If signed into law by President Trump, the Consolidated Appropriations Act, 2021 – passed by Congress earlier this week – will provide strong consumer protections against surprise balance billing. | Image: W.Scott McGill / stock.adobe.com
In this edition
- Open enrollment continues in 11 states, Washington, DC
- Enrollment up 6.6% for 2021 in states that use HealthCare.gov
- Trump administration finalizes rule changes for grandfathered group plans
- Congress passes legislation to protect consumers from surprise balance billing
- Congress passes legislation to make health insurers subject to federal antitrust laws
- Ohio enacts legislation to end “fail first” drug requirements for stage 4 cancer treatment
- Delaware proposal calls for increased investment in primary care
Open enrollment continues in 11 states, Washington, DC
Although open enrollment for 2021 individual and family health insurance ended last week in most states, and ended last night in Minnesota, open enrollment is still ongoing in 11 states and Washington, DC, with the following enrollment deadlines:
- Idaho: December 31 (enroll by December 31 for a January 1 effective date)
- Colorado: January 15
- Connecticut January 15
- Pennsylvania: January 15
- Nevada: January 15 (enroll by December 31 for a January 1 effective date)
- Washington: January 15
- Massachusetts: January 23 (enroll by December 23 for a January 1 effective date)
- Rhode Island: January 23 (enroll by December 31 for a January 1 effective date)
- California: January 31 (enroll by December 30 for a January 1 effective date)
- DC: January 31
- New Jersey: January 31 (enroll by December 31 for a January 1 effective date)
- New York: January 31 (enroll by December 31 for a January 1 effective date)
Enrollment up 6.6% for 2021 in states that use HealthCare.gov
Last Friday, CMS published preliminary enrollment data for the 36 states that used HealthCare.gov during the open enrollment period that ended last week. Across those 36 states, a total of 8.23 million people enrolled in private plans through HealthCare.gov. As Charles Gaba notes, that’s a 6.6 percent increase over last year, after we account for the fact that Pennsylvania and New Jersey are now running their own exchange platforms and will report their enrollment numbers separately. (Both also have ongoing enrollment periods, as noted above.)
As detailed by Andrew Sprung, private-plan enrollment via the exchange in states that have not expanded Medicaid is about 10 percent higher for 2021 than it was for 2020, while enrollment is slightly lower in states that have expanded Medicaid. Sprung offers several explanations for this, including the fact that many who lost their incomes in 2020 have transitioned to Medicaid, which is more likely to be an available option in states that have expanded Medicaid. Sprung has also tracked the significant increase in the number of people covered by Medicaid this year.
Trump administration finalizes rule changes for grandfathered group plans
Earlier this month, the Trump administration finalized new rules for grandfathered group health plans. The rule change is essentially the same as the changes that the administration proposed in July, but the effective date has been pushed out to mid-June 2021, as opposed to the originally proposed effective date of 30 days after the rules were finalized.
Under the new rules, grandfathered group plans that are HSA-qualified will be able to make cost-sharing increases necessary to retain their HSA-qualified status, even if the increases exceed the limits that would otherwise have applied to grandfathered plans. (This situation has not yet arisen, but if it does in the future, the rule change will allow these plans to keep both their HSA-qualified status and their grandfathered status.) And the new rules will also allow grandfathered group plans to increase their cost-sharing amounts by a larger threshold than previously permitted, with allowable cost-sharing expected to be about 3 percentage points higher under the new rule.
Congress passes legislation to protect consumers from surprise balance billing
The surprise balance billing legislation that we told you about last week was included in the Consolidated Appropriations Act, 2021, which passed earlier this week with strong bipartisan support in both the House and Senate. President Trump was widely expected to sign it as soon as it reached his desk, but he cast doubt on that via Twitter on Tuesday night, expressing displeasure at some aspects of the legislation. Trump didn’t say that he would veto the bill, but the video he shared on Twitter indicated that the current bill is no longer a sure thing.
In its current form, the massive bill includes government funding for the first three quarters of 2021, extensive COVID-19 relief, and numerous other provisions, including strong consumer protections against surprise balance billing that will take effect in January 2022. As the Kaiser Family Foundation’s Larry Levitt explains in this Twitter thread, the new legislation provides strong consumer protections, and – assuming it does get signed into law – will result in consumers having to pay just their normal in-network cost-sharing when they receive emergency care or unknowingly receive care from an out-of-network provider at an in-network facility.
Protections against surprise balance billing for ground ambulance charges are not included in the legislation, despite the fact that ambulance rides often result in surprise balance billing. But the legislation does call for a commission that will study ground ambulance charges in hopes of incorporating additional consumer protections in a future piece of legislation.
Congresses passes legislation to make health insurers subject to federal antitrust laws
The Competitive Health Insurance Reform Act of 2020 – H.R.1418 – passed in the Senate last night and is now headed to President Trump’s desk (it was passed by the House in September). Under the terms of this legislation, health insurance companies will be subject to federal antitrust laws, reversing a 75-year-old exemption that was granted in 1945 via the McCarran-Ferguson Act.
Sens. Steve Daines (R-Montana) and Patrick Leahy (D-Vermont) shepherded the bipartisan bill through the Senate. In announcing the passage of the bill, Daines noted that it “will ensure that health insurance issuers are subject to the same federal antitrust laws prohibiting unfair trade practices, such as price-fixing and collusion, as virtually every other industry in our economy.” The rest of the McCarran-Ferguson Act – which gives states the right to regulate their insurance markets — is unchanged by H.R.1418.
Ohio enacts legislation to end ‘fail first’ drug requirements for stage 4 cancer treatment
This week, Ohio Gov. Mike DeWine signed a new law prohibiting Ohio health insurance plans from imposing “fail first” requirements on drug coverage for people with stage 4 cancer. S.B.252 prohibits insurers from requiring these patients to try a cheaper medication first and then only cover another medication if the first did not work. These “fail first” requirements are often imposed on newer, cutting-edge therapies that tend to be more expensive than older medications, but Ohio’s legislation stems from the fact that time is of the essence with metastatic cancer.
Delaware proposal calls for increased investment in primary care
Delaware’s Insurance Commissioner, Trinidad Navarro, and the state’s Office of Value-Based Health Care Delivery have published a report that outlines proposals for improving access to primary care in the state without increasing healthcare costs. The report calls for health insurers in Delaware to increase their investments in primary care while decreasing price growth for some other services, including hospital care, and to transition to a value-based payment model instead of a fee-for-service model. The state is accepting public comments on the report until January 25, 2021.
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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