The Scoop: June 17, 2020 Edition

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

Colorado's legislature has passed a bill designed to make individual health coverage more affordable. The legislation awaits signature by Gov. Jared Polis. | Image: steheap / stock.adobe.com

COVID-19 special enrollment periods extended in New York, Vermont

Most of the fully state-run health insurance exchanges opened up special enrollment periods this spring to address the COVID-19 pandemic. Several of them are still ongoing, including New York’s and Vermont’s. Those were scheduled to end earlier this week, but both were extended at the last minute. Uninsured residents in New York now have until July 15 to enroll in a health plan; uninsured Vermont residents have until August 14.

The COVID-19 enrollment window in Massachusetts is scheduled to end next Tuesday, June 23. California’s is scheduled to end the following week, and DC’s continues until mid-September.

In every state, Medicaid and CHIP are available year-round to people who meet the eligibility criteria (which vary by state). And people in any state are allowed to enroll in an individual market health plan if they recently lost – or are about to lose – other health coverage, since that’s a qualifying event. But people who aren’t eligible for Medicaid and who don’t have a qualifying event would normally have to wait until the fall open enrollment period (November 1 – December 15) to sign up for a self-purchased health insurance plan. The COVID-19 special enrollment periods – including the ones that were just extended in New York and Vermont – give people in this situation an opportunity to enroll in coverage mid-year, even if they don’t have a qualifying event.

Mid-year health plan enrollments increase dramatically in 2020 due to COVID-19

The COVID-19 pandemic has ravaged the American job market. Although the rate of job losses has slowed in recent weeks as businesses begin to reopen, there are still millions of Americans who are out of work. The majority of non-elderly Americans get their health insurance from an employer, so job losses tend go to hand in hand with loss of health insurance coverage – particularly alarming when the source of the job losses is a pandemic.

But the loss of an employer-sponsored health plan is a qualifying event that triggers a special enrollment period during which a person can buy coverage in the individual market – through the exchange or off-exchange. And in most states, Medicaid becomes available if a person’s monthly income drops below 138 percent of the federal poverty level (that amounts to about $1,467/month for a single person this year), even if they were earning too much to qualify for Medicaid earlier in the year.

It’s important to note, as Andrew Sprung explains here, that the availability of Medicaid for people experiencing a sudden drop in income is not as well-publicized as it should be. Nevertheless, Medicaid enrollment is increasing sharply as a result of the pandemic, even in states that haven’t expanded Medicaid. And in some states that have expanded Medicaid, enrollment is growing faster due to pandemic-related job losses than it did in 2014, when Medicaid expansion first took effect.

According to an analysis by the Georgetown University Health Policy Institute, Medicaid enrollment across a subset of 21 states grew by 2.8 percent from February to April. And the states with the sharpest Medicaid enrollment growth included Missouri and Florida, neither of which have expanded Medicaid under the Affordable Care Act.

HealthCare.gov declined to open a COVID-19 special enrollment period for people who didn’t have a qualifying event and weren’t eligible for Medicaid, but enrollment via HealthCare.gov has certainly climbed sharply this spring, due to enrollments among people who did have qualifying events (in most cases, loss of other coverage). With the exception of Idaho, all of the fully state-run exchanges opened COVID-19 special enrollment periods, and saw significant enrollment as a result. Several of them have published enrollment data stemming from their COVID-19 enrollment windows (generally including enrollments among people who had a qualifying event as well as those who did not):

  • California: More than 155,000 people enrolled (COVID-19 enrollment window continues through June 30)
  • Colorado: More than 14,000 people enrolled
  • Connecticut: More than 37,000 people enrolled
  • Maryland: 14,000 enrolled in private plans, plus about 26,000 enrolled in Medicaid
  • Minnesota: More than 9,400 people enrolled in private plans (and enrollment in MinnesotaCare, the state’s BHP, grew by more than 16,000)
  • Nevada: More than 6,000 people enrolled
  • Washington: 22,000 people enrolled

As expected, these numbers are all significantly higher than they would normally be outside of open enrollment.

Colorado legislature passes bill to make individual health coverage more affordable

Last week, we told you about Colorado Senate Bill 215, which had passed the Senate and been sent to the House. The legislation, which is designed to make individual health coverage more affordable in Colorado, has now passed the House and been sent to Gov. Jared Polis. If signed into law, the legislation will add another five years of funding for Colorado’s existing reinsurance program, and will also provide state-based subsidies to make coverage more affordable, particularly for people with modest incomes (up to 300 percent of the poverty level) who aren’t eligible for the ACA’s premium subsidies. This includes people subject to the family glitch as well as undocumented immigrants.

Missouri Chamber of Commerce announces support for Medicaid expansion

Missouri voters will have an opportunity to vote on Medicaid expansion this summer, with a Medicaid expansion initiative (Amendment 2) that will be on the state’s August 4 primary ballot. Late last week, the Missouri Chamber of Commerce endorsed Amendment 2, noting that expanding Medicaid would create 16,000 jobs per year for the next five years in Missouri, and would increase the state’s economic output by $2.5 billion (data based on this report from the Missouri Foundation for Health). The Missouri Chamber of Commerce tends to side with Republican lawmakers, but has endorsed Medicaid expansion despite the fact that Republican Gov. Mike Parson and many of the state’s GOP lawmakers are opposed to Amendment 2.

CMS gives insurers the option to pay MLR rebates early this summer

In guidance issued last Friday, CMS announced that health insurers will have the option to estimate and prepay medical loss ratio (MLR) rebates this summer. The rebates are normally paid in a lump sum by the end of September, or credited to premiums that are due on or after September 30. This year, CMS is allowing insurers to estimate the MLR amounts (which are expected to be much larger than they’ve been in prior years), and issue rebates to consumers earlier than normal. Especially for insurers that provide premium credits, this could help to offset premiums that people will owe over the next several months, making it easier for people to maintain their coverage.

Trump administration rolls back Obama administration’s nondiscrimination healthcare protections

Late last week, HHS and the Office for Civil Rights published a new final rule for how Section 1557 of the ACA should be interpreted. Section 1557 provides broad framework for non-discrimination in healthcare, but as with many aspects of the ACA, specific guidance was left to HHS. The Obama administration had published a final rule in 2016 that extended nondiscrimination protections to include termination of pregnancy, gender identity, and sex stereotyping. The new rule replaces the 2016 rule, and significantly rolls back the nondiscrimination protections that the Obama administration had put in place.

HHS had published the proposed rule change last summer, and received nearly 199,000 comments on its proposal (as opposed to about 25,000 comments that were submitted in 2015, when the initial Section 1557 implementation rules had been proposed under the Obama administration). But the final rule that was issued last week was mostly unchanged from what the administration had proposed last summer.

The final rule is wide ranging, and includes a rollback of the Obama-era requirement that healthcare entities provide tag lines in multiple languages on various communications they send to consumers. But one of the most significant changes was the elimination of nondiscrimination protections for transgender Americans in terms of their health insurance coverage and access to healthcare.

Just three days after the rule was finalized, however, the Supreme Court issued a landmark 6-3 ruling that protects the LGBTQ community from discrimination in the workplace. It’s unclear whether the Trump administration’s new healthcare discrimination rules can stand in the face of the Supreme Court’s ruling that discrimination “on the basis of sex” includes discrimination based on sexual orientation and gender identity.


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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