I just finished writing up a deep dive into the Arkansas Insurance Dept's move from laissez faire-style Silver Loading to fully-regulated & maximized Premium Alignment in an attempt to mitigate the massive net premium damage about to be caused if the enhanced ACA premium tax credits expire at the end of 2025.
However, it's not just Arkansas which has finally seen the light and joined about a dozen other states in putting full-bore Premium Alignment (PA) pricing into place to help reduce the financial burden on ACA individual market enrollees in 2026.
Other states which have already done so in the past include Colorado (sort of), Texas, New Mexico, Maryland, Pennsylvania (somewhat), Illinois, Vermont and Wyoming.
Warning: This isn't just gonna get deeply wonky, it also requires digging deep into histroy. You've been warned.
Chapter 1: The (simplified) Backstory:
The ACA includes two types of financial subsidies: Advance Premium Tax Credits (APTC), which reduce monthly premiums; and Cost Sharing Reductions (CSR), which cut down on deductibles, co-pays & other out-of-pocket (OOP) expenses for low-income enrollees.
In 2014, then-Speaker of the House John Boehner filed a lawsuit on behalf of Congressional Republicans against the Obama Administration, in part because they claimed that CSR payments were unconstitutional because they weren't explicitly appropriated by Congress in the text of the Affordable Care Act.
A long legal process ensued, the end of which resulted in a federal judge ruling in the GOP's favor and ordering that CSR payments stop being made...but also staying that same order pending appeal of her decision by the Justice Department (then still run by the Obama Administration).
I've been following this bill for awhile now but never got around to writing about it until after it passed through both chambers of the Illinois legislature. That's a shame, because it's a pretty Big F*cking Deal for Illinois residents.
The Illinois House passed the Healthcare Protection Act Saturday to help curb predatory insurance practices and protect consumers.
Gov. JB Pritzker's monumental plan could make Illinois the first state to ban prior authorization for in-patient adult and children's mental healthcare. The legislation also bans step therapy, or the fail first method, where insurers force people to receive less effective treatment before moving to options initially recommended by doctors.
...The measure requires prior approval from the Department of Insurance before large group insurance plans can increase rates and states premiums must align with the actual cost of providing care as well.
Today I want to address the question of Actuarial Value (AV)...that is, what percent of medical expenses (in aggregate) a given healthcare policy actually pays for. As a quick reminder, ACA policies are generally broken into four AV categories, labeled by metal levels: Bronze, Silver, Gold and Platinum, which generally cover roughly 60%, 70%, 80% or 90% of enrollees in-network medical expenses per year (there's a fifth category in front of Bronze called Catastrophic plans, but these have limited eligibility and hardly anyone enrolls in them anyway).
Advocates To CMS: Fix Rate Misalignment In Next Exchange Reg
A coalition of patient advocates is urging HHS to address high out-of-pocket costs by demanding that insurers selling marketplace coverage strictly adhere to the Affordable Care Act’s rate-setting requirements. Insurers have strayed from the mandate in recent years by underpricing silver-tier plans and overpricing the more-generous gold-level products, the advocates say, highlighting an issue that experts have been raising for years and that some states are already addressing at the local level.
But health experts also say that HHS must fix misalignments in the risk adjustment program - and that exchanges must have strong consumer decision support tools -for a policy fix to be sustainable.
By clarifying and enforcing the ACA’s single risk pool requirement, HHS could significantly reduce consumers’ cost-sharing burdens while also discouraging gaming, the advocates say.
