About 2 years ago, GOP Georgia Governor Brian Kemp submitted an ACA Section 1332 Waiver request to the Centers for Medicare & Medicaid Services. As Katie Keith of Health Affairs explained at the time, it consisted of two parts...the first of which was fairly noncontroversial, the second of which was...well, not good:
The application reflects a two-phase approach: a state-based reinsurance program to begin in plan year 2021, followed by a transition to the “Georgia Access” model beginning in plan year 2022. Both components of the waiver application would extend through plan year 2025.
Last June, the U.S. Health & Human Services Dept. confirmed my estimate that total enrollment in healthcare policies either specifically created by (or expanded to more people by) the Affordable Care Act had broken 31 million Americans:
Today, the U.S. Department of Health and Human Services (HHS) released a new report that shows 31 million Americans have health coverage through the Affordable Care Act – a record. The report also shows that there have been reductions in uninsurance rates in every state in the country since the law’s coverage expansions took effect. People served by the health Marketplaces and Medicaid expansion have reached record highs.
via the Centers for Medicare & Medicaid Services (CMS), by email:
Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.
Medicare
As of January 2022, over 64.2M people are enrolled in Medicare. This is an increase of 52K since the last report.
34.9M are enrolled in Original Medicare.
29.3M are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
49.8M are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage.
Nearly 11.9 million individuals are dually eligible for Medicare and Medicaid, so are counted in the enrollment figures for both programs.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of tweaks to some of the specifics of how the ACA is actually implemented.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of tweaks to some of the specifics of how the ACA is actually implemented.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of tweaks to some of the specifics of how the ACA is actually implemented.
This morning, CMS issued the final NBPP for the upcoming 2023 Open Enrollment Period. Since there's so many provisions included, this year I've decided to break it into multiple posts which only focus on one or a few of them at a time:
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of tweaks to some of the specifics of how the ACA is actually implemented.
This morning, CMS issued the final NBPP for the upcoming 2023 Open Enrollment Period. Since there's so many provisions included, this year I've decided to break it into multiple posts which only focus on one or a few of them at a time:
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of tweaks to some of the specifics of how the ACA is actually implemented.
This morning, CMS issued the final NBPP for the upcoming 2023 Open Enrollment Period. Since there's so many provisions included, this year I've decided to break it into multiple posts which only focus on one or a few of them at a time:
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of tweaks to some of the specifics of how the ACA is actually implemented.
This morning, CMS issued the final NBPP for the upcoming 2023 Open Enrollment Period. Since there's so many provisions included, this year I've decided to break it into multiple posts which only focus on one or a few of them at a time:
I talked about it endlesslythroughout2017 & 2018, but it's been awhile since I last discussed the ACA's quirky Silver Loading pricing strategy in detail.
The ACA includes two types of financial subsidies. Advance Premium Tax Credits (APTC) reduce monthly premiums for low- and moderate-income.
Cost Sharing Reductions (CSR), meanwhile, reduce deductibles, co-pays and other out-of-pocket expenses for low-income enrollees.
In 2017, Donald Trump cut off CSR reimbursement payments in a failed attempt to sabotage the ACA, thinking this would cripple the ACA exchanges. Instead, insurance carriers implemented a very smart alternative pricing mechanism to make up for their CSR losses, which came to be known as "Silver Loading."
The carriers basically calculated how much they expected owe in CSR expenses the following year...and then simply added that amount to their premiums for the following year instead.
While there's several ways that carriers can add the extra CSR cost to their premiums, "Silver Loading" involves doing so by adding 100% of the extra cost to Silver plans only, as opposed to spreading it out across Bronze, Silver, Gold & Platinum plans.
It's been another month since my last attempt to estimate a grim but vitally important number: Just how many Trump voters vs. Biden voters have become fatal victims of the GOP/FOX News coordinated anti-vaxx/anti-mask campaign to date, and what sort of impact might this end up having on the midterm elections this November?
As I said at the time, I'm not going to attempt to justify this cynical bean counting anymore...the evidence is now overwhelming that Republican leadership, in coordination with outlets like FOX News and other right-wing outlets, made a conscious decision in spring 2021 to push hard against Americans getting vaccinated against COVID-19 for purely cynical political math reasons.
Enrollment Specialists Available at YMCAs Across the State on April 30th
New Yorkers Can Learn About the Availability of Expanded Financial Assistance
Year-Round Enrollment Opportunities Available
ALBANY, N.Y. (April 25, 2022) - NY State of Health, the state’s official health plan Marketplace, announced today that it will join the YMCA in celebration of their annual Healthy Kids Day, held this year on Saturday, April 30th. NY State of Health enrollment specialists are attending Healthy Kids Day events throughout the State, to educate New Yorkers about obtaining quality, low-cost health coverage through the Marketplace. Event attendees will be able to meet certified enrollment assistors at more than 25 YMCA locations to receive enrollment guidance and learn about the availability of increased financial assistance made available through the American Rescue Plan Act.
TRENTON —The New Jersey Department of Banking and Insurance today announced that it is accepting public comment on access to comprehensive reproductive care, coverage of reproductive services and related health impacts.
The department is collecting public comment as part of the implementation of the historic Freedom of Reproductive Choice Act recently signed by Governor Phil Murphy, which codifies the constitutional right to freedom of reproductive choice in New Jersey.
“In signing the Freedom of Reproductive Choice Act, Governor Murphy protected a woman’s right to make medical decisions about her reproductive health,” said Commissioner Marlene Caride. “The department is looking forward to hearing from the public as we examine the impact of insurance coverage on the availability of comprehensive reproductive care services.”
ST. PAUL, Minn.—New data released by the Minnesota Department of Health shows actions taken by state officials and the Biden administration helped drop the state’s uninsured rate in 2021 to 4.0%, the lowest level ever measured.
“The Minnesota Heath Access Survey shows that more Minnesota families have been able to access and maintain their health insurance during this critical time,” said MNsure CEO Nate Clark. “Minnesota has been able to reduce the uninsured rate thanks in part to targeted, effective policies, including the expansion of premium tax credits that lower the cost of monthly premiums for private health plans available through MNsure.”
Access Health CT Announces New Special Enrollment Period for Connecticut Residents with Lower Income
HARTFORD, Conn. (April 25, 2022) — Access Health CT (AHCT) today announced a new Special Enrollment Period (SEP) for Connecticut residents with lower income beginning April 25. This new SEP will provide access to no- or very low-cost health insurance plans made possible by the American Rescue Plan Act (ARPA).
To be eligible for this SEP, Connecticut residents must:
Be new or returning customers who are not currently enrolled in a health insurance plan through Access Health CT.
Have a household income at or below 150% of the Federal Poverty Level (FPL).
If you don't know what 150% FPL is, it depends on your household size:
NOTE: With national COVID deaths continuing to thankfully drop off (the 7-day avg. is down to ~410/day now), I've decided to switch to monthly updates going forward unless COVID deaths start spiking again.
I also recently stopped posting the relative case rates as they've been pretty much stable for the past couple months and the rise of home-based testing, which usually isn't reported to county/state health departments anyway, has made that data somewhat less meaningful.
I've been posting weekly looks at the rate of COVID-19 cases & deaths at the county level since the point at which every U.S. adult could theoretically have received 2 COVID vaccination doses nearly a year ago, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020), as well as by the vaccination rate of each county in the U.S. (nonpartisan).
I go by county residents who have received the 2nd COVID-19 shot only (or 1st in the case of the J&J vaccine).
I base my percentages on the total population via the 2020 U.S. Census including all ages (i.e., it includes kids under 12).
For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
EAST PROVIDENCE, R.I. (April 14, 2022) HealthSource RI’s Open Enrollment period was held from November 1, 2021 and ended on January 31, 2022. This was a very successful Open Enrollment period for HealthSource RI (HSRI), with enrollments increasing to 31,445 in 2022 compared to 30,071 in 2021. These mark HealthSource RI’s highest enrollment numbers since 2020.
The American Rescue Plan Act (ARPA), enacted by the federal government in February 2021, provided historically high savings in the form of subsidies/tax credits for eligible individuals and families in Rhode Island. ARPA also created a new opportunity for individuals and families whose income is over 400% of the federal poverty level (FPL) to receive financial assistance.
Again, here's what the subsidy tables look like under the ACA itself and under the American Rescue Plan. The premium caps are the maximum percent of household income which a household has to pay for the benchmark Silver plan at various income ranges:
I've been posting weekly looks at the rate of COVID-19 cases & deaths at the county level since the point at which every U.S. adult could theoretically have received 2 COVID vaccination doses nearly a year ago, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020), as well as by the vaccination rate of each county in the U.S. (nonpartisan).
For a long time I used July 1st, 2021 as my start point, but in recent months I decided to back this up to May 1st, 2021 instead. Pinning down an exact date for this is a bit tricky since a) different populations were made eligible at different points in 2021, and b) it takes 3-4 weeks after getting your first vaccination dose before you can get the second one, but May 1st is what I've finally settled on.
Enrollment Assistors Visit Public Libraries in Upstate New York Throughout April and May to Educate Patrons on Their Health Plan Options and Help Them Enroll
ALBANY, N.Y. (April 13, 2022) - NY State of Health, the state’s official health plan Marketplace, today announced that certified enrollment assistors will be available at public libraries across upstate New York this spring. The enrollment assistors will visit libraries throughout April and May to educate New Yorkers about enrolling in quality, affordable health insurance. Assistors will provide in-person support to library patrons by educating them on their plan options, answering questions, scheduling appointments, and helping with enrollment.
Grandfathered Policies: These are non-ACA compliant policies which people were already enrolled in prior to March 2010, when the ACA was signed into law. Anyone enrolled in one of these can keep renewing them until the day they die if they wish (as long as they keep paying the premiums), or until the carrier chooses to (voluntarily) discontinue the policy.
Transitional (or "Grandmothered") Policies: These are non-ACA compliant policies which people enrolled in between March 2010 and October 2013. This category was created by President Obama and the HHS Dept. in November 2013 during the ugly "If You Like Your Plan You Can Keep It!" backlash. Basically, the ACA originally would have required that these policies be terminated as of 12/31/13. However, after a bunch of people received cancellation notices from their carrier, there was a massive backlash, leading Obama to announce an extension program.
As I (and many others) have been noting for many months now, the official end of the federal Public Health Emergency (PHE), whenever it happens, will presumably bring with it reason to celebrate...but will also likely create a new disaster at the same time:
What goes up usually goes back down eventually, and that's likely to be the case with Medicaid enrollment as soon as the public health crisis formally ends...whenever that may be.
Well, yesterday Ryan Levi and Dan Gorenstein of of the Tradeoffs healthcare policy podcast posted a new episode which attempts to dig into just when that might be, how many people could be kicked off of the program once that time comes and how to mitigate the fallout (I should note that they actually reference my own estimate in the program notes):
New Program Connecting Tax Filers to Health Coverage Ends April 15
DENVER— Colorado’s new Tax Time Enrollment Program that connects uninsured tax filers to health coverage is coming to a close this Friday, April 15. Due to a state law passed in 2020, this tax season was the first in which residents could mark on their Colorado tax form that they were uninsured and interested in getting connected to coverage with Health First Colorado (Colorado’s Medicaid program) or Connect for Health Colorado, the state’s official health insurance marketplace.
I've been posting weekly looks at the rate of COVID-19 cases & deaths at the county level since the point at which every U.S. adult could theoretically have received 2 COVID vaccination doses nearly a year ago, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020), as well as by the vaccination rate of each county in the U.S. (nonpartisan).
For a long time I used July 1st, 2021 as my start point, but in recent months I decided to back this up to May 1st, 2021 instead. Pinning down an exact date for this is a bit tricky since a) different populations were made eligible at different points in 2021, and b) it takes 3-4 weeks after getting your first vaccination dose before you can get the second one, but May 1st is what I've finally settled on.
With the Build Back Better Act having passed the U.S. House of Representatives last fall only to come screeching to a halt when it reached the U.S. Senate due to all 50 Republicans + Dem. Senator Joe Manchin refusing to support it, Congressional Democrats have started introducing standalone bills in an attempt to push through at least some of the more popular provisions.
The Health Insurance Exchange is seeking responses to an official request for proposals and is allocating up to $400,000 to support the initiative
HARTFORD, Conn. (April 7, 2022) — Access Health CT (AHCT) today announced the opening of its fiscal year 2023 Navigator Grant Program. The program will allow AHCT to deepen its community relationships with the goal of engaging, educating, informing and enrolling individuals in health insurance throughout Connecticut, particularly in minority communities that experience significant health disparities and higher uninsured rates.
ST. PAUL, Minn.—More than 1,100 residents used the Minnesota Insulin Safety Net Program to access over $6 million worth of insulin in 2021, according to a recent report from the Minnesota Board of Pharmacy.
Together, MNsure and the Minnesota Board of Pharmacy are reminding all Minnesotans that this program is available to provide fast, reliable help for those who need insulin and may be struggling to afford this life-saving drug.
For residents who are in immediate need of assistance – that is, have less than a seven-day supply of insulin and will likely face significant health consequences without it – the urgent need program enables eligible Minnesotans to receive a 30-day supply of insulin right away at their pharmacy and pay no more than a $35 co-pay, one time per year.
Federal and State Health Insurance Subsidies Boosted Enrollments on Colorado’s Exchange
Record number of Coloradans enrolled during the annual enrollment period
DENVER— In a report released today, the state’s official health insurance marketplace, Connect for Health Colorado, attributes record enrollments this past Open Enrollment Period to federal and state policy changes making health coverage more affordable.
The Biden-Harris Administration is announcing today that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to Food and Drug Administration (FDA) approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. People with Medicare can get up to eight tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency.
The Biden-Harris Administration is announcing that, beginning today, as many as 720,000 pregnant and postpartum people across the United States could be guaranteed Medicaid and Children’s Health Insurance Program (CHIP) coverage for a full 12 months after pregnancy thanks to the American Rescue Plan (ARP). Medicaid covers 42 percent of all births in the nation, and this new option for states to extend Medicaid and CHIP coverage marks the Biden-Harris Administration’s latest effort to address the nation’s crisis in pregnancy-related deaths and maternal morbidity by opening the door to postpartum care for hundreds of thousands of people.
New Mexico would raise a state health-insurance tax and dedicate the new revenue to programs intended to make health care more affordable under a proposal that passed the state House on Sunday.
Rep. Deborah Armstrong, D-Albuquerque, described the legislation as an unusual opportunity to generate more revenue for health care without increasing the total amount consumers now pay.
The increased state tax would partially replace a federal tax that’s being repealed, she said, meaning health insurance carriers would actually be charged less in taxes than they are now, even after the state increase.
The legislation, House Bill 278, would raise about $125 million in annual revenue when fully phased in — the bulk of it dedicated to a new fund for health care affordability, according to legislative analysts.
Former President Barack Obama will return to the White House on Tuesday for the first time since he left office to promote the Affordable Care Act in an event alongside President Joe Biden, a White House official said.
...Vice President Kamala Harris will join them in delivering remarks about the expansion of health care benefits under the law, as well as Biden’s efforts to further reduce health care costs and expand access to care, the official added.
Health and Human Services Secretary Xavier Becerra and other members of the Cabinet, which includes a number of people who served in the Obama administration, are also expected to attend.
I've been posting weekly looks at the rate of COVID-19 cases & deaths at the county level since the point at which every U.S. adult could theoretically have received 2 COVID vaccination doses nearly a year ago, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020), as well as by the vaccination rate of each county in the U.S. (nonpartisan).
For a long time I used July 1st, 2021 as my start point, but in recent months I decided to back this up to May 1st, 2021 instead. Pinning down an exact date for this is a bit tricky since a) different populations were made eligible at different points in 2021, and b) it takes 3-4 weeks after getting your first vaccination dose before you can get the second one, but May 1st is what I've finally settled on.
