A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country.
Week of October 28, 2013
With Congress now focused on dissecting the troubled rollout of health insurance exchanges, the Obama administration is making modifications to its marketplace schedule and is facing pressure to do more. The administration announced last week that it will issue new guidance pushing back the date by which individuals must have health care coverage or face a penalty. The new date, March 31, 2014, coincides with the end date for the open enrollment sign-up period. Late last week, 10 Senate Democrats signed on to a letter calling on the administration to extend the open enrollment period, by an unspecified period, as well. Another Democratic Senator, Joe Manchin of West Virginia, is urging a one-year delay in the mandate. Meanwhile, experts called in to fix the website are predicting an end to the majority of problems by late November. Even if the projection is accurate, many fear enrollment in exchanges will suffer as a result of the significant rollout issues.
The House Energy and Commerce Committee held a lengthy hearing last week on the initial rollout of the exchanges and the healthcare.gov website, with the contractors handling key Affordable Care Act (ACA) implementation issues testifying. They testified that the problems with the healthcare.gov website are fixable, but they declined to provide a specific timeframe. In response to questions, the witnesses emphasized that they tested the functionality of the systems they designed and that CMS, in its role as system integrator, was responsible for end-to-end testing of the website. They testified that end-to-end testing occurred only during the final two weeks of September. Health and Human Services (HHS) Secretary Kathleen Sebelius is expected to testify at another oversight hearing before the House Energy and Commerce Committee on October 30. In addition, CMS Administrator Marilyn Tavenner is scheduled to testify at an October 29 House Ways and Means Committee hearing.
ARIZONA: With Washington focused on the rocky launch of the federal marketplace enrollment website, HHS Secretary Katherine Sebelius was in Phoenix last week to tour a call center and meet with stakeholders, some of whom are reporting that they are turning to alternatives to cope with the situation. Meritus, the co-op created to offer insurance coverage on the exchange, reported that it is focused on educating the public. Some brokers reported they are assisting clients in completing paper applications for submission by mail. Enrollment in the Arizona Health Care Cost Containment System (Medicaid) has been less problematic, with at least 6,500 people enrolled to date.
CALIFORNIA: Shelley Rouillard has been appointed director of the California Department of Managed Health Care effective December 1, 2013. Rouillard has served as chief deputy director since 2011 and served as deputy director of the California Managed Risk Medical Insurance Board, Benefits and Quality Monitoring Division from 2007 to 2011. Her appointment requires Senate confirmation. Rouillard is a Democrat and will replace Brent Barnhart, who is retiring.
CONNECTICUT: HealthPocket, a technology company that compares and ranks health plans, has released a study on the state exchange shopping experience and found Access Health CT to be among the best – able to produce a plan comparison on its website within four steps. The state exchange requiring the most steps (18) to get plan comparisons was Minnesota. According to the study, the 36 states using the federally facilitated marketplace at healthcare.gov require “nearly four times as many steps to produce a health plan comparison page”.
IOWA: Iowa is one of five states and the District of Columbia sharing in a total of $146.1 million in new grants for the development and implementation of a state health insurance exchange. Iowa will receive $17.5 million. According to CMS, the grant will be used to support state planning for transition from a federal-state partnership exchange to a state-based marketplace in 2016. This is Iowa’s fourth exchange-related grant from CMS.
MAINE: Governor Paul LePage was quoted by the press last week as being open to compromise on Medicaid expansion. Two separate Medicaid expansion bills were vetoed by the governor in the more recent legislative session, and the legislature failed to override his vetoes. Legislators had already indicated they intend to bring a new Medicaid expansion bill before the legislature in early 2014. There appears to be interest in exploring alternative ways to undertake Medicaid expansion, similar to what Arkansas and Iowa have done. Many are watching how New Hampshire deals with the issue as well.
NEW YORK: New York State of Health, the state’s health exchange, announced last week that nearly 174,000 New Yorkers have completed the full application process and have been found eligible for health insurance coverage. According to state officials, the state’s completed applications make up more than 30 percent of the applications completed nationwide. To date, 37,030 New Yorkers have fully enrolled for health insurance through the NY State of Health marketplace. Additionally, since Oct. 1, the state’s customer service center operators have provided assistance to more than 77,000 New Yorkers. Of those fully enrolled, more than 20,000 have been found to be Medicaid eligible. The state continues to promote its cost estimator tool, which has produced estimates indicating that 75 percent of individuals eligible to purchase through the exchange will be eligible for financial assistance.
OHIO: By a 5-2 vote, the Ohio Controlling Board approved Governor John Kasich’s request for an appropriation to spend federal dollars in 2014 for expansion of the Medicaid program up to 138 percent of the federal poverty level (FPL). The move will allow coverage to more than 275,000 low-income adults beginning January 2014. Earlier this month, Governor Kasich announced that the administration had authority under current law to expand the Medicaid program and received federal approval of a state plan amendment to add the individuals under the program. However, the move has resulted in a lawsuit by a group of House Republicans claiming that the Ohio constitution forbids the Controlling Board from enacting a major policy that diverges from the expressed intent of the General Assembly. The lawsuit filed with the Ohio Supreme Court asks the Controlling Board be ordered to vacate the decision appropriating additional Medicaid funds.
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