CMS Approves 12-month Extension of Postpartum Coverage in Washington State
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved Washington state’s extension of Medicaid and Children’s Health Insurance Program (CHIP) coverage for 12 months after pregnancy. As a result, up to an additional 12,000 people annually will now have access to Medicaid or CHIP coverage for a full year after pregnancy. With today’s approval, an estimated 265,000 Americans annually in 15 states and D.C. have gained access to 12 months of postpartum coverage.
Access Health CT Announces Special Enrollment Period For Covered Connecticut Program
Eligible Connecticut residents have until June 30 to enroll
HARTFORD, Conn. (Feb. 15, 2022) — Access Health CT (AHCT) today announced a Special Enrollment Period for the Covered Connecticut Program that provides health insurance at no cost to Connecticut residents who meet eligibility requirements. This Special Enrollment Period runs now through June 30.
Created and funded by the State of Connecticut, the Covered Connecticut Program pays the customer’s portion of the monthly payment (premium) directly to their insurance company. The program also covers the cost-sharing amounts they would typically have to pay with a health insurance plan, such as co-pays, co-insurance, deductibles and maximum out-of-pocket costs.
The looming disaster on Obamacare subsidies keeps looking worse
Congressional Democrats are confronting a ticking time bomb that threatens both the health security of millions of Americans and Democrats’ own political security in the midterm elections. If they don’t act fast, it’s going to explode.
...Now, another group of Democrats outside Washington is getting increasingly nervous about this prospect. Democratic governors, many of whom are up for reelection this year, don’t want to watch while Congress makes life more difficult for their constituents.
Underscoring the point, a group of Democratic governors has released a new letter imploring congressional leaders to extend the enhanced subsidies.
Insurers File Proposed Rates for 2023 District of Columbia Health Plan Offerings
Wednesday, May 25, 2022
Washington – The District of Columbia Department of Insurance, Securities and Banking (DISB) has received 208 proposed health insurance plan rates for annual review in advance of open enrollment for plan year 2023. The proposed rates were submitted for DC Health Link, the District of Columbia’s health insurance marketplace, from Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and United Healthcare.
The proposed rates are for individuals, families and small businesses for the 2023 plan year. Overall, the number of plans submitted for 2022 is up by 51 from those submitted for 2022.
Today, Secretaries Xavier Becerra, Marty Walsh, and Janet L. Yellen of the U.S. Departments of Health & Human Services, Labor and Treasury (Departments), respectively, issued a letter to group health plans and health insurance issuers reminding them of their obligations under the Affordable Care Act (ACA) to provide coverage for contraceptive services at no cost.
In all fifty states, the ACA guarantees coverage of women’s preventive services, including free birth control and contraceptive counseling, for individuals and covered dependents. Recent reports have shown that some issuers and plans may not be appropriately providing this coverage. The letter is another step for the Departments to put the industry on notice for the required coverage and demand prompt action to ensure that people can rightfully access the birth control they need.
Once again, here's what the Affordable Care Act's premium subsidy tables look like under the original ACA itself and under the American Rescue Plan (ARP). The premium caps are the maximum percent of household income which a household has to pay for the benchmark Silver plan at various income ranges.
The ARP table is currently scheduled to sunset at the end of December, at which point, without legislation passing Congress & being signed into law by President Biden, it will revert back to the original ACA subsidy table:
(sigh) The Sword of Damocles continues to dangle over the head of the Affordable Care Act. This time it isn't about an existential threat to the PPACA, at least...but the expanded/enhanced subsidies which were put into place temporarily by the American Rescue Plan (ARP) are definitely at risk.
Conversations are underway between Joe Manchin III, D-W.Va., and Senate Majority Leader Charles E. Schumer to negotiate a budget reconciliation bill, which would require only a simple majority for passage, that would meet Manchin’s demands without losing support from other Democrats.
...Another Manchin condition is that the measure avoid any “cliffs” that sunset new programs early to keep the price tag down, something Manchin argues artificially hides the true costs since programs will prove too popular not to extend.
No, this is not a repeat, though it may sound like it. From March:
Since the collapse of the Build Back Better Act in the U.S. Senate last December (reminder: It passed the House but came to a screeching halt when all 50 Republican Senators along with conservative Democrat Joe Manchin refused to support it), Congressional Democrats have been quietly trying to put at least some of the pieces of the bill back together in an attempt to salvage something out of President Biden's signature social spending agenda.
...One of the other provisions of BBB which some members of Congress are trying to save has been reintroduced as a standalone bill in both the House (H.R. 6833) and Senate (S.3700), the Affordable Insulin Now Act.
Today, the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) announced that during the Biden-Harris Administration 253,000 parents have gained access to 12 months of postpartum coverage through Medicaid and Children’s Health Insurance Program (CHIP) extensions. President Joe Biden and Vice President Kamala Harris have made addressing the maternal mortality and morbidity crisis a key priority for their Administration.
BeWellnm Announces Operational Changes to Aid Leadership Transition
Albuquerque, N.M. (June 16, 2022) – BeWellnm, the New Mexico Health Insurance Exchange, announces operational updates as the state prepares for a successful 2023 Open Enrollment Period in the fall. As beWellnm begins its search for a permanent CEO, it has contracted with GetInsured, the nation’s leading provider of health insurance exchange technology and customer service solutions for health and human services agencies, to provide consultative and operational support during the period of transition. The organization will provide temporary, interim operational leadership for a 10-month period and offer strategic oversight and direction to beWellnm, along with long-term recommendations for maintenance and operations.
No formal press release from the Rhode Island Insurance Dept. yet, but according to the SERFF database, here's the preliminary rate filings for 2023 for their individual & small group markets.
Blue Cross Blue Shield of Rhode Island:
CY 2021 Experience Period
We did not adjust the 2021 experience period for Covid‐19. We also did not make any adjustments due to the end of the expanded federal subsidies under the American Rescue Plan Act (ARPA) or the end of the federal public health emergency.
CY 2023 Projection Period
We included a Covid‐19 factor in Other to adjust CY 2023 to reflect a 50% decrease in anticipated Covid‐related spend for the CY 2023 projection period compared to the level in the CY 2021 experience period.
House Speaker Nancy Pelosi (D-CA) said Thursday (June 16) that budget reconciliation legislation might not extend an increase in subsidies for health exchange insurance premiums; the subsidies are needed to avert a spike in Obamacare insurance rates right before the midterm elections.
...When a Punchbowl News reporter asked Thursday about that meeting and whether a reconciliation deal is expected soon, Pelosi’s response was, “It’s alive.”
“There are certain concerns we have about subsidies in the health care bill and the rest, which may or may not be in the negotiations,” she said.
...President Joe Biden included drug pricing reform in an inflation-fighting proposal released over the weekend -- but his plan did not mention the enhanced ACA credits, raising some eyebrows.
..Democrats had counted on drug price controls to pay for the enhanced ACA subsidies, but Manchin recently said the subsidies did not come up in his talks with the White House.
Depending on the state & carrier, some of these can be found easily; others are either heavily redacted, partial, not available until later in the year; and some are never made available at all.
In addition to the filings for the upcoming year, however, the SERFF database also includes a mountain of other filing forms, from non-ACA compliant insurance policies (short-term, indemnity, etc.) and from previous years (I have no idea how far back they go, but I'm guessing it's at least since the turn of the century). This also includes "grandfathered" and "grandmothered" policies.
The FDA’s independent vaccine advisers voted unanimously Wednesday to recommend the agency authorize two Covid-19 vaccines for babies, toddlers and preschool-age children, putting the country’s youngest age group one step closer to immunizations nearly two-and-a-half years into the pandemic.
Florida is the only state in the union that did not preorder COVID-19 vaccines for children ages 4 and under, according to a report from the Miami Herald.
The nation’s third-largest state missed Tuesday’s deadline to preorder the doses from the federal government, which the Herald reports could delay delivery to Florida’s pediatricians, clinics, pharmacies and pediatric hospitals.
The Food and Drug Administration on Friday approved Pfizer and Moderna COVID-19 vaccines for emergency use in children under the age of 5, a monumental step for parents who have spent the past two years buffeted by day care and school closures while taking strict precautions for the health of their kids.
Shots could be in toddlers’ arms before the end of June, pending approval from the Centers for Disease Control and Prevention.
Today, the Centers for Medicare & Medicaid Services (CMS) posted Frequently Asked Questions (FAQs) regarding compensation paid by issuers to agents and brokers who assist consumers with enrollment during a Special Enrollment Period (SEP) or during Open Enrollment Periods (OEPs). The Biden-Harris Administration has made it a priority to provide those who are uninsured and underinsured with quality, affordable health care coverage and recognizes that agents and brokers play a vital role in helping consumers enroll in coverage that best fits their needs and budget.
The New York Dept. of Financial Services hasn't issued a formal press release yet, so it's conceivable that a few more filings will be added, but as far as I can tell, the spreadsheet below contains the preliminary unsubsidized 2023 premium change requests for every carrier offering ACA-compliant individual and small group market healthcare policies.
I've poked around the actual actuarial nattative summaries for several of the carriers with the higher market share (Excellus, Fidelis, etc) and while I see a couple of references to the set-to-expire expanded American Rescue Plan subsidies being set to expire at the end of 2022, this isn't listed as a significant factor in the rate filings (at least the ones I've looked at).
Assuming these rate hikes are approved of as is (which is no sure thing; New York tends to cut them down somewhat), unsubsidized individual market enrollees will be looking at average premium increases of 18.8%, while small group market policyholders will see a 16.3% average increase.
Throughout the 2 1/2 years of the pandemic, there have been numerous accusations of "cooking the books", "hiding deaths" and so forth thrown around at various administrations at the state and federal level. Some of these have proven to be false, others to be accurate, and many to be somewhere in between, depending on your perspective.
Perhaps no state-level administration has been subjected to as many accusations of "hiding data" as that of Florida Gov. Ron DeSantis. In my own case, the biggest data discrepancy I've written about regarding Florida was the massive vaccination rate outlier status of Miami-Dade County...a discrepancy which, at least in that case, turned out to be more about the legal residence of those vaccinated rather than whether the vaccinations actually took place or not.
Over the past few months, this site and numerous other healthcare policy outlets have been sounding the alarm over the ugly fallout if the expanded ACA subsidies put into place by the American Rescue Plan (ARP) last year are allowed to expire:
The Michigan Legislature is considering joining the 18 other states that have established state-run health insurance marketplaces through HB 6112. Having an exchange run by the state instead of the federal government, supporters of the bill say, will save Michiganders money by leaving the “rigid and inflexible” federal market for a Michigan-tailored market that can be more responsive and potentially lower premiums. The bill is still in the early days of the legislative process, awaiting a vote from the House Health Policy Committee.
I go by county residents who have received the 2nd COVID-19 shot only (or 1st in the case of the J&J vaccine).
I base my percentages on the total population via the 2020 U.S. Census including all ages (i.e., it includes kids under 12).
For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
HOWEVER, there's one major outlier over the 65% threshold...Miami-Dade County.
According to the Centers for Disease Control, Miami-Dade has fully vaccinated 68% of their entire population (1.84 million out of 2.72 million residents). I use the slightly lower official 2020 U.S. Census popualtion count for Miami-Dade County (2,701,767), which makes the vaccination rate slightly higher still: 68.24%.
And yet, somehow the 10th-largest county in the United States, which has the 6th highest vaccination rate of any county over 1 million residents, also has the highest new case rate of any county over 1 million residents.
At the time, it was Miami-Dade's massive outlier status in terms of COVID cases since the beginning of July which had tipped me off; it looked like this:
HOWEVER, the MLR rule is still pretty important...and while the dollar amounts I'm about to discuss aren't much more than a rounding error in terms of federal budget numbers, it's possible that the could play a small role in helping get a much larger project moving forward.
Before I begin, here's a short refresher on how the MLR rule works:
I've received quite a bit of attention for these analyses, including several national media outlets which have used my work (sometimes with proper attribution, sometimes without) However, there have also been numerous critics who have pointed out that I don't run multivariate analysis when I do this.
Put simply, I look at the correlation between partisan lean and COVID death/vaccination rates or between vaccination rates and COVID death rates...but I don't include other factors like age, income, race/ethnicity, urban-rural status, employment status, health insurance status and so forth.
States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports. This policy update marks the latest action by the Biden-Harris Administration to strengthen the health care workforce, help people receive care in the setting of their choice, and reduce unnecessary reliance on institutional care.
Regular readers may have noticed that I barely posted anything on the site last week, with good reason: I was out of town. I drove out to DC for a few days, ostensibly to attend the annual National Institute of Health Care Media (NIHCM) Awards Dinner, where I was a finalist in the Digital Media category this year.
(I didn't win, but that's OK...the competition was extremely impressive and it really was an honor just to be nominated, really!)
This was the fifth time I've visited the nation's capital, but the first time that I've driven. It's also the first road trip I've taken in an electric car, a brand-new 2022 Kia Niro EV (it replaced my 17-year-old Hyundai which was so badly rusted underneath that my mechanic was surprised it survived the past winter).
I don't often post blog entries about non-healthcare related issues, but I've had a lot of folks express curiosity about what it's like owning/driving an EV in the real world, so I figured this trip (which was, after all, for a healthcare awards dinner, and I also had healthcare policy meetings with a couple of folks on Capitol Hill) would be a good case study to give some thoughts on the subject.
Today, the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) approved California, Florida, Kentucky, and Oregon actions to expand Medicaid and Children’s Health Insurance Program (CHIP) coverage to 12 months postpartum for a total of an additional 126,000 families across their states, annually—supporting 57,000; 52,000; 10,000; and 7,000 parents, respectively.
via the Centers for Medicare & Medicaid Services (CMS), by email:
Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.
As of February 2022, over 64.2M people are enrolled in Medicare. This is a decrease of 6K since the last report.
34.9M are enrolled in Original Medicare.
29.4M are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
49.9M are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage.
Over 11.9 million individuals are dually eligible for Medicare and Medicaid, so are counted in the enrollment figures for both programs.
Almost exactly ten years ago, in the federal National Federation of Independent Business v. Sebelius case which was the first of several high-profile federal lawsuits which attempted to eliminate or cripple the Patient Protection & Affordable Care Act, the U.S. Supreme Court spared the ACA...mostly:
The Supreme Court, in an opinion written by the Chief Justice, John Roberts, upheld by a vote of 5–4 the individual mandate to buy health insurance as a constitutional exercise of Congress's Taxing and Spending Clause (taxing power). A majority of the justices, including Roberts, agreed that the individual mandate was not a proper use of Congress's Commerce Clause or Necessary and Proper Clause powers, although they did not join in a single opinion. A majority of the justices also agreed that another challenged provision of the Act, a significant expansion of Medicaid, was not a valid exercise of Congress's spending power, as it would coerce states to either accept the expansion or risk losing existing Medicaid funding.