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Doing More Harm Than Good

Several healthcare groups, including the American Hospital Association and Blue Cross and Blue Shield plans, have joined coalitions that oppose “Medicare for All” plans, according to The New York Times.

Three things to know:

1. While 2020 presidential hopefuls incorporate Medicare for All into their platforms, hospitals, physicians, drugmakers and insurers are lobbying against the idea and proposed legislation.

2. In June 2018, the Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America created a coalition to combat Medicare for All proposals. The lobbying group, the Partnership for America’s Health Care Fund, also includes the American Medical Association, the AHA and Blues plans, according to the NYT.

3. The AHA’s president and CEO, Rick Pollack, recently cautioned against Medicare for All proposals in a Feb. 22 blog post, writing that such legislation “could do more harm than good to patient care.”

Source: Morgan Haefner, Becker’s Hospital Review.

Drug Coverage Proposal

Improvements in the cost of medications for Medicare-eligible customers may not be too far off. The Centers for Medicare and Medicaid (CMS) has proposed some new ways to lower drug costs for those in the Medicare program, and with drug coverage through a stand-alone prescription drug plan or with a Medicare Advantage plan that includes drug coverage.

One provision in the proposal targets e-prescribing and would require the person’s plan “to adopt a provider Real Time Benefit Tool by the start of 2020.

“‘RTBTs have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit, which can improve medication adherence, lower prescription drug costs, and minimize beneficiary out-of-pocket costs,’ CMS stated.

Another provision of the CMS proposal is that drug coverage Explanations Of Benefits (EOBs) that people receive from their plans will be tasked with including drug pricing information and lower cost therapeutic alternatives as part of these EOBs to give customers the information in hand that can also potentially help them lower their out-of-pocket costs for their particular medications.

This is not a comprehensive list of the provisions of the CMS proposal which could become a set of new rules in the near future. However, we do want to get info about these two particular provisions out there, so everyone can have confidence in any changes to come and know there will be tangible things for American households coming that can help lower their drug costs.

Source: Kyle Murphy, “HealthPayer Intelligence.”

CMS Encourages Innovation!

On Monday April 9, 2018 the Centers for Medicare and Medicaid finalized the rule that “eliminates (Affordable Care Act) standardized options starting in 2019 to encourage innovative plan designs among insurers.”

This is a good move for the coming years in the, non-Medicare, individual/family health insurance markets of America!  This change indicates that our current government recognizes that health insurance plans are not a one-size-fits-all financial product.  We have been saying this all along and CMS Director Verma has now been quoted saying as much- and we are thankful.

At this time it is unclear if ACA-compliant plans this fall, for the 2019 calendar year, will reflect this change in standardization requirements, and make health insurance plans more reflective of the coverage needs of the people in each state.  However, since the standardization requirements are eliminated in 2019- we do expect the individual/family plans, for the 2020 calendar year, to be more fitted to each state.

As everyone anticipates smart changes coming in the years ahead to the individual/family health insurance market we should be aware that according to Director Verma, the states are still subject to the ACA requirement that insurers offer 10 essential health benefits.  Although the standardization requirements are eliminated, this doesn’t mean states can allow ACA-compliant plans to exclude maternity care or mental health benefits.

We do expect to have more appropriate premiums and coverage choices for individuals and families in the coming years.  All in all, a good day.

Reference: Shelby Livingston and Susannah Luthi, Modern Healthcare.

Anthem ’18 ACA Only in 5 IN Counties

Anthem has confirmed that in Indiana, next year, it will only be offering Affordable Care Act individual/family plans in 5 counties.  The 5 Northwest Indiana Counties include:  Newton, Jasper, White, Benton, and Warren.

Current Anthem individual/family plan customers will be able to continue with their current coverage through December 31, 2017.  These plans will terminate effective January 1, 2018.

All Indiana residents with an individual/family plan that is terminating will receive notification via US Mail in early September.

Anthem Will Not Offer ACA Plans in Indiana in ’18

Just Anounced:  Anthem will not be offering Affordable Care Act plans on the federal exchange in Indiana in 2018.  At this time it appears that it will only be offering off-exchange (subsidy in-eligible) plans in 5 counties: Benton, Newton, White, Jasper and Warren.

Additionally, MD Wise has announced they will not be offering ACA plans in Indiana in 2018.  It will instead be focusing on its Medicaid business.

The loss of these insurers in 2018, in the ACA market, will affect about 76,800 Hoosiers.

Source: Indy Star.

Insurance Companies Have Deadline

“The federal deadline for insurers to file rate proposals with the federal government is June 21. Many insurers had been hoping that the Trump administration would say for certain whether it would continue to pay cost-sharing reduction (CSR) subsidies for covering low-income enrollees.

“No such assurances from the administration appear to be coming, leaving insurers with a difficult choice.

“Next week’s filings will give the most comprehensive look yet at what the ObamaCare markets could look like next year. It’s not clear whether the Trump administration will make the requests public, though sometimes individual states will release the information for their insurers.

“Still, early filings already show several insurers requesting double-digit rate increases. Some have already announced they won’t participate in the law’s marketplaces next year, leaving an unprecedented 47 counties with no options on the exchanges for 2018.

“‘We’ve seen so far pretty high premium increases in a number of states. Some of that seems to be because of uncertainty insurers are facing over CSR payments and individual mandate enforcement,’ said Cynthia Cox, an insurance expert with the Kaiser Family Foundation.”  Source: The Hill.

States Stand Up for People

In today’s news there is still talk of US House of Representatives continuing with the lawsuit against the government demanding an end to deductible and co-pay cost-sharing subsidies.   These subsidies help Americans pay for their Affordable Care Act (ACA) health plan deductibles, co- insurance,  and co-pays.

Up to 87% of people with an Affordable Care Act plan get help paying for their insurance premium and/or out-of-pocket costs.

Insurers know there would be devastating effects to them and American households both, if the cost-sharing subsidies were to be stopped.  Many, if not most, households with an ACA plan would simply be forced to incur medical bills that they have no way to pay.  This would end up creating waves and waves of medical care by providers all across the country to go completely unpaid.

In light of this situation: “16 state attorneys general have asked a federal appeals court to let them intervene in a legal case to keep those payments flowing.

“On Thursday, attorneys general from both Republican- and Democratic-led states filed a motion to intervene in House v. Price, a case originally brought by House Republicans to block federal payment to insurers to fund the Affordable Care Act’s cost-sharing reductions for low-income exchange plan members.

“The U.S. Court of Appeals for the District of Columbia Circuit is scheduled to hear a status report in the case on May 22. Meanwhile, insurers around the country, citing uncertainty about the cost-sharing reduction payments, have filed requests for 2018 premium hikes in the double digits. The CSR payments are estimated to total $7 billion this year.”

So the natural question is: What happens to the healthcare industry in America if nearly $7 billion dollars goes missing to pay for medical care?

If we are going to be forced to live under the law called the  Patient Protection and Affordable Care Act, those in Congress need to develop understanding about the current situation that American households are in, and they need to free insurance companies to manage premiums, claims, and their own business.

Source:  Modern Healthcare.

Aetna To Exit Iowa ACA in ’18

“Aetna spokesman T.J. Crawford said that the company had informed federal and state regulators that it would not offer plans in Iowa’s exchange because of “financial risk and an uncertain outlook for the marketplace” on Thursday. That followed the announcement Monday that Wellmark Blue Cross and Blue Shield would also pull out of Iowa’s marketplaces next year.

“The combination of the two exits will leave the vast majority of counties in the states with only one insurer, assuming that there are no other changes, according to Cynthia Cox of the Kaiser Family Foundation.

“While we have seen signs that the market is moving toward stabilization, generally speaking, there are parts of the country that are likely fragile and at high risk of losing insurers or having premium increases,” Cox said. “There’s a lot of uncertainty around repeal and replace; it’s not clear what the Trump administration may do around the individual mandate or cost sharing subsidies and without more clarity from the administration and Congress, insurers are likely very hesitant to participate in the individual market.”  Source: Reuters, Washington Post, Wall street Journal.

White House: More ACA Changes

The Trump administration has announced new Affordable Care Act (ACA) rules for individuals and employers for this fall open enrollment and for the health insurance plans next year.

1.  As of now, the ACA open enrollment period will start on November 1st and end on December 15th.  This is substantially shorter than the most recent open enrollment period.  The intention seems to be to provide a standard 12- month policy period for everyone, and shore up complexities in processing insurance plans that could have a  1/1,  2/1,  or a 3/1 effective date.

2.  Anyone who signs up for health insurance outside of the open enrollment period, will have to provide specific and verifiable proof of eligibility to enroll based on a qualifying life event.  In the years before the ACA this was always the case, and is a reasonable requirement.  The intention to return to this protocol is to eliminate the opportunity to “game the system”  and for people to obtain coverage when they were not actually eligible to do so.  In many cases, over the years, expensive medical procedures and treatments were covered for some of these people, but then they stopped paying premiums and cancelled their plans as soon as the coverage was not needed for those procedures and treatments.  This ultimately affects everybody’s premiums.

3.  The administration’s new ACA rule allows insurers to refuse to cover a person who hasn’t paid their premiums.  The insurance companies will have to apply this to all employers or individuals.  Supposedly some state laws will have to change regarding this rule.   Also, this rule will apparently not be applied to employer plans sold on the federal small business SHOP marketplace due to “operational constraints,” according to the information available.

Regardless, Evansville Insurance Center deems this to be creating an uneven playing field.  The problems with SHOP enforcement of this rule should be resolved before it is a rule levied on all other insurance plans.

4.  Health plans will also get more flexibility in creating products to sell in their market- and not be restricted to the bronze, silver, gold, and platinum Qualified Health Plan benefit designs that were required by ACA rules.   This is the great news!  Insurance companies should now be able to design health insurance plans that are more suited to the particular people they are intended to cover.  Hopefully this new rule will be the mark that we are on the way to good changes.

Source:  Virgil Dickson, Modern Healthcare.