California’s health exchange may require its health plans to pay sales commissions to insurance agents to keep insurers from shunning the sickest and costliest patients.
Covered California is working on a proposal that would force the plans to pay commissions effective next year, said Executive Director Peter Lee. The proposed rules could apply to regular and special enrollment periods, and would leave the specific commission amount or percentage up to insurers, he said.
Regulators in other states have warned insurers about altering commissions in a way that discriminates against higher-cost consumers, but Lee said Covered California may be the first exchange to adopt specific rules.
The state’s Kynect health insurance exchange is a financially unsustainable boondoggle that has cost $330 million, Gov. Matt Bevin’s top health officials told lawmakers at the Capitol Tuesday. Additionally, state spending on Medicaid will jump by 20 percent in the next two-year budget, to $3.7 billion, as federal support declines, they said.
“The day of reckoning has come, and we’re going to have to pay the bills,” Health and Family Services Secretary Vickie Yates Brown Glisson told the House budget subcommittee for human services.
People are starting to get excited about another ObamaCare work-around: The section 1332 waiver. This refers to a section of ObamaCare that allows states great flexibility in how they deliver ObamaCare within their borders. The curious thing about section 1332 waivers is that they can only be issued as of January 1, 2017.
Why? Why not allow states to get section 1332 waivers as of October 2010, when ObamaCare’s first regulations took effect? Or January 2014, when the gushers of tax credits began to flow through the exchanges? Who knows? Maybe the administration just thought they needed a few years for the cement around ObamaCare to solidify.
Newt Gingrich and Tom Daschle have co-authored a report on how states can use section 1332 waivers to execute policy preferences either to the left or the right of ObamaCare. Anne Phelps of Deloitte & Touche LLP has also written a report describing the benefits of using a section 1332 waiver.
- At least 70% of the recent slowdown in health care spending per capita—and possibly as much as 98%—can likely be explained by long-standing patterns known to affect health care spending trends, not by new, unexplained conditions in the medical sector.
- Breaking down those figures, roughly 41% of the slowdown probably resulted from the decline in real per capita income because of the Great Recession.
- Other factors known to affect health care spending growth—such as changes in the number of physicians and hospital beds per capita and in the percentage of the population with insurance coverage—account for somewhere between 32% and 57% of the slower health care spending growth.
- The projected expansion of Medicaid coverage owing to the ACA will likely raise national health care spending in 2019 to about 1% higher than it would have been without the expansion.
The federal government is poised to start making state-based exchanges pay for using HealthCare.gov’s technology, and that has some states mulling the possibility of sharing services with others to control costs.
The Centers for Medicare and Medicaid Services proposed a rule last year requiring that certain states essentially “lease”HealthCare.gov through a user-fee rate of 3 percent of the monthly premium the issuer charges for each policy plan—meaning that, for the first time, using the federal platform for state-based marketplaces won’t be free.
Last month, marketplace officials from several states gathered in Portland, Oregon to discuss the rule, increased collaboration, and long-term marketplace affordability and sustainability.
After the passage of the Affordable Care Act, the federal government gave Oregon $300 million to build an online health insurance exchange. The state then hired Oracle, the world’s second-largest software company, with profits of nearly $10 billion last year, to build the website.
The website never worked. In May 2014, then-Gov. John Kitzhaber, who was running for re-election and getting a lot of heat for Cover Oregon’s failure—asked Attorney General Ellen Rosenblum to sue Oracle.
For nearly two years, Oracle has been in a bruising, $5.5 billion legal battle with the state of Oregon over who is at fault for Cover Oregon, the failed $300 million health insurance website.
The decision states face of whether to expand Medicaid to non-disabled, working-age, childless adults—the Affordable Care Act primary expansion population—involves tradeoffs. These tradeoffs include higher taxes, reduced spending on items like education, transportation, or infrastructure, or reduced spending on other Medicaid populations such as the disabled, children, or the elderly. The ACA funding formula allows states to pass a much greater share of the costs of covering non-disabled childless adults to federal taxpayers, but the tradeoffs still exist.
Kentucky’s new Republican governor, Matt Bevin, has notified the Obama administration that he plans to dismantle the state’s ObamaCare marketplace. Bevin, who was sworn in last month, promised to scrap the marketplace, called Kynect, as part of his campaign, but he is now making it official. Bevin’s office said in a statement to WFPL News in Kentucky that having the state run the marketplace is a “redundancy.”
A recent about-face by the Obama administration on so-called “state innovation waivers” may be the most important change to ObamaCare that no one is paying attention to. These waivers, which will begin in 2017, allow states to take a block grant of funding and waive nearly every major component of the law. A major change, however, is now set to make these experiments mostly impossible. In recent guidance, stealthily released at the close of business on a Friday last month, the Department of Health and Human Services announced that the rules are changing.
Wyoming Gov. Matt Mead announced last month that he would spend the next few months advocating for ObamaCare’s Medicaid expansion in next year’s budget. But so far, Wyoming legislators have taken a thoughtful approach, carefully reviewing all of the evidence and ultimately rejecting ObamaCare expansion. Just 26 out of 90 lawmakers supported the issue during the last legislative session. With expansion costs exploding in other states and federal funding now on the chopping block, it’s clear that their decision was the right one.