CMS gives thumbs-up to Medicaid work requirements in Ohio
The Centers for Medicare & Medicaid Services has approved a waiver request for work requirements in Ohio’s Medicaid program.
...CMS rolled out guidance on these waivers in January 2018, and since then eight states, including Ohio, have had requests approved. Several additional states have submitted waivers that the agency has yet to weigh in on.
...Arkansas is the only state where such work requirements have formally been launched, and in the last several months of 2018, more than 18,000 people lost Medicaid coverage as a result of the work requirement. The Kaiser Family Foundation estimated that most of these losses were a result of the administrative requirements associated with reporting work hours.
This was actually released a month ago, but I was a bit preoccupied with my kid's Bar Mitzvah at the time (he did great, by the way, thanks for asking!).
Access Health CT, Connecticut's state-based ACA exchange, released their 2019 Open Enrollment Period report, and it's one of the most extensively detailed & granual looks at the year's enrollment data. They've included the normal stuff, of course (subsidized vs. unsubsidized, metal levels, age and income brackets, etc)...but they've also done a very deep dive into data points I haven't seen before by cross-indexing categories.
For instance, not only did they break out "enrollment attrition reasons" (that is, why 2018 enrollees who didn't renew their policies chose not to), but they actually broke that out into what those enrollees' financial assistance status was.
The level of detail here is pretty impressive and somewhat overwhelming (there's 25 pages of charts & graphs), but if you're a healthcare nerd interested in what's going on in the Nutmeg State, knock yourself out!
Via Email from the Connect for Health Colorado exchange...
Customers Receiving Financial Help Through Connect for Health Colorado® Seeing a 14% Drop in Net Monthly Premium Cost
DENVER – Coloradans who get financial help buying health insurance through Connect for Health Colorado® are paying an average 14 percent less in “net premium” – what they pay after assistance – compared to the average net premium in 2018, according to data released today.
Three of every four current Connect for Health Colorado customers qualify for financial help to reduce the monthly cost of health insurance. The average net premium for those Coloradans is $117 per month, down from $136 per month last year.
“We are happy that we are able to make health insurance affordable for so many people,” said Kevin Patterson, Chief Executive Office of Connect for Health Colorado. “The number of our customers receiving help rose this year by seven percentage points, to 76 percent, an important increase. We know we have more work to do, and are committed to expanding our impact as we work with policy makers, our stakeholders and our customers throughout the state.
In light of the flurry of state-level legislation locking in ACA protections in New Mexico and Maine over the past few weeks, this seems like a good point to check in on other states as well.
One more time: Here's what the ACA's "3-Legged Stool" looks like as of March 2019. The Trump Administration and Congressional Republicans tried to sabotage the Green Leg by cutting off Cost Sharing Reduction reimbursement payments...but the insurance carriers mostly cancelled this out by Silver Loading. The end result of this is that the federal government is actually shelling out up to $20 billion more in APTC subsidies per year, more than cancelling out the $10 billion or so they're saving in unpaid CSR costs (and they may still have to pay that as well anyway!)
Last week I noted that New Mexico had capped off a flurry of positive healthcare policy legislation by passing a bill (in dramatic fashion) which would lock in ACA-level protections for those with pre-existing conditions in the event the ACA itself is ever repealed or weakened.
Once this bill is signed by the Governor (which is almost certain to happen), New Mexico will join four other states (Massachusetts, New York, Colorado and Virginia) in fully protecting all three types of "blue leg" protections: Guaranteed Issue, Community Rating and Essential Health Benefits. The New Mexico bill also locks in a fourth ACA protection: The prohibition on annual or lifetime coverage limits.
The CSR Lawsuit Saga has been a continuous rollercoaster ride since 2014 at this point, with the original lawsuit (brought by John friggin' Boehner) seeing twists including one of the plaintiffs becoming one of the named defendents, and the named defendent changing at least three times as the Trump Administration went through several HHS Secretaries over the course of a few months.
The extremely short version, again: Donald Trump attempted to sabotage the ACA exchanges by pulling the plug on Cost Sharing Reduction reimbursement payments...but in doing so, unintentionally ended up:
NOT hurting the very people he was trying to hurt (low-income enrollees);
HURTING the very people he supposedly wasn't trying to hurt (middle-income enrollees), and as an added bonus...
INCREASING federal spending by a projected $20 billion dollars per year in increased premium subsidies
Nearly 100 insurance carriers who were stiffed by Trump out of a couple billion dollars owed to them for 2017 sued the federal government, and the judges in the cases ruled in their favor, ordering the feds to pay up. This much was completely expected and not at all out of the ordinary.
When it comes to discussing changes in healthcare policy, one of the most important--and most frustrating--topics which have to be tackled is how much healthcare services actually cost. I'm not necessarily talking about how much the patient pays, although that's obviously important as well...I'm referring to how much the healthcare providers charge and get paid.
Doctors, hospitals, clinics, pharmaceutical companies, medical device makers and so forth all get paid different amounts for different services from different payors, depending on whether it's a private insurance carrier, Medicare or Medicaid...and those rates generally range widely from state to state and carrier to carrier. One partial exception to this is Maryland, where they've been experimenting fairly successfully with a concept called "all-payer" rate setting:
*("major" is obviously a subjective term depending on who's using it.)
Until this weekend, "Medicare for All or Bust" seemed to be the most critical litmus test for any major 2020 Democratic Presidential candidate. No fewer than sixteen Democratic Senators co-sponsored Bernie Sanders' S.1804 "Medicare for All" single payer bill in September 2017, including five of the six U.S. Senators currently running for the 2020 nomination: Sanders himself, Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren (the only Senator running who didn't cosponsor the bill was Amy Klobuchar.)
Recently, however, there have been a few interesting developments along the "Where do the Dem candidates stand on healthcare policy" front:
In the 5 1/2 years that I've been operating this website (has it really been that long?), I was surprised (pun intended) to realize that out of the 5,600+ blog entries that I've posted, only 2-3 have mentioned "Surprise Bills" (also known as "Balance Billing", although I think there are some differences between the two):
