Category: Implementation

In a major policy shift that could affect millions of low-income people, the Trump administration said Thursday it is offering a path for states that want to seek work requirements on Medicaid recipients.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said work and community involvement can make a positive difference in people’s lives and in their health.

The administration’s latest action spells out safeguards that states should consider to obtain federal approval for waivers imposing work requirements on “able-bodied” adults. Technically, those waivers would be “demonstration projects.” In practical terms, they would represent new requirements for beneficiaries in those states.

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In a bid to expand access to affordable healthcare coverage, the Trump administration early Thursday rolled out proposed rules that would allow more small businesses and self-employed workers to band together to buy insurance.

The rule is part of the administration’s objective to encourage competition in the health insurance markets and lower the cost of coverage. But some experts say expanding access to these “association health plans,” which aren’t subject to many of the same regulations and consumer protections as other health plans sold under the Affordable Care Act, could weaken the individual health insurance market.

Democrats won a wave election in Virginia a month ago, not only winning the gubernatorial race but at least coming close to taking control of the legislature. Recounts are continuing in three races that could put Republicans in the minority, an astounding defeat for a party that assumed that they could maintain their position by doubling down on Donald Trump. Ralph Northam arguably has a broad mandate to pursue the Democratic agenda in the Old Dominion, but he tells the Washington Post that he wants to de-escalate the bitter partisanship first.

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Speaker Paul Ryan and Senate Majority Leader Mitch McConnell are about to lock horns over Obamacare — part of a House-Senate clash that needs to be resolved by Friday to avert a government shutdown.

McConnell promised moderate GOP Sen. Susan Collins of Maine that he would prop up President Barack Obama’s signature health law in a must-pass, year-end spending bill — so long as she backs tax reform. But Ryan’s more conservative conference is flatly rejecting that idea and urging the Wisconsin Republican to stand firm against his Senate counterpart.

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Calls to fund CSRs and other payments to insurers in 2018 are rooted partly in a fundamental misunderstanding of why Obamacare premiums continue to rise. Although premium increases are to some degree attributable to the Administration’s cancellation of CSR payments, premium increases were considerable even for policies unaffected by the Administration’s decision.

Lavishing billions of federal dollars on the insurance industry in 2018 is misguided policy. Insurers have secured another round of rate hikes and, with them, billions more in federal premium subsidies. Nor are federal dollars necessary for a state to operate a successful risk-mitigation program, as Alaska has shown.

Trying to rush CSR and reinsurance payments out the door in 2018 will result in wasteful and unnecessary spending, and is more likely to create confusion than to produce the predictability lawmakers seek.

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Some Americans will be given several extra days to sign up for Obamacare insurance plans after the federal enrollment period officially ends Friday, amid long waits on the government’s enrollment phone line.

Pro-Obamacare lawmakers and activists are urging the Trump administration to allow a grace period for open enrollment so that people who have trouble using healthcare.gov are able to finish their applications.

The Trump administration has not said if it will allow a grace period, but an announcement about a final decision may not come until Friday.

During the 2015 and 2016 open enrollments, the Obama administration announced extensions on the same day as the deadline. The decision was made in 2015 to extend the deadline by two days because of “unprecedented demand,” and in 2016, the deadline was extended by four days as about 1 million people left their names at the call center to keep their place in line.

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Consumer advocates reported some glitches Monday in the final days for “Obamacare” sign-ups, although the Trump administration largely seemed to be keeping its promise of a smooth enrollment experience.

In Illinois, some consumers who successfully completed an application for financial assistance through HealthCare.gov got a message saying they would likely be eligible to buy a health plan, “but none are available to you in your area.”

That information was incorrect because every county in the nation currently has at least one health insurer offering plans under the Affordable Care Act for next year.

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Health insurance a la carte?

As the Affordable Care Act open-enrollment season moves into its final weeks, some consumers looking for lower-cost alternatives are considering a patchwork approach to health insurance. The products may secure some basic protection but leave patients on the hook for high medical bills.

The idea involves mixing and matching several types of insurance products originally designed to cover the deductibles and other gaps in traditional coverage.

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Cyndee Weston can barely remember the last time she didn’t have to switch health plans during an Affordable Care Act sign-up season. By her count, she has been on five plans in five years.

Every fall, after she has spent months figuring out her insurance plan’s deductibles, doctor networks, list of covered drugs and other fine print, she receives notice that the policy will be canceled as of Dec. 31. Because her job doesn’t come with insurance, “it’s agonizing going through all the plans and trying to compare,” said Weston, 55, who has diabetes and a history of melanoma. “Every year it’s the same scenario: ‘We’re not going to renew your policy.’”

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