Six state insurance officials submitted positive comments about one or both of the proposals.

Healthcare Reform News Update for May 25, 2018

Bipartisan Bill Proposes Delay of ACA’s Health Insurance Tax Until 2021

A bill introduced Thursday by bipartisan House members proposes to delay the Affordable Care Act’s health insurance tax until 2021.

The tax was enacted in 2014, but it was suspended last year and for 2019. Insurance companies are required to pay the tax for this year.

A delay of the tax could help prevent premium increases of up to 2.8 percent; however, it could also lead to a decrease in federal revenue by $144.7 billion over 10 years.

Healthcare Reform News Update for May 24, 2018

CBO Report: ACA Premiums, Number of Uninsured to Rise Through 2028

The Congressional Budget Office (CBO) issued a report Wednesday projecting a 15 percent rise in silver plan premiums and an additional 3 million uninsured people next year. The report projects continued increases through 2028, with premiums rising about 7 percent each year and the number of uninsured rising to 35 million people.

The increases are due to the repeal of the Affordable Care Act’s individual mandate and other alterations of the law by the Trump administration, according to the report.

The CBO also estimates the total cost of subsidies for ACA health plans and other individual health coverage will be $55 billion this year.

Healthcare Reform News Update for May 22, 2018

CDC Survey: 2017 Uninsured Rate Remained Steady at 9.1%

In 2017, the uninsured rate remained flat at 9.1 percent, which is just over 29 million people, according to a new survey from the Centers for Disease Control and Prevention (CDC).

Although the overall numbers were statistically unchanged from the end of the Obama administration into the beginning of President Donald Trump’s presidency, some groups are seeing a rise in not having insurance coverage. The CDC’s data show that:

  • The middle-class uninsured rate rose to 8.2 percent possibly due to rising premiums and no subsidized coverage.
  • Uninsured rates rose to an average of 19 percent in states that did not expand Medicaid coverage per the Affordable Care Act.

The survey also found a rise in the use of high-deductible health plans with almost 44 percent of insured Americans with deductibles that are at least $1,300 for individuals and $2,600 for families.

Healthcare Reform News Update for May 21, 2018

Four Healthcare Bills in Virginia Rejected by Governor

Virginia Governor Ralph Northam (D) on Friday vetoed four separate pieces of healthcare legislation that he said would destabilize the marketplace.

The vetoed bills sought to establish association plans, create nonprofit “benefits consortiums,” allow the purchase of short-term policies for up to a year, and allow more people to purchase catastrophic health plans.

In each of his veto statements, Northam said, “this legislation would place consumers at risk of being underinsured and would fragment Virginia’s federal marketplace risk pool, leading to rapidly increasing premiums.”

Northam would prefer to lower healthcare costs by expanding Medicaid to the state’s low-income adults. In each veto statement, he said, “we are fortunate to have a better opportunity to expand healthcare to people who need it and make it more affordable for all Virginians.”

Maryland Reinsurance Program Delayed

A $462 million reinsurance program proposal created by Maryland has been delayed, and acceptance is uncertain due to a disagreement from the two insurance companies that sell plans on the state’s Affordable Care Act exchange.

Kaiser Permanente of the Mid-Atlantic States claims that the reinsurance plan would favor CareFirst BlueCross BlueShield through “double dipping” the reinsurance program and a separate federal risk adjustment plan.

The state’s ACA marketplace, The Maryland Health Benefit Exchange, has asked for an independent analysis, which will not be complete until June 30. This poses a problem for the state as the deadline to file an application with the Centers for Medicare & Medicaid Services is May 31.

Healthcare Reform News Update for May 18, 2018

Insurance Companies Selling ACA Plans Received Highest Profits in 2017

Companies selling individual health plans on the Affordable Care Act marketplace posted their strongest financial year in 2017, according to a new Kaiser Family Foundation report.

The findings are based on two different financial indicators:

  • The average share of health premiums paid out in claims fell to 82 percent in 2017. In 2016, it was 96 percent. In 2015, it was 103 percent.
  • Average premiums collected in excess of claims were $79 in 2017 per member per month, compared to $14 in 2016 and $9 in 2015.

The analysis indicates that future profitability is unclear. “These new data from 2017 offer further evidence that insurers in the individual market are regaining profitability, even as political and policy uncertainty, repeal of the individual mandate penalty as part of tax reform legislation, and proposed regulations to expand loosely-regulated short-term insurance plans cloud expectations for the future,” according to the analysis.

CMS Rejects Ohio’s Plan to Nullify ACA Individual Mandate

The Centers for Medicare & Medicaid Services (CMS) has denied Ohio’s request to eliminate the Affordable Care Act’s provision that all residents have health care coverage.

In a letter to the state’s Department of Insurance, CMS said the state failed to provide an alternate program that was equivalent to ACA coverage and did not provide a reason for the request.

Congress repealed the tax penalty for not having tax coverage in December, but the requirement for having insurance still remains part of the law.

The state is reviewing CMS’ position and is working to develop potential responses.

California ACA Premiums Expected to Rise 11%

Covered California, the state’s ACA marketplace, released estimates Thursday projecting that 2019 individual plan premiums will rise 11 percent and enrollment will drop 12 percent. Actual premium increase amounts will be announced in July.

The state has the largest ACA enrollment in the country with 2.4 million people, including 1.3 million who receive subsidies.

Healthcare Reform News Update for May 17, 2018

Federal Judge Allows Democratic States to Proceed in ACA Lawsuit

A federal judge has granted California Attorney General Xavier Becerra and 16 other attorneys general from Democratic states the right to intervene in a lawsuit filed in Texas that seeks to eliminate the Affordable Care Act.

“Today’s ruling allows us to protect the health and wellbeing of these Americans by defending affordable access to healthcare,” Becerra said. “Before the Affordable Care Act, Americans had shorter lives and paid twice as much for their healthcare as other developed countries. The passage of the ACA was the first step toward fixing that problem. We must continue to move forward, not backward.”

The lawsuit was filed in February by Republican attorneys general who argue that the repeal of the ACA’s individual mandate made the law unconstitutional.

Graham Continues ACA Repeal and Replace Efforts

Senator Lindsey Graham (R-SC) said Wednesday that he is continuing his efforts to put together a bill to repeal and replace the Affordable Care Act.

Graham’s new bill is expected to contain components from his failed effort last year that gives block grant money to states instead of subsidies or Medicaid expansion.

“I haven’t given up. Will there be another effort to replace Obamacare with a state-centric plan? I hope so,” he said.

VT Governor Signs Bill to Allow Drugs From Canada

Republican Governor Phil Scott of Vermont signed first-of-its-kind legislation on Wednesday to allow importing prescription drugs from Canada.

The law allows Canadian drug wholesalers to sell their products to wholesalers in Vermont. Other states permit individuals, but not wholesalers, to import prescription drugs. Before being enacted, the law must first be certified by the Department of Health and Human Services.

Both President Donald Trump’s administration and drug companies have voiced their opposition to the legislation.

Healthcare Reform News Update for May 16, 2018

Expanded Short-Term Health Plans Could Cost Government $1.2 Billion

President Donald Trump’s proposal to increase short-term health plans to 12 months would attract more consumers and cost up to seven times more than previously estimated, according to an independent study conducted by Medicare’s chief actuary Paul Spitalnic.

Originally, the Trump administration estimated that the plans would enroll a few hundred thousand consumers and cost between $96 million and $168 million a year. However, the plan could increase federal spending by $1.2 billion next year, Spitalnic believes.

Spitalnic estimated that premiums for the short-term plans would average $340 per month compared to $600 for unsubsidized silver plans sold on the Affordable Care Act exchanges. The lower cost of the plans would attract people who don’t need all the essential benefits, which would lead to “relatively less healthy” people in the ACA marketplaces.

The study also found that “skimpy” short-term plans would cover 50 percent of enrollee costs, compared to 70 percent for ACA silver plans.

Oregon ACA Plans Request 8% Average Increase

Oregon’s seven insurance companies that sell Affordable Care Act plans have requested premium changes for 2019 that would raise costs an average of 8 percent.

The increases range from Regence BlueCross and BlueShield’s 5 percent hike to HealthNet’s request of 16.3 percent. PacificSource is the only company asking for a decrease, requesting 10 percent lower premiums due to lower-than-expected costs.

Oscar ACA Plans to Expand Into More States

Oscar Insurance Corp. announced that it will begin to sell Affordable Care Act plans in Arizona and at least three additional states for 2019 enrollment. Due to incomplete state filings, Oscar CEO Mario Schlosser was not able to name the other markets it will enter.

“We feel comfortable that the risk pool will remain comfortable, and that we can roll out the blueprint for expansion that we have in more areas,” Schlosser said.

This year, Oscar enrolled 240,000 people in ACA plans, up from 90,000 in 2017.

Healthcare Reform News Update for May 15, 2018

Survey: Number of Uninsured Americans Rises to 15.5%

About 15.5 percent of Americans between 19 and 64 are uninsured in 2018, up from 12.7 percent in 2016, according to a new Commonwealth Fund tracking survey. That’s 4 million people who have dropped coverage between the two years.

Specific findings in the survey include:

  • Texas leads the nation in uninsured residents with 4.5 million without insurance. That number includes nearly 700,000 uninsured children.
  • States that have not implemented the Affordable Care Act’s Medicaid expansion have seen a rise in uninsured residents from 16.1 percent in 2016 to 21.9 percent this year.
  • About 20 percent of people in the South are currently uninsured.
  • About 5 percent of adults are expected to drop coverage in 2019 due to the repeal of the ACA’s individual mandate.

HHS Considers Plans to Reduce Medicare Drug Prices

Health and Human Services Secretary Alex Azar announced that he is studying a plan to help lower the cost of prescription drugs for Medicare beneficiaries.

Azar wants to simplify the way Medicare pays for some expensive drugs by having them paid through Part D instead of Part B.

“We believe there are more private sector entities equipped to negotiate these better deals in Part B, and we want to let them do it. More broadly, the President has called for me to merge Medicare Part B drug payments into Part D, where negotiation has been so successful,” Azar said.

A pilot program could be used to roll out the new plan, but no details have been released.

Medica Doubles ACA Enrollment Numbers

Health insurance company Medica increased the number of people enrolled in plans it sells on the Affordable Care Act marketplace from 91,000 in 2017 to 196,479 in 2018. Most of the increase came from Iowa and Nebraska, where it is currently the only choice on the state exchange.

Maryland’s Expanded Medicare All-Payer Model Approved

The Centers for Medicare & Medicaid Services (CMS) approved Maryland’s requests to expand its unique all-payer model.

The state requires Medicare payers to charge the same rate for all hospitals. The new model will include nonhospital community providers such as long-term care and mental health facilities.

The new model is expected to save Medicare $1 billion by 2023.

Healthcare Reform News Update for May 14, 2018

Up to 10% of ACA Enrollees Could Switch to Association Health Plans

Enrollment in Affordable Care Act plans could drop anywhere from 3 to 10 percent due to people switching to less-expensive association health plans (AHPs), according to a new study released Friday by The Actuary magazine.

The study analyzed two scenarios based on how association plans could be implemented by the U.S. Department of Labor. In both scenarios, the analysis showed that:

  • healthier people are more likely to switch to association health plans.
  • the cost of ACA premiums would rise as a result.

The first scenario projects a 3 percent drop in ACA enrollment if self-employed individuals are allowed to opt in to AHPs. In this instance, enrollees would be subject to strict verification requirements and could not be excluded due to health status.

The second scenario projects a 10 percent drop in ACA enrollment if self-employed AHP enrollees could be excluded based on health status and the regulations preempt some state regulatory authority.

Healthcare Reform News Update for May 11, 2018

HHS Secretary Defends 12-Month Short-Term Insurance Plans

During a Senate budget hearing Thursday, Health and Human Services (HHS) Secretary Alex Azar reiterated his support of short-term insurance plans that can be purchased for up to 12 months.

The lower-cost plans do not require the Affordable Care Act’s 10 essential benefits nor are they required to cover pre-existing conditions.

Azar said that the plans “may not be the right option for everybody” but are better than being uninsured. “If we start making them the equivalent of the Affordable Care Act, we’ll end up with the same pricing regime [and the problem of unaffordable insurance won’t be solved],” he said.

NY and MN Settle Lawsuit Over ACA’s Basic Health Programs

Officials in New York and Minnesota have settled a lawsuit against Health and Human Services (HHS) over its decision to cut funding for the states’ Basic Health Programs, which insure residents whose income is above the Medicaid threshold, but below 200 percent of the poverty level.

HHS will pay $151.9 million to New York and $17.3 million to Minnesota by May 14.

“We are gratified that the federal government has agreed to make this interim payment,” Acting New York Attorney General Barbara Underwood said in a statement. “We hope and expect that, in the coming weeks, we’ll reach agreement with the federal government on a payment formula for the program, so that we can resolve this matter fairly and appropriately for all New Yorkers.”

HHS stopped funding the programs in December 2017 as part of the decision to stop cost-sharing reduction (CSR) payments to insurance companies. Funding for the Basic Health Programs is partially determined by CSR subsidy amounts.

The Basic Health Programs were established by the Affordable Care Act and cover 800,000 low-income people in New York and Minnesota, the only states that operate the programs.

Healthcare Reform News Update for May 10, 2018

CMS to Update Online Medicare Plan Finder Tool

At the urging of patient advocates, the Centers for Medicare & Medicaid Services (CMS) will update its Medicare Plan Finder tool to make it easier for consumers to navigate.

“CMS is undertaking several consumer-friendly improvements for Medicare Open Enrollment so that people with Medicare can make an informed choice between original Medicare and Medicare Advantage,” said CMS Administrator Seema Verma.

Some of the new features will include:

  • A mobile out-of-pocket cost calculator for prescription drugs
  • A simplified login process
  • A webchat option

The improvements will be ready by the 2019 enrollment period, which begins October 15, Verma said.

GOP Senators Try to Accelerate ACA State Waiver Process

Republican Senators Lamar Alexander (TN) and Susan Collins (ME) are in discussions with CMS Administrator Seema Verma about expediting the process for states to obtain Affordable Care Act innovation waivers to establish reinsurance programs.

Insurance companies are beginning to request premium increases for 2019 plans, and reinsurance programs can help balance the increases, but getting approval in time is a factor.

“Obviously most of what we proposed to do has to be done with legislation, but [Verma] might have some flexibility to change things,” Alexander said.

Healthcare Reform News Update for May 9, 2018

CMS Hopes to Improve Services in Rural Areas

The Centers for Medicare & Medicaid Services (CMS) unveiled a new rural healthcare strategy Tuesday that addresses how its policies affect rural providers and communities.

The department wants to alleviate disparities by:

  • Loosening telehealth regulations
  • Reaching out to rural providers to increase awareness of CMS programs
  • Pinpointing the policies that work best for the 60 million people who live in rural areas

“This administration clearly understands that one of the keys to ensuring that those who call rural America home are able to achieve their highest level of health is to advance policies and programs that address their unique healthcare needs,” said CMS Administrator Seema Verma.

The document did not contain any specific policy measures.

Senator Working With Trump Administration on ACA Flexibility

After failing in a bipartisan effort with Senator Patty Murray (D-WA) to help stabilize the Affordable Care Act marketplace and lower premiums, Senator Lamar Alexander (R-TN) is now in talks with the Trump administration for solutions.

In a recent letter to supporters, Alexander said that he is working with the president’s officials to find “other administrative actions they can take to give states more flexibility to help lower health insurance premiums, especially for the 9 million working Americans in the individual market who do not receive a federal subsidy.”

In a separate statement, Murray expressed her disappointment with Alexander’s partisan efforts.

Healthcare Reform News Update for May 8, 2018

CMS Hires Contractor to Validate Medicare Beneficiary Addresses

The Centers for Medicare & Medicaid Services (CMS) has signed an emergency $5.5 million contract with a vendor to help ensure that the new Medicare ID cards are mailed to the correct beneficiaries.

A data vulnerability revealed that some addresses may not be accurate. West Publishing Corp. has been tapped to track down beneficiaries and ensure that the cards are not misdirected.

CMS has planned to mail new cards to approximately 60 million Medicare enrollees by April 2019.

Maryland Insurers Request 2019 ACA Rate Hikes of up to 91%

Two health insurance companies in Maryland have sent requests to the state for double-digit premium increases on 2019 plans sold on the Affordable Care Act marketplace.

CareFirst BlueCross BlueShield has asked for an increase of 18.5 percent for its HMO plans and a hike of 91.4 percent for its PPO plans. Kaiser Permanente has proposed an overall 37.4 percent increase.

The companies cite several Trump administration policies that may cause healthy people to drop their coverage, including the repeal of the individual mandate, intentions to allow short-term plans to extend the maximum period to 12 months, and the approval of “skimpier” health plans that do not meet all ACA regulations.

State regulators must approve the increases by the annual enrollment period in November before they can go into effect.

House Farm Bill Includes Establishment of Association Health Plan

The House version of a massive farm bill includes $65 million in loans and grants to help organizations create association health plans for ranchers, farmers, and other agribusiness.

The bill proposes that, beginning in 2019, the secretary of Agriculture could issue up to 10 loans of no more than $15 million each to existing agricultural associations. Due to changes from the Trump administration, the plans would not have to offer the Affordable Care Act’s 10 essential health benefits.

The bill was approved by the House Committee on Agriculture last month but is currently waiting consideration on the House floor.

Texas Regulators Demand Clarity in LTCI Rate Hike Letters

The Texas Department of Insurance has sent a bulletin to insurers that offer long-term care coverage, urging them to clearly explain rate hikes to beneficiaries.

In the bulletin, the department “strongly encourages carriers to use plain language in all rate change notices and other communications.” It requests that any notifications to enrollees include:

  • A clear explanation of the rate change
  • What options the consumers have
  • How to get more information
  • Any appropriate deadlines

In addition, insurers “must explain why a rate adjustment was necessary, and the increase must be certified by an actuary credentialed by both the Society of Actuaries and the American Academy of Actuaries. The explanation of the increase should not be false or misleading,” according to the bulletin.

Healthcare Reform News Update for May 7, 2018

Virginia Insurance Companies Ask for Double-Digit Premium Increases

Two insurance companies in Virginia have requested significant premium rate hikes for their 2019 Affordable Care Act health plans, citing the repeal of the individual mandate as the primary reason.

Cigna has asked for an average premium increase of 15 percent for its 103,264 Virginia enrollees. CareFirst BlueCross BlueShield is seeking a 64 percent hike for its 4,500 enrollees.

However, Optima Health has asked for a 5 percent decrease for 2019 ACA premiums. The remaining four state insurers participating in ACA exchanges have yet to file rate requests.

Healthcare Reform News Update for May 3, 2018

Price Explains Support for ACA Individual Mandate Repeal

Former Health and Human Services Secretary Tom Price said that comments he made at Tuesday’s World Health Care Congress were taken out of context. At the event, Price said the repeal of the Affordable Care Act’s individual mandate would increase insurance premiums and destabilize the marketplace.

“Repealing the individual mandate was exactly the right thing to do. Forcing Americans to buy something they don’t want undermines individual liberty as well as free markets. The only fair and effective way to bring down health-care costs is to allow markets to create more choices for consumers and small businesses,” Price said in a statement on Wednesday.

Healthcare Reform News Update for May 2, 2018

Former HHS Secretary Criticizes ACA Individual Mandate Repeal

Tom Price, former secretary of Health and Human Services, said Tuesday that the repeal of the Affordable Care Act’s individual mandate will drive up premiums and damage marketplace stability.

“[…] There are many, and I’m one of them, who believes that that actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently, that drives up the cost for other folks within that market,” he said.

Price’s remarks during the World Health Care Congress are a reversal from his previous position during his time in the Trump administration, where he pushed for a repeal of the law and its individual mandate.

CMS Concerned About Medicaid Work Requirements in Non-Expansion States

Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said Tuesday that she’s worried about some people losing coverage if Medicaid work requirements are approved in states that have not expanded Medicaid under the Affordable Care Act.

Verma is concerned about a “subsidy cliff.” This would happen if a person earns enough to make them ineligible for Medicaid but not enough to receive a subsidy for a marketplace plan, causing them to be uninsured.

“Because there is no tax credit for them to move on to the exchanges, what happens to those individuals? We need to figure out a pathway, a bridge to self-sufficiency,” Verma said.

Work permit waivers in Arkansas, Indiana, and Kentucky have been approved. Kansas, Maine, Mississippi, Utah, and Wisconsin are currently seeking waivers, with other states expected to follow soon.

Healthcare Reform News Update for May 1, 2018

ACA Medicaid Expansion an Issue in Maine, Idaho, and Virginia

Several of the 18 states that have not expanded Medicaid through the Affordable Care Act are now either putting the measure up for ballot votes or creating legislation. Under the ACA, Medicaid expansion provides insurance coverage to adults earning up to 138 percent of the federal poverty level, which is $16,800 for an individual and $34,600 for a family of four.

The topic has been raised this week in Maine, Idaho, and Virginia:

  • In Maine, supporters of the Affordable Care Act filed a lawsuit against the Maine Department of Health and Human Services to force it to implement a law that was approved by voters in November. Republican Governor Paul LePage refuses to expand Medicaid services to the 80,000 residents that qualify, despite 59 percent of voters approving the measure.
  • An activist group in Idaho has collected enough signatures to put the measure on the ballot in this fall’s election. Similar efforts are underway in Nebraska and Utah.
  • In Virginia, the state legislature is working on an expansion bill that includes a work requirement for eligible enrollees. Arkansas, Indiana, and Kentucky have previously been granted approval to require that Medicaid beneficiaries be employed.

Healthcare Reform News Update for April 30, 2018

House Democrat Proposes Changes to ACA Enrollment

Representative Ami Bera (D-CA) has unveiled two healthcare bills that would change how and when people sign up for individual insurance.

Bera’s first bill proposes reducing uninsured rates by providing states with grants to test a system that would automatically enroll consumers into Affordable Care Act health plans or Medicaid. Enrollees would have 60 days to opt out.

“Reducing complexity and making non-enrollment the onerous choice has been found to be both popular and effective. Opt-out enrollment in retirement plans boosted participation rates to 90 percent from just 33 percent using traditional enrollment,” according to Bera’s office.

His second bill moves the end of the open enrollment period to April 15, lining up with the deadline to file taxes. Bera thinks consumers would be more willing to sign up in spring rather than the busy holiday season.

Healthcare Reform News Update for April 27, 2018

CMS Extends Renewal of Transitional Health Plans

The Centers for Medicare and Medicaid Services (CMS) has allowed an extension for transitional health plans through December 31, 2019.

Transitional plans were available to individuals and small groups prior to the enactment of the Affordable Care Act (ACA) and do not comply with all of the law’s regulations. These “grandmothered” lower-cost plans were initially allowed to continue coverage in 2014 and have received three prior extensions.

There are currently about 1 million enrollees in transitional plans, and moving these consumers to ACA plans would help lower premiums, experts say. Since transitional plans base their premium costs on health status, they often attract healthier Americans, which increases the premiums of plans sold on the ACA marketplace.

States are allowed to discontinue the transitional plans, but many lawmakers fear that doing so would cause consumers to cancel their health coverage.

20 States Ask Court to Invalidate the Affordable Care Act

A coalition of 20 states, led by the attorneys general of Texas and Wisconsin, has asked a federal court to temporarily overturn Affordable Care Act regulations.

The coalition filed its original suit in February. The suit argues that, when Congress repealed the penalty for being uninsured, it invalidated the overall law. That lawsuit has been challenged by 16 Democratic governors.

This latest filing asks the court to grant a preliminary injunction while the larger suit proceeds.

Healthcare Reform News Update for April 26, 2018

New BCBS of Texas Policy Could Put 100% of ER Costs On Enrollees

Blue Cross and Blue Shield of Texas has implemented a controversial new emergency room policy for its 500,000 group and individual HMO members: Beginning in June, enrollees who visit an out-of-network emergency room will pay 100 percent of the costs if it’s later determined that the trip was unnecessary.

The policy is intended to prevent consumers from going to an emergency room for minor problems such as “head lice or sprained ankles,” according to a company memo sent to brokers and consultants. “We want to make healthcare affordable for our members, and to do so, we have to be good stewards of their money.”

The new policy is a reaction to higher than normal out-of-network emergency room claims, especially for freestanding locations.

A licensed physician will review all claims before determining if it will be accepted or denied. Patients will have the ability to appeal any decision. The new policy would not apply to children under 12 months.

Some consumer advocates and doctor groups are concerned that the policy could cause patients to second-guess their decisions and result in delayed care.

The Texas Department of Insurance says it will investigate if the policy meets state approval. “We’ll be watching this closely to make sure consumers have access to care and understand their rights,” said the agency in a statement.

California Marketplace Director Calls on HHS to Restore ACA Outreach Funds

Peter Lee, the executive director of California’s state-run Affordable Care Act marketplace, has requested that Health and Human Services (HHS) reinstate the previous funding levels for advertising and outreach for the ACA’s open enrollment period.

In a letter to HHS Secretary Alex Azar on Wednesday, Lee warned that the 90 percent cut to funding by the department last year will be a factor in higher health insurance premiums for ACA plans.

“The reality is clear: If the federal government maintains the current cuts in marketing and outreach, premiums will be higher than necessary, consumers will be hurt as a result, and taxpayers will pay the price by supporting higher [than] necessary subsidies,” Lee wrote.

Throughout the past two years, enrollment for ACA plans on the national marketplace declined by 9 percent overall, and first-time enrollees decreased by 40 percent. For state-run ACA marketplaces, which maintained their outreach funding levels, enrollment remained steady.

Healthcare Reform News Update for April 24, 2018

New HHS Medicare Rules Tease Expected Increase in Uninsured Consumers

The Centers for Medicare and Medicaid Services’ (CMS) annual updates to Medicare payment rules suggest the Trump administration expects more Americans to be without health insurance in the coming year.

The department is proposing a $1.5 billion increase to disproportionate share payments that help hospitals serve patients who are unable to pay their bills. “It is a recognition of what appears to be a trend in uninsured patients across the country. It is critically important to hospitals,” said Charles N. “Chip” Kahn, president of the Federation of American Hospitals.

Other Medicare proposals that CMS would like to implement include:

  • Having hospitals publish their standard charges online in a machine-readable form
  • Improving electronic medical records so that patients can more easily share the data with providers
  • Removing 19 measures of quality that hospitals are required to report and eliminate redundancy in 21 others

Insurance, Hospital Groups Weigh in on Short-Term Health Plans

Associations representing insurance companies and hospitals have sent comments to Health and Human Services Secretary Alex Azar about the department’s plan to extend short-term health insurance plans to 12 months.

America’s Health Insurance Plans, a leading industry lobbying group, warned that the extension would curtail access to affordable comprehensive coverage and raise premiums for those with pre-existing conditions. “Policies that disproportionately draw healthy consumers away from the individual market, like expanding access to short-term plans, will likely have an even more devastating effect on affordability, choice, and competition,” the organization said.

Alliance of Community Health Plans believes short-term plans should remain capped at their existing 90-day limit and an extension would destabilize the individual health insurance marketplace. Association for Community Affiliated Plans also expressed concern that the plans would harm consumers and warned that, in the past, coverage has been rescinded for some beneficiaries who try to file substantial claims.

Some insurance companies, such as Aetna, Agile Health Insurance, and The IHC Group, are generally in favor of the proposal but request some consumer protections, including:

  • Allowing plans to be in effect until the next open enrollment period
  • Prohibiting the practice of denying claims based on pre-existing conditions more than a year old
  • Limiting policy rescissions to occurrences when enrollees omit information on applications
  • Creating a minimum coverage guarantee
  • Allowing state insurance departments to create a standardized policy that would be effective in several states

Healthcare Reform News Update for April 23, 2018

Kaiser Releases Explanatory Brief on Short-Term Plans

Because the repeal of the Affordable Care Act’s individual mandate has put a larger focus on short-term health plans, the Kaiser Family Foundation compiled a brief on the plans and how they differ from comprehensive ACA plans.

Here are some of the features that distinguish short-term plans from comprehensive ACA plans:

  • Applicants with health conditions man pay more or be denied coverage due to health status, gender, age, and other factors.
  • Coverage may be excluded due to pre-existing conditions.
  • The plans are not required to cover the 10 essential health benefits.
  • These plans may include lifetime and annual limits.
  • The plans are not required to include cost-sharing limits.
  • They do not need to meet ACA market requirements, including rate review or minimum medical loss ratios.

AHIP Fears Short-Term Plan Proposal Could Hurt Consumers

Health insurer lobby America’s Health Insurance Plans (AHIP) has expressed its concerns about the Trump administration’s proposal to extend the maximum period of short-term plans to 12 months.

Matt Eyles, chief executive of AHIP, believes consumers may not fully understand what the lower-cost plans offer, which could cause an unexpected loss of coverage.

“We are concerned that this proposed rule will lead to more people being uninsured and under-insured, and to higher costs in the long run. Short-term plans can provide an important temporary bridge for Americans who are transitioning between plans. But they are not a replacement for comprehensive coverage,” Eyles said.

Judge Grants Class-Action Status to Insurance Companies in CSR Lawsuit

Judge Margaret Sweeney of the U.S. Court of Federal Claims has allowed insurance companies to sue the federal government as a class concerning its failure to pay cost-sharing reduction (CSR) payments.

The request for class-action status came from Common Ground Healthcare Cooperative. If the group is successful in court, the government could be responsible for billions in back payments of CSR bills.

The government argued that a class-action suit was not appropriate because damages to individual companies would vary since many insurers raised premiums to offset the CSR payment cutoff.

It’s expected that the government will appeal the decision.

Healthcare Reform News Update for April 20, 2018

Colorado Employees Shouldering Larger Share of Healthcare Costs

Health insurance costs for Colorado employers are rising faster than the national average, and a larger percentage of those costs are being pushed to employees, according to a report released in April.

Professional services firm Lockton found that employer healthcare costs rose in Colorado by 7.7 percent in 2017. Companies responded to the increase in various ways, including raising employee premiums and deductibles, limiting provider networks, increasing the use of telemedicine, and switching insurers. The workarounds resulted in an employer cost increase of 5.8 percent.

The employer changes are likely to affect compensation packages offered by companies and increase employee out-of-pocket costs for healthcare.

A separate study by the Colorado Health Institute showed that less than 50 percent of the state’s population relies on employer-sponsored health plans, even with a record-low uninsured rate. A cause for the drop is currently being evaluated and results should be released in a few months.

Wisconsin Seeks a Federal Waiver for Reinsurance Program

Wisconsin has requested a waiver from the federal government for a state reinsurance program, which will help insurance companies pay for the most expensive claims.

The $200 million program is expected to help lower premiums for the state’s Affordable Care Act health plans by 5 percent in 2019, which is a significant reversal from this year’s increase of 44 percent.

Currently, Wisconsin has more than 202,000 residents enrolled in ACA plans with premiums averaging $751 a month. With the reinsurance program, premiums are projected to average $710.

“We feel very, very positive about our ability to get an approval and do so on a timely basis,” said Wisconsin Governor Scott Walker.

Healthcare Reform News Update for April 19, 2018

Senate Democrats Propose New Healthcare Option

Senators Chris Murphy (D-CT) and Jeff Merkley (D-OR), along with eight Democratic cosponsors, introduced an expanded public option healthcare proposal on Wednesday.

The Choose Medicare Act is a compromise idea that borrows measures from “Medicare for all” proposals and builds on existing measures of the Affordable Care Act.

The proposal gives consumers and businesses the choice to use private health insurance coverage or Medicare-based coverage. It also increases ACA subsidy amounts and includes people with higher income levels than current requirements allow.

CA Hospitals Must Continue ACA Charity Care Obligations

Three hospitals in California have been ordered to pay millions of dollars in lump-sum payments to local nonprofit organizations after state Attorney General Xavier Becerra declined their requests to be relieved from Affordable Care Act charity obligations.

The hospitals argued that insurance gains under the ACA last year overrode the law’s requirement to provide free or discounted care (or other charity donations) in exchange for tax breaks.

Senators Request Justification for Risk Corridor Decisions

The ranking Democrats of the Senate finance and health committees have asked Health and Human Services Secretary Alex Azar to explain the department’s sudden decision to stop making risk-corridor payments to insurance companies on the ACA marketplace.

Ron Wyden (D-OR) and Patty Murray (D-WA) have requested the disclosure of:

  • The accounting practices used to rationalize the decision.
  • Why the department believes it no longer has “unfunded obligations” to the insurance companies.
  • Whether federal accounting standards or Office of Management and Budget (OMB) guidance was used as justification.

“The Trump administration’s approach to funding the risk-corridors program amounts to budgetary whiplash, leaving many unanswered questions about its ability to be good financial stewards of taxpayer funds,” Wyden and Murray wrote.

An HHS spokesperson responded that the department “has updated its accounting of the risk-corridor program to reflect the fact that there is no obligation to make payments beyond the amounts collected from insurers under the program.”

Healthcare Reform News Update for April 17, 2018

Utah Likely to Include ACA Medicaid Expansion on Ballot

Organizers in Utah have collected enough signatures to put an Affordable Care Act expansion of Medicaid initiative on the state’s election ballot this fall. The advocacy group Utah Decides Healthcare needed more than 113,000 signatures; it gathered more than 165,000.

If passed by voters, the measure will allow 150,000 Utah residents who make 138 percent of the federal poverty level to enroll in Medicaid with no enrollment caps.

Utah lawmakers are also working on a “partial expansion” proposal that would include a work requirement and limit enrollment to residents who make up to 100 percent of the poverty level, which is about $25,000 for a four-person family. The proposal would cover 60,000 people. CMS’ approval of the measure is unclear, since the ACA requires the full 138 percent.

Healthcare Reform News Update for April 16, 2018

New Jersey Legislature Approves 3 State Healthcare Stabilization Initiatives

Late last week, New Jersey lawmakers passed three healthcare bills to address rising costs and consumer protections, including a state individual mandate penalty.

The bills awaiting Governor Phil Murphy’s signature include:

  1. A requirement that most New Jersey residents have health insurance, or pay a fine of either 2.5 percent of their household income or $695 per adult and $347.50 per child, whichever is greater. This law would be the first of its kind since President Donald Trump signed the tax bill late last year that included a repeal of the Affordable Care Act’s individual mandate.
  2. A reinsurance plan that helps insurance companies cover the most expensive healthcare claims.
  3. An out-of-network consumer protection measure that requires healthcare providers to disclose whether they are in a patient’s insurance network and discuss the patient’s out-of-pocket costs prior to an appointment. It also includes extensive reporting and transparency requirements for insurance companies.

Congressional Lawmakers Decry Short-Term Insurance Proposal

The top Democrats of five House and Senate committees have asked the Trump administration to scrap its proposed rule to increase the availability of short-term health insurance plans from three months to 12 months.

The short-term plans do not include consumer protections currently included in plans sold on the Affordable Care Act exchanges, including equal premiums for those with pre-existing conditions, as well as coverage for mental health care and prescription drugs.

“This proposed rule would expand the availability of discriminatory, deceptive, and insufficient plans … that deceive consumers into thinking they are covered for major medical expenses and is yet another attempt to sabotage the health care markets on which millions rely for coverage,” wrote Democratic Representatives Richard Neal (MA) and Bobby Scott (VA) and Senators Ron Wyden (OR) and Patty Murray (WA).

Healthcare Reform News Update for April 13, 2018

Poll: Slim Majority Favors a Single-Payer Government Program

A new Washington Post-Kaiser Family Foundation poll shows that 51 percent of Americans are in favor of the government creating a single-payer national health plan.

Democrats are more strongly in favor of a single-payer program, with 74 percent supporting it, compared to nearly 20 percent of Republicans. A majority of Independents support the program, with 54 percent saying they favor the program.

This latest poll mirrors a similar one last year that showed a 53 percent majority supporting a single-payer program.

Healthcare Reform News Update for April 10, 2018

ACA Rules for States Relaxed, New Individual Mandate Exemptions Added

President Donald Trump’s administration has taken steps to weaken Affordable Care Act rules on state insurance standards and provide exemptions to the law’s individual mandate.

Under the final rule issued by the Centers for Medicare and Medicare Services (CMS), states will have more control over individual health plan coverage. States will be allowed to:

  • Have more flexibility in how they choose their essential health benefits (EHB)-benchmark plan. From CMS’s press release: “Instead of being limited to 10 options, states will now be able to choose from the 50 EHB-benchmark plans used for the 2017 plan year in other states or select specific EHB categories, such as drug coverage or hospitalization, from among the categories used for the 2017 plan year in other states.”
  • Request “reasonable adjustments” to the medical loss ratio formula (MLR) if it could help stabilize the state’s healthcare exchange. The MLR is the amount an insurance company spends on medical claims compared with income from premiums.
  • Require state regulators to review premium increases of 15 percent or more. Previously, the threshold was 10 percent.

The administration also added two retroactive exemptions to the rule that requires all Americans to have health insurance coverage. The mandate was repealed late last year, but the penalty is in effect until 2019.

Exemptions will be available to people living in areas where only one insurer is selling ACA health plans. They will also extend to those who oppose abortion but live in places where the only available plan covers abortion services.

Sixteen Attorneys General File to Defend ACA from Texas Lawsuit

A group of attorneys from 15 states and the District of Columbia have filed a motion to intervene in a Texas lawsuit that claims the Affordable Care Act has become invalid since the individual mandate’s repeal.

Led by California Attorney General Xavier Becerra, the motion states that eliminating the law would cause “immediate and irreparable harm” to residents of their states.

“We’re taking this action to protect the health and financial security of millions of people in our country, as well as billions of dollars of federal funds that go to our states to make sure that we can afford the healthcare that our families need,” Becerra said.

CBO Predicts Rise in Some ACA Premiums

The premiums for ACA silver plans will increase by 34 percent for 2019 plans, due mostly to the repeal of the individual mandate and the cutoff of cost-sharing reduction (CSR) payments to insurance companies, according to a new estimate from the Congressional Budget Office (CBO). The CBO also expects federal subsidies to rise 21 percent in response to the premium increases. It projects that, after 2019, subsidies will rise by 5 percent per year for the next decade.

Healthcare Reform News Update for April 6, 2018

Maryland Tackles Measures to Stabilize State ACA Exchange

Maryland Governor Larry Hogan (R) has expressed his support for legislation that will establish a reinsurance program and keep premiums down for plans on the Maryland Health Care Exchange.

Hogan signed the bipartisan reinsurance bill Thursday, which will require a federal waiver before being enacted.

A separate bill, passed by the legislature Thursday, will enable the state to use $380 million that insurance companies no longer pay in federal taxes to help keep insurance premiums from rising on the state’s healthcare exchange throughout the next year. Hogan is expected to sign the bill next week.

Insurance Companies May Lose Profitability Due to CSR Elimination

Due to the way the Affordable Care Act calculates risk adjustment, smaller health insurance companies that sell plans on the marketplace could hit a profitability snag. The problem stems from the Trump administration’s elimination of cost-sharing reduction (CSR) payments late last year.

The lack of CSRs caused those costs to be placed into the middle-tier silver plans, creating higher premiums for those plans, a process called “silver-loading.” It also made smaller companies take on a larger share of risk.

Since tax credits are based on the price of silver plans, enrollees who qualified for subsidies were able to purchase bronze plans for a low or even $0 premium. These higher-risk enrollees could cause insurance companies to lose money when it comes time for risk-adjustment payment transfers.

Healthcare Reform News Update for April 4, 2018

Signups for 2018 ACA Plans Take a Dip

CMS Administrator Seema Verma announced Tuesday that 11.8 million people signed up for 2018 plans on the Affordable Care Act marketplace. The total is roughly 400,000 fewer than last year, a much smaller number than predicted before the enrollment period began in November.

Other enrollment information released by the department includes:

  • Of all signups, 27 percent were new enrollees.
  • The average premium for those signing up on the federal exchange before tax subsidies were applied was $621 compared to $476 for 2017.
  • Of all enrollees, 7 percent chose gold plans, 29 percent chose bronze plans, and 63 percent chose silver plans.
  • A majority, 83 percent, of enrollees qualified for tax subsidies.

The federal exchange saw a reduction in signups, and states with their own marketplaces remained equal to last year’s, according to the report.

Ohio Asks for ACA Individual Mandate Waiver

Ohio is the first state to seek a waiver for the Affordable Care Act’s individual mandate.

Even though Congress repealed the penalty for not having insurance late last year, the requirement that all Americans have health coverage is still in effect, the state’s insurance director said.

Approval of the waiver has the potential to reduce health insurance premiums for residents.

CMS Expands Medicare Advantage Coverage

This week, the Centers for Medicare & Medicaid Services (CMS) announced its plan to expand products and services covered by Medicare Advantage plans.

The department has revised its definition of “primarily health-related” benefits to help Medicare Advantage enrollees lead more independent lives. Some of the new services could include minor home modifications such as grab bars, transportation to and from medical appointments, and home-delivered meals.

A prescription is not needed for the new covered services, but they must be “medically appropriate” and recommended by a healthcare provider. Coverage will vary depending on the plan.

Healthcare Reform News Update for April 3, 2018

Poll: Most ACA Enrollees Are Satisfied With Their Plan

Most people who have purchased their health plan on the Affordable Care Act exchange like their insurance coverage but fear that the marketplace is “collapsing,” according to a Kaiser Family Foundation poll released Tuesday.

Findings from the poll include:

  • 61 percent of marketplace enrollees are satisfied with their insurance choice
  • 53 percent think the ACA marketplace is collapsing
  • 19 percent are aware that the individual mandate was repealed but is currently still in effect
  • 34 percent said the mandate was the main reason for purchasing health insurance
  • 90 percent of those with a nongroup plan said they would still purchase insurance without the mandate
  • 58 percent of ACA enrollees say they are worried about a lack of available insurance coverage in the future

Georgia Bill Mandates Commissions for Health Plans

A new law in Georgia makes it mandatory for all insurance companies to pay commissions to agents and brokers for virtually all health insurance plans, including those sold on the Affordable Care Act marketplace.

The law does not provide specific amounts for commissions or require commissions for individual plans sold during ACA special enrollment periods.

The law was created in response to the falling number of agents and brokers selling ACA plans. The number of brokers registered for the federal ACA exchange is down 31 percent from last year and 50 percent from 2015.

Healthcare Reform News Update for March 29, 2018

Iowa Governor to Sign Legislation for Alternatives to ACA Health Plans

On Tuesday, Iowa lawmakers approved a bill that will allow the state to sell two new types of cheaper health plans that do not meet some requirements of the Affordable Care Act. Governor Kim Reynolds (R) is expected to sign it.

The legislation includes:

  1. Association health plans for small businesses and the self-employed.
  2. Benefit plans sold through a partnership between the Iowa Farm Bureau and Wellmark Blue Cross and Blue Shield. These plans are not health insurance and will not be required to comply with state or federal insurance regulations.

Neither of the plans will include the ACA’s essential health benefits such as maternity care, mental health care, substance abuse treatment, or equal premium charges for those with pre-existing conditions.

The Trump administration has not indicated whether it will challenge the state’s law.

Premiums for Minnesota State Exchange Plans Reduced by 15 Percent

New research from the Urban Institute found that 2018 insurance premiums on MNsure, Minnesota’s state healthcare exchange, are 15 percent lower than last year’s.

Researchers found that the average silver plan on the MNsure marketplace for a 40-year-old nonsmoker was $365 for 2018 compared to $429 in 2017. The reduction was primarily due to the state’s enactment of a reinsurance program in 2017.

“Last year, [Minnesota] premiums were significantly above the national average,” said Erik Wengle, an Urban Institute researcher. “With the addition of reinsurance payments, that has come down to significantly below the national average.”

Healthcare Reform News Update for March 27, 2018

Poll: Healthcare Remains Primary Concern for Majority of Americans

For the fifth continuous year, healthcare is a top concern for a majority of Americans, according to a new Gallup poll conducted March 1-8.

When asked about the cost and availability of healthcare:

  • 55 percent worry about the topic “a great deal.”
  • 23 percent worry “a fair amount.”
  • 23 percent worry “only a little” or “not at all.”

The poll included 14 additional issues. Other top-ranking worries include crime and violence, government spending, and the availability of firearms.

Healthcare Reform News Update for March 23, 2018

Majority Whip Plans to Put ACA Stabilization Bill Up for Vote

Senate Majority Whip John Cornyn (R-TX) said Thursday that “there will be a vote” on an Affordable Care Act stabilization bill that was removed from the omnibus spending package.

Lawmakers are at odds over abortion language within the legislation. Republications support new ACA funding aimed at lowering premiums that would add abortion restrictions, which Democrats oppose.

It’s not clear whether the bill would be added to the spending package as an amendment or if it would be presented as a stand-alone measure.

Washington State Expands Reproductive Health Coverage

Washington Governor Jay Inslee signed the state’s Reproductive Parity Act into law, which expands Affordable Care Act provisions for maternity, contraception, and abortion access.

The new law requires insurance companies to provide abortion coverage if they also cover maternity care. It also ensures that there are no out-of-pocket costs for any form of contraception.

The law will “make sure that women have access to the full spectrum of healthcare they need without cost barriers or stigma,” Inslee said.

Healthcare Reform News Update for March 22, 2018

ACA Stabilization Left Out of Spending Package

The bipartisan plan to help stabilize the Affordable Care Act marketplace was dropped from Congress’ $1.3 trillion spending package. The effort stalled due to disagreements between lawmakers over abortion language and auto-renewal of short-term health plans.

Advocacy group America’s Health Insurance Plans was disappointed by the decision. “In every other market, state and federal leaders have supported healthy markets that deliver better affordability and care,” the group said in a statement. “Through employer-provided coverage, Medicare Advantage, and Medicaid-managed care, nearly 300 million Americans see the value that insurance providers bring to improve health, access, and financial security. Americans who rely on the individual market deserve the same access to stable and affordable comprehensive coverage.”

The package includes new ACA oversight provisions:

  1. Congressional committees must be notified by CMS before any ACA-related data or grants are released.
  2. The president’s administration must “publish ACA-related spending by category since its inception” and publicly release the personnel and processes required to execute, manage, or enforce ACA rules.

Also included was the provision that continues the ban on risk corridor payments to insurance companies.

Healthcare Reform News Update for March 21, 2018

Warren Proposes New Bill to Increase ACA Affordability, Reliability

Senator Elizabeth Warren (D-MA) submitted a new bill Wednesday that intends to help healthcare plans on the Affordable Care Act marketplace be more affordable and reliable.

The legislation, titled the Consumer Health Insurance Protection Act, would work with the current healthcare system to improve the efficiency of both individual and employer-sponsored coverage. Some provisions in the bill include:

  • Enabling more people to qualify for premium subsidies.
  • Capping premiums at 8.5 percent of income.
  • Basing premium subsidies on the cost of gold plans.
  • Capping out-of-pocket costs for prescriptions at $250 per month for private plans.
  • Requiring private insurance companies to spend 85 percent of premium dollars on insurance claims.
  • Barring insurance companies from dropping enrollee coverage during their course of treatment.
  • Increasing funding for ACA outreach and education.
  • Requiring that insurance companies cover the 10 essential benefits as outlined in the ACA.
  • Reinstating cost-sharing reduction (CSR) payments.
  • Requiring insurance companies that bid on public healthcare plans in areas of the country with limited competition to also offer plans on the ACA marketplace.

The bill is co-sponsored by senators Kamala Harris (D-CA), Maggie Hassan (D-NH), Kirsten Gillibrand (D-NY), (Tammy Baldwin (D-WI), and Bernie Sanders (I-VT). It has also been endorsed by liberal groups Families USA, Public Citizen, Consumers Union, and Community Catalyst.

The Congressional Budget Office has not yet estimated how much the bill would cost.

Healthcare Reform News Update for March 20, 2018

Chances Dwindle for ACA Stabilization Inclusion in Funding Bill

The inclusion of restored cost-sharing reduction (CSR) payments in Congress’ $1.3 trillion omnibus spending package, which would keep the government from another shutdown, is uncertain due to last-minute negations.

Senators Patty Murray (D-WA) and Lamar Alexander (R-TN) hoped to include the measure, which will help stabilize the Affordable Care Act marketplace, in the spending package. President Donald Trump on Monday voiced his support for the provision.

Lawmakers are at odds over abortion language. Republicans want to include expanded Hyde Amendment restrictions to prohibit federal funding for abortions. Democrats say that doing so would restrict access for many low-income women.

“One of the regrets we have about the negotiation is that we thought there’d be a chance to have a health piece, like ‘reinsurance,’” Pelosi said on Thursday.

The spending bill needs to be finalized by Friday to avoid a government shutdown. Without the stabilization measures, ACA health insurance premiums are expected to rise significantly for 2019 plans.

Healthcare Reform News Update for March 19, 2018

Virginia Debating ACA Expansion of Medicaid

Virginia may include a proposal to expand Medicaid under the Affordable Care Act during a special session for a budget agreement that begins April 11. The state is one of 18 that has not enacted the expansion.

The issue became possible after November’s election of Democratic Governor Ralph Northam and the flipping of 15 state House seats to Democrats. However, Republicans who are against the expansion continue to be a slim majority of 51 to 49.

Second Liberal Group Comes Out Against CSR Funding

Liberal advocacy group Families USA has said it opposes the proposal in Congress to fund the Affordable Care Act’s cost-sharing reduction (CSR) subsidies. The announcement comes after last week’s analysis from liberal group The Center on Budget and Policy Priorities showed the funding would raise premium subsidies.

“Enacting the new proposal from Senator Lamar Alexander (R-TN) will be worse for consumers than if Congress does nothing at all to stabilize the individual insurance market. If this is the best package members can produce, we encourage Congress to reject it,” Families USA wrote.

Report: Most Blue Cross Plans Saw ACA Profitability in 2017

For the first time in four years, most Blue Cross Blue Shield plans saw profitability on the Affordable Care Act marketplace, according to a new Politico analysis of financial filings.

The study showed that:

  • Of 29 regional Blue plans, all but eight earned money from ACA plans.
  • On average, the plans spent 80 percent of premium revenue on medical costs, down 12 from the previous year.
  • Health Care Service Corporation improved its premium revenue versus medical cost percentage 18.5 percent; Blue Cross Blue Shield of North Carolina improved by 10 percent.
  • The 29 regional plans had 4.5 million ACA enrollees in 2017, which comprised one-fifth of the total marketplace enrollment.

Insurance companies caution that analyzing financial performance of a single year can be misleading and that a variety of factors can upend the statistics for 2018, including the repeal of the individual mandate and the possible expansion of non-compliant short-term plans.

Healthcare Reform News Update for March 16, 2018

Idaho Lawmakers Discuss State Health Plans with Washington Officials

Idaho Insurance Commissioner Dean Cameron and Idaho Senator Jim Risch met with officials from the Trump administration on Wednesday to discuss the state’s plan to sell lower-cost health insurance plans that do not meet the requirements of the Affordable Care Act.

Centers for Medicare and Medicaid Services Administrator Seema Verma denied the state’s proposal last week on legal grounds, suggesting that the plans be sold instead as short-term health insurance plans. Cameron has opposed the idea.

Cameron said he will “see what areas we can further adjust and decide how and when to submit that to Ms. Verma.” One possibility, he said, is providing discounts to healthy enrollees because charging people with preexisting conditions higher premiums goes against ACA rules.

Healthcare Reform News Update for March 15, 2018

Senators’ Revamped Stabilization Bill Will Lower Premiums by 10 Percent

Senators Lamar Alexander (R-TN) and Susan Collins (D-ME) have revised their Affordable Care Act stabilization package in hopes that it will be included in next week’s omnibus funding bill. If enacted, it will reduce premiums by 10 percent in 2019 and 20 percent in 2020 and 2021, according to an estimate from the Congressional Budget Office.

The new stabilization package includes:

  • Three years of funding for ACA cost-sharing reduction (CSR) subsidies
  • $30 billion for three years of federal reinsurance and invisible high-risk programs
  • Expansion of catastrophic plans to people 30 years old and older
  • Increased ability for states to design their own health plans
  • Streamlining the process for states to implement their own plans
  • A “requirement that funds not be used for plans that cover abortions”

It’s unclear whether the new package has enough support to pass.

New Poll Shows Americans Shifting ACA Responsibility

A new Morning Consult/Politico poll of nearly 2,000 registered voters, shows that 44 percent of Americans hold former President Obama responsible for the state of the Affordable Care Act, which is down from 50 percent compared with a poll conducted in October. Twenty-eight percent of respondents held President Trump accountable, which is comparable to the October poll.

Other findings from the poll:

  • 49 percent of respondents support the concept of single-payer healthcare
  • 50 percent of respondents believe “that the nation spends too little on healthcare”


Healthcare Reform News Update for March 13, 2018

Conservative Coalition Asks Congress to Deny ACA Stabilization Efforts

A group of 15 conservative organizations asked Congress on Monday to reject a “bailout” of the Affordable Care Act (ACA) in the upcomng omnibus spending bill.

The group is against including cost-sharing reduction (CSR) and reinsurance payments in the government funding bill that needs to be passed by March 23 to avoid a government shutdown.

“Lawmakers should fulfill their longstanding promise of repealing and replacing Obamacare, not setting the dangerous precedent of bailing it out,” wrote the coalition that includes Americans for Prosperity, Club for Growth, and Heritage Action

Premera Blue Cross Commits to Washington State and Alaska

Citing a refund made possible by the new tax law, health insurance company Premera Blue Cross announced that it will continue to provide coverage on the Affordable Care Act (ACA) marketplace in Washington state and Alaska in 2019.

The company committed to offering health insurance to any counties in Washington that lack an insurance company on the state’s ACA marketplace. It also pledged to “ensure continued stability” in Alaska where it is the only health insurance company on the ACA marketplace.

“This refund has given us an unexpected opportunity to reach beyond our own company to further address the critical health care needs of the communities where we live and work. I am especially pleased to continue our commitment to the individual market and build stability for families in Washington and Alaska,” said Premera Blue Cross CEO Jeff Roe in a statement.

Judge Strikes Down Challenge to ACA Birth Control Exemptions

U.S. District Judge Nathaniel Gorton rejected a lawsuit that challenged the Trump administration’s easing of Affordable Care Act (ACA) contraception rules.

Massachusetts Attorney General Maura Healy filed the suit, hoping to overturn rules that allow businesses and nonprofits to claim religious or moral objections in providing birth control.

In his decision, Gorton cited a new Massachusetts law that requires all employer health plans to cover contraception with no co-pays, saying that it prevents companies from taking advantage of the exemptions and that women in the state were less likely to be affected by the federal law.

Healthcare Reform News Update for March 12, 2018

Liberal Group Says Funding CSRs Would Hurt Subsidized ACA Enrollees

A new analysis from the liberal group The Center on Budget and Policy Priorities says that funding the Affordable Care Act’s cost-sharing reduction (CSR) subsidies in Congress’s upcoming omnibus spending bill would “do more harm than good.”

When President Trump cut off the CSR funding late last year, insurance companies raised premiums on ACA health insurance plans to make up for the loss of funding. Because of a “quirk” in the law’s structure, the increased premiums made the plans more affordable for lower-income Americans by increasing premium subsidy amounts (premium tax credits). According to the analysis, resuming CSR funding would reduce the premium subsidies and increase costs for subsidized enrollees.

The group believes that lower-income enrollees would be better served by blocking the Trump administration’s call to create “skimpier, cheaper” short-term health plans, which could draw people away from ACA-compliant plans.

Idaho Governor to Continue Talks About Non-Compliant Health Plans

Idaho Governor Butch Otter said on Friday that the Trump administration’s rebuke of the state’s plan to provide health insurance that does not meet Affordable Care Act requirements was not a rejection.

“In fact, we consider the letter an invitation from CMS to continue discussing the specifics of what can and cannot be included in state-based plans,” said Otter in a statement with the

lieutenant governor and state insurance commissioner.

“Idaho’s proposal would allow [insurance companies] to sell plans that charge people with pre-existing conditions more, which is barred by ObamaCare, and not cover all of the health services required under the health law.” However, in her letter, CMS Administrator Seema Verma offered the state another way to do this: short-term health plans.

Healthcare Reform News Update for March 9, 2018

Trump Administration Rejects Idaho’s State-Based Health Plans

Idaho’s plan to allow stripped-down, low-cost health insurance that does not meet the requirements of the Affordable Care Act is unlawful, said Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma in a letter to the state’s Republican Governor C.L. “Butch” Otter.

In the letter sent Thursday, Verma said that, since the health plans do not meet the minimum ACA standards, the federal agency would have to enforce the law, which would pull regulatory authority away from the state and fine insurance companies up to $100 per day for every resident enrolled in a noncompliant plan.

Verma listed eight areas where the plans did not meet legal standards, such as failing to cover the 10 essential health benefits; charging customers more based on age, location, or history; and discriminating against people with pre-existing conditions.

With some modifications, the proposed plans could be legally issued as short-term plans.

Study: ACA Premiums Could Increase Up to 94%in 3 Years

Insurance premiums could rise for individual plans on the Affordable Care Act marketplace between 35 and 94 percent by 2021, according to a new study from Covered California, the state’s healthcare exchange.

The study found that the primary factor in the increase was the repeal of the individual mandate, which imposed a penalty on Americans without health coverage. Other causes include a shorter open enrollment period and the president’s recent plan to extend “skimpy” short-term plans.

“The effect is going to be: The individual market will be poor people who get subsidies and sick people who buy no matter what. And the middle class will be priced out of insurance in about a third of America,” said Covered California’s Executive Director Peter V. Lee.”

Florida Bill Would Broaden Eligibility for Healthcare Ministries

The Florida Legislature passed a bill Wednesday aimed at increasing enrollment in healthcare sharing ministries.

Participation in the ACA-exempt programs is currently limited to people who share the same religious beliefs. The new bill, if signed by Republican Governor Rick Scott, would expand eligibility to include people who hold the same ethical beliefs.

Trump Proposes Eliminating CSR Reimbursements for 2017

The White House urged Congress on Thursday to pass legislation that doesn’t authorize cost-sharing reduction (CSR) payments and reinsurance for 2017—even though insurers contributed to the program.

The request states that insurers should pay back any excess money paid out by the government before President Donald Trump cut off the payments late last year.

The proposed legislation asserts that “… there is no obligation under this act or any other act, including the Patient Protection and Affordable Care Act, to make payments on or after October 1, 2017 for purposes of reconciling any such cost-sharing reduction payments made for benefit years 2016 or 2017.”

The proposal also makes clear that insurers are still obligated to make CSR payments to their low-income enrollees.

HHS Secretary Touts Healthcare Options

The Trump administration would do what it can “within the law” to allow insurers to sell health plans that don’t meet Affordable Care Act rules, Health and Human Services (HHS) Secretary Alex Azar said Thursday.

Speaking at a conference sponsored by America’s Health Insurance Plans, Azar said he wants to ensure that consumers have choices in their healthcare decisions.

“More broadly, we are committed to using the flexibilities we have within the law to allow insurers to offer competitive products that work for consumers. We know the layers of regulation imposed by the Affordable Care Act have made this almost impossible. Consistent with the law, we want to work with you to open up new affordable and flexible options,” he said.

Healthcare Reform News Update for March 8, 2018

GOP Senator Proposes Splitting ACA Individual Marketplace

Senator John Barrasso (R-WY) has authored a new bill that would essentially divide the individual Affordable Care Act marketplace into two separate exchanges.

Barrasso’s plan would create non-ACA compliant, short-term plans that last as long as 364 days and give enrollees the option of guaranteed renewability. Premiums would be allowed to go up if the enrollee became more expensive to insure.

Critics of the plan say it would create a parallel marketplace, with healthier people moving to the cheaper, “skimpier” short-term plans and sicker people staying with ACA policies. Since the ACA plans are not allowed to discriminate based on risk, the premiums on ACA plans could then go up significantly.

New Analysis Charts Outperformance of State-Run ACA Marketplaces

The 17 states that run their own Affordable Care Act marketplaces perform better than the federal marketplace, according to a new analysis from The Commonwealth Fund. The data review found that state-run marketplaces have:

  • Lower projected premiums ($633 per month vs. $526 per month) for the individual market.
  • Lower projected medical claims ($478 per month vs. $419 per month).
  • A lower portion of premiums going to medical claims rather than overhead (20.2 percent vs. 24.7 percent).
  • A lower percentage of cost increases in 2018 compared to 2017.
  • A lower percentage of rate increases year over year.

State Attorneys General Demand Hearing on Association Plans

A coalition of 17 Democratic state attorneys general has sent a formal comment letter to the Labor Department asking for public hearings on the Trump administration’s plans to expand association health plans.

The administration’s proposal would allow groups to purchase cheaper health plans that don’t meet the requirements of the Affordable Care Act, including coverage of essential health benefits such as maternity care, prescription drugs, and mental health care.

The coalition, led by attorneys general Eric Schneiderman of New York and Maura Healey of Massachusetts, said the measure undermines protections in the ACA.

The proposal “is nothing more than an unlawful end run around the consumer protections enshrined in the Affordable Care Act, part of President Trump’s continued efforts to sabotage the ACA,” Schneiderman said.

Changes to Dodd-Frank Could Affect Medicare Insurance Agents

Three sections of a proposed change to the Dodd-Frank Act, called the “Economic Growth, Regulatory Relief, and Consumer Protection Act” bill, could change some reporting requirements for Medicare insurance agents.

The three sections of the bill would:

  1. Possibly provide federal legal protection if the agent reports suspicious financial abuse of seniors to authorities.
  2. Require insurers to provide training and credential tracking if they want their agents to report suspicions of elder abuse.
  3. Make available annual reports from the federal government about international insurance regulatory developments.

Healthcare Reform News Update for March 7, 2018

White House Would Back ACA Stabilization With Conservative Changes

The Trump administration would support efforts to stabilize the Affordable Care Act, but only if measures backed by conservatives are included, according to a memo issued by the White House.

The memo includes support for renewing cost-sharing reduction (CSR) payments and states that all efforts need to be “life-protected,” which prevents government funds from being used for abortions.

“Although congressional efforts to provide taxpayer money to prop up the exchanges is understandable, any such efforts must also provide relief to middle-class families harmed by the law and protect life,” the memo states.

The document specified three policies that the administration wants to pursue, including:

  1. Extending “skimpier” short-term health plans, which Trump previously proposed, and allowing them to be renewed with no health underwriting.
  2. Expanding access to health savings accounts.
  3. Allowing insurers to charge older people as much as five times more than younger people (the current ratio is three to one).

OMB Analysis: CSR Funding Would Lower Premiums Up to 20%

Funding Obamacare’s cost-sharing reduction (CSR) subsidies would lower premiums by 15 to 20 percent, significantly more than a reinsurance program, according to an analysis by the Office of Management and Budget.

The analysis found that reinsurance would reduce premiums by 1 percent for every $1 billion spent on the program.

“We project funding CSRs would have a greater impact on reducing premiums than any of the reinsurance funding levels that have been proposed, and would have more bang for the buck in terms of federal spending,” according to the analysis.

Health Coalition Urges Congress to Include ACA Stabilization in Funding Bill

A group made up of healthcare providers and insurers has asked congressional lawmakers to include funds for stabilizing the Affordable Care Act in an omnibus spending package scheduled for later this month.

“Congress has an important opportunity to act and reduce premiums for consumers for 2019, but time is running short. We urge you to take immediate action to advance bipartisan legislation that includes both premium reduction/reinsurance and funding for CSR benefits as part of the March 23rd omnibus appropriations,” the group said.

The coalition includes America’s Health Insurance Plans, the American Hospital Association, and the American Medical Association.

Healthcare Reform News Update for March 6, 2018

Federal Appeals Court Revisits Cost-Sharing Reduction Settlement

The D.C. Circuit Court of Appeals is calling into question a settlement deal over cost-sharing reduction (CSR) subsidy payments to insurers under the Affordable Care Act.

The settlement agreement said that House Republicans, the Trump administration, and liberal states would not cite a previous ruling by U.S. District Court Judge Rosemary Collyer in any future case. Collyer ruled in 2016 that the Obama administration did not have the authority to make the CSR payments because Congress did not properly fund them.

On Monday, the federal court panel issued an order to pursue further briefing in the case. The order questioned the legality of overturning part of the lower-court order.

Healthcare Reform News Update for March 5, 2018

Congressman Wants Immediate Repeal of ACA Individual Mandate

Representative Mark Meadows (R-NC), chairman of the conservative House Freedom Caucus, is calling for the immediate repeal of the Affordable Care Act’s individual mandate.

Currently, the penalty for not having health insurance is in effect until 2019. Meadows would like to eliminate the penalty for 2017 and 2018 tax returns.

“Unfortunately, many Americans believe the mandate to be immediately repealed and no longer in effect, but will be surprised to learn that it still applies for both 2017 and 2018 tax returns. Congress must resolve this,” Meadows wrote in a letter to a House Appropriations Committee subpanel.

Healthcare Reform News Update for March 2, 2018

California Could Lose 18% of ACA Marketplace Enrollees Next Year

Without the Affordable Care Act’s individual mandate, 18 percent of California residents with Covered California marketplace health plans could drop their coverage, according to a new survey by Harvard Medical School researchers.

Without a penalty for being uninsured, healthier residents are more likely to go without coverage. The loss of these enrollees could raise premiums by 12 to 16 percent next year.

“While California would continue to have a stable individual market, and we have the reserves and flexibility to adjust for this impact, the impacts would be real and significant for California’s consumers,” said Peter Lee, Covered California’s executive director.

Healthcare Reform News Update for March 1, 2018

Association Plans Could Bump 4.3 Million Off ACA Coverage

The Trump administration’s plan to expand association health plans could cause between 2.4 million and 4.3 million people to switch from ACA marketplace plans to association plans by 2022, according to a study by Avalere Health.

The study also found that the association plans would cause:

  • A premium increase for ACA marketplace plans by as much as 4 percent.
  • Between 130,000 to 140,000 people to become uninsured by 2022 due to high premiums.
  • Between 1.7 million and 3.2 million people to exit the small group market.
  • 700,000 to 1.2 million people to leave the individual market.

Premiums for the association plans could be up to $10,800 lower than the individual market and up to $4,100 lower than the small group market.

“Changes that allow or incentivize healthier individuals to exit the individual and small group market to pursue other, sometimes non-ACA-compliant coverage offerings, could lead to higher costs for those sicker, less healthy individuals and groups who remain behind in the ACA-regulated markets,” the study states.

Wisconsin Governor Signs Reinsurance Bill

Wisconsin Governor Scott Walker (R) signed a bill Tuesday that will allow the state to apply for a federal waiver to help stabilize its health insurance marketplace though a reinsurance program.

The program would cover 80 percent of medical claims between $50,000 and $250,000, which would help lower premiums for healthier residents by 13 percent in 2019 and 12 percent in 2020.

“Our Health Care Stability Plan is our solution to Washington’s failure; we want to provide health care stability and lower premiums for Wisconsin,” Walker said.

GOP Lawmakers Consider Budget Procedure for ACA Funds

Republican leaders in the House are considering a complex budget maneuver to help pay for Affordable Care Act funds—a controversial move as many conservatives see the action as a “bailout.”

The two-step plan would direct the Congressional Budget Office (CBO) to take cost-sharing reduction (CSR) payments out of its baseline for projected federal spending. It would then use the savings from the first step to pay for reinsurance programs. The move would help lower premiums and, subsequently, reduce the cost of government subsidies for health insurance.

Supporters of the plan say it would fund reinsurance programs without having to create a budget for it. But conservative lawmakers call the move a budgetary “gimmick.”

ACA Popularity Reaches Record High

A recent poll by the Kaiser Family Foundation shows that 54 percent of Americans approve of the Affordable Care Act, the highest rating since the group began its monthly poll in 2010.

In addition, only 13 percent of respondents were aware that the repeal of the individual mandate goes into effect in 2019. Others were either unaware of the repeal or unclear on when it will be implemented.

Health Agents Meet With Washington Legislators

Over 700 members of the National Association of Health Underwriters are attending a conference in Washington, D.C., this week. The group plans to lobby lawmakers on a number of topics including stabilizing subsidy programs, protecting the group health premium tax exclusion, and addressing Affordable Care Act agent compensation rules.

Healthcare Reform News Update for February 27, 2018

20 States Sue to End Affordable Care Act

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.

“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.

Healthcare Reform News Update for January 30, 2018

Pro-ACA Group Launches Ads Targeting GOP Lawmakers

The Affordable Care Act advocacy group Save My Care is releasing television ads this week that are critical of Republican efforts to repeal the law.

The ads claim that the failed bills GOP lawmakers proposed would have increased health insurance premiums and left millions of people without coverage. They will run in West Virginia, where Congressional Republicans are holding a retreat, in addition to Washington D.C., Maine, and Alaska.

Leslie Dach, Save My Care’s campaign chairman, hopes the ads will remind lawmakers to act. “It’s time to listen to what Americans demand, move on from repeal and sabotage, and work on bipartisan solutions that keep and improve on the Affordable Care Act,” he said in a press release.

Azar Sworn in as HHS Secretary

Alex Azar was sworn in Monday to lead the Department of Health and Human Services.

“As our new secretary, Alex will continue to implement the administrative and regulatory changes needed to ensure that our citizens get the affordable high-quality care that they deserve,” President Donald Trump said at a White House ceremony honoring Azar.

Azar was confirmed last week in a 55-43 Senate vote.

Open Enrollment Period Ends Tomorrow for 3 Exchanges

California, New York, and Washington D.C. will end their Open Enrollment Periods at midnight January 31.

California’s state exchange has signed up about 1.2 million residents renewing their policies and 342,000 new enrollees. New York will enroll 2.1 million people. And the Washington D.C. exchange says its poised to match last year’s numbers.

Healthcare Reform News Update for January 29, 2018

Trump Administration Sued Over Cuts to ACA Plans

The attorneys general for New York and Minnesota have sued the Trump administration for cutting off more than $1 billion in annual federal funding for state Affordable Care Act plans that cover almost 1 million low-income residents.

The Department of Health and Human Services (HHS) announced December 21 that it would not pay the $266 million to New York or $32 million to Minnesota for their Basic Health Program plans in the first quarter. The cuts represent more than 25 percent of the overall funding to the programs and $1.2 billion over one year.

The states are the only two that participate in the Basic Health Program, which provides low out-of-pocket plans with premiums of $0 to $80 per month. New York has 700,000 enrollees.

“The abrupt decision to cut these vital funds is a cruel and reckless assault on New York’s families,” said New York Attorney General Eric Schneiderman.

Healthcare Reform News Update for January 26, 2018

Two Reinsurance Bills Vie for Congressional Support

Two rival reinsurance bills — one with only GOP support in the House, the other with bipartisan support in the Senate — are complicating ACA stabilization efforts.

The House version, sponsored by Representatives Ryan Costello (R-PA) and Collin Peterson (D-MN), will cost $30 billion over three years at the discretion of the secretary of Health and Human Services. It consolidates a federal reinsurance program and includes retroactive funding of cost-sharing reduction (CSR) payments for 2017 and funding for 2019.

The Senate bipartisan version, sponsored by Senators Susan Collins (R-ME) and Bill Nelson (D-FL), uses 1332 wavers to give states a $2.25 billion pool every two years to fund their own reinsurance programs.

Costello says his approach has the advantage of “speed, efficiency, and certainty,” because obtaining waivers can be uncertain. Collins says the waivers will ultimately benefit states more.

Costello and Collins have discussed the proposals, and talks are ongoing. It’s unclear which proposal has more support from lawmakers.

Warren Calls for ACA Supporters to ‘Go on Offense’

Senator Elizabeth Warren (D-MA) in a Thursday speech called for supporters of the Affordable Care Act to be more aggressive over healthcare issues in response to Republican efforts to repeal the law.

“We need to do more than play defense,” she said at a conference held by Families USA, a liberal healthcare advocacy group. “I believe it is time for us to go on offense.”

Warren spoke about building on the ACA’s fundamentals, including creating a public health insurance option and expanding Medicare eligibility. She also criticized insurance carriers and said the government needs to “hold America’s insurance companies accountable.”

Healthcare Not Priority for Battleground Voters

Even though healthcare is a top issue for voters nationwide, it lags behind the economy, North Korea, and immigration as a priority for voters in states with competitive political races, according to a recent poll from the Kaiser Family Foundation.

Nationwide, healthcare is the top issue for 29 percent of voters, followed by the economy and immigration. For the 13 states with congressional or gubernatorial races, 21 percent of voters choose healthcare as the priority.

The poll also found that 50 percent of voters were not aware that the ACA’s individual mandate had been repealed. The same percentage said they supported the ACA.

Healthcare Reform News Update for January 25, 2018

Azar Confirmed as Health & Human Services Secretary

Former Eli Lilly executive Alex Azar was confirmed Wednesday as the new secretary for the Department of Health and Human Services (HHS) in a 55-43 Senate vote.

Azar previously served the department as general counsel and then as deputy secretary under former President George W. Bush. “He understands the process, and he knows the levers and how you make it work and where the potential roadblocks are,” said former HHS Secretary Mike Leavitt.

Azar has four main objectives for the department:

  • help contain prescription drug prices
  • make health insurance more affordable and accessible
  • continue working to make Medicare payments based on quality—not quantity
  • tackle the opioid addiction epidemic

Idaho to Allow Sale of Non-ACA-Compliant Health Insurance

Idaho revealed a plan Wednesday that would allow the sale of health insurance that does not meet the consumer protections established under the Affordable Care Act. It’s the first state to do so without prior federal approval.

The director of the Idaho Department of Insurance says the plan is necessary to make cheaper insurance available to more people. But the legality of the measure is being questioned by healthcare experts.

Under Idaho’s guidelines, the new, cheaper plans could:

  • Deny coverage for pre-existing conditions for up to 12 months
  • Exclude pediatric dental coverage and vision care
  • Charge people more based on where they live, health history, and age
  • Charge consumers separate out-of-pocket maximums for different services

Insurers in the state would continue to have ACA-compliant marketplace plans available.

Trump Administration Seeks to Expand Individual Mandate Exemptions

The Affordable Care Act’s individual mandate was repealed last month, but it doesn’t go into effect until 2019. In response, the Trump administration is exploring ways for more consumers to qualify for exemptions on 2018 tax returns.

The Centers for Medicare and Medicaid Services (CMS) is creating guidance to expand hardship exemptions but has yet to finalize or publish the details.

Ted Cruz Continues Fight to Repeal ACA

Senator Ted Cruz (R-TX) on Wednesday said he is still working to repeal the Affordable Care Act this year.

Cruz said he has been “speaking with a wide number of senators” about repeal efforts and is trying to get enough support for an effort to pass.

“I don’t think leadership is interested in going down this road again until we can get 50 votes, and so we need to do the hard work of bringing the rest of the conference together. I think we’re still quite close,” he said.

Healthcare Reform News Update for January 24, 2018

ACA Tax Delays Will Cost $31.3 Billion

The postponement of three Affordable Care Act taxes in the stopgap spending bill, which ended the three-day government shutdown, will reduce federal revenue by $31.3 billion over 10 years, according to the Joint Committee on Taxation.

  • Delaying the medical device tax will cost $3.8 billion.
  • Postponing the Cadillac tax will cost $14.8 billion.
  • Deferring the health insurance tax will cost $12.7 billion.

HHS Nominee Advanced by Senate

Alex Azar, President Donald Trump’s nominee to lead the Department of Health and Human Services (HHS), won Senate approval Tuesday in a 54-43 vote. Final confirmation is expected today. Azar is a former Eli Lilly executive.

Healthcare Reform News Update for January 23, 2018

Stopgap Bill Includes 3 ACA Tax Delay Extensions

The bill that reopened the federal government today includes three measures that affect the Affordable Care Act.

The “Extension of Continuing Appropriations Act, 2018″ (ECAA) bill will delay:

  • the start date of the ACA’s Cadillac tax through 2022.
  • the health insurance tax through 2019.
  • the medical device tax through 2019.

The Congressional Budget Office (CBO) has estimated that the three taxes represent $12.7 billion in federal revenue.

California Marketplace Enrollment Up 7 Percent

Covered California, the state’s ACA marketplace, has signed up about 342,000 healthcare enrollees since Open Enrollment began November 1. That’s a 7 percent increase compared to the same time last year.

“The demand — as well as the need — for health insurance is as strong today as it was when we first began offering coverage five years ago,” said Peter V. Lee, Covered California’s executive director, in a statement.

Enrollment will continue for the state through January 31.

ACA Stabilization Bills Still Alive in Congress

Senator Susan Collins (R-ME) remains optimistic about bipartisan legislation created to help lower premiums and stabilize the Affordable Care Act marketplace.

Collins expects the measures to be included in an omnibus bill due for a vote within the next few weeks.

“Our negotiations with the House are going very, very well. The deadline slipped but the policy is what is important,” she said.

Healthcare Reform News Update for January 18, 2018

Azar Moves to Full Confirmation for HHS Secretary

The Senate Finance Committee voted 15-12 to advance Alex Azar’s nomination to head the Department of Health and Human Services (HHS). All committee Republicans voted for Azar; Tom Carper (DE) was the only Democrat voting in support of the nominee.

Azar was an HHS official during the George W. Bush administration and is a former executive for pharmaceutical company Eli Lilly. Azar has said he intends to cut back the Affordable Care Act through new regulations and help stem the rise of drug prices.

A confirmation date has not been scheduled, but lawmakers expect a vote by the end of the month.

GOP Plans for ACA Taxes Unveiled

Republican lawmakers introduced measures Tuesday to suspend or delay some ACA taxes as part of the efforts to avoid a government shutdown.

The proposals include delaying the health insurance tax (HIT) for one year and a two-year delay on the medical device tax and the Cadillac tax on high-cost insurance plans. It also included a six-year reauthorization of the Children’s Health Insurance Program (CHIP).

Opponents have asked to suspend the HIT tax retroactively for 2018, saying it would lower premium costs. “While we welcome the suspension of the health insurance tax (HIT) in 2019, small businesses need help now. It’s critical that policymakers provide urgent relief and much-needed certainty by suspending the tax immediately for 2018 and 2019,” said Elena Tompkins, executive director of Stop the HIT, a coalition representing small-business owners.

Healthcare Reform News Update for January 16, 2018

Uninsured Americans Grew to 12.2 Percent Last Year

After years of decline due to the Affordable Care Act, the number of Americans who do not have health insurance rose to 12.2 percent in 2017, compared to 10.9 percent at the end of 2016, according to a new national survey from Gallup.

This is the first time in nine years where there was not a year-over-year decrease in the number of uninsured.

About 3.2 million Americans lost coverage in 2017. Especially affected were young adults, blacks, Latinos, and households making less than $36,000 a year. The majority of the newly uninsured had previously purchased individual insurance, rather than receiving group coverage from an employer, Medicare, or Medicaid.

It’s expected that the Trump administration’s efforts to weaken portions of the Affordable Care Act, such as repealing the individual mandate, could continue to impact the number of uninsured. “It seems likely that the uninsured rate will rise further in the years ahead,” according to the report.

Republican Leaders Hope to Eliminate ACA Employer Mandate

House Republicans Devin Nunes (CA) and Mike Kelly (PA) have introduced a bill that would suspend the Affordable Care Act’s mandate that employers offer healthcare to employees, canceling penalties that would be imposed for any year from 2015 to 2018.

“The employer mandate is a job-killer, a wage-killer, and a business-killer,” said Representative Kelly.

Currently, if an employer does not offer minimum essential coverage to full-time employees, the business is subject to a penalty of $2,260 per year for each employee in excess of 30. It’s estimated that businesses will pay $12 billion in penalties in 2018.

Democrats oppose repealing the employer mandate saying that the measure has not harmed businesses since the law’s implementation in 2010.

Healthcare Reform News Update for January 12, 2018

ACA Exchange Carrier Faces Lawsuit

A class-action lawsuit claiming inadequate access to doctors was filed Thursday in a federal court against Centene, one of the largest insurance carriers on the federal healthcare exchange.

Centene sells Ambetter plans in more than 15 states and insures 1.4 million people. In some areas of the country, the company is the only provider available on the exchange.

The lawsuit alleges that Centene falsified its network of doctors and that patients have trouble finding providers who accept the plans. “Centene misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers — some of whom have specifically asked to be removed — as participants in their networks and by listing nurses and other non-physicians as primary care providers.”

The company said it was not aware of the lawsuit until Thursday. According to a spokesperson, “We believe our networks are adequate. We work in partnership with our states to ensure our networks are adequate and our members have access to high quality healthcare.”

House Chairman Hopes ACA Cadillac Tax Will Be Eliminated

House Ways and Means Committee Chairman Kevin Brady (R-TX) said there is a chance that a repeal of the Affordable Care Act’s “Cadillac tax” could be included as part of the government funding measure under negotiation in Congress. Currently, the tax will not go into effect until 2020.

The Cadillac tax imposes a 40 percent excise tax on employer-funded health insurance plans that cost more than $10,200 for individuals and $27,500 for families.

Healthcare Reform News Update for January 11, 2018

Internal Document Discloses Trump Administration’s ACA Strategy

An internal Trump administration document recently obtained by Senator Bob Casey (D-PA) outlines 10 actions that Health and Human Services (HHS) planned to implement via executive authority to make changes to the Affordable Care Act.

The March 23, 2017, document says the measures would “improve the individual and small group markets most harmed by Obamacare.”

Casey called the list “sabotage” of the ACA. “The primary problem here is government officials, government agencies, were taking steps that would lead to fewer people having coverage and erecting barriers to people having coverage,” Casey said.

The document was used during a meeting with House GOP lawmakers in March, including House Speaker Paul Ryan (R-WI).

Most of the proposals have since been implemented. The suggested actions include:

  1. Require 100 percent verification for Special Enrollment Periods.
  2. Tighten rules on payment grace periods.
  3. Shorten the Open Enrollment Period to six weeks.
  4. Give oversight authority for network adequacy back to the states.
  5. Give states the authority to select essential health benefit benchmarks.
  6. Set up expedited review and approval of Section 1332 state innovation waivers. (These apply to the individual and small group markets.)
  7. Prevent providers from steering patients to ACA plans instead of Medicaid and Medicare.
  8. Allow alternative enrollment pathways.
  9. Give states the authority to review plan designs and formularies.
  10. Promote states to create “skinny” state exchanges, which cost less and rely on innovation from the private sector.

Healthcare Reform News Update for January 10, 2018

Maryland Lawmakers Propose Replacement for ACA Individual Mandate

Two Maryland Democratic state lawmakers proposed a program Tuesday that will impose a penalty on Maryland residents who don’t buy health insurance. The money would be used as a down payment for a plan on the state exchange.

The measure is the nation’s first response to the recent repeal of the Affordable Care Act’s individual mandate, which imposed a penalty on Americans who did not have health insurance.

Stat Senator Brian J. Feldman and Delegate Joseline A. Peña-Melnyk introduced the proposal, which would start in 2020.

The law would charge uninsured residents a penalty that could be used to help pay for a plan on the state exchange. If the cost of the penalty is equal to or more than the cost of an available plan, the resident can receive coverage at no additional charge. Residents would also have the option of simply paying the penalty.

Supporters of the measure are optimistic that Governor Larry Hogan (R) will support it, but he has not commented.

Alexander: President Supports Stabilization Bill

Senator Lamar Alexander (R-TN) told reporters Tuesday that President Donald Trump voiced his approval of the bipartisan Alexander-Murray bill, which was created to help stabilize the ACA marketplace.

The measure extends cost-sharing reduction (CSR) payments to insurers for two years. Proponents hope to include the bill as part of an upcoming funding package.

Repeal of ACA Takes a Backseat for GOP Leaders

After a meeting with the president last weekend, leading Republicans say that repealing and replacing the Affordable Care Act is no longer a primary issue.

“There’s some work we need to do on the healthcare front, but I would hope we’re in a position to do things on a bipartisan basis,” said Majority Whip Sen. John Cornyn (R-TX). He said they did not discuss ACA repeal during the meeting.

Some lawmakers, including Senator Lindsey Graham (R-SC), want to keep up the effort, but Trump and other GOP leaders have prioritized other issues, such as job training.

Healthcare Reform News Update for January 9, 2018

HHS Nominee Gets Pushback From Pro-ACA Group

As Health and Human Services (HHS) secretary nominee Alex Azar begins his confirmation hearing today, pro-Affordable Care Act group Protect Our Care has released a digital ad urging senators to oppose his nomination.

“President Trump and Republicans in Congress are in search of a new leader for their war effort to captain their repeal and sabotage campaign, and in a former pharmaceutical executive they have found their man,” the ad states.

Despite opposition from the group and several Democratic lawmakers, Azar’s appointment to the position is expected to be confirmed.

HHS Sued by Insurer for Failure to Reimburse CSR Payments

Nonprofit insurer Maine Community Health Options (MCHO) has filed suit against the Trump administration for its failure to pay cost-sharing reduction (CSR) reimbursements of $5.6 million last year.

In October, President Donald Trump signed an executive order that stopped the payments.

In its lawsuit, MCHO says that the failure to provide the CSR payments violated an Affordable Care Act contract between HHS and insurers.

Healthcare Reform News Update for January 8, 2018

Idaho Opens the Door to Skimpier Health Plans

Governor Butch Otter (R) of Idaho signed an executive order Friday allowing state health insurers to sell policies that do not meet Affordable Care Act requirements.

In an attempt to provide lower-cost options for consumers, the new plans would not cover all of the ACA’s 10 essential benefits, which include prescription drugs, emergency care, maternity care, and mental health services. The plans would also not be eligible for government subsidies.

Some officials have questioned the legality of the plans, but Otter said recent actions in Washington helped make way for his order.

“Congress and President Trump have eliminated the individual mandate requiring all Americans to buy Obamacare plans or face financial penalties. That means we will no longer be penalized for buying coverage that doesn’t meet all the Obamacare rules,” Otter said in a statement.

The state will still be required to sell ACA-compliant plans.

Healthcare Reform News Update for January 5, 2018

Labor Department Issues Association Health Plan Proposal

The Trump administration on Thursday proposed new rules allowing small employers and self-employed individuals to form associations to purchase health insurance.

The Department of Labor issued the proposal, which would expand the definition of eligible members and provide health coverage that’s exempt from many of the Affordable Care Act’s essential benefits, including prescription drugs, hospitalization, maternity care, and emergency care.

The proposal also allows associations to form specifically to provide healthcare for its members. “A plan could serve employers in a state, city, county, or a multi-state metro area, or it could serve all the businesses in a particular industry nationwide,” according to the release.

Poponents of the new rules say that it will provide lower-cost health insurance alternatives and give businesses more choices. Critics fear they could increase consumers’ out-of-pocket costs and cause healthier people to drop from ACA individual plans, which could lead to instability.

The proposal is now open for comment from the public for the next 60 days.

Senator Hopes ACA Stabilization Bills Pass This Year

Senator Susan Collins (R-ME) continues to push for passage of both bipartisan ACA stabilization bills despite pushback from the House. She now believes it can happen before 2019.

Collins voted in favor of the tax overhaul legislation that repealed the ACA’s individual mandate under the condition that the stabilization measures become law to prevent rising premium costs.

One of the stabilization bills restores cost-sharing reduction (CSR) payments to insurers for two years; the other allows states to set up reinsurance programs.

“When the mandate is repealed in 2019, we must have other health care reforms in place in order to prevent further increases in the cost of health insurance. Senator Collins believes that averting these price spikes, particularly for low-income families, should be a goal that members of both parties can embrace,” said a statement from the senator’s office.

Healthcare Reform News Update for January 4, 2018

Analysts Predict Stable 2018 ACA Marketplace

Global credit rating organization A.M. Best believes that insurance markets under the Affordable Care Act (ACA) will be relatively stable this year.

According to a briefing released Wednesday: “Negative factors continue to impact the industry, but A.M. Best believes that insurers overall have been able to adapt and as a result, does not expect any significant deterioration in market conditions over the next year.”

However, the firm’s analysts said the forecast could change if Congress succeeds in repealing and replacing the ACA.

Healthcare Reform News Update for January 3, 2018

Conservative Groups Urge President to Promote ACA Repeal

Forty-three conservative advocacy groups sent a letter to President Donald Trump asking for his administration and Congress to prioritize repealing the Affordable Care Act this year.

Signers included Independent Women’s Voice, Heritage Action, Americans for Tax Reform, and Susan B. Anthony List.

An excerpt from the letter: “Health reform must be the focus of the 2019 budget reconciliation instructions. And your administration’s leadership can help the Senate and the House design a bill that can muster the votes needed for passage of true health reform to give Americans more choices of more affordable health coverage and care that meet their needs.”

The White House made no commitments, but a spokesman said that healthcare will be one of the topics discussed in meetings with Congress this week.

Confirmation Hearing for HHS Secretary Scheduled for Next Week

President Donald Trump’s pick to lead the Department of Health and Human Services (HHS) will face his confirmation hearing with the Senate Finance Committee on January 9.

Alex Azar was previously a deputy secretary for HHS and an executive at pharmaceutical company Eli Lilly.

If confirmed by the full Senate, Azar would replace Tom Price, who resigned from the position in September.

Healthcare Reform News Update for December 29, 2017

Vermont to Consider State Individual Mandate

With last week’s repeal of the Affordable Care Act’s individual mandate, Vermont is the latest state to explore its own version of the provision.

If the number of uninsured Vermont residents rises, Governor Phil Scott will review a state mandate that requires all citizens to have health coverage or pay a penalty, said Al Gobeille, Vermont’s secretary of the Agency of Human Services.

ACA Signups Drop to 8.7 Million

The latest enrollment figure for the federal healthcare exchange has dipped to 8.7 million, about 80,000 fewer enrollees than announced last week. The drop in signups was mostly due to late cancellations.

The latest count also includes 66,000 new last-minute signups. Enrollment has reached almost 95 percent of last year’s numbers, even with the enrollment period cut in half.

The final ACA enrollment number will not be available until March due to the longer enrollment period for some states, including California and New York.

Healthcare Reform News Update for December 27, 2017

4 in 5 ACA Plan Enrollees Live in Trump-Backed States

Eighty percent of people who recently enrolled in health plans on the federal exchange live in states that President Donald Trump won in the 2016 election, according to an Associated Press analysis. The analysis also found:

  • The president won the four states with the largest number of enrollees—Florida, Texas, North Carolina, and Georgia.
  • Of the 11 states that increased enrollment from last year, eight were states that Trump won. Those states include: Iowa, Kansas, Kentucky, Missouri, Nebraska, North Dakota, South Dakota, and Wyoming.

Final enrollment numbers for all 2018 ACA enrollments are still incomplete, as some state exchanges continue their enrollment periods through January 31.

Healthcare Reform News Update for December 26, 2017

ACA’s Individual Mandate Overturned as Tax Bill Becomes Law

President Donald Trump signed the GOP-backed tax overhaul bill into law December 22, eliminating the Affordable Care Act’s mandate that all individuals have health insurance or pay a penalty.

As he signed the bill, Trump expressed his disapproval with the mandate. “The individual mandate was very unfair, because you’re basically saying, pay for something in order to not have to get healthcare. So you’re paying—you’re paying not to have healthcare. It was very unfair. Many people thought it should have been overturned at the Supreme Court,” he said.

Proponents of the repeal claimed it would save the government $338 billion, but the action could allow 13 million people to become uninsured.

GOP Continues Strategy to Repeal, Replace ACA

Senate Majority Leader Mitch McConnell (R-KY) said Friday that if Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) can draw enough support for legislation to repeal and replace the Affordable Care Act, he’d encourage the Senate to vote on the bill.

Noting that the repealed individual mandate was “one of the pillars” of the ACA, McConnell said he would “love to make more substantial changes to Obamacare than we have.”

McConnell’s comments come a day after he said in an interview that, next year, the Senate will probably focus on other issues besides repealing the law.

Healthcare Reform News Update for December 22, 2017

ACA Signups Nearly Equal Last Year’s Numbers

The federal healthcare exchange saw a surprising surge of enrollments in its final week, reaching a total of 8.8 million signups. That nearly matches last year’s total, despite working with an enrollment period that was half as long.

More than one million new enrollees signed up in the week of December 10. This brings the total number of new enrollees to 2.4 million—almost 30 percent of all enrollees.

The numbers are likely to rise in a final count, as some areas affected by hurricanes and other natural disasters have been given enrollment extensions.

State-run exchanges have enrolled 2.5 million Americans so far. Since 10 states and Washington, D.C., have longer enrollment periods than the federal marketplace, this number will increase.

Congress Retains Medical Expense Deduction

This week’s tax overhaul package not only kept the medical expense deduction but temporarily lowered the threshold for some people.

Taxpayers can subtract some out-of-pocket medical expenses from their taxes that exceed 7.5 percent of their adjusted gross income for 2017 and 2018. For 2019, the threshold increases to 10 percent.

The deduction will apply to all taxpayers, regardless of age. Currently, the deduction is 10 percent for those under 65 and 7.5 percent for those 65 and older.

Majority Leader Ready to ‘Move On’ From ACA Repeal

Senate Majority Leader Mitch McConnell (R-KY) said he wants to focus on stabilizing the insurance marketplace next year rather than try to repeal and replace the law.

“Well, we obviously were unable to completely repeal and replace with a 52-48 Senate. We’ll have to take a look at what that looks like with a 51-49 Senate. But I think we’ll probably move on to other issues,” McConnell said.

McConnell said he wants to focus on keeping insurance premiums from rising. “We want to steady the insurance markets if we can … and I think we’ll probably be addressing that part of healthcare sometime next year,” he said.

Poll: Healthcare a Top Concern for Americans

A new poll by The Associated Press-NORC Center for Public Affairs Research showed that 48 percent of Americans named healthcare as the most important topic for lawmakers. That is an increase of 17 points over the past two years.

Of the respondents who named healthcare as a priority, 7 in 10 said they didn’t have confidence that government would be able to help. Some of those polled said their skepticism was due to costs not being manageable any more.

Healthcare was the top issue for Democrats and Independents; for Republicans, top issues were immigration, health care, and taxes.

Second Judge Blocks Contraception Executive Order

A second federal judge blocked the Trump administration from enforcing new rules that allow businesses to obtain exemptions on moral or religious grounds for an ACA requirement to provide insurance that covers birth control. The action by California U.S. District Judge Haywood Gilliam, Jr. comes after a similar ruling from a federal judge in Philadelphia last week.

A Trump administration official hinted that the Department of Justice may appeal the ruling. “We disagree with the court’s ruling and are evaluating next steps,” she said.

Healthcare Reform News Update for December 21, 2017

ACA Stabilization Bills Not Included in End-of-Year Funding Package

Senators Susan Collins (R-ME) and Lamar Alexander (R-TN) have scrapped plans to include two bipartisan Affordable Care Act stabilization bills in an end-of-year funding measure.

The senators hope to instead have the bills be part of an omnibus spending bill in January, they said in a joint statement on Wednesday.

“There is every reason to believe that these important provisions can and will be delivered as part of a bipartisan agreement. And Majority Leader McConnell has told us that he will uphold his commitment to schedule and support the legislation,” the statement said.

The two bills would fund:

  • cost-sharing reduction (CSR) payments to insurers to help offset expected premium increases as a result of the individual mandate repeal.
  • reinsurance funding to offset insurers’ most expensive customers.

The president supports both bills, a White House spokesperson said Wednesday. “We believe we will work with the House to get those passed. We think that we’ll be in a more comfortable place in January to get that passed,” the official said.

Passage of the bills became uncertain last week when House and Senate Republicans clashed on including language to ensure that funds would not be used on plans that covered abortions. Negotiations on a resolution are ongoing.

Medical Device Firms Ask Trump to Delay ACA Tax

Trade firms representing medical device manufacturers have asked President Donald Trump to repeal or delay an ACA tax that’s set to be reinstated at the first of the year.

The device makers had hoped that a repeal of the 2.3 percent tax on medical device sales would be included in the tax overhaul package approved yesterday. There is proposed legislation in the House that would extend the tax delay for an additional five years.

“Unfortunately, while Congress worked with you to advance this major legislative undertaking, they have failed to address a punitive tax that singles out the American medical technology industry, threatening jobs in the U.S. and future innovations for patients, and washing away the benefits of tax reform for our companies,” said Advanced Medical Technology Association CEO Scott Whitaker in a letter.

Healthcare Reform News Update for December 20, 2017

Congress Repeals ACA Individual Mandate

The Republican tax overhaul bill that included the repeal of the Affordable Care Act’s individual mandate was approved by Congress today after a House vote of 224-201. No Democrats backed the bill, and 12 Republicans voted against it.

The ACA provision stipulated that all Americans must have health insurance coverage or pay a penalty. After President Donald Trump signs the bill into law, the repeal will go into effect in 2019.

The Congressional Budget Office (CBO) has estimated that repealing the mandate will reduce government spending by $300 billion over 10 years; however, it will increase premiums by 10 percent and raise the number of uninsured people to 13 million in that same timeframe.

Some GOP lawmakers and Trump believe that the elimination of the mandate is the beginning of dismantling the ACA, a measure they were unable to pass in a repeal-and-replace bill a few months ago.

Senate Majority Whip: Mandate Repeal Makes ACA ‘Unworkable’

Senator John Cornyn (R-TX), the Senate’s Majority Whip, said the repeal of the ACA’s individual mandate could push Democrats into negotiations to replace the law.

“Arguably, doing away with the individual mandate makes the Affordable Care Act unworkable—not that it was particularly great beforehand. Hopefully this will precipitate the bipartisan negotiation on what we need to do as an alternative,” Cornyn said.

House and Senate Clash Over ACA Stabilization Bills

House Republicans are pushing back against a Senate plan to attach the Alexander-Murray stabilization bill that funds cost-sharing reduction (CSR) payments in a year-end spending package.

The clash between House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) could cause a government shutdown if not resolved by the end of the week.

McConnell made a promise to Senator Susan Collins (R-ME) that the Alexander-Murray bill would be included in the spending package. Conservative Republican House members want to add abortion prohibition language into the CSR-funding bill, which Senate Democrats oppose.

It’s unclear how Ryan intends to negotiate a solution. Negotiations are ongoing.

Healthcare Reform News Update for December 18, 2017

Some States Weighing Whether to Implement Individual Mandates

With congressional Republicans prepared to repeal the Affordable Care Act’s individual mandate in their tax reform legislation, some states are weighing state-level measures.

Democratic-leaning states such as California, Connecticut, and Maryland are beginning to create strategies to preserve the law that all Americans have health coverage or face a penalty.

  • In California, the chief executive of Covered California recently floated the idea of a state mandate as one of several possibilities to help stabilize the state’s marketplace.
  • In Connecticut, Democratic officials considered the option during a recent meeting with four state legislators.
  • Maryland Senator Brian Feldman said, “I’m fairly confident there will be a bill if the tax plan results in a repeal of the individual mandate.”
  • Officials in Washington and New Jersey are exploring whether their states would implement individual mandates.
  • Massachusetts is the only state that has an individual mandate already in place.

Federal Judge Blocks Order Against Contraception Coverage

A U.S. judge in Pennsylvania on Friday ordered the Trump administration not to enforce a new rule that would expand the types of employers that could claim a religious or moral objection to providing birth control for employees.

Judge Wendy Beetlestone temporarily halted the law, which overrode an Affordable Care Act provision that most employers provide contraception at no cost. The judge’s injunction said that the new rule puts employers’ religious beliefs over women’s constitutional rights.

Her ruling is in effect while the case brought by Pennsylvania Attorney General Josh Shapiro moves forward in the courts.

Medical Device Trade Group Pushes Lifting ACA Tax

The CEO of a medical device trade group wrote Congress last week asking that the Affordable Care Act’s device tax be delayed.

The 2.3 percent tax is scheduled to go into effect January 1, unless Congress includes the delay in its end-of-year spending package. The House Ways and Means Committee has proposed a five-year delay.

“Addressing the device tax now will provide medical technology innovators with the certainty necessary to support future job growth and sustainable, cutting-edge R&D that will ultimately lead to the next generation of breakthroughs in patient care and treatment,” wrote Scott Whitaker, CEO of AdvaMed.

Prolife Groups Urge Congress to Amend Stabilization Bills

Anti-abortion groups, including Susan B. Anthony List and National Right to Life Committee (NRLC), are asking lawmakers to revise the language in the two bipartisan healthcare stabilization bills that are expected to be in the end-of-the-year spending deal.

The groups want assurance that the bills specifically stipulate that funds will not be used on health plans that cover abortion. The requests primarily refer to the Alexander-Murray bill, which extends cost-sharing reduction (CSR) payments. The NRLC also would like to add the restrictions to the Collins-Nelson reinsurance bill.

CSRs already include the provision that the funds can’t be used to cover abortions, but the prolife groups don’t believe the language is adequate.

Healthcare Reform News Update for December 15, 2017

ACA Enrollees Who Receive Hold Messages Can Still Get Coverage

Some consumers who call the federal exchange phone line to sign up for coverage by today’s deadline may receive a message that says a representative will return the call.

The last-minute surge of consumers has caused hold times to grow. Today’s enrollees who need to wait for a callback will still be able to receive coverage that goes into effect January 1.

Health Groups Ask States to Override Trump’s ACA Executive Order

Several healthcare groups have written a letter to state insurance commissioners urging them to override an executive order from President Donald Trump that seeks to expand short-term insurance plans.

The letter warns that extending cheaper, short-term plans from three months to one year would lead to “higher premiums for consumers, particularly those with pre-existing conditions.”

Members of the coalition who wrote the letter include the American Cancer Society Cancer Action Network and America’s Health Insurance Plans.

California State Exchange Extends Deadline for ACA Plans

Covered California announced Thursday that healthcare enrollees now have until December 22 to sign up for coverage that starts January 1. Formerly, the deadline was today.

Enrollment in the state exchange continues through January 31. California consumers who sign up after December 22 will receive coverage that starts February 1 at the earliest.

Healthcare Enrollment for Florida Residents Extended

Due to damage caused by Hurricane Irma, most residents of Florida have been given an extended deadline of December 31 to sign up on the federal healthcare exchange.

To receive the extension, Florida residents must call the exchange to request it. Enrollment counselors in the state recommend using navigators, also called enrollment counselors, to help streamline the process.

Healthcare Reform News Update for December 14, 2017

Study: ACA Helped Millions Gain Access

The Affordable Care Act has had a direct impact in increasing access to medical care, particularly in states that expanded Medicaid eligibility, according to a new report from the nonprofit Commonwealth Fund.

Some of the findings in the report include:

  • The uninsured rate for adults declined in all states between 2013 and 2016, with 47 states seeing at least a 5 percent drop.
  • The largest reduction of people who delayed care due to cost concerns was most pronounced in states that expanded Medicaid and launched significant enrollment efforts.
  • In Oregon, the percentage of people who delayed care due to costs was cut in half from 35 percent to 17 percent.
  • The percentage of those at risk of being in poor health who had not seen a doctor in at least two years was reduced in 37 states.
  • The largest coverage gains were seen in California, with uninsured working-age adults dropping from 24 percent to 10 percent.
  • Children’s uninsured rates declined by at least two percentage points in 33 states.

GOP Compromise Tax Bill Retains Repeal of ACA Individual Mandate

A compromise tax bill from Senate and House negotiators would repeal the Affordable Care Act’s mandate that all Americans have health coverage or pay a penalty.

Also, the bill would lower the amount consumers need to spend on health-related costs before deducting those costs. Under the bill, the amount would be 7.5 percent of the consumer’s income, instead of the current 10 percent.

The new bill now moves to both houses of Congress for approval.

More Than 1 Million Sign Up in Week 6 of ACA Enrollment

During the sixth week of the Open Enrollment Period, the federal healthcare exchange signed up more than 1 million people, including 389,000 new enrollees. That surpasses the 823,000 signups from the previous week.

Overall, more than 4.7 million people have signed up for 2018 plans on the federal healthcare exchange.

Maryland Extends ACA Enrollment to December 22

Maryland’s state-run healthcare marketplace has extended its enrollment deadline from December 15 to December 22.

“While enrollments have been very strong so far this year, we want to ensure that everyone in Maryland in need of 2018 health coverage has additional time to shop and enroll,” Howard Haft, interim executive director for the Maryland Health Benefit Exchange, said in a statement.

Alabama Senate Election Result May Curtail ACA Repeal Efforts

The election of Alabama Democrat Doug Jones to the Senate this week might have hindered the GOP’s plans to repeal the Affordable Care Act in 2018.

Jones reduced the Republican majority in the Senate to a slim 51-49. With the failure to pass a repeal effort over the summer due to the opposing votes of three GOP senators, the chances of future success have been greatly reduced.

Even with the smaller margin, the Trump administration said on Wednesday that it would like Congress to continue with ACA repeal efforts next year.

Healthcare Reform News Update for December 13, 2017

Senate Democrats Ask for ACA Enrollment Deadline Extension

Senators Patty Murray (D-WA) and Ron Wyden (D-OR) have asked the Trump administration to extend the healthcare enrollment deadline to January 31.

The senators argue that the administration’s decision to cut the Open Enrollment Period in half compared to previous years is not enough time for people to enroll.

“The Administration’s decision to depart from years of agency policy by ending Open Enrollment on December 15th is compounded by the many other efforts by this Administration to destabilize the insurance market, making it likely that many consumers miss this deadline and forgo insurance next year — all despite clear indications that consumers are highly interested in seeking coverage for 2018,” the senators wrote.

Neither the Trump administration or the Centers for Medicare and Medicaid Services (CMS) gave any indication whether an extension would be granted.

“The deadline for people to shop and pick a plan for the upcoming year is December 15. We continue to encourage people to make plan selections by that deadline so that their coverage can begin on January 1,” a CMS spokesman said.

Actuaries: Mandate Repeal Would Damage the Marketplace

The American Academy of Actuaries sent a letter to Congress saying that a repeal of the ACA’s individual mandate will raise premiums and cause people with individual insurance to lose coverage.

The tax overhaul bill currently being reconciled by House and Senate leaders includes the repeal of the provision that levies a fine to individuals who do not have health coverage.

The group says the two proposed stabilization measures would not be able to offset the damage that a repeal would trigger in the health insurance market.

“Insurers would likely reconsider their future participation in the market. This could lead to severe market disruption and loss of coverage among individual market enrollees,” according to the letter.

House Committee Unveils Bills to Delay ACA Taxes

Republican members of the House Ways and Means Committee released several bills on Tuesday that delay or halt some Affordable Care Act taxes and lift the employer mandate. The proposed rollbacks are separate from the tax overhaul bill currently being reconciled.

The bills’ recommendations include:

  • Delaying the medical device tax for five years.
  • Halting the 2018 health insurance tax (HIT) to insurers that provide premium rebates.
  • Halting HIT for all insurers in 2019.
  • Lifting the employer mandate retroactively for the past three years and for 2018.
  • Delaying the “Cadillac” tax for one year.
  • Temporarily lifting the ban on paying for over-the-counter drugs from health savings account funds.

Credit Report Freeze Can Cause a Holdup in ACA Enrollment Process

Consumers who put security freezes on their credit reports this year may experience a delay in the enrollment process on the federal healthcare exchange.

During enrollment on the website, users are asked to confirm their identities via questions that are tied to their credit histories. If there is a freeze on their credit data, applicants may have to call a marketplace help desk or call center before being able to continue with enrollment.

Instead of suspending the freeze on their credit reports, consumers can upload or mail in documents to the exchange.

In the event of an identity glitch, consumers should be able to complete the enrollment process as long as they start their applications before the December 15 enrollment deadline.

Lawmakers Ask to End ACA Program Operating in Only One State

Representative Mark Meadows (R-NC) and Senator Ron Johnson (R-WI) have called for the elimination of the Affordable Care Act’s Multi-State Plan program.

The program requires that the Office of Personnel Management (OPM) contract with two national health plans to compete with existing state plans. Only Arkansas is scheduled to participate in 2018.

Johnson said in a statement: “The program has failed to meet statutory requirements and is diverting necessary resources from what should be the OPM’s priorities, such as retirement and security backlogs. Congress needs to let the OPM focus on its job, eliminate this failed program and work to ensure healthcare is more affordable for all Americans.”

Healthcare Reform News Update for December 12, 2017

ACA Funding for Community Health Centers Extended by HRSA

Several community health centers that received funding through a provision of the Affordable Care Act have had their funding extended by the Health Resources and Services Administration (HRSA).

Funding for the centers expired September 30 and has yet to be renewed by Congress. To help cover the shortfall, the HRSA will provide funding from fiscal 2018 discretionary appropriations and remaining mandatory funds. This will continue on a month-to-month basis until the program is reauthorized or the funds run out.

HRSA sent funds for January and February to the 25 percent of community health centers that have grant periods beginning January 1. The agency plans to soon send out one month of funding to the 17 percent of community health centers that have grant periods beginning February 1.

Healthcare Enrollment Sees Small Glitch in Illinois, Final Push From Obama

Some consumers in Illinois received an erroneous message Monday when they tried to sign up on the website in the final week of Open Enrollment.

The website incorrectly generated a message that said health plans were not available in the area. The computer glitch occurred after enrollees completed their application for government subsidies.

Despite the error, the federal exchange website has operated efficiently for users throughout the Open Enrollment Period.

To help draw more people to the federal exchange, former President Barack Obama joined healthcare navigators and volunteers on a conference call to help encourage their efforts.

“So far, we’ve gotten more people covered this year than in past years, which is incredible given that there’s been so little advertising or outreach from some official quarters to remind people when and how they should get covered,” Obama said.

Healthcare Reform News Update for December 11, 2017

ACA Enrollment Enters Final Week

The last day for consumers to sign up for healthcare coverage on the federal exchange ends Friday. Those seeking coverage must be enrolled by midnight (Pacific time) December 15.

Due to disruption from recent hurricanes in Texas and Florida, people in affected areas can get a deadline extension to December 31.

Typically, the final week is one of the busiest, but the Trump administration has said little about any contingency plans.

The Centers for Medicare and Medicaid Services (CMS) has not announced if it will continue an Obama administration policy of creating a grace period for people who started an application prior to the deadline but didn’t complete it in time. In prior years, this extension enabled hundreds of thousands to receive coverage.

Heavy traffic could lead to delays on the website, but so far there have been no reported problems.

Government Shutdown Could Hinge on Extending CSR Payments

The Alexander-Murray stabilization bill, which extends cost-sharing reduction (CSR) payments to insurers for two years, has become an issue in avoiding a government shutdown.

Congress is negotiating a spending package to keep the government funded past December 22. Senate Majority Leader Mitch McConnell (R-KY) wants to include Alexander-Murray in the spending bill as part of a promise made to Senator Susan Collins (R-ME) for her vote on the tax overhaul bill.

But Republicans in the House aren’t interested in including the Alexander-Murray bill in the measure. “None of us voted in favor of Obamacare, so supporting it, sustaining it’s not exactly a high objective,” said Representative Tom Cole (R-OK.).

If the Senate includes Alexander-Murray in the spending package, it could cause a legislative stalemate that would trigger a shutdown.

ACA’s ‘Cadillac Tax’ Slowing Bipartisan Healthcare Negotiations

The ACA’s so-called Cadillac tax has become an obstacle in Congress’ attempt to delay certain healthcare taxes before the end of the year.

The Cadillac tax is a 40 percent excise tax on employer plans exceeding $10,200 in premiums per year for individuals and $27,500 for families. It’s currently scheduled to begin in 2020.

Democrats want to include delaying the Cadillac tax into the year-end spending package. Republicans prefer the delay of only the healthcare insurance tax and medical device tax, which go into effect in 2018. Negotiations are ongoing.

Healthcare Reform News Update for December 8, 2017

House Lawmakers Consider the Fate of ACA Taxes

Republican tax writers in the House are in discussions about delaying or suspending the Affordable Care Act’s health insurance tax (HIT), medical device tax, and the “Cadillac” tax as part of a year-end government funding bill.

Lawmakers are considering suspending HIT for all markets in 2019 but delaying it in limited markets next year. However, small businesses and private Medicare plans would still be subject to HIT in 2018.

HIT charges a 4-to-6 percent tax on every insurance plan sold. It can raise premium rates by up to 2.6 percent.

House lawmakers would also like to delay the ACA’s medical tax device tax for two years and the ACA’s Cadillac tax, which is a 40 percent excise tax on employer-funded health insurance plans that cost more than $10,200 for individuals and $27,500 for families.

Healthcare Reform News Update for December 7, 2017

Bipartisan ACA Bills Reduce Health Plan Premiums

If two bipartisan ACA stabilization bills are enacted, health insurance premiums for 2019 would be reduced by 18 percent, according to an analysis by Avalere Health.

The Alexander-Murray bill, which would fund cost-sharing reduction (CSR) payments to insurers for two years and increase flexibility for states to change ACA rules, would reduce premiums by 14 percent. The Collins-Nelson bill, which would provide funding for reinsurance, would reduce premiums by 4 percent.

If the ACA individual mandate is repealed in the tax overhaul bill, these reductions would help offset an expected 10 percent premium increase.

The bills may be included in an end-of-year government spending package, but support for the measures is not clear.

On Wednesday, House Freedom Caucus Chairman Mark Meadows (R-NC) said he’d be open to supporting the Alexander-Murray bill if Senate Democrats would agree to back increased defense spending.

ACA Plans Showing Profitability

Many insurers will see a profit on ACA plans for the first time, according to a Politico analysis of 31 regional Blue Cross Blue Shield plans.

On average, insurance companies spent 78 percent of their premium revenue on medical claims through September 2017, which is seven points over the break-even threshold.

The turnaround comes after three years of losses. In 2015 and 2016, carriers lost more than $12 billion, which resulted in many leaving the federal exchange marketplace.

ACA Enrollments Increase in Week 5

Healthcare sign-ups on the federal exchange during the fifth week of Open Enrollment outpaced the previous week, but overall numbers may be down from last year.

For the week of November 26, there were 823,180 sign-ups compared to 504,181 for the week of November 19. There were 271,207 new enrollees compared to 152,243 in the prior week.

Overall enrollment during this year’s Open Enrollment Period totals about 3.6 million people. That is about half the number of sign-ups during a comparable point from last year, according to Avalere Health.

With only one week left to enroll, experts expect this year’s final numbers to decrease 20 percent from last year’s 9.2 million sign-ups.

California State Exchange Enrollment Increases 28%

Covered California has currently signed up more than 102,000 new enrollees, which is a 28 percent increase over last year. In addition, almost 400,000 existing California consumers have switched coverage for 2018. The state’s Open Enrollment Period ends January 31.

Consumers Using Supplemental Coverage as Health Insurance

With rising premium costs making plans unaffordable to some consumers, many brokers are selling a combination of supplemental packages as an alternative.

Even though the mix-and-match supplemental approach does not give full coverage and is not exempt from the ACA’s individual mandate penalty, some consumers find it an affordable option.

Brokers are typically combining fixed-benefit indemnity, critical illness, and drug discount cards to help families have a minimum amount of health coverage for around $900 to $1,000 a month.

Though consumers may find the option attractive, in many cases purchasing a marketplace plan would have a lower premium, fewer out-of-pocket expenses, and provide full coverage.

Healthcare Reform News Update for December 6, 2017

Repeal of Individual Mandate Sees Strong Push in House

As the tax overhaul bills from the Senate and House are being reconciled, the House Republican Study Committee (RSC) and House Ways and Means Committee Chairman Kevin Brady (R-TX) are pushing to assure inclusion of the repeal of the Affordable Care Act’s individual mandate.

The Senate version of the bill includes the repeal, the House version does not. A committee will reconcile the differences in the two bills and merge them into a single bill.

On Tuesday, the RSC sent a letter to the House Ways and Means Committee and Senate Finance Committee urging for the repeal. “Including language to repeal this harmful policy will return personal decisions about health care choices to patients, fulfilling a key promise we have made to the American people,” the group wrote.

Also on Tuesday, Brady said the repeal is popular in the House. “We’ll be asking our members where do they want us to be on that position. I suspect there will be strong support,” he said.

Support of Stabilization Bills Not Guaranteed in House Vote

House Speaker Paul Ryan (R-WI) said on Monday that he has not entered into an agreement to support two bipartisan bills that could help stabilize the Affordable Care Act (ACA).

Last week, Senate Majority Leader Mitch McConnell (R-KY) promised Senator Susan Collins (R-ME) that the two measures would be included in an end-of-month government funding bill. Support in the House is now unclear.

One stabilization bill extends cost-sharing reduction subsidy payments to insurers for two years and gives states flexibility to change ACA rules. The other provides two years of funding for reinsurance, which “helps pay for the costs of sick ObamaCare enrollees with the intent of bringing down premiums.”

Adding to doubts about passage, the House Freedom Caucus expressed its opposition to the bills last week, and Representative Tom Cole (R-OK) said Monday that there were not enough votes in the House to pass the measures.

Healthcare Reform News Update for December 5, 2017

Funding for Reinsurance Bill Grows by $5.5 Billion

Senator Susan Collins (R-ME) announced that she has increased the amount of funding for the reinsurance bill she authored with Bill Nelson (D-FL) from $4.5 billion to $10 billion over two years.

The bill sets aside funds to reimburse insurance companies for customers with the biggest medical problems.

“We know from experiences in the states of Maine and Alaska that high-risk pools can help to lower premiums substantially — by an average of 20 percent,” Collins said in a statement.

Last week, Senate Majority Leader Mitch McConnell (R-KY) promised Collins that he would add the reinsurance measure to an end-of-year spending bill in exchange for her vote for the tax overhaul bill.

Collins raised the funding amount in response the tax bill, which repeals the Affordable Care Act’s individual mandate. According to the Congressional Budget Office, the repeal would cause 4 million people not to have insurance in 2019 and would raise premiums 10 percent.

Poll: ACA Individual Mandate Supported by Majority of Well-Informed Voters

A recent poll by the Kaiser Family Foundation shows that even though the Affordable Care Act’s individual mandate is the least popular part of the law, a majority of voters support it once they understand how the provision works.

Previous polling showed that 42 percent of voters supported the mandate that requires all Americans to have health coverage. But opinions rose when told of the impact from a repeal.

  • When told that people with insurance from employers, Medicare, or Medicaid already have coverage required by the mandate, support rose to 62 percent.
  • When told that repeal would increase premiums by 10 percent, support rose to 60 percent.
  • When told that 13 million Americans would lose coverage, support rose to 59 percent.
  • When told that low-income people who can’t afford coverage do not have to pay the penalty, support rose to 59 percent.

Healthcare Reform News Update for December 4, 2017

Senate Passes Elimination of Individual Mandate

Republicans in the Senate narrowly passed a tax overhaul bill early Saturday that includes the repeal of the Affordable Care Act’s requirement that all Americans have health coverage or pay a penalty.

The Congressional Budget Office (CBO) estimates that the repeal of the individual mandate would cause insurance premiums to rise. It would leave about 13 million people without health insurance coverage.

The bill will go through a reconcile process with the House, which is expected to be completed sometime next week.

Healthcare Reform News Update for December 1, 2017

Health Plans for 2018 More Restrictive, Have Higher Deductibles

Seventy-three percent of 2018 health plans sold on the federal exchange have more restrictive networks and an average deductible of almost $4,000, according to a new analysis from Avalere.

The percentage of health plans on the marketplace that use restrictive Health Maintenance Organizations (HMOs) or Exclusive Provider Organizations (EPOs) has risen significantly over the past three years. In 2015, 54 percent of plans were HMOs or EPOs; in 2017, it was 68 percent.

HMOs and EPOs limit coverage to exclusive in-network providers and specialists, whereas Preferred Provider Organizations (PPO) and Point of Service (POS) plans offer broader coverage.

Deductibles for silver plans have also risen. In 2015, the average deductible was $3,703; for 2018, it’s $3,937. Deductibles for bronze plans have dropped over the past three years, mostly as a consequence of cost-sharing reduction (CSR) payments for lower-income consumers. Platinum plan deductibles have also lowered.

“For the most popular exchange plans, we see an increase in deductibles for 2018. This trend helps reduce premium costs but may increase what consumers must pay out-of-pocket for their care,” said Avalere Senior Vice President Elizabeth Carpenter.

House Conservatives Against Marketplace Stabilization Bills

Some conservative Republican members of the House said they probably would not support a short-term spending bill if it contains provisions to stabilize the Affordable Care Act marketplace.

In a deal reached this week between Senate Majority Leader Mitch McConnell (R-KY) and Senator Susan Collins (R-ME), bipartisan bills that extend cost-sharing reduction (CSR) payments for insurers and provide funds for state reinsurance programs would be included in the spending bill in exchange for Collins’ vote for the tax overhaul bill.

House conservatives believe the stabilization efforts are bailouts to insurance companies and the measure wouldn’t pass in a House vote. “For me, I think probably largely for many of our members, that doesn’t make sense. I wouldn’t be supportive of that,” said Representative Jim Jordan (R-OH).

Enrollment for CT State Exchange Equals Last Year’s

Connecticut’s state-run health exchange program, Access Health CT, estimates that it will have about the same number of enrollees as last year.

CEO Jim Wadleigh estimates that final enrollment numbers will be between 105,000 and 110,000. Currently, about 101,000 people have signed up for 2018 coverage.

Open enrollment for Access Health CT ends December 22.

Healthcare Reform News Update for November 30, 2017

Obamacare Enrollments Decrease in Week 4

The rate of people who have signed up for health insurance on the federal exchange slowed last week to 504,181, down from 798,829 in the previous week. However, overall numbers are up from last year’s Open Enrollment Period.

Nearly 2.8 million people have enrolled on the federal exchange since November 1, which outpaces last year’s 2.1 million during the first four weeks.

New enrollments during the week of November 20 fell to 152,243 compared to 220,323 in the third week.

Stabilization Bill Ineffective if ACA Individual Mandate is Repealed

According to the Congressional Budget Office (CBO), the bipartisan Alexander-Murray stabilization bill would have little impact on reducing an increase in the number of uninsured Americans if the Affordable Care Act’s individual mandate is repealed.

Previously, the CBO estimated that if the individual mandate were repealed, it would cause 4 million people not have insurance and raise premiums 10 percent.

The stabilization bill seeks to restore cost-sharing reduction (CSR) payments to insurers that President Donald Trump recently cut. Several Republican senators have cited the legislation as a necessary measure should the individual mandate be repealed in their tax overhaul bill.

Senate Leader Agrees to Include Stabilization Bill in Upcoming Legislation

Senate Majority Leader Mitch McConnell (R-KY) has promised Senator Susan Collins (R-ME) that he will include the Alexander-Murray bipartisan stabilization measure in legislation this year.

Collins has said that her vote for the repeal of Obamacare’s individual mandate in the tax overhaul bill hinged on passing the stabilization effort, which extends cost-sharing reduction (CSR) payments to insurers for two years and provides states with more flexibility in defining their health plans.

Republican Disapproval of Individual Mandate Grows

Republican voters’ opposition to the ACA’s individual mandate has increased 14 percent since September, according to a recent Morning Consult/Politico poll. Sixty-five percent of GOP respondents said they opposed the regulation compared to 51 percent previously.

Other findings from the poll:

  • Disapproval of the mandate from all voters increased from 49 percent to 54 percent, mostly driven by Republican opinions.
  • Democrats disapproval remained stable at 41 percent.
  • Independents’ opposition increased one point to 57 percent.
  • Support for the Affordable Care Act is at 80 percent for Democrats and 23 percent for Republicans. Overall support is at 51 percent.

Healthcare Reform News Update for November 29, 2017

Trump Supports Marketplace Stabilization Bills

President Donald Trump told Senate Republicans that he would support two bipartisan measures to help stabilize the Affordable Care Act’s health insurance marketplace if they pass the tax overhaul bill that includes the repeal of the ACA’s individual mandate.

The first bill, from Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), would extend cost-sharing reduction (CSR) payments to insurers for two years and give states more flexibility to define their plans. The second bill, from Senators Susan Collins (R-ME) and Bill Nelson (R-FL), would provide states with $4.5 billion over two years for reinsurance programs.

“[President Trump] said that he understood the need to have something to offset the premium increases and appeared very open” to enacting the two bills, Murray said.

Senate Democrats are against repealing the individual mandate that requires all Americans to have health insurance coverage or pay a fine. They have also disapproved of the GOPs efforts to tie the tax bill to ACA stabilization. Posts Draft Proposals for 2019 Health Plans

The Center for Consumer Information and Insurance Oversight (CCIIO), which runs the Obamacare federal exchange, posted on Monday an informational letter draft to plan issuers of 2019 marketplace health plans. The draft included filing deadlines and a proposed filing deadline summary sheet.

According to the draft, plan rates will be due July 25, 2018, and will be available to the public on the federal exchange website August 1. The Open Enrollment Period will begin November 1.

Proposed marketplace changes include:

  • Elimination of the requirement that new marketplace plans be meaningfully different from existing plans.
  • Changing the threshold on when a health plan needs to explain premium increases from 10 percent to 15 percent.
  • Allowing web brokers to choose which outside entity will decide whether they are qualified to use the direct enrollment process.

NYT Provides Snapshot of People Who Pay Insurance Penalty

The upcoming tax bill currently includes a repeal of the Affordable Care Act’s individual mandate, which levies a penalty for most Americans who don’t have health insurance coverage. The New York Times published a study on Tuesday that provided an overview of the people who paid the penalty in 2015.

Some of the findings include:

  • The penalty was paid by 4.5% of taxpayers, which was about 6.7 million filers.
  • People earning between $25,000 and $50,000 were the most likely to pay the penalty.
  • The average penalty was $462 (for 2017, the average was $708).
  • In general, states with the highest rates of uninsured residents have the highest share of people who pay the penalty.

Patient Groups Ask Senate to Drop Repeal of Individual Mandate

A letter from a coalition of 19 patient groups to Republican lawmakers urged them to remove the repeal of the individual mandate from the senate tax bill.

The letter to senators says that the repeal would cause “coverage losses and higher premiums,” and would cause many people with chronic or major health conditions to lose coverage. It’s signed by groups including the American Heart Association, American Cancer Society Cancer Action Network, and the American Diabetes Association.

Healthcare Reform News Update for November 28, 2017

Republican Senators Push Reinsurance Funding

Several Senate Republicans appear open to adding funds for a reinsurance program as a way to offset the impact of repealing Obamacare’s individual mandate in their tax overhaul bill.

Susan Collins (R-ME), a key swing vote, implied she would vote for a tax bill that repeals the mandate only if Congress also passes a separate measure to establish a new reinsurance fund. She wants to add the funding measure to the stabilization bill proposed by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) that extends cost-sharing reduction (CSR) payments.

Collins’ amendment would provide states with $4.5 billion over two years for reinsurance programs. The funds help compensate insurance companies for their most expensive policyholders and could help lower premiums for consumers.

Senators including Bill Cassidy (R-LA), Roger Wicker (R-MS), and Mike Rounds (R-ND) applaud the idea of reinsurance funding but are skeptical of the proposal passing.

President Donald Trump is against the measure. His administration has been receptive to state-run reinsurance programs but not to federal funding.

California Marketplace Outspending Federal Exchange Advertising

The state-run Covered California health exchange has dedicated $45 million in marketing efforts to its Open Enrollment Period (OEP), which runs through January 31. That is significantly above the federal Obamacare exchange, which slashed its advertising budget from last year’s $100 million to $10 million this year.

“California’s budget reflects a different approach to the ACA, which is that it is an important source of insurance,” said Gerald Kominski, director at the University of California-Los Angeles Center for Health Policy Research.

The OEP marketing efforts in California include television, radio, digital, social media, and billboard advertisements.

Approximately 1.4 million people are currently insured through Covered California. As of November 14, 48,000 new consumers had enrolled, which is up from 39,000 during the same period last year.

Healthcare Reform News Update for November 27, 2017

States Prepare for Possible Children’s Health Insurance Shutdown

Almost 9 million children and 370,000 pregnant women who depend on the Children’s Health Insurance Program (CHIP) are at risk of losing their insurance. A September deadline for Congress to extend funding for the program was missed, leaving nearly a dozen states scrambling for alternatives.

A November 9 notice from the Centers for Medicare and Medicaid Services (CMS) directed state health officials to determine whether the affected lower-income families are eligible for Medicaid or if they need to enroll in Obamacare plans. As soon as next week, enrollees will receive state notices letting them know that their insurance may be eliminated.

Lawmakers have not come to an agreement on how to continue CHIP funding. Earlier this month, the House passed a bill that extends payments for five years while raising Medicare premiums and eliminating an Obamacare prevention fund. The Senate is still working on a bipartisan solution.

New Obamacare Enrollees Increase in Week Three of OEP

The third week of Obamacare’s open enrollment period saw a surge of first-time consumers with 220,323 signing up compared to 208,397 the previous week.

About 800,000 people signed up the week of November 13, which is about 75,000 fewer than the week of November 6. So far, overall signups on the federal exchange total 2.28 million.

The states with the highest enrollment numbers in week three were Florida, Texas, North Carolina, Georgia, and Pennsylvania.

High Premiums Attract Individual ‘Skinny’ Plan Offerings

The rising costs of health insurance has generated new “skinny” plans that tout low costs, come with limited benefits, and are being sold without approval from state regulators.

Dozens of brokers are offering the individual plans that assert to be low-cost alternatives to the marketplace’s bronze, gold, and silver offerings. Previously, the plans were only available to groups.

Premiums start at $93 for individuals and $516 for families. They cover preventative care, limited doctor visits per year, lab tests, and some prescription drugs. They provide little-to-no coverage for hospitals, emergency rooms, and high-cost prescription drugs.

The plans concern insurance experts and regulators who fear these limited plans take advantage of buyer confusion and may cause policyholders to think they are exempt from the Obamacare individual mandate penalty. A regulator in California has requested an investigation.

Healthcare Reform News Update for November 22, 2017

Massachusetts Governor Signs State Contraception Bill

Republican Governor Charlie Baker signed a new law that requires health insurance plans in Massachusetts to cover most types of birth control pills without copays.

The legislation overrides President Donald Trump’s recent executive order that allows most employers to opt out of the Affordable Care Act’s contraception mandate on religious or moral grounds.

The law includes most types of oral contraception and over-the-counter emergency contraception. It exempts plans purchased by church or church-owned entities and self-insured businesses. It also allows copays for brand-name contraceptives if generics are available.

“This is exactly the sort of opportunity where Massachusetts has a chance to send a message to the rest of the country about how we think and how we feel about this issue, and I’m proud to be part of the team,” Baker said.

Murkowski Backs Repealing Obamacare Individual Mandate

Senator Lisa Murkowski (R-AK), a key swing vote, says she supports Republican efforts to include the repeal of Obamacare’s individual mandate in the tax overhaul bill.

“While I support repealing the individual mandate, I strongly support enacting the bipartisan compromise Alexander/Murray legislation into law as fast as possible to stabilize our markets, provide more control to states and more choices to individuals,” she wrote in an op-ed for the Daily News-Miner.

A spokesman for the senator said the comments should not be construed as support for the overall tax bill.

Actuaries: Repeal of Mandate Could Increase Health Insurance Premiums

The American Academy of Actuaries cautioned Senate leaders that repealing the Affordable Care Act’s individual mandate in the tax overhaul bill could lead to higher health insurance premiums and prompt some insurers to leave the market.

In a letter sent to Congress, the organization’s vice president, Shari Westerfield, said without the regulation that all Americans have health insurance, “insurers would likely reconsider their future participation in the market. This could lead to severe market disruption and loss of coverage among individual market enrollees.” The letter also requested that Congress consider “the adverse consequences of eliminating the individual mandate.”

Healthcare Reform News Update for November 21, 2017

Obamacare Funds for Community Health Centers May Lapse

Community health centers that provide care for 26 million medically underserved patients may have their funding cut off.

Funding for the health centers was established by the Affordable Care Act, which makes up 70 percent of their budgets. The funds were renewed in 2015 for $7.2 billion over two years and expired on September 30.

Community health centers are anxious about the fate of the funds, as 25 percent of them have new grant periods that start January 1. Another 17 percent have grant periods that begin February 1. The Health Resources and Services Administration says it may provide short-term grants to the centers but not at the current funding levels.

If the funding is not renewed, 41 percent of community health centers would have to lay off employees, 47 percent would reduce hours, and more than 50 percent would cancel or delay facility expansions.

The House has passed a bill to extend funding for two years. The Senate has not yet passed any legislation, but a bill has been proposed to provide five years of funding.

Hurricane Victims Struggling with Healthcare Decisions

Some Puerto Rico residents who were displaced to the mainland by recent hurricanes have had difficulty navigating their healthcare coverage.

The federal government has extended the Obamacare enrollment period for hurricane victims to December 31, but people who sign up after the standard December 15 cutoff won’t receive coverage until February 1. The deadline extension has caused enough confusion that congressional leaders from Florida have asked for clarification from CMS.

In addition, Puerto Ricans who receive Medicaid or Medicare aren’t sure if their coverage will continue due to differences in eligibility standards.

CMS released a memo in September that says that hurricane victims may be eligible for a special enrollment period and directs them to call the federal exchange hotline with any questions.

Healthcare Reform News Update for November 20, 2017

White House Could OK Removal of ACA’s Individual Mandate Repeal

Office of Management and Budget Director Mick Mulvaney said that the Trump administration would be willing to accept the removal of a repeal of the Affordable Care Act’s individual mandate in the Senate tax overhaul bill.

“If it becomes an impediment to getting the best tax bill we can, then we are OK with taking it out,” Mulvaney said.

The House version of the tax bill approved last week did not include a repeal of the mandate that requires all Americans to have health coverage or pay a fine. The Senate version is expected to go to a vote next week.

Many on Medicare Will See Higher Part B Premiums in 2018

Due to increases in Social Security, many enrollees will see higher 2018 premiums for Medicare Part B. The Centers for Medicare and Medicaid Services (CMS) on Friday announced the out-of-pocket costs for 2018 Medicare Part A and Part B.

2018 Part A premium and deductible:

  • For Americans who pay Part A premiums, the cost will rise from $413 to $422 per month.
  • For Americans who have used up transitional Medicare benefits, Part A will rise from $232 to $227 per month.
  • The deductible for Part A will rise from $1,316 to $1,340.

2018 Part B premium and deductible:

  • The standard Part B premium will remain the same as 2017. (The premium will be either $134 or $428.60 per month, depending on income.)
  • For people with low to moderate incomes who currently pay $109 per month, premiums will rise an average of $25 per month due to an increase in Social Security cost-of-living adjustments. This change will affect 70 percent of enrollees.
  • The deductible for Part B remains the same as 2017 at $183.

Healthcare Reform News Update for November 17, 2017

Kaiser Survey: One-Third Unaware of Open Enrollment Period

Nearly a third of Americans are not aware of the Obamacare Open Enrollment Period (OEP), according to a recent Kaiser Family Foundation study.

The poll of 1,201 adults showed that:

  • 31 percent of those surveyed have not heard about OEP.
  • 30 percent have heard a little about OEP.
  • 21 percent have heard some about OEP.
  • 18 percent have heard a lot about OEP.

Forty-five percent said they have heard less about OEP compared to previous years, and 38 percent said they have heard about the same amount.

Even though the Trump administration cut funding for Obamacare enrollment advertising, the survey showed that awareness of ads selling health plans increased from 34 percent last month to 41 percent this month. People who saw ads that provided information on how to get insurance on one of the Obamacare exchanges increased from 20 percent to 32 percent.

Insurance Enrollments Rise in California and Colorado

Two states that run their own insurance exchanges have seen a jump in enrollments compared to last year.

The Covered California exchange saw an increase of 23 percent over last year for the first two weeks of open enrollment. About 48,000 new customers signed up, compared to 39,000 in 2016.

In Colorado, enrollment rose 33 percent with 22,000 people signing onto its state exchange.

ACA Premiums Most Expensive in Charlottesville, VA

An analysis by the Kaiser Family Foundation has pinpointed Charlottesville, Virginia, and its surrounding county as having the highest health premiums on the federal Obamacare exchange.

Prices for some plans in the city have gone up as much as three times the price of 2017 plans. The average price of a benchmark silver plan in the Charlottesville area is $1,011 for a 40-year-old individual.

After insurance companies Aetna and Anthem pulled out of the area, a single insurer, Optima, took over. Consumers now have only five health plans to choose from, compared to 19 previously.

Virginia has more than 350,000 people who purchase health insurance through the federal exchange. Almost 80 percent qualify for tax credits that lower premium prices.

Pope Asks for Healthcare Laws to Protect Underprivileged

Pope Francis addressed a medical association at the Vatican on Thursday and said that politicians need to ensure that healthcare law “promotes the common good” to protect the most vulnerable.

“Increasingly, sophisticated and costly treatment are available to ever more limited and privileged segments of the population, and this raises questions about the sustainability of healthcare delivery and about what might be called a systemic tendency toward growing inequality in health care,” he said.

Healthcare Reform News Update for November 16, 2017

IRS to Enforce Obamacare Employer Mandate

For the first time, the Internal Revenue Service is enforcing the Affordable Care Act regulation that requires companies with 50 or more employees to provide qualifying health insurance to their full-time employees.

Since last month, the IRS has been sending compliance notices to companies that disregarded the law in 2015 when the mandate took effect.

President Donald Trump’s first executive order requested that the department waive, defer, or delay the regulation. However, the IRS stated that it is required to enforce the mandate. Previously, fines were not collected due to a lack of funds and time needed to update the department’s compliance systems.

In general, the law states that companies will incur fines of around $2,000 per employee (excluding the first 30) for noncompliance. The penalty goes into effect if at least one employee purchases health insurance on the federal exchange and receives a tax credit.

A company with 100 workers that ignored the law this year would owe a penalty of more than $158,000, according to The New York Times.

Bipartisan Stabilization Bill May Be in Year-End Spending Package

Senate Majority Whip John Cornyn (R-TX) said Wednesday that bipartisan legislation proposed by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) to extend cost-sharing reduction (CSR) subsidies for insurers could be included in an end-of-year funding bill.

Earlier this week, Republican senators introduced a provision to their tax overhaul bill that would repeal the Obamacare individual mandate. Approving the repeal, which would extend CSR payments by two years, “probably makes more sense,” Cornyn said.

In response, Senate Minority Leader Chuck Schumer (D-NY) said, if proposed, the Democrats would not vote for the measure. “The Republicans cannot expect to pass their own separate ideological healthcare provision and then turn around and ask Democrats to vote to pass Alexander-Murray,” he said.

Kaiser Study Shows Marketplace Premium Changes for 2018

A recent Kaiser Family Foundation analysis outlining health insurance premium increases on the federal exchange for 2018 found that the lowest-cost bronze plans rose 18 percent. The lowest-cost silver plans rose 32 percent, and the lowest-cost gold plans rose 18 percent, according to the study.

The large increase in silver plans boosted the tax credit amounts, which have made bronze and gold plans more affordable. For example, a 40-year-old with an income of $25,000 will have a tax credit high enough to purchase the lowest-cost bronze plan at a $0 premium in 1,679 counties across the country.

Obamacare Enrollments Continue to Outpace 2016

The first 12 days of the Open Enrollment Period is running 47 percent ahead of last year’s numbers. The first 11 days saw almost 1.5 million people apply for health coverage, compared to 1 million in 2016. New customers have accounted for 23 percent of the enrollees, which is almost comparable to last year’s 24 percent.

Healthcare Reform News Update for November 15, 2017

Senate Adds ACA Individual Mandate Repeal to Tax Bill

Senate Republicans released a new version of their tax reform legislation that includes a provision to repeal the Affordable Care Act’s mandate that every individual have health insurance or pay a penalty. The move comes one day after President Donald Trump’s latest push for the inclusion.

Senate Finance Committee Chairman Orrin Hatch (R-UT) said the measure would “help provide additional relief to low- and middle-income families.” Repealing the mandate would save an estimated $338 billion over 10 years, but it would also create an additional 4 million more uninsured people by 2019, according to the Congressional Budget Office (CBO).

It’s unclear if the Senate has enough votes to pass this latest version of the tax bill. But leaders, including Senate Majority Leader Mitch McConnell (R-KY) and John Thune (R-SD), are confident.

Senate Democratic leader Chuck Schumer (NY) was not pleased with the provision. “Rather than learning the lessons from their failure to repeal healthcare, Republicans are doubling down on the same partisan strategy that would throw our healthcare system into chaos,” Schumer said.

Healthcare Reform News Update for November 14, 2017

Alex Azar Nominated for Health and Human Services Secretary

President Donald Trump has chosen former pharmaceutical executive Alex Azar for secretary of the Department of Health and Human Services (HHS).

In a tweet Monday, Trump said Azar would be “a star for better healthcare and lower drug prices!”

Prior to working as president of Eli Lilly and Company, Azar served as deputy secretary of HHS under President George W. Bush. Azar is replacing Tom Price, who left the role in September

Former HHS Secretary Mike Leavitt said that Azar would work to alter the Affordable Care Act to be more in line with Republican beliefs and will “change the ideology under which the existing law is implemented.”

Trump Again Appeals for Repeal of ACA Individual Mandate

In a tweet sent Monday, President Donald Trump urged lawmakers to include a repeal of Obamacare’s individual mandate in their tax overhaul bill.

Trump’s tweet, which came hours prior to a Senate Finance Committee meeting, asked “Now, how about ending the unfair & highly unpopular Indiv Mandate in OCare & reducing taxes even further?”

The individual mandate requires all Americans to have health coverage or face a penalty. Neither the House nor Senate versions of the tax bill currently include a measure to repeal the regulation.

Healthcare Reform News Update for November 13, 2017

Fewer Insurance Options Available for Marketplace Shoppers

The number of insurance companies on the federal marketplace has declined, but no counties are without carriers offering coverage, according to a new analysis from the Kaiser Family Foundation.

The study determined that 75 percent of enrollees have a choice of two or more insurers, and 48 percent have three or more. However, the number of people with only one insurance company in their county has increased by 24 percent since 2016.

In comparisons over the last three years, the analysis showed:

2016 2017 2018
Number of insurers per state 5.6 4.3 3.5
Percentage of enrollees with one insurer 2% 21% 26%


States Sue Trump Administration Over Contraception Mandate

The attorneys general of California, New York, Maryland, Delaware, and Virginia filed a motion Thursday night to stall implementation of President Donald Trump’s order that exempts most employers from Obamacare’s contraceptive coverage mandate if they state a religious or moral objection.

The filing is part of a lawsuit the states filed in October that argues the order is unconstitutional.

Healthcare Reform News Update for November 10, 2017

Senate Tax Bill Retains ACA Individual Mandate, Medical Deductions

Republican leaders in the Senate released their version of a tax overhaul bill Thursday. Like the House version, the bill does not include a repeal of the Affordable Care Act’s individual mandate. But the senators did not rule out adding the provision at a later date.

Earlier this week, the Congressional Budget Office (CBO) found that repealing the regulation requiring all Americans have health coverage would cause 13 million people to become uninsured over 10 years.

The Senate tax bill does differ from the House version over medical expense deductions. The Senate version continues to allow people with qualified medical expenses to deduct them from their federal taxes. The House bill repeals the deduction.

ACA Enrollments Continue to Outpace Last Year

More than 600,000 people signed up last week for health insurance under the federal healthcare exchange, which continues to outperform 2016 enrollments.

Overall, total daily signups were up 79 percent compared to 2016 for the first few days of the Open Enrollment Period, which began November 1.

The first four days of enrollment saw a daily average of 150,00 enrollees, compared to 84,000 in the first 12 days of 2016. Of these signups, more than 34,000 people a day were new to the marketplace compared to 26,000 last year.

Healthcare Reform News Update for November 9, 2017

Healthcare a Top Issue at the Polls

Tuesday’s election results showed that voters put healthcare as a leading issue in their decisions with especially strong support for the Affordable Care Act in Maine and Virginia.

In Maine, voters approved a referendum that would expand Medicaid under the ACA to insure an estimated 70,000 to 90,000 individuals who earn $16,600 or less per year. Republican Governor Paul LePage campaigned against the measure and said he would not implement it until funding details could be worked out by the legislature.

In Virginia, 40 percent of those polled said that healthcare was the most important issue for them. Democrat Ralph Northam won the state’s governor’s race and received support from 77 percent of the voters who put healthcare as their top concern, making the issue his biggest strength.

The voting results confirm a recent poll from the Kaiser Family Foundation, which showed that Obamacare has a small favorability lead with 52 percent of respondents who approve of the ACA and 39 percent who disapprove.

CBO: Repealing Obamacare Mandate Would Leave Millions Uninsured

The Congressional Budget Office (CBO) released a new analysis on the effects of repealing Obamacare’s individual mandate, as some Republicans push to include the provision in their tax reform bill.

According to the CBO, removing the requirement that all Americans be insured or pay a fine would reduce the federal budget deficit by $338 billion. However, this would also mean that 13 million people would be uninsured by 2027. The analysis also predicted that a repeal would cause health insurance premiums to increase about 10 percent most years over the next decade.

President Donald Trump and many Republican leaders have shown support for including a repeal of the mandate in the tax overhaul. However, House Committee on Ways and Means Chairman Kevin Brady (R-TX) has been against the idea.

Senators Propose Changes to Obamacare State Waiver Program

Senate Finance Chairman Orrin Hatch (R-UT) and Senator Michael Crapo (R-ID) have introduced a bill that would change how Obamacare state waivers are executed.

The legislation would:

  • Allow governors to implement waivers under the Affordable Care Act without approval from their state legislators.
  • Give governors the power to end the waiver program.
  • Require that the Department of Health and Human Services (HHS) secretary make a decision on waivers within 100 days.
  • Prevent insurance companies from limiting access for people with pre-existing conditions.

The waiver program enables states to alter portions of the Affordable Care Act as long as it doesn’t lower the quality of care or make care more expensive.

Hatch said: “While fully repealing and replacing Obamacare remains a priority, this approach would remove some of the current hurdles facing states across the country and provide concrete options to assist states in caring for their low-income populations in creative and fiscally responsible ways.”

Healthcare Reform News Update for November 7, 2017

Obamacare Enrollment Off to Strong Start

The first day of the Obamacare Open Enrollment Period saw twice the number of enrollees as last year. More than 200,000 people signed up for healthcare on the federal exchange on November 1 compared to 100,000 in 2016.

Traffic on the website was up on the first day of OEP, receiving 1 million visitors compared to 750,000 in 2016.

A government spokesperson said the first few days of enrollment have gone well. “The website performed optimally and consumers easily accessed enrollment tools to compare plans and prices.”

Executive Order Would Weaken Individual Mandate

The Trump administration has prepared an executive order that would weaken the Affordable Care Act’s requirement that all Americans have healthcare coverage. This executive order could be released if congressional Republicans do not address it in a new tax reform bill.

If President Donald Trump issues the executive order, it would expand the “hardship exemption” so that more people could avoid paying a fine for a lack of insurance. Currently, an exemption is granted in the instance of the death of a family member, bankruptcy, a natural disaster, or poverty.

Congressional Republicans have been split on whether to include a repeal of the individual mandate within the tax bill.

If the regulation is eliminated, it would cause 15 million people to be uninsured by 2026, according to the Congressional Budget Office.

Health Care Voter Coalition Set to Mobilize Constituents

A group of 30 Democratic progressive organizations has joined to rally a million voters against Republican candidates who are against Obamacare.

The Health Care Voter campaign is focusing on the 2018 midterm elections to highlight healthcare reform issues. The effort kicked off this week with a video that features prominent Democrats including House Minority Leader Nancy Pelosi, former Health and Human Services Secretary Kathleen Sebelius, and DNC Chairman Tom Perez.

Healthcare Reform News Update for November 3, 2017

Tax Bill Drops Medical Deductions, Keeps Individual Mandate

House Republicans released tax reform legislation Thursday that would eliminate a deduction for qualified medical expenses.

The medical deduction covers out-of-pocket expenses that exceed 10 percent of a person’s adjusted gross income. In 2015, it was used by 8.8 million people who claimed an estimated $87 billion in healthcare expenses. The majority of people who claimed the deduction were 50 or older with incomes under $75,000.

The bill does not include the repeal of Obamacare’s individual mandate, which President Donald Trump and some Republican leaders wanted eliminated. The issue is not addressed in the proposal.

Study: Zero-Premium Bronze Plans Available for Low-Income Citizens

Older, lower-income Americans can purchase a bronze plan with no monthly premium in 98 percent of counties on the federal exchange, according to a study released Thursday by Avalere Heath.

The analysis was based on 50-year-olds who had a single income of $18,090 or were the head of a four-person household with an income of $36,900.

Healthcare Reform News Update for November 2, 2017

Millions Cut From OEP Email Notices

The Trump administration sent initial healthcare enrollment notices to millions fewer Americans as compared to previous years.

Emails that went out prior to the start of the Open Enrollment Period (OEP) on Wednesday were only sent to people who currently are enrolled in a plan from the federal exchange. Recipients did not include the 20 million Americans who previously had an Obamacare plan.

In a change from emails sent in previous years, the notices did not include encouragement to sign up, the benefits of shopping for a new plan, or potential cost savings.

Emails to people who previously had a plan will be sent, although the communications will not mention the availability of cost-sharing reduction (CSR) payments that lower healthcare costs for low-income consumers, a spokesman told The Washington Post.

CMS says it will send out three to five emails to consumers throughout OEP. “The emails encourage potential consumers to shop around for the plan that best meets their needs,” said an agency spokesperson.

Trump Wants Obamacare Mandate in Tax Bill

President Donald Trump called on Congressional leaders to repeal the Affordable Care Act’s individual mandate in tweets posted Wednesday morning. “Wouldn’t it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts for the Middle Class,” Trump tweeted.

The idea to eliminate the ACA’s requirement that everyone have health coverage as part of the year-end tax reform package was suggested by Senator Tom Cotton (R-AR). Many Congressional GOP leaders are opposed to the idea. “I think tax reform is complicated enough without adding another layer of complexity,” said Senate Majority Whip John Cornyn (R-TX).

The president’s tweets seemed to contradict statements made Tuesday to reporters from White House Press Secretary Sarah Huckabee Sanders when she told reporters that she didn’t think that eliminating the mandate needed to be included in the tax bill.

Bipartisan Stabilization Bill Backed by 200 Groups

The bipartisan healthcare stabilization bill proposed by the Senate Health Committee has been endorsed by more than 200 health and business organizations, including the American Medical Association and the American Hospital Association.

The bill would extend cost-sharing reduction (CSR) subsidy payments to insurers for two years and give states more flexibility to change some Affordable Care Act rules.

The bill may have the votes needed to pass, but Senate Majority Leader Mitch McConnell (R-KY) will not call for a vote without presidential approval.

Obama Touts Obamacare in Promotional Video

Former President Barack Obama took to social media Wednesday in a short video to boost the first day of the Open Enrollment Period for Obamacare.

Obama encouraged his Twitter and Facebook followers to sign up for coverage on the healthcare exchange as part of the promotional efforts of nonprofit Get America Covered.

Healthcare Reform News Update for November 1, 2017

Federal Officials Propose Changes to ACA State Rules

The Department of Health and Human Services has released proposals to revise Affordable Care Act rules that allow states to change health plan benefit requirements and limit navigator programs. The changes would become effective in 2019.

Proposed changes include:

  • The ability for states to change their benefit standards or use the standards enacted by other states.
  • Reducing the number of navigator organizations per geographic area from two to one.
  • Removing the requirement that the navigator groups must be physically in the area they represent.
  • Allow states to decide if plans provide patients with a sufficient number of providers in its network to guarantee “reasonable access.”
  • Removing restrictions that require insurance companies to allocate 80 percent of premium funds to customer care.

House Leader Opposes Adding ACA Mandate Repeal in Tax Bill

Representative Kevin Brady (R-TX), chairman of the House’s Committee on Ways and Means, said he is against a proposal from Senator Tom Cotton (R-AR) that would repeal the Affordable Care Act’s individual mandate in tax reform legislation.

“Look, I want to see that individual mandate repealed. I just haven’t seen, no one has seen 50 votes in the Senate to do it,” Brady said.

Groups File Lawsuit Against New Birth Control Rule

The National Women’s Law Center and Americans United for Separation of Church and State filed a federal lawsuit Tuesday against a recent rule change from the Trump administration that allows more employers to be exempt from covering birth control for moral or religious reasons.

Healthcare Reform News Update for October 31, 2017

Availability of Free Bronze Plans Increases

Consumers in more than half of U.S. counties will be able to get an Obamacare bronze plan with no premium cost, according to a Kaiser Family Foundation analysis released Monday.

The study evaluated the 39 states that use the federal healthcare exchange and found that a consumer who is 40 years old with an income of $25,000 could find a zero-premium bronze plan in 1,540 counties throughout the nation.

“The availability of zero-dollar or ultra low-cost plans has a huge impact on consumer decision making. The chief question is whether consumers will know that they exist,” said Joshua Peck, a former Obama administration official. Peck is involved with an independent campaign to promote exchange enrollment.

HHS Confirms 37% Premium Increase for Silver Plans

Premiums for benchmark silver plans will rise 37 percent for 2018, according to a Department of Health and Human Services report released Monday.

The report also noted that tax credits would also rise, enabling 80 percent of enrollees on the federal exchange to be able to find plans for less than $75 per month after tax credits.

Congressman Wants Repeal of Individual Mandate in Tax Reform Bill

Senator Tom Cotton (R-AR) wants tax-reform legislation to include the repeal of Obamacare regulations that require individuals to have healthcare coverage.

Cotton said Sunday that the repeal would be “a tax cut for working families” and referred to data from the Congressional Budget Office that said the measure could save $300 billion over 10 years.

Bipartisan Group Urges Reauthorization of Community Health Center Funds

More than 150 bipartisan lawmakers have asked Congress to renew funding for community health centers, which serve about 25 million people, regardless of their ability to pay for treatment. The funding for the program expired September 30.

The department of Health and Human Services estimates that 2,800 community health centers, created from funds established by the Affordable Care Act, will be forced to close if the funding is not reauthorized.

“We understand that community health centers across the country are already facing disruptions as a result of going over the so-called ‘funding cliff’ at the end of September, and we urge you to work with Republicans and Democrats in a bipartisan manner to reauthorize this critical program for five years,” the lawmakers wrote in a letter to Speaker Paul Ryan (R-WI) and Minority Leader Nancy Pelosi (D-CA).

Healthcare Reform News Update for October 30, 2017

Expectations for the Upcoming Enrollment Period: Options, Costs, and Subsidies

Axios was given an early look at a Department of Health and Human Service’s report about this year’s open enrollment period. Here are some highlights:

  • The average marketplace enrollee has 25 insurance plans to choose from.
    • 45 percent of marketplace enrollees will have three or more competing insurance options
    • 26 percent will have two insurance options
    • 30 percent will have one insurance option
  • The benchmark plan available to 27-year-olds is increasing its premiums by 37 percent on average.
  • Premium tax credits (or subsidies) are increasing by 45 percent on average due to rising benchmark plan prices.

Trump Administration Proposes Changes to Essential Health Benefits

On Friday, the Trump administration proposed a new plan that would give states the option to alter essential health benefits on insurance plans. “Starting in 2019, states could select from coverage levels in another state, which could be less generous. Ten broad categories of services required by the health law would still have to be covered, but the fine print could change.” For example, insurers could choose to only cover specific prescription drugs.

The proposal also makes changes to subsidy eligibility, insurance company reimbursement, and small business health insurance markets.

Healthcare Reform News Update for October 27, 2017

Poll: A Majority of Americans Support Obamacare

Most U.S. citizens approve of the Affordable Care Act, and support for it has grown, according to a Reuters/Ipsos poll conducted October 14-23.

The poll found that 62 percent now want the law to be maintained, compared to 54 percent in January.

The poll also showed that 51 percent of Democrats and 56 percent of Republicans prefer that a bipartisan group work together to improve the law, instead of a single party.

As in other recent polls, this latest one exposed the continued consumer confusion on the state of the law with 11 percent believing that Obamacare had ended and 67 percent who believe it is “still operating.” Additional results from the poll are below.

On President Donald Trump’s decision to halt cost-sharing reduction (CSR) subsidies:

  • 56 percent were opposed to it
  • 29 percent supported it

On who would do a better job at fixing Obamacare:

  • Most Democrats said the federal government
  • Most Republicans said individual U.S. states

On whether the law has been successful:

  • Most Democrats said yes
  • Most Republicans said no

Healthcare Reform News Update for October 26, 2017

ACA Silver Plan Premiums Will Rise 34 Percent

Premium increases for silver plans from will go up an average of 34 percent for 2018, according to a study released Wednesday by consulting firm Avalere Health.

Premium changes will vary by state. For example, Iowa will raise premiums by 69 percent; Alaska is lowering premiums by 22 percent.

The rate hike is due to “market uncertainty and the federal government’s failure to pay for cost-sharing reductions,” said Avalere Senior Vice President Caroline Pearson.

It’s not just silver plans that are affected. The study also found that bronze plans will rise an average of 18 percent, and gold plans will increase an average of 16 percent.

Due to the Trump administration’s halting of cost-sharing reduction (CSR) payments, some states are adding a surcharge to their silver plans, which will help eligible consumers take advantage of tax credits to lower costs. Low-income consumers who receive subsidies won’t be affected by the increases if they choose a silver plan with the lowest or second-lowest cost in their region.

Federal Judge Denies Bid to Resume Cost-Sharing Reduction Subsidies

U.S. District Judge Vince Chhabria denied a request from 19 attorneys general across the country that would force the Trump administration to immediately resume funding cost-sharing reduction payments under the Affordable Care Act.

Chhabria noted that states had devised workarounds to the lost subsidies, which totaled $7 billion this year, and that “emergency relief sought by the states would be counterproductive.”

The judge’s decision concerned only the emergency restraining order; lawsuits remain in effect over halting the payments.

Bipartisan Stabilization Bill Would Lower Deficit by $3.8 Billion

The bipartisan healthcare stabilization bill, authored by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), would lower the federal deficit by $3.8 billion over 10 years, according to a Congressional Budget Office cost estimate.

The CBO report also noted that the bill would not affect the number of people with health insurance.

Conservative Republicans have not shown support for the bill, but Democrats and at least 12 Republicans are backing it.

Maryland to Raise Premiums as Much as 76 Percent

On Wednesday, regulators in Maryland gave two insurance companies permission to raise health premiums on some plans by as much as 76 percent for 2018.

CareFirst Blue Cross and Kaiser Permanente said that recent orders from the Trump administration made the increases necessary. CareFirst will raise premiums 58.2 percent for silver HMO plans and 76 percent for silver PPOs. Kaiser premiums will go up 43.4 percent for silver HMO plans.

The increases will affect approximately 25,000 consumers in the state.

Maryland Insurance Administration Commissioner Al Redmer explained the approvals, which come less than two weeks before the open enrollment period. “We didn’t want to arbitrarily increase rates a month or so ago without having to. We erred on the side of the consumer to keep prices as low as possible for as long as we could.”

Democrats Propose Public Option Bill

Senator Brian Schatz (D-HI) and Representative Ben Ray Luján (D-NM) proposed a healthcare bill with 17 cosponsors on Wednesday that lets states set up a public option that expands Medicaid eligibility to anyone.

Even with backing by Congressional Democratic healthcare advocates such as Bernie Sanders (I-VT), Coy Booker (D-NJ), and Kamala Harris (D-CA), the bill is not expected to pass in the House.

House Will Not Vote on Healthcare This Year

House of Representatives Speaker Paul Ryan said Wednesday that he has no plans to address the Alexander-Murray bipartisan stabilization bill or attempt to repeal and replace the Affordable Care Act until next year.

Healthcare Reform News Update for October 25, 2017

GOP Lawmakers Offer Alternative Healthcare Bill

Senator Orrin Hatch (R-UT) and Representative Kevin Brady (R-TX) on Tuesday proposed new legislation to help stabilize the healthcare marketplace. The bill includes restoring cost-sharing reduction (CSR) subsidies for two years like the current bill approved by a bipartisan committee, but adds some conservative measures.

The new bill includes delaying enforcement of the individual mandate, retroactively exempting businesses from offering healthcare, and allowing individuals to contribute more to health savings accounts. It also includes “pro-life protections,” details of which were not available.

President Donald Trump praised the work of representatives but gave no indication on whether he approves of the bill.

Poll: Voters Prefer to Keep Cost-Sharing Payments

A plurality of voters are against Trump’s move to cut off cost-sharing reduction (CSR) subsidies to insurance companies that help pay healthcare costs for low-income consumers, according to a recent Morning Consult/Politico poll.

It also showed that even with a Republican majority in both houses and the White House, most voters blame Democrats and former President Barack Obama for the current state of the Affordable Care Act.

On ending the subsidies:

  • 46 percent disapprove
  • 39 percent approve
  • 16 percent had no opinion

When asked who is responsible for the current state of the healthcare law:

  • 67 percent said Obama
  • 20 percent said Trump

The poll also showed considerable voter confusion on stabilization efforts:

  • 45 percent correctly answered that the law has not been repealed or replaced
  • 24 percent thought the law has been partially repealed
  • 15 percent thought the law has been entirely repealed or replaced

Healthcare Reform News Update for October 24, 2017

Analyst Predicts 1.1 Million Fewer Healthcare Enrollees

At least 1.1 million fewer people will sign up for healthcare coverage on the exchanges this year, according to an analysis released Monday.

Joshua Peck, the former chief marketing officer for, said that, due to President Donald Trump’s cuts to advertising budgets, fewer consumers will be aware that this healthcare option is still available.

Peck’s predictions are based on studies that showed how much previous advertising efforts cost the government per person.

The Trump administration disputes Peck’s findings. “Last year, fewer Americans bought Obamacare coverage despite the previous administration nearly doubling the advertising budget. More marketing will not convince Americans to sign up for failed coverage they cannot afford or that does not meet their needs,” said Health and Human Services spokesperson Matt Lloyd.

U.S. Judge Hears Subsidy-Payment Lawsuit

A lawsuit filed by 19 states and the District of Columbia against Trump’s recent order to discontinue cost-sharing reduction (CSR) payments to insurance companies was heard in a San Francisco federal court on Monday.

U.S. District Judge Vince Chhabria appeared unconvinced by arguments, noting that some states, anticipating the subsidies would end, devised a workaround to ensure consumers would not pay more for health insurance.

He is expected to issue a ruling Tuesday.

Iowa Withdraws ACA Proposal

Iowa has halted its efforts to overhaul the Affordable Care Act by offering an alternative individual health insurance system. The state wanted to offer just one type of insurance plan in the individual market for 2018 and reshape the subsidies that help people buy coverage.

The state’s only insurer, Medica, recently raised its premiums an average of 57 percent, which may cause up to 22,000 people to lose coverage, according to the state’s insurance commissioner.

Iowa officials said Obamacare’s waiver rules prevented the Trump administration from approving the request, but two months ago Trump reportedly told a top federal health official to reject it.

Healthcare Reform News Update for October 23, 2017

Schumer Asks for Floor Vote on ACA Stabilization Bill

Senate Minority Leader Chuck Schumer (D-NY) said on Sunday that the Alexander-Murray bipartisan healthcare stabilization bill has support from a majority of senators and asked Senate Majority Leader Mitch McConnell (R-KY) for a floor vote this week.

In defense of the bill, Schumer said: “It will pass. It will pass by a large number of votes. That’ll put pressure on the House because let’s not forget what this bill does is prevent premiums from going up.”

McConnell said he will be “happy to bring a bill to the floor” only if he knows that President Donald Trump is willing to sign it.

Healthcare Reform News Update for October 20, 2017

Study: ACA Helped Increase Insurance Coverage for Cancer Patients

New research published in JAMA Oncology showed that the passage of the Affordable Care Act helped increase health insurance coverage for people diagnosed with cancer, especially in states that expanded Medicaid.

Compared to the years prior to the ACA becoming law, the study found that:

  • The law reduced newly diagnosed uninsured cancer patients overall by one-third.
  • States that expanded Medicaid reduced the number of uninsured cancer patients by 50 percent.
  • The percentage of uninsured patients fell for each type of cancer reported.
    • Breast cancer: 26 percent
    • Prostate cancer: 29 percent
    • Lung, bronchial, or thyroid cancer: almost 33 percent
  • Uninsured white patients fell 37 percent, blacks fell by 18 percent, and Latinos fell by 40 percent.

Bipartisan Stabilization Bill Formally Introduced

Twelve Republicans and 12 Democrats helped formally announced the Bipartisan Health Care Stabilization Act of 2017, the bill put together by the Senate Health, Education, Labor and Pensions Committee to stabilize the Obamacare marketplace.

The bill will extend cost-sharing reduction (CSR) payments to insurers for two years and allow states to waive some ACA regulations.

Republicans aren’t expected to bring the bill up for a vote without approval from President Donald Trump, whose support has been unclear.

On Thursday, Marc Short, a senior White House aide, said that Trump wouldn’t sign off on the bill unless mandates and taxes were rolled back and more emphasis was put on health-savings accounts. “We’re willing to work on this but we need to make sure that we’re getting something that will actually reduce healthcare costs,” Short said.

GOP Senators Ask for Conservative Changes to Healthcare Bill

Republican Senators Lindsey Graham (SC) and Bill Cassidy (LA) said Thursday they were working to add more “flexibility provisions” to the Bipartisan Health Care Stabilization Act.

The pair hope to add some of the conservative changes they had included in their own healthcare bill that failed last month, including waiving the individual mandate penalty, increasing the duration of short-term health plans, and not requiring employers to provide health coverage.

Senate Democrats Challenge Contraception Executive Order

Nineteen Democrats in the Senate have endorsed a bill that that would overturn President Trump’s recent executive order that expands the rules that exempt employers from providing birth control coverage if they cite a religious or moral objection. Four Democrats in the House will present a similar bill.

Senator Patty Murray (D-WA) was one of the signers. “President Trump wants to make birth control about ideology, but let’s be clear: for women and their families in the 21st century, birth control is about being healthy and financially secure—and that’s why Democrats are going to keep fighting back against his shameful attacks on women with this bill and any other way we can,” she said.

Healthcare Reform News Update for October 19, 2017

ACA Stabilization Effort Falters, Could Appear in Year-End Spending Package

The Senate’s latest bipartisan healthcare deal, which would continue cost-sharing reduction (CSR) payments, has lost its chances of approval—a day after it was announced by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA).

House Speaker Paul Ryan (R-WI) says he won’t support the measure. President Donald Trump opposes the bill but has not specified if he would veto it. Their opposition could force the issue to be addressed in an end-of-year spending package.

Many GOP lawmakers contend that they will have to address instability on the exchanges, which was exacerbated last week by Trump’s move to end the subsidies that help insurers pay low-income individuals’ out-of-pocket costs.

18 States, D.C. File Emergency Order to Reinstate Subsidies

A week after filing a lawsuit against the Trump administration for cutting off cost-sharing reduction subsidies, the same 18 states and the District of Columbia issued an emergency temporary order on Wednesday to try to immediately continue the payments. U.S. District Judge Vince Chhabria said he expects to hold a hearing early next week.

Governors Ask for Healthcare Vote

Ten bipartisan governors sent a joint letter to Congress voicing their approval of funding cost-sharing reduction payments through 2019. “We urge Congress to quickly pass legislation to stabilize our private health insurance markets and make quality health insurance more available and affordable,” the governors wrote.

The governors include: John Kasich (R-OH), John Hickenlooper (D-CO), Steve Bullock (D-MT), Bill Walker (I-AK), Tom Wolf (D-PA), Brian Sandoval (R-NV), Terry McAuliffe (D-VA), John Bel Edwards (D-LA), Charlie Baker (R-MA), and Phil Scott (R-VT).

Healthcare Reform News Update for October 18, 2017

Bipartisan ACA Deal Announced; President’s Approval Unclear

Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) unveiled their long-negotiated measure to help stabilize the Obamacare marketplace. It reinstates the cost-sharing reduction (CSR) subsidies to insurers that President Donald Trump halted last week.

Under the bipartisan agreement, the CSRs would continue for two years while states are given more leeway in coverage requirements, including revising regulations for state waiver applications and allowing insurers to offer catastrophic copper plans to people over 30, while maintaining a single risk pool.

Trump appeared to show his support for the measure Tuesday morning, calling the deal “a very good solution.” However, he grew skeptical later in the day, saying “I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies.”

Republican Senators John McCain (AZ) and Lisa Murkowski (AK)—who were integral in the failure of the two repeal-and-replace bills earlier this year—praised the agreement. Other Republican leaders have not shown that they would back the bill, and approval is not assured.

GOP Senators Propose Relaxing ACA Individual Mandate Requirements

Senators Pat Toomey (R-PA) and Tom Cotton (R-AR) introduced legislation that would exempt some people from Obamacare’s mandate that requires most Americans to purchase health insurance or pay a financial penalty.

In a joint statement, the senators said they wanted to help working-class individuals. “Nearly 80 percent of the Americans who paid the individual-mandate penalty in 2016 earned less than $50,000.”

The measure would exempt:

  • People who earn less than the national median household income.
  • People who live in states where the insurance premiums increased an average of more than 10 percent.
  • People in counties with a single insurer on the exchange.

Poll Shows Support for Healthcare Executive Order

A new Morning Consult/Politico poll showed that more than half of voters expressed approval of Trump’s executive order to allow businesses to form groups to offer low-cost health insurance but are divided on its impact. Poll findings include:

  • 52 percent approve of association health plans (AHPs)
  • 39 percent think AHPs will lower premiums
  • 46 percent would be unlikely to switch to a lower cost, less generous plan
  • 36 percent think costs for health insurance will likely rise

Healthcare Reform News Update for October 17, 2017

Trump Backs Bipartisan ACA Fix, Predicts Solution by April

President Donald Trump on Monday backed a bipartisan Obamacare fix, after speaking with Health Committee Chairman Senator Lamar Alexander (R-TN). He also said there would be a long-term fix by April of next year.

The president urged Alexander to get a bipartisan deal that will continue cost-sharing reduction payments for up to two years, according to an aide.

On his future plans, Trump said: “I think we’ll have a short-term fix, and then we’ll have a long-term fix, and that will take place probably in March or April. We will have a very solid vote. It’ll be probably 100 percent Republican, no Democrats, but most people know that’s gonna be a very good form of health insurance.”

Two Senators to Propose New Healthcare Option

Senators Tim Kaine (D-VA) and Michael Bennet (D-CO) plan to unveil legislation this week that would allow non-elderly workers to enroll in Medicare-style plans.

The proposal is considered a public option called “Medicare-X” that would allow consumers to purchase healthcare plans that use the network of Medicare providers and physicians at similar rates. Low-income workers would receive tax credits. The plan would be rolled out in two phases. At first, Medicare-X would only be available in counties that have one or no providers on the Obamacare exchange. Phase two would roll the plan out to all counties.

A similar plan was proposed in 2009 and 2010 during the Obama administration but was dropped.

Healthcare Reform News Update for October 16, 2017

18 States Sue Over Trump’s ACA Subsidy Decision

President Donald Trump’s move to eliminate cost-sharing reduction (CSR) subsidies has brought about a multistate lawsuit filed in federal court October 13. Eighteen states and Washington, D.C., filed a complaint to try to ensure that scheduled payments to insurers resume.

The Trump administration says that the subsidies are illegal. In a statement, the White House commented: “Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments.”

One of the complainants, New York Attorney General Eric Schneiderman says the subsidies must be paid as long as the Affordable Care Act remains in force. He said that eliminating the subsidies is “… breathtakingly reckless. This move is unacceptable, it’s cruel, and it is unlawful.”

Pro-Trump States Most Affected by Subsidy Cutoff

States that helped elect Trump benefited the most from insurance cost-sharing reduction payments. An analysis by The Associated Press found that:

  • 70 percent of beneficiaries live in states that Trump won last November.
  • In the 30 states he won, nearly 4 million people benefited from the subsidies.
  • Of the 10 states with the highest percentage of consumers benefiting from CSR payments, all but one favored Trump.

Key Republican Urges Trump to Resume Payments

Senator Susan Collins of Maine has called on Trump to support a bipartisan effort to reinstate insurer payments. Collins said: “What the president is doing is affecting people’s access and the cost of health care right now. This is not a bailout of the insurers. What this money is used for is to help low-income people afford their deductibles and their co-pays.”

A bipartisan attempt by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) would fund the subsidies for up to two years to help to stabilize Obamacare. The subsidies help insurers lower out-of-pocket costs for about 6 million people enrolled in Obamacare plans.

The insurer payments have stopped just two weeks prior to the open enrollment period.

Healthcare Reform News Update for October 13, 2017

Trump to End Subsidies to Health Insurers

The federal government will discontinue cost-sharing subsidies that help health insurance companies defer costs for low-income citizens, the Trump administration announced Thursday. The payments will stop immediately, with no transition period.

Press Secretary Sarah Huckabee Sanders said that “based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare.”

Many insurance companies predicted the move and raised premiums for 2018 plans accordingly; some left the marketplace. It’s too soon to know if additional insurers will follow suit.

Cutting the subsidies is seen as a blow to the Affordable Care Act. Critics call the move “sabotage.” In reaction, attorneys general from California and New York announced their intentions to sue the Trump administration in an attempt to protect the payments.

Anthem Reduces Planned Premium Hikes in California

Anthem Blue Cross in California will reduce its 2018 planned premium increases to individuals by 3 percent and small business by 2.5 percent after questioning by state regulators. The company will now increase rates approximately 37 percent.

It’s anticipated that the new rates will save roughly $21 million for individuals and $93 million for small businesses.

Healthcare Reform News Update for October 12, 2017

Navigator Groups to Severely Reduce Services After Funding Cuts

The majority of Obamacare Navigator groups are limiting their services due to budget cuts by the Trump administration, according to a Kaiser Family Foundation survey conducted between September 22 and October 4.

Funding for the Navigator groups, which provide outreach, education, and enrollment assistance, was cut an average of 41 percent for the 2018 budget year, though the amount of cuts for each state vary widely from none to 82 percent.

Findings from respondents who answered the survey as “very likely” or “somewhat likely” include:

  • 55 percent of statewide programs and 72 percent of regional programs will limit services to rural residents.
  • 89 percent expect to lay off staff due to the cuts.
  • 89 percent will spend less on advertising.
  • 81 percent will reduce the number of their outreach activities and events.
  • 57 percent will reduce the number of months that they provide enrollment assistance.
  • 57 percent will reduce the time they devote to assisting consumers with complex cases.

California Imposes Surcharge on Silver Plans

California’s state health exchange said it plans to impose a surcharge of 12.4 percent to silver-level health plans in 2018. The surcharge is a result of the Trump administration’s refusal to commit to making key insurer payments known as cost-sharing reductions. With the surcharge, average rates for silver-level plans will be about 25 percent higher next year, according to Covered California.

About 78 percent of the consumers who have been using cost-sharing reductions will face little or no increase in their actual out-of-pocket coverage payments as a result of the change, officials said. Of the remaining consumers, about half will see increases of less than $25 per month.

West Virginia Approves Double-Digit Exchange Increases

West Virginia officials approved double-digit rate increases for health plans offered in the state through the federal Obamacare exchange. Highmark West Virginia will increase premiums by 25.6 percent for 2018, while CareSource Insurance will increase 19.6 percent.

Healthcare Reform News Update for October 11, 2017

Iowa Seeks to Leave Federal Health Insurance Marketplace

Iowa is seeking to move out of the federal marketplace system and set up a state-run exchange instead. If approved, the state would be allowed to eliminate key Obamacare features, including its federally run exchange, subsidy structure, and providing affordable coverage for low-income individuals.

Iowa’s proposed plan creates a single healthcare option for customers with a deductible of $7,350 for a single person and $14,700 for families. It would redirect federal money dedicated to people with lower incomes and use it for premium assistance for all customers, regardless of income.

President Donald Trump has requested that the plan be rejected. It currently remains under review.

Acting HHS Secretary Appointed

Eric Hargen has been appointed the acting secretary of the Department of Health and Human Services (HHS). He fills the position after the resignation of Tom Price last month.

Hargen, a former corporate lawyer, served under former President George W. Bush and was part of President Donald Trump’s HHS transition team.

Trump Executive Healthcare Order to Come This Week

President Donald Trump will sign his healthcare executive order by the end of the week, according to White House Press Secretary Sarah Huckabee Sanders.

On Tuesday, the president tweeted that “Since Congress can’t get its act together on HealthCare, I will be using the power of the pen to give great HealthCare to many people — FAST.” The order is expected to allow more businesses and individuals to buy association health plans that can cross state lines, extend short-term health plans, and encourage health savings accounts.

Healthcare Reform News Update for October 10, 2017

California Governor Signs Drug Transparency Bill

California Governor Jerry Brown on Monday signed the country’s most comprehensive legislation that addresses rising drug prices. The new law will require drug companies to give 60 days’ notice to state agencies and health insurers anytime they plan to raise the price of a drug by 16 percent over a 2-year period. The legislation also ramps up annual disclosure requirements on overall pricing.

“The essence of this bill is pretty simple,” Brown said. “Californians have a right to know why their medical costs are out of control, especially when the pharmaceutical profits are soaring.”

Trump Could Sign Healthcare Executive Order This Week

President Donald Trump is expected to sign an executive order later this week that would allow small businesses or other groups to join together to purchase health insurance across state lines. The order would change existing association health plan (AHP) regulations, including loosening Obamacare protections to consumers with pre-existing conditions.

Proponents of AHPs say the order could help lower prices and grow the free market. Others say that it would cause insurance companies to leave the exchanges and increase instability in the marketplace.

Healthcare Reform News Update for October 9, 2017

Call Center for ACA Enrollment Will Stay Fully Staffed

The Centers for Medicare and Medicaid Services (CMS) will not cut the number of employees at a call center that helps individuals enroll for Obamacare health coverage.

Last year, the center staffed 11,000 phone representatives during the open enrollment period; CMS anticipates having a similar number this year.

Healthcare Reform News Update for October 6, 2017

Trump Administration to Dismantle Contraception Mandate

President Donald Trump issued new rules Friday that will allow more employers be exempt from covering birth control for moral or religious reasons. The move could affect hundreds of thousands of women who currently receive contraception coverage at no charge under the Affordable Care Act.

“Application of the mandate to entities with sincerely held religious objections to it does not serve a compelling governmental interest,” according to the new rules administered by the Trump administration.

The new rules would take effect immediately, according to the Trump administration. The American Civil Liberties Union (ACLU) on Friday filed a lawsuit against the Trump administration over the roll back. Several women’s advocacy and public health groups have promised to file lawsuits against the action.

Healthcare Reform News Update for October 5, 2017

California Strengthens State Marketplace With 2 Laws

Two measures signed by California Governor Jerry Brown on Wednesday will help ensure extended enrollment and care for citizens who participate in Covered California, the state’s Affordable Care Act marketplace.

The first bill continues the state’s 3-month enrollment period. The second bill enables people with certain serious conditions and those needing maternity or infant care to remain with their established doctors for up to 1 year, even if those physicians are not in the network of their new insurance plan.

“Providing these continuity-of-care protections and keeping a 12-week open enrollment period are simple but important steps to ensure access to care,” said Anthony Wright, executive director of Health Access California.

Healthcare Reform News Update for October 4, 2017

Obamacare Proponents Launch Enrollment Campaign

A new group started by former Obama administration officials is spearheading an ad campaign called Get America Covered to encourage Americans to buy health insurance during this year’s open enrollment period (OEP), which runs from November 1 to December 15.

Lori Lordes and Joshua Peck, who oversaw enrollment efforts within the Department of Health and Human Services under President Barack Obama, have joined with political figures and celebrities to create digital advertising to encourage people to sign up.

Get America Covered has formed partnerships with employers, community organizations, and other existing avenues for outreach to try to help offset some of the recent cuts made to the OEP advertising budget by the Trump administration.

Marketplace Stabilization Talks Bring Compromise on Subsidies

On Tuesday, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced a bipartisan market stabilization bill, which will continue to fund Obamacare subsidies for 2 more years. Initially, Republicans pushed for 1 year of payments, but Democrats said 2 years would better shore up the Affordable Care Act exchanges.

Healthcare Reform News Update for October 2, 2017

Healthcare Ranks as Top Voter Issue

A Morning Consult/Politico survey shows that healthcare is now tied with the economy as the top issue for voters. This is the highest ranking it’s had in more than 3 years. Twenty-four percent of survey respondents said healthcare is the most important voting issue. Liz Hamel, director of the Kaiser Family Foundation’s Public Opinion and Survey Research team, said: “It has to do with attention being brought to the issue from both sides of the political spectrum.”

HHS Secretary Tom Price Resigns

Health and Human Services (HHS) Secretary Tom Price resigned Friday amid controversy over his use of private jets for personal travel. President Donald Trump appointed Deputy Assistant Health Secretary Don Wright to serve as acting secretary until Price is replaced.

Healthcare Reform News Update for September 29, 2017

Bipartisan Healthcare Deal Nears Finalization

On Wednesday, Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and ranking member Patty Murray (D-WA) moved toward a plan to stabilize Obamacare in the short term.

The deal would help individuals who buy health insurance plans on federal and state exchanges by stabilizing the market. Senate Democratic Leader Chuck Schumer said the action was nearly complete. “They both inform me that they’re on the verge of an agreement, a bipartisan healthcare agreement to stabilize markets and lower premiums,” Schumer said.

GOP Vows Continued Fight for Repeal

Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) said Thursday that they would continue their efforts to pass legislation to repeal the Affordable Care Act.

After their healthcare bill failed to get enough votes to pass this week, the pair met with President Donald Trump to discuss healthcare and stated that they were “… committed to holding congressional hearings and working with our nation’s governors who believe returning power to states is a vast improvement over Obamacare.”

Healthcare Reform News Update for September 28, 2017

Trump Plans Executive Action on Interstate Healthcare Sales

President Donald Trump said Wednesday that he could sign an executive order as soon as next week to allow insurers to sell health plans across state lines and make it easier for individual consumers to buy coverage as a group.

Republicans have sought to give insurers leeway to sell policies to consumers in a state where they aren’t licensed; such policies would only need to meet the insurer’s home-state regulations.

Mike Consedine, CEO of the National Association of Insurance Commissioners, said his group won’t comment on Trump’s order until it sees details, but, “as a general matter, health insurers already have the ability to sell insurance in multiple states as long as they comply with state consumer protection and licensing laws, which many already do. The NAIC has long been opposed to any attempt to reduce or preempt state authority or weaken consumer protections.”

Healthcare Reform News Update for September 27, 2017

Marketplace Instability Will Impact Insurance Premiums

Insurers must decide by today whether to sign contracts to sell coverage in the Obamacare marketplace for 2018. But the failure of the Graham-Cassidy repeal bill and slowdown on bipartisan attempts to stabilize the market will most likely cause insurers to raise premiums by an average of 15 percent, with some states seeing even higher increases.

Medicare Reform Bill Passes in Senate

On Tuesday, the Senate unanimously passed the CHRONIC Care Act, a bill that would make changes to Medicare payment policies aiming to lower overall costs and improve care for people with chronic health conditions.

Some of the proposals in the bill include:

  • Expanding and extending the Independence at Home (IAH) program.
  • Improving the flexibility of Medicare Advantage through value-based insurance design, special needs plans, and expanded supplemental benefits.
  • Improving efficiencies of Accountable Care Organizations (ACOs).
  • Expanding access to telehealth services.

The bipartisan bill was introduced last year from a group led by Senators Mark Warner (D-VA) and Johnny Isakson (R-GA).

Bipartisan Healthcare Stabilization Talks May Resume

Last week, Senate Health Committee Chairman Lamar Alexander (R-TN) suspended bipartisan negotiations on stabilizing the healthcare marketplace. But on Tuesday, he said he would work to revive the effort.

Alexander said: “I will consult with Senator [Patty] Murray [D-Wash.] and with other senators … to see if senators can find consensus on a limited bipartisan plan that could be enacted into law to help lower premiums and make insurance available to the 18 million Americans in the individual market in 2018 and 2019.”

Healthcare Reform News Update for September 26, 2017

GOP Lacks Votes to Pass Obamacare Repeal Bill

Senator Susan Collins (R-ME) announced Monday that she would oppose the GOP’s last attempt to repeal Obamacare. The move ensured that Republicans would not have the votes they need to pass the Graham-Cassidy bill.

Also on Monday, the Congressional Budget Office said its preliminary analysis of the bill showed that it would reduce the number of insured by millions.

Senate Republicans are set to meet today on whether to try to open debate on healthcare again.

Healthcare Reform News Update for September 25, 2017

Obamacare Website to Go Dark Most Sundays During Enrollment

The Trump administration plans to shut down the Affordable Care Act’s website for 12 hours nearly every Sunday of the upcoming enrollment season. This will affect more than 30 states that use the federal website for their marketplaces.

The site will go down for maintenance every Sunday, except December 10, from midnight until noon. It will also shut down overnight November 1, the first day of open enrollment.

CMS Asks for Public’s Opinion on Healthcare Revamp

The Centers for Medicare & Medicaid Services (CMS) has put out an informal request to hear from the general public about ways to revamp government healthcare programs.

The Centers for Medicare and Medicaid Innovation (CMMI), an idea development lab based inside CMS, has put out an informal request for information and seeks feedback on a new direction that “will promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.”

CMMI is interested in testing models in 8 focus areas:

  • Increased participation in advanced alternative payment models (APMs)
  • Consumer-directed care and market-based innovation models
  • Physician specialty models
  • Prescription drug models
  • Medicare Advantage (MA) innovation models
  • State-based and local innovation (includes Medicaid-focused models)
  • Mental and behavioral health models
  • Program integrity

There are 2 ways to submit responses:

  1. Fill out the RFI online submission form.
  2. Send an email to

All comments are due by November 20.

Hurricanes Prompt Request to Extend ACA & Medicare Enrollment Dates

Due to the impacts of hurricanes Harvey and Irma, 2 top House Democrats have asked the Trump administration to extend the upcoming open enrollment season for both Obamacare and Medicare Advantage plans through January 2018.

Representatives Richard Neal (D-MA) and Frank Pallone Jr. (D-NJ) argued in a letter to Health and Human Services Secretary Tom Price that residents affected by the storms should be given more time due to rebuilding efforts.

Healthcare Study: Most Americans in Agreement About Insurance

A majority of Americans agree on major points of health insurance decisions, according to a new study from the Texas Medical Center Health Policy Institute. The findings show:

  • 98 percent consider health insurance important.
  • 28 percent think health insurance systems should include basic coverage for everyone. (This was the most popular answer to the question).
  • 49 percent said they’ve had to cut expenses to pay for healthcare.
  • 55 percent said that cost was the primary reason for their lack of health insurance.

The survey, taken earlier this summer, was given to more than 450 physicians and 9,200 people across 15 states.

Deadline for Waiving Medicare Late Enrollment Penalty Ends This Week

A temporary rule change that enabled people to enroll in Medicare late without paying a lifetime of penalties ends on September 30.

Last week, several health and insurance groups asked Medicare chief Seema Verma to extend the waiver, saying many people were not aware of the waiver.

Typically, if people over 65 do not sign up for Medicare Part B as soon as they are eligible, their monthly premium may go up 10 percent for each year that they could have had Part B.

Health, Insurance Groups Oppose GOP Healthcare Bill

The Graham-Cassidy Obamacare replacement bill has garnered strong opposition from dozens of national health and medical advocacy groups, including the American Cancer Society, Alzheimer’s Association, American Hospital Association, American Diabetes Association, and the American Congress of Obstetricians and Gynecologists. In addition, Blue Cross Blue Shield Association and America’s Health Insurance Plans have also come out against the bill.

Bipartisan Healthcare Bill Halted

Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) says there’s not a path forward for the bipartisan work he and Patty Murray (D-WA) have recently completed in an effort to stabilize the healthcare marketplace.

Democrats call the move a political strategy to bolster the Graham-Cassidy replacement bill. House Speaker Paul Ryan and the Trump Administration announced their opposition to the bipartisan plan last week.

Healthcare Reform News Update for September 20, 2017

Insurance Premiums for Job-Based Coverage Show Modest Rise

Annual premiums for employer-based family plans continued to increase this year, while the share of employers who provide insurance for their workers continued to decline, according to an annual poll of employers by the Kaiser Family Foundation and the Health Research & Educational Trust.

Other findings from the survey include:

  • There was a 3 percent increase for people getting family health insurance through their employers.
  • On average, the total cost of family premiums was $18,764 for this year.
  • Workers are paying, on average, about a third of the total cost for family coverage.
  • Individuals are paying an average of $1,213 for employer-provided coverage. This is a 4 percent increase.
  • Employees at small firms (companies with fewer than 200 workers) pay about $1,550 more each year for family premiums than those at larger firms.

Feds Make September Cost-Sharing Reduction Payments

Health insurers will receive key Obamacare payments this month that help them reduce out-of-pocket costs for millions of low-income enrollees. An effort in Congress to extend the payments, known as cost-sharing reductions (CSR), has failed as the White House and GOP leaders push for another vote to repeal Obamacare.

Ryan, White House Reject Senate Committee ACA Fix

House Speaker Paul Ryan and the White House informed Senate GOP leaders that they oppose a bipartisan push from the Health, Education, Labor and Pensions (HELP) Committee to stabilize the Affordable Care Act exchanges. This move potentially halts negotiations as GOP senators try to build momentum for the Graham-Cassidy repeal bill.

Governors, Healthcare Groups Oppose Graham-Cassidy ACA Repeal Bill

The GOP Senate’s new Obamacare repeal bill, drafted by Senators Lindsey Graham (SC) and Bill Cassidy (LA), was strongly rejected by 11 bipartisan governors on Tuesday. Opposition also came from the AARP and the American Hospital Association, the nation’s largest lobbying group for hospitals and doctors.

Healthcare Reform News Update for September 19, 2017

CBO to Release Limited Analysis of ACA Repeal Bill Next Week

The Congressional Budget Office (CBO) is aiming to provide a “preliminary assessment” of an Obamacare repeal bill sponsored by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) by early next week.

The analysis will only include basic budgetary estimates. Details on how the bill will affect healthcare coverage or insurance premiums won’t be available for several more weeks, which would be after the September 30 deadline Republicans have to pass the bill using only party-line support.

Private Insurer Launches OEP Ad Campaign

After federal funds for ACA advertising were cut by 90 percent, startup insurance company Oscar Health decided to launch a multimillion dollar ad campaign this week. The campaign is aimed at millennials, in hopes of getting them to sign up on the ACA exchanges during the open enrollment period (OEP).

Oscar Health is the first private company to run its own campaign in lieu of the cuts. “Particularly in this year of uncertainty, it’s really important for us to be in market early and reassure the 22 million folks that are insured that it is really important to get covered,” said Sara Rowghani, the company’s vice president.

Healthcare Reform News Update for September 18, 2017

Anthem Decides to Remain in Virginia ACA Exchange

Anthem, Inc. announced Friday that, in 2018, it will sell Affordable Care Act health plans in 68 Virginia cities and counties that had been at risk of having no individual coverage options. This act is a reversal of the company’s previous decision to not sell insurance in the state.

This move eliminates the risk of bare counties, meaning there are no longer any U.S. counties without at least 1 insurer willing to sell individual market health plans in 2018.

Anthem is still working with other state regulators concerning its market participation for next year.

Healthcare Reform News Update for September 15, 2017

ACA Stabilization Committee to Craft Bill Next Week

The Senate Health, Education, Labor and Pensions (HELP) Committee on Thursday held its fourth and final hearing on stabilizing the insurance market. Chairman Lamar Alexander (R-TN) says the panel intends to produce a new bipartisan bill by early next week that would stabilize the market. The panel hopes to pass it by the end of the month.

Alexander summarized the ideas that were heard in the 3 previous hearings:

  • Funding cost-sharing reduction (CSR) payments
  • Expanding copper plans to those 30 and over
  • Granting states more flexibility to approve health insurance plans and prices

The committee has posted a package of hearing materials, including a video recording and written versions of the witnesses’ testimony.

ACA Navigator Enrollment Programs Face 92% Cut

Department of Health and Human Services (HHS) officials have informed navigators, groups who assist with Affordable Care Act enrollment, that their funding will be reduced by up to 92 percent.

The groups have braced for the cuts since the Trump administration announced two weeks ago that it would shrink overall program funding from $62.5 million to $36.8 million for the 2017 enrollment season and cut the ACA advertising budget by $90 million.

Grant funds for the navigator programs ran out at the beginning of September, and the groups will not be paid retroactively for the first 2 weeks of September.

CBO Projects 15 Percent Hike in 2018 Premiums

The nonpartisan Congressional Budget Office (CBO) predicts that individual health insurance premiums will rise around 15 percent next year. The projected increase is due to marketplace anxiety about whether the Trump administration will block federal subsidies. Also, more people are living in regions with only one insurer, which creates less competition for companies.

According to the CBO report, the amount of Americans buying insurance on the ACA exchange is expected to rise by 1 million in 2018; however, the increase would be constrained by rising premiums, dissolved outreach programs, and a shortened enrollment period.

Healthcare Reform News Update for September 14, 2017

Trump Meets With House Bipartisan Committee on ACA Stabilization

President Donald Trump met with the House’s bipartisan Problem Solvers Caucus on Wednesday to discuss an Affordable Care Act stabilization plan that is similar to what is being considered by the Senate Health, Education, Labor and Pensions (HELP) Committee.

Trump appeared “open” to the idea of a stabilization bill but did not make any commitments. He also did not commit to proposed cost-sharing reductions.

“He was clearly listening but he was not committal about what he was going to do,” Representative Peter Welch (D-VT) said of Trump.

GOP Rolls Out Latest Obamacare Repeal Bill

Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI) released an Obamacare repeal bill on Wednesday. With only 17 days left to get the bill passed, it’s a last-shot effort to repeal and replace Obamacare before the expiration of fast-track procedural powers, which Republicans hope to use to bypass the threat of a Democratic filibuster.

Highlights of the bill:

  • Block grants that will allow each state to define its own rules for health plans.
  • An elimination of the ACA tax on medical devices.
  • Americans won’t be required to carry insurance.
  • Large employers won’t be required to offer health coverage.
  • People with preexisting medical conditions will continue to be covered by insurers.

“It should have been our first bill to repeal and replace Obamacare, but it is now our last,” Graham said. “To those in the Republican Party who feel like we have not fought as hard as we could, you’re right.”

Trump Administration Working to Revamp Healthcare Regulations

The Trump administration is moving forward with plans to overturn major Obama-era healthcare rules and relax federal oversight over parts of the healthcare industry.

Health and Human Services Secretary Tom Price and CMS Administrator Seema Verma have indicated their intentions, which include:

  • Ending mandatory programs to make hospitals more accountable for their patients’ health.
  • Slowing the transition to a system that pays doctors based on quality rather than quantity.
  • Restoring nursing homes’ ability to require that patients pre-emptively give up their right to sue for negligence.
  • Stopping Medicare’s move to a new medical equipment bidding program that would cut government payments to the industry.

Anthem, ConnectiCare Will Continue on Access Health CT Exchange

Anthem and ConnectiCare announced they will continue to sell policies on Connecticut’s Access Health CT exchange in 2018. However, the company will charge more for most policies. Anthem has been approved for a 31.7 percent increase on individual policies both on and off the exchange; ConnectiCare was approved for a 27.8 percent rate hike for individuals. Actual increases will vary.

Healthcare Reform News Update for September 13, 2017

Uninsured Rate Falls to Record Low

The share of people in the U.S. who lacked health insurance for 2016 declined to a record low of 8.8 percent, according to a U.S. Census Bureau report released Tuesday. This is down from 9.1 percent in 2015. The number of uninsured Americans fell to 28.1 million in 2016, down from 29 million in 2015. Both the overall percentage and number of uninsured are record lows.

Other findings in the report:

  • Massachusetts had the lowest uninsured rate at 2.5 percent.
  • Texas had the highest rate with 16.6 percent.
  • States that expanded Medicaid had an average uninsured rate of 6.5 percent.
  • States that did not expand Medicaid had an average uninsured rate of 11.7 percent.

Bernie Sanders Unveils ‘Medicare for All’ Bill

Senator Bernie Sanders (I-VT) on Wednesday rolled out details of his healthcare bill, Medicare for All Act of 2017. The bill has support from several Democratic senators; however, the measure has little chance of passing in a Republican-led Congress. The legislation would expand Medicare to cover all Americans, and people and businesses would no longer owe premiums to insurers.

Highlights of the bill include:

  • Americans under 18 would be immediately covered.
  • Those over 18 who are not currently eligible for Medicare would be phased in over 4 years.
  • Employer-provided insurance would be replaced, with businesses paying higher taxes.
  • Private insurers would remain to cover elective treatments.
  • Doctors would be reimbursed by the government.
  • Providers would sign a yearly participation agreement with Medicare to remain with the system.

Sanders’ description of the legislation omitted specifics about how much it would cost and final decisions about how he would pay for it.

At least 15 Senate Democrats had signed onto Sanders’ bill by late Tuesday. Those senators include California’s Kamala Harris, Massachusetts’ Elizabeth Warren, New York’s Kirsten Gillibrand, and New Jersey’s Cory Booker.

Latest GOP ACA Replacement Bill to be Announced

Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) met with Senate Majority Leader Mitch McConnell (R-KY) on Tuesday to discuss their Obamacare repeal bill. McConnell encouraged the senators to find the 50 votes needed to pass the legislation.

The bill would end funding for Obamacare subsidies and Medicaid expansion and instead provide money for state block grants.

Considered a last-ditch effort to repeal and replace Obamacare, the bill faces odds. Graham and Cassidy will introduce the legislation Wednesday along with Senators Dean Heller (R-NV) and Ron Johnson (R-WI).

House Democrats Request Funding for Obamacare Navigators

A group of 31 House Democrats sent a letter to President Donald Trump asking the administration to release funding for Obamacare navigator groups. Led by Representative Carol Shea-Porter of New Hampshire, the letter pressed the president to reinstate grant money for the education and outreach services.

An excerpt from the letter: “Destabilizing the Navigator program could further compound the challenges consumers will face in understanding when and how to enroll. [D]iscouraging enrollment could weaken the market and drive up premiums.”

Blue Cross and Blue Shield of Illinois Leaving Obamacare Small Business Exchange

Blue Cross and Blue Shield of Illinois announced that it will no longer provide group plans for small businesses through the ACA health insurance exchange. However, the company will continue to offer individual plans through the exchange.

Healthcare Reform News Update for September 12, 2017

Several ACA Marketplace Navigator Groups Halt Operations

Navigator groups that help educate and enroll consumers in the Affordable Care Act insurance exchanges are shutting down because they are not being paid by the federal government.

Last month, the Centers for Medicare & Medicaid Services (CMS) announced plans to cut funding for the groups by 40 percent. However, CMS did not indicate how navigators would be affected. The University of South Florida, one of the country’s largest navigation services, is among the groups suspending activities.

Navigator contracts for the 2018 enrollment period from Health and Human Services (HHS) were to begin September 2, but navigators say they have yet to receive notice from the agency regarding funding.

Senate’s Bipartisan ACA Talks Hit a Speed Bump

Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) has reportedly suggested substantial changes to the Affordable Care Act in private negotiations with Senate Democrats. These changes would make it easier for states to waive some consumer protections and benefits. However, the proposals are opposed by Democrats and could stall a last-minute effort to stabilize health insurance marketplaces.

Rand Paul Objects Cassidy-Graham Healthcare Proposal

Senator Rand Paul (R-KY) opposed the new Republican effort to replace Obamacare on Monday. Paul does not think the bill goes far enough to repeal the law. “I don’t think it’s going anywhere. I haven’t heard anybody talking about it,” Paul said.

The bill, authored by Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) is expected to fund key Obamacare payments known as cost-sharing reductions (CSR).

Healthcare Reform News Update for September 11, 2017

Senate Committee to Review ACA’s Innovation Waivers

The Senate Health, Education, Labor and Pensions (HELP) Committee’s push to stabilize the Affordable Care Act exchanges could include changes that make it easier for states to obtain innovation waivers, such as letting states essentially copy each other’s applications and letting governors submit applications without approval from the state legislature.

The committee scheduled 2 more hearings for this week—one on state flexibility and another with healthcare stakeholders.

Conservative Leader Offers Support for New ACA Repeal Bill

Representative Mark Meadows (R-NC), who leads the conservative Freedom Caucus of lawmakers, said the ACA bill being promoted by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) is the “most promising” option for replacing the federal healthcare law.

But the effort faces uphill odds. On Friday, President Donald Trump expressed doubt through a tweet: “Republicans, sorry, but I’ve been hearing about Repeal & Replace for 7 years, didn’t happen!”

Bernie Sanders to Release his ‘Medicare for all’ Bill

Senator Bernie Sanders (I-VT) will reveal his single-payer healthcare bill on Wednesday. He will be joined by cosponsors, medical professionals, business leaders, and patients.

Healthcare Reform News Update for September 8, 2017

Five Governors Urge Congress to Aid Markets for 2018

In the second day of bipartisan ACA hearings with the Senate Health, Education, Labor and Pensions (HELP) Committee, five governors agreed that guaranteeing payments to ACA insurers to help defray certain coverage expenses for consumers ranks as the most urgent step Congress should take.

Republican and Democratic governors from Colorado, Massachusetts, Montana, Tennessee, and Utah endorsed proposals to stabilize health insurance markets by providing federal money for continued payment of subsidies to insurance companies, offsetting the cost of discounts provided to low-income consumers.

The governors urged the committee to extend these payments for longer than the 1-year window favored by Chairman Lamar Alexander (R-TN). Utah Governor Gary R. Herbert (R) said: “It would be irresponsible to allow these markets to collapse simply because of [federal] inaction.”

The group also requested simplification of the ACA federal waiver process and more flexibility over the benefits ACA health plans must cover.

Senate GOP Accepts Defeat on ACA Repeal

Senior Senate Republicans have given up on trying to repeal and replace the Affordable Care Act. The Trump administration and Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) tried to muster support for a plan to keep most Obamacare taxes and convert federal funding into block grants to the states.

“We’ve seen that we don’t have 51 votes to do it, so we’re going to have to do it bipartisan,” said Senate Majority Whip John Cornyn of Texas.

Optima Cuts Virginia Coverage in Half

Optima Health Plan announced its plans to exit about half the Virginia counties it served in 2017. The company will enter only the Charlottesville area, Halifax County, and Mecklenburg County, leaving 63 counties without a coverage option.

Anthem Reduces ACA Offerings in Kentucky

Healthcare insurer Anthem will now offer individual market plans in only 59 of the 120 counties in Kentucky. Initially, the company had planned to cover every county in the state. However, Anthem cited mounting policy uncertainty and a deteriorating market as its reason for the decision.

Healthcare Reform News Update for September 7, 2017

Senate Committee Holds First ACA Hearing

The Senate Health, Education, Labor and Pensions (HELP) Committee held the first of 4 bipartisan hearings on ways to stabilize the Affordable Care Act’s exchanges. Five state insurance regulators were questioned on a variety of ACA topics, including:

  • Reinsurance programs,
  • Cost-sharing subsidies,
  • Expanded regulatory waivers for states, and
  • Allowing people younger than 30 to buy only catastrophic care (also known as copper plans).

Trump’s $15 Billion Cut to HHS Rejected

A Senate appropriations subcommittee rejected a proposed multibillion-dollar cut to Health and Human Services (HHS) funding over concerns that it could hinder medical innovation.

In the president’s 2018 budget proposal, HHS received a $15.1 billion cut, a 17.9 percent decrease from the 2017 budget. The group released a summary of a forthcoming appropriations bill, recommending that HHS receive $79.4 billion in discretionary funding in 2018. This is an increase of $1.7 billion from what HHS received in 2017.

Impending Renewal of Children’s Health Plan Causes Concern

The Senate Finance Committee will hold a hearing on reauthorizing the Children’s Health Insurance Program (CHIP), which covers millions of children from lower- and middle-income families. The program is up for renewal Sept. 30. CHIP advocates are concerned that the busy legislative agenda facing Congress could complicate the reauthorization. Bruce Lesley, president of the advocacy group First Focus, voiced his concern: “With all that is on Congress’ plate, I am very worried that a strong, wildly successful program with strong public support will get lost in the shuffle and force states to begin the process of winding down CHIP.”

Healthcare Reform News Update for September 6, 2017

Several States Extend Obamacare Sign-Up Beyond Federal Limit

The District of Columbia and five states that run their own healthcare exchanges will extend their healthcare enrollment period beyond the new Trump administration deadline of December 15. California, Colorado, Minnesota, Washington, Massachusetts, and D.C. now have sign-up dates that run as far as mid-January.

State Insurance Commissioners in Center of Obamacare Debates

Several state insurance commissioners, who negotiate health insurance premiums and rates, will testify Wednesday before the Senate health committee. The hearings will last four days, allowing insurance commissioners to discuss how to achieve market stability and ensure affordable healthcare.

Healthcare Reform News Update for September 5, 2017

GOP Ability to Dismantle ACA Expires Sept. 30

Senate Parliamentarian Elizabeth MacDonough has decided that the rules governing the effort to eliminate the Affordable Care Act will expire September 30. If Republicans don’t repeal the measure before this deadline, they must work together with Democrats to revise the law.

Tennessee Senator Sets Brief Timetable for Obamacare Fixes

Senate Health CommitteeCchairman Lamar Alexander (R-TN) hopes to pass a bipartisan Obamacare repair bill in only three weeks to help stabilize health insurance markets. Alexander’s bill would not fix everything; however, the senator anticipates a narrow bill that would give insurers selling coverage for next year some assurances.

States Offer Bipartisan Obamacare Model

State bipartisan efforts to fix and modify Obamacare have inspired members of Congress to focus more on how the law can be made to work better rather than simply repealing it. Representative Ed Clere (R-IN) said, “The fact is, Obamacare isn’t all good or all bad. It’s sweeping legislation that requires major ongoing work. … I hope someday there will be more appreciation for that.”

Healthcare Reform News Update for September 1, 2017

Feds to Cut 90% of Obamacare Advertising Funding

The federal government is decreasing the Obamacare advertising budget for the upcoming 2018 enrollment season by $90 million, senior officials with the U.S. Department of Health and Human Services (HHS) announced late Thursday. The budget will drop from $100 million to $10 million. Additionally, funding for navigator organizations, which help individuals enroll in coverage, will be cut nearly in half, going from $63 million to $37 million.

The funding cuts are drawing the ire of many Democrats. Senate Minority Leader Chuck Schumer (D-NY) replied to the decision in a statement: “The Trump administration is deliberately attempting to sabotage our healthcare system. When the number of people with health insurance declines and costs skyrocket, the American people will know who’s to blame.”

Governors Release Proposal to Stabilize Marketplace

Led by John Kasich (R-OH) and John Hickenlooper (D-CO), a bipartisan group of governors released a proposal Thursday that aims to stabilize the individual marketplace. The proposal recommends that Congress do the following.

  • Take immediate federal action to stabilize markets by:
    • Funding cost-sharing reduction (CSR) payments,
    • Creating a temporary stability fund,
    • Offering choices in underserved counties, and
    • Keeping the individual mandate (for now).
  • Create reforms that preserve recent coverage gains and control costs by:
    • Maximizing market participation,
    • Promoting appropriate enrollment,
    • Stabilizing risk pools, and
    • Reducing cost through coverage redesign.
  • Have an active federal/state partnership that is based on innovation and a shared commitment to improve overall health system performance by:
    • Improving the regulatory environment,
    • Supporting state innovation waivers, and
    • Controlling cost through payment innovation.

Senate Health Committee Adds Two More ACA Hearings

In addition to hearing from governors (Sept. 6) and state insurance officials (Sept. 6), the Senate Health Committee will also hear from health policy experts (Sept. 13) and stakeholders (Sept. 14). The goal of the hearings is to create a bipartisan healthcare reform bill.

Healthcare Reform News Update for August 29, 2017

Several House Dems Back This Single-Payer Healthcare Plan

Representative John Conyers (D-MI) has authored a single-payer healthcare plan that currently has support from 60 percent of House Democrats. The plan only has an outline of how to raise the funding needed for a single-payer system, which has caused Conyers to suggest the plan isn’t yet ready for a vote in Congress. Read more on Conyers’ plan here.

Governors Reach Agreement on Marketplace Stabilization Proposal

Governors John Kasich (R-OH) and John Hickenlooper (D-CO) announced Monday “that they have reached an agreement on a bipartisan proposal to stabilize Obamacare markets.” However, the proposal and its details have not been released.

Healthcare Reform News Update for August 28, 2017

All U.S. Counties Now Have at Least One Marketplace Option

The last county without a health insurance company in the individual marketplace is now covered. CareSource has agreed to offer marketplace plans in Paulding County, Ohio. CareSource CEO and President Pamela Morris said this about the company’s decision: “We want to be a resource to consumers left without options. Our decision to offer coverage in the bare counties speaks to our mission and commitment to the marketplace and serving those who are in need of healthcare coverage.”

Healthcare Reform News Update for August 23, 2017

Ohio, Colorado Governors Plot ACA Fixes

Ohio Governor John Kasich and Colorado Governor John Hickenlooper are creating their own proposals to fix the individual marketplace. The governors’ plans are expected to be released as soon as next week and could include:

  • Ensuring cost-sharing reduction (CSR) payments
  • Creating a reinsurance program
  • Increasing the threshold for the employer mandate

State Insurance Commissioners, Governors to Weigh in on Healthcare

The Senate Health Committee will start September with hearings from state insurance commissioners and governors. The committee is conducting these hearings to create legislation that will stabilize the individual marketplace. The state insurance commissioners are scheduled to testify September 6, and the governors are scheduled for September 7.

On Tuesday, Chairman Lamar Alexander (R-TN) explained, “At these hearings, we will hear testimony from state insurance commissioners and governors—those closest to the problem—on steps Congress can take to help make insurance available at affordable prices. Any solution that Congress passes for a 2018 stabilization package will have to be small, bipartisan, and balanced.”

Healthcare Reform News Update for August 21, 2017

Iowa, Oklahoma Aim to Reform ACA Via Healthcare Waivers

Officials in Iowa are planning to submit a vast state healthcare waiver request to the Centers for Medicare and Medicaid Services (CMS) next week. The waiver would alter the “ACA premium tax credit model and use some of the federal subsidy money to set up a reinsurance program to protect insurers that sign up high-cost enrollees.”

Oklahoma officials filed a state waiver request to CMS last Wednesday. The waiver would “use federal subsidy money to fund a new reinsurance program, as the first step in a broader reform of the ACA coverage system.” The waiver also wants to change the ACA’s essential benefit requirements for individual coverage.

Both state waiver requests include replacing federal marketplaces with state-based platforms and changing the income eligibility for premium subsidies. They also share a main goal of lowering premiums and stabilizing the individual marketplace.

Healthcare Reform News Update for August 17, 2017

Iowa’s Single Remaining ACA Insurer Seeks Rate Hike

Medica, the only insurance company offering Obamacare marketplace plans in Iowa, has filed a revised premium rate increase of almost 57 percent. Medica cited uncertainty over cost-sharing reduction (CSR) payments as the reason for steep premium rate increases.

Geoff Bartsh, Medica’s vice president of individual and family business, said in a statement: “We remain hopeful the federal government will fund the cost-sharing reductions, but we are working with the Iowa Insurance Division to help consumers understand the implications of lack of this funding. We regret the disruption this creates for consumers.”

Trump Will Make August CSR Payments

August’s cost-sharing reduction (CSR) payments will be made to insurers, according to a White House spokesperson. However, no guarantee was made for future payments. An update on the CSR case (on whether or not the payments are constitutional) is expected Sunday, though it could get delayed again.

Healthcare Reform News Update for August 16, 2017

CBO Analysis Shows Impact of Ending CSR Payments

The Congressional Budget Office (CBO) released an analysis Tuesday titled “The Effects of Terminating Payments for Cost-Sharing Reductions.” Here are the overall effects noted in the analysis:

  • Ending CSRs would increase the deficit by $194 billion over the next 10 years.
  • The number of areas with no marketplace options (5 percent of Americans) would increase during the next two years and be about the same as it is now in 2020.
  • The average premium for a marketplace silver plan will increase by 20 percent in 2018 and 25 percent in 2020.
    • The premium increases will also expand the amount of premium tax credits, raising spending on subsidies by $365 billion over the next 10 years.
    • The majority of people using premium tax credits (subsidies) will pay the same amount in premiums for the next 10 years.
  • The uninsured rate would increase in 2018 but decrease slightly in 2020.

Centene Expands in Nevada to Cover ‘Bare’ Counties

Centene announced Tuesday that it will expand its individual marketplace coverage in Nevada. The company’s coverage means that no counties in Nevada, including rural areas, will be without a marketplace option. After Centene’s expansion, only 2 counties in the nation are currently left without a 2018 marketplace option: one county in Ohio and one in Wisconsin.

Healthcare Reform News Update for August 14, 2017

GOP Representatives Working on Marketplace Stabilization Bill

Representatives Mark Meadows (R-NC), chair of the Freedom Caucus, and Tom MacArthur (R-NJ), former chair of the Tuesday Group, are working together to create a marketplace stabilization bill. The bill is likely to fund cost-sharing reduction subsidies. Additionally, it may allow states to waive Obamacare regulations.

In relation to the bill, MacArthur said in a statement, “I’ve been working on a plan that will lower the cost of premiums, while stabilizing the individual marketplace, so that we can provide Americans with the high quality and affordable healthcare they deserve.”

CBO Analysis to Show Effects of Ending Insurer Payments

The Congressional Budget Office (CBO) announced Friday that it will release an analysis this week “detailing the effects of ending key Obamacare insurer payments,” also known as cost-sharing reduction (CSRs) payments. The president recently threatened to discontinue these payments, which help insurance companies lower out-of-pocket costs such as deductibles and copays.

CMS Extends Deadline for 2018 Rate Requests

The Centers for Medicare and Medicaid Services (CMS) announced Thursday that it would extend the Obamacare marketplace filing deadline. The deadline was extended by three weeks, making the new date September 5 and the final deadline September 20.

Anthem Exits Virginia’s Individual Marketplace

Health insurer Anthem Blue Cross Blue Shield announced Friday that it will stop offering individual marketplace plans for Virginia in 2018. The insurer cites the uncertainty in Washington as the reason for its departure. This is the third insurance company to exit Virginia’s ACA marketplace.

Healthcare Reform News Update for August 11, 2017

Freedom Caucus to Petition for ‘Clean Obamacare Repeal’ Bill

The conservative House Freedom Caucus is planning to file a petition Friday in order to influence House Speaker Paul Ryan (R-WI) to “bring up a so-called ‘clean Obamacare repeal’ bill.” The bill would repeal Obamacare after a transition of two years. However, the same bill failed in the Senate last month.

Kaiser Family Foundation Publishes 2018 Premium Preview

On Tuesday, the Kaiser Family Foundation published “An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges.” The study looks at initial premium rate charges and insurance companies’ participation in the marketplace for 2018 and makes comparisons to previous years. From the report: “In the past, requested premiums have been similar, if not equal to, the rates insurers ultimately charge. This year, because of the uncertainty insurers face over whether the individual mandate will be enforced or cost-sharing subsidy payments will be made, some companies have included an additional rate increase in their initial rate requests, while other companies have said they may revise their premiums late in the process.”

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

Increases: Insurance 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.”

Healthcare Reform News Update for August 1, 2017

If Trump Ends CSR Payments, Congress May Appropriate Funding

President Donald Trump is expected to decide early this week whether or not the administration will continue making cost-sharing reduction (CSR) payments. If he decides to end the payments, members of Congress have suggested that they might appropriate the funds.

  • Senator John Thune (R-SD): “I hope the president will use his authority to extend those payments. He can do that. If he doesn’t, then Congress will have to look at what our options are.”
  • Finance Committee Chairman Orrin Hatch (R-UT): “I think we’re going to have to [appropriate funds]…I’m for helping the poor, always have been. And I don’t think they should be bereft of healthcare.”

Republicans Rally Support for Graham-Cassidy Plan

A healthcare reform proposal suggested by senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) would give annual block grants to states, allowing each state to regulate healthcare as they see fit. States that expanded Medicaid are expected to be disadvantaged in the block grant proposal. The proposal would also:

  • Force severe healthcare spending decreases
  • Set new limits on Medicaid spending
  • Endanger subsidies

Senators Cassidy, Graham, and Dean Heller (R-NV) met with Trump’s top aides Monday to discuss the proposal. The senators are trying to get the support of conservative colleagues Mike Lee (R-UT) and Mark Meadows (R-NC).

Senior GOP Senators Ready to Move Past Healthcare

Some Senate Republicans seem ready to move on to tax reform. During an interview with Reuters, Senator Orrin Hatch (R-UT) said, “There’s just too much animosity, and we’re too divided on healthcare. I think we ought to acknowledge that we can come back to healthcare afterward, but we need to move ahead on tax reform.”

Senator Roy Blunt (R-MO) echoed Hatch’s sentiment during an interview with CNN: “If the question is, ‘should we stay on healthcare until we get it done,’ I think it’s time to move on to something else. Come back to healthcare when we have more time to get beyond the moment we are in. See if we can put some wins on the board.”

Additionally, Senator John Thune (R-SD) told reporters, “Until someone shows us how to get that elusive 50th vote, I think it’s over.”

Five Insurers Will Cover 19 ACA Counties in Ohio

Buckeye Health Plan, CareSource, Medical Mutual of Ohio, Molina Healthcare Inc., and Paramount Health Care have all agreed to expand into the Ohio marketplace. The expansions will cover 19 of the 20 counties (about 11,000 people) that were at risk of having no Affordable Care Act marketplace options in 2018. Ohio is still working to cover the remaining county with no coverage options.

Healthcare Reform News Update for July 31, 2017

Bipartisan Leaders Unite to Fix Obamacare

The Problem Solvers caucus, a group of about 40 House Republicans and Democrats, have created a set of Obamacare fixes. The caucus plans to announce its potential solutions Monday and hope the suggestions will gain support after the recent failures to repeal and replace Obamacare.

The Obamacare fixes focus on:

  • Stabilizing the marketplace as quickly as possible
  • Funding cost-sharing reduction subsidies (CSRs)
  • Altering the employer mandate to include only companies with more than 500 employees (rather than the current 50)
  • Creating a federal stability fund to help states reduce healthcare costs for those with extremely high medical charges
  • Eliminating the medical-device tax
  • Creating greater flexibility for state innovation with stricter guidance on how states can use waivers

The Problem Solvers caucus is led by Tom Reed (R-NY) and Josh Gottheimer (D-NJ). Legislators from the New Democrat Coalition and the Republican moderate Tuesday Group are also involved with the caucus.

Trump Threatens to End CSR Payments if Reform Bill Fails

President Donald Trump threatened Saturday over Twitter to end cost-sharing reduction (CSR) payments if Congress doesn’t pass a healthcare reform bill. He also threatened to end funding for Congress’ healthcare. Trump’s tweet reads, “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

What Could Happen if CSR Payments Are Eliminated?

If cost-sharing reduction (CSR) payments are no longer funded by the government, here are some likely effects.

Assuming states remain in ACA marketplaces:

  • The cost of a silver plan’s premium will increase by 19 percent.
    • 15 percent in states that expanded Medicaid
    • 21 percent in states that did not expand Medicaid
  • The increase in the benchmark silver plan would increase the amount of premium tax credits.
  • The expense of increased tax credits would cost the federal government 23 percent more than it would save from eliminating CSRs.
    • That is a cost of $2.3 billion for fiscal year 2018 and $31 billion over the next decade.

The change in price of silver plans may influence consumers to look for lower-cost plans, and enrollment could shift to other metal level plans. Some consumers might be encouraged to use subsidies they have not previously applied for.

Lawsuits Could Push Government to Pay ACA Insurers

Health insurance companies have filed almost two dozen lawsuits against the government over risk corridor funding. The companies claim that the government owes them $8 billion in payments from a program meant “to blunt their losses in the Obamacare marketplaces.”

Minuteman Health CEO Tom Policelli said, “[The Obama administration] repeatedly assured us it was there, and it would be a clear obligation of the government. Even the federal government is subject to the rules.”

HHS Secretary Promises to Uphold Obamacare

During an interview on “Meet the Press,” U.S. Health and Human Services Secretary Tom Price told NBC he would implement Obamacare as it was intended. “Our job is to follow the law of the land,” Price said, despite the fact he believes “the law … is failing the American people.”

Continued Marketplace Uncertainty Puts Hundreds at Risk

The four top health insurance companies that provide ACA coverage—Anthem Inc, Cigna Corp, Health Care Service Corp, and Molina Healthcare—continue to weigh whether or not to pull out of 2018 marketplaces.

There are currently 40 counties that could be left without a marketplace insurance option, but that could increase to hundreds of counties if insurance companies continue leaving the marketplace. Presently, more than 1,300 counties—primarily in 15 states—have only one insurer participating in 2018. Anthem and HCSC are the remaining insurers in one-third of those counties and states, leaving those areas at risk.

Healthcare Reform News Update for July 28, 2017

Senate Votes Down ‘Skinny’ Obamacare Repeal

A Republican Senate bill (nicknamed the “skinny repeal”) that would repeal the individual mandate, the employer mandate, and the medical excise tax was voted down Thursday night. Senators Susan Collins (R-ME), John McCain (R-AZ), and Lisa Murkowski (R-AK) joined their Democratic colleagues in voting against the measure.

Following to vote, Senate Majority Leader Mitch McConnell (R-KY) said it was time for the Senate to move on from healthcare reform. Other senators suggested attempting a bipartisan approach to stabilizing health insurance marketplaces, but the next steps in healthcare reform are unclear.

Healthcare Reform News Update for July 27, 2017

Senate Votes Down Two Healthcare Reform Proposals

Two healthcare reform proposals were put to a vote Wednesday on the Senate floor. First, the repeal and delay bill was voted down 45-55. The proposed legislation included an amendment from Senator Rand Paul (R-KY) that would ban the use of subsidies to buy plans that cover abortion. Seven Republicans and all Democrats voted against the measure. Next, a vote to return healthcare reform to a committee process was voted down 48-52. All Republicans voted against the measure, and all Democrats voted for it.

Senate Republicans Unite Behind ‘Skinny Repeal;’ House Is Wary

After a full repeal bill was rejected Wednesday, Senate Republicans are moving on to their back-up plan: a “skinny repeal.” The proposal would eliminate the individual mandate, the employer mandate, and one ACA tax. It would also allow Republicans to succeed in passing a healthcare reform bill.

However, House conservatives seem to disagree with a small repeal. On Wednesday, Representative Mark Meadows (R-NC) told reporters that a skinny repeal delivered to the House would be “dead on arrival.” Speaking on the idea of a scaled-back repeal, Representative Mark Walker (R-NC) said, “I don’t think it’s going to be very well received.”

What Could a ‘Skinny Repeal’ Mean for Individual Marketplaces?

Health insurance companies have warned that a “skinny repeal” of the ACA’s mandates could hurt the individual health insurance market. CareFirst BlueCross and BlueShield President and CEO Chet Burrell said that eliminating the individual mandate would dismantle the individual market. “It is hard to think of anything more devastating, especially if nothing else is done to stabilize the health insurance market,” Burrell said. “The significant coverage gains we have made for Americans in recent years would be wiped away with this damaging blow.”

The Congressional Budget Office (CBO) determined that a “skinny repeal” would cause 16 million more Americans to become uninsured by 2021. Additionally, premiums would increase by around 20 percent annually.

Anthem May Exit More Marketplaces

Anthem CEO Joe Swedish said Wednesday that the company needs “certainty quickly” on whether Congress will move to fund cost-sharing subsidies, which low-income Americans who buy ACA plans use to pay their out-of-pocket costs. Swedish said, “There are still many areas of marketplace uncertainty—principally, cost-sharing reduction subsidy funding—that make it challenging to be comfortable with the level of predictability of a sustainable marketplace. If we aren’t able to gain certainty on some of these items quickly, we do expect that we will need to revise our rate filings to further narrow our level of participation.”

The company has already announced its intentions to stop selling individual coverage on public exchanges in three states next year.

Healthcare Reform News Update for July 26, 2017

Senate Votes Against First ACA Repeal, Replacement Proposal

In a 43-57 vote, the Senate opposed an initial repeal-and-replacement proposal for Obamacare on Tuesday night. The vote rejected the Senate’s healthcare bill (the Better Care Reconciliation Act) and proposals from Senators Ted Cruz (R-TX) and Rob Portman (R-OH). This was the first amendment to get a vote after the Senate picked up the American Health Care Act, the House-passed bill that is being used as a vehicle for any Senate action.

Which Bills Will the Senate Vote on Next?

Wednesday afternoon: The Senate will vote on a repeal-and-delay bill with the Paul amendment, which would ban the use of subsidies to buy plans that cover abortion. If that bill does not pass, the Senate will vote on whether or not to return healthcare reform bills to a bipartisan process.

Later: If senators cannot agree on a comprehensive repeal or replacement for Obamacare, Republicans may move forward with a “skinny” repeal. The smaller repeal would eliminate the individual mandate, the employer mandate, and the medical device tax. The scaled-down bill would allow the Senate to succeed in passing a bill and start negotiations with the House.

The Senate may also vote on a Graham-Cassidy amendment, which keeps the ACA’s taxes and allows states to administer health insurance. As a note, Senate members still have time to propose new healthcare bills.

Senate Parliamentarian Advises Against Two Additional Senate Bill Provisions

Two more provisions from the Republican healthcare bill may not meet reconciliation standards, Senate Parliamentarian Elizabeth MacDonough said Tuesday. If the provisions are argued against and found to fall outside of reconciliation standards, they will need 60 votes (rather than 51) to be included in a healthcare bill. The two provisions advised against: 1) allowing insurance companies to increase the amount they charge older individuals in comparison to younger ones and 2) allowing small businesses to create association health plans.

Healthcare Reform News Update for July 25, 2017

Senate Healthcare Bill Advances With 51-50 Vote

Vice President Mike Pence cast the tiebreaking vote to move the legislation to repeal Obamacare to floor debate. Senator John McCain (R-AZ), who was recently diagnosed with brain cancer, returned to Washington on Tuesday to participate in the Republican-led healthcare vote. He voted in favor of the legislation—a critical move after fellow senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) expressed their opposition. Here’s a closer look at how each senator voted.

President Donald Trump praised the Senate and thanked McCain for advancing the legislation: “I’m extremely happy that we got this vote. This is the tough vote to get. Now we’re all going to sit together, and we’re going to try and come up with something that’s really spectacular. We have a lot of options and a lot of great options. And the Republican senators really went out there—it’s not easy.” Trump criticized Collins and Murkowski’s opposition, saying the result is “very, very sad for them.”

The legislation will move to floor debate; however, it’s not guaranteed what the final bill will look like or if there will be enough votes to pass it.

Democrats Lay Out a 3-Tier Approach to Lowering Prescription Costs

Congressional Democrats included a 3-tier approach to combatting drug prices in a proposal called A Better Deal.

  • The proposal would “create an independent, Senate-confirmed ‘price gouging’ enforcer to identify medicines with ‘unconscionable’ price increases and impose fines on manufacturers that are proportional to the size of the price hike. Money paid will be given to the National Institutes of Health (NIH) to further its work on new drug development.”
  • Drug makers would also be required to publicly justify extreme pricing increases to the U.S. Department of Health and Human Services (HHS) at least 30 days before the cost change will begin
  • The government would be allowed to negotiate prescription drug prices for medications covered by Medicare Part D.

Healthcare Reform News Update for July 24, 2017

Senate Parliamentarian: Parts of Updated Bill Don’t Meet Reconciliation Rules

Abortion provisions in the Senate bill would need a super-majority vote, Senate Parliamentarian Elizabeth MacDonough said Friday. Provisions eliminating Medicaid coverage requirements, altering medical loss ratios for insurance companies, and pertaining directly to New York would require a super-majority vote, MacDonough said. That means these provisions would need 60 favorable votes to pass and follow Senate rules (rather than the 50 Republicans anticipated) because they do not follow reconciliation rules.

Senate Republicans Determined to Hold Healthcare Vote This Week

Senate Majority Leader Mitch McConnell (R-KY) is pressing forward to hold a vote this week on healthcare reform. Two key factors remain unclear: which legislation will be voted on and whether or not Republicans have the necessary support to move the bill forward.

Senator Susan Collins (R-ME) told “Face the Nation” that Senators “don’t know whether we’re going to be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill, a new version of the Senate bill, or a 2015 bill that would have repealed the Affordable Care Act now and then said that somehow we’ll figure out a replacement over the next two years.”

Senator Rand Paul (R-KY) echoed Collins’ confusion, telling CNN’s “State of the Union,” “The real question is, what are we moving to? What are we opening debate to?”

A Look at Premiums, Deductibles Under the ACA Versus the Senate Healthcare Bill

The Kaiser Family Foundation has published an interactive map comparing premiums and tax credits under the Affordable Care Act (current law) and the Better Care Reconciliation Act (Senate healthcare bill). The map includes estimates by county, age, and income.

The Hill has reported on the Congressional Budget Office’s (CBO) analysis of the Senate healthcare bill, specifically on drastically increasing deductibles. The CBO found that “a standard benchmark plan under the GOP bill could face a deductible of $13,000 in 2026.” Under Obamacare, someone making around $57,000 would have a deductible of $5,000, and someone making around $27,000 would have a deductible of $800.

Healthcare Reform News Update for July 21, 2017

GOP Plans a Healthcare Vote for Tuesday

Republican senators are pushing for a Tuesday vote on a healthcare reform bill. However, it’s not clear which legislation senators will be voting on or if Republicans have the necessary votes to move a bill forward.

This year, several different healthcare reform bills (and versions of those bills) have been introduced.

  • The American Health Care Act was passed by the House.
  • The Better Care Reconciliation Act, created by the Senate, was originally introduced June 22.
    • The first revision, introduced July 13, included the Cruz Amendment, additional funding for opioid treatment, and other small changes.
    • The second revision was introduced July 20. The Cruz Amendment was removed, some Obamacare taxes remained, and other small changes were made.
  • The Obamacare Repeal Reconciliation Act, a repeal-only bill, has also been introduced by the Senate.

Even if Republicans can get enough votes to proceed, it isn’t clear which of the bills above will be presented. Also, Senator John McCain (R-AZ), who was diagnosed with brain cancer earlier this week, is still recovering from surgery, lowering the GOP’s already slim majority in the Senate. However, Rand Paul (R-KY) said Thursday he will vote yes to proceed with the House-passed bill, but he has stipulations. He told reporters, “If they want my vote, they have to at least agree that we’re going to at least have a vote on clean repeal.”

CBO Analysis: 22 Million Would Lose Coverage Under Latest Healthcare Bill

The Congressional Budget Office (CBO) released its examination of the Senate’s most recent healthcare bill. According to the report, the Senate healthcare bill will:

  • Reduce the federal deficit by $420 billion over the next 10 years
    • The initial Senate bill reduced the deficit by $321 billion.
  • Increase the number of uninsured people by 22 million in 2026
  • Decrease premiums by 30 percent after 2020
  • Create a standard-level plan deductible of $13,000

Trump Administration Ends ACA Help in 18 Cities

Last week, community groups were told that “Affordable Care Act contracts that brought assistance into libraries, businesses, and urban neighborhoods in 18 cities” would be terminated. The end of these contracts means that potential enrollees shopping on the individual marketplace “will have fewer places to turn for help signing up for coverage.”

Centers for Medicare & Medicaid Services spokesperson Jane Norris said the contracts were never meant to last long term. “These contracts were intended to help CMS provide temporary, in-person enrollment support during the early years.”

Healthcare Reform News Update for July 20, 2017

Senate Republicans Resume Talks on Healthcare Bill

Rather than moving forward with a repeal-only bill, GOP senators are reopening negotiations on their healthcare reform legislation. This change in direction occurred after a Wednesday meeting at the White House with President Donald Trump.

During the meeting, Trump told senators they should cancel their August recess and stay until a healthcare reform bill is finalized. “We shouldn’t leave town until this is complete. We should hammer this out and get it done,” Trump said during the lunch meeting. Additionally, Trump suggested senators repeal and replace Obamacare at the same time: “We can repeal, but we should repeal and replace. Frankly, I don’t think we should leave town unless we have a health insurance plan, unless we can give people great health care.”

Senate Healthcare Bill Renegotiations May Include ‘Medicaid Wraparound’

Senate Republicans are rushing to settle their healthcare reform bill. In order to win over moderates, one change may include a “Medicaid wrap-around.” This would allow states to use additional Medicaid funding to cover healthcare costs for individuals who would lose coverage when Medicaid expansion ends. The additional funding, estimated around $200 billion, would primarily be given to states that expanded Medicaid.

CBO: 32 Million Would Lose Insurance By 2026 After a Straight ACA Repeal

The Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) released an analysis of the effects enacting the Obamacare Repeal Reconciliation Act of 2017 would have on Americans. This amendment would revoke many provisions of Obamacare. Here are the main findings:

  • The bill will reduce the federal deficit by $473 billion over the next decade.
  • The bill will increase the number of uninsured people by 17 million in 2018.
    • 27 million in 2020
    • 32 million in 2026
  • The bill will increase the average individual premium by 25 percent in 2018.
    • 50 percent in 2020
    • 100 percent in 2026
  • By 2020, 50 percent of Americans will live in areas with no individual health insurance options.
    • 75% in 2026

Healthcare Reform News Update for July 19, 2017

Senate Will Hold Healthcare Repeal Vote Next Week

The Senate is expected to vote early next week on whether or not to pick up the House’s passed healthcare bill, Senate Majority Leader Mitch McConnell (R-KY) announced Tuesday night. If the vote passes, the Obamacare repeal proposal would be added as an amendment to the existing bill.

During his announcement, McConnell said, “For the information of all senators, at the request of the President [Trump] and Vice President [Pence] and after consulting with our members, we will have the vote on the motion to proceed to the Obamacare repeal bill early next week.”

Senators Susan Collins (R-ME), Lisa Murkowski (R-AK), and Shelley Moore Capito (R-WV) are expected to vote “no” on the legislation.

Trump to Talk Healthcare With GOP Senators Over Lunch

President Donald Trump will host a lunch Wednesday for Republican senators where he will discuss the next steps on healthcare reform and other policy matters.

The meeting comes after Trump made several comments suggesting Republicans allow the marketplace to collapse. Trump said, “I think we’re probably in that position where we’ll let Obamacare fail. We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.”

Are There Enough Insurance Companies on the Individual Marketplace for 2018?

Bloomberg has collected data on the nation’s individual insurance marketplace. Although select areas will struggle to find individual coverage, the vast majority of Americans will have options.

  • 0.2 percent of enrollees will have no marketplace options.
    • Nevada will be heavily affected by the lack of marketplace options.
  • 20 percent of enrollees will have 1 marketplace option.
  • 22 percent of enrollees will have 2 marketplace options.
  • 23 percent of enrollees will have 3 marketplace options.
  • 34 percent of enrollees will have 4 or more marketplace options.

Healthcare Reform News Update for July 18, 2017

GOP Senate Healthcare Bill Halted; Reform Talks Continue

Senate Majority Leader Mitch McConnell (R-KY) announced late Monday that the Senate will drop its latest healthcare reform bill. The decision came after Senators Jerry Moran (R-KS) and Mike Lee (R-UT) said they would not support the legislation. The senators joined colleagues Rand Paul (R-KY) and Susan Collins (R-ME) in their opposition, leaving the bill no chance of passing if put to a vote.

McConnell’s efforts are now focused on pushing senators to vote on a bill that will repeal Obamacare within two years.

In a statement, McConnell said: “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful. So, in the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.”

Healthcare Reform News Update for July 17, 2017

Senate Healthcare Vote, CBO Score Delayed

Senator John McCain (R-AZ) recently announced a planned absence to undergo surgery to remove a blood clot above his left eye. With the temporary loss of McCain’s vote, Senate Majority Leader Mitch McConnell (R-KY) decided Saturday to delay the highly anticipated vote on the Senate healthcare bill. The postponement is expected to last for a week, allowing McCain to recover from surgery and return to Capitol Hill. The Senate is split 52-48 between Republicans and Democrats. (Here is where GOP senators stand on the updated bill.) In order for the legislation to pass, McConnell can’t lose more than two votes.

Adding to the Senate’s delay, the Congressional Budget Office (CBO) announced Sunday that it was not prepared to release an analysis of the Senate’s updated bill. The CBO was expected to release an analysis on Monday.

Two Leading Health Insurance Organizations Oppose Cruz Amendment

America’s Health Insurance Plans and the Blue Cross Blue Shield Association, two influential health insurance groups, wrote the Senate a letter requesting the removal of the Cruz Amendment from the updated healthcare bill. The Cruz Amendment would allow insurance companies to sell plans that do not meet Affordable Care Act coverage requirements as long as at least one plan that does meet coverage requirements is offered.

In the letter, the organizations include these statements: “As healthy people move to the less-regulated plans, those with significant medical needs will have no choice but to stay in the comprehensive plans, and premiums will skyrocket for people with pre-existing conditions…Finally, this provision will lead to far fewer, if any, coverage options for consumers who purchase their plan in the individual market. As a result, millions of more individuals will become uninsured.”

Colorado’s Individual Market Will See Large Premium Hikes

Health insurance companies participating in Colorado’s individual market are requesting an average premium rate increase of 27 percent. Colorado Insurance Commissioner Marguerite Salazar expressed her lack of surprise in the high rate requests. In an interview, Salazar said, “I believe that the dubious situation at the federal level has contributed to the premium increase requests we’ve seen from the companies.”

Healthcare Reform News Update for July 14, 2017

Where GOP Senators Stand on the Updated Healthcare Bill

Here is how Senate Republicans are leaning. Two Republican senators have said they will oppose the new piece of legislation:

  • Susan Collins (R-ME)
  • Rand Paul (R-KY)

Eight Republican senators have either currently or previously expressed concerns over the bill’s language and are likely to vote against it without change:

  • Shelley Moore Capito (R-WV)
  • Bill Cassidy (R-LA)
  • Bob Corker (R-TN)
  • Dean Heller (R-NV)
  • John McCain (R-AZ)
  • Lisa Murkowski (R-AK)
  • Rob Portman (R-OH)
  • Ben Sasse (R-NE)

Twenty-three Republican senators are unsure, and the remaining 19 are likely to vote yes on the bill in its current state.

Senator Lindsey Graham Introduces State-Focused Healthcare Proposal

In the event that the Senate GOP’s healthcare bill does not progress, Senator Lindsey Graham has introduced a separate proposal. In Graham’s plan, federal funding for healthcare would be sent directly to states to allocate as they see fit.

When talking about the bill, Graham explained: “Instead of having a one-size-fits-all solution from Washington, we should return dollars back to the states to address each individual state’s health care needs. Just like no two patients are the same, no two states’ health care needs are the same. A solution that works in California may not work in Virginia. These funds are already being spent on Obamacare, but instead of having Washington decide, we’ll empower each individual state to choose the path that works best for them.”

Graham has been working with colleague Bill Cassidy on the proposition.

Healthcare Reform News Update for July 13, 2017

Senate Releases Updated Healthcare Reform Bill

The Senate on Thursday released an updated version of its healthcare reform bill. The majority of the bill has been left the same, but the following sections have been modified:

  • Obamacare taxes: For individuals making more than $200,000, a 3.8 percent investment tax would no longer be repealed. Additionally, taxes on health-insurance executives and a Medicare tax would no longer be repealed.
  • Opioid crisis funding: Financing to tackle the nation’s opioid dilemma would increase from $2 billion to about $45 billion.
  • The Cruz amendment: A modified version of Texas Senator Ted Cruz’s amendment, which allows health insurance companies to sell plans with less coverage if they also sell ACA-compliant plans, is included in the Senate’s healthcare bill.
  • Tax credits on catastrophic coverage: Under the updated Senate healthcare bill, individuals would be allowed to use tax credits to purchase these high-deductible plans.
  • State individual market stability fund: Funding to help states lower premiums and healthcare costs would increase by $70 billion. This is an addition to the $112 billion allotted in the Senate bill’s previous version.
  • Health savings accounts and premiums: A new provision in the Senate bill would allow individuals to use health savings accounts to pay for their premiums.

The revised bill does not address cuts to the Medicaid program that concern many moderate Republican senators. However, it would lift federal budget restraints “for areas of a state during a declared emergency.”

Senate Parliamentarian Agrees House’s Healthcare Bill Follows Reconciliation Rules

Elizabeth MacDonough, the Senate Parliamentarian, has agreed with Republicans and decided that the House’s healthcare bill follows Senate reconciliation rules. This judgement will allow the Senate to make revisions without any procedural obstacles, although members are already modifying their own healthcare bill.

House Subcommittee Proposes $1.1 Billion Funding Increase for NIH

The House subcommittee proposed a $1.1 billion funding increase for the National Institutes of Health (NIH) on Wednesday. The White House previously suggested a $5.8 billion decrease in funding, though the proposal was met with opposition from members of both congressional parties.

President Trump Will Be ‘Very Angry’ If Obamacare Reform Bill Does Not Pass

During an interview with Christian Broadcasting Network’s Pat Robertson, President Donald Trump said this about the possibility that the Senate won’t pass a healthcare bill: “Well, I don’t even want to talk about it, because I think it would be very bad. I will be very angry about it, and a lot of people will be very upset. But I’m sitting waiting for that bill to come to my desk. I hope that they do it. They’ve been promising it for years…He’s got to pull it off. [Senate Majority Leader Mitch McConnell (R-KY)] has to pull it off. He’s working very hard. He’s got to pull it off.”

Healthcare Reform News Update for July 12, 2017

The Senate Is Looking Into a Possible Bipartisan Bill to Reform Healthcare

Since the GOP’s healthcare bill might not pass in the Senate, many lawmakers are considering a bipartisan effort to reform healthcare. Around a half-dozen Republicans are holding discussions with Democrats about coming together to prevent the possibility of a complete collapse of small-group and individual insurance markets throughout the country.

Many Democrats see this as an opportunity to prevent a complete repeal of a key accomplishment of the Obama years. Some Republican senators, under pressure from constituents who are worried about losing their healthcare, believe a bipartisan bill could alleviate many problems. The bill’s main ideas involve creating a reinsurance fund and authorizing cost-sharing payments for [insurance companies] so they don’t have to raise prices for covering a sicker pool of customers.

Senate Republicans Will Unveil a Revised Healthcare Bill on Thursday

Majority Leader Mitch McConnell (R-KY) plans to unveil the details of the Senate’s healthcare reform bill tomorrow. The Senate is expected to reject this bill, according to key Republican senators such as Charles Grassley (R-IA), John McCain (R-AZ), and Susan Collins (R-ME).

GOP Drops Tax Cuts For Higher-Income Earners in Revised Health Bill

In a move designed to win over some moderate Republicans, the Senate Republican leadership is dropping its plans to remove the Affordable Care Act’s 3.8 percent tax on investment income for people who earn more than $200,000 and couples who earn more than $250,000. This could produce nearly $231 billion in revenue over a decade, according to the Joint Committee on Taxation.

Some sources are suggesting that Senator Mitch McConnell, in closed-door talks, is negotiating with Republican holdouts about other components of healthcare spending as well. A GOP aide requesting anonymity suggested that increased Medicaid funding and increased funding to stabilize the cost of premiums for individuals might be under consideration.

Texas Senator’s Amendment Could Raise Premiums For 1.5 Million People With Pre-Existing Conditions

Senator Ted Cruz (R-TX) is sponsoring an amendment that would give insurance companies the power to sell plans in the individual insurance market that don’t meet two major Affordable Care Act requirements (essential health benefits and community rating).  The stipulation is that insurance companies must also offer plans that do meet these ACA necessities. Many conservatives have expressed support for this amendment. They believe it would encourage insurance companies to offer cheaper insurance plans to some people.

The amendment’s critics, including Democrats and moderate Republicans, contend that the amendment would create two tiers of plans, which could allow insurance companies to entrap sick people into plans they’ll need but won’t be able to afford. Also, 1.5 million people with pre-existing conditions could face higher premiums with the amendment, according to a Kaiser Family Foundation analysis.

Healthcare Reform News Update for July 7, 2017

If Senate’s Bill Doesn’t Pass, McConnell to Seek Stabilizing Legislation

According to Senate Majority Leader Mitch McConnell, if a full repeal and replacement of Obamacare does not occur, the Senate will have to work on a limited bill to stabilize the individual marketplace. Because this type of limited bill would not fall under reconciliation, the GOP would have to work with Democrats to pass a stabilization bill.

In a response to questions about if the GOP will need bipartisanship for healthcare reform, Senator McConnell said, “If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur.”

Senate Not Expected to Vote on Bill Immediately After July 4 Recess

Several Republican senators have said that a healthcare vote won’t happen next week.

  • Senator Pat Toomey: “We’re still several weeks away from a vote, I think.”
  • Senator Ted Cruz said that a vote might occur “in the next several weeks.”
  • Senator Mitch McConnell also predicted that a healthcare vote would happen in a “couple weeks.”

Aetna Better Health of Illinois Threatens to Leave Illinois Medicaid Program

In a court filing last week, Aetna Better Health of Illinois said Illinois had not paid an owed amount of $698 million dollars. Company President Laurie Brubaker said last week that Aetna will pull out of Illinois’ Medicaid program if the state did not pass a budget by July 1 and pay Aetna the owed amount.

Georgia Expected to See Large Premium Hikes for 2018 Marketplace Plans

Many Georgia health insurance companies are increasing premiums as healthcare reform uncertainty continues, including Blue Cross and Blue Shield of Georgia, which is the only insurance company in all Georgia counties. Companies are seeking these average premium increases:

  • Blue Cross and Blue Shield of Georgia: 40%
  • Kaiser Foundation Health Plan of Georgia: 25%
  • Alliant: 18.6%
  • Ambetter of Peach State: 12.4%

Healthcare Reform News Update for July 5, 2017

The House Has Drafted a Provision That Would Prevent the IRS from Enforcing the Individual Mandate

The House Committee on Appropriations has written a provision that would prevent the IRS from enforcing the tax penalties associated with the individual mandate. The drafted provision is not part of the House’s nor the Senate’s healthcare reform bills. The provision would also prevent the IRS “from enforcing a requirement that employers and insurance companies inform the government of the name and Social Security number of anyone to whom they provide health insurance coverage.” The government currently uses this information to enforce the individual mandate and other requirements.

Insurance Companies on the Marketplace May Ask for Enrollment Caps

Insurance companies that have not left the marketplaces have seen their enrollment increase, but those increases haven’t translated to higher profits, as many of the new enrollees are unhealthy individuals who require expensive medical care. Because their risk pools are unequal (with more sick individuals than healthy ones), many companies worry that they will lose money. In order to stem their losses, some companies may ask the government to cap enrollment for their plans.

Centene’s Entrance Into Missouri’s Marketplace Will Cover Potentially Barren Counties

On Friday, Centene announced that it would enter the Missouri health insurance marketplace for 2018. The company states that it plans to cover 39 counties, including 25 counties that would have had no individual insurance options. In a statement, Centene’s chairman, president, and chief executive Michael Neidorff said, “We strive to be a responsible partner with the state and are committed to working closely with regulators and policymakers to collaborate on actions that stabilize the market and offer affordable coverage options.”

Healthcare Reform News Update for July 3, 2017

Conservative Republicans Bring Up an Old Idea: Repeal Now and Replace Later

Senator Ben Sasse brought up the “repeal now and replace later” idea in both a letter to the President and on Fox News. Senator Rand Paul and an advocacy group called Americans for Prosperity seem to support the idea. In a Tweet, President Trump also voiced support for the two-step approach.

Premier Health Plan and Memorial Hermann Health System Announce Market Exits

Premier Health Plan has announced that it will leave Ohio’s individual health insurance market. The company cited uncertainty over the individual Marketplace and difficulty pricing as its reason to exit the market.

Memorial Hermann Health System will completely exit the individual market at the end of 2017. A spokeswoman explained the company’s exit in an email: “After careful consideration, Memorial Hermann Health Plans has made the difficult decision to withdraw from the individual segments due to challenging market conditions and continued uncertainty in this segment of the health insurance industry.” The company will still sell Medicare Advantage plans.

Healthcare Reform News Update for June 30, 2017

CBO Publishes Separate Analysis on Medicaid Spending and Its Effects

The Congressional Budget Office (CBO) has published a secondary Medicaid analysis titled the “Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending.” The analysis finds that under the Better Care Reconciliation Act of 2017, Medicaid spending would decrease by 26% in 2026. That percentage increases to 35% in 2036.

Senator Ted Cruz Proposes Allowing Insurance Companies to Sell Cheap Plans with Fewer Benefits

In order to win over conservatives and introduce plans with lower premiums, Senator Ted Cruz has given the GOP a proposal to let insurance companies sell plans that have fewer benefits. The plans would be less expensive, but may take young and healthy individuals out of the same market pool as sick and older Americans. This could increase costs for the ill and elderly, and it may also lead to adverse selection in the individual marketplace.

Healthcare Reform News Update for June 29, 2017

Changes to the Senate’s Healthcare Bill Underway

Two changes are already being added to the Better Care Reconciliation Act of 2017 (the Senate’s healthcare bill). The White House and Senate Republicans have agreed to add $45 billion in funding in order to address the opioid crisis. Additionally, Senators may soon agree to let Americans pay their premiums with their health savings accounts (HSAs).

Republican Senators Question Tax Eliminations in GOP’s Healthcare Bill

Some Republican senators have started questioning whether the GOP’s healthcare bill should repeal certain taxes on high-income earners while cutting back on subsidies and Medicaid. Susan Collins, Mike Rounds, and Bob Corker have publically criticized the tax repeal.

  • Senator Collins: “I do not see a justification for doing away with the 3.8 percent tax on investment income, because that is not something that increases the cost of health care.”

Senator Corker: “I want to make sure that we’re not in a situation where we’re cutting taxes for the wealthy and at the same time … passing a larger burden on to [lower-income citizens].”

Senators Reiterate Requests After GOP’s Healthcare Vote Postponed

With the GOP’s healthcare vote delayed until after the July 4 recess, Senators on both sides of the aisle are repeating their previous healthcare reform requests. Republican Senator Rand Paul “highlighted a letter he sent to President Donald Trump and Senate GOP leaders with a list of conservative proposals that would help resolve his issues with Senate Republicans’ health care legislation.” While the proposal would please conservatives, the requests detailed in it are likely to alienate moderates.On Tuesday, Senate Minority Leader Chuck Schumer also repeated his previous requests for bipartisan healthcare reform.

President Trump Accuses Democrats of Misstating Facts About Medicaid Spending

In a Tweet posted on Wednesday, President Donald Trump said, “Democrats purposely misstated Medicaid under new Senate bill – actually goes up.” While the total spending for Medicaid would indeed slowly increase, “the accounting he uses to show Medicaid spending is wildly divergent from the way budget analysts, policymakers and many lawmakers account for spending levels.” When accounting for inflation, Medicaid spending would not increase. Instead, there would be a decrease of around $772 billion in federal Medicaid outlays.

Healthcare Reform News Update for June 28, 2017

Senate Healthcare Vote Won’t Happen Before July 4 Recess

On Tuesday, Senate Republicans announced they will delay a healthcare reform vote until after the July 4 recess. Although the GOP planned to have a vote by the end of this week, opposition within the Republican Party over the Senate bill’s current language remains unresolved.

After the announced delay, President Trump told senators at a White House meeting, “This will be great, if we get it done. And if we don’t get it done, it’s just going to be something that we’re not going to like, and that’s OK and I understand that very well. But I think we have a chance to do something very, very important for the public, very, very important for the people of our country that we love.”

Also after the announcement, 3 more Republican senators announced that they would not have supported a healthcare vote this week.

The GOP will revise its healthcare bill over the July 4 recess, which will need a new analysis from the Congressional Budget Office. Republicans hope to vote after the recess.

Healthcare Reform News Update for June 27, 2017

CBO Releases Analysis of Senate’s ‘Better Care Reconciliation Act of 2017’

The Congressional Budget Office (CBO) has released its analysis of the Senate’s healthcare reform bill, called the Better Care Reconciliation Act of 2017 (BCRA). Here are some of the main takeaways:

The Uninsured Rate

  • 15 million more Americans would be uninsured by 2018. This is mostly due to the elimination of the individual mandate.
  • 22 million more Americans would be uninsured (compared to the Affordable Care Act) in 2026.
    • This means that a total of around 49 million Americans would be uninsured by 2026. (Around 28 million would be uninsured in 2026 under the ACA.)
    • For comparison, the House’s bill increased the uninsured population to 23 million.

The Federal Deficit

The federal deficit would decrease by $321 billion by 2026. (The House’s bill decreased the deficit by $119 billion.)


  • Over the next 10 years, the government would decrease Medicaid spending by $772 billion (26%). (The House’s bill reduced Medicaid spending by $834 billion.)
  • By 2026, enrollment in Medicaid would decrease by 16% for those under the age of 65.

The Individual Market

  • In most parts of the United States, the individual health insurance market will remain stable in 2020.
  • Due to state waivers on essential health benefit requirements, some insurance plans that cover certain services will become more expensive in those areas.
    • Individuals who require waived essential health benefits will see substantial increases in their out-of-pocket costs or skip those services.
    • Individuals who live in states that have waived certain services could also see large increases in their out-of-pocket costs because annual and lifetime limits wouldn’t be capped.
  • The average premium will rise faster than the ACA’s average premium until 2020. Then, the increase in premium costs will slow.
  • By 2026, the average premium is expected to be 20% less.
    • This is mostly because 1) plans will cover fewer costs and services and 2) there’s federal funding aimed at lowering premium prices.
    • For example, let’s compare the costs for a 45-year-old male below 200% of the federal poverty level. For the ACA premium after tax credit, he would pay $67. For the Senate’s BCRA premium after tax credit, he would pay $215. See more premium comparisons here.

Tax Provisions

  • Over the next 10 years, the government will lose $541 billion in revenue by repealing the ACA’s tax provisions.
  • Because of the lower actuarial value for a benchmark plan (meaning a plan covers fewer costs) and higher deductibles, few low-income Americans will purchase Marketplace plans in 2020.

After CBO’s Analysis, Republican Senators to Oppose Procedural Vote

Shortly after the Congressional Budget Office (CBO) released its analysis of the Better Care Reconciliation Act of 2017, several Republican senators “threatened to oppose beginning debate.”

  • Susan Collins said she would vote no to the Senate’s bill. In a tweet, she said she’d rather have a bipartisan fix to the ACA.
  • Rand Paul, Dean Heller, Ted Cruz, and Mike Lee are expected to vote against the motion without further changes to the bill.
  • Ron Johnson said he would have a “hard time believing” he had the information he needed to vote for a motion this week.

With the additional savings estimated by the CBO, Republicans have some leeway to try and negotiate with Senators (by editing the healthcare reform bill) in order to win their support.

Senate Adds a Waiting Period to Its Bill

The Senate has revised the Better Care Reconciliation Act of 2017 (BCRA) to include a waiting-period penalty for individuals who let their coverage lapse. “Starting in 2019, people who try to buy a healthcare insurance policy during open enrollment, or because of a life-qualifying event, will not be able to do so for six months if they had a break in coverage of 63 days or longer during the prior year.”

California Won’t See a Single-Payer Healthcare System This Year

The leader of the state Assembly in California announced that he will not proceed with a single-payer healthcare system this year. Although a single-payer bill passed the state Senate, Speaker Anthony Rendon said the bill doesn’t properly detail “delivery of care and cost.”

Senators May Add Penalties for Lapses in Coverage to Healthcare Bill

The “discussion draft” of the Senate’s healthcare bill did not penalize individuals who let their coverage lapse. According to health insurance industry sources, Senators are planning to add a provision that could prevent people from using the individual market for six months if their coverage lapses. The provision may be included to keep healthy people on the market, which balances out the cost for sicker individuals.

President Trump Talks to Reporters About the Senate’s Healthcare Bill

During an interview on Sunday with “Fox & Friends,” President Donald Trump said that he doesn’t think the GOP is “that far off” from finalizing its healthcare reform bill. The Senate is pushing to vote on the bill by the end of this week, despite Senators expressing opposition or concern over the current language.

When referring to the now 5 Republican Senators that have confirmed an opposition to the current bill’s language, the President said, “We have a very good plan. They want to get some points, I think they’ll get some points.”

Trump also complained about the lack of bipartisan efforts on healthcare reform. “It would be so great if the Democrats and Republicans could get together, wrap their arms around it and come up with something that everybody’s happy with. And I’m open arms; but, I don’t see that happening. They fight each other. The level of hostility.”

Healthcare Reform News Update for June 26, 2017

Updates on the Senate’s Position with the Healthcare Bill

The New York Times continues to update Senators’ standings on the GOP’s healthcare reform bill. Here are the numbers as they currently stand:

  • 48—no
  • 8—no without changes, or concerned
  • 27—undecided
  • 17—yes

Kaiser Family Foundation Publishes a Topical Comparison of 3 Healthcare Reform Bills

The Kaiser Family Foundation has published an in-depth comparison of three healthcare reform bills: Better Care Reconciliation Act of 2017 (the Senate’s healthcare bill), the American Health Care Act (AHCA, the House’s healthcare bill), and the Affordable Care Act (ACA, also known as Obamacare). The comparison, starting with a summary and then making comparisons based on topic, can be viewed here.

Healthcare Reform News Update for June 23, 2017

Senators’ Current Positions on the GOP’s Healthcare ‘Discussion Draft’

All Democratic Senators (48) are expected to vote against the Republican Senate’s healthcare reform bill. That leaves 52 Republican Senators to vote in favor of the bill. The bill needs 50 votes in favor in order to pass (which will leave a tie breaker that Republicans expect to win). Here are the current standings on the remaining 52 votes according to The New York Times.

  • 7 Senators are likely to vote against the bill if further changes are not made or if their concerns with the current bill’s language are not addressed.
    • Ted Cruz, Mike Lee, Ron Johnson, and Rand Paul have required further repeal of the Affordable Care Act in order to vote in favor of the bill.
    • Susan Collins, Dean Heller, and Rob Portman have expressed concerns over the cuts to Medicaid.
  • 28 Senators are undecided.
  • 17 Senators are in favor of the bill.

The Washing Post also counts Senators Shelley More Capito and Lisa Murkowski among those who are likely to vote against the bill over its current language. The site also only lists 16 Senators supporting the current bill.

President Trump Supports the Senate’s Healthcare Bill While Obama Denounces It

In a tweet posted on Thursday evening, President Donald Trump said, “I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, Obamacare is dead.” He was even supportive of the four conservative Republican Senators who have already voiced their opposition to the bill’s current language, saying, “They’re four good guys and they’re friends of mine. We have four very good people, and it’s not that they’re opposed. They’d like to get certain changes, and we’ll see if we can take care of that.”

Former President Barack Obama had stronger, more negative words for the Senate bill. Obama wrote, “The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. Simply put, if there’s a chance you might get sick, get old, or start a family — this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.”

Ways to Compare the Senate’s Healthcare Reform Bill to Previous Bills

There are several simple ways that you can compare the Senate’s healthcare bill to the House-approved American Health Care Act (AHCA) or the Affordable Care Act (ACA, also known as Obamacare). These news sources have done so, using easy-to-review charts and comparisons.

What Are the Senate Bill’s Next Steps?

The Senate has finally produced a draft of its healthcare reform bill. Now, that draft will go through the following processes to become law or be voted down:

  1. The Congressional Budget Office will analyze the bill, which is expected to be finished early next week.
  2. The Senate will debate the bill. Senators will also have the opportunity to offer amendments to the bill.
  3. Senate Majority Leader Mitch McConnell can offer the final amendment to the healthcare bill.
  4. The Senate will vote on the bill and amendments.
    • If the bill passes, the House will either need to reconcile the bill with their own or approve the Senate version. If the bill is reconciled, both the Senate and the House will need to vote on the final bill again.
    • If the bill does not pass, the bill does not move forward.
  5. If a final bill passes both the Senate and the House, the bill will be sent to the President for his signature.

Humana Won’t Return to Individual Market, Even With Healthcare Reform

During an interview, Humana CEO Bruce Broussard announced that Humana will not return to the individual health insurance market. Broussard said, “This is just not a business that we will be good at. No matter what they do in Washington, we are not going to go back in. And we’ve had a lot of people ask us from Washington D.C. if we would go back in and we’ve said no, it’s not there.”

Healthcare Reform News Update for June 22, 2017

Senate Republicans Release ‘Discussion Draft’ of GOP’s Healthcare Reform Bill

This Morning, Senate Republicans released their healthcare reform bill’s “discussion draft”. The 142-page bill:

  • Makes deep cuts to Medicaid
  • Puts the Medicaid program on a closed budget
    • States would choose to receive funding as a block grant or per capita (a set amount per enrollee).
  • Phases out Medicaid expansion
    • The phase out would begin in 2020, gradually reducing the increased funding given for expansion over 4 years.
  • Ends the individual and employer mandates
    • Unlike the House-approved bill, individuals who let their coverage lapse will not be penalized with a surcharge
  • Creates a new system of tax credits to replace health insurance subsidies
    • Unlike the House-approved bill, tax credits will take into account income and geography in addition to age.
  • Allows states to opt-out of many benefit requirements in the Affordable Care Act (like emergency services, mental health treatment, and maternity care)
  • Repeals the tax increases created by the Affordable Care Act
  • Provides $50 billion (over 4 years) to states to stabilize health insurance markets
  • Provides funding (for 2 years) for cost-sharing reduction payments
  • Keeps the popular Affordable Care Act feature of allowing children to stay on a parent’s plan until the age of 26

The Senate’s bill maintains the structure of the House-approved healthcare bill, but it is more moderate that the House’s AHCA (increasing financial assistance). Even with these adjustments the bill is still relatively conservative.

A vote on the Senate’s bill is expected to happen next week (after 20 hours of debate), with a Congressional Budget Office analysis expected in the next few days.

Republican Senators Voice Skepticism About Short Healthcare Vote Timeline

During an interview Wednesday, Republican Senator Ron Johnson voiced his uncertainty about holding a healthcare vote next week. The senator said, “I have a hard time believing anybody will have enough time to have a true evaluation and get (public) input on this by next week. … I am going to need the information to justify a yes vote. I’ll need the information to vote on a very imperfect bill that doesn’t even come close to doing the things that I want to see done.”

On Wednesday, Republican Bill Cassidy told MSNBC, “If I don’t get to read it, I don’t vote for it. If I don’t get to study it, I don’t vote for it.”

Will Hundreds of Amendments Stall the Senate’s Healthcare Reform Vote?

Senate Majority Leader Mitch McConnell has promised that senators will have the opportunity to bring any amendment to the floor during a healthcare reform vote. Democrats could use hundreds of proposed amendments to stall a healthcare vote. McConnell has the equal opportunity to cut off the multiple amendment votes if he calls them a delay tactic.

Anthem and Farm Bureau Health Plans Will Exit Certain ACA Marketplaces

Wednesday, Anthem announced plans to exit the Indiana and Wisconsin marketplaces for 2018. In a statement, spokesperson Leslie Porras explained the company’s exit: “Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies and the restoration of taxes on fully insured coverage.”

Farm Bureau Health Plans has also announced that it will not sell marketplace plans in 2018 due to projected losses of more than $15 million. The CEO, Anthony Kimbrough, put out this statement to explain the company’s exit from the marketplace: “Congress has yet to agree to new legislation and CMS Administrator Seema Verma acknowledges rule changes proposed by the department are only temporary corrections … not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system. So our decision is not solely about the year 2017; it is about the lack of a clearly drawn long-term solution from where things are today.” Farm Bureau Health Plans covered more than 25,000 Tennessee residents.

FDA to Hold Public Hearings on Drug Manufacturers Potentially Gaming the System

In order to investigate ways that drug makers could be manipulating federal regulations, the Food and Drug Administration will hold a public hearing next month. “The hearing, scheduled for July 18, is the latest step taken by newly installed FDA Commissioner Scott Gottlieb to have the agency take a more active role in policing drug prices.”

Healthcare Reform News Update for June 21, 2017

Senate’s Healthcare Bill to Be Released for Review Thursday

Senate Majority Leader Mitch McConnell told reporters a “discussion draft” of the GOP’s healthcare reform bill would be sent out Thursday. McConnell said that reporters would also have access to the draft, and a Senate vote on the bill is likely to occur next week.

Thursday will be the first time many senators see the GOP’s bill, including those meant to be working on it.

  • Senator Mike Lee, who was part of the 13-member working group meant to create the Senate bill, said he hasn’t seen a draft. “It has become increasingly apparent in the past few days that even though we thought we were going to be in charge of writing this bill within this working group, it’s not being written by us. So, if you’re frustrated by the lack of transparency in this process, I share your frustration — I share it wholeheartedly,” Lee said.
  • Senator Rob Portman, another member of the 13-member working group, also told reporters that he hasn’t seen a draft.

Senators have voiced their reluctance to support a bill they’ve yet to review thoroughly, making it hard to tell if a vote held next week would pass.

CSR Payments Made in June, But There’s No Guarantee They’ll Continue

The Trump Administration has made cost-sharing reduction (CSR) subsidy payments for June. However, the administration has not clarified whether these payments will continue through the rest of the year (or into 2018). Press secretary for the Department of Health and Human Services, Caitlin Oakley, put out this statement: “The June payment has been made. We are weighing our options and still evaluating the issues. Congress could resolve any uncertainty about the payments by passing the [American Health Care Act] AHCA and reforming Obamacare’s failed funding structure.”

Healthcare Reform News Update for June 20, 2017

Senate Expected to Vote on Healthcare Bill Next Week

Senator John Barrasso (R-WY) told Fox News that Senate Republicans are planning to vote on a healthcare bill next week. “I believe we’re going to vote before the Fourth of July recess on a healthcare plan, a repeal and replacement of Obamacare,” Barrasso said.

Lawmakers, and the public, have yet to see the Senate’s bill. If the week goes smoothly, “Senators are expected to see the text of the bill as soon as the end of this week.”

Will the Senate’s Healthcare Bill Have Enough Support From All Republicans?

With much of the Senate’s policy focus on winning over moderates, the GOP risks alienating conservatives in the Senate and the House.

  • In the Senate: Senator Rand Paul (R-KY) has said that he will not support legislation that creates a new Republican entitlement program (specifically refundable tax credits). Senators Mike Lee (R-UT) and Ted Cruz (R-TX) have been pressing the Senate to allow states to opt out of guaranteed issue and community rating provisions to win their support. “Guaranteed issue mandates that insurance companies sell insurance plans to people regardless of how sick they are, and … community rating prohibits insurance companies from pricing those plans to reflect the greater financial risk of insuring people with pre-existing medical conditions.”
  • In the House: The Republican Study Committee (RSC) is the largest conservative group in the House. The RSC warned GOP Senators that if the bill goes too far toward moderates, it will die in the House. The conservative group listed four provisions that it finds necessary in the Senate’s healthcare bill.

Democratic Senators Prepared to Slow Down Senate Over Closed-Door Healthcare Reform

Democrats are prepared to use procedural rules to slow down the Senate’s processes if Republicans continue creating healthcare reform behind closed doors. Senate Minority Leader Chuck Schumer (D-NY) said, “If Republicans won’t relent and debate their healthcare bill in the open for the American people to see, then they shouldn’t expect business as usual in the Senate.”

Senate’s Healthcare Bill Could Have Deeper Medicaid Cuts Than the AHCA

According to aides and lobbyists, the Senate has sent a Medicaid spending proposal — one that may “make even deeper cuts to Medicaid spending than the bill passed by the House” — to the Congressional Budget Office (CBO) for analysis. The Medicaid proposal “would start out the growth rate for a new cap on Medicaid spending at the same levels as the House bill, but then drop to a lower growth rate that would cut spending more, known as CPI-U, starting in 2025.”

Health Insurance Companies Work to Stay in State Marketplaces

While many health insurance companies have made the tough decision to exit the Marketplace, these companies are planning to stick around to provide coverage in these states.

  • Washington: Premera Blue Cross will continue selling plans in a county that may have been left without any options. Only one county in Washington state remains without a marketplace option.
  • Illinois: Blue Cross and Blue Shield of Illinois, the state’s largest health insurance company, has submitted rates for 2018. However, the company has not fully committed to selling plans in 2018.
  • Iowa: The only carrier left in the state, Medica, plans to keep selling plans in 2018. However, premium rates could increase by 43.5%.

Healthcare Reform News Update for June 19, 2017

Senate’s Lack of Transparency With Healthcare Bill Raises Bipartisan Concerns

The lack of transparency and speedy process surrounding the Senate’s healthcare bill is raising concerns for both Republican and Democratic senators.

  • Democratic Senator Richard Blumenthal is calling an “emergency healthcare hearing,” which is scheduled for Monday. The senator told the Hartford Courant that the committee writing the healthcare reform bill is “a small group of Republicans meeting in secret, [and] none of us on the Democratic side have a clue as to what they’re doing. … How do we vote in the next few weeks on a bill that has not been … reduced to writing, that has been done in secret without any kind of public hearing?”
  • On Friday, Senate Minority Leader Charles Schumer reached out to Majority Leader Mitch McConnell. Schumer asked that an all-senator meeting be held on Friday to discuss the bill.
  • Republican Senator Lisa Murkowski expressed unhappiness with the secrecy of the healthcare bill’s deliberations. She told the Alaska Dispatch News, “I think that we do better as a body when we respect the process. And the process allows for committee involvement, debate and discussion. … If I’m not going to see a bill before we have a vote on it, that’s just not a good way to handle something that is as significant and important as healthcare.”
  • During an interview on CBS’ “Face the Nation,” Republican Senator Marco Rubio advised against rushing a secretive healthcare bill through the Senate. “The Senate is not a place where you can just cook up something behind closed doors and rush it for a vote on the floor,” Rubio said. “Every camera in the world’s going to have to see what’s in it.”

Senate Democrats Planning Late-Night Protest of GOP’s Healthcare Reform Plan

According to a Senate aide, Democratic Senators are planning to hold late-night speeches on the Senate floor Monday. The speeches are expected to last until at least midnight, with the main focus on protesting the GOP’s healthcare replacement plan.

Democratic Senators are also considering using other rules to halt Senate procedures, like preventing “any Senate committees from meeting after the Senate had been in session for two hours” and “objecting to routine requests on votes.”

7 Governors Write Bipartisan Healthcare Appeal Letter to Senate Leaders

On Friday, 7 governors sent letters to Senate Majority Leader Mitch McConnell and Senate Minority Leader Chuck Schumer. In the letter, the governors asked that Congress “focus on health care reform that cuts costs while promoting market stability and giving states more flexibility.” The letter also urges “Congress to scrap the GOP health care bill and work toward a bipartisan solution.”

Where Are 6 Major Healthcare Reform Policies Headed?

Speculation continues for what will end up in the Senate’s healthcare reform bill. According to the Hill, here is where these 6 controversial policies seem to be headed.

  1. Medicaid expansion will have a slower phase-out. Something between Senator Rob Portman’s proposed 7-year phase-out and Senate Majority Leader Mitch McConnell’s 3-year phase-out is expected to be in a final bill.
  2. Tax credits proposed in the House’s American Health Care Act (AHCA) will increase. Senator John Thune has been tasked with creating a tax credit structure that will provide more assistance to lower-income and older Americans. Thune’s tax credits are expected to be tied to age and income.
  3. Some Obamacare taxes will remain, at least for a while. These will help fund tax credits, among other healthcare allowances.
  4. More funding (than provided in the AHCA) will be provided to fight the opioid crisis. This is in part to assure senators worried that the phase-out of Medicaid expansion will hurt opioid addiction treatment.
  5. The bill will attempt to stabilize the individual health insurance Marketplace. This could be done by funding cost-sharing reductions.
  6. Funding to support those with pre-existing conditions will increase. After criticism that the AHCA underfunds high-risk pools for those with pre-existing conditions, the Senate’s bill is expected to increase this funding.

Nevada Gov. Brian Sandoval Signs Strict Insulin Pricing Legislation into Law

Thursday, Nevada Governor Brian Sandoval signed “the nation’s strictest requirements for pharmaceutical companies to reveal how they set certain prescription drug prices” into law. The law focuses on insulin, requiring “drugmakers to annually disclose the list prices they set, profits they make and discounts they give market middlemen on insulin.” Drugmakers must also “give state officials written explanations of any insulin price hikes that surpass the previous year’s inflation rate, or are higher than twice the inflation rate of the previous two years.”

Healthcare Reform News Update for June 16, 2017

Senator Lamar Alexander Calls for CSR Payments to Be Funded Through 2019

Senator Lamar Alexander is the chairman of the Senate Health, Education, Labor, and Pensions Committee. At a hearing on Thursday, Alexander recommended that funding for cost-sharing reduction (CSR) payments continue through 2019. Alexander said during the hearing, “The payments will help to avoid the real possibility that millions of Americans will literally have zero options for insurance in the individual market in 2018.”

Senator Rand Paul Criticizes “New Entitlements” in the Senate’s Healthcare Bill

Conservative Senator Rand Paul has denounced two important aspects of the Republican healthcare bill, each of which are seen in the House’s and the Senate’s healthcare bills. Refundable tax credits (which help people afford individual healthcare plans) and a “stabilization fund” (which helps lower premiums) are being called new entitlements by Paul.

Paul told reporters, “I think we shouldn’t have new entitlements that will go on forever in a Republican plan to fix healthcare. We can’t pay for what we already have: Medicare, Medicaid and Social Security.”

Trump Administration to Address Drug Pricing With New Executive Orders

On Friday, President Trump is scheduled to meet with key officials to discuss an executive order aimed at lowering prescription drug pricing. The order “could be to direct federal agencies to pursue value-based purchasing contracts for drugs.” Another policy being discussed “would instruct agencies to pursue trade policies that would strengthen the intellectual property rights of pharmaceutical companies.”

Neither of the executive orders under discussion would cause drastic changes to the pharmaceutical industry.

Healthcare Reform News Update for June 15, 2017

Four Democrats Introduce a Reinsurance Bill

Four Democratic Senators (including Tim Kaine and Tom Carper) introduced a bill on Wednesday that would make reinsurance a permanent component of the Obamacare individual marketplace. Specifically, the bill “would provide federal funding to cover 80% of claims from $50,000 to $500,000, starting next year, with the same level of support through 2020.” The bill would also help states improve enrollment by dedicating $500 million in federal funding each year (for the next three years).

Marketplace Rate Hikes Continue as Senate Works Through Healthcare Reform 

Health insurance companies are filing proposed health insurance rates for individuals’ plans on and off the marketplace. In order to recoup losses, and prepare for funding provided through Obamacare to discontinue, many companies are filing double digit rate increases. These states are in recent news for their premium rate hikes:

  • Michigan: If cost-sharing reduction subsidies are defunded, Blue Cross Blue Shield of Michigan could increase rates by up to 31%.
  • Connecticut: Anthem, one of Connecticut’s largest insurance companies, has requested a 33.8% rate increase for plans sold on and off the exchange. ConnectiCare has requested a 17.5% increase for its plans on the marketplace and a 28.3% increase for its plans off the marketplace.

Healthcare Reform News Update for June 14, 2017

CMS Actuary Publishes AHCA Analysis That Differs Greatly From CBO’s

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary published an “Estimated Financial Effect of the ‘American Health Care Act of 2017’.” Here are the main takeaways from the CMS Office of the Actuary’s analysis:

  • The AHCA will cause 12.6 million more Americans to become uninsured in the next 10 years.
  • The AHCA will reduce federal spending by $328 billion in the next 10 years.
    • The CBO’s analysis estimated that federal funding would be reduced by $119 billion.*
  • Under the AHCA, the average premium will be 13% lower in 2026 for individuals without subsidies.
  • Taking subsidies into account, premiums will increase by 5% and out-of-pocket costs will increase by 61%.
  • The CMS analysis excludes the estimated effects of taxes repealed in the AHCA.
  • The CMS analysis does not “reflect the possibility that some states could obtain waivers under the AHCA that severely limit what benefits must be covered or allow insurers to charge higher premiums for people with expensive medical conditions.”
    • According to the CMS actuary, if states did receive such waivers “we would expect that the individual market in these areas would destabilize such that the premiums for comprehensive coverage for a significant proportion of the population would become unaffordable and the coverage would cease to be offered.”

*The estimates found in the CMS Office of the Actuary’s analysis and the Congressional Budget Office’s analysis vary due to “differing assumptions about whether cost-saving measures in the House bill will work.”

Centene to Enter 3 New States in 2018, Expand Its Presence in 6 More

On Tuesday, Centene announced plans to enter the Marketplace in Kansas, Missouri, and Nevada in 2018. The company will also expand its presence in 6 states that it currently participates in (Florida, Georgia, Indiana, Ohio, Texas, and Washington).

Michael F. Neidorff, chairman, president, and CEO of Centene, released this statement: “Centene recognizes there is uncertainty of new healthcare legislation, but we are well positioned to continue providing accessible, high-quality and culturally sensitive healthcare services to our members. Centene has demonstrated disciplined execution, agility and capacity to successfully navigate industry changes to the benefit of our members, customers and shareholders.”

Aetna May Offer Plans in Nevada After All

Despite sharing plans to exit the market, Aetna filed premium rates for the Nevada individual marketplace for 2018. Although it has filed rates, Aetna has not made a final decision on whether or not to participate in Nevada.

Trump Urges Senators to Draft a More “Generous” Healthcare Bill

President Trump met with Republican Senators on Tuesday during a White House lunch and discussed their in-progress healthcare bill. During the lunch, the President called the House’s AHCA “mean” and asked Senators to create a bill that was “more generous.”

Healthcare Reform News Update for June 9, 2017

Chairman of House Committee Calls for CSR Continuation

Kevin Brady, a Republican and the chairman of the House Ways and Means Committee, has called for the continuation of cost-sharing reduction subsidies (CSRs) in order to stabilize the individual market. “We should act within our constitutional authority now to temporarily and legally fund cost-sharing reduction payments as we move away from Obamacare. Insurers have made clear the lack of certainty is causing 2018 proposed premiums to rise significantly,” Brady stated.

Senate Parliamentarian Flags Language in AHCA That May Not Be Allowed

Elizabeth MacDonough, the Senate Parliamentarian, has found language that she warns may not meet reconciliation. The Hyde Amendment is a part of the American Health Care Act (AHCA) that disallows people from using refundable tax credits for private insurance plans that cover abortions. MacDonough has flagged this amendment, warning Republicans that it is “unlikely to be allowed.”

A precedent set in 1995 may support MacDonough’s warning. Robert Dove, the Senate Parliamentarian in 1995, “ruled that an abortion provision affecting a state block grant program failed to meet reconciliation requirements.”

Healthcare Reform News Update for June 8, 2017

What’s Going into the Senate’s Healthcare Bill?

As the Senate works to come to a consensus on dividing aspects of healthcare reform, there is an ongoing discussion over what will end up in the finalized bill. Here is a short breakdown of how the Senate is progressing through those aspects of healthcare reform.

Healthcare Reform News Update for June 7, 2017

McConnell Tells Trump: Expect Healthcare Vote by July 4

During a meeting held Tuesday, Senate Majority Leader Mitch McConnell told President Donald Trump that the Senate may vote on healthcare reform by July 4. McConnell also said he expects the Congressional Budget Office (CBO) to score the Senate’s healthcare bill soon, at least on portions that it has submitted for review.

In a joint statement, McConnell and Paul Ryan said this about the meeting: “We had a good, productive meeting with President Trump, Vice President Pence, and congressional leadership. The discussion focused on the continued progress of our shared legislative agenda and how we can accomplish our goals.”

Budget Committee Approves Senate’s Healthcare Bill

On Tuesday, the Senate Budget Committee announced that the American Health Care Act (AHCA) fulfills reconciliation rules and can officially move on to the Senate.

Some State Waivers May Remain in the Senate’s Healthcare Bill

According to senior GOP aides, the following state waivers could be in the Senate healthcare bill:

  • Essential Benefits
  • Medical Loss Ratio Requirement (a “regulation on how much of [insurance companies’] premium revenue must be spent on claims”)
  • Age Rating Band (The ACA allows “older people to be charged no more than three times as much as younger people.”)

The ACA’s requirements for insurance companies to insure people with pre-existing conditions, and the prohibition on charging those individuals more for coverage, are not likely to be included in state-allowed waivers.

Anthem Leaves Ohio Marketplace Over Unstable Market

On Tuesday, Anthem announced that it will not offer plans on the individual marketplace in Ohio for 2018. The company cited “volatility in the individual insurance market and uncertainty over funding for cost-sharing subsidies” as its reasons for exiting the exchange. Anthem’s exit will leave at least 18 counties with no marketplace options, affecting around 10,500 residents.

In a statement Anthem said, “Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to the shrinking individual market as well as continual changes in federal operations, rules and guidance.”

Healthcare Reform News Update for June 6, 2017

Senate Pushing for June Healthcare Vote

The Senate is under pressure to vote on healthcare reform and move onto tax reform before the August recess.

Although the Senate drafted portions of its bill during a recent recess, the draft leaves out many polarizing topics (like Medicaid expansion). In order to come to a consensus on the unresolved — and included — policy decisions, the GOP has scheduled a meeting Tuesday. Senate Republicans will be “presented with legislative options … with the goal of making decisions on what is in and what’s out of their bill.”

Whether or not the final bill is expected to pass, the Republican Senate is planning to vote on its healthcare bill as soon as this month.

New York’s Governor Takes Steps to Keep Obamacare Mandates, Repeal or Not

Governor Andrew M. Cuomo has announced plans to prevent the removal of Obamacare safeguards in the individual market in New York. The plans “include requiring any private company doing business on the state’s insurance marketplace to guarantee the 10 ‘essential health benefits’ … [and directs] the state’s health department to block any company that withdraws from the exchange from participating in Medicaid or its children’s health plan.”

Minuteman Health in New Hampshire Requests 30% Premium Rate Increases

During an interview Monday, Minuteman Health Chief Executive Officer Tom Policelli revealed a premium rate increase around 30% for 2018. The company blamed the high “increase on two provisions of the health care law — Medicaid expansion and federally imposed risk adjustments.”

Healthcare Reform News Update for June 5, 2017

State Insurance Commissioners Working to Keep Insurance Companies in the Market

For many state insurance regulators, keeping insurance companies in the individual market is their ultimate goal. In order to combat marketplace uncertainty, and keep health insurance companies in the market, state insurance commissioners are becoming increasingly flexible.

  • The insurance superintendent of New Mexico, John Franchini, said: “As a regulator, instead of being rigid on timelines, the type of pricing I’m going to want, I’m being more open about this. I’m trying to be more flexible to give them confidence that if things change, we as regulators will be flexible with them.”
  • The insurance commissioner for California, Dave Jones, said: “Based on what we were hearing from insurers, we anticipated Trump rates would be double-digit increases over the past year. I wanted to give insurers the opportunity to file rates based on Trump.”

In California, insurance companies may file two premium rate requests (one if Obamacare rules are upheld and one if they are eliminated).

Healthcare Reform News Update for June 2, 2017

Pennsylvania Insurance Companies File Low Rate Increases, But Only If Obamacare Rules Continue

Teresa Miller, Pennsylvania’s Insurance Commissioner, reported low aggregate rate increases (8.8%) for the state’s 5 insurance companies in 2018. But this low increase will only go into effect if the individual mandate is upheld and cost-sharing reduction subsidies (CSRs) are funded.

  • If the mandate is repealed, rates could increase by 23.3% in the state.
  • If CSRs are no longer funded, rates could increase by 20%.
  • If they are both eliminated, rates could increase as much as 36%.

Senator Richard Burr Does Not Expect to Pass a Healthcare Reform Bill This Year

On Thursday, Republican Senator Richard Burr appeared on a North Carolina news station. During the interview, he painted a less-than-optimistic portrait of the Senate’s ability to pass healthcare reform laws in the next 6 months. “It’s unlikely that we will get a healthcare deal. I don’t see a comprehensive healthcare plan this year,” Burr said.

Healthcare Reform News Update for June 1, 2017

John Cornyn Promises Healthcare Reform Bill This Summer

Senate Majority Whip John Cornyn appeared on The Chad Hasty Show Wednesday. During his appearance, he asserted that the Senate would finish an Obamacare repeal bill by the end of the summer. “We’ll get it done by the end of July at the latest,” Cornyn said during the interview.

Healthcare Reform News Update for May 30, 2017

The Senate Parliamentarian’s Role in Healthcare Reform

Elizabeth MacDonough, the Senate parliamentarian, will soon decide if the American Health Care Act (AHCA) meets the reconciliation requirements that allow a bill to pass in the House and Senate with a simple majority vote. MacDonough will sit down with 8 lawyers (4 Democrats and 4 Republicans), listen to both sides’ arguments, and make an unbiased decision on each piece of the AHCA.

Healthcare Reform News Update for May 26, 2017

Senate to Begin Drafting Healthcare Bill During Weeklong Recess

Now that the CBO score for the American Health Care Act has been published, the Senate can begin drafting its own bill. Thursday, Senator Ron Johnson said, “Over the break, initial legislation will be drafted and then we’ll have more time, actually have a basis to discuss” policies. While there are no final agreements on critical reform points, the initial draft will be a step forward for the Senate.

FDA Steps Into Efforts to Lower Drug Prices

Scott Gottlieb, the new FDA Commissioner, informed a congressional panel that the FDA is creating a “drug competition action plan.” This plan would speed up the approval process for generic medications (specifically generic versions of brand-name drugs with no competition).

Blue Cross and Blue Shield of North Carolina Hikes Premiums over CSR Payment Uncertainty

Blue Cross and Blue Shield of North Carolina has asked state regulators to approve a 23% premium rate increase for 2018. The company did say it could afford a 9% increase with the assurance of CSR payments, but it is currently planning on the high rate increase “because it doesn’t expect [the] crucial payments from the federal government to continue.”

“Blue Cross and Blue Shield of North Carolina sells coverage in all 100 North Carolina counties, and it is the lone option in 95. It said Thursday that its participation for next year is not guaranteed.”

Wisconsin Proposes Drug Screenings for Medicaid Applicants

Wisconsin has proposed a drug-testing requirement for Medicaid applicants, as well as time limits for recipients who do not work or train for employment. Florida and Michigan, states that previously tried to implement drug-testing requirements, “faced lawsuits and court rulings that held that the requirement was unconstitutional.” The proposal “has won approval from the Legislature’s budget-writing committee.”

Healthcare Reform News Update for May 25, 2017

Key Findings From the CBO’s AHCA Report

Yesterday, the CBO published a report on the American Health Care Act, estimating its effect on healthcare costs and the insurance market. Here are the main findings:

  • The uninsured rate will increase by 14 million after one year.
  • The uninsured rate will increase by 23 million after 10 years.
  • By 2026, the uninsured rate is estimated to reach 51 million (28 million under the Affordable Care Act).
  • Medicaid funding would be cut by $834 billion and insure 14 million fewer people.
  • Premiums would increase in 2018 and 2019. Then they will vary on the states’ decision to opt in or out of essential benefit rules.
  • States that opt out of some essential benefit rules will see an estimated premium decline of 20% in the next 10 years.
  • In 2020, 17% of Americans will experience an unstable insurance market in which sick people have difficulty getting coverage. Everyone else will experience fairly stable insurance markets.
  • Low-income, older Americans will see higher premiums (about 9 times more).
  • The federal deficit would reduce by $119 billion over the next 10 years, and $664 billion in taxes and fees would be repealed.

The report also gave the following predictions for coverage:

  • “Less healthy people would face extremely high premiums, despite the additional funding that would be available.”
  • In states that decided to opt out of coverage requirements, “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

Blue Cross and Blue Shield of Kansas City to Exit Marketplace

On Wednesday, Blue Cross and Blue Shield of Kansas announced its decision to exit the ACA Marketplace for 2018. The marketplace exit will affect 67,000 residents in 30 counties in Missouri and Kansas. It was the only marketplace insurance plan for about 25 counties in Missouri. The company cited more than $100 million in losses for its decision.

Healthcare Reform News Update for May 24, 2017

The CBO Has Released Its Score on the Newest Draft of the AHCA

The Congressional Budget Office (CBO) released its estimate of the American Health Care Act of 2017 (AHCA) this afternoon. According to the estimate, the House-approved AHCA would reduce the federal deficit by $119 billion over the next 10 years. It would also increase the number of uninsured people by 23 million in 2026. The bill is confirmed in following reconciliation rules and can now move on to the Senate.

Senate Working Group Meets With BCBS to Discuss Healthcare Reform

On Tuesday, the 13-member Senate group working on healthcare reform met with Blue Cross Blue Shield. Senator John Hoeven spoke on the meeting, intended to get health insurance companies’ perspectives. “We really focused on the insurance aspect — how do we build a plan that works for the insurers in terms of making sure they participate and helping keep premium costs down?”

Senate Interested in Phasing Out Medicaid Expansion

According to Senator John Thune, Republican Senators on the 13-member working group are planning to end Medicaid expansion in their healthcare reform proposal. However, a gentle phase-out is being discussed over a quick termination of the expansion. “There’s an interest among many of our members having a longer phaseout, a smoother glide path. At some point you’re gonna get back to the original [reimbursement rate], it’s just a question of how quickly that happens.”

Administration’s Proposed Budget Draws Concern and Criticism

After the White House proposed steep spending cuts, legislators and analysts have voiced their concerns and criticisms over the effect of certain funding decreases.

  • Lower-income children would have their federal health benefits cut sharply, … which analysts say could reverse gains that have pushed uninsured rates for this vulnerable population below 5 percent.”
  • The EVP of the Planned Parenthood Foundation of America, Dawn Laguens, called the budget “the worst budget for women and women’s health in a generation.”
  • Senator Bill Cassidy, on Medicaid cuts: “I don’t think the president’s budget is going anywhere … You don’t cut $800 billion over 10 years and keep your same level of coverage. I think that President Trump’s campaign contract with the voters should be fulfilled.”
  • Senator Susan Collins: “Obviously I’m concerned about the additional cuts proposed in Medicaid.”
  • Tom Cole, on NIH cuts: “I certainly understand wanting to plus up defense, but you have to remember part of defending the American people is protecting them from pandemics,” said Cole, the chairman of the House health appropriations subcommittee. “Part of getting hold of the long-term expenses of the federal government is dealing with things like Alzheimer’s.”

California’s Single-payer Healthcare Plan Expected to cost $400 billion

Legislative analysts estimate that California’s proposed single-payer healthcare bill will cost the state $400 billion and result in payroll tax increases. The cost would be offset by existing spending and payroll tax increases, though individuals may see savings from no longer paying premiums and out-of-pocket costs.

States Passing Bills Aimed to Lower Prescription Drug Pricing

Several states have recently passed, or proposed, bills to curb prescription drug prices.

  • New York passed a bill that increases pricing scrutiny to influence drug makers.
  • Nevada’s Senate has passed a bill that would require diabetes drug manufacturers to disclose insulin pricing, profit, expense information, aimed to increase transparency.
  • California’s Senate has passed a bill that restricts most payments made by drug manufacturers to doctors, citing a study showing such practices increased the use of more expensive medications.
  • Ohio is working to pass a bill that “would require state agencies to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs.” The bill faces heavy opposition from the group called Ohioans Against the Deceptive Rx Ballot Issue.

Healthcare Reform News Update for May 23, 2017

Administration Asks for Third Postponement in CSR Case

On Monday, the Trump administration and House Republicans requested a 90-day extension over the ongoing cost-sharing reductions (CSR) payment case. This is the third requested delay in the case as the House and the administration try to work out CSR payments out of court.

White House’s Proposed Budget Cuts for Medicaid, Biomedical Research, and More

The administration mistakenly posted (and quickly removed) their planned budget for 2018. Significant budget reductions include:

  • $610 billion cut from Medicaid, in addition to the $839 billion cut included in the AHCA
  • 18% cut from the National Institutes of Health (NIH)
    • 19% cut from the National Cancer Institute
    • Elimination of the Fogarty International Center (an NIH program “that promotes medical research overseas”)
  • 17% cut from the Centers for Disease Control and Prevention
    • 17% cut in spending for HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis prevention
    • 18% cut from the CDC’s global health program
    • 28% cut in spending for environmental health
  • Elimination of the Agency for Healthcare Research and Quality (NIH would absorb many functions)
  • 31% cut from the FDA
  • $403 million cut from physician training programs

Healthcare Reform News Update for May 22, 2017

Will the CSR Subsidy Payment Case Continue, Drop, or Stall?

The administration has to make a decision today about the ongoing court case regarding cost-sharing reductions (CSRs), mainly whether or not it will continue to fight in favor of the payments. President Trump has said he wants to end the payments, but a number of his advisers are opposed to that idea.

Rather than supporting or dropping the payments, the administration and House also have the option of asking for a 3-month hold on the case.

Planned Budget Reduction Includes $800 Billion Cut from Medicaid

President Trump’s upcoming budget cuts are expected to include an $800 billion cut from the Medicaid program. “The $800 billion reduction … assumes that the GOP health care bill that the House passed earlier this month would become law.”

Other programs, like the Children’s Health Insurance Program (CHIP), are also expected to see cuts as a result of the planned budget reduction.

Healthcare Reform News Update for May 19, 2017

The House Hasn’t Officially Handed Off the AHCA to the Senate

Despite not publically announcing plans to hold onto its healthcare reform bill, the House has not officially delivered the American Health Care Act to the Senate. The House decided to hold onto the bill out of caution, waiting to see if last-minute revisions still meet reconciliation rules.

The Congressional Budget Office’s (CBO) estimates must prove that the AHCA will reduce spending by at least $2 billion. If it does not, the AHCA will not meet the reconciliation rules the House used to pass the bill by a simple majority. Republicans would have to revise their bill and vote on it again.

Democratic Attorneys General Seek to Intervene in Ongoing CSR Case

A group of Democratic attorneys general want to intervene in the ongoing lawsuit against cost-sharing reduction subsidies (CSRs). Arguing that the administration is not defending CSRs strongly enough, at least 15 attorneys general are looking to take up the defense.

In their motion, the attorneys general wrote, “The States [that the attorneys general represent] have a vital interest in this litigation. If the district court’s injunction goes into effect, it would critically undermine the proper implementation of the ACA—just as the House, and now the President, intend. Immediate loss of CSR funding, with any future funding subject to the myriad uncertainties of the appropriations process, would harm millions of state residents and the States themselves. Those harms amply justify intervention.”

Senate Finance Committee Passes Legislation to Improve Medicare for Chronically Ill Patients

On Thursday, the Senate Finance Committee unanimously approved Medicare legislation in order to improve care for patients with chronic illnesses. The bipartisan bill “is aimed at reducing costs associated with chronic illness by giving people greater access to telehealth services, promoting care coordination between providers, and expanding value-based payment models.”

Bipartisan Amendment Aims to ‘Curb Abusive Drug Pricing’

A bipartisan amendment “aiming to curb abusive drug pricing on pharmaceuticals without generic competition” was added to the FDA user fee reauthorization bill as it was approved on Thursday. The amendment “offers a six-month exclusive rights period [to] generic manufacturers who choose to compete against an off-patent drug that currently has no competition.”

Healthcare Reform News Update for May 18, 2017

Individuals Will Be Able to Buy ACA-approved Health Plans Without

Wednesday, Centers for Medicare & Medicaid Services announced plans for an enrollment change for individuals purchasing health insurance approved by the Affordable Care Act (ACA). Rather than having to use, an individual can purchase an approved plan directly through an agent, broker, or health insurance company’s website.

The motivation of this announcement, according to Seema Verma, is to make shopping for coverage as simple and easy as possible. Eliminating the step of using could increase the use of agents and brokers, who tend to allow consumers to “get the most appropriate coverage.”

Senate May Consider a Short-Term Healthcare Package

Insurance companies have to decide whether or not to participate in Obamacare (ACA) exchanges by June 21. With no expectation that a full healthcare reform bill will be finished in the next month, the Senate may consider passing short-term market stabilization bills. A bill has already been introduced that would allow individuals with no marketplace options to use subsidies to buy plans outside of the exchange.

Republican Governors Create Healthcare Reform Proposal

Around a dozen governors crafted a healthcare reform proposal (9 pages) in February. The group is using that proposal to influence the Senate to adopt what they think an Obamacare (ACA) replacement bill should entail. Their proposal recommends maintaining Medicaid expansion “while also limiting federal spending for certain populations.”

The group of governors is also trying to form a bipartisan partnership with multiple states to propose individual insurance market reforms.

State Insurance Departments Release Early Insurance Rate Increase Requests

Five states and the District of Columbia have now released rate increase requests for 2018 Obamacare plans. Within those states, the lowest rate increase is 6.7% and the highest jumps to 54.3%

Connecticut Lowest: 15.2% Highest: 33.8%
D.C. Lowest: 13% Highest: 39.6%
Maryland Lowest: 9.1% Highest: 53.4%
Oregon Lowest: 6.9% Highest: 21.8%
Vermont Lowest: 6.7% Highest: 12.7%
Virginia Lowest: 9.8% Highest: 54.3%

New York State Assembly Passes Single-Payer Healthcare Bill

A single-payer healthcare bill was passed Tuesday by New York’s state Assembly. The bill provides universal coverage to all state residents, paid for with a “progressive payroll tax and levies on non-earned income, such as capital gains.” While one economist suggests the bill could save New York $45 billion in the first year, another suggests the bill would need $226 billion in increased tax revenue. The bill is now in the hands of the Republican-controlled New York Senate.

Healthcare Reform News Update for May 17, 2017

Senator John Thune Working to Improve AHCA’s Subsidies

Senate Republicans largely agree that subsidies laid out in the American Health Care Act (AHCA) need to be altered. Tennessee Senator Bob Corker has said, “The way the subsidies were in the House bill, it really wasn’t enough to help people who were on the lower end of the economic spectrum to be able to actually purchase it.”

South Dakota Senator John Thune, who said, “We clearly want to drive more of the benefit of the tax credit to people on the lower-income part of the scale and the elderly,” is crafting a proposal with others that would:

  • Tie subsidies to income
  • Lower the income-based eligibility limit currently listed in the AHCA
  • Increase tax credits for those still eligible
  • Provide more support for older Americans

Healthcare Reform News Update for May 16, 2017

Bipartisan Group of Senators Meets for Healthcare Reform Talk

Monday night, a group of Democratic and Republican Senators met to “discuss whether there is a bipartisan way forward on healthcare reform.” The preliminary meeting, organized by Republican Senators Susan Collins and Bill Cassidy, was attended by around 10 Senators.

Bipartisan Lawmakers Re-Introducing Fair Drug Pricing Act

Lawmakers plan to re-introduce a drug-pricing transparency bill Tuesday. The bill requires drug manufacturers to justify price increases and detail their expenses before raising the cost of certain medications. “Under the Fair Drug Pricing Act, companies will have to notify the U.S. Department of Health and Human Services and submit a report 30 days before they increase the price of certain drugs that cost at least $100 by more than 10 percent in one year, or 25 percent over three years.”

CMS Plans to Close Online SHOP Enrollment, Offer Small Business Health Care Tax Credits

In a press release published on Monday, the Centers for Medicare and Medicaid Services (CMS) announced a plan to alter the Federally-Facilitated Small Business Health Options Program (SHOP). Currently through SHOP, small businesses could apply for a determination of SHOP eligibility. After receiving the designation, small businesses could purchase health insurance coverage for their employees through the SHOP online marketplace and received a Small Business Health Care Tax Credit.

In CMS’s planned change, SHOP would discontinue online enrollment through Small businesses could still receive a SHOP eligibility determination and receive the Small Business Health Care Tax Credit. However, small businesses would “access coverage through an agent or broker, or an issuer of their choice, for plan years beginning on or after January 1, 2018.”

Healthcare Reform News Update for May 15, 2017

An Update on Senate’s Healthcare Bill Progress

The Senate is currently debating healthcare reform, mostly on a partisan basis. While no proposal has been released (the Senate will wait for a CBO score on the AHCA), here is an update on their progress:

Legislative Conversations on Drug Pricing Continue

A prior proposal to allow drug-importation from Canada was dismissed by the Senate last week. However, legislators are still working to find ways to lower drug prices. All ideologies seem interested in speeding up the generic drug approval process and increasing transparency in drug pricing.

Department of Health and Human Services Secretary Tom Price is holding listening sessions with patient groups, insurance companies, pharmacy groups, and hospital groups. Proposals from these organizations “include boosting competition through generic drug development, price transparency, and more communication between regulators and government payers.”

Mick Mulvaney, the White House budget director, also suggested changing Medicare drug pricing negotiations during a conference at Stanford University. During the conference, Mulvaney drew a direct comparison between drug price negotiations in Medicaid (which includes mandatory rebates) and Medicare (in which drug companies and insurance companies negotiate to win rebates).

Trump Releases Supportive Statement in Celebration of Women’s Health Week

“Ensuring affordable, accessible, and quality health care is critical to improving women’s health and ensuring that it fits their priorities at any stage of life,” Trump said in a statement released on Mother’s Day, during Women’s Health Week.

The statement continues: “The number of women dying from heart disease and cancer—the top two killers of women in America—has been decreasing for decades. Thanks to new breast cancer treatments, our health care professionals have saved lives and improved the quality of life for millions of women. We must continue to foster an environment that rewards these needed advances in research.”

Trump added that “he is committed to working with Congress on behalf of paid family leave for mothers and fathers, and to ‘invest in the comprehensive care that women receive at community health centers.’”

Healthcare Reform News Update for May 12, 2017

Conservative Senators Begin Outlining Healthcare Reform Ideals

Conservative Republicans have several ideals for the healthcare bill they are currently drafting and negotiating with other members of the Senate:

  • Change the AHCA’s refundable tax credits to non-refundable tax credits
  • Remove Medicaid expansion eligibility for “able-bodied” adults
  • Repeal insurance regulations put in place by the ACA — “such as the requirement that plans don’t charge higher premiums to people with pre-existing conditions — or make states opt in.”

Senate Assures Women’s Involvement in Healthcare Reform

The Republican Senate has recently faced criticism pointing at the lack of women in the 13-member healthcare reform working group, despite the number of women’s health issues at play. Senate Majority Leader Mitch McConnell has assured his colleagues, and the public, that women will not be (and haven’t been) excluded. According to a member of the GOP, “The leader has assured us that at least one of the women will attend all of the meetings going forward.”

McConnell extended invitations to three female colleagues for a Tuesday meeting of the working group, which Senator Shelley Moore Capito attended. A Thursday meeting was attended by Senator Joni Ernst. Additionally, McConnell has reportedly given an open invitation to any Republican Senator interested in attending the working group’s meetings.

Senate May Revert to Income-Based Subsidies in Revised Healthcare Bill

According to Senator John Hoeven, the House bill’s financial assistance “is just not robust enough to make sure that low-income individuals can actually afford a [health] plan.” Because of this, the Senate may consider using income-based health insurance subsidies in their healthcare bill.

Healthcare Reform News Update for May 11, 2017

Aetna Pulls Final 2 States From Individual Marketplace

Aetna has announced that the company will not offer any ACA Marketplace plans in Delaware or Nebraska in 2018. This marks the withdrawal of Aetna’s last two Marketplace plans, leaving the company with no ACA Marketplace participation for 2018. Aetna cited financial losses.

Healthcare Reform News Update for May 10, 2017

Republican Senators Take Different Sides on Medicaid Expansion

Ohio Senator Rob Portman and West Virginia Senator Shelley Moore Capito want two very different things for Medicaid. Portman “supports rolling back the Medicaid expansion by ending the extra federal money for it, as long as there is a ‘soft landing.’” On the other hand, Capito “wants the expansion of coverage to remain, though she said it did not have to be in the same form.”

Healthcare Reform News Update for May 9, 2017

Health Insurance Companies Raise Premiums as Marketplace Uncertainty Continues

Three states—Connecticut, Maryland, and Virginia—are the first to make their health insurance premium rates public. In each state, premiums will increase by more than the anticipated 20%.

  • Connecticut, with 2 marketplace insurance companies, will have an average rate increase of 24%.
  • Maryland, with 4 marketplace insurance companies, will have an average rate increase of 45%.
  • Virginia, with 6 marketplace insurance companies, will have an average rate increase of 31%.

Moderate Senators’ Concerns May Reshape Healthcare Bill

With a slim margin needed to pass the bill (Republicans can lose only two votes), the Senate’s Republicans will have to negotiate and appease both sides (conservative and moderate) of their party. Because of this, moderate Republicans have the leverage to alter several more controversial aspects of the AHCA. Moderate Republicans’ concerns with the current healthcare reform bill are predominantly about:

  • Changes to Medicaid
  • Early CBO estimates that the AHCA would result in 24 million people losing coverage
  • Coverage for pre-existing conditions
  • Planned Parenthood Funding and abortion language

Healthcare Reform News Update for May 8, 2017

Senate Healthcare Vote Will Likely Be a Simple Majority

Republican Senate Majority Leader Mitch McConnell told the Associated Press that he didn’t expect Democratic support on healthcare legislation. “We don’t anticipate any Democratic help at all, so it will be a simple majority vote situation.”

More Senators Suggest Rewriting, Not Refining, GOP Healthcare Bill

Rather than revising the American Health Care Act of 2017 (AHCA), more members of the Senate have said that a completely new bill will be written. Moderate Republican Senator Susan Collins stated, “The Senate is starting from scratch. We’re going to draft our own bill, and I’m convinced that we’re going to take the time to do it right.”

Senator Collins and Senator Bill Cassidy have already introduced a bill called the Patient Freedom Act. Their bill “keeps some of the consumer protections within Obamacare for people with pre-existing conditions while seeking to solve some of the flaws within the healthcare law.”

Democrats Criticize Lack of Women in Republican Group Working on Healthcare Reform

Republicans have created a group of 13 Senators to “craft a plan to pass legislation to repeal and replace Obamacare.” Democratic Senators questioned why the group included no women, despite the number of women’s health issues involved in healthcare reform.

  • Democratic Senator Dianne Feinstein: “Women’s health is a big part of this and women are a majority of the population, and their health interests deserve to be contemplated in any reform.”
  • Democratic Senator Patty Murray: “It matters to have women at the table—and it matters when they aren’t.”
  • Democratic Senator Kamala Harris: “The GOP is crafting policy on an issue that directly impacts women without including a single woman in the process. It’s wrong.”

Trump Relying on Senate to Improve Healthcare Bill

White House chief of staff Reince Priebus told reporters that President Trump expects Senate Republicans to improve the healthcare reform bill. “Everyone is committed to getting this thing done and getting it done as soon as possible,” Priebus told Fox News. Trump also tweeted, adding pressure to the Senate, “Republican senators will not let the American people down!”

Former President Obama Pressures Senate to Preserve ACA

On Sunday night, Former President Barack Obama urged Congress to maintain the ACA (or Obamacare) and its patient protections. “I hope they understand that courage means not simply doing what’s politically expedient, but doing what, deep in our hearts, we know is right,” Obama said. Obama also expressed his hope that Congress members “recognize it takes little courage to aid those who are already powerful, already comfortable, already influential—but it takes some courage to champion the vulnerable and the sick and the infirm, those who often have no access to the corridors of power.”

Healthcare Reform News Update for May 5, 2017

Senators Likely to Alter House-Approved AHCA

Senator Roy Blunt (R-MO) has already indicated that the AHCA will be altered in the Senate. “We’re going to look at what the House has done and see how much of that we can incorporate in a product that works for us with reconciliation.”

Senator Lamar Alexander (R-TN) supported his colleague’s statement, saying, “We’re writing a Senate bill and not passing the House bill. We’ll take whatever good ideas we find there that meet our goals.” Alexander also gave no hints about when a Senate bill would be ready. “There will be no artificial deadlines in the Senate. We’ll move with a sense of urgency but we won’t stop until we think we have it right.”

Senator Lindsey Graham (R-SC) gave a harsher statement against the House’s passage of the AHCA, noting the lack of a score from the Congressional Budget Office. “Like y’all, I’m still waiting to see if it’s a boy or a girl. Any bill that has been posted less than 24 hours, going to be debated three or four hours, not scored? Needs to be viewed with suspicion.”

House Passes Bill Removing AHCA Coverage Exemptions

Shortly after passing the AHCA, the House voted on a separate piece of legislation. This separate bill nullifies exemption language in the AHCA (which allows lawmakers and their staff to maintain coverage regardless of their states’ coverage changes). The bill is now with the Senate.

What’s Next for the American Health Care Act Bill?

Now that the AHCA has been approved by the House, it will go straight to the Senate. In order for the Senate to pass the bill by a simple majority (51 votes), the bill must follow the “Byrd Rule.” The rule dictates that, as a reconciliation bill, the AHCA can only alter budget-related provisions of the Affordable Care Act. Additionally, the bill cannot increase the federal deficit in the long term. Any provisions in the bill that are not budget-related can be rejected, and the Senate has the authority to completely alter the bill.

After the Senate has reviewed and potentially changed the bill, they will vote on it. If the bill passes, the House must review the Senate’s altered bill. The House can approve the Senate’s bill, or they can try to reconcile the differences between the two. In the latter case, the two chambers of Congress will create a bill that meets the needs of both chambers, and each will vote again on the final bill.

When a final bill has been approved by the House and the Senate, the bill goes to the President. Trump can accept the bill and sign it into law, or he can veto the bill.

Healthcare Reform News Update for May 4, 2017

House Passes the American Health Care Act (H.R 1628)

This afternoon at 2:19 p.m. EST, the House passed the amended American Health Care Act of 2017 (AHCA). The bill passed by a slim margin (217 to 213). As with any bill, the AHCA will be sent to the Senate. The Senate might amend different parts of the bill or write its own bill. If the Senate passes a different version of the bill, then the House and Senate will hold a conference committee to resolve the differences between the two bills. Once a new bill has been created, it must then pass unchanged through both the House and Senate, and be signed by the President, in order to become a law.

Under the AHCA, the following will be repealed:

  • The individual mandate
  • The employer mandate
  • Cost-sharing reduction subsidies
  • Certain ACA taxes

The following will be changed:

  • Medicaid expansion
  • Pre-existing condition policies
  • Essential health benefit policies
  • Restrictions on increased costs for older Americans (age band rating)
  • Premium subsidies
  • Health savings accounts

The following will not change:

  • Dependent coverage until the age of 26
  • Prohibitions on annual and lifetime limits

GOP Healthcare Plan Still Includes Congressional Exemption

Language in the GOP healthcare plan still exempts Congress and their aids from being subject to state waiver provisions. This protects Congress and their staff from “losing the [ACA’s] popular provisions.” According to Rep. Tom MacArthur’s office, separate legislation will eliminate this controversial exemption.

Aetna to Exit Virginia ACA Marketplace

Aetna will no longer offer individual health insurance plans, on- and off-exchange, in Virginia. The company cited $200 million in anticipated losses and market uncertainty as its reason to exit Virginia’s individual market. Including Iowa, this marks the second state where Aetna has withdrawn individual plans.

News Update for May 3, 2017

Can Moderate Republicans Draft a Winning Proposal?

After moderate Republican Reps. Fred Upton (MI) and Billy Long (MO) announced their opposition to the current healthcare reform bill, they drafted a proposal addressing their concerns. Upton’s and Long’s proposal “would provide $8 billion over five years to help some people with pre-existing medical conditions afford coverage.” Upton and Long “said Wednesday they were now backing the high-profile [healthcare reform bill] after winning President Donald Trump’s support for their proposal.”

News Update for May 2, 2017

Will Republicans Have Enough Support for a Healthcare Reform Vote?

Concern over pre-existing conditions isn’t helping the GOP pass healthcare reform legislation. In addition to moderates withholding their support, a Republican legislator—and Trump supporter—has decided to vote against the amended American Health Care Act (AHCA). Rep. Billy Long (MO-R), in explaining his decision to vote no, said this: “I have always stated that one of the few good things about Obamacare is that people with pre-existing conditions would be covered. The MacArthur amendment strips away any guarantee that pre-existing conditions would be covered and affordable.”

The New York Times has created a report of the number of “no” votes, collecting and updating numbers from 4 additional news organizations. To see how many “no” votes there currently are, and who is voting “no,” read their article here.

Trump Talks Pre-existing Conditions With Bloomberg News

During an interview with Bloomberg News, President Trump said, “I want it to be good for sick people. It’s not in its final form right now. It will be every bit as good on pre-existing conditions as Obamacare.”

By “final form,” it is not clear if the President is saying that the current, amended healthcare bill is still being negotiated or if he is commenting on future Senate revisions after the bill is passed in the House.

10 Patient Advocacy Groups Speak Out Against Revised AHCA

Patient advocacy groups, including the American Cancer Society Cancer Action Network and the American Heart Association, have spoken out in opposition to the most recent Republican healthcare reform proposal. In the group’s statement, they wrote: “As introduced, the bill would profoundly reduce coverage for millions of Americans—including many low-income and disabled individuals who rely on Medicaid—and increase out-of-pocket costs for the sickest and oldest among us. We are alarmed by recent harmful changes to the AHCA, including provisions that will weaken key consumer protections.”

News Update for May 1, 2017

Will GOP Try for Another Healthcare Vote Before One-Week Recess?

The House will leave for a one-week recess on Thursday. This gives Republicans four days to shore up enough votes before going back home to their constituents. Some lawmakers have hinted at a vote this week, but publically GOP leaders have said they have until the end of May to pass healthcare legislation.

President Trump Comments on New Healthcare Bill, Pre-existing Conditions

Trump told CBS, during an interview Sunday on “Face the Nation,” that the Republican healthcare bill has “evolved” and will protect those with pre-existing conditions. While he mentioned that the proposed bill would set up high-risk pools, he “also repeatedly seemed to suggest continuing the current mandate.” Trump said, at different points in the interview:

  • “Pre-existing conditions are in the bill—and I mandate it. I said, ‘Has to be,’ Trump said, later adding that the proposal has ‘a clause that guarantees’ protection for those with preexisting conditions.”
  • “Pre-existing is going to be in there, and we’re also going to create pools, and pools are going to take care of the pre-existing.”

Trump Vows Not to Alter the ‘Concept of Medicare’

President Trump, during an interview Sunday with “Face the Nation” on CBS, said he had no intentions of altering Medicare. Trump said, “I’m not going to touch it, because I said it. Now, waste, fraud and abuse, I’m going to touch. If there’s something in Medicare that’s been abused, I will touch that. There are certain provisions in Medicare that are horrible and abusive and there’s been terrible things happening. So that kind of stuff, I will absolutely touch … But the concept of Medicare, I’m not touching.”

NIH Gets Funding Increase

Rather than the proposed cut of $1.2 billion, the National Institutes of Health (NIH) will receive $2 billion in increased funding through the next five months.

New Kaiser Family Foundation Poll on Prescription Drug Prices

In a new poll, the Kaiser Family Foundation found that 60% of Americans think that lowering prescription drug costs is a “top priority.” Most of those polled supported the following actions to lower drug prices:

  • Allowing the government to negotiate Medicare drug prices (92% in favor)
  • Making it easier for generic medications to enter the market (87% in favor)
  • Requiring drug companies to release how they set their prices (86% in favor)
  • Limiting how much companies can charge for high-cost medications (78% in favor)
  • Allowing Americans to purchase imported Canadian prescriptions (72% in favor)
  • Creating an independent group to oversee the pricing of drugs (72% in favor)
  • Allowing Americans to purchase prescriptions from online Canadian pharmacies (64% in favor)
  • Eliminating prescription advertisements (56% in favor)
  • Encouraging consumers to purchase lower-cost drugs by increasing responsibility for higher-cost drugs (52% in favor)

News Update for April 28, 2017

No Vote on Revised Healthcare Bill This Week

The Republican healthcare reform bill doesn’t have the 216 votes needed to pass the House this week. Despite revisions that were made to appeal to conservative lawmakers, recent changes have not persuaded moderate Republicans to support the bill. Rep. Ryan Costello (R-PA) stated his concerns by saying, “Protections for those with pre-existing conditions without contingency and affordable access to coverage for every American remain my priorities for advancing health care reform, and this bill does not satisfy those benchmarks for me. I remain a no vote on this bill in its current form.”

Healthcare Industry Shut Out of Republican Healthcare Reform

In addition to excluding Democrats, healthcare officials are also being shut out of healthcare reform talks. “Health insurers, who initially found House Republicans and Trump administration officials open to suggestions for improving insurance markets, say it is increasingly difficult to have realistic discussions, according to numerous industry officials.”

At almost every level (insurance companies, patient advocates, healthcare providers, and hospitals), those working in the healthcare system have had little luck in talking with the administration. “‘To think you are going to revamp the entire American healthcare system without involving any of the people who actually deliver healthcare is insanity,’ said Sister Carol Keehan, president of the Catholic Health Assn., whose members include many of the nation’s largest medical systems.”

News Update for April 27, 2017

House Freedom Caucus Officially Endorses Revised Healthcare Bill

The House Freedom Caucus has made an official endorsement in favor of the amended Republican healthcare reform bill, meaning at least 80 percent of its members will vote yes on the bill. House Freedom Caucus spokesperson Alyssa Farah stated, “Over the past couple of months, House conservatives have worked tirelessly to improve the American Health Care Act to make it better for the American people. [Because of those changes,] the House Freedom Caucus has taken an official position in support of the current proposal.”

Despite Revisions, Moderate Republicans Remain Opposed to Republican Healthcare Bill

While revisions have won the support of conservative Republicans, moderates seem to be backing away from the most recent healthcare proposal. “Rep. Charlie Dent (R-Pa.), co-chair of the moderate, 50-member Tuesday Group, said he hasn’t detected any reversals among the opponents of the health care bill — in fact, he said, their ranks may grow.”

Democrats also opposed language that “appeared to exempt members of Congress and their aides from weakened regulations that states would be allowed to adopt.” Spokesman for Nancy Pelosi, Drew Hammill, stated, “It should be no surprise that TrumpCare has gotten so terrible that Republicans have resorted to exempting themselves and their families from the pain it inflicts. Speaker Ryan and congressional Republicans promised that Americans with pre-existing conditions would be protected, but it turns out they were only talking about themselves.”

Republicans are quickly trying to revise this controversial portion of their current healthcare reform proposal.

CSR Payments Not in Upcoming Spending Bill

Paul Ryan told reporters on Wednesday that funding for cost-sharing reductions (CSRs) will not be in the upcoming spending bill (which will fund the government through September). “We’re not doing that,” Ryan said. “That is not in an appropriation bill. That’s something separate the administration does.”

But this doesn’t mean the payments will be stopped. The White House has agreed to continue funding CSRs for the time being. Nancy Pelosi, House Minority Leader, confirmed the news. “Our major concerns in these negotiations have been about funding for the wall and uncertainty about the CSR payments crucial to the stability of the marketplaces under the Affordable Care Act. We’ve now made progress on both of these fronts.”

The future of CSR subsidies will be decided “outside of the congressional spending process.”

News Update for April 26, 2017

Healthcare Reform Discussions Ongoing After April Recess

The deadline for passing a government spending bill, and avoiding a shutdown, is Friday. While nothing has been fully agreed upon or scheduled, here is a short update of what’s happening with healthcare reform:

  • A new Obamacare repeal and replace plan has been finalized by the Republican Party. The Freedom Caucus has not given an official statement about the revision, though it conceded to many Freedom Caucus demands. You can read the document, an amendment to the previous American Health Care Act bill, here.
  • Democrats will agree to increase the military budget by $15 billion if funding for cost-sharing reduction subsidies is guaranteed (around $10 billion). Otherwise, “Democrats will demand that the $15 billion … be matched with an equal increase in supplemental funding for non-military programs.”

News Update for April 19, 2017

Most Health Insurance Companies Plan to Stay on the Marketplace

A survey conducted by Oliver Wyman indicates that 96 percent of health insurance companies intend to keep offering Marketplace plans. A majority of those intending to continue on the Marketplace (71 percent) have no plans to change the coverage they offer. Of the companies surveyed, 75 percent plan to increase their rates, with increases ranging from less than 10 percent to more than 20 percent. Read the full survey here.

News Update for April 14, 2017

CSR Subsidy Funding Now a Top Priority for Democrats

After President Trump’s suggestions that he would use cost-sharing reduction (CSR) subsidies as a negotiating tactic, Democrats are insisting that any new healthcare spending bill should guarantee funding for subsidies. A Senate Democratic aide said, “Given [Trump’s] threat, we’ll be pushing for a robust cost-sharing reduction appropriation.”

Aside from prompting a funding requirement to be included in the next healthcare bill, Trump’s tactic of potentially withholding CSR funding has received negative criticism from Democrats.

  • Senator Ron Wyden: “There is no outcome in which the administration sabotaging insurance markets persuades Democrats to pass Trumpcare, a disastrous proposal which would only make our health care system worse. When the president drops his threats on Americans’ health care — including the latest threat to withhold insurance payments, which he clearly understands puts people’s care in danger — Democrats will be prepared to work on bipartisan improvements to the Affordable Care Act.”
  • Senate Democratic Leader Chuck Schumer: “Our position remains unchanged: drop repeal, stop undermining our health care system, and we will certainly sit down and talk about ways to improve the Affordable Care Act.”
  • House Democratic Caucus Head Joseph Crowley: “Rather than improving our country’s healthcare system, President Trump is bent on destroying it. His most recent threat — to raise premiums for millions of Americans by withholding the law’s cost-sharing reduction payments — amounts to nothing more than political blackmail.”

Administration Finalizes Proposed Market Stabilization Rule

Late Thursday, a proposed rule aimed at stabilizing the ACA marketplace was finalized. As reported yesterday, the final rule affects outstanding premium payments and plan renewals, the open enrollment period, special enrollment verifications, and actuarial value requirements. Read the final rule document produced by the Department of Health and Human Services here.

Trump’s Statement on CSRs Concerns Health Insurance Industry

The threat of discontinuing CSRs in order to pull Democrats into negotiations is also weighing heavily on the health insurance industry. Chief Executive of Avalere Health commented on Trump’s recent statements: “This is a very potent threat, because the administration has the authority unilaterally to do this, and this is really a kill switch. This makes the program unprofitable for the majority of health plans operating in it today. The timing of this threat is really curious, in the sense that now is the time that the plans have to be deciding whether to bid on 2018. If you’re on the bubble and the president is making a threat like this … this just puts more uncertainty on the program.”

News Update for April 13, 2017

Trump Plans to Use CSR Subsidies as a Negotiation Tactic

Three administration officials told Politico that “President Donald Trump wants to use a key Obamacare subsidy program as leverage to draw Democrats to the negotiating table on health care.” During an interview with The Wall Street Journal, President Trump acknowledged his plans to use the cost-sharing reduction (CSR) subsidies to start negotiations. “I don’t want people to get hurt. What I think should happen—and will happen—is the Democrats will start calling me and negotiating,” said Trump.

Democratic Senator Chuck Schumer criticized Trump’s statements, saying, “President Trump is threatening to hold hostage health care for millions of Americans, many of whom voted for him, to achieve a political goal of repeal that would take health care away from millions more. This cynical strategy will fail.”

Healthcare Groups Write Letter to Trump, Calling on Administration to Continue CSR Payments

Healthcare industry groups wrote a direct appeal letter to the President and administration on April 12. In an excerpt from the letter, the groups state that “the most critical action to help stabilize the individual market for 2017 and 2018 is to remove uncertainty about continued funding for cost sharing reductions (CSRs).” Along with the clarity needed by insurance companies, the letter explains what will happen if CSR funding is lost.

A Proposed Rule Could Make Big Changes to the ACA Marketplace

The Trump administration has proposed a rule to try and stabilize the Marketplace. The current draft’s changes to the Affordable Care Act (ACA) Marketplace include:

  • Allowing insurance companies to require customers to pay outstanding premiums before issuing a new plan. (For example: If you owe 2 months of premiums at the end of 2017, you will have to pay them before your 2018 plan begins.)
  • Shortening the open enrollment period to run from November 1 through December 15. (The previous open enrollment period ran from November 1 through January 31.)
  • Increasing verification before individuals may enroll in special enrollment period plans (sold outside of the normal open enrollment period).
  • Increasing the allowable variation of actuarial values used in metal tier plan determination. “Bronze plans, for example, currently must cover an average of 60 percent of costs, while a silver one is 70 percent — and insurers are allowed wiggle room of plus or minus 2 percent around those averages. The Trump proposal would tweak the formula. … So, for example, a bronze plan might cover only 56 percent of costs and silver 66 percent.”

Poll Shows Support for a Single-Payer Healthcare System

In a Morning Consult/Politico poll of 1,988 registered voters, 44 percent of those polled were in favor of a single-payer healthcare system. Thirty-six percent oppose it, and 19 percent don’t know. Read here to see more on the poll and how political affiliation affected individuals’ outlooks.

News Update for April 12, 2017

Freedom Caucus Working With Paul Ryan on 2 Healthcare Reform Options

Rep. Mark Meadows, the House Freedom Caucus leader, stated Tuesday that Republicans are close to striking a deal on healthcare reform. Meadows stated that his group is waiting for Paul Ryan to contact them today about two potential options, adding during a local radio show, “We’re very close. The biggest thing for all of us is we want to make sure we don’t just have repeal, but we have a replacement that drives down insurance premiums. It’s our encouragement to have a vote as soon as we possibly can, even perhaps before we return back to DC in 13 days.”

Meadows also spoke to USA TODAY about the deal. “What I’m getting to [Ryan] is based on conversations that I’ve had with (Tuesday Group co-chairman) Tom MacArthur and leadership, but I wouldn’t say that it’s approved at this point. What we’re trying to do is work through issues that are important to all of us but make sure that pre-existing conditions are taken care of.”

CSR Subsidies Still Not in the Clear

Despite previous statements, the Department of Health and Human Services (HHS) seems to be walking back assurances for cost-sharing reduction (CSR) subsidies. HHS spokesperson Alleigh Marré gave this statement recently after a New York Times article stated that CSRs were safe during the lawsuit:

“The New York Times report is inaccurate. The administration is currently deciding its position on this matter. We have not been contacted by Democrats to help save Obamacare, perhaps because they consider Obamacare to be a losing cause. Democrats need to help solve this failed Obamacare plan. The report was in reference to the current status of the lawsuit and is not an indication of what will happen in the future. No decisions have been made about how the administration will proceed.”

Trump Interview Confirms President Isn’t Moving Past Healthcare if He Can Help It

During an interview between President Trump and Fox Business Network, Trump stated his desire to pass healthcare reform legislation before moving on to tax reform. “We’re going to have a phenomenal tax reform, but I have to do health care first. I want to do it first to really do it right.” However, he isn’t willing to hold back on tax reform if healthcare takes too long. “Now, if it doesn’t happen fast enough, I’ll start the taxes. But the tax reform and the tax cuts are better if I can do health care first.”

Moderate Republicans Calling for Bipartisanship on Healthcare Reform

Co-chair of the moderate Tuesday Group, Rep. Charlie Dent, spoke to Axios about the need for bipartisanship when trying to reform healthcare. “If we attempt to muscle this thing through on a partisan basis, I feel we’ll have a similar result … the reform won’t be durable.”

Republican Senator David Perdue also talked about the need to make a bipartisan effort to reform healthcare. “How’d the other direction work out? It didn’t work out very well when we pretty much ignored them. There’s a great chasm up there and I would argue that polarization is one of our great threats to solving a problem. I believe there’s no danger to finding a compromise solution.”

Democrats Fight Back in Battle of Ad Campaigns

A $1 million ad campaign supported by “a liberal group backed by labor and progressive interests” is targeting seven Republicans. The campaign attacks these Republicans’ support of the American Health Care Act (AHCA), utilizing growing support for Obamacare.

News Update for April 11, 2017

Ad Campaigns Target Moderates and Democrats Over Healthcare Reform During April Recess

Club for Growth, a conservative group, wants moderate Republicans to accept the most recent healthcare bill proposal. The group announced Monday that it will use a $1 million dollar ad campaign to target at least 10 moderate House Republicans. Club for Growth President David McIntosh commented on the campaign, “Our message in this ad is: Come on board, keep the promise that you and our party made to finally repeal Obamacare and lower health-care insurance costs for Americans across the board.”

The National Republican Congressional Committee (NRCC) is also using ad campaigns to target those who opposed the most recent healthcare reform draft: Democrats. NRCC is aiming at 5 Democrats with digital billboards. The billboards highlight “each Democrats’ support for Obamacare and [urge] constituents to contact their representatives.”

Lawyers Create Watchdog Group to Monitor Conversations Surrounding Obamacare

A group of lawyers have created the watchdog group called “American Oversight.” By using the Freedom of Information Act, they hope to review emails and other conversational documents between Department of Health and Human Services (HHS) officials and other agencies concerning Obamacare. Their ultimate goal is to promote transparency, discover how Obamacare decisions are being made, and “[look] for evidence of ‘sabotage.’”

“The topics they’re focusing on:

  • The decision to cut back Obamacare advertising in the last week of enrollment
  • Whether HHS will advertise in the next enrollment season
  • What it will do about the law’s ‘essential health benefits’
  • What it will do about the cost-sharing subsidies
  • Any changes it might make to the Obamacare marketplaces
  • What insurers have told the Trump administration about whether they’ll participate next year”


News Update for April 10, 2017

Health Insurance Companies May Start Seeing Obamacare Profits, According to S&P

Standard & Poor’s (S&P) analyzed the performance of many Blue Cross plans operating in different states. According to the analysis, these insurance companies stemmed their losses in 2016, could break even in 2017, and could make a marginal profit in 2018. S&P analysts commented on their findings: “We are seeing the first signs in 2016 that this market could be manageable for most health insurers. The market is not in a ‘death spiral.’ ”

House Republicans Defending Popular Obamacare Policies in Face of Freedom Caucus’ Demands

Many House Republicans are speaking up for popular Obamacare policies. This support is in opposition to the Freedom Caucus’ strict goal of repealing them. Coverage for pre-existing conditions, Medicaid expansion, and coverage mandates for mental health services and prescription drugs are all getting support from the middle-right.

News Update for April 7, 2017

House Goes on April Recess But Continues Healthcare Reform Talks

After last-minute amendments to the latest healthcare reform draft, the House commenced its two-week recess. The changes intended to swing the Freedom Caucus seem to be working, with Freedom Caucus chairman Rep. Mark Meadows stating positively that “the majority of the Freedom Caucus would be favorably inclined to vote for” a bill that eliminated essential health benefits, community ratings, and guaranteed issue plans. While these changes suit conservative Republicans, moderates seem less enthusiastic. Moderate GOP Rep. Leonard Lance said of the latest draft, “I favor making sure no one is denied coverage due to a pre-existing condition. So I doubt [the latest revision] would be enough.”

Despite the recess, healthcare reform talks are still in progress. House Majority Leader Kevin McCarthy warned representatives that the planned recess could be cut short. If a healthcare reform deal can be made between moderates and conservatives, representatives could be called back to vote on a new bill.

Aetna Leaves Iowa’s Marketplace

Aetna announced on Thursday that it would stop selling individual health insurance plans in Iowa, both on and off of the Affordable Care Act (ACA) Marketplace. Aetna made the decision based on “financial risk and an uncertain outlook for the marketplace.” After the Wellmark Blue Cross and Blue Shield withdraw — and now Aetna’s withdraw — from Iowa, this leaves 5 counties with two insurance options and the remaining 99 counties with only one health insurance option.

Cost-Sharing Reduction Subsidies and Medicaid: What Effects Would Funding Cuts Have?

Based on a recent Kaiser Family Foundation analysis, the loss of cost-sharing reduction (CSR) funding would lead to a 19% increase in silver tier plan premiums. “The analysis … finds that the estimated premium increase for silver plans would be higher (21%) in states that did not expand Medicaid under the ACA than in states that expanded Medicaid (15%).” And according to the Commonwealth Fund, cuts to Medicaid funding would mostly affect older and sicker individuals. “Any changes to the Medicaid program could disproportionately affect many of our neediest, sickest Americans.”

News Update for April 6, 2017

Insurance Companies Withhold Commissions, Brokers Forced to Leave Marketplace

In order to mitigate losses in the individual market, insurance companies are refusing to pay brokers on platinum tier and special enrollment plans that brokers have already sold. Additionally, companies are lowering commission rates for those being delivered.

Despite their moral conflict over leaving consumers without an advocate, 36,000 brokers (35% of those representing the Marketplace) have had to exit the Marketplace in order to protect their livelihood. This mass exodus may negatively impact the Marketplace’s enrollment because 50% of enrollments are attributed to brokers.

House GOP Schedule Emergency Meeting to Amend Latest Healthcare Reform Draft

House Republicans are scheduled to meet today (Thursday) to add a “risk-sharing fund” to their current healthcare reform draft. This addition would allocate $15 billion to health insurance companies to help subsidize care for those with pre-existing conditions or high medical costs. Sources do not believe that this meeting will affect the upcoming 2-week recess.

Fate of Cost-Sharing Subsidies Still Unknown

Trump’s advisers, who had expected Congress to have passed a repeal bill by now, have not agreed what to do about the subsidies, which help low-income people covered by Obamacare pay for their out-of-pocket health costs. One senior official said that the Department of Health and Human Services and the White House Office of Management and Budget were studying the impact of abruptly stopping billions of payments to the health plans that participate in the Obamacare markets. Insurers would have to pick up these costs, regardless of whether the federal funds are released.”

The fate of cost-sharing subsidies hinges on the lawsuit. “The House Republicans won the first round of the lawsuit over the cost-sharing subsidies, although the Obama administration appealed the decision. The Trump administration asked for some extra time, and the next deadline for the Trump Justice Department is May 22.”

Another complicating factor is how the government will decide to budget for the subsidies, at least until the outcome of the lawsuit is decided. “Congress must approve a spending bill for the rest of the year by late April to avoid a government shutdown.”

News Update for April 4, 2017

Revisions to Republican Healthcare Bill Stir Hope for Winning Vote

Accompanied by White House officials, Vice President Mike Pence presented an offer for healthcare reform to the Freedom Caucus during a closed-door meeting Monday night. While it was not an official revision, the offer included:

  • Allowing states to apply for coverage requirement waivers (specifically the essential health benefits) and pre-existing condition coverage exemptions
  • Removing the “community rating” rule, which “requires insurance companies to charge the same price to everyone who is the same age.”

States would apply for waivers if they could “improve coverage and reduce costs” without the essential health benefits. There was also discussion of creating high-risk pools for those with pre-existing conditions, redirecting money from state stability funds to cover the cost.

The Freedom Caucus will not make a final decision until the members can review the new bill in writing.

Proposed NIH Funding Cuts Meet Strong Opposition

Months after increasing biomedical research funding, Republicans and Democrats are visibly unhappy with proposed cuts to the National Institutes of Health (NIH). Representatives are “extremely concerned about the potential impact of the 18 percent cut” and believe that patients and researchers could see “catastrophic results” if the funding cuts are approved.

Joe Biden, former Vice President, had this to say about the proposed cuts. “[President Trump is] proposing draconian cuts—not only to biomedical research, but also to the entire scientific expertise across the board. This would set the NIH budget, and biomedical research, back 15 years—and that’s not hyperbole.”

A Proposed Rule Could Lower the Value of Your Health Plan

A rule proposed by the Trump administration in February could lower the actuarial value of all metal tier health plans by 2%. This means insurance companies could offer “bronze plans with actuarial values as low as 56 percent instead of the 60 percent standard” coverage of medical costs. While it may lower expenses for insurance companies, consumer advocates and insurance experts think the rule falls short of consumer needs and concerns. The lower actuarial value both reduces potential subsidies and increases out-of-pocket costs.

Wellmark Blue Cross and Blue Shield Withdraws from Iowa’s ACA Marketplace and Regulations

Without clarity into the future of healthcare reform, Iowa’s Wellmark Blue Cross and Blue Shield has had to make a difficult decision. Wellmark will stop offering health plans on the Marketplace, and it will no longer offer ACA-compliant plans in 2018. The company cites a $90 million dollar loss, 43% premium rate increases, and unclear healthcare reform as its primary reasons for making such enormous changes. Without Wellmark on the Marketplace, 21,400 individual enrollees will have to weigh the changes to their plans or seek new coverage in 2018.

News Update for April 3, 2017

Trump Meets with Zeke Emanuel and Rand Paul on Healthcare

The Trump administration met with both Obamacare architect Zeke Emanuel and Republican Senator Rand Paul last week. White House press secretary Sean Spicer said, “I think that despite our political and policy differences, [Trump] wants to hear ideas not just of [Emanuel] but a lot of people.” Trump and Rand Paul golfed together on Sunday, Paul commenting that he “had a great day with the president. Played some golf, and we talked and we talked about a little bit of healthcare. I continue to be very optimistic that we are getting closer and closer to an agreement on repealing Obamacare.”

“Trump, who took a political hit last month when House Republicans failed to agree on an alternative health care plan, also tweeted: ‘Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck.’”

Wisconsin Works on Medicaid, Florida House Passes Legislation

Scott Walker, the Republican Governor of Wisconsin, wants to implement drug tests and work requirements for Medicaid recipients. Both ideas have drawn criticism because they could further stigmatize the poor and waste money. Two state examples and a Kaiser Family Foundation (KFF) analysis support critics of Walker’s proposal:

  • North Carolina and Michigan, who screen their welfare applicants, have seen little use in drug testing—less than 0.3% of North Carolina’s applicants and 0% of Michigan’s applicants tested positive.
  • An analysis done by the KFF broke down the work status of Medicare beneficiaries. Of those not working, 35% were disabled or unwell, 28% were taking care of family members, 18% were enrolled in school, 8% were retired, and 8% were not able to find work. This leaves only 3% of those not working to fail proposed work requirements.

The Florida House passed a “direct primary care” bill on Thursday. This bill allows patients to directly negotiate regular payments and costs with doctors.

News Update for March 31, 2017

The Importance of CSRs to the Marketplace and Current Litigation Threatening Them

Under the Obama administration, subsidies used to lower the cost of out-of-pocket expenses were created. These subsidies, called cost-sharing reductions (CSRs), guaranteed payments to health insurance companies if they offered reduced out-of-pocket pricing to certain customers. However, “the GOP argued the payments were being made unconstitutionally, without a congressional appropriation.”

Republican House members sued the Obama administration over the funding of CSRs, and Trump’s administration inherited this ongoing lawsuit. If the lawsuit is won, or if the current administration dismisses the case, insurance companies stand to lose millions (which have already been used to fund CSRs) promised by the government. The potential loss is influencing many insurance companies to drop out of the Marketplace or increase premiums.

Speaker Paul Ryan stated on Thursday that payments will continue to be made to insurance companies that offer CSRs. However, his guarantee was limited to the ongoing case. “While the lawsuit is being litigated, then the administration funds these benefits. That’s how they’ve been doing it and I don’t see any change in that. We don’t want to drop the lawsuit because we believe in the separation of powers. We believe in Congress retaining its lawmaking power, but this lawsuit hasn’t run its full course,” Ryan said.

Ryan’s statement has done little to comfort insurance companies. Kristine Grow, spokesperson for America’s Health Insurance Plans, doesn’t think payments continuing only during the lawsuit are enough. “Insurers need certainty that the payments will be there throughout 2018, or else they might need to raise premiums for next year to factor in the uncertainty.” Grow said, “As soon as this lawsuit stops the CSRs no longer have a guarantee.”

Chairman of the House Energy and Commerce Committee, Greg Walden, gave a stronger guarantee with the hope of keeping insurance companies in the marketplace. “I will do everything I can to make sure the cost-sharing reduction payments get made, especially this year where they were promised by the federal government under the contracts. That’s an obligation not only to insurers but also to the people who took on those plans. We cannot leave them high and dry.”

Healthcare Reform Vote Doesn’t Have a Set Date, or Enough Support, According to Speaker Ryan

House Speaker Paul Ryan addressed questions surrounding Republican healthcare reform during his weekly news conference. When asked about the timeline and bill details, Ryan stated, “I’m not going to commit to when and what the vote is going to look like, because it’s my job to make sure that House Republicans can coalesce and come together and draw a consensus.”

Ryan also commented on President Trump’s frustrations with Republicans’ inability to pass the first reform bill, shared during conferences and on Twitter. “I understand the president’s frustration. I share that frustration. About 90 percent of our conference is for this bill and about 10 percent are not. And that’s not enough to pass the bill.”

States Continue to Move Forward With Their Own Healthcare Reforms

In California, Democratic Senator Ricardo Lara released proposed details for a state-wide single-payer healthcare system. “With Republicans’ failure to repeal the Affordable Care Act, Californians really get what is at stake with their healthcare. We have the chance to make universal healthcare a reality now. It’s time to talk about how we get to healthcare for all that covers more and costs less,” Lara said in a statement.

In Florida, the State House passed two bills that support “a free-market, consumer-driven healthcare system.” HB 161 allows individuals and employers to negotiate and contract with doctors directly for healthcare services (this is normally done by health insurance companies). HB 145 lets surgical centers hold patients for 24-hours and makes new recovery centers to care for post-operative patients for 72 hours.

In Kansas, Governor Sam Brownback has vetoed a Medicaid expansion bill previously approved by the state’s House and Senate. In his veto message, Brownback stated, “I am vetoing this expansion of Obamacare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs.” The House and Senate have 30 days to override the veto.

News Update for March 30, 2017

Ryan Doesn’t Want Bipartisan Healthcare Reform

During an interview on “CBS This Morning,” Ryan voiced his concerns on Trump’s sway toward Democratic healthcare reform. Republicans’ inability to come together on healthcare reform, as well as campaign promises, may be leading the President to consider Democrats’ reform requests. “This is a can-do president, who’s a business guy, who wants to get things done, and I know that he wants to get things done with a Republican Congress, but if this Republican Congress allows the perfect to be the enemy of the good, I worry we’ll push the president into, um, working with the Democrats; he’s suggested as much,” Ryan said during the interview.

Two GOP Senators Introduce Legislation to Help Those With No Marketplace Options

If insurance providers withdraw from already limited markets, many Americans would have no options on the Marketplace and couldn’t utilize subsidies. Republican Tennessee Senators Lamar Alexander and Bob Corker introduced legislation on Wednesday hoping to limit this fallout. Their proposed bill would allow Americans to use their subsidies to purchase coverage off the exchange.

States Take Action to Lower Healthcare Spending

Colorado’s State Senate has approved a $26.8 billion state budget bill. The bill includes controversial funding cuts to state hospitals ($500 million).

Texas’ House submitted a spending proposal that cuts $2.4 billion in funding from Medicaid ($1 billion from Texas state and $1.4 billion from the federal government).

Minnesota’s House and Senate announced they’d made a deal on a bill aimed to control health insurance costs in their state. This deal would support health insurance companies (helping them cover the cost of high medical claims) and cost $542 million dollars in the next two years.

News Update for March 29, 2017

Republican House Members Not Ready to Leave Healthcare Reform Behind

House Speaker Paul Ryan brokered a meeting between the Tuesday Group of moderates and the House Freedom Caucus. During the meeting, the two groups “reopened the conversation on how to repeal and replace Obamacare.” While there hasn’t been a consensus, it was clear to meeting attendees that “everyone in that room is dying to get to yes.”

Despite House Republicans voicing their desire to revive reform efforts, Senate Republicans and White House officials seem ready to move past healthcare.

The American public seems divided on healthcare reform. Review the public’s views on healthcare reform.

Insurance Companies Uncertain About Staying in Marketplaces

Without clarity into the administration’s plans for subsidies and the individual mandate, insurance companies are hesitant to create and adapt their 2018 products. Dr. Mario Molina, CEO of Molina, said, “We need some clarity on what’s going to happen with cost-sharing reductions and understand how they’re going to apply the mandate. [If subsidy payments stopped,] it would certainly play into our decision [to leave Marketplaces]. We’ll look at this on a market-by-market basis. We could leave some. We could leave all.”

States Move Forward With Medicaid Legislation

The Kansas Senate voted to approve Medicaid expansion on Tuesday. Kansas Governor Sam Brownback now has the opportunity to approve or veto the expansion. A veto can be overridden by 84 House and 27 Senate votes.

The Arkansas Senate voted to keep its hybrid Medicaid expansion and budget. Arkansas’ House is now voting on the Medicaid bill.

News Update for March 28, 2017

Is Obamacare Really Exploding, Like Trump Says?

No, the Affordable Care Act (ACA) isn’t about to fail or explode. Health insurance marketplaces—also known as exchanges—are stable, allowing people to shop for the best price possible. The uninsured rate has fallen greatly, and premiums rates are relatively steady.

But the healthcare bill still has room for improvement. Many Americans have few choices in their regions for health insurance providers, some states have seen varying levels of success and failure (like enormous premium rate hikes in Arizona), and the rise in deductibles is making out-of-pocket spending increase. Additionally, the U.S. is still spending more per capita than other industrialized nations on healthcare.

Tom Price to Administer Obamacare, May Be Working to Stabilize Marketplace

Tom Price, secretary of the Department of Health and Human Services, came into his position with the goal of repealing the ACA. But after the failure of the American Health Care Act, he doesn’t seem to be letting Obamacare (the healthcare reform he fought against) fail. In fact, he may be working to stabilize health insurance markets. Small regulatory changes made in February and a letter from Price to governors support these stabilizing claims.

4 Potential Healthcare Solutions Gaining New Attention

Right now, health insurance companies are developing plans they will file for 2018. So, planned healthcare reform efforts have to happen as soon as possible to keep these companies in the health insurance marketplace. With time ticking on the reform clock, here are 4 potential healthcare reform solutions that are currently gaining traction:

  1. Gain insight from Seema Verma on potential improvements to the ACA. Verma is “famous for being the woman who figured out how to build health reimbursement arrangements into Medicaid coverage for moderately low income adults.”
  2. Repeal the ACA completely, rather than through a budget reconciliation process. Two full repeal bills (H.R. 175 and H.R. 370) have already been introduced by members of congress.
  3. Use a single-payer healthcare system, also called universal healthcare, to cover everyone. Senator Bernie Sanders (D-VT) made headlines and has said a draft of his bill will be ready within weeks.
  4. Cross party lines by having Republicans and Democrats work together to craft healthcare reform. At the moment, small bursts of bipartisan effort have been made. “Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) are hoping they can convince Democrats to back their health insurance overhaul, which would let states choose whether to keep or replace Obamacare.”

News Update for March 27, 2017

Are Single-Payer Plans the Next Big Talking Point in Healthcare Reform?

On Sunday, Senator Bernie Sanders (D-VT) told CNN’s “State of the Union” that he is “going to introduce a Medicare-for-all single-payer program.” The plan, which can be called universal healthcare, was also mentioned during a town hall the previous day. According to Vermont Public Radio, Sanders said the plan could be ready within weeks. “It is a commonsense proposal, and I think once the American people understand it, we can go forward with it,” Sanders said after the Saturday town hall. Sanders invited Republicans to negotiate his upcoming plan; he even invited the President to work with him. “President Trump, come on board. Let’s work together. Let’s end the absurdity of Americans paying by far the highest prices in the world for prescription drugs.”

The plan seems to have the support of Rep. Peter Welch (D-VT), who said he planned to introduce Sanders’ single-payer plan to the House. Welch commented on the single-payer plan by saying, “We need in this country, like any industrialized country, a healthcare system that’s affordable, accessible and universal.”

Democrats See Opportunity for Universal Healthcare After AHCA Loss

In addition to Bernie Sanders (D-VT), other Democrats are rallying behind the idea of a single-payer program, also known as universal healthcare. Here are what some lawmakers are saying in favor of universal healthcare:

  • Jim Langevin (D-RI): “We have to look harder at a single-payer system.”
  • Jack Reed (D-RI): “I’m old enough to have voted for a single-payer system in the House.”
  • House Minority Leader Nancy Pelosi (D-CA): “I supported single payer since before you were born.”
  • Sheldon Whitehouse (D-RI): “The very best market-based solution is to have a public option. The best way to show that a stick is crooked is to put a straight stick next to it. If you do that, the private sector can’t manipulate the market by withdrawing.”

Trump May Have Lost the AHCA Battle, But He Can Still Undermine Obamacare

Even though the American Health Care Act did not have enough Republican support to hold a vote on the House floor, the White House can still help or hurt the current “law of the land.” Here is what the administration can still do to help or harm Obamacare—with the aid of Health and Human Services (HHS) secretary Tom Price.

  1. The lawsuit over cost-sharing reduction payments: Although the House of Representatives is currently winning, Trump has the power to stop defending the lawsuit that addresses the legality of these subsidies. If he did stop defending the lawsuit, 7 million people could lose their subsidies.
  2. The individual mandate: There is already an executive order in place telling government agencies to lessen the individual mandate’s burden on individuals. The IRS has agreed to “use a light touch” when enforcing the law, which “requires people to sign up for health insurance or pay a fine.”
  3. Advertising the public healthcare Marketplace: Trump’s administration pulled some ads and outreach toward the end of this year’s open enrollment period. “One big question is how much the Trump administration will encourage people to sign up for next year.” Without advertisements and outreach, enrollment could be undermined.
  4. Market regulations: The HHS has proposed rules in order to make the Marketplace more appealing to insurance companies. Some of the rules “could reduce the number of people taking advantage of loopholes in the [Affordable Care Act], potentially lowering premiums for the rest.”
  5. Political influence: Obamacare kept insurance companies in the Marketplace with the help of the Obama administration’s persuasion. Without such persuasion, insurance companies could decide to drop out of the Marketplace in greater numbers and leave some people with fewer choices.

News Update for March 24, 2017

News Update as of 4:25 p.m. CST

Obamacare Is Here To Stay

House Speaker Paul Ryan addressed the AHCA’s recent defeat in a press conference held this afternoon. “Obamacare is the law of the land. We’re going to be living with Obamacare for the foreseeable future.


While Ryan does not believe that Obamacare is viable, he has hopes that Tom Price will find ways to make the healthcare law sustainable. In the meantime, Ryan and the White House will move on to other priority issues.

News Update as of 3:12 p.m. CST

White House Pulls AHCA Ahead of House Vote

Republicans have decided to pull the American Health Care Act from the House floor. Despite last-minute concessions to conservative Republicans, the party still lacked the votes to approve the healthcare reform bill. House Speaker Paul Ryan was seen rushing to the White House during the House’s debate to inform President Trump. In a phone interview with The Washington Post, President Trump said, “We just pulled it.” The President did not cast blame on Ryan, telling The Washington Post, “I don’t blame Paul.”

Trump Demands Friday Vote on AHCA

Mick Mulvaney, Office of Management and Budget Director, issued strong words from Trump to lawmakers Thursday. Trump wants the vote on American Health Care Act to happen today (March 24), and if it fails, he will leave Obamacare in place and move on to other priorities.

The House Is Debating the American Health Care Act

Currently, the U.S. House is debating for and against the AHCA. The scheduled 4-hour debate began at 10:20 a.m. central and can be viewed live here. It still is not clear if the bill has gained enough Republican votes to pass.

Kansas Moves Forward With Medicaid Expansion Amid Federal Medicaid Debate

On Thursday, state lawmakers in Kansas moved a Medicaid expansion proposal forward. It is currently headed to the Senate floor, despite healthcare reform debates over Medicaid funding. Supporters of the expansion don’t want national debate to derail Kansas-state needs, but opponents want Kansas lawmakers to wait until federal debates over Medicaid-expansion funding have settled.

News Update for March 23, 2017

Healthcare Reform Vote Postponed

While the House planned to pass the American Healthcare Act tonight (Thursday, March 23), the vote has been postponed. The White House remains confident in its ability to vote quickly on the bill despite the delay. Sarah Huckabee Sanders, White House deputy press secretary, said, “Debate will commence tonight as planned and the vote will be in the morning to avoid voting at 3 a.m. We feel this should be done in the light of day, not in the wee hours of the night and we are confident the bill will pass in the morning.”

Last-Minute Changes to AHCA Aim to Appease Conservatives but Irk Moderates

Recent changes to the American health Care Act (AHCA) have been focused on persuading conservative Republicans, particularly the Freedom Caucus. Unfortunately, these changes might be repelling moderate Republicans.

Late Wednesday, conservatives of the Freedom Caucus added the removal of some essential health benefits (like prescription drugs, maternity care, and substance abuse treatment) and protections for people with pre-existing conditions to their list of things the bill must do before they will vote in favor of it. While even these changes may not guarantee all conservative voters, Randy Weber (R-Texas) of the Freedom Caucus told reporters, “Negotiations are taking place. The president’s moving our way.”

Moderate Republicans seem dissuaded by these potential additions to the AHCA. GOP Rep. Ryan Costello of Pennsylvania stated, “The Freedom Caucus has presented what it will take for them to get some yeses, and I think there are now members who will have to now evaluate things a little bit further.” A more strongly worded disapproval was given by Rep. Charlie Dent of Pennsylvania. Dent said, “After careful deliberation, I cannot support the bill and will oppose it. I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals.”

According to ABC News, at least 30 Republicans still oppose the AHCA.

Biden Speaks Out Against AHCA Before House Vote

On Wednesday, Former Vice President Joe Biden shared his strong opposition to the AHCA. Joined by fellow Democrats, Biden said, “The costs [of an Affordable Care Act repeal] are enormous” and the proposed healthcare bill uses tax benefits for the “transfer of about a trillion dollars” to wealthy households.

Two Non-ACA Healthcare Bills Have Been Passed by the House

On Wednesday, two healthcare bills were passed by the U.S. House:

  • R. 372, the Competitive Health Insurance Reform Act of 2017, means to repeal the McCarran-Ferguson Act. The McCarran-Ferguson Act is an antitrust exemption directed toward health insurance companies.
  • R. 1101, the Small Business Health Fairness Act, “would let a multi-state association health plan sell coverage outside its state of domicile, even if the other states objected. The regulators in the state of domicile would regulate the plan.”

Read more about the passing of these bills here.

News Update for March 22, 2017

The Senate Is Just as Divided Over the AHCA

If as few as 3 Republicans vote against the American Health Care Act (AHCA) in the Senate, it will fail. Factions of the Republican Senate want more from the AHCA, and they may be willing to kill the bill if they don’t see even greater changes. And those refining the bill will have a hard time pleasing these differing factions.

  • More Affordable Care Act (ACA) Repeal: Conservatives (particularly Rand Paul, Ted Cruz, and Mike Lee) have stated strong opposition toward the current draft of the AHCA and want stronger repeals of the ACA.
  • Planned Parenthood: Those defending Planned Parenthood (particularly Susan Collins and Lisa Murkowski) oppose the AHCA’s defunding of the program, but removing the bill’s current provision could upset conservative voters.
  • Medicaid: Those protecting Medicaid expansion (particularly Murkowski, Rob Portman, Shelley Moore Capito, Cory Gardner, Dean Heller, and Brian Sandoval) have expressed shared concerns about the bill’s plans to withdraw Medicaid expansion funding from their represented states. Removing this phase-out would upset conservatives, who want it to happen even sooner than planned in the bill.
  • Loss of Coverage & House Majority: Those concerned over the loss of coverage for people, as well as the loss of the House majority, make up the last two factions (Bill Cassidy and Tom Cotton). Bill Cassidy has grave concerns about the 24 million who will lose coverage based on the Congressional Budget Office (CBO) estimate. Tom Cotton “thinks the bill could endanger the House majority and won’t pass the Senate.”

Can Mitch McConnell Save the AHCA?

Senior United States Senator and Majority Leader Mitch McConnell will be in charge of altering the AHCA before it can be rejected by the Senate. On Tuesday, McConnell said, “We’re not slowing down. We will reach a conclusion on health care next week.”

How Do American Voters Feel About Current Healthcare Reform?

The Morning Consult and Politico recently published a new poll asking nearly 2,000 registered voters how they felt about the AHCA and other healthcare reform. Here are the results:

Reform Speed

  • 43% think the GOP needs to take more time
  • 17% think Republicans are taking the right amount of time

AHCA Effects on Healthcare Costs

  • 39% think healthcare costs will increase
  • 20% think healthcare costs will decrease

AHCA Effects on Quality of Healthcare

  • 32% think quality will decrease
  • 28% think quality will increase

AHCA Effects on the Healthcare System

  • 36% think the healthcare system will be negatively affected
  • 30% think the healthcare system will improve

Around half of the respondents stated that they were more likely to back the bill after the CBO predicted a $337 billion decrease in the federal deficit in 10 years, as well as an eventual 10% decrease in the average premium. However, over half of respondents stated that they were less likely to back the bill after CBO estimates that 24 million people would lose coverage and premiums would increase by 15%-20% for the first two years of the AHCA.

To see if your representative shares your feelings on upcoming healthcare reform, visit this NPR article.

News Update for March 21, 2017

House Freedom Caucus Won’t Vote as a Bloc, But That Doesn’t Mean a Yes Vote

The conservative House Freedom Caucus has around 3 dozen members, enough to kill the healthcare reform bill in the House if they voted against it as a bloc. However, chairman of the Freedom Caucus Rep. Mark Meadows (R-NC) has announced that the group will not be voting in bloc. “We’re not taking any official positions. I’m going to encourage them to vote for their constituents,” Meadows told reporters.

But this doesn’t mean the Freedom Caucus will be voting for the AHCA. Because of ongoing concerns with the bill, many members have expressed that they will vote against it in the House. A co-founder of the Freedom Caucus, Rep. Jim Jordan (R-OH) said after negotiations with the White House, “Nothing’s changed. We’ve still got lots of problems with this bill. … The president’s a good man, and the White House has been great to work with, but opposition is still strong with our group.”

Republicans Changing AHCA to Strengthen Chances of Passing It

While Democrats are set to oppose the AHCA bill, the White House is making changes to try and win more Republican votes.

  • A provision may be added to lower prescription costs with a “competitive bidding process”
  • An amendment may:
    • Remove a provision allowing consumers to move excess tax credit funds into health savings accounts (HSAs). Anti-abortion groups fear the provision allows taxpayers to fund abortions.
    • Accelerate the repeal of around a dozen Affordable Care Act (ACA) taxes.
    • Delay implementing the Cadillac tax again (from 2025 to 2026).
  • In addition to allowing states to choose block grants and requiring enrollees to provide proof of employment, Medicaid enrollees may:
    • Be required to renew their coverage every six months.
    • Lose the ability to request retroactive coverage.

While some have changed their votes based on recent changes to Medicaid, subsidies for older Americans, and ACA taxes, these changes aren’t enough to sway all lawmakers. Justin Amash, Michigan Rep. and strong critic of the bill, tweeted, “They haven’t changed the bill’s general framework. They don’t have the votes to pass it. They have seriously miscalculated.”

Republicans Reintroduce Small Business Healthcare Legislation

A bill passed by the House in 2003, which did not advance, has been reintroduced in help improve small businesses’ health insurance purchasing power. At the time, the bill was criticized because it “would do little to enhance the coverage options or control costs of many small businesses, especially those that employ older, sicker workers, while at the same time weakening consumer protections against plan insolvency and fraud.” “Health policy experts say there’s no reason to change that assessment now.” The bill would:

  • Establish nationwide “association health plans,” allowing small business owners to join associations and purchase health insurance in larger groups. In turn, this would ideally lower costs.
    • These plans have existed, but were not regulated well and neither states nor the federal government had clear authority over them. Fraud and insolvency cases in the ’70s and ’80s lessened the appeal of these plans.
    • Federal law was amended to let states regulate them, and in 2010 the ACA required them to meet qualified health plan standards.
  • Remove state regulations and give the federal Department of Labor oversight of association health plans.
  • Remove ACA group health insurance requirements but maintain individual health insurance ACA requirements for association health plans.
  • Allow association health plans to charge companies with more unhealthy workers higher premiums.


News Update for March 20, 2017

Likely Changes for the American Health Care Act (AHCA)

Under strong opposition, House Speaker Paul Ryan and other Republican leaders have opened the door to making changes to the AHCA. Particularly, the bill will likely see changes to states’ flexibility with Medicaid and individual coverage for older Americans. The House is expected vote on the bill this Thursday. Here is more on the proposed changes.

States’ Flexibility With Medicaid

  • States may gain the option to require “able-bodied Medicaid recipients to work” in order to receive coverage. Health & Human Services Secretary Tom Price and Administrator of Centers for Medicare and Medicaid Services Seema Verma have stated in letters to governors that they are open to this option.
  • States may have the option of receiving federal funding in the form of block grants, meaning they would receive a set amount of funding regardless of the state’s number of enrollees. The current legislation calls for per capita funding, meaning a set amount per enrollee.

Individual Coverage for Older Americans

  • Older Americans, those in their 50s and 60s, shopping on the individual market may see enhanced tax credits compared to the AHCA’s original proposal. Sunday, Ryan said, “We believe that we do need to add some additional assistance with people in those older cohorts.”
    • Americans in their 50s would receive $3,500 in refundable tax credits.
    • Americans in their early 60s would receive $4,000 in refundable tax credits.
  • There is no mention of how allowing insurance companies to charge older individuals more may change, but the CBO projection does not bode well, even with the increased subsidy amount. A 64-year-old with an income of $26,500 might end up paying up to $14,600 in 2026 under the AHCA. Compare this to the projected Affordable Care Act (ACA) cost of $1,700 in 2026.

Republican Governors Argue the Current AHCA “Hurts States”

Ohio, Michigan, Nevada, and Arkansas governors sent a joint letter to the House and Senate leaders arguing against the current version of the AHCA. Republican governors John Kasich (OH), Rick Snyder (MI), Brian Sandoval (NV), and Asa Hutchinson (AR) all signed the letter, which states that the AHCA “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to the state.” Each of these states expanded Medicaid under the ACA, and the governors outlined alternative approaches to Medicaid reform.

States Will Take Greater Share of Medicaid Costs Under AHCA

Moody’s Investors Service theorizes that states’ credit ratings could suffer under the AHCA. States would take on a larger share of Medicaid funding, increasing their borrowing costs and lowering the current value of bonds. Any funding decrease from the federal government would force states to reduce spending on their individual Medicaid programs, raise taxes, or do both.

Rand Paul Does Not Believe the AHCA Will Pass

Senator Rand Paul sat down with ABC’s “This Week” on Sunday to voice his feelings about the AHCA and its chances of passing through Congress: It won’t happen. “I think there’s enough conservatives that do not want ‘Obamacare Lite.’ … None of us ran on this plan,” Paul said.

News Update for March 17, 2017

Are You Confused by Terms in the Obamacare Repeal and Replacement Process?

Kaiser Health News has released a new article that helps clear up some of the more confusing terms pertaining to the Obamacare repeal and replacement process going on right now. Here are some of those terms. Check out the article for more details.

  • Budget Reconciliation: An obscure legislative process that permits bills to pass through Congress with just a simple majority. Budget reconciliation bills only deal with budgetary issues and can’t be filibustered.
  • Health Savings Accounts: HSAs allow consumers to save money on a tax-free basis for healthcare expenses.
  • High-Risk Pools: Insurance groups that cover individuals with pre-existing conditions. These individuals tend to have high health insurance costs.
  • Individual Market: The individual market is where people who don’t have health insurance through their employer or the government can get a plan from an insurance company.
  • Medicaid Block Grants: A block grant is when the federal government gives states a “set amount of money to pay for coverage for Medicaid recipients.” Right now, the federal government matches a percentage of a state’s Medicaid spending to help alleviate states’ costs.
  • Per-Capita Caps: With per-capita caps, states would get a fixed amount of money each year, but that fixed amount would be determined by how many people are enrolled in each Medicaid program.

American Health Care Act Narrowly Passes House Budget Committee

The Republican plan to repeal Obamacare passed a key hurdle on Thursday. The House Budget Committee “narrowly voted to move [the bill] to the House floor and recommended a series of changes to the plan reflecting concerns from conservatives and centrists.” The committee voted for two motions supporting more cuts to Medicaid beyond what is currently in the bill, as well as a third motion “endorsing a requirement that ‘able-bodied’ participants in [Medicaid] work in exchange for their benefits.” This is in line with what many conservatives have wanted from this bill. The committee voted 19 to 17 to advance the bill. All the Democrats and three Republicans voted against moving the bill to the House floor. All the dissenting Republicans are members of the conservative House Freedom Caucus. More revisions are expected soon.

Republican Leaders Planning Vote on AHCA Bill Next Thursday

GOP leaders have told reporters at CNN that they are planning on holding a vote on the American Health Care Act in the House of Representatives on Thursday. Thursday also happens to be the 7th anniversary of former President Barack Obama’s signing of the Affordable Care Act. The bill is currently being reworked to include Medicaid work requirements. Other changes “may also include making tax credits for older Americans more generous” in order to appease moderate Republicans.

Many in Disabled Community Worried About Medicaid Cuts

Medicaid covers some in-home and transportation services for disabled people in every state. However, the federal government doesn’t require those things to be covered. It does require that states cover “doctor’s visits, nursing home care and laboratory tests.” In-home and transportation services are important for providing disabled people with a degree of independence throughout their everyday lives. These services aren’t required by the federal government. Many people are worried that if federal Medicaid funding decreases, these services would be the first to go and disabled people will see their quality-of-life and independence greatly decreased.

News Update for March 16, 2017

Speaker Paul Ryan Changes Tune, Says AHCA Must Change In Order to Pass House

In a private meeting on Wednesday, Speaker of the House Paul Ryan told House Republicans the American Health Care Act would have to be modified if Republicans wanted to pass it through the House. The bill had initially been crafted by Republican leadership in the House with little input from rank-and-file Republicans. However, resistance from within Ryan’s own party, coupled with an unfavorable Congressional Budget Office report, made Ryan walk back “from his earlier position that the carefully crafted legislation would fail if substantially altered.” Ryan hasn’t given any details on what changes are currently under consideration. “Now that we have our [CBO] score we can make some necessary improvements and refinements to the bill,” said Ryan.

Republicans Debate Adding and Subtracting Different Provisions from Obamacare Repeal

Some Republican leaders are thinking about getting rid of a provision in the American Health Care Act. As a way of replacing the individual mandate, which requires that eligible Americans sign up for health insurance, the AHCA would institute a provision that would require insurance companies “to charge a 30 percent penalty to customers who go without coverage for at least 63 days.” Like the individual mandate, this 30 percent penalty is also an incentive to encourage young, healthy consumers to buy insurance so that insurance pools will have the finances to cover people with pre-existing conditions. Many conservatives are not onboard with the 30 percent penalty, believing that it is another form of the individual mandate. Senator Ted Cruz (R-TX) called for something that would “scrap the requirement to cover pre-existing conditions along with other [insurance company] regulations.” Cruz believes these regulations to be the “principal driver of skyrocketing premiums.”

Conservative House Republicans are also proposing an amendment to the AHCA that “would institute work or education requirements for Medicaid.” The hope is that this Med