As always, the Texas individual and small group markets are pretty messy. For starters, they have up to 20 individual market carriers depending on the year, along with over a dozen small group market carriers some years (this year they're at 17 and 8 respectively).
On top of that, as is also the case in some other states, some of the names of the insurance carriers can be confusing as hell. There's the "Insurance company of Scott & White" which seems to have changed its name to "Baylor Scott & White Insurance Co.," which isn't to be confused with "Scott & White Health Plans" and so on.
I was only able to acquire hard enrollment data for five of the carriers on the individual market this year, and one of those doesn't really count since they're brand new and don't have any (Wellpoint Insurance Co.). For another 11 of them the rate filings include the number of policyholders but not the actual number of covered lives; for those I'm using an average 1.4x multiplier, based on the actual multiplier found in the carriers I have both numbers available for.
It's been another several months since the last time I wrote about the seemingly never-ending Braidwood v. Becerra lawsuit which threatens to not only end many of the ACA's zero-cost preventative services, but which could also throw all sorts of regulatory authority into turmoil depending on what precedents it sets.
On March 30, 2023, a federal district court judge issued a sweeping ruling, enjoining the government from enforcing Affordable Care Act (ACA) requirements that health plans cover and waive cost-sharing for high-value preventive services. This decision, which wipes out the guarantee of benefits that Americans have taken for granted for 13 years, now takes immediate effect.
It's been a whopping nine months since the last time I wrote anything about the seemingly never-ending Braidwood v. Becerra lawsuit which threatens to not only end many of the ACA's zero-cost preventative services, but which could also throw all sorts of regulatory authority into turmoil depending on what precedents it sets.
On March 30, 2023, a federal district court judge issued a sweeping ruling, enjoining the government from enforcing Affordable Care Act (ACA) requirements that health plans cover and waive cost-sharing for high-value preventive services. This decision, which wipes out the guarantee of benefits that Americans have taken for granted for 13 years, now takes immediate effect.
On the other hand, well, at least if women manage to survive childbirth, they & their newborn baby will have Medicaid coverage for a full year in the future. Via the Austin American-Statesman:
Texas mothers are one step closer to getting health coverage for 12 months following pregnancy.
This week, the federal Centers for Medicare and Medicaid Services approved Texas' plan to provide 12 months of postpartum health care coverage through Medicaid or Children's Health Insurance Program instead of the current 60 days. Those programs are for people who qualify based on income. The extended coverage will begin March 1.
Emergency rooms not required to perform life-saving abortions, federal appeals court rules
The Biden administration reminded hospitals of their obligation to perform life-saving abortions under the Emergency Medical Treatment and Labor Act after the overturn of Roe v. Wade. Texas sued, arguing it was an overstep that mandated abortions.
Federal regulations do not require emergency rooms to perform life-saving abortions if it would run afoul of state law, a federal appeals court ruled Tuesday.
After the overturn of Roe v. Wade in June 2022, the U.S. Department of Health and Human Services sent hospitals guidance, reminding them of their obligation to offer stabilizing care, including medically necessary abortions, under the Emergency Medical Treatment and Labor Act (EMTALA).
As always, the Texas individual and small group markets are pretty messy. For starters, they have up to 20 individual market carriers depending on the year, along with over a dozen small group market carriers some years.
On top of that, as is also the case in some other states, some of the names of the insurance carriers can be confusing as hell. There's the "Insurance company of Scott & White" which seems to have changed its name to "Baylor Scott & White Insurance Co.," which isn't to be confused with "Scott & White Health Plans" and so on.
In addition, this year there seem to be a lot of carriers bailing on the Texas market altogether: Ambetter, Ascension and FirstCare appear to be pulling out of the states individual market, while Aetna (up to four different divisions?) along with Humana are leaving the small group market.
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.
Last week Amy Lotven of Inside Health Policy noted that the 5th Circuit Court panel was trying to come up with some sort of stopgap solution to the ongoing Braidwood v. Becerra lawsuit until such time as the case winds its way up to the U.S. Supreme Court.
One judge on the federal appeals court panel considering whether an order blocking HHS from enforcing the Affordable Care Act preventive services coverage mandate should continue to be partially stayed through its appeal is urging the parties to pursue a workable resolution, and legal expert Tim Jost says the panel appeared open to the government’s suggestion the court issue a narrow solution that only applies to insurers in Texas.
When we last checked in on the Braidwood v. Becerra federal lawsuit, there was a lot of confusion as to exactly which preventative services mandated by the Affordable Care Act to be covered at no out-of-pocket (OOP) charge to enrollees were supposed to be stricken and which weren't.
...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:
