Charles Gaba's blog

(original headline: "Just when you thought the big ACA lawsuits were over...")

UPDATE 7/26/22: Apparently this case is scheduled to be heard by TX District Judge Reed O'Connor today.

UPDATE 9/07/22: Annnnd there it is, via SCOTUS, legal & political journalist Chris Geidner:

BREAKING: US District Judge Reed O’Connor in Texas rules that requiring employers to provide coverage for PrEP drugs (preventing the transmission of HIV) violates the religious rights of employers under federal law (RFRA).

...O’Connor also rules that the U.S. Preventive Services Task Force (PSFT) violates the Appointments Clause because he finds the members are officers of the United States not appointed properly.

...O’Connor rejects several other claims, as to Appointments Clause claims and as to the nondelegation doctrine.

Rate Changes

I'm about 1/3 (update: make that 2/3) of the way through my Annual Individual & Small Group Market Rate Filing project, having analyzed & crunched the numbers for 18 36 states + DC. This seems like a good time to step back and see where things stand.

So far, I've compiled the preliminary unsubsidized average premium rate filings for both the ACA-compliant individual and small group markes in Akransas, Colorado, Connecticut, Delaware, DC, Georgia, Hawaii, Indiana, Kentucky, Maine, Maryland, Michigan, Minnesota, New York, Oregon, Rhode Island, Tennessee, Vermont and Washington State. It's important to remember that these are preliminary filings only--many of the carriers will have their final 2023 rate changes reduced, although in most cases they tend to be approved as is, and in some cases they're even increased beyond what the carrier originally requested.

It's also important to note that these 18 states + DC only represent around 30% of the total U.S. population...aside from New York, the other big states (California, Florida, Texas, Pennsylvania, etc.) haven't posted their 2023 filings yet.

Outline of Puerto Rico

via the Centers for Medicare & Medicaid Services:

The Centers for Medicare & Medicaid Services announced today additional resources and flexibilities available in response to Hurricane Fiona in the commonwealth of Puerto Rico.  CMS is working closely with the Commonwealth of Puerto Rico to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.

On September 18, 2022, President Biden determined that an Emergency exists in the Commonwealth of Puerto Rico due to the emergency conditions resulting from the then Tropical Storm Fiona beginning on September 17, 2022, and continuing.  Additionally, on September 20, 2022, Department of Health and Human Services Secretary Xavier Becerra determined that a Public Health Emergency exists in the Commonwealth of Puerto Rico and has existed since September 17, 2022.

CMS stands ready to assist with resources and waivers to ensure hospitals and other facilities can continue to operate and provide access to care to those impacted by the consequences of the hurricane.

New Jersey

via the New Jersey Dept. of Banking & Insurance:

TRENTON —The New Jersey Department of Banking and Insurance today announced that it has determined that Horizon Blue Cross Blue Shield of New Jersey’s application to reorganize its corporate structure as a nonprofit mutual holding company is complete.  The application is available at: nj.gov/hschearings/ along with information on how to register to attend upcoming public hearings. 

The department will hold three public hearings on the plan to form a mutual holding company as required by statute (P.L. 2020 c. 145). 

“As part of the public hearing process, Horizon Blue Cross Blue Shield of New Jersey will present an overview of their plan to reorganize as a mutual holding company,” said Commissioner Marlene Caride. “The public will have multiple opportunities to share comments on the application and plan through one in-person hearing, two virtual sessions as well as the submission of written comments.” 

Public hearing information can be found below: 

Arizona

via the Arizona Dept. of Insurance & Financial Institutions:

Arizona Announces Extension of Major Medical Transitional Policies Until Further Notice

Phoenix - The Arizona Department of Insurance and Financial Institutions (DIFI) announced that insurers in the individual and small group major medical health insurance markets can choose to renew "transitional policies" for a policy year beginning after October 1, 2022, and thereafter until CMS modifies its non-enforcement policy.  Transitional policies are policies that individuals had in place before the Affordable Care Act went into full effect on January 1, 2014.  

This extension aligns with the extension announced by the Center for Consumer Information and Insurance Oversight (CCIIO) in Insurance Standards Bulletin Series – INFORMATION – Extension of Limited Non-Enforcement Policy through 2023 and Later Benefit Years.  The Bulletin gives insurers the option to annually renew applicable pre-2014 individual and small group policies until further notice.  Approximately 30,000 Arizonans have health insurance coverage through a transitional plan.

North Carolina

via the Centers for Medicare & Medicaid Services:

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved the extension of Medicaid and Children’s Health Insurance Program (CHIP) coverage for 12 months after pregnancy in North Carolina. As a result, up to an additional 28,000 people will now be eligible for Medicaid or CHIP for a full year after pregnancy in North Carolina. With today’s approval, in combination with previously approved state extensions, an estimated 361,000 Americans annually in 24 states and D.C. are eligible for 12 months of postpartum coverage. If all states adopted this option, as many as 720,000 people across the United States would be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy.

After both the Washington HealthPlan Finder and Pennsylvania's Pennie ACA exchange announced that they were setting up Special Enrollment Periods for residents who were scammed by Benefytt Technologies into buying non-ACA compliant heatlhcare policies, this shouldn't be surprising.

via Amy Lotven of Inside Health Policy (paywall):

MNsure Logo

via MNsure, Minnesota's ACA exchange:

ST. PAUL, Minn. — When Minnesota’s open enrollment period starts November 1, Minnesotans who need health insurance can find walk-in assistance from a broker at 18 locations, known as broker enrollment centers. Thanks to new partnerships between MNsure and competitively selected insurance agencies, this expert help is provided free of cost to Minnesotans.

Finding the right health insurance can feel complex and overwhelming, especially for first-time applicants. Taking advantage of free, personalized help from a health insurance expert can make the enrollment process easier and less time-consuming than trying to go it alone, whether applying for the first time, changing plans, or renewing coverage.

Pennie Logo

A couple of weeks ago I noted that the Washington HealthPlan Finder has launched a special enrollment period for several hundred WA residents who were misled into enrolling in non-ACA compliant healthcare policies via fraudulent marketing by a company called "Benefytt Technologies."

Last week Pennie, Pennsylvania's ACA exchange followed suit:

The Federal Trade Commission Took Action Against Benefytt Technologies for Providing Deceptive Health Plans – Pennie is Helping Impacted Pennsylvanians Enroll in Quality Coverage  

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