Back in February, I wrote about a bill introduced into the Illinois State Senate by Sen. Laura Fine (SD-09) which made my heart sing:
Amends the Department of Insurance Law.
Provides that the Department of Insurance shall establish the Office of the Healthcare Advocate.
Provides that the Office shall be administered by the Chief Health Care Advocate, who shall report to the Director of Insurance.
Amends the Illinois Insurance Code and the Health Maintenance Organization Act.
Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department for approval.
Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved.
Provides that when an insurer files a schedule or table of premium rates for individual or small group health benefit plans, the insurer shall post notice of the premium rate filings and a filing summary in plain language on the insurer's website.
Provides that the Department shall post all insurers' rate filings and summaries on the Department's website.
Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website.
...With the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:
Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.
These free, in-person events will take place in Meriden, Norwich and Waterbury
HARTFORD, Conn. (May 24, 2023) — Access Health CT (AHCT) today announced it will host three free, in-person enrollment fairs in June to help HUSKY Health enrollees who have been affected by recent legislation. HUSKY Health is Connecticut’s Medicaid program. The events will take place in Meriden, Norwich and Waterbury.
Medicaid Unwinding is a term the federal government is using to describe the process of resuming the regular annual review of households for Medicaid eligibility after a three-year hiatus during COVID. The eligibility redetermination process resumed April 1. The Medicaid Unwinding process will be taking place over a 12-month period.
Connecticut residents who remain eligible for HUSKY Health will likely be automatically reenrolled; those who need to take action will receive mail with instructions about when they need to take action.
The main distinction between the New Mexico and Minnesota approaches has to do with which existing publicly-funded healthcare program they're based on. While New Mexico went with Medicaid (which half the state's population is already enrolled in anyway), Minnesota is basing theirs on their Basic Health Plan program, MinnesotaCare. I first wrote about this back in February.
Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
CMS Approves Delaware Postpartum Coverage Expansion Under the American Rescue Plan
May 15: CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage expansion in Delaware, an opportunity made possible through the American Rescue Plan. This approval marks 33 states and the District of Columbia that have extended postpartum Medicaid/CHIP coverage to a full year. Information about Delaware’s postpartum coverage extension for Medicaid can be found here; Delaware’s postpartum coverage extension for CHIP can be found here.
Theodore Mermigos,
Acting Director Division of Medicaid and Medical Assistance
Molly Magarik, Secretary, DHSS
Delaware Health and Social Services
P.O. Box 906 New Castle, DE 19720-0906
Ever since the ACA went into effect in 2011 (3 years before newly-sold policies had to be ACA compliant), to help reduce price gouging, insurance carriers have been required to spend a minimum of 80% of their premium revenue (85% for the large group market) on actual medical claims.
Put another way, their gross margins are limited to no more than 20% (or 15% in the large group market). Remember, that's their gross margin, not net; all operational expenses must come out of that 20% (15%). The idea is that they should be spending as much of your premium dollars as possible on actual healthcare, as opposed to junkets to Tahiti or marble staircases in the corporate offices, etc. Anything over that 20% (15%) gross margin has to be rebated to the policyholder.
With all the controversy over the frighteningly quick expansion of Artificial Intelligence (AI) systems over the past year or so into every facet of our lives, I decided to run a quick experiment using ChatGPT. My request was pretty simple:
"Write a blog post in the style of Charles Gaba."
I didn't include anything about healthcare or the Affordable Care Act...just my name.
Here's what it came back with, verbatim. I'm putting the whole thing in quotes because while it was sophisticated enough to make the topic of the post the history of the ACA and the U.S. healthcare system in general, I sure as hell didn't write this:
Title: The Healthcare Odyssey: Navigating the Waves of Change
Subtitle: Charting a Course Through the Turbulent Sea of Healthcare Reform
To: State Department Directors and Autonomous Agency Heads
From: Governor Gretchen Whitmer
The federal Families First Coronavirus Response Act, passed to respond to the COVID-19 pandemic, required Medicaid programs to keep participants continuously enrolled and provided additional federal funding to do so. In December 2022, Congress passed a law ending the continuous enrollment and winding down the associated federal funding. As a result, more than 3 million Michiganders will need to undergo redeterminations for Medicaid coverage or find alternative health insurance if they no longer qualify.
During the COVID pandemic emergency, Congress passed legislation which, among other things, required states to provide "continuous coverage" of people who enrolled in Medicaid or the CHIP program.
Normally Medicaid/CHIP enrollees have their eligibility statuses "redetermined" every month (or quarter in some states, I believe) to make sure they were still eligible for the program, but the Families First Coronavirus Response Act (FFCRA) stated that in order to receive increased federal funding of their Medicaid/CHIP programs, states couldn't kick anyone off as long as the public health emergency was in place (unless they died, moved out of state or asked to be disenrolled).
This requirement ended effective April 1st, 2023 via an omnibus bill passed back in December.
