Charles Gaba's blog

Just wanted to let my readers know that I'll be on vacation from tomorrow (Saturday the 14th) through the following Sunday the 23rd.

I'll post something if there's a major ACA/healthcare development but otherwise no site updates until Monday the 24th.

via Cara Smith of Inside Health Policy:

Some health care policy experts are sounding the alarm that allowing standalone telehealth plans may simply be a shortcut for employers to cut rising health care costs while subverting Affordable Care Act consumer protections, but telehealth proponents tout the policy as simply a way to complement not replace more-expansive health insurance benefits. The debate has been muddied by confusion over how the bill’s “excepted benefits” policy differs from a narrower pandemic waiver that allowed some workers to get standalone telehealth plans that mimicked excepted benefits.

The Telehealth Benefit Expansion for Workers Act would add telehealth as an excepted benefit to the “menu” of health care options for all employees, not just those who do not qualify for major medical insurance plans as was the case under an expired pandemic telehealth flexibility. The legislation has been passed by the House Education & the Workforce committee and will be taken up by E&C Thursday (July 13).

via MNsure:

ST. PAUL, Minn.—As roughly 1.5 million Minnesotans who currently have Medical Assistance (Minnesota’s Medicaid program) or MinnesotaCare coverage are scheduled to go through the eligibility renewal process over the next year, some will find out they are no longer eligible for these public health care programs and need to find new health insurance. Minnesota’s official health insurance marketplace, MNsure, is here to help those Minnesotans find new coverage.

“If you learn you no longer qualify for Medical Assistance or MinnesotaCare coverage, you may have more health insurance options than you think,” said MNsure CEO Libby Caulum. “MNsure is here to help you and your family understand your options, apply for discounts to save money on monthly premiums, and make a smooth transition to a private health plan if you’re eligible. We can help you find new coverage so you can keep getting the care you need.”

via the Indiana Dept. of Insurance:


The companies listed below have submitted ACA-compliant rate filings for Plan Year 2024. Information about the filings may be found at the IDOI SERFF Filing Access or Rate Review.

The IDOI will finalize its review of the 2024 ACA compliant filings both on and off the federal Marketplace by August 17, 2023. The Centers for Medicare and Medicaid Services (CMS) will issue the ultimate approval for the Marketplace plans sold in Indiana. CMS will issue its approval on or before September 20, 2023.

General Note:

Humana Insurance Company and Humana Health Plan Inc. are filing rates for groups who choose to renew for a short plan year. Groups renewing in first quarter 2024 will receive a six-month plan year renewal, while groups renewing in 2nd quarter 2024 will receive a three-month plan year renewal. The plan associated with each filing will only be available for renewals during 1Q24 and 2Q24.

Georgia's health department doesn't publish their annual rate filings publicly, but they don't hide them either; I was able to acquire pretty much everything via a simple FOIA request. Huge kudos to the GA OCI folks!

Unfortunately, it looks like less than half of Georgia's small group market carriers have submitted their filings (alternately, it's conceivable that the other have have pulled out of the G small group market, though I highly doubt that). Only four of the eleven carriers offering policies in 2023 have filings included in the package sent to me by GA OCI. Not sure what that's about.

In any event, Georgia's individual market has grown dramatically over the past year (813,000 people vs. 660,000 a year ago), but the requested 2024 rate filings are pretty ugly, ranging from a somewhat reasonable 6.4% to as high as 27.7% for Cigna (ouch). The weighted average overall is just over 15% even.

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, in which AR carriers are seeking an average 5.0% rate hike on the individual market and 5.5% for small group plans. 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.

via the Centers for Medicare & Medicaid Services (CMS):

New Report Projects Nearly 19 Million Seniors Will Save $400 Per Year on Out-of-Pocket Prescription Drug Costs

Today, the U.S. Department of Health and Human Services (HHS), announced actions to protect consumers from junk health plans, surprise medical bills, and excess costs that lead to medical debt. These actions build on the Biden-Harris Administration’s effort to eliminate hidden fees in every sector of the economy and lower health care costs for American seniors and families.

Coinciding with the actions taken today, HHS also released a new report projecting that nearly 19 million seniors will save approximately $400 per year on prescription drug costs when the $2,000 out-of-pocket prescription drug spending cap from the Inflation Reduction Act – President Biden’s historic lower cost prescription drug law – goes into effect in 2025.



In late 2020 after years of bipartisan attempts to tackle one of the uglier problems with the U.S. healthcare system, Congress somehow ended up quietly slipping in a bill which resolved a large chunk of the issue with minimal fanfare:

Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.

See my prior post about short-term, limited duration plans & their regulation history under the Obama, Trump & Biden Administrations.

via the Centers for Medicare & Medicaid Services:

Short-Term, Limited-Duration Insurance; Independent, Noncoordinated Excepted Benefits Coverage; Level-Funded Plan Arrangements; and Tax Treatment of Certain Accident and Health Insurance (CMS-9904-P)

Jul 07, 2023

Original story: 6/29/23:

I haven't written about #ShortAssPlans ("Short-Term, Limited Duration") healthcare policies since back in January, when it was announced that the Biden Administration would be announcing new regulations on them sometime in April 2023. Obviously that time has come and gone, but it looks like the Office of Management & Budget (OMB) is finally ready for the Centers for Medicare & Medicaid Services (CMS) to roll the new rule out: