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Across the Country in ACA World - Sept No. 4

9/26/2019

Tomorrow, Sept. 26 The Census Bureau releases 2018 American Community Survey stats on health insurance coverage, economic and housing characteristics, language, educational attainment, commute to work, employment, mortgage status and rent, and income for places with populations of 65,000 or more.
Ending cost sharing reimbursements actually increased ACA enrollment, says a new study in Health Affairs. The federal government’s decision to end CSR payments seems to have increased marketplace enrollment by about 5 percent and contributed to a healthier marketplace risk pool, because of “silver loading.” Restoring CSR payments would likely reverse these effects. Health Affairs explains it well.
The 5th Circuit Court of Appeals decision in Texas v. US is due any time. The case on whether the ACA is constitutional was argued July 9. According to the Washington Post, the court says judges try to decide cases within two months after they are argued. Kaiser explains the lawsuit.
Access Health CT’s Healthy Chat sessions start October 1. Nine sessions are scheduled so far. The AHCT Community Conference takes place October 16 in Cromwell. For coverage of the Sept board meeting, see Access Health Gets Ready for Open Enrollment.
Maryland is busy.
- The Maryland Health Benefit Exchange released its Affordability Work Group Report. The MD Exchange established an Affordability Work Group to recommend ways to reduce out of pocket costs; maximize APTCs for subsidized consumers; and maximize affordability for unsubsidized consumers. The group got data and ideas from Covered California, Families USA, and Rhode Island. The MD Health Care Commission broke out data on chronic disease (a big driver of cost) in on- and off- exchange enrollees in the individual market. Recommendations start at page 9 of the report.
- MD’s Easy Enrollment Health Insurance Program lets people check a box on their state tax returns to jump-start health insurance enrollment. Maryland’s exchange will get eligibility info sent electronically from the tax return. People who qualify for Medicaid will be enrolled automatically, and the exchange will help people who qualify for private coverage enroll a plan. This program, which has broad bipartisan support, is the first of its kind in the US.
- MD’s QHP insurance rates will fall by 10.3% for 2020. This is the second year in a row that premium rates for every individual health plan sold on MD’s exchange have fallen.
- The exchange published an excellent blog post explaining the impact of the public charge rule and provided contact info for 17 organizations that help with immigration services.
Washington’s QHP rates will see a record-low average rate decrease of 3.27%, although out-of-pocket costs continue to go up. Washington is also expanding premium tax credits to people earning up to 500% FPL, as part of its public option legislation.
Vermont’s QHP rates will increase by double digits.
Colorado is now getting feedback and developing recommendations for a public option. Providers, insurers, consumer advocates and others have weighed in on the feasibility, scope, and design. The final policy proposal will be submitted to the state legislature by mid-November. Presentations and feedback here.
The Colorado Health Institute releases the Colorado Health Access Survey results today. The survey’s been conducted every two years since 2009.

Across the Country in ACA World - Sept No. 3

9/13/2019

The Connecticut Insurance Commissioner issued decisions for 2020 health insurance rates, approving average rate increases of 6.5% for Anthem individual plans, 2.0% for Connecticare plans. For small group plans, the approved average rate increase was 14.3% for Anthem, 4.8% for Connecticare.
The US Census Bureau released new reports on Health Insurance Coverage in the United States. The uninsured rate in Connecticut went from 5.5% in 2017 to 5.3% in 2018. But nationwide, this is the first year-to-year increase in the percent of uninsured since 2008-2009. Nationwide, the uninsured rate increased from 7.9% in 2017 to 8.5% in 2018. That meant 27.5 million people did not have health insurance at any point during 2018, up from 25.6 million in 2017. In 2018, 3.3% of people nationwide, or 30.8% of people with direct-purchase insurance, got their coverage through the state or federal health insurance marketplace. Between 2017 and 2018, the percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9%. The percentage of people with employment-based coverage, direct-purchase coverage, TRICARE, and VA or CHAMPVA health care did not statistically change. Employer-based insurance remained the most common source of coverage, covering 55.1% of the population for all or part of the calendar year. See uninsured maps by Connecticut county for 2017.
Connecticut Attorney General files suit to stop Trump 'public charge' rule for immigrants. The US Department of Homeland Security (DHS) recently finalized a rule that significantly changes immigration policies related to “public charge” determinations. Under long-established US immigration policies, individuals who are deemed likely to become a “public charge” and require extensive government support can be denied an adjustment of their immigration status (e.g., issued a green card) or entry into the country. NASHP explains.
According to an August CMS report, Connecticut saw a 30% drop in unsubsidized enrollment from 2017 to 2018 (rank among states = 19). Unsubsidized enrollment changes ranged from an 85% drop in Iowa to a 7% gain in North Carolina. The five states experiencing the largest declines include Iowa (-85 percent), Georgia (-60 percent), Nebraska (-59 percent), Tennessee (-53 percent) and Virginia (- 51 percent).
Covered California released regional data behind its 0.8% record-low rate change.
States Flubbed the Rollout of Their Health Insurance Exchanges. Now They’re Ready to Try Again: At least six states — Maine, New Mexico, New Jersey, Nevada, Oregon and Pennsylvania — are creating their own marketplaces or seriously considering doing so.
All Medicaid expansions are not created equal: A fall 2019 Brookings research paper finds that Medicaid expansion under the ACA tends to be associated with more hospital visits, primarily through ER visits for non-emergency conditions, although that finding did not hold true in Connecticut (I think).
Pat Baker, President and CEO of the Connecticut Health Foundation, will retire in June 2020. The foundation will conduct a national search for her successor.

Across the Country in ACA World - Sept No. 2

9/9/2019

Why People Remain Uninsured is a new report from the Commonwealth Fund. “Although the ACA has greatly expanded health insurance coverage in the U.S., some 30.4 million people are still uninsured. The Commonwealth Fund finds they are disproportionately lower income, Latino, and under age 35. The authors say the cost of insurance is a key reason why so many remain without coverage.” The report also shows that nearly half of uninsured adults may be eligible for subsidies through the marketplace or their state’s expanded Medicaid program; Northeastern states outperform the rest of the country; and men are more likely to be uninsured than women. (See also separate map of CT's uninsured on policymap.com)
CT Dept of Insurance Sept 4 hearing on rate requests: "Anthem asked for an average increase of 15.2% on individual health plans, mostly because of a 9.3% increase in medical cost trends and the reinstatement of the federally mandated health insurer tax. Anthem served approximately 21,900 members in Connecticut last year. ConnectiCare, which serves about 75,600 consumers, proposed an average 4.9% increase in its rates. It also attributed the increase to a 9.3% increase in medical cost trends." Stories at
- Hartford Courant: Connecticut health insurers defend higher rates for 2020 as consumer advocates urge state regulators to slow steadily rising costs
- CT Mirror: Customers, lawmakers urge state insurance officials to address rising costs
- CT News Junkie: Consumers Insist On Health Insurance Affordability at DOI rate hearing.
Health disparities in CT: Blacks and poor people are at higher risk of heart disease, even though the overall death rate from heart disease is falling. Despite decreases in deaths from heart disease in CT and across the country, African Americans and low-income individuals in Connecticut remain at a higher risk for obesity, high blood pressure and diabetes, all chronic illnesses connected to heart disease, according to the 2017 Connecticut Cardiovascular Disease Statistics Report by the state Department of Public Health.
Sept 17 Conference on the Future for Community Health Workers in CT - Hear firsthand from community health workers about their experience and the benefits of certification, and the Department of Public Health will also dive into the certification process specifically for CT.
MNsure announced it is extending open enrollment by a week, until Dec. 23, for 2020 coverage.
Colorado is implementing a reinsurance program in 2020 and a public option program in 2021.
Maine is moving to a state based marketplace using the federal IT platform as a stepping stone to a fully state-based exchange.

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Across the Country in ACA World - Sept No. 4

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Across the Country in ACA World - Sept No. 2

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