Charles Gaba's blog

Covered California and the Challenged Athletes Foundation Team Up to Promote Open Enrollment and the Dec. 15 Deadline for Coverage During All of 2020

  • While Covered California’s Open Enrollment period runs through Jan. 31, 2020, consumers must enroll by the end of Dec. 15 to have their coverage begin on Jan. 1.
  • Covered California is teaming up with the Challenged Athletes Foundation, to host a Holiday Boot Camp to promote the importance of health, fitness and the open enrollment period. 
  • The Boot Camp will be led by Paralympian, 2019 Parapan Gold Medalist and World Record Holder Scout Bassett and Nike Master Trainer Betina Gozo.
  • Californians who choose to go without coverage could face a penalty when they file their 2020 taxes.

Covered California continued its statewide open enrollment campaign by teaming up with the Challenged Athletes Foundation in San Diego for its Holiday Boot Camp on Tuesday. The event comes as Covered California alerts consumers about a critical upcoming deadline. Consumers must sign up by Dec. 15 if they want their coverage to start on Jan. 1.

For three years running, thanks to a combination of the way the ACA's premiums subsidy formula works and the Silver Loading workaround, several million low-income people are eligible for fully ACA-compliant healthcare policies which end up costing them NOTHING in premiums after federal tax credits are applied.

Here's why: Under the ACA's subsidy formula, if you earn between 100% - 400% of the Federal Poverty Line ($12,490 - $49,960/yr if you're single), you're eligible for subsidies which bring the cost of the benchmark Silver ACA plan down to between 2.06 - 9.78% of your income, on a sliding scale.

If you earn less than 200% FPL (just under $25,000), you also qualify for heavy cost sharing reduction assistance as well...but only if you enroll in a Silver plan.

So, let's suppose you earn exactly $25,000/yr (just over 200% FPL). At that income, you'd qualify for subsidies bringing the benchmark Silver down to 6.5% of your income, or $135/month. If the benchmark plan costs, $600 at full price, you'd therefore be eligible for $465/month.

 

Tuesday, December 10th, is gonna be a pretty big day for federal healthcare policy, especially in the U.S. House of Representatives.

For one thing, it's my understanding that the big Prescription Drug Bill (H.R. 3, the Lower Drug Costs Now Act) is scheduled for a floor vote on Tuesday, although it's possible that it'll be bumped until later in the week given the grumbling by the Congressional Progressive Caucus.

For another, the House Energy & Commerce Committee is holding what I'm assuming are all-day hearings on not one, not two, but nine different Universal Coverage bills, including the Big Ones: Medicare for All and Medicare for America:

HEARING ON "PROPOSALS TO ACHIEVE UNIVERSAL HEALTH CARE COVERAGE"

Date: Tuesday, December 10, 2019 - 10:30am

 

(h/t @CarenaAK via Twitter)

The hits just keep on coming for CMS Administrator Seema Verma:

Medicare chief asked taxpayers to cover stolen jewelry

A top Trump health appointee sought to have taxpayers reimburse her for the costs of jewelry, clothing and other possessions, including a $5,900 Ivanka Trump-brand pendant, that were stolen while in her luggage during a work-related trip, according to documents obtained by POLITICO.

Seema Verma, who runs the Centers for Medicare and Medicaid Services, filed a $47,000 claim for lost property on Aug. 20, 2018, after her bags were stolen while she was giving a speech in San Francisco the prior month. The property was not insured, Verma wrote in her filing to the Health and Human Services department.

The federal health department ultimately reimbursed Verma $2,852.40 for her claim, a CMS spokesperson said.

via email from the House Energy & Commerce Committee:

Bipartisan House and Senate Committee Leaders Announce Agreement on Legislation to Lower Health Care Costs

  • Legislation ends surprise medical bills; funds Community Health Centers for five years; increases the purchasing age of tobacco to 21; lowers prescription drug and other medical costs by requiring more transparency and competition

WASHINGTON, December 8, 2019 — Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-N.J.) along with Ranking Member Greg Walden (R-Ore.) today announced they have reached a bipartisan, bicameral agreement on legislation to lower what Americans pay out of pocket for their health care.

Whether it actually makes it through both the House and Senate and gets signed by Trump or not, just getting this type of announcement itself is pretty unheard of these days for any significant policy.

As noted a few days ago, House Democrats have officially scheduled a floor vote on H.R. 3, the Lower Drug Costs Act of 2019, for next week:

Pelosi, Hoyer, Pallone, Neal and Scott Joint Statement Announcing Floor Vote on H.R. 3

Washington, D.C. – Speaker Nancy Pelosi, Majority Leader Steny Hoyer, Energy & Commerce Committee Chairman Frank Pallone Jr., Ways & Means Committee Chairman Richard E. Neal and Education & Labor Committee Chairman Bobby Scott released the following joint statement:

“Next week, the House of Representatives will pass the Elijah E. Cummings Lower Drug Costs Now Act.

“We have now received enough guidance from CBO to bring the Lower Drug Costs Now Act to the Floor and to reinvest its savings in one of the most transformational improvements to Medicare since its creation.

via the Washington Health Benefit Exchange:

Washington Health Benefit Exchange Issues Statement on Approval of Cascade Care Plan Designs

Washington Health Benefit Exchange (Exchange) board approved the design for Cascade Care plans today. Cascade Care plans are qualified health plans that have a standard health benefit design across health insurance carriers making it easier to understand and offer more value for Washington Healthplanfinder consumers.

Today, Pam MacEwan, CEO of the Washington Health Benefit Exchange, and Ron Sims, the Exchange’s Board Chair, issued the following statement regarding the approval of the designs as a step in implementing Senate Bill 5526 (Cascade Care):

via HealthSource RI:

The clock is ticking on picking the best health insurance plan for 2020. High quality and affordable health coverage is available through HealthSource RI, and Rhode Islanders have until December 23rd to purchase coverage that starts on January 1st.
 
Getting health insurance is even more important this year because coverage is now required in the state of Rhode Island. As of January 1st, residents who don’t have health insurance will pay a tax penalty when filing for the prior year.

AGAIN: The federal shared responsibility requirement (aka the individual mandate penalty) may have been zeroed out by Congressional Republicans, but in addition to the District of Columbia, four states (Massachusetts, New Jersey, California and Rhode Island) have reinstated it at the state level.

A few weeks ago, I did a write-up about a concerning development at HealthCare.Gov: The growing push under the Trump Administration to not only partner with 3rd-party web brokers (which has been done since the first days of the ACA under the Obama Administration), but to actively promote those third-party brokers over HealthCare.Gov itself.

In and of itself, this wouldn't be too problematic as long as people are still ultimately enrolling in fully ACA-compliant policies and receiving ACA subsidies if they're eligible for them. Hell, one of these 3rd-party authorized web brokers even has a banner ad at the top of my website...which I only allow because this particular one only sells on-exchange ACA-compliant policies.

Your Health Idaho doesn't post presse release very often, but when they do it's usually helpful info:

Open Enrollment for Idaho is coming to a close, don’t miss out on enrolling in an affordable health insurance plan! You can set up an account, shop for plans, and apply for coverage online. Visit Apply and Enroll for more information. No computer? No problem. To apply over the phone or to request a paper application, call Your Health Idaho at 1-855-944-3246.

We’re Here to Help!

Your Health Idaho will have extended hours throughout December*:

  • December 1 – 6: 7am – 7pm
  • December 9 – 13: 7am – 8pm
  • December 14 (Saturday): 10am – 4pm
  • December 16 – 20: 7am – 8pm
  • December 21 (Saturday): 10am – 4pm

This is the perfect opportunity for those Idahoans who were unable to reach us during the busy work week.
*All times are in Mountain Time Zone.

What is an Open Enrollment Period?

This just in from MNsure, the Minnesota ACA exchange:

All private health plans offered on the MNsure marketplace limit the out-of-pocket cost to enrollees for insulin prescriptions in 2020. Each of MNsure's four insurers are offering either low-cost or free insulin benefits, meaning consumers purchasing plans through MNsure will pay no more than 25 dollars per month for insulin.

"The rising cost of insulin has put a huge financial burden on many families across Minnesota," said Nate Clark, MNsure CEO. "It’s so important to have access to insulin at an affordable price. We encourage all those looking for prescription insulin coverage to check out the plan options at MNsure.org."

Just another quick update from AccessHealthCT:

This year, their press release page states the following:

Stats as of December 6, 2019:

Qualified Health Plans (QHP):

  • Net Total QHP Enrollment: 99,322
  • 2020 OE Acquisition Summary: 10,281

Overall Volume

  • Unique Website Visitors: 128,886
  • Calls Handled: 119,089

Medicaid: Completed applications/redeterminations processed through the integrated eligibility system: 29,692

I'm assuming this means that they've joined several other state exchanges and are front-loading their auto-renewals of everyone currently enrolled. I'm further assuming that of those 99,322 people, 10,281 of them are new enrollees. If so, that means they'll have to enroll just 11,744 more people over the next four weeks to beat last year's 111,066 total.

Connect for Health Colorado reported 24,000 QHP selections as of 11/15. Now they're out with another update:

Connect for Health Colorado® Urges Residents to Shop by December 15 for January Coverage

Nearly 42,000 Coloradans signed up for a health insurance plan through Connect for Health Colorado’s Marketplace between Nov. 1 and Nov. 30. Approximately 70 percent of applicants qualify for financial help in the first month of the Open Enrollment period. Residents must sign up for a plan by Dec. 15, 2019 to have coverage in place by Jan. 1, 2020, however, Open Enrollment runs through Jan. 15, 2020. 

Coloradans can sign up for a Marketplace plan online, over the phone or in person with a certified enrollment expert. Connect for Health Colorado has 23 enrollment centers to provide residents with walk-in help at different times throughout the week. Residents can also schedule an appointment. 

I have a different California-specific post coming later this afternoon, but I stumbled across a mildly interesting bit of data and figured this would be a good time to share it while I wait to be able to post that one.

As you may recall, while the ACA required that most individual market major medical healthcare policies sold have to comply with full ACA regulations, there were some exceptions to this. The biggest exception made was for major medical plans which had been continuously enrolled in since before the ACA was signed into law in March 2010.

These plans were grandfathered in, and so are appropriately called "Grandfathered Plans", and applied to perhaps 5 million people or so back in 2014, when ACA-compliance became mandatory for newly-sold policies.

Don't ask me why, but for some reason, in the midst of my pushing hard for the major ACA 2.0 bills to be passed (H.R. 1868 and H.R. 1884), I've written nary a word about another important (and actually more impactful if it were to be passed and signed into law) bill: H.R.3, the Lower Drug Costs Now Act of 2019:

This bill establishes several programs and requirements relating to the prices of prescription drugs.

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