Week of September 30, 2013
A report released by the Department of Health and Human Services (HHS) this week finds that consumers will see lower than projected premiums in the Health Insurance Marketplaces set to go live on October 1st. According to the report, consumers will be able to choose from an average of 53 health plans in the Marketplace.
The majority of consumers will have a choice of at least two different health insurance companies – although some consumers will only have one option available for 2014. Premiums nationwide will also be around 16 percent lower than originally projected – with about 95 percent of eligible uninsured live in states with lower than expected premiums – before taking into account financial assistance.
Congress moved the nation closer to a government shutdown this past weekend as House Republicans voted early Sunday 231-192 to advance a stopgap spending measure to delay implementation of President Obama’s health care law for one year. The House voted just past midnight on Sunday to send the bill back to the Senate following a day of vigorous debate over the Affordable Care Act, which begins open enrollment on Tuesday. House Minority Whip Steny Hoyer, D-Md., reminded his colleagues that Americans had already weighed-in on the health care law in 2012 with the re-election of Obama and accused Republicans of “rampant irresponsibility” that increased the prospects of an Oct. 1 shutdown.
The house measure is certain to be defeated in the Senate, where Majority Leader Harry Reid, D-Nev., has said he will not support any bill that dismantles the law. Obama also said he would veto any such bill in the unlikely event it reaches his desk.
CALIFORNIA: The legislature hosted an informational hearing on the California Health Benefit Exchange and the progress toward ACA implementation. The panel featured Covered California Executive Director Peter Lee and Department of Health Care Services Director (DHCS) Toby Douglas. Lee confirmed that the California Health Eligibility Enrollment Retention System, the state’s one-stop shop for enrollment, will be ready on October 1. There will also be ongoing improvements to the system moving forward. Lee emphasized that the success of Exchange implementation depends on community outreach and engagement. Covered California has a goal of enrolling between 800,000 and 1.8 million people by the end of 2014. Additionally, Douglas projected the state will add 1.4 million to the Medi-Cal system, the state’s Medicaid program.
DELAWARE: The Delaware Department of Insurance (DOI) issued a bulletin regarding specialty tier prescription drug coverage requirements established under recently enacted law limiting maximum out of pocket expenses. The new law imposes dollar limits on specialty tier prescription drug cost-sharing and limits patients’ co-insurance or co-payment fees for specialty tier drugs to $150 per month for up to a 30-day supply of any single specialty tier drug. The bulletin states that the DOI will not promulgate a regulation because the law and the bulletin provide adequate guidance for compliance. The law is effective January 1, 2014.
ILLINOIS: The Administration announced that health plan rates on the state-federal partnership Exchange are 25% below HHS estimates. Of the 165 plans that will be made available by 8 companies, 57 plans will be available in all counties with two individual PPO plans and three small group plans available statewide.
MAINE: The Maine Health Exchange Advisory Committee met for the first time this past week, focusing their attention largely on operational aspects of the federally-facilitated Exchange set to open on October 1st. Legislators created the multi-stakeholder advisory committee via a “joint study order” which enabled it to bypass Executive action. It will meet numerous times over the next year, with a final report due to the Legislature in November of 2014. Both health plans offering products on the Exchange are members of the Committee, and many of the questions raised were directed to them. Concern was expressed about the narrow network offerings, the calculation and impact of family rates, and offerings through the SHOP. The afternoon session was devoted almost entirely to outreach and enrollment with a focus on the role of navigators and how enrollment would be tracked to ensure customers did not fall through the cracks.
MASSACHUSETTS: Earlier this year the US Department of Health & Human Services (HHS) granted Massachusetts a three-year transition period for phasing out certain currently allowed rating factors that are disallowed under the Affordable Care Act (ACA) such as group size, industry and participation rate. Despite the transition period, the Legislature passed a bill requiring the Governor to seek a permanent waiver of these rating factors. In a September 24 letter, HHS rejected Governor Deval Patrick’s request for a permanent waiver, stating that HHS couldn’t find any flexibility in the ACA that would allow such and therefore issuers in Massachusetts will need to be in full compliance with ACA’s rating factors for policy years beginning on or after January 1, 2016.