A couple of years ago, the health insurance exchange in Minnesota – MNsure – was in deep trouble. Health insurance premiums for individual policies had shot up by as much as 67 percent, among the steepest increases in the country. Insurers were abandoning the market, leaving 116,000 Minnesotans with scant choices.
The Minnesota Legislature offered a solution: a $271 million, publicly funded reinsurance pool that would help health insurance companies pay the most expensive medical claims, thereby lowering overall insurance premiums. The hope was that backstopping the insurers would stabilize the market and halt the rocket-like rise in premiums.
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Congress has been unable to agree on “market stabilization” for the Affordable Care Act (ACA), and it was left out of the recently passed omnibus. Yet, a key discussion has been missing from the conversation, the need to rethink the single risk pool in the ACA.
Throwing money at the status quo will simply slow a market decline, which could leave millions with no access to affordable coverage. Splitting subsidized lives from nonsubsidized into two different risk pools could provide structural relief that allows markets to stabilize longer term.
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The Centers for Medicare & Medicaid Services (CMS) plans to “wind down” support for the federal exchanges by the time open enrollment hits in 2019 and shift funding to states.
For that strategy to work, the agency is relying on Congress to do something it failed to do several times last year: Pass an ACA repeal.
CMS detailed its plan in a fiscal year 2019 budget justification (PDF) released this week that outlines a $403 million cut to its program operations budget next year. With less funding to oversee the federal exchanges for plan year 2020, CMS would dole out grants that allow states to “assume more control of their markets and expand enrollment options.”
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Since the managed care debacle of the 1990s, billions of dollars have been spent in time and resources to improve and measure the quality of patient care. However, measuring the quality of care in the effort to improve it in a cost-efficient manner is showing evidence of being counter-productive, particularly for small physician practices and practices with complex patient populations.
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Maryland lawmakers on Wednesday finalized a bipartisan measure to collect $380 million in taxes from health insurers next year to help curtail surging premiums for 150,000 Marylanders and prevent the state’s Obamacare marketplace from a potential collapse.
The legislation was a quiet, one-year compromise between the Democratic-controlled General Assembly and Republican Gov. Larry Hogan, who is expected to sign the measures.
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After years of being a central political question, health care is on the back burner. Both parties contain experts and activists who want to make major changes to health policy. But for now, both parties’ politicians are wary. Democrats are, as usual, more interested in the subject than Republicans, but they are somewhat divided about what to do next and in any case are not yet in a position to enact anything. Republican politicians, meanwhile, seem to have concluded from their failed efforts to repeal and replace Obamacare that the whole issue is best avoided. It is not surprising, then, that talk of a bipartisan deal to shore up Obamacare’s insurance exchanges has petered out.
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It’s the pragmatists versus the idealists in California’s latest quest for universal health care. Increasing numbers of lawmakers and advocates are pushing for policy goals that realistically can be accomplished this year. But there’s an unrelenting camp clinging to single-payer-or-bust.
The Golden State, which has been pushing back against the Trump administration on multiple fronts, is leaning toward the more incremental approach. This includes bills and budget items that would cover everything from insuring undocumented adults to preventing Medicaid work requirements and shielding the state from insurance products favored by the GOP, such as short-term plans.
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California is indeed the Golden State where Medicaid is concerned. The HHS Office of Inspector General (OIG) has found that, by exploiting Obamacare’s expansion of the program, California has enrolled hundreds of thousands of ineligible adults in Medicaid. Consequently, the state has bilked the federal government out of more than $1 billion in funding to which the state was not entitled. Indeed, these figures probably understate the amount of money that California officials have fraudulently extracted from the taxpayers. The OIG sampled a mere six-month period, from October 1, 2014 through March 31, 2015, to arrive at its damning assessment.
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The Trump administration said on Tuesday that 11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the ACA through their own marketplaces, enrollment remained the same as last year.
Ohio officials asked the Trump Administration on Friday to formally waive the Affordable Care Act individual mandate that requires residents to have health insurance, making it the first state to make such a waiver request.
Ohio’s Legislature called for the 1332 waiver last summer, and Congress zeroed out the financial penalty for not having coverage in its tax bill in December.
“The (tax) legislation zeroed out the penalty that is associated with the individual mandate … but … did not eliminate the mandate itself,” Ohio Department of Insurance Director Jillian Froment said in a March 30 letter to HHS Secretary Alex Azar. “That is why Ohio is submitting an application to waive [the mandate].”
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