Charles Gaba's blog

Last month, the U.S. House of Representatives passed eight different healthcare-related bills. Three of them related to regulating prescription drugs and/or reducing drug prices; the other five composed about half of the dozen or so "ACA 2.0" bill package.

As a reminder, here's the eight bills which passed the full House:

H.R. 938, the "Bringing Low-cost Options and Competition while Keeping Incentives for New Generics (BLOCKING) Act of 2019," introduced by Reps. Kurt Schrader (D-OR) and Buddy Carter (R-GA), would discourage parking of 180-day exclusivity by a first generic applicant that is blocking the approval of other generics.

H.R. 1499, the "Protecting Consumer Access to Generic Drugs Act of 2019," introduced by Rep. Bobby Rush (D-IL), would make it illegal for brand-name and generic drug manufacturers to enter into agreements in which the brand-name drug manufacturer pays the generic manufacturer to keep a generic equivalent off the market.

As I noted back in February, this one was pretty unexpected:

Bill expanding ‘Insure Oklahoma’ program passes Senate committee

A Senate bill seeking to expand the Insure Oklahoma program has advanced out of committee Monday morning.

Senate Bill 605, authored by Sen. Greg McCortney, R-Ada, directs the Oklahoma Healthcare Authority to implement "the Oklahoma Plan" within Insure Oklahoma. An agency spokesperson said the program provides premium assistance to low-income working adults employed by small businesses.

The latest numbers from Insure Oklahoma show less than 19,000 are enrolled.

According to McCortney, the intent of his bill is to provide insurance for Oklahomans who would qualify for Medicaid in states which opted to expand but are currently not insured.

Last year, I noted several times that regardless of what your opinion may be of the ACA's Individual Mandate Penalty (which was, until this year, either $695 per adult/$348 per child or 2.5% of your household income, unless you received an exemption), one of the key things to keep in mind about the penalty is that any impact it has on encouraging people to go ahead and enroll in ACA-compliant healthcare coverage is entirely dependent on two things:

Last May, I noted that Vermont was supposedly joining Massachusetts, New Jersey (and later in the year, the District of Columbia) in reinstating the ACA's Individual Mandate Penalty, which added an additional tax to people who don't enroll in ACA-compliant healthcare coverage (whether private or public) and who don't qualify for an exemption due to an affordability threshold, hardship or some other qualifying reason.

I also noted at the time, however, that Vermont seemed to be dragging their heels on the mandate penalty itself:

Strike One: Vermont's mandate won't go into effect until 2020, leaving a one-year gap. This bill getting signed is still good news, but mostly irrelevant for 2019. The "coordinated outreach efforts" part is really more of a counter to the Trump Administration's slashing of the ACA's marketing/outreach budget...but not really, since Vermont already runs their own exchange and should have their own marketing/outreach budget anyway. So this is more of a token gesture, I'd guess.

Along with Massachusetts and Vermont, the District of Columbia merges their Individual and Small Group markets for purposes of risk pools and risk adjustment. This does not, however, necessarily mean that their Indy and Sm. Group average premium changes are identical. For one thing, there are more carriers which offer small group plans than individual market plans; for another, the market share ratios between the two differ.

A week ago, the DC Dept. of Insurance, Securities and Banking (DISB) issued preliminary 2020 rate filings along with this press release:

Washington, DC – The District of Columbia Department of Insurance, Securities and Banking (DISB) received 181 proposed health insurance plan rates for review from Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and United Healthcare in advance of open enrollment for plan year 2020 on DC Health Link, the District of Columbia’s health insurance marketplace.

 

OK, this one caught me by surprise. I'm not sure how I missed it last fall, but back in October of last year, around the same time CMS Administrator released her proposal to turn the ACA's 1332 Waiver rules into a complete joke, Trump's IRS, Labor and HHS Dept. got together and came up with this proposal for opening up the rules on Health Reimbursement Arrangements for employer-based healthcare coverage:

Last year individual market carriers here in my home state of Michigan only raised premiums 1.7% on average in 2019, with Oscar Insurance Co. being a new addition to the market. For 2020, they're reducing average premiums by about 2.0%. Oscar made very little headway in their debut year, only enrolling 649 people statewide.

On the surface, it looks like Michigan's total ACA-compliant individual market has plummeted by a whopping 18% (281K vs. 344K last year). However, this can be misleading because the enrollment numbers listed each year only include the number of enrollees actually impacted by the rate changes. For instance, if a carrier pulls out of half the state, then a chunk of their current total enrollment won't be listed since enrollees in that half aren't seeing their current premiums change...they'll be losing coverage altogether and will have to switch to a different carrier.

A couple of weeks ago I noted that Louisiana Governor John Bel Edwards, a Democratic governor in a pretty red state, was trying to take whatever measures he could to provide ACA protections at the state level in case the insane federal "Texas Fold'em" lawsuit against the ACA ends up tearing down the entire law:

On Tuesday, May 21, Governor John Bel Edwards issued an executive order launching the Protecting Health Coverage in Louisiana Task Force after efforts to have protections offered to Louisianans with preexisting conditions repealed.

Energy & Commerce Committee

 

There's another Congressional healthcare hearing going on right now as well, this time in the House Energy & Commerce Committee; this one is on Surprise Billing:

HEARING ON “NO MORE SURPRISES: PROTECTING PATIENTS FROM SURPRISE MEDICAL BILLS”

The Subcommittee on Health of the Committee on Energy and Commerce will hold a legislative hearing on Wednesday, June 12, 2019, at 10 a.m. in the John D. Dingell Room, 2123 of the Rayburn House Office Building.  The hearing is entitled, “No More Surprises: Protecting Patients from Surprise Medical Bills.”  

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