health insurance

Colorado continues innovative approach to reducing health care costs – State of Reform

Billie S. Dickenson July 3, 2022

Colorado became the first state in the country to have a state-designed health care insurance option for its residents approved by CMS last Thursday.

Approval of the Colorado Option through the federal 1332 waiver now means the state can proceed with rate setting for its standardized health insurance plan, which is mandated to be sold at lower prices and should be finalized by summer’s end to take effect in 2023, culminating a decade’s worth of health policy efforts aimed at reducing health care costs.

 

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Those efforts include the state’s reinsurance program, which was extended for an additional 5 years last year and spreads risk across the health insurance market to help insurers pay expensive claims, and the Hospital Provider Fee that supports hospitals serving Medicaid and uninsured patients.

The Division of Insurance recently finalized its reinsurance payment parameters for 2023 that aims to maximize rate reductions, increase enrollments, and improve morbidity all while encouraging engagement and competition among carriers and providers in the individual marketplace.

In its most recent legislative session, Colorado enacted 3 pieces of consumer protection legislation, House Bills 1284, 1285, and 1370, all designed to lower health care costs.

HB 1284 requires emergency medical services to be billed at the in-network rate regardless of the facility and guards against unexpected and costly charges. HB1285 prohibits hospitals from pursuing debt collection if federal price transparency standards are not followed, requiring providers to publicly post their standard pricing for various services. 

Meanwhile, HB 1370 requires carriers to implement a copayment-only structure for prescription medications in at least a quarter of their health plans. 

CMS hailed Colorado as a national leader in health care cost reduction efforts.

“Through this new model, Colorado leverages federal savings to expand affordability and coverage in the state like no other state has done before,” said CMS Administrator Chiquita Brooks-LaSure. “The Colorado Option is groundbreaking and a step in the right direction to reduce the uninsured rate, while investing in health insurance coverage affordability and improvements, and advancing health equity. We encourage all states to consider innovative ways to use section 1332 waivers in the future to expand and improve coverage and lower costs for their residents.”

Passed in 2021, the Colorado Option instructed state regulators to write up a “standardized plan”—a consistent package of benefits and cost structures like co-pays—that insurance companies are mandated to sell with premiums 5% below what they were in 2021, after inflation adjustments. That target increases to 15% below by 2025.

Offered only on the individual and small group markets, the plan is designed to save the federal government on its existing insurance premium subsidies by creating what are known as “pass-through” savings that can come back to the state.

The state’s waiver application estimates those savings would amount to $13.3 million in 2023 and $147.9 million by 2027.

The moves come as Coloradans struggle with higher costs of living.  

In the current environment of inflation, cost of living has emerged as a “serious” problem according to nearly 90% of those recently polled by the Colorado Health Foundation.  In its adjacent poll, two-thirds of Coloradans characterized the cost of health care as a “very serious” problem. 

This sentiment was reflected by the Colorado electorate who voted for moderate candidates in Republican primaries, results that reflect broad support for “kitchen table” issues, according to local politics reporter Marianne Goodland.

The percentage of personal consumption expenditures on health care services climbed to 14.9% in 2019 prior to the pandemic.

Source: Colorado Department of Health Care Policy and Finance

 

The inflationary trends have insurance companies skeptical that reduction targets can be met while being actuarially sound. The Colorado Association of Health Plans stated that the methodology used to calculate inflation, the Consumer Price Index’s medical index, will not reflect the true rise in costs being seen on the ground.

In 2020, providers along Colorado’s Front Range reported a 25% drop in health care visits that had “profound” impacts on the health of Coloradans, according to the Colorado Health Institute.

That delay in care along with the persistent workforce shortage have contributed to rising health maintenance costs, according to the Colorado Hospital Association (CHA), as providers struggle to meet the pent-up demands of a growing population.  

“Much of the focus of state policy in recent years has been on health care affordability,” said Katherine Mulready, Chief Strategy Officer and Vice President for Legislative Policy at CHA. “The reality is that when supply outstrips demand, prices rise. So this does not portend well for affordability, which in turn, doesn’t portend well for access. We’re talking about both indirect access of costs, but also direct access. 

The provider is not there when you need them to be there. There’s not a lot of optimism I can paint in that picture right now other than we’re doing everything we can to stave off [the] continued crisis.”

Providers nationwide are coordinating efforts to reimagine health care where telemedicine is emerging as a solution to meeting demand and improving access.

Mulready said the association is utilizing new tools and roles as a part of that reimagination, such as advocating a policy that would allow greater use of certified registered nurse anesthetists in advanced practices to manage some anesthesiologist services.

“The policy principle that underlies all of our workforce is allowing the market or allowing employers the flexibility they need to continue to deliver high quality and accessible care,” Mulready said. “As long as we can find a professional who has the experience and training to do the tasks that’s being contemplated, we should be able to use them and we shouldn’t see artificial limitations on their scope through their licensing boards or other places. Some of that’s reimbursement policy, some of that’s licensing policy, some of its facility policy, but there’s a lot of work. [CHA is] invested there to try to advance that reimagination of care delivery.”

Gov. Jared Polis has made clear his administration’s goal of lowering health care costs for consumers. In 2020, for instance, Polis vetoed a bill that would have increased coverage for alternative opioid treatments over concerns the measures would increase private insurance costs.

As costs rise and the midterm elections approach, health policy advocates will look to continue striking that balance between holding the line on health insurance prices and adding benefits for Coloradans in next year’s legislature.

 

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Gov. Wolf Urges Congress to Preserve Affordable Care Act Subsidies to Ensure Health Care Remains Affordable for Tens of Thousands of Pennsylvanians

Billie S. Dickenson July 2, 2022


Healthcare,  Press Release

Governor Tom Wolf is urging Congress to take action to preserve Affordable Care Act (ACA) subsidies to ensure that individuals and families who were eligible for this important subsidy may continue to obtain health care. 

In a joint letter, Gov. Wolf and 13 other governors urged Congress to take action and ensure funding is in place to preserve ACA subsidies known as advanced premium tax credits
(APTCs), which were expanded through the American Rescue Plan Act of 2021. The ARPA-expanded subsidy eligibility is set to expire at the end of the current plan year, leaving consumers exposed to dramatic premium increases.

“Tens of thousands of Pennsylvanians will be impacted if this subsidy expansion expires in December, which will mean their insurance premiums will increase, putting individuals in a health and financial risk. It’s critical that we continue to make affordable coverage as accessible as possible to as many as possible, and I applaud President Joe Biden for his leadership to not only expand coverage as part of ARPA, but also to make it permanent,” Gov. Wolf said. “I urge Congress to make these subsidies permanent so that Pennsylvanians can continue to have a better quality of life through affordable comprehensive ACA coverage.”

Governor Wolf has made access to affordable health coverage a priority throughout his administration.

In July 2019, Governor Wolf signed legislation establishing Pennie, the state-based ACA marketplace. Pennie replaces healthcare.gov as Pennsylvania’s official destination for shopping for quality health insurance plans and the only source of financial assistance to help with the cost of coverage and care. Currently there are nearly 360,000 Pennie customers throughout the commonwealth.

In addition to Pennie, Governor Wolf expanded Medicaid in 2015 — one of his first acts as governor — ensuring more Pennsylvanians have access to Medical Assistance in Pennsylvania. Today, more than 3.3 million Pennsylvanians are covered by Medical Assistance including almost 1 million people through the expansion. By expanding access to health care, the commonwealth realized the lowest uninsured rate in Pennsylvania history during the Wolf Administration and insurance rates are now the most stable year over year than they’ve ever been.

View a copy of the letter: 

As governors, we are working to expand access to quality, affordable healthcare for the people of our states. Since the beginning of the pandemic, we have seen the tragic impact of disease and illness among the uninsured and underinsured, particularly in communities of color and other underserved populations. As we have experienced during the COVID-19 pandemic, access to affordable health insurance can sometimes mean the difference between life or death. At a time when governments at all levels are struggling to find ways to reduce costs for the American people, we cannot allow the looming specter of rising health costs to cause more uncertainty and stress for American families. Therefore, we urge you to take action and ensure funding is in place to preserve Affordable Care Act (ACA) subsidies known as advanced premium tax credits (APTCs). 

We applaud Congress for the passage of the American Rescue Plan Act of 2021 (ARP), which expanded and enhanced ACA APTCs. The ARP’s expansion of subsidies, along with the Biden Administration’s investment in marketing and enrollment support, led to a record high 14.5 million people signing up for ACA coverage during the most recent open enrollment period, a 21 percent increase from the prior year.

Health insurance coverage is critical to ensure consumers have access to healthcare and the best way to increase enrollment is to make coverage more affordable. The ARP has lowered costs for consumers: families saved an average of $200 a month in premiums, with four out of five consumers eligible to obtain a plan for $10 or less. The ARP expanded access to financial assistance and increased the number of consumers eligible for subsidies by 2.8 million in 2022 compared to the prior year.3 With the Biden Administration’s reinvestment in the ACA and the proposed rulemaking to fix the “Family Glitch,” we have a historic opportunity to build upon these enrollment gains and affordability improvements next year and in years to come.

Unfortunately, the ARP-expanded subsidy eligibility is set to expire at the end of the current plan year, leaving consumers exposed to dramatic premium increases, and threatening the progress we have made. As inflation continues to put a strain on consumers’ budgets, we are concerned that many people will choose to reduce health insurance coverage or even go without coverage if Congress fails to act. The Biden Administration estimates that approximately 3.4 million consumers currently enrolled could lose coverage if the ARP subsidy expansions expire at the end of 2022. The expiration of the enhanced subsidies would also lead to a decrease in enrollment and an increase in premiums, destabilizing health insurance markets, and impacting affordability for the broader population. Additionally, as the Public Health Emergency is expected to end in the coming months, some consumers will no longer be eligible for Medicaid but may become eligible for ACA subsidies. Without the enhanced subsidies to ensure there are affordable marketplace options, those consumers are likely to become uninsured.

Healthcare is a right—not a privilege. The ARP greatly improved health insurance affordability to ensure lifesaving healthcare is accessible to all Americans. We urge you to take action immediately to make the ARP expanded subsidies permanent to prevent a disastrous erosion of health insurance coverage.

Health insurance premiums through marketplace poised to jump in 2023

Billie S. Dickenson July 1, 2022

The Good Brigade | Digitalvision | Getty Images

If you get your health insurance through the government Health Insurance Marketplace, you may want to brace for higher premiums next year.

Unless Congress takes action, enhanced premium subsidies — technically, tax credits — that have been in place for 2021 and 2022 will disappear after this year. The change would affect 13 million of the 14.5 million people who get their health insurance through the federal exchange or their state's marketplace.

"The default is that the expanded subsidies will expire at the end of this year," said Cynthia Cox, a vice president at the Kaiser Family Foundation and director of its Affordable Care Act program. "On average, premiums would go up more than 50%, but for some it will be more."

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Most enrollees — which includes the self-employed and workers with no job-based health insurance — receive subsidies, which reduce what they pay in premiums. Some people also may qualify for help with cost-sharing such as deductibles and copays on certain plans, depending on their income.

Before the temporary changes to the calculation for subsidy eligibility, the aid was generally only available to households with income from 100% to 400% of the poverty level.

The American Rescue Plan Act, which was signed into law in March 2021, removed — for two years — that income cap, and the amount that anyone pays for premiums during the reprieve is limited to 8.5% of their income as calculated by the exchange.

Assuming Congress does not extend the expanded tax credits, only people with household income from 100% to 400% of the federal poverty level will once again qualify for subsidies.

Exactly how much of a premium increase a person would see depends on income, age, the premium cost where they live and how the premiums charged by insurers change for next year, according to Kaiser.

Here's a hypothetical example, based on a report from the Congressional Budget Office: Say a 64-year-old with $58,000 in income — about 430% of the 2022 poverty level of $13,590 — has insurance through the exchange. The 8.5% limit currently in place means they would pay no more than $4,950 for premiums this year. However, if faced with a 400% cap on eligibility in 2023, that same person would pay $12,900 for premiums because they'd no longer qualify for subsidies.

A proposal to extend the extra subsidies through 2025 was included in the Democrats' Build Back Better bill, which cleared the House last year but fell apart in the Senate.

It's uncertain whether the provision will be revived in some form via other legislation that Democrats may try to get through the Senate before a new Congress starts in January — the makeup of which could look very different due to the midterm elections Nov. 8.

New Study: Employer-Sponsored Health Insurance Produces +47% Return on Investment for American Businesses

Billie S. Dickenson June 30, 2022

Washington, D.C. — Employers in the United States this year will earn an average return on investment (ROI) of 47% from their employer-sponsored health insurance (ESI) programs, according to a new study from Avalere Health. This means for every dollar spent on ESI, employers get back $1.47 in financial benefits. The analysis from the health data firm finds that the average ROI is projected to grow to 52% in 2026, and that businesses that invest more in their ESI programs tend have a higher ROI. 

While providing employees high quality health insurance is the right thing to do for workers, the report shows how it makes business sense. Avalere attributes the direct financial return for employers to lower direct medical costs, increased productivity, lower recruitment costs, stronger retention, lower short- and long-term disability costs, as well as tax benefits. More than 155 million Americans currently get their health insurance through ESI.  

The study was commissioned by the U.S. Chamber of Commerce on behalf of the Protecting Americans’ Coverage Together (PACT) campaign. PACT members, including the U.S. Chamber of Commerce, Business Roundtable, The National Association of Manufacturers, Council for Affordable Health Coverage, and Vermeer Corporation, represent leading employer voices focused on strengthening the employer-sponsored insurance (ESI) system and protecting the coverage and benefits that American families depend on for their health.  

The report from Avalere looks across industries at trends that drive ROI higher and lower. Avalere highlights the manufacturing industry as an example, finding American manufacturers see an ROI of 42% on their ESI programs.  

“Employee-sponsored health insurance is a win-win for employers and employees,” said Katie Mahoney, Vice President of Health Policy at the U.S. Chamber of Commerce. “We know employees place a high value on quality health insurance in the workplace, and now we have more evidence that employers benefit significantly from investing in these programs as well. Employer-provided coverage is the backbone of the American health care system, and this report reinforces that any reforms should build off this model that is good for workers and companies alike.”  

“Improving productivity and wellness make America more competitive and prosperous,” said Joel White, President of the Council for Affordable Health Coverage. “While employers offer health coverage to improve the health and welfare of their employees, employees and their families benefit significantly. This study shows that Congress and the Administration must work to expand job-based coverage, not weaken it. 

“Manufacturers are in the business of innovating and delivering best-in-class products to their customers,” said Robyn Boerstling, Vice President, Infrastructure, Innovation and Human Resources Policy at the National Association of Manufacturers. “That philosophy extends to the benefits provided to their employees, and this report further validates that offering comprehensive and innovative health benefits is not only the right thing to do but also critical to attracting and retaining the best talent. We are proud that approximately 99% of NAM member companies offer health benefits to employees, and working Americans understand the value and competitiveness of employer-sponsored health care.”  

“As an employer, knowing who we are caring for and the communities they come from gives us the advantage of providing access to quality, affordable care to our team and their families,” said Vermeer Corporation. “It is an incredibly important part of how we care for our people.” 

The study, which examined employers with 100 or more employees, defined ROI as “the monetary value of benefit for each dollar employers invest in healthcare coverage. Investment in ESI may include health insurance premiums, wellness programs, direct medical expenses, administrative costs associated with processing medical claims, and other costs associated with providing health insurance. Avalere calculated the ROI derived from ESI by dividing the total employer benefits by the total costs of providing ESI.”  

The full report including methodology can be found here.

# # # 

They Thought They Were Buying Obamacare Plans. What They Got Wasn’t Insurance.

Billie S. Dickenson June 28, 2022

[UPDATED on June 8]

Tina Passione needed health insurance in a hurry in December. The newly retired 63-year-old was relocating to suburban Atlanta with her husband to be closer to grandchildren. Their house in Pittsburgh flew off the market, and they had six weeks to move out 40 years of memories.

Passione said she went online to search for the federal health insurance marketplace, clicked on a link, and entered her information. She promptly got multiple calls from insurance brokers and bought a plan for $384 a month. Later, though, when she went to a pharmacy and doctor offices in Georgia, she was told she did not have insurance.

In fact, it said it right on her card: “THIS IS NOT INSURANCE.”

Passione is one of 10 consumers who told KHN that they thought they were buying insurance but learned later that they had been sold a membership to a Houston-based health care sharing ministry called Jericho Share. The ministry formed in 2021 when House of Prayer and Life Inc., a half-century-old Christian congregation, assumed the name Jericho Share, according to Texas business filings.

Health care sharing ministries are faith-based organizations whose members agree to share medical expenses. The ministries grew in popularity before the Affordable Care Act’s mandate for having insurance coverage was repealed because they offered a cheaper alternative to insurance. But they are not insurance, largely not regulated as such, and don’t necessarily cover members’ medical bills. Massachusetts is the lone state that requires ministries to regularly report data, and only about half of claims submitted to ministries there were deemed eligible for payment. This spring, the Colorado legislature passed similar requirements that await the governor’s signature.

The Better Business Bureau gives Jericho Share an F rating, its lowest, and its website shows more than 100 complaints filed in less than a year. Texas Department of Insurance documents show two complaints, from February and March, about Jericho Share. The department responded to both by saying it regulates insurance, which ministries are not, and forwarding them to the state attorney general’s office. The attorney general’s office did not respond to KHN questions about the status of the complaints.

John Oxendine, a lawyer who was elected four times as Georgia’s insurance commissioner, responded to KHN’s inquiries made to Jericho Share. He is currently facing federal charges of conspiracy to commit health care fraud that he said are unrelated to Jericho Share. He denied any wrongdoing. If Jericho memberships are being sold to consumers in misleading ways, “that’s a good way for a broker to get fired,” he said.

“Jericho Share does not tolerate any type of misrepresentation or unethical conduct on the part of its programs,” according to a statement sent through Oxendine. “Whenever we become aware of inappropriate conduct, we take appropriate action to remedy the situation.”

Consumers can always cancel their Jericho Share plans, Oxendine said. Many consumers who spoke to KHN did cancel their plans and receive refunds, but several said the process to do so was frustrating. Some were left to sort out payment for bills they incurred while they thought they were insured. At least seven of the people KHN spoke with said they ended up with Jericho Share after beginning their health insurance searches on Google.

A screenshot of a Google search for "healthcare marketplace" shows three advertisement links before a listing for healthcare.gov, the federal government's health insurance marketplace.
A screenshot taken May 11, 2022, shows advertisements for “lead-generating” websites that popped up after Googling “healthcare marketplace.” The most relevant search result is the federal government’s official health insurance marketplace, healthcare.gov.(KHN screenshot of Google.com)

Encountering such issues while shopping for health insurance is not uncommon, said JoAnn Volk, co-director of Georgetown University’s Center on Health Insurance Reforms. She co-authored a 2021 report that found “misleading marketing practices” were directing consumers to alternative health plans, like ministries, that can cost more than marketplace plans and offer fewer protections.

“It’s especially unfortunate because people have set out to buy comprehensive coverage,” Volk said.

Susan Fauman looks at the camera while taking a selfie. The background behind her is blurred.
Susan Fauman thought she was buying health insurance but learned later that she had bought a membership to Jericho Share, a Houston-based health care sharing ministry.(Susan Fauman)

Susan Fauman, 47, a metalsmith from Germantown, New York, relied on her spouse’s insurance coverage but wanted her own insurance policy before submitting her divorce paperwork last fall. Fauman said her Google search landed her on a series of what the advertising industry calls “lead-generating” websites: nongovernmental webpages that connect insurance brokers to consumers.

None of the consumers KHN spoke with could say with certainty which site ultimately connected them to the brokers who sold them Jericho Share memberships. ObamacarePlans.com and AffordableHealthPlans.org are among the lead-generating websites that show up on Google when someone searches with terms such as “Obamacare insurance” or “healthcare marketplace.” Those site listings are actually advertisements that resemble ordinary Google search results but are labeled with the word “Ad” and are placed above the most relevant search result: the federal government’s official health insurance marketplace, healthcare.gov.

Google spokesperson Christa Muldoon said companies that advertise on searches related to the Affordable Care Act must prove they are licensed to sell insurance via the federal or state marketplaces.

Those marketplaces let consumers shop for comprehensive health insurance, tell them whether they qualify for financial assistance, and connect consumers with enrollment assistance, if needed. By contrast, lead-generating websites typically just sell the personal information provided by consumers to insurance brokers and agents who can sell other types of plans.

Fauman said she unwittingly put her information into what turned out to be several lead-generating websites. She was soon inundated with phone calls from insurance brokers, she recalled.

Eager to get insurance, Fauman said, she bought a plan for about $330 a month, plus a $99 sign-up fee. She said the broker — who, she later realized, never named the plan — said she’d have basically no copays and no restrictions on where to get care. But he did not tell her it was a health care sharing ministry, she said, or that it wasn’t insurance — something she didn’t know to ask about. When she received her Jericho Share card with its disclaimer, she thought, “What the hell did I sign up for?”

Ministries and aggressive insurance marketing practices have raised eyebrows before, and the Washington state attorney general issued a consumer alert last year about “ads and websites posing as the official health insurance marketplace.” But Georgetown University’s Volk said large-scale crackdowns would likely require cooperation by multiple state regulators because states are the default enforcers of insurance rules. The Federal Trade Commission did bring a case against a Florida-based operation in 2018, alleging it collected over $195 million by enrolling consumers in “worthless plans.” The case is ongoing.

And it’s not always clear who can and should be protecting consumers in this complicated space that covers public and private insurance, interstate commerce, websites, and health care sharing ministries.

The Centers for Medicare & Medicaid Services manages the healthcare.gov website. “When CMS sees an ad we think is misrepresenting HealthCare.gov, we share it immediately with the search engines,” deputy administrator Ellen Montz said in a statement.

Louise Rasho, a spokesperson for MediaAlpha, which operates ObamacarePlans.com, said in an email that the company’s code of conduct does not allow brokers who buy customer leads to mislead consumers. It periodically monitors calls to ensure compliance. She also noted the site has disclaimers saying that it is not a government website.

Craig Sturgill of Excel Impact LLC, which owns AffordableHealthPlans.org, said that if the company learns a broker has broken the law or used questionable tactics, it terminates contracts and takes “further action” as necessary. “As a digital marketing company, we aren’t necessarily in the business of deeply educating consumers from beginning-to-end about all of their available options,” Sturgill said in an email. “Our role is to connect consumers to advisors who can and should effectively educate consumers.”

The broker callback number that consumer Hemani Hughes said she used to correct the spelling of her name on her Jericho Share plan — before she realized it was a ministry — is listed on the websites of the Better Business Bureau and the Utah Insurance Department as belonging to Florida-based Prosperity Health LLC. In an email, Prosperity Health’s registered business agent, Ahmed Shokry, said it had “never sold Health Shares.”

Hughes, a 49-year-old communications strategist in Kansas, said she was sold a Jericho Share plan in February after specifically telling a broker she did not want a health care sharing ministry plan. Hughes said she realized after her call that the broker never mentioned the plan by name, saying only that she was signing up for a “national PPO” and walking her through the copays.

When Hughes realized it was a health care sharing ministry, she said, she called to cancel her plan. She was met with what she described as “a pretty manipulating and very belligerent gantlet of customer service reps and hold times” over multiple calls.

At one point, Hughes said, the people she was speaking with told her it was irresponsible to go without insurance — even though Jericho Share itself is not insurance.

Tina Passione smiles while taking a selfie outdoors.
When Tina Passione was searching for health insurance online, she entered her information into what she thought was a government website for Affordable Care Act plans. After being inundated with calls, she purchased a plan. But when she went to the pharmacy and doctor offices, she was told she did not have insurance. In fact, it said it right on her card: “THIS IS NOT INSURANCE.” (Tina Passione)

Hughes outlined her story in a complaint she filed with the Better Business Bureau. Jericho Share responded to the consumer watchdog that it was contacting Hughes directly to protect her private health information and said, “We are working very diligently to investigate this complaint thoroughly.” Hughes ultimately received a refund.

Passione said she filed her complaint with the Better Business Bureau after she couldn’t get a straight answer about payment for her doctor appointments and prescriptions. In March, Passione canceled her Jericho Share plan and signed up for COBRA coverage through her former employer for $782 a month.

“A bit expensive, but at least I know what I am getting,” Passione said.

She said she was reimbursed by Jericho Share for one month’s payment and is waiting to hear whether her credit card company can recoup payments she made in January and February.

Fauman, who also filed a complaint, received a refund, too, but spent two months uninsured and avoided calling her doctor while she sorted out the situation.

“I was afraid of what it was going to cost me,” Fauman said.

She eventually got marketplace insurance with the help of a “navigator,” someone trained to help consumers enroll in coverage without earning a commission. After subsidies, Fauman’s premium is around $95 a month, costing her about $2,800 less a year than what she said her Jericho Share plan would have — and her new plan is actually insurance.

Where to Buy Marketplace Insurance
To find a health insurance plan, visit the federal marketplace, healthcare.gov, or call 800-318-2596.

[Update: This article was revised at 11:15 a.m. ET on June 8, 2022, to report lawyer John Oxendine’s unrelated indictment charges.]

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Possible Expiration of Pandemic-Era Measures Among Drivers of 2023 Health Insurance Premium Changes

Billie S. Dickenson June 25, 2022

WASHINGTON, June 22, 2022 /PRNewswire/ -- The American Academy of Actuaries has released a public policy issue brief that points to the possible expiration of two signature pandemic-era measures that boosted health insurance affordability and coverage as among the drivers of potential premium changes for individual and small group plans in 2023.

American Academy of Actuaries. (PRNewsFoto/American Academy of Actuaries)American Academy of Actuaries. (PRNewsFoto/American Academy of Actuaries)

American Academy of Actuaries. (PRNewsFoto/American Academy of Actuaries)

"Proposed health insurance premium rates reflect many factors, which can include the effects of legislative and regulatory changes," said Academy Senior Health Fellow Cori Uccello. "This is especially true for 2023 rates, due to the possible expiration later this year of enhanced Affordable Care Act (ACA) premium subsidies and of a key support of Medicaid coverage during the pandemic."

The issue brief, developed by the Academy's Individual and Small Group Markets Committee, Drivers of 2023 Health Insurance Premium Changes, discusses these key factors and others that may account for differences in premium rates being filed with state insurance departments this year for 2023, compared to 2022 rates. The factors are illustrated in a new infographic as well.

The American Rescue Plan Act of 2021 (ARPA) increased advanced ACA premium tax credits in 2020 and 2021 for all eligible income brackets, including extending tax credits to those who earn over 400% of the federal poverty level. These subsidies, which make plans more affordable, are set to end with the expiration of ARPA on Jan. 1, 2023, reversing enrollment gains and possibly worsening plan risk pools.

Provisions in the Families First Coronavirus Response Act (FFCRA) increased federal fiscal aid to states for covering Medicaid enrollees during the pandemic-related Public Health Emergency (PHE), contingent on the states suspending their usual processes for redetermining eligibility for Medicaid coverage. These provisions are set to expire at the end of the quarter in which the PHE is not renewed, which could happen this year. In that event, states could restart the usual redetermination process, meaning some individuals who received Medicaid coverage during the pandemic could no longer be eligible for Medicaid and shift to the individual market, the employer group markets, or become uninsured—a shift that could affect risk pools in the individual and small groups markets.

Other factors expected to drive premium rate changes for 2023 include changes to the composition of the small group market due to the continued shift of small employers to self-funded, level-funded, or other risk-rated coverage, or otherwise leaving the market; changes in utilization patterns for telehealth visits and for mental health care; and changes in provider contracting including the expected impacts of medical inflation. The costs of preventing, testing for, and treating COVID-19, while expected to stabilize, could also be important factors for certain health insurance plans, depending on projected trends in the pandemic, particularly should a new variant emerge that is not mitigated by the immunity provided by prior infections or vaccinations. State-level measures such as reinsurance programs aimed at lowering premiums could also reduce premiums, with an outsized reduction in the first year of new reinsurance programs.

Learn more about the Academy's health policy work under the public policy tab at actuary.org.

The American Academy of Actuaries is a 19,500+ member professional association whose mission is to serve the public and the U.S. actuarial profession. For more than 50 years, the Academy has assisted public policymakers on all levels by providing leadership, objective expertise, and actuarial advice on risk and financial security issues. The Academy also sets qualification, practice, and professionalism standards for actuaries in the United States.

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SOURCE American Academy of Actuaries

Republican states trying to ban abortion expand health benefits for new mothers | Abortion

Billie S. Dickenson June 24, 2022

A number of Republican-led states that are moving to ban abortion are, at the same time, extending health insurance benefits to new mothers, professing to support “women in crisis”.

As the US supreme court prepares to rule on national abortion rights, many Republican states are seeking severe abortion bans that would force many women to carry pregnancies to term, likely worsening the US maternal mortality crisis.

Some of those same lawmakers are now passing bills that extend Medicaid benefits to low-income mothers, typically for one year after they give birth rather than the current two months.

Arizona, Florida, Tennessee and Texas have all extended health benefits for low-income mothers in recent months, and Alabama and Georgia have both moved to implement such extensions, according to the Kaiser Family Foundation. All have also sought to impose severe abortion restrictions or bans.

Although expanding pregnancy-related health coverage is “a win in many ways”, it does not counteract the fact that abortion bans “would certainly lead to higher risks for maternal morbidity or mortality,” said Sarah Blake, an associate professor of health policy at Emory University in Georgia.

Blake said Georgia lawmakers are in “Jekyll and Hyde mode”. Even as advocates for maternal health, herself included, are “very happy” for the extension, she said, “we know the state is very against women and their access to full scope reproductive health services”.

Changes to postpartum benefits come as the supreme court is expected to rule in the coming days on a critical abortion rights case, Dobbs v Jackson Women’s Health Organization. A leaked draft opinion showed conservative justices are on the verge of ending federal abortion protections. If that happened, 26 states would be certain or likely to ban abortion.

“It shows you how [Republicans] are not operating in good faith,” said Loretta Ross, an associate professor at Smith College in Georgia and a reproductive justice activist. “If they really cared about maternal mortality they’d reduce the causes of maternal mortality – and it goes way beyond Medicaid expansion.”

State legislators in both Democrat- and Republican-led states have made changes to Medicaid, a federal and state partnership that provides health insurance for the poor and disabled, to take advantage of a provision of federal pandemic aid which streamlined postpartum benefit changes.

However, the most dramatic effects would be in Republican-led states, where lawmakers have long refused to expand the program to more low-income people.

The refusal is a legacy of Obamacare debates. Around the time the Affordable Care Act, better known as Obamacare, Republicans sued to stop the expansion of Medicaid. They succeeded in the supreme court, and each state was forced to adopt Medicaid expansion individually.

A dozen states, mostly in the US south, still refuse to do so, even though the federal government would pay 90% of the costs of expanding the program.

Expanding Medicaid only to postpartum women appears to be a way for Republican-led states to champion their aid to a sympathetic group, even as they oppose broader Medicaid expansion and ban abortion, said Ross.

In Texas, for example – a state where one-quarter of women of reproductive age lack health insurance, the highest rate in the nation, and which is among the 10 worst states for maternal mortality – lawmakers recently expanded Medicaid to pregnant patients for six months after giving birth, instead of two.

A single adult supporting two children cannot earn more than $2,760 a year and qualify for Medicaid – unless they are pregnant, in which case they can earn up to $45,600 a year and qualify. However, the exemption previously lasted just 60 days after birth – the federal minimum – after which most people become uninsured once again.

The expansion to six months is welcome but insufficient, said Erika Ramirez, director of policy and advocacy for the Texas Women’s Healthcare Coalition: “We got six, which is better than nothing … [But] over and over, [the] top recommendation [from maternal health experts] has been for women to get postpartum care for a full 12 months.”

When the legislation was signed, Texas state senator Lois Kolkhorst, who sponsored it, described the Medicaid extension as a “bipartisan effort to help keep Texas moms healthy and provide the care needed to avoid preventable deaths and illnesses” .

Yet just two days before the bill passed in the Senate, Kolkhorst and her Republican colleagues passed a total abortion ban, which is expected to go into effect immediately if the US supreme court ends federal abortion protections. It is one of 26 abortion restrictions Kolkhorst voted for in her 11-year career as a legislator.

A similar effort to simultaneously extend Medicaid to pregnant women and ban abortion is under way in Alabama. There, one of the most vocal proponents of expansion is Republican state representative Debbie Wood, who also opposes abortion in nearly all circumstances, including rape and incest.

Kolkhorst could not be reached for comment and Wood did not respond to requests for an interview.

In Tennessee, the Republican governor, Bill Lee, directly connected the state’s postpartum Medicaid expansion and abortion. At a press conference in May, he spoke about Tennessee’s “trigger” ban, a law that will allow the state to immediately ban abortion if the supreme court ends federal protections.

“The lives of unborn children – it’s very important that we protect the lives of them,” he said, adding: “It’s also important that we recognize that women in crisis need support and assistance through this process. For example, that’s why we’ve expanded our postpartum coverage for women in TennCare.”

“This kind of strategy pits needy people against each other,” said Ross. “We’re supposed to advocate for postpartum women to get Medicaid, and screw everybody else who needs it? It’s a classic divide and conquer strategy.”

Links: Mark Shields’ death; universal health insurance; free speech

Billie S. Dickenson June 23, 2022

Political columnist Mark Shields died last week. There have been many tributes, all of which focused not only on his sharp commentary but also on what a decent person he was, and the fact that he was interested in, not appalled by, encounters with people who saw the world through different lenses from the ones he used. That is to say, he was an intellectual liberal as well as a political one. Two years ago, when he retired, his sparring partner on PBS's "NewsHour," David Brooks, wrote a lovely encomium.

There is nothing liberal about billionaire libertarian Peter Thiel, whom The Washington Post's Elizabeth Dwoskin profiled in Sunday's June 19 paper. I knew some but not all of this, and was especially intrigued by the title of a biography of Thiel: The Contrarian. Huh? There is nothing contrarian about this ideologue. That is what is so frightening about ideologues: Their ideological framework levels all of life's complexities. In their framework, no one hits a bump in the road, and it is those bumps that keep us humane. He is a 21st-century Ayn Rand with gobs of money. How boring.

In The Guardian, a report on the cost of not having universal health insurance: A new study indicates that the lack of such universal coverage in the United States resulted in an additional 338,000 lives lost during the pandemic and an additional $105 billion in health care costs. So, the next time someone says we can't afford universal health insurance, point out that we can't afford what we have, morally or financially.

At The New York Times, Coral Davenport takes a thorough and bracing look at the potential danger to environmental protections, and other necessary government functions, posed by a forthcoming Supreme Court decision in the case West Virginia v. Environmental Protection Agency. In this histrionic age, it is best to avoid the temptation to overstate the stakes in our various political and cultural battles. In this instance, to paraphrase a famous orator, extremism in the defense of common sense is no vice.

Politico looks at the challenges of changing newsroom cultures with a focus on the leadership of Sally Buzbee at The Washington Post, where she replaced Marty Baron in 2021. There is no way for democracy to function without a free press, and there are multiple dangers facing a free press today — some ideological, some financial, some cultural.

Relatedly, at The Atlantic, Conor Friedersdorf looks at the recent struggle at Georgetown University Law School over the limits of free speech. Newly hired Ilya Shapiro tweeted something that was undeniably stupid and offensive. He apologized, was suspended and the university investigated the matter. Shapiro ended up resigning but he also objected to the investigation by campus bureaucrats. The case raises serious issues about the direction of higher education. As health-law scholar Gregg Bloche told Friedersdorf: "Fear of career-ruining responses to words that offend is chilling classroom discussions, faculty scholarship, and conversation among colleagues."

At Chicago Catholic, Cardinal Blase Cupich offers some advice about preaching on the Trinity, and he cites the book The Vision of Catholic Social Thought: The Virtue of Solidarity and the Praxis of Human Rights, by St. John's University moral theologian Meghan Clark. At a time when too many reduce religion to ethics, it is wonderful to highlight the work of a theologian who recognizes the ways in which are dogmatic truths ground our ethical teachings, and even more when that work gets noticed by a bishop! I reviewed Clark's wonderful book here.

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