Connecticut: Another State to make mid-year rate reductions

On January 22nd H.R 195 was signed into law, suspending the collection of health insurance provider fees in the 2019 calendar year. The bill was originally introduced on January 3, 2017 to resolve differences throughout the year from House actions and Senate actions. From this new law, States were mandated to pass on requirements for each health insurance Issuers within their state to submit updates to rates.  

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Enhanced direct enrollment eliminates ‘double redirect’, establishes new policy management strategy

In June 2018, the Federally-Facilitated-Marketplace (FFM) is expected to launch new technology known as Enhanced Direct Enrollment (EDE) – which will allow consumers and agent/brokers to shop, enroll, and manage policy changes to Marketplace health products, without ever having to create an application on Healthcare.gov or contact Marketplace Customer Service. 

EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to HealthCare.gov, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.  

In our new whitepaper former Executive Director for Aetna’s Exchange program and Founder, JGood Advisors, Jane Good discusses Enhanced Direct Enrollment (EDE) and this new policy strategy.

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New York SHOP program removes online enrollment & premium billing

Starting this month, NY State of Health (NYSOH) made several changes to the state’s SHOP program in an effort to give the federal tax credit to as many small businesses as possible.   

In New York, 98% of businesses have fewer than 100 employees and over 40% of the workforce is employed in these small businesses. The recent changes impacting these businesses were allowed through the November 2017 rule that allows small employers to enroll directly through issuers and brokers and still receive the small business tax credits.  

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A unified platform: Healthcare for all

On February 27th, Congressman Ben Ray Luján (D-NM), hosted a Medicaid Buy-In roundtable discussion, with the intent to connect the New Mexico Legislature with national healthcare professionals to collaborate and develop a robust Medicaid Buy-In study. The study tried to find ways to reduce the state’s uninsured rate. This would be achieved by making health insurance more affordable and allow those who earn too much to qualify for Medicaid to pay premiums for a Medicaid-like program.  

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States look to protect brokers on Healthcare.gov from commission cuts

Georgia legislation passed a bill that will create guidelines for insurance carriers to pay commission to brokers. House Bill 64 states: 

  • A carrier that issues a benefit plan in this state will pay a commission consistent with the amount proposed in the rates filed with the department 
  • No compensation is required for any individual health plan sold during a Special Enrollment Period (SEP) 

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Iowa Governor signs bill allowing non-ACA health plans

Iowa’s Republican Gov. Kimberly Reynolds signed a state law Monday that lets some insurers skirt Obamacare regulations. The law would let the Iowa Farm Bureau and Wellmark Blue Cross Blue Shield sell health plans to the farm bureau’s members that ignore the mandates. 

The mandates require insurers to cover essential health benefits such as maternity care or hospitalization and prevents insurers from charging sick people higher prices. Gov. Reynolds said the state’s market is collapsing because of the high cost of Obamacare, with many citizens choosing to go without insurance because the law is pricing them out of the market. 

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Iowa gov. expected to sign off on legislation allowing some health plans to avoid Affordable Care Act mandates

This week, Iowa senators approved controversial legislation that would make certain health plans exempt from Affordable Care Act mandates. If signed into law, the bill would have a significant impact on the way many Iowans receive health coverage.

The legislation, approved in a 37-11 vote, combines two proposals that would do the following:

  • Allow the Iowa Farm Bureau Federation to partner with Wellmark Blue Cross/Blue Shield to offer an association health plan to qualifying participants
  • Allow multiple small businesses to band together to provide health coverage for their employees under plans that would not be regulated by the state insurance commissioner or subject to ACA rules and regulations.

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Obamacare stabilization funds left out of $1.5 trillion budget deal

On Friday, March 23rd, President Trump signed a $1.5 Trillion budget deal to fund the government through September 2018. While the bill boosted funding for several federal agencies, including the National Institutes of Health and the Department of Health and Human Services, it did not include any funds to help stabilize the health insurance market.   

Sen. Lamar Alexander (R-TN) and Sen. Patty Murray (D-WA) had been working on a bipartisan plan to stabilize the health insurance market, but the plan was ultimately left out of the final budget deal.  

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Stakeholders are in standby after DOL’s proposed association health plan regulation comment period

After the end of the Department of Labor’s (DOL) comment period for its planned expansion of association health plan eligibility, the healthcare community awaits a decision.  

The regulation would broaden access to AHPs by allowing employers to form an association on the basis of geography or industry, instead of only industry, trade, or professional association. It would also allow sole proprietors to join AHPs. According to a recent Avalere Health analysis, the proposed rule would have the following impacts 

  • Higher premiums for individual and small group – Premiums are projected to rise in the current individual (2.7% – 4%) and small group (0.1% to 1.9%) markets, relative to current law. This would be largely due to healthier employees shifting to AHPs  
  • Increased number of uninsured – An estimated 130k to 140k individuals will become uninsured, mostly due to increasing premiums in the individual market as healthier individuals move to AHPs.   
  • Additional 2.4M to 4.3M enrolled in AHPs – This represents members switching from the individual market (0.7M to 1.2M) and small group market (1.7M to 3.2M) into the expanded AHPs.   
  • Lower premiums for AHPs – Premiums in the new AHPs are projected to be between $1,900 to $4,100 lower than the yearly premiums in the small group market and $8,700 to $10,800 lower than the yearly premiums in the individual market by 2022. 

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Proposed rule could provide an extra $10 billion for reinsurance

As Congress struggles to keep the federal government open, analysis continues surrounding how to help stabilize the Affordable Care Act (ACA). Oliver Wyman and the Congressional Budget Office (CBO) suggest that the federal reinsurance funds would reduce premiums for years to come.

A Cost sharing reduction (CSR) is a discount that is applied to the individual’s health insurance premium which lowers the amount the member must pay for deductibles, copayments, and coinsurance. “The proposal to fund the CSRs would lower federal spending enough to pay for the reinsurance program and leave about $2 billion extra” says Senate health committee Chairman Lamar Alexander.

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