Major Health Policy Developments coming out of the Federal Administration

While Congressional efforts to change or repeal the Patient Protection and Affordable Care Act (ACA) continue to be stalled, the federal administration announced two significant health policy developments at the end of last week – an Executive Order aimed at promoting access to plans not subject to the full range of ACA protections as well as the decision to stop making cost-sharing reduction payments immediately. [More]

Congress takes steps to reauthorize CHIP

On October 4, 2017, the U.S. Senate Finance Committee approved a bill that would reauthorize federal funding through FFY 2022 for the Children’s Health Insurance Program (CHIP), a program that currently serves over nine million low-income children. New funding authorization for CHIP expired on September 30, 2017. For now, states are operating CHIP on federal allotments left over from prior years. Those reserves vary widely from state to state. [More]

Balance billing – a new report on recent efforts by state

PCG subject matter experts recently completed a survey report entitled “Balance Billing: Report of Recent Efforts to Protect Consumers.” The practice of balance billing is historically commonplace, but increased scrutiny on rising out of pocket health care costs is driving efforts to provide greater transparency into the practice.

For those states contemplating crafting consumer balance billing protections, this paper aims to provide a landscape of the options available, with national models from organizations like the National Association of Insurance Commissioners and the National Conference of Insurance Legislators outlined. Additionally, our report includes a comprehensive list that outlines enacted and pending balance billing legislation in a variety of states. [More]

Developments in Section 1332 State Innovation Waivers

Progress has continued on state efforts to secure Section 1332 State Innovation Waivers. Oregon submitted a waiver application at the end of August, seeking support for a state-based reinsurance program, and that application has since been determined complete. Iowa submitted two recent updates to its pending waiver application, which it initially submitted in June. Its waiver application has also now been determined complete.

While those states await decisions on their applications, at the end of September, Minnesota received approval of its Section 1332 Waiver application that it submitted in May. [More]

Senators introduce ACA repeal legislation

On September 13, 2017, U.S. Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson introduced legislation to scrap many provisions of the Affordable Care Act (ACA) while imposing funding caps on the traditional Medicaid program. The bill could become law under budget reconciliation rules that block a Senate filibuster. The bill could pass the Senate and House on a majority vote before September 30, 2017.

The non-partisan Congressional Budget Office (CBO) says that it can’t comprehensively analyze the bill’s potentially adverse impact on health insurance premiums and coverage until next month. Congress will be acting this month based on a preliminary CBO analysis expected to show long-term federal budget savings. [More]

Governors outline market stabilization strategy

On August 30, 2017, a bipartisan coalition of Governors issued a letter to Congress on steps needed to restore stability and affordability in coverage to 22 million Americans served through individual health insurance markets under the Affordable Care Act (ACA). The Governors’ letter sets the stage for testimony before a US Senate committee on September 7, 2017, by Massachusetts Governor Charlie Baker, Montana Governor Steve Bullock, Tennessee Governor Bill Haslam, Utah Governor Gary Herbert, and Colorado Governor John Hickenlooper. [More]

CMS proposes reductions in Medicaid allotments to states for hospitals’ uncompensated care

On July 28, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to implement $43 billion in reductions in federal Medicaid allotments to state Medicaid agencies for payment adjustments to hospitals serving a disproportionate share of low-income persons. The reductions in such allotments under the proposed rule will apply to federal fiscal years 2018-2025. Reductions nationwide will start at $2 billion in FY 2018 and will reach $8 billion per year in FY 2024 and FY 2025. [More]

U.S. District Court in Connecticut certifies nationwide class of Medicare beneficiaries in challenge to “observation status”

On July 31, 2017, the U.S. District Court for the District of Connecticut certified a nationwide class of Medicare beneficiaries who desire to challenge their placement on “observation status” during their hospital stays. Alexander v. Price, No. 3:11-cv-1703 (D. Conn. July 31,2017).

The plaintiffs in this long-running action argue that the decision to categorize Medicare beneficiaries as outpatients on observation status rather than inpatients should be subject to administrative review. Currently, Medicare does not allow beneficiaries to appeal this determination. [More]

Developments in Section 1332 State Innovation Waivers

Halfway through the first year that states are eligible to implement Section 1332 Waivers, and with states seeking to stabilize their markets in the face of uncertainty at the Federal level, the pace is picking up on Section 1332 Waivers. In recent weeks, there have been two major developments on this front with the Federal government approving Alaska’s waiver request and Iowa submitting an unprecedented emergency and abbreviated Section 1332 Waiver request. More details on both of those developments are below. Additionally, the Federal agencies made a preliminary determination on June 20th that Minnesota’s Section 1332 Waiver application is complete starting the clock on review and approval. [More]