The Scoop: January 8, 2020 Edition

A look at state-level headlines regarding individual health insurance and health reform

Virginia Gov. Ralph Northam's vision for a newly blue Virginia included a transition to a state-run health insurance exchange – and legislation has been introduced to create one that would be operational by 2023. Photo credit: Eli Wilson/Shutterstock

Welcome to this week’s round-up of state-level health reform news, including:

Open enrollment continues in DC and five states

Although open enrollment for individual-market health insurance has ended in most of the country, several state-run exchanges extended their open enrollment periods, and some of those enrollment windows are still in progress. Residents in Connecticut, Colorado, Massachusetts, California, New York, and Washington, DC can still enroll in ACA-compliant coverage for 2020. Here are the details.

Legislation filed in Virginia to create a state-run exchange

After Democrats won enough seats in the November election to gain control in both chambers of Virginia’s legislature, Governor Ralph Northam laid out his vision for a newly blue Virginia. This included the possibility of transitioning to a state-run health insurance exchange – and legislation has now been introduced in Virginia to create a state-run exchange that would be operational by 2023.

Individual mandates now in effect in California and Rhode Island

There’s no longer a federal penalty for being uninsured. But Massachusetts, New Jersey, and Washington, DC all had penalties in effect last year, which will appear on tax returns that residents file in the next few months. And as of last week, California and Rhode Island have joined them; penalties will start to show up on California and Rhode Island tax returns next year, when residents file their 2020 taxes.

53,000 people have gained coverage under Idaho’s Medicaid expansion

Medicaid expansion took effect in Idaho last week (enrollment began in November) and more than 53,000 people have gained coverage as a result. The state is still working with CMS to implement a Medicaid work requirement, but for the time being, eligibility has been expanded without strings attached.

Medicaid fully expanded in Utah

Full Medicaid expansion took effect in Utah last week. The state had partially expanded Medicaid last April, covering people with income up to the federal poverty level. Medicaid is now available in Utah for people with income up to 138 percent of the poverty level, although there’s a Medicaid work requirement in effect for all non-exempt Medicaid expansion enrollees.

Medicaid work requirement in effect in Michigan

Michigan expanded Medicaid under the Affordable Care Act in 2014, but the state has now implemented a work requirement for Medicaid expansion enrollees who don’t qualify for an exemption. A lawsuit was filed in November to block the work requirement, and it’s still working its way through the court system. But for now, the work requirement is in effect and enrollees will need to begin reporting their work hours to the state next month.

Utah and Michigan are currently the only two states where Medicaid work requirements are in effect. There are several other states where they’ve been approved by the federal government but have either been blocked by lawsuits or delayed by state officials.

Legislation filed in New Mexico to expand exchange board’s authority

New Mexico has a state-run health insurance exchange but uses the HealthCare.gov enrollment platform. The state plans to transition to a fully state-run exchange by this coming fall, however, following in Nevada’s footsteps. Legislation filed for the 2020 session would expand the duties and authority of New Mexico’s exchange board, in anticipation of the switch to a fully state-run exchange. The new legislation would grant the exchange board the authority to create standardized health plans, extend the open enrollment window, and potentially become an active purchaser exchange.

Surprise balance billing protections now in effect in Texas

A new law took effect in Texas last week, protecting some state residents from surprise balance billing when they receive emergency care at an out-of-network facility, or receive care from an out-of-network provider at an in-network facility. But the new law only applies to state-regulated health insurance plans, and as the Texas Tribune explains, only about 16 percent of Texas residents have health insurance policies that are regulated by the state.

West Virginia AG works to overturn ACA while simultaneously backing legislation to protect WV residents from that possibility

West Virginia’s attorney general, Patrick Morrisey, is one of the plaintiffs seeking to overturn the Affordable Care Act in the Texas v. Azar/U.S. lawsuit, which is currently under appeal. But Morrisey is also backing legislation that would codify various ACA consumer protections into West Virginia state law if and when the ACA is overturned. The irony is strong, but a similar scenario took place in Louisiana last year.

The crucial question would be funding, as the federal government currently supplies the bulk of the funding for West Virginia’s Medicaid expansion, and covers the majority of the premiums for West Virginia exchange enrollees. All of that would end if the ACA were to be overturned. Morrisey indicated that the state would establish an invisible risk-sharing fund, but Charles Gaba has noted that West Virginia would need $1 billion per year in funding to replicate the current level of coverage and affordability granted by ACA rules and funding.

California and 19 Democratic-led states ask SCOTUS to hear Texas v. Azar this year

The Texas v. Azar/U.S. lawsuit has been making its way through the courts for two years. Last month, a panel of judges for the 5th Circuit Court of Appeals in New Orleans agreed with a lower court that the ACA’s individual mandate is unconstitutional, but opted to send the case back to the lower court to determine which parts of the ACA should be overturned, despite the fact that the lower court already ruled that the entire ACA should be overturned. This simply delays the process and adds to the ongoing uncertainty over the future of the ACA.

But last week, California Attorney General Xavier Becerra, along with 19 other states and DC, filed a petition seeking to have the Supreme Court step in and review the case this term, before the appeals process is finalized. Democrats in the U.S. House of Representatives are also asking the Supreme Court to expedite the case.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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