The Scoop: February 26, 2020 Edition

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

Michigan governor wants federal judge to quickly overturn state’s Medicaid work requirement

Michigan and Utah are currently the only states with Medicaid work requirements in effect. Michigan Gov. Gretchen Whitmer took office in 2019 after the work requirement had been approved under Gov. Snyder’s administration. Because it was created by state legislation, Whitmer hasn’t been able to eliminate the work requirement. But a lawsuit was filed last fall to overturn it, and Whitmer’s administration has asked U.S. District Judge James Boasberg (the same judge who overturned Medicaid work requirements in Arkansas, Kentucky, and New Hampshire) to expedite a decision on the lawfulness of Michigan’s Medicaid work requirement. Earlier this month, an appeals court panel ruled that the Medicaid work requirement Arkansas established in 2018 was not lawful. Legal experts expect that Michigan’s work requirement will be overturned as well, and Whitmer’s administration is hoping to avoid the cost and confusion that will result when the state otherwise has to send notices to 80,000 people next month, letting them know that they failed to comply with the work requirement in January.

Virginia House, Senate pass surprise balance billing protections

Lawmakers in Virginia’s House and Senate have passed similar bills (HB1251 and SB172) that are aimed at protecting Virginia residents from surprise balance billing. The bills, which are now each being considered by the other chamber, would ensure that patients would only have to pay their plan’s regular in-network cost-sharing (deductible, copays, coinsurance) if they receive emergency care from an out-of-network provider, or if they receive non-emergency care from an out-of-network provider at an in-network facility. The bills would both require insurers to pay “market-based” rates to the out-of-network provider, and include a provision for arbitration if the provider doesn’t accept the payment rates.

The bills would apply to individual-market and fully-insured group plans, but not to self-insured group plans, which are regulated at the federal level rather than the state level.

Virginia’s State Corporation Commission is also working on a much weaker form of surprise balance billing protection, stemming from HB2538, which was enacted in 2019. The SCC is accepting public comment through March 20 on a proposed rule that would require medical facilities to inform patients if a scheduled non-emergency procedure is likely to involve an out-of-network medical provider.

Colorado lawmakers consider legislation to create ‘easy enrollment’ program

Maryland implemented an “easy enrollment” program this year, allowing uninsured residents to indicate on their tax return whether they’d like the state-run exchange to determine their eligibility for free or subsidized health insurance. Colorado is considering the same thing, with legislation now under consideration that would create the Colorado Health Care Coverage Easy Enrollment Program.

If approved by lawmakers, the program would allow uninsured Colorado residents to give the state permission to share data from their tax returns with Connect for Health Colorado (the state-run exchange). The exchange would then determine whether the person is likely to be eligible for free or low-cost health coverage, and provide enrollment assistance. Enrollment in Medicaid and CHP+ are year-round, and the legislation would create a special enrollment period for people who are found to be eligible for subsidized coverage in the exchange.

New Mexico lawmakers pass legislation to cap out-of-pocket insulin costs at $50/month

Numerous states are working this year to cap out-of-pocket insulin costs for residents who have state-regulated health insurance plans. New Mexico HB292 has passed with overwhelming bipartisan support in both the House and Senate, and Gov. Michelle Lujan Grisham has indicated she is eager to sign it into law. The bill is more robust than bills many other states are considering, as it caps an insured’s out-of-pocket insulin cost at no more than $50 per month. (West Virginia’s House passed a bill last week that would limit out-of-pocket insulin costs to no more than $25 per month.)

New Mexico’s legislation will also create an advisory group that will “study the cost of prescription drugs for New Mexico consumers and make recommendations on increasing accessibility of prescription drugs,” including drugs used to treat asthma, diabetes, severe allergic reactions, opioid overdoses, hypertension, depression, psychosis, high cholesterol, and epileptic seizures.

Virginia lawmakers pass bills to expand access to association health plans, limit access to short-term health plans

Earlier this month, we told you about legislation under consideration in Virginia that would expand access to association health plans. The bill calls for sole proprietors to be allowed to join AHPs – which is what the Trump administration’s 2018 AHP regulations allow (although that rule is currently blocked by a federal judge). Virginia’s Senate passed the measure unanimously, and the House passed it by a vote of 91 to 3. The legislation directs the state to seek a 1332 waiver in order to implement the provisions of the law, but Virginia’s Bureau of Insurance has informed lawmakers that 1332 waivers cannot be used to waive ERISA provisions, which is what the state would be seeking to do. (The Trump administration’s AHP regulation was blocked because it was too much of a stretch of ERISA rules.) So although the measure has passed with a veto-proof majority, it remains unclear what its impact will actually be in the state.

But Virginia lawmakers have also passed legislation (SB404 and HB1037) that would limit short-term health plans in the state. The bills have changed a bit since they were introduced, and the current versions do allow for renewals of short-term plans in some circumstances, but both bills call for short-term plans to have initial terms of no more than three months, and for their sale to be prohibited during the ACA open enrollment period in the fall.

Arizona Senate passes bill to fund reinsurance study

Arizona’s Senate has approved a bill that would provide funding for the state to conduct a study on the feasibility, cost, and impact of a reinsurance program aimed at stabilizing Arizona’s individual health insurance market. A dozen states have already implemented reinsurance programs and their average individual-market premiums are significantly lower than they would otherwise have been. But reinsurance also results in smaller premium subsidies, which can mean that some enrollees who get premium subsidies end up paying more for their coverage after a reinsurance program is in place.

Wyoming lawmakers pass budget bill that would prevent UW’s student health plan from covering abortion

Both chambers of Wyoming’s legislature have agreed, as part of the state budget bill, that the University of Wyoming should not be able to include abortion coverage in its student health plan. The student health plan is funded by student fees, but the university then controls the money and uses it to obtain health coverage via UnitedHealthcare, so lawmakers can exert control here through the budget process. If this provision in the budget remains in place after the two chambers hammer out their differences in other aspects of the budget, UW will have to rework its student health plan. UW’s student body president, Jason Wilkins, has noted that the legislature did not collaborate with the student body on this issue, and that “we at ASUW were not engaged in the process of making changes to something as substantial as student health insurance.”

West Virginia Senate passes bill designed to protect residents if ACA is overturned – as state actively works to overturn the ACA

Last month, West Virginia Attorney General Patrick Morrisey threw his support behind legislation aimed at protecting West Virginia residents in case the ACA is overturned. The irony is that Morrisey is one of 18 GOP attorneys general actively working to overturn the ACA in the Texas v. Azar case. West Virginia’s legislation would codify some of the ACA’s consumer protections into state law, but it would lack the federal funding that the state currently receives to pay for Medicaid expansion and premium subsidies. The bill – SB284 – passed in West Virginia’s Senate this week (on a party-line vote) and now heads to the House.

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.