I had heard that this was in the works, and with the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:
Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.
So, I've been combing through a mountain of healthcare & health insurance-related legislation which has been introduced by various state legislators around the country, and this one caught my eye:
OR HB3326
Relating to changing the name of the Oregon Health Authority; declaring an emergency.
The bill summary doesn't provide much more detail:
Changes name of Oregon Health Authority to Oregon Department of Health. Makes conforming changes. Becomes operative on January 1, 2024. Declares emergency, effective on passage.
OK, so it changes the name of the health department and...declares an emergency relating to that? Huh? What?
It was introduced about a month ago by GOP state representative Werner Reschke. It doesn't have any other cosponsors from either party so far.
I decided to take a look at the actual legislative text.
New DIFS Bulletin to Protect LGBTQ+ Michiganders from Discrimination in Insurance, Financial Markets
March 17, 2023
(LANSING, MICH) The Michigan Department of Insurance and Financial Services (DIFS) has issued a bulletin that reaffirms the department’s commitment to protecting Michiganders from discrimination based on sex, sexual orientation, and gender identity in the insurance or financial services industries. The bulletin ensures that the insurance and financial services industries, including health insurance, must comply with the newly-amended Elliott-Larsen Civil Rights Act as signed into law by Governor Gretchen Whitmer yesterday afternoon.
The first section of the legislative text is about as frank and clear as I've ever seen:
The legislature finds that Hawaii has long been a leader in advancing reproductive rights and advocating for access to affordable and comprehensive sexual and reproductive health care without discrimination. However, gaps in coverage and care still exist, and Hawaii benefits and protections have been threatened for years by a hostile federal administration that has attempted to restrict and repeal the federal Patient Protection and Affordable Care Act and limit access to sexual and reproductive health care. The Trump administration made it increasingly difficult for insurers to cover abortion care and assembled a Supreme Court that restricted abortion access and that may eliminate the Patient Protection and Affordable Care Act in the near future.
The Children’s Health Insurance Program (CHIP) is offered through the Healthy and Well Kids in Iowa program, also known as Hawki. Iowa offers Hawki health coverage for uninsured children of working families.
No family pays more than $40 a month. Some families pay nothing at all. A child who qualifies for Hawki health insurance will get their health coverage through a Managed Care Organization (MCO).
Mazel Tov to Audrey Morse Gasteier, who I know via online discussions & have met a couple of times in person at the annual Families USA conference. I'm sure she'll continue to do a great job:
BOSTON — Audrey Morse Gasteier, who has served as a policy leader at the Massachusetts Health Connector for more than a decade, was named executive director of the state-based Marketplace today by Secretary of Health and Human Services and Health Connector Board Chair Kate Walsh.
Morse Gasteier had been serving as acting executive director since January.
“Since its establishment in 2006, the Health Connector has been where Massachusetts residents can find affordable health care,” said Secretary Walsh. “Audrey has been a key part of that important work for many years, and I look forward to working with her as we continue to make health care coverage accessible to everyone in Massachusetts.”
One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).
I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):
As I noted last month, as we've reached the 3rd anniversary of the COVID-19 pandemic hitting U.S. shores and with the Public Health Emergency winding down, it's become more & more difficult for data analysts and researchers to acquire comprehensive, county-level data about cases, hospitalizations, deaths, vaccinations and so forth.
With two of these already discontinued and the third set to do so within the next few weeks, this story is somehow even more depressing to me (via Robert King at Fierce Healthcare; h/t Katherine Hempstead for the heads up):
Earlier today I received a first: A "cease & desist"-type email from Humana Inc's "Sales Integrity Department" asking me to remove their logo from a blog post about the company:
Dear Website Owner:
Humana encourages agents and agencies (collectively, “Agents”) to promote the Humana Brand in a manner that complies with applicable laws and Humana’s own policies and procedures.
Internet-based capabilities are providing new and interactive ways to sell Humana products and services. Although these capabilities offer tremendous opportunities, they also create responsibilities for Humana and its Agents to maintain a system of controls and monitoring.
The Sales Integrity Department at Humana has done a review of websites containing the Humana logo and we have detected your use of the logo...
Arizona Senate Bill 1292 was introduced by Democratic state Representative Rosanna Gabaldon in February. Here's the most relevant portionf of the legislative text:
Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding a new section 20-123, to read:
20-123. Health care insurers; requirements; prohibitions; definitions
A. Notwithstanding any other law, every health care insurer that offers an individual health care plan, short-term limited duration insurance or a small employer group health care plan in this state:
1. Shall:
(a) Ensure that all products sold cover essential health care benefits.
(b) Limit cost sharing for the coverage of essential health care benefits, including deductibles, coinsurance and copayments.
Inflation Reduction Act Tamps Down on Prescription Drug Price Increases Above Inflation
New Medicare Prescription Drug Inflation Rebate Program protects people with Medicare and taxpayers when drug companies increase prices faster than the rate of inflation
HHS announces savings for some people with Medicare on 27 Part B prescription drugs
The Biden-Harris Administration has made lowering prescription drug costs in America a key priority — and President Biden is delivering results. Today, the Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced 27 prescription drugs for which Part B beneficiary coinsurances may be lower from April 1 – June 30, 2023. Thanks to President Biden’s new law to lower prescription drug costs, some people with Medicare who take these drugs may save between $2 and $390 per average dose starting April 1, depending on their individual coverage. Through the Inflation Reduction Act, President Biden and his Administration are lowering prescription drug costs for American seniors and families.
Sometimes the simplest bills can have huge positive impacts. California Assembly Bill 503 was introduced by Democratic Assemblymember Juan Carrillo in February.
AB 503, as introduced, Juan Carrillo. Health care: organ donation enrollment. Existing law, the Uniform Anatomical Gift Act, authorizes the creation of a not-for-profit entity to be designated as the California Organ and Tissue Donor Registrar and requires that entity to establish and maintain the Donate Life California Organ and Tissue Donor Registry for persons who have identified themselves as organ and tissue donors upon their death. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department, in consultation with the board governing the California Health Benefit Exchange, to develop a single paper, electronic, and telephone application for insurance affordability programs, including Medi-Cal.
As I noted at the time, Vought's proposed budget would include, among many other horrific things, completely eliminating funding for the ACA's Medicaid expansion program as well as complete elimination of all Advance Premium Tax Credit (APTC) funding for ACA exchange-based individual market enrollees.
I went on to note that if this proposal were to somehow pass the Senate and be signed into law by President Biden (neither of which is likely to happen, to put it mildly), nearly 40 million Americans would lose healthcare coverage as a result nationally.
Below, I've broken that number out by state to give better context about just how draconian such an eventuality would be.
SACRAMENTO, Calif. — Covered California announced that 263,320 people had newly selected a health plan for 2023, continuing a trend of steady growth in recent years. The total is more than 14,000 higher than 2021’s total, and 8,000 higher than last year’s figure. In addition, more than 1.4 million Californians renewed their health insurance for 2023, bringing Covered California’s overall enrollment to 1.74 million.
“Covered California is woven into the fabric of our health care system, providing quality coverage in every corner of the state and protecting more than 1.7 million Californians,” said Jessica Altman, executive director of Covered California. “The strength in these numbers is driven by the Inflation Reduction Act, which provides increased and expanded financial help, bringing the cost of coverage within reach for millions of Californians who need health insurance.”
Obviously much of this is unlikely to actually go anywhere given House Republicans plans to almost completely defund the ACA and completely gut Medicaid overall, but as President Biden always says, "Don’t tell me what you value. Show me your budget—and I’ll tell you what you value.”
HHS Releases President’s Fiscal Year 2024 Proposed Budget
Investments address urgent needs to extend Medicare solvency, lower drug costs, bolster public health preparedness, improve the well-being of children and seniors, expand access to health care, increase the health care workforce, and advance research underlying medicine, public health, and social services
In my post a few weeks ago about Minnesota's plan to dramatically expand their existing Basic Health Plan (BHP) program, MinnesotaCare, into a full-fledged Public Option open to residents not currently eligible for the program, I made an offhand reference to similar BHP expansion-related news happening in New York State. However, I haven't gotten around to actually writing about NY's BHP program until now.
New York's implementation of the ACA's BHP provision (Section 1331 of the law) is called the Essential Plan, and it already serves over eleven times as many people as Minnesota's does (around 1.1 million vs. 100K). Part of this is obviously due to New York having a larger population, but that's only part of it (NY has 19.84M residents, just 3.5x higher than MN's 5.71M).
Last fall I noted that Oregon (along with Kentucky, although it looks like the latter got cold feet later on) may end up becoming the third state (after Minnesota and New York) to create a Basic Health Plan program which would provide comprehensive, inexpensive (or potentially free) healthcare coverage for residents who earn between 138% - 200% of the Federal Poverty Level (FPL)...basically, the next income tier above the cut-off for ACA Medicaid expansion. A few days ago, the state legislature passed a bill which would create a task force to put together their findings and recommendations no later than September 1st of this year.
I didn't actually get around to writing up the post until June, but I actually bought the car, a 2022 Kia Niro EV, in early March...March 5, 2022 to be precise, almost exactly one year ago.
With a year of real world driving (including an 1,100 mile (round trip) road trip from Metro Detroit to the District of Columbia) baked in, I figured this would be a good time to post an update on how things are going for those who've never owned an EV and are wondering about the good, the bad & the ugly of the experience.
Before I get started, I should take a moment to note that the EV industry and market have both gone through some tumultuous changes over the past 12 months, including (but not limited to):
As of this writing, 69.3% of the total U.S. population has completed their primary COVID-19 vaccination series (including 94.3% of those 65+), but a mere 16.2% of the total population has also gotten their updated bivalent booster shot. Even among seniors it's only at 41.4% nationally.
Harrisburg, PA – At the conclusion of Pennie’s Open Enrollment Period on January 15th, nearly 372,000 Pennsylvanians were enrolled in a comprehensive health plan. Almost 245,000 Pennsylvanians were automatically renewed into a 2023 plan, another 62,000 existing customers returned and shopped for a plan, and nearly 65,000 new enrollees joined the marketplace in 2023.
Pennie provides significant savings on health coverage to improve access to health care and to counter rising costs. Almost 90 percent of total customers are receiving financial savings, which on average, is more than $520 a month for those customers. With these savings, over 32 percent of customers pay less than $50 a month for coverage, and over 50 percent of customers pay less than $150 a month.
4,318 Rhode Islanders are newly insured, supporting state’s outstanding insured rate of 97%
PROVIDENCE – HealthSource RI (HSRI) announces that its annual Open Enrollment period has concluded as of January 31, with 4,318 Rhode Island residents newly enrolled in the affordable qualified health plans available through the state marketplace. An additional 24,343 individuals, or 83% of last year’s customers, renewed their coverage during the same period starting November 1.
That's 28,661 QHP selections total, down 11.4% from the 2022 Open Enrollment Period.
“We’re encouraged that each year more Rhode Islanders are taking advantage of the quality, affordable coverage options available to them through HealthSource RI,” said Governor Dan McKee. “Rhode Island continues to be a national leader in health coverage and HSRI is an instrumental piece of the effort to maintain our extraordinarily high rate of insurance coverage.”
UPDATE 3/15/23: The agreed-to Medicaid expansion deal has passed the NC State Senate! It now just needs to pass the state House one final time and then it's on to Gov. Cooper's desk to be signed into law!
As I noted a couple of weeks ago, the GOP-controlled North Carolina House of Representatives voted to expand Medicaid to nearly 600,000 state residents under the ACA, nearly a decade after they could have done so. This was actually the second time the NC House voted for Medicaid expansion; last year both the state House and the GOP-controlled state Senate passed different versions of the bill...but were unable to rectify the differences between the versions, and another year went by without expansion being signed into law.
Thankfully, it looks like this time it's actually going to happen:
UPDATE 3/8/23: HB 400 just overwhelmingly passed the New Mexico House!
HUGE NEWS! #HB400 just passed the House Floor by a vote of 58-10! Huge thanks to Rep. @reenaszcz & Speaker @JavierForNM for their work carrying #MedicaidForward through the House of Representatives & to everyone who reached out to their legislator. On to the Senate! #nmleg#nmpol
— NM Together for Healthcare (@NMT4HC) March 8, 2023
Well, the lines didn't flip after all in January--the reddest quintile jumped up faster than the bluest quintile after all--two months earlier than I expected:
Bluest Quintile: 4.70 per 100K residents
Reddest Quintile: 5.33 per 100K residents (13% higher)
The January gap wasn't that significant by itself...except that it had looked like the rate in the reddest quintile might be lower last month.
Sure enough, the COVID death rate gap between the reddest and bluest fifths of the country widened out more in February, with the rate in the reddest quintile running 63% higher than the bluest quintile (4.22/100K vs. 2.39/100K). The rate actually dropped from January to February in every quintile, but it dropped considerably more in the bluest fifth (to the lowest rate since April 2022) than the reddest.
