Illinois is second state to enact legislation to cap out-of-pocket insulin costs. | Image: Shutterstock

The Scoop: January 29, 2020 Edition

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

Reviewed by our health policy panel.

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

New York extends open enrollment (enrollment also continues in DC, CA)

Open enrollment for individual market health insurance continues until Friday in Washington, DC and California. It was scheduled to end on Friday in New York as well, but a last-minute extension was issued this week, giving residents until February 7 to sign up for coverage. The enrollment window ended last month in most of the country, but states that run their own exchanges have flexibility to extend enrollment, and most did so.

California’s exchange has been reminding residents that not only does enrollment continue until January 31, but that a new state law requires residents to have health coverage or pay a penalty. California also enacted legislation this year that provides new state-funded subsidies to help make coverage more affordable.

Legislation introduced in Maryland would create state-based premium subsidies

In most states, premium subsidies are only available via the Affordable Care Act’s tax credits. But lawmakers in Maryland are considering legislation that would create a state-based premium subsidy program. California began offering state-based premium subsidies this year, and Washington plans to do so next year. Massachusetts and Vermont both have programs (which pre-date the ACA) that provide supplemental subsidies to certain enrollees. Lawmakers in Colorado have previously considered legislation that would have created state-based subsidies.

Single-payer legislation introduced again in Vermont

Soon after the Affordable Care Act was enacted, Vermont began moving forward with a plan to use a 1332 waiver to create a single-payer system that would have taken effect in 2017. But by 2014, the state had scrapped the idea amid concerns over the cost. A new bill has been introduced in Vermont that would resurrect the single-payer plan with a 2024 effective date, although similar legislation was also considered in 2019 and didn’t advance.

Illinois is second state to enact legislation to cap out-of-pocket insulin costs

Last fall, we told you about legislation in Illinois to cap out-of-pocket costs for insulin on state-regulated health plans. That legislation was signed into law last week, making Illinois the second state to enact a law to cap out-of-pocket costs for insulin. Colorado’s law was enacted last year and took effect this month. Several other states are considering similar bills. The American Diabetes Association has applauded state legislation to cap out-of-pocket costs for insulin, but the caps are not a panacea: Most very large employers have self-insured coverage, which is regulated at the federal level rather than the state level. And of course, people who don’t have health insurance at all aren’t helped by laws that address out-of-pocket costs under insurance plans.

New Jersey enacts legislation to cap prescription costs

Last month, we told you about New Jersey legislation to cap out-of-pocket prescription costs. The legislation, which passed unanimously in the state’s legislature,  was enacted last week, after initially being rejected by Gov. Phil Murphy over concerns about its impact on New Jersey’s state employee health plan. As of 2021, state-regulated plans in New Jersey will have to cap out-of-pocket costs at $150 per month per prescription ($250 in the case of Bronze plans, and there are exceptions for catastrophic plans and HSA-qualified plans).

New Jersey joins several other states that have caps on out-of-pocket prescription costs. And the state is now also considering legislation that would further limit out-of-pocket costs for insulin – as are numerous other states.

Bipartisan legislation would protect Delaware residents from surprise balance bills

Surprise balance bills happen when a patient inadvertently sees an out-of-network provider – either in an emergency situation or in a situation where a patient uses an in-network facility but some of the services are performed by out-of-network providers. Delaware already protects patients from surprise balance billing in emergency situations, but new bipartisan legislation has been introduced that would extend protections to people who receive services from out-of-network providers while at in-network facilities.

Indiana legislation would allow Farm Bureau to sell medically underwritten plans

Indiana SB184 is scheduled for a hearing today in the Senate’s Insurance and Financial Institutions Committee. The legislation would allow Indiana Farm Bureau to offer medically underwritten health plans to sole proprietors in the state who are Farm Bureau members. Tennessee has long allowed medically underwritten Farm Bureau plans to be sold. Kansas and Iowa have recently followed suit. The legislation under consideration in Indiana calls for a similar approach, with medically underwritten plans that won’t be regulated as insurance, and thus wouldn’t be subject to normal insurance rules. (Nebraska’s Farm Bureau takes a different approach, offering guaranteed-issue short-term plans to members who are actively engaged in agriculture.)

Medicaid expansion legislation filed in Wyoming

Last fall, lawmakers on Wyoming’s Joint Interim Revenue Committee voted in favor of a draft Medicaid expansion bill, agreeing to send it to the full legislature for consideration during the 2020 session. The legislation was filed this week, and the session gets underway next month. Rather than simply calling for Medicaid to be expanded under the terms of the ACA, the legislation directs state officials to work with CMS to “explore options” for Medicaid expansion, and authorizes the governor to seek waivers from CMS if necessary.

A group of Wyoming health organizations has joined together to lobby for Medicaid expansion in the state, and medical students from the University of Wyoming have long urged lawmakers to expand coverage in the state.


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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