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.

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

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. 

Medicaid Unwinding

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).

KFF's data is now pretty comprehensive (it includes nearly every state plus DC), and it's bad if not worse than many healthcare advocates feared as the numbers have continued to grow dramatically:

As widely expected, just one day after the Food & Drug Administration (FDA) approved updated mRNA COVID-19 vaccines to help battle the XBB.1.5 strain of the disease, a panel of Centers for Disease Control (CDC) advisors have also given the updated vaccine their blessing. All that's left now is for CDC director Mandy Cohen (who was newly appointed as of July 10th) to sign off on it in order for distribution to the general public to begin. Via NPR:

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.

via the Maryland Insurance Administration:

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.

Over at Inside Health Policy, Dorothy Mills-Gregg has decided to check in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:

As noted by Madeline Guth of the Kaiser Family Foundation last year:

...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:

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

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:

North Dakota:

via the U.S. Food & Drug Administration:

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.

What You Need to Know

via Pennie (Pennsylvania's ACA exchange):

Pennie, Pennsylvania’s official health insurance marketplace, is proud to present their inaugural Health Equity Data Report.

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.

This report: