Health Insurance

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Healthcare reform


Under the leadership of Center Director Gerald Kominski, a “rapid response” team of six 
researchers began tracking in December 2016 major activity surrounding “repeal and replacement” of the ACA.

The team – all post-graduate students from the Department of Health Policy and Management at the UCLA Fielding School of Public Health – compiles a multi-page weekly report that has short descriptions of events such as legislators’ actions on repeal and ACA-related court cases at the federal level; health coverage plan changes or proposals in various states; health insurance and ACA-related reports published by organizations such as the Commonwealth Fund and polls by the Kaiser Family Foundation; relevant journal articles and news stories, such as marketplace enrollment tallies and the planned departure of Humana, Inc. the from state health exchanges in 2018.

Find weekly briefs compiled by the “rapid response” team below:

Following July 4th Recess, Senate releases revised version of Better Care Reconciliation Act1,2,3,4,5

Thursday, July 13

The Senate released a revised version of their ACA repeal and replace bill, known as the Better Care Reconciliation Act (BCRA). Changes in the new draft include:

• Keeping many of the ACA’s tax increases but repealing one that is aimed at medical device manufacturers;

• Sen. Ted Cruz’s amendment that would allow insurance companies to sell non-ACAcompliant plans in states where they also sell compliant plans. These non-compliant plans would be able to exclude services and have high cost-sharing and insurers could also consider individuals’ health status and preexisting conditions when setting the prices for the plans;

• An additional $70 billion to the stability fund aimed at reimbursing insurers with heavy losses;

• $45 billion to address the opioid epidemic;

• Allowing people to use the money they contribute to HSAs to pay for their insurance

Key aspects of the bill that were also included in the previous draft include:

• A six-month waiting period for individuals who have a break in coverage (and being enrolled in a non-ACA-compliant plan would be considered a break in coverage);

• Eliminating the employer mandate;

• Tax credits for individuals purchasing plans on the individual market would be based on age, income, and geography;

• Ending cost-sharing subsidies in 2020;

• Older adults could be charged five times more than younger customers in the individual market;

• Medicaid would be funded through a per capita amount or block grant beginning in 2021;

• The ACA’s Medicaid expansion would effectively be repealed;

• Planned Parenthood would receive a one-year freeze in their federal Medicaid funding;

Republicans can only lose two GOP senators and still pass the bill. After the revised version was released both Sens. Susan Collins (ME) and Rand Paul (KY) announced that they would vote to block debate on the bill. The two senators oppose the legislation for different reasons. Sen.Collins is unhappy with the bill’s deep cuts to Medicaid while Sen. Paul does not think that the legislation goes far enough in repealing the ACA. If one more Republican senator joins them the bill will not proceed to debate and a vote. Republicans on the fence about the legislation include Sens. Capito (WV), Cassidy (LA), Corker (TN), Murkowski (AK), McCain (AZ), Portman (OH), Sasse (NE), Lee (UT), Hoeven (ND), Moran (KS), and Heller (NV).

A score of the revised bill from the CBO is expected to be released early next week, perhaps as early as Monday. The score will likely look at the bill with and without Sen. Cruz’s amendment, allowing senators to decide if they want to keep it in the legislation. Majority Leader Mitch McConnell has definitively stated that the Senate will be voting on the bill next week. McConnell also announced that the Senate would push back the August recess for two weeks to get more work done. This delay to the recess gives him more time to work on passing the BCRA. 

Sen. Ted Cruz gains support and faces opposition with his BCRA amendment6,7,8,9,10

Senator Ted Cruz has put forth an amendment to the BCRA, known as the Consumer Freedom Amendment, that would allow health insurers who sell ACA-compliant plans in a state to also offer non-compliant, skimpy health plans in that state. These plans would not count as coverage for the purpose of the bill’s waiting period for enrolling in comprehensive coverage if an individual has a break in coverage. Insurers would also be able to take consumers’ preexisting conditions into consideration when setting the price of these plans. The amendment, which is under review by CBO and being scored, is a key part of the recently released updated version of the Senate’s BCRA. While Sen. Mike Lee is strongly supported the amendment, he has yet to come out in favor of the new version of the bill as a whole. Vice President Pence has endorsed the amendment as well as a number of conservative think tanks. However, America’s Health Insurance Plans (AHIP) released a position paper on the amendment, saying that it would destabilize the market and harm people with pre-existing conditions. AHIP highlighted that premiums of ACA-compliant plans would rise much faster under the amendment than they would “under the existing market conditions” and lead to the state health insurance marketplaces acting like a high-risk pool. Patient groups, such as the American Cancer Society and the American Heart Association have also come out against the amendment. There are also questions as to whether this amendment would meet budget reconciliation rules.  

Alaska’s health insurance marketplace waiver for reinsurance program approved11,12

The Trump administration approved a section 1332 waiver to Alaska to help stabilize the state’s individual market. The waiver asks for federal aid for a reinsurance program for the sole insurer offering plans through the state’s marketplace. HHS will give $323 million to Alaska between 2018 and 2022 for this program. This money is expected to be paid for through lower spending on premium subsidies in the state. The state has been running its own reinsurance program in 2017, lowering premiums for everyone but costing millions of dollars to the state. 

Democrats in House unveil plan to fix issues in ACA marketplaces13

Ten House Democrats have released information on a plan they are putting together to deal with some of the challenges facing the ACA. At this point, the proposal includes providing more funding to health insurance plans that cover the sickest patients, making the ACA’s cost-sharing reduction subsidies permanent, changing the timing of open enrollment to be around tax season, enforcing the individual mandate, better advertising for open enrollment periods, and a Medicare buy-in for older Americans. It is unclear how far this proposal could get in the House. 

Gallup: Uninsured rate in 2017 up from end of 201614

A Gallup survey from the first quarter of 2017 found that 11.7% of U.S. adults are uninsured. This is an increase from the survey’s findings in the last quarter of 2016 when 10.9% of U.S. adults were uninsured. This percent increase is equivalent to about 2 million more uninsured Americans. 

MEDICAID 

Ohio considers freezing Medicaid enrollment15

After Governor John Kasich vetoed a budget provision that would freeze enrollment in Medicaid, Republicans in the state’s congress met to discuss overriding his veto. The Ohio Medicaid expansion has covered more than 700,000 low-income residents and is strongly supported by the governor but less popular among the state’s Republicans in the Legislature.

Kentucky submitted amended CMS waiver request to allow stricter work requirements forMedicaid enrollees16 

Nearly a year after its first submission, Kentucky has sent an amended version of their 1115 waiver to CMS to review. The waiver originally required able-bodied adults without dependents to spend at least 5 hours a week in job training or community engagement in order to be eligible for Medicaid. This requirement would have gradually increased to 20 hours a week after a year of enrollment in the program. In the amended waiver, however, the ramp up period was eliminated, making the 20 hours a week requirement a part of eligibility for Medicaid. Individuals would also be locked out of Medicaid coverage for up to six months if they fail to tell the state when they obtain a new job or salary. The state has estimated that these changes (along with others) will result in saving $2.4 billion in federal and state dollars over five years. Public comments are being collected on the waiver through August 2nd. 

New Harvard study finds Medicaid recipients like their care and coverage17

A study from researchers Harvard’s Chan School of Public Health finds that Medicaid enrollees are satisfied with their coverage and care. 84% of enrollees reported being able to get all of the care that they and/or their physician thought they needed in the past 6 months. Only 3% of enrollees said they were not able to get care because of waiting times or because of physicians not accepting their coverage. In rating their insurance, enrollees gave Medicaid a rating of 7.9 out of 10, with 46% of enrollees scoring Medicaid as a 9 or 10 and only 7.6% scoring Medicaid below 5.

1 http://www.politico.com/tipsheets/politico-pulse/2017/07/14/repeal-effort-in-jeopardy-221324                                                                                                          

2 https://www.washingtonpost.com/graphics/2017/politics/ahca-senate-whip-count/?utm_term=.1ad46f741b00                                                                                           

3 https://www.vox.com/2017/7/13/15964194/new-senate-health-bill-explained-preexisting-conditions 

4 https://www.washingtonpost.com/graphics/2017/politics/obamacare-senate-billcompare/?utm_term=.b9b8033e99a1&wpisrc=nl_evening&wpmm=1 

5 http://thehill.com/blogs/floor-action/senate/341306-senate-gop-eyes-obamacare-repeal-vote-next-week

 6 https://www.vox.com/policy-and-politics/2017/6/29/15890954/senate-health-care-bill-insurance-regulationsted-cruz 

 7 https://www.wsj.com/articles/ted-cruzs-plan-to-save-republican-health-care-bill-gains-traction-1499294541 

 8 http://thehill.com/policy/healthcare/341635-insurers-warn-cruz-amendment-would-hurt-coverage-for-preexisting 

 9 https://www.washingtonpost.com/news/wonk/wp/2017/07/12/health-insurers-have-been-strangely-quietabout-undoing-obamacare-until-now/  

10 http://www.politico.com/tipsheets/politico-pulse/2017/07/05/democrats-are-holding-more-than-7-times-asmany-town-halls-as-republicans-221162 

11 http://www.politico.com/tipsheets/politico-pulse/2017/07/12/senate-republicans-push-forward-with-repealeffort-221283                                                                      12 https://www.vox.com/health-care/2017/7/12/15961644/trump-administration-saved-obamacare-alaska                                                                                           13 https://www.vox.com/policy-and-politics/2017/7/12/15955982/democrats-fix-obamacare

14 http://www.politico.com/tipsheets/politico-pulse/2017/07/11/conservatives-bet-on-cruzs-risky-plan-but-itcould-tank-markets-22125

15 http://www.politico.com/tipsheets/politico-pulse/2017/07/06/an-inside-look-at-the-white-houses-healthstrategy-221182 

16 http://www.modernhealthcare.com/article/20170705/NEWS/170709995 

17 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2643347