Saturday Short Cuts: Maryland Oversight, Arkansas Exchange, Kansas Hypocrisy

Hmmm...the headline looks bad, but when you read further it's clearly a matter of perspective more than anything else:

Maryland's health insurance exchange improperly billed the federal government $28.4 million, a Department of Health and Human Services audit reported Friday.

An inspector general's probe found a lack of oversight and internal controls, not criminal wrongdoing, was the cause of the exchange's problems since the marketplace opened in 2013.

...The audit said the state used a 2013 and 2014 federal grant to cover the exchange's costs when it should have used funds from a Medicaid program jointly financed by Maryland and the federal government. State officials contended the federal grant was the appropriate for funding because their projections indicated most residents using the exchange would sign up for private health coverage; when the projections were seen to be erroneous, at the end of the first open enrollment period, the state was slow to correct the record with Medicaid regulators, the audit said.

In other words, at the time, Maryland thought that they'd have more private QHP enrollments than Medicaid additions. Since the 1st version of the exchange was a mess, this turned out to be way off (they ended the year with about 81K QHP selections vs. 263K via Medicaid), but it sounds like an honest mistake.

For the record, for 2015 (so far) the tally is about 123K QHPs vs. 166K Medicaid...still favoring the Medicaid side, but not by nearly as much of a ratio.

This has taken on even more significance with the impending King v. Burwell decision coming up, but Arkansas has been planning, like Idaho did for 2015 and as New Mexico may (or may not?) be doing for 2016, to move off of Healthcare.Gov onto their own state-based ACA exchange...starting in 2017:

Three Little Rock firms competing for the contract to promote enrollment in Arkansas' health insurance exchanges for individual consumers and small businesses made presentations to a state board Wednesday.

...A nonprofit organization created by the Arkansas Legislature in 2013, the marketplace is using money from a $99.9 million federal grant to set up exchanges that would replace those established for the state by the federal government.

Enrollment in a state-based exchange for small businesses is expected to begin this fall for coverage that will start in January.

Enrollment in the state-based exchange for individual consumers is expected to start next year for coverage that will start in 2017.

Finally, Ted Cruz isn't the only Republican ACA opponent showing a jaw-dropping amount of hypocrisy:

Kansas Rep. Tim Huelskamp, the chairman of the Tea Party Caucus in the U.S. House of Representatives, admits he, too, has enrolled for health care coverage through the Affordable Care Act, despite repeatedly voting to repeal it.

...It’s true that members of Congress who want to take advantage of health benefits offered through their employer – the federal government – must use plans offered through a government-run exchange in the District of Columbia.

But that’s not the whole story.

Huelskamp could have foregone coverage completely, or shunned the exchange and purchased a family health plan directly from a private broker.

As much as I may disagree with them on pretty much everything else, I do have to give other GOP legislators a bit of credit for at least not being hypocrites on this issue:

Rep. Louis Gohmert, R-Texas, decided to go without health insurance rather than sign up for Obamacare. Some other lawmakers have said they would go through the private market to avoid the exchanges, including Rep. Frank LoBiondo of New Jersey and Rep. Diane Black of Tennessee, both Republicans.

MNsure has lowered its enrollment projections again for the next year and trimmed its budget to cover the reduced income.

Minnesota's state-run health insurance exchange now predicts 95,000 private enrollees subsequent year. That is down from a projection of 107,000 made in November and an original forecast of 297,000 in January 2013.

As of this week, MNsure had 61,109 people enrolled in private plans, so the exchange is still projected to attract significantly much more enrollees over the subsequent 12 months -- just fewer than initially believed.

The federal health care overhaul is leading some colleges and universities to get out of the health insurance business.

Experts are divided on whether this change will be good or bad for students. Some call it an inevitable result of health care reform and a money-saver for students since insurance in the marketplace is usually cheaper than the college plans. Others worry that more students will go without health insurance since their premiums won't be folded into the lump sum they pay for school, and they say college health plans offer more coverage for the money than other options.

The main driver of colleges getting out of the insurance business is a provision in the Affordable Care Act that prevents students from using premium tax subsidies to purchase insurance from their college or university, according to Steven M. Bloom, director of federal relations for the American Council on Education, a Washington, D.C., group representing the presidents of U.S. colleges and universities.

Add to that the provision that allows young people to stay on their parent's health insurance plans until age 26, plus the expansion of Medicaid in some states and the rising cost of student insurance. The result is cheaper health insurance available for students off campus.