Charles Gaba's blog


October 2022:

Texas: Friday Health Plans Bails; Another ~230K Enrollees Will Have To Pick A Different Day Of The Week

It was just four days ago that Bright Healthcare, which had been aggressively expanding their individual market coverage area footprint as recently as a year ago, suddenly announced that they were doing a complete 180 and instead pulling out of virtually the entire individual & small group markets nationally starting in January 2023.

...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:

via the White House website:

Last night, the Fifth Circuit issued a decision which invalidates the scientific, independent judgment of the FDA about when and how a medicine is available to Americans. The Justice Department has already announced that they are seeking emergency relief from the Supreme Court.
More than 20 years ago, the FDA approved medication abortion as safe and effective for the American people. Last week, a Texas district court ruled to block access to this medication in every state in the country.
The Fifth Circuit’s decision—just like the district court’s—second-guesses the agency’s medical experts. If this decision stands, no medication—from chemotherapy drugs, to asthma medicine, to blood pressure pills, to insulin—would be safe from attacks. This decision threatens the rights of Americans across the country, who can look in their medicine cabinets and find medication prescribed by a doctor because the FDA engaged in a process to determine the efficacy and safety of that medication.

Last August, Ben D'Avanzo of the National Immigration Law Center wrote a guest post here at ACA Signups about the 23% of uninsured Americans who are immigrants, and the challenges in providing healthcare coverage for them. In it, he noted that:

...given the slow nature of congressional action, the Biden administration can take some important steps now. For example, HHS could make hundreds of thousands of DACA recipients eligible for ACA coverage through regulatory action. It could also build on its existing investment in outreach and assistance programs to fund more Navigators and other community organizations that are best suited for immigrant-focused enrollment work.

via the Doctors for America website:

WASHINGTON, D.C. – Doctors for America and the Reproductive Health Coalition have filed a new amicus brief in support of FDA’s approval of the use of mifepristone to end pregnancy through ten weeks gestation.  

The brief, filed in the U.S. Court of Appeals for the Fifth Circuit, is in response to the decision made last week by Judge Kacsmaryk in the case of Alliance for Hippocratic Medicine vs. U.S. Food and Drug Administration (FDA), in which Judge Kacsmaryk ordered the FDA to stay the approval of mifepristone. Both Doctors for America (DFA) and the Reproductive Health Coalition (RHC) are deeply concerned that the decision made by Judge Kacsmaryk is not based on medical science, nor the robust data available. Mifepristone is a medication that has been safely used by physicians and patients for over 20 years, with research showing that adverse events and outcomes are exceedingly rare, occurring in less than a fraction of 1% of cases. 

Hmmm...this is a bit odd. Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.

For the December update, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow which I summarized yesterday, along with another note leading to their new Medicare Monthly Enrollment database.

In any event, according to the spreadsheet I exported, as of December 2022:

Yesterday I noted that the Maryland legislature, which has had an excellent record on healthcare reform policy in recent years, had a rare misstep when they took a pass on allowing undocumented immigrants to enroll in the states ACA exchange. While the lack of federal subsidy eligibility would have severely limited the number of undocumented Maryland residents who would be able to utilize this path towards healthcare, it was still a missed opportunity.

Today, however, I can report that the MD legislature has passed several other bills which move things in the right direction. Via Rob Flaks of WMDT:

With just days left in the General Assembly session, Maryland lawmakers have passed a series of bills aimed at expanding healthcare access and combating costs across the state.


Via the Centers for Medicare & Medicaid Services:

Arizona became the latest state to extend postpartum coverage for individuals enrolled in Medicaid and the Children’s Health Insurance Program, following CMS’ approval of the state’s postpartum coverage extension state plan amendments (SPAs). The opportunity to extend this coverage was made possible by the American Rescue Plan, and this approval marks 31 states and D.C. that have extended postpartum Medicaid/CHIP coverage to a full year.

I have no idea why the administration hasn't put out a formal standalone press release about this...they've done so for every other state to my knowledge (including Oklahoma just two weeks ago), but whatever; it's still good news!

via NJ Gov. Murphy's website:

Feds Approve Innovative NJ FamilyCare Projects Addressing Housing, Behavioral & Physical Health, Providing Care & Other Creative Approaches

  • 1115 Demonstration Approval Continues Long-Standing Medicaid Programs and Allows New Innovations

TRENTON – The Centers for Medicare and Medicaid Services (CMS) has approved innovative NJ FamilyCare projects designed to address priorities such as housing, integrating behavioral and physical health services, and new and creative approaches to providing care.

CMS signed off on the projects by approving NJ FamilyCare’s Comprehensive 1115 Demonstration renewal. The 1115 demonstration provides the state with federal authority to operate large parts of the NJ FamilyCare program.  The approval is in effect from April 1, 2023 through June 30, 2028.

via the Washington Post:

...The proposal at issue would allow undocumented immigrants to buy health insurance through the state exchange, a policy change that state analysts predict would lead to coverage for about one-third of the state’s undocumented population, or 82,500 people. The move would add Maryland to a small number of states targeting the group in an effort to shore up gaps in health care access — a goal that has faced head winds in Congress.

Supporters say the proposal dovetails with Gov. Wes Moore’s goal of eliminating child poverty and would reduce overall premiums and care provided by hospitals free of charge to the uninsured. But instead of passing a bill that would open the insurance marketplace, which would require a federal waiver, lawmakers instead approved legislation that calls for the Maryland Health Department and the Maryland Health Benefit Exchange to study options for undocumented immigrants’ health care needs to guide their work moving forward.

via the California Dept. of Justice website:

Attorney General Bonta Announces $2.1 Million Settlement Against Companies Over Sham Health Insurance Plans

OAKLAND — California Attorney General Rob Bonta today announced a $2.1 million settlement against two companies, Shared Health Alliance, Inc. (SHA) and Alliance for Shared Health (ASH), to resolve allegations that they offered and deceptively advertised sham health insurance and violated insurance regulations that protect consumers. ASH, a nonprofit corporation that purported to be a healthcare sharing ministry (HCSM), created, operated, and sold unauthorized health insurance through its for-profit administrative vendor, SHA.