As I noted a month ago, Virginia insurance carriers participating in the ACA individual market submitted preliminary 2024 rate filings which averaged over a 20% hike, almost entirely due to the prospect of the states reinsurance program (which had only been implemented one year earlier) possibly not being funded for the second year.
In 2023, average unsubsidized indy market premiums in Virginia had dropped by around 13% thanks to the new reinsurance program, which offloads a portion of high-cost enrollee care to the federal government in return for reducing the amount of subsidies received by low/moderate-income enrollees.
Fortunately, cooler heads eventually prevailed, and in the end the state legislature passed a budget which did indeed properly fund the program. This allowed insurance carriers to file modified rates for 2024 which include the reinsurance program being in place.
Virginia is slated to become the nation’s 19th state-based exchange now that CMS has given officials the greenlight to fully transition away from healthcare.gov starting Nov. 1 for the 2024 plan year. Meanwhile, the State Corporation Commission (SCC), which administers the exchange, has suspended the state’s reinsurance program that had lowered premiums by about 20% for 2023, so individual plan rates are set to increase by an average 28.4%, according to a presentation made during an Aug. 9 hearing on the 2024 rates.
Virginia’s Health Benefit Exchange (VHBE) was enacted in 2020 by former Gov. Ralph Northam (D) and has been operating as a state-based exchange reliant on the federal platform (SBE-FP) since plan year 2021. The state paused the transition activity in 2021 after the enhanced premium tax credits were enacted but restarted it the following year.
CMS approved a postpartum coverage extension state plan amendment (SPA) for Wyoming to extend postpartum coverage for a full year for individuals enrolled in Medicaid. The opportunity to extend postpartum coverage was made possible under the American Rescue Plan and made permanent in the Consolidated Appropriations Act, 2023. Wyoming’s approval marks 37 states, D.C., and the U.S. Virgin Islands that have extended postpartum Medicaid coverage to a full year. This approval supports the CMS Maternity Care Action Planand Biden-Harris Maternal Health Blueprint.
Mississippi is one of the ten states where ACA Medicaid expansion still hasn't gone through a full decade after it could have.
A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While GOP Governor Tate Reeves and the Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.
As for when the program would actually go into effect, however...that's been something of a mystery for awhile now. Apparently the wording of the legislation ties it in with it being included in the general state budget, which wouldn't be voted on or approved for months. As a result, no one seemed to be sure when the healthcare expansion program for up to ~600,000 North Carolina residents will actually launch.
Back in July, the Health & Human Services Dept. took an optimistic stance, preparing for the possibility of the program kicking off starting on October 1st of this year. Unfortunately, that was based on the assumption that the GOP-controlled state legislature would actually pass the general budget required for it to happen by September 1st...which didn't happen.
CMS believes that eligibility systems in a number of states are programmed incorrectly and are conducting automatic renewals at the family-level and not the individual-level, even though individuals in a family may have different eligibility requirements to qualify for Medicaid and CHIP. For example, children often have higher eligibility thresholds than their parents, making them more likely to be eligible for Medicaid or CHIP coverage even if their parents no longer qualify. This conflicts with existing federal Medicaid requirements and may have a disproportionate impact on children.
Since the nation’s first health Community Health Centers opened in 1965, expansion of the federally supported health center system to over 1,400 organizations has created an affordable health care option for more than 30 million people. Health centers in every state, U.S. territory, and the District of Columbia, provide care to patients, regardless of ability to pay.
Health centers help increase access to crucial primary care by reducing barriers such as cost, lack of insurance, distance, and language for their patients. In doing so, health centers — also called Federally Qualified Health Centers (FQHCs) — provide substantial benefits to the country and its health care system.
I managed movie theaters for most of the '90's, and was in charge of the concession stand & its staff. One year I came back from vacation to find the employees cleaning the concession stand after a big rush of customers.
I was happy to see this until I realized that some of the staff were using a mop with bleach-based cleanser to clean the floor at the same time other staffers were using an ammonia-based cleanser to clean the glass popcorn bins right next to the employee mopping.
I freaked out a bit, ordering them to stop immediately and turning on a fan to blow the fumes in opposite directions. Apparently neither the employees nor the other manager who had been covering my department while I was on vacation had ever learned that mixing bleach and ammonia can be fatal.
When I asked about it, the other manager apologized but explained that they were simply trying to follow both state and local health/safety board rules. You see, some of the staff were college students while others were minor high school students.
While most states are reaching the height of their post-pandemic Medicaid renewals, Idaho is returning to nearly normal redeterminations, closing out the bulk of its pandemic eligibility unwinding after removing more than 121,000 Medicaid and CHIP beneficiaries the state deemed most likely ineligible from the programs in six months.
Hmmm...IHP's estimate is lower than that of KFF's daily tracker, which puts Idaho's total disenrollment number at 145,000 as of today.
Idaho’s Medicaid and Children’s Health Insurance Program enrollment grew by roughly 150,000 people during the pandemic’s continuous coverage requirement, maxing out at about 450,000 beneficiaries. An estimated 42% of the beneficiaries who were disenrolled lost coverage due to procedural or paperwork issues.
The Centers for Medicare & Medicaid Services’ (CMS’) final rule will make it easier for millions of eligible people to enroll in and retain their Medicare Savings Program (MSP) coverage. The final rule reduces red tape and simplifies Medicare Savings Program enrollment, helping millions of seniors and people with disabilities afford coverage. The final rule follows President Biden’s executive orders in January 2021, December 2021, and April 2022, directing federal agencies to take action to expand affordable, quality health coverage.
A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While the states GOP Governor and Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.
As for when the program would actually go into effect, however...that's been something of a mystery for awhile now. Apparently the wording of the legislation ties it in with it being included in the general state budget, which hasn't happened yet. As a result, no one seems to be sure when the healthcare expansion program for up to ~600,000 North Carolina residents will actually launch.
Back in July, the Health & Human Services Dept. took an optimistic stance, preparing for the possibility of the program kicking off starting on October 1st of this year. Unfortunately, that was based on the assumption that the GOP-controlled state legislature would actually pass the general budget required for it to happen by September 1st.
Maryland Insurance Administration Approves 2024 Affordable Care Act Premium Rates
Reinsurance Program Continues Positive Impact on Individual Rates
BALTIMORE – Maryland Insurance Commissioner Kathleen A. Birrane today announced the premium rates approved by the Maryland Insurance Administration for individual and small group health insurance plans offered in the state for coverage beginning Jan. 1, 2024.
Rate Changes for the Individual Market
The rates for individual health insurance plans subject to the Affordable Care Act (ACA) will change/increase by an average of 4.7% for 2024. Approximately 229,000 Marylanders are impacted by the approved rates. However, the actual percentage by which the rates for a specific plan will change depends on the carrier and plan.
NJDOBI Adopts Regulations to Require Comprehensive Abortion Coverage in Department Regulated Health Insurance Markets
TRENTON – As part of the Murphy Administration’s efforts to protect access to reproductive health care, the New Jersey Department of Banking and Insurance today announced the adoption of rules to require comprehensive abortion coverage as a part of all health benefits plans regulated by the department. This requirement, which was in place as of January 1, 2023 in the individual and small employer health insurance markets, will now be in effect for the fully-insured large employer health insurance market upon plan issuance or renewal.
Note: I decided that while the original headline accurately reflected my feelings about this WSJ Op-Ed, it was a bit over the top, so I've changed it to something less crude.
For years, the Patient Protection & Affordable Care Act, generally shorthanded as the ACA or, more colloquially known as "Obamacare," was the top policy target of Republicans and other conservatives.
It seemed as though not a day went by without some right-wing opinion piece being published attacking the ACA for one thing or another. Once in awhile these attacks had some validity, but the vast majority were either completely baseless or grossly exaggerated.
And yet, after the dust settled on the infamous 2017 ACA "repeal/replace" debacle, it seemed as though the GOP had pretty much tired of their relentless assault on the healthcare law. They had failed to repeal it even with control of the White House, Senate, House of Representatives and Supreme Court, and ended up settling for zeroing out of the federal Individual Mandate Penalty as a consolation prize.
While the Census found the percentage of Americans without insurance fell, even as a supplemental poverty measure increased following the end of pandemic-era assistance, ranking House Ways & Means Committee Democrat Richard Neal (MA) is highlighting the need to extend the enhanced Affordable Care Act credits that are set to expire at the end of 2025.
According to the 2023 Current Population Survey Annual Social & Economic Supplement (CPS ASEC):
...92.1% of the U.S. population had health insurance coverage for all or part of 2022 (compared to 91.7% in 2021). An estimated 25.9 million or 7.9% of people did not have health insurance at any point during 2022, according to the 2023 Current Population Survey Annual Social and Economic Supplement (CPS ASEC). That compares to 27.2 million or 8.3% of people who did not have health insurance at any point during 2021.
In Oregon, Democrats passed a bill in March to establish a basic health program, the details of which are being ironed out by a task force that began meeting this week. In Kentucky, Republicans approved $4.5 million in state funds this spring to set up a basic health program, which was signed into law by the state’s Democratic governor. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.
Fourteen health insurers have been approved to sell in Washington's 2024 individual health insurance market. Insurers requested an average increase of 9.11% but 8.94% was approved. How much premium someone pays will depend on the plan they select, the number of people covered, their age, whether or not they smoke and where they live.
I've been a healthcare wonk for nearly a decade (in fact, the 10th anniversary of this website is coming up exactly one month from today), and I've learned a lot about how the U.S. healthcare system works (or, oftentimes, doesn't). Yet, even after all that time, I still occasionally stumble upon information about it which seems like it should have been something I knew all along, yet somehow never knew until now.
The Indian Health Service falls into this category. Don't get me wrong; I knew the IHS existed, and I knew that it serves roughly 2.2 million eligible Native Americans and Alaska Natives nationally. I've referenced it many times before, usually when discussing the types of healthcare coverage people have or funding included in various Congressional bills.
However, in all that time, I somehow was under the impression that the IHS was similar to either the Veterans Administration or Medicaid in terms of how it works, how it's paid for...and how comprehensive it is. I offer no excuses as to why I thought that was the case; I just did.
Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation
CMS announces savings for some people with Medicare on 34 Part B prescription drugs
A continuing key priority of the Biden-Harris Administration is lowering prescription drug costs for seniors and families. Today, the Centers for Medicare & Medicaid Services (CMS) announced the list of 34 prescription drugs for which Part B beneficiary coinsurances may be lower between October 1 – December 31, 2023. Some people with Medicare who take these drugs may save between $1 and $618 per average dose starting October 1, 2023, depending on their individual coverage. Through the Inflation Reduction Act, President Biden and his Administration are lowering prescription drug costs for millions of American seniors and their families.
I haven't checked in on how many Americans have lost Medicaid or CHIP coverage due to the ongoing Medicaid Unwinding process playing out nationally since the end of July. Fortunately, KFF (formerly the Kaiser Family Foundation) has been diligently tracking the data, and it continues to be extremely depressing and concerning.
At the time, "only" 3.77 million people had been confirmed to have lost coverage purely due to procedural/red tape reasons (as opposed to others who lost coverage after being determined ineligible any longer).
A panel of advisers to the Centers for Disease Control and Prevention backed the broad use of new COVID-19 vaccines, as cases of the respiratory illness rise.
The advisers voted 13-1 to recommend the vaccines for people ages 6 months and older. While the benefits appear to be greatest for the oldest and youngest people, the benefits of vaccination exceed the risks for everyone, according to a CDC analysis.
Arkansas is a problematic state for many reasons, but I have to give their insurance dept. website high praise for posting their annual rate filings in a clear, simple & comprehensive fashion (which is to say, not only do they post the avg. premium changes for each carrier, they also post the number of covered lives for each, which is often difficult for me to dig up). Better yet, they also include direct links to the filing summaries and include the SERFF tracking number for each in case I need to look up more detailed info.
Anyway, there's nothing terribly noteworthy in the 2024 filings. Insurance carriers sought an average 5.0% rate hike on the individual market and 5.5% for small group plans; these were shaved down slightly by state regulators for overall weighted average increases of 4.1% and 5.4% respectively.
USAble HMO is launching a new line of HMO insurance products in the state next year (called "Octave" I believe) but otherwise it looks pretty calm.
Aetna CVS Health will join Maryland Health Exchange individual market in 2024
BALTIMORE – Aetna, a CVS Health company, has filed to offer its Aetna CVS Health individual health plans through Maryland Health Connection in 2024, giving consumers across Maryland another option for health coverage through the state-maintained marketplace.
“This is great news for the individuals and families who choose their health insurance coverage through the Maryland Health Connection marketplace,” said Governor Wes Moore. “It is vitally important for consumers to have choices to select the best plan for their needs. Maryland continues to be a national leader in maintaining a robust, affordable marketplace.”
Currently, three insurers – CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare – offer individual market health plans through Maryland Health Connection.
...in spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:
CMS Approves Added Benefits to Essential Health Benefits (EHB) Benchmark Plans in North Dakota and Virginia
September 6: CMS approved added benefits to the Essential Health Benefits (EHB) benchmark plans for North Dakota and Virginia for the 2025 plan year. The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in ten benefit categories. For plan year 2020 and after, the Final 2019 HHS Notice of Benefits and Payment Parameters provides states with greater flexibility by establishing new standards for states to update their EHB-benchmark plans, and for tailoring them to fit the health care needs of their states.
Here's the best summaries I could find of the additional benefits for each state:
FDA Takes Action on Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants
Today, the U.S. Food and Drug Administration took action approving and authorizing for emergency use updated COVID-19 vaccines formulated to more closely target currently circulating variants and to provide better protection against serious consequences of COVID-19, including hospitalization and death. Today’s actions relate to updated mRNA vaccines for 2023-2024 manufactured by ModernaTX Inc. and Pfizer Inc. Consistent with the totality of the evidence and input from the FDA’s expert advisors, these vaccines have been updated to include a monovalent (single) component that corresponds to the Omicron variant XBB.1.5.
Pennie was created with the promise of providing quality and accessible health coverage to all Pennsylvanians. Since its inception, Pennie has implemented several initiatives to expand access to health coverage through the marketplace, including through record levels of financial help and reducing language access barriers. The data included in this report, as explained in detail throughout, support several key takeaways that establishes not only the current status of health equity in Pennsylvania, but also the additional steps necessary to reduce health inequities.
Last Tuesday I noted that a package of bills designed to codify various ACA protections into state law here in Michigan (most of which are low-hanging fruit of my own healthcare wish list which I posted back in February) had managed to make it halfway through the legislative process: Five of them have passed the Michigan House, but not the Senate; the other three have passed the Michigan Senate...but not the House. I applauded the state legislature for pushing these bills halfway through and encouraged them to get the other half of the job done.
CONNECTICUT INSURANCE COMMISSIONER ANNOUNCES 2024 HEALTH INSURANCE RATES SAVING ACA HEALTH INSURANCE PLAN MEMBERS $96.2 MILLION AND HOLDING INSURER PROFITS TO 0.75%
(Hartford, CT) – In a significant move to protect Connecticut consumers against unsupported health insurance cost increases, Connecticut Insurance Commissioner Andrew N. Mais announced today that the Connecticut Insurance Department (CID) continues to protect consumers by reducing health insurers’ 2024 requested rates, despite ongoing increases in underlying health care costs. These 2024 rates are for individual and small group plans offered on and off the state exchange Access Health CT. The Connecticut Insurance Department does not regulate self-funded plans which fall under the authority of the U.S. Department of Labor.
Over at KFF (previously the Kaiser Family Foundation), researchers/analysts Jared Ortaliza, Krutika Amin & Cynthia Cox have put together a new analysis of the overall individual (aka non-group) U.S. health insurance market as of early 2023. While ACA exchange-based enrollment is publicly available (for both subsidized & unsubsidized enrollees) and is the primary focus of this website, off-exchange enrollment is always somewhat fuzzier for several reasons:
New CMS data, quietly released in late August, show about 178,000 consumers chose a qualified health plan (QHP) through a state or federal exchanges after losing Medicaid and CHIP coverage in the first two months of the Medicaid unwinding. Those sign-ups through the end of May are more than three times the 54,000 enrollments that CMS reported in July, which reflected only the April numbers.
During 2021, the Virginia General Assembly passed HB 2332, the Commonwealth Health Reinsurance Program, which was signed into law on March 31, 2021 as Chapter 480, of the 2021 Virginia Acts of Assembly. This bill requires the State Corporation Commission to submit a waiver request for federal approval to establish a reinsurance program beginning January 1, 2023.
Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has 10 different carriers participating in the individual market.
One thing which sets Massachusetts (along with Vermont) apart from every other state is that their Individual and Small Group risk pools are merged for premium setting purposes.
Normally you would think this would make my job easier, since I only have to run one set of analysis instead of two...but until recently, it was surprisingly difficult to get ahold of exact enrollment data for each carrier on the merged Massachusetts market (and even more difficult to break out how many are enrolled in each market since they're merged...not that that's relevant to the actual rate changes).
Model aims to improve the overall health of a state population by ensuring providers are delivering efficient, high-quality, and coordinated care to patients
Today, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative step to test a state’s ability to improve the overall health care management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health, and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set health care expenditures on a more sustainable trajectory, and lower health care costs for patients.
Medicaid Forward would allow residents whose incomes are too high to qualify for Medicaid to instead purchase an affordable plan through the program. Medicaid is a robust, comprehensive program that already provides high-quality care to nearly 50% of our residents. Expanding this simple and trusted system will make healthcare less expensive for people of all backgrounds.
...Medicaid Forward is a good deal for New Mexico. New Mexico can raise its current Medicaid income limit and the federal government will still match nearly 73% of the costs. For the remaining costs, participants will pay for coverage on a sliding scale based on their income.
...Medicaid Forward would open Medicaid so every resident has access to affordable care. We envision a New Mexico where every person, regardless of their background or income, has the opportunity to live their healthiest life.
The annual report, as mandated by the 2021 New Mexico Statutes Chapter 59A, Article 23F, Section 59A-23F-10, and compiled jointly by beWellnm, New Mexico’s Health Insurance Exchange, and the New Mexico Office of the Superintendent of Insurance (NM OSI), offers a comprehensive analysis of various key aspects. These include the individual health insurance market, both on- and off-Exchange enrollment, small business enrollment, qualified health plan pricing, outreach and enrollment assistance activities, as well as strategies aimed at addressing the challenge of the remaining uninsured population in New Mexico.
Overview of the Individual Health Insurance Market
Salem – Oregon consumers can get a first look at requested rates for 2024 individual and small group health insurance plans, the Oregon Department of Consumer and Business Services (DCBS) announced today.
In the individual market, six companies submitted rate change requests ranging from an average 3.5 percent to 8.5 percent increase, for a weighted average increase of 6.2 percent. That average increase is slightly lower than last year's requested weighted average increase of 6.7 percent.
In the small group market, eight companies submitted rate change requests ranging from an average 0.8 percent to 12.4 percentincrease, for a weighted average increase of 8.1 percent, which is higher than last year's requested 6.9 percent average increase.
Earlier today I noted that according to the most recent Medicare enrollment report from the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage enrollment--in which a private insurance carrier is paid by the federal government to administer Medicare benefits, and which differs in some important ways from "traditional" or "Fee for Service" Medicare--is on the verge of overtaking traditional Medicare in terms of total enrollment.
As of May 2023, 48.5% of all Medicare enrollees were covered via a Medicare Advantage plan, a percentage which has been steadily increasing over the years (it was only at 35.5% as of 2019).
While I mention this every time I post about the latest Medicare enrollment report, it's been some time since I've checked on the traditional vs. privately administered variants of Medicaid enrollees. For a long time I've been under the impression that roughly 70% of Medicaid enrollment was handled via Managed Care Organizations (MCOs):
In May 2023, 93,815,749 individuals were enrolled in Medicaid and CHIP.
86,783,676 individuals were enrolled in Medicaid in May 2023, a decrease of 279,373 individuals (-0.3%) from April 2023.
7,032,073 individuals were enrolled in CHIP in May 2023, a decrease of 41,687 individuals (0.6%) from April 2023
As of May 2023, enrollment in Medicaid and CHIP has decreased by 61,085 since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
Medicaid enrollment has increased by 69,102 individuals (0.1%).
CHIP enrollment has decreased by 130,187 individuals (1.8%)
Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,001,765 individuals (32.5%) to 93,876,834.
Medicaid enrollment increased by 22,634,781 individuals (35.3%).
CHIP enrollment increased by 366,984 individuals (5.4%)
Builds on President Biden’s Historic Commitment to Create a Long-Term Care System Where People Can Live with Dignity
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a proposed rule that seeks to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards—to ensure access to safe, high-quality care for the over 1.2 million residents living in nursing homes each day. This proposed rule builds on the President’s historic Action Plan for Nursing Home Reform launched in the 2022 State of the Union.
These free, in-person events will take place in Litchfield, New Britain, Vernon and Willimantic
HARTFORD, Conn. (Aug. 30, 2023) — Access Health CT (AHCT) can help eligible Connecticut residents enroll in HUSKY Health, the state’s Medicaid program, and Qualified Health Plans. To help residents understand the types of health coverage available to them, AHCT will host free, in-person enrollment fairs in September and October. Many HUSKY Health clients have been affected by “Medicaid Unwinding,” a term the federal government is using to describe the process of resuming reviewing households for Medicaid eligibility after a three-year break during the Public Health Emergency. The eligibility redetermination process resumed April 1 and HUSKY clients will be notified when it is their turn to enroll.