September 2023

I originally wrote about this a month ago; today the Massachusetts Health Connector posted an updated press release in a more succinct, consumer-friendly format:

Exciting news: Massachusetts is making health care more affordable and accessible for thousands of people through the ConnectorCare program. The Massachusetts Health Connector Board of Directors has approved important changes to help more people get the care they need. Here’s what you need to know: 

via MNsure:

Minnesota Department of Commerce and MNsure, Minnesota’s official health insurance marketplace, are issuing a joint public service announcement alerting consumers to be aware of scams targeting Minnesotans who are no longer eligible for Medical Assistance (Minnesota’s Medicaid program).

This alert is specifically for Minnesotans who submitted their Medical Assistance renewal paperwork, found out they do not qualify for the program, and need to find new health insurance. When trying to buy health insurance, they may be vulnerable to scams from someone pretending to be MNsure that sells them a bogus insurance product. In some cases, scammers have taken money from consumers by saying they must pay for help enrolling in a plan or asking them to pay for premiums up front over the phone.

“Consumers should be on the alert for health insurance scams, including people claiming to represent MNsure who are not legitimate. MNsure.org is the safest place for consumers to shop for and buy health insurance with confidence or connect with a trusted, MNsure-certified assister for free application and enrollment help,” said CEO Libby Caulum.

Last month I noted that Amy Lotven of Inside Health Policy had reported that Virginia's brand-new state-based ACA health insurance exchange had been officially approved by the Centers for Medicare & Medicaid Services:

Virginia is slated to become the nation’s 19th state-based exchange now that CMS has given officials the greenlight to fully transition away from healthcare.gov starting Nov. 1 for the 2024 plan year. Meanwhile, the State Corporation Commission (SCC), which administers the exchange, has suspended the state’s reinsurance program that had lowered premiums by about 20% for 2023, so individual plan rates are set to increase by an average 28.4%, according to a presentation made during an Aug. 9 hearing on the 2024 rates.

Virginia’s Health Benefit Exchange (VHBE) was enacted in 2020 by former Gov. Ralph Northam (D) and has been operating as a state-based exchange reliant on the federal platform (SBE-FP) since plan year 2021. The state paused the transition activity in 2021 after the enhanced premium tax credits were enacted but restarted it the following year.

Mississippi is one of the ten states where ACA Medicaid expansion still hasn't gone through a full decade after it could have.

A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While GOP Governor Tate Reeves and the Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.

Unfortunately, just a few weeks later, the Mississippi Supreme Court crushed that effort:

Three weeks ago, the Centers for Medicare & Medicaid Services (CMS) announced that they were cracking down on one of the main reasons why so many people are being kicked off of Medicaid and the Children's Health Insurance Program (CHIP) even though they were still eligible: 

CMS believes that eligibility systems in a number of states are programmed incorrectly and are conducting automatic renewals at the family-level and not the individual-level, even though individuals in a family may have different eligibility requirements to qualify for Medicaid and CHIP. For example, children often have higher eligibility thresholds than their parents, making them more likely to be eligible for Medicaid or CHIP coverage even if their parents no longer qualify. This conflicts with existing federal Medicaid requirements and may have a disproportionate impact on children.

I managed movie theaters for most of the '90's, and was in charge of the concession stand & its staff. One year I came back from vacation to find the employees cleaning the concession stand after a big rush of customers.

I was happy to see this until I realized that some of the staff were using a mop with bleach-based cleanser to clean the floor at the same time other staffers were using an ammonia-based cleanser to clean the glass popcorn bins right next to the employee mopping.

I freaked out a bit, ordering them to stop immediately and turning on a fan to blow the fumes in opposite directions. Apparently neither the employees nor the other manager who had been covering my department while I was on vacation had ever learned that mixing bleach and ammonia can be fatal.

When I asked about it, the other manager apologized but explained that they were simply trying to follow both state and local health/safety board rules. You see, some of the staff were college students while others were minor high school students.

via Dorothy Mills-Gregg of Inside Health Policy:

While most states are reaching the height of their post-pandemic Medicaid renewals, Idaho is returning to nearly normal redeterminations, closing out the bulk of its pandemic eligibility unwinding after removing more than 121,000 Medicaid and CHIP beneficiaries the state deemed most likely ineligible from the programs in six months.

Hmmm...IHP's estimate is lower than that of KFF's daily tracker, which puts Idaho's total disenrollment number at 145,000 as of today.

Idaho’s Medicaid and Children’s Health Insurance Program enrollment grew by roughly 150,000 people during the pandemic’s continuous coverage requirement, maxing out at about 450,000 beneficiaries. An estimated 42% of the beneficiaries who were disenrolled lost coverage due to procedural or paperwork issues.

Mississippi is one of the ten states where ACA Medicaid expansion still hasn't gone through a full decade after it could have (well...eleven if you include North Carolina, where the Republican-controlled legislature is currently holding it hostage).

A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While the states GOP Governor and Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.

Unfortunately, just a few weeks later, the Mississippi Supreme Court crushed that effort:

via the Maryland Insurance Dept:

Maryland Insurance Administration Approves 2024 Affordable Care Act Premium Rates

• Reinsurance Program Continues Positive Impact on Individual Rates

BALTIMORE – Maryland Insurance Commissioner Kathleen A. Birrane today announced the premium rates approved by the Maryland Insurance Administration for individual and small group health insurance plans offered in the state for coverage beginning Jan. 1, 2024.

Rate Changes for the Individual Market

The rates for individual health insurance plans subject to the Affordable Care Act (ACA) will change/increase by an average of 4.7% for 2024. Approximately 229,000 Marylanders are impacted by the approved rates. However, the actual percentage by which the rates for a specific plan will change depends on the carrier and plan.

Note: I decided that while the original headline accurately reflected my feelings about this WSJ Op-Ed, it was a bit over the top, so I've changed it to something less crude.

For years, the Patient Protection & Affordable Care Act, generally shorthanded as the ACA or, more colloquially known as "Obamacare," was the top policy target of Republicans and other conservatives.

It seemed as though not a day went by without some right-wing opinion piece being published attacking the ACA for one thing or another. Once in awhile these attacks had some validity, but the vast majority were either completely baseless or grossly exaggerated.

And yet, after the dust settled on the infamous 2017 ACA "repeal/replace" debacle, it seemed as though the GOP had pretty much tired of their relentless assault on the healthcare law. They had failed to repeal it even with control of the White House, Senate, House of Representatives and Supreme Court, and ended up settling for zeroing out of the federal Individual Mandate Penalty as a consolation prize.

Yesterday the U.S. Census Bureau published new reports on Income, Poverty and Health Insurance Coverage in the United States as of 2022. Obviously all three of these are extremely important and interact closely with each other, but given that my focus is healthcare policy, I'm going to stick with the health insurance coverage portion.

According to the 2023 Current Population Survey Annual Social & Economic Supplement (CPS ASEC):

...92.1% of the U.S. population had health insurance coverage for all or part of 2022 (compared to 91.7% in 2021). An estimated 25.9 million or 7.9% of people did not have health insurance at any point during 2022, according to the 2023 Current Population Survey Annual Social and Economic Supplement (CPS ASEC). That compares to 27.2 million or 8.3% of people who did not have health insurance at any point during 2021.

I've been a healthcare wonk for nearly a decade (in fact, the 10th anniversary of this website is coming up exactly one month from today), and I've learned a lot about how the U.S. healthcare system works (or, oftentimes, doesn't). Yet, even after all that time, I still occasionally stumble upon information about it which seems like it should have been something I knew all along, yet somehow never knew until now.

The Indian Health Service falls into this category. Don't get me wrong; I knew the IHS existed, and I knew that it serves roughly 2.2 million eligible Native Americans and Alaska Natives nationally. I've referenced it many times before, usually when discussing the types of healthcare coverage people have or funding included in various Congressional bills.

However, in all that time, I somehow was under the impression that the IHS was similar to either the Veterans Administration or Medicaid in terms of how it works, how it's paid for...and how comprehensive it is. I offer no excuses as to why I thought that was the case; I just did.

I haven't checked in on how many Americans have lost Medicaid or CHIP coverage due to the ongoing Medicaid Unwinding process playing out nationally since the end of July. Fortunately, KFF (formerly the Kaiser Family Foundation) has been diligently tracking the data, and it continues to be extremely depressing and concerning.

At the time, "only" 3.77 million people had been confirmed to have lost coverage purely due to procedural/red tape reasons (as opposed to others who lost coverage after being determined ineligible any longer).

KFF's data is now pretty comprehensive (it includes nearly every state plus DC), and it's bad if not worse than many healthcare advocates feared as the numbers have continued to grow dramatically:

Arkansas is a problematic state for many reasons, but I have to give their insurance dept. website high praise for posting their annual rate filings in a clear, simple & comprehensive fashion (which is to say, not only do they post the avg. premium changes for each carrier, they also post the number of covered lives for each, which is often difficult for me to dig up). Better yet, they also include direct links to the filing summaries and include the SERFF tracking number for each in case I need to look up more detailed info.

Anyway, there's nothing terribly noteworthy in the 2024 filings. Insurance carriers sought an average 5.0% rate hike on the individual market and 5.5% for small group plans; these were shaved down slightly by state regulators for overall weighted average increases of 4.1% and 5.4% respectively.

USAble HMO is launching a new line of HMO insurance products in the state next year (called "Octave" I believe) but otherwise it looks pretty calm.

Over at Inside Health Policy, Dorothy Mills-Gregg has decided to check in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:

As noted by Madeline Guth of the Kaiser Family Foundation last year:

...in spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:

via the U.S. Food & Drug Administration:

FDA Takes Action on Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants

Today, the U.S. Food and Drug Administration took action approving and authorizing for emergency use updated COVID-19 vaccines formulated to more closely target currently circulating variants and to provide better protection against serious consequences of COVID-19, including hospitalization and death. Today’s actions relate to updated mRNA vaccines for 2023-2024 manufactured by ModernaTX Inc. and Pfizer Inc. Consistent with the totality of the evidence and input from the FDA’s expert advisors, these vaccines have been updated to include a monovalent (single) component that corresponds to the Omicron variant XBB.1.5.

What You Need to Know

Last Tuesday I noted that a package of bills designed to codify various ACA protections into state law here in Michigan (most of which are low-hanging fruit of my own healthcare wish list which I posted back in February) had managed to make it halfway through the legislative process: Five of them have passed the Michigan House, but not the Senate; the other three have passed the Michigan Senate...but not the House. I applauded the state legislature for pushing these bills halfway through and encouraged them to get the other half of the job done.

I was therefore highly amused and pleased to see MI Governor Gretchen Whitmer call for doing that the very next day in her "What's Next" address:

Over at KFF (previously the Kaiser Family Foundation), researchers/analysts Jared Ortaliza, Krutika Amin & Cynthia Cox have put together a new analysis of the overall individual (aka non-group) U.S. health insurance market as of early 2023. While ACA exchange-based enrollment is publicly available (for both subsidized & unsubsidized enrollees) and is the primary focus of this website, off-exchange enrollment is always somewhat fuzzier for several reasons:

A few weeks ago, I noted that Virginia's average 2023 unsubsidized ACA individual market premiums dropped by nearly 13% thanks to the newly-implemented state-based reinsurance program...but that they were at risk of skyrocketing by as much as 25% in 2024 due to that same reinsurance program being at risk of not continuing for a second year because of a budget standoff:

During 2021, the Virginia General Assembly passed HB 2332, the Commonwealth Health Reinsurance Program, which was signed into law on March 31, 2021 as Chapter 480, of the 2021 Virginia Acts of Assembly. This bill requires the State Corporation Commission to submit a waiver request for federal approval to establish a reinsurance program beginning January 1, 2023.

via the Centers for Medicare & Medicaid Services (CMS):

Model aims to improve the overall health of a state population by ensuring providers are delivering efficient, high-quality, and coordinated care to patients

Today, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative step to test a state’s ability to improve the overall health care management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health, and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set health care expenditures on a more sustainable trajectory, and lower health care costs for patients.

via BeWell NM, New Mexico's state-based ACA exchange:

The annual report, as mandated by the 2021 New Mexico Statutes Chapter 59A, Article 23F, Section 59A-23F-10, and compiled jointly by beWellnm, New Mexico’s Health Insurance Exchange, and the New Mexico Office of the Superintendent of Insurance (NM OSI), offers a comprehensive analysis of various key aspects. These include the individual health insurance market, both on- and off-Exchange enrollment, small business enrollment, qualified health plan pricing, outreach and enrollment assistance activities, as well as strategies aimed at addressing the challenge of the remaining uninsured population in New Mexico.

Overview of the Individual Health Insurance Market

Original story published 8/17/23.

Tennessee's preliminary 2024 individual & small group market health insurance rate filings are now available, including actual enrollment numbers, which allows me to run weighted averages for both markets.

For the most part they're fairly straightforward: The individual market is looking at average rate increases of around 4.8%, while the small group market averages around +7.8% overall.

The biggest news here is Humana dropping out of Tennessee's small group market, making Tennessee the 12th state where Humana is doing so in 2024. I'm embarrassed to say it took me taking note of this over a dozen times before remembering that I already wrote about Humana pulling out of the entire employer group market nationally back in February.

UPDATE 10/02/23: Well, all of Tennessee's filings appear to have been approved as is by the state regulatory department...they all say "approved" at the SERFF database and the newest filing versions all predate the original publication of this blog post from 8/17, so I'm concluding the preliminary rates are also the final rates.

Earlier today I noted that according to the most recent Medicare enrollment report from the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage enrollment--in which a private insurance carrier is paid by the federal government to administer Medicare benefits, and which differs in some important ways from "traditional" or "Fee for Service" Medicare--is on the verge of overtaking traditional Medicare in terms of total enrollment.

As of May 2023, 48.5% of all Medicare enrollees were covered via a Medicare Advantage plan, a percentage which has been steadily increasing over the years (it was only at 35.5% as of 2019).

While I mention this every time I post about the latest Medicare enrollment report, it's been some time since I've checked on the traditional vs. privately administered variants of Medicaid enrollees. For a long time I've been under the impression that roughly 70% of Medicaid enrollment was handled via Managed Care Organizations (MCOs):

via the Centers for Medicare & Medicaid Services:

Builds on President Biden’s Historic Commitment to Create a Long-Term Care System Where People Can Live with Dignity 

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a proposed rule that seeks to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards—to ensure access to safe, high-quality care for the over 1.2 million residents living in nursing homes each day. This proposed rule builds on the President’s historic Action Plan for Nursing Home Reform launched in the 2022 State of the Union.