The GAO reports an increase in choice of plans both on and off Marketplaces; Hawaii submits the first 1332 waiver application, with a focus on substituting the employer mandate and SHOP provisions with pre-existing State requirements; and Rhode Island’s Marketplace reports on the State’s drop in uninsured rates.
FEDERAL NEWS:
GAO Finds Increased Plan Choice in Individual Markets On and Off Marketplaces
According to a new Government Accountability Office (GAO) report, consumers purchasing individual market plans on and off the ACA’s Marketplaces had access to more health plans in 2015 compared to 2014. The report found that the increase in plan choice was most pronounced on the Marketplaces. In 2015, 94% of counties had six or more silver Marketplace plans and 88% of counties had six or more bronze Marketplace plans, compared to 80% for both categories in 2014. Plan choice remains even more robust off the Marketplace, where the percentage of counties reporting six or more silver and bronze plans increased from 97% to 100% between 2014 and 2015. In reviewing premiums, GAO found that the lowest-cost plans in the individual markets tended to be sold on Marketplaces. Specifically, the lowest-cost silver plan in the individual market was available through the Marketplace in 81% of counties analyzed, an increase of 18 percentage points from 2014. The premiums for lowest-cost plans in each state varied widely, though the study revealed that the cost for the minimum and median premiums for silver plans increased from 2014 to 2015 in most states.
Federal Judge Permits House Republicans to Proceed with Lawsuit Against Obama Administration
A U.S. District Court judge ruled that the House can proceed with a lawsuit challenging whether the Administration unconstitutionally took the “power of the purse” from Congress by spending funds on Marketplace subsidies that were not appropriated by Congress, reports the Washington Post. The judge also ruled that the House cannot pursue a separate argument in the lawsuit, which alleges that the Administration's delay of the employer mandate violated the Constitution. The Administration is expected to appeal to a higher court before the case is heard, according to Modern Healthcare.
Agent and Broker Hotline to Launch for 2016 Open Enrollment
Agents and brokers will have a dedicated call center for questions pertaining to clients utilizing HealthCare.gov, according to Politico. The call center hotline is expected to be operational by November 1 for the start of the 2016 open enrollment period.
STATE MEDICAID & MARKETPLACE UPDATES:
Hawaii: Draft 1332 Waiver Application Released
The State Health Care Innovation Task Force released its draft Waiver for State Innovation this week in advance of public hearings that began September 14. Hawaii's draft 1332 waiver, the first in the country to be released, proposes to waive the ACA's employer mandate and Small Business Health Options Program (SHOP) Marketplace provisions and replace them with the State's longstanding employer-sponsored insurance requirements under the Hawaii Prepaid Health Care Act ("Prepaid"), which has higher standards than the ACA. Fewer than 1% of employers and only one insurer in Hawaii used the State’s SHOP, which closed in June 2015. Under the proposed waiver, Hawaii would waive the requirement to maintain a SHOP Marketplace and redirect small business tax credits to premium relief under Prepaid. Because Prepaid is exempt from ERISA regulation, which generally restricts a state’s ability to regulate employer-sponsored health benefits, Hawaii is likely the only state that could strengthen its employer mandate with this approach.
Oregon: Medicaid Provider Reimbursement Rates to Decrease
The Oregon Health Authority announced that reimbursement rates for the State's 16 Coordinated Care Organizations (CCOs) will drop by 0.8% in aggregate this year, having developed new reimbursement rates for 2015 after CMS requested that it re-examine its previous rate-setting methodology. The new methodology aims to match payments to risk for each CCO, minimize variability within each region and incorporate data from the Medicaid expansion population. All CCOs received sharp rate decreases for adults under 45, with decreases ranging from 15% to 46%, while rate changes for other groups were mixed. For example, the State raised rates for older Medicaid members by as much as 47%. The overall impact on individual CCOs under the new methodology will vary.
Rhode Island: Marketplace Reports Uninsured Rate Drops to 5%
The percentage of uninsured in Rhode Island has been reduced by more than half since 2012, from 11% in 2012 to 5% in 2015, according to a state-wide survey commissioned by HealthSource RI. State officials credit the decrease to expanded Medicaid and the State-based Marketplace. Nearly half of the remaining uninsured are eligible for Medicaid and another 41% “would likely qualify” for a federal premium tax credit, according to HealthSource RI. The survey also found that 52% of uninsured Rhode Islanders are ages 18-34 and that the uninsured tend to earn less than 200% of the federal poverty level. HealthSource RI will release additional survey findings related to access and the insurance market over the coming weeks.
STATE HEALTH STAFFING NEWS:
Michigan: New State Medicaid Director Named
Chris Priest, Governor Rick Snyder's (R) Deputy Strategy Director, was named the new State Medicaid Director and will assume the role October 12. Priest replaces the interim Medical Services Administration Chief, Kathy Stiffler, who has held the position since the June retirement of Steve Fitton.
New Mexico: Two Exchange Board Members Appointed
Two members were added to the New Mexico Health Insurance Exchange board in September: Eva Jean Fomalot, Vice President of Sales at BenefitSource, who was appointed by the Legislature, and Lisa Farrell Lujan, President of Presbyterian Health Plan (one of four companies offering plans on the Exchange in 2016), who was appointed by the Governor.