The Scoop: Health Insurance News – Jan 20, 2021

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President Biden’s American Recovery Plan calls for additional premium subsidies and COBRA subsidies

The newly appointed President Joe Biden outlined his American recovery plan last week and contains some important provisions to improve access to health insurance. The sweeping $ 1.9 trillion proposal, which should be approved by Congress, calls for premium tax credits to be increased “to reduce or eliminate health insurance premiums” and each participant’s post-subsidy premium to no more than 8.5 percent to limit their income. This second provision would primarily help people with incomes near or just over 400 percent of the poverty line and could make a significant difference in the affordability of coverage – sometimes the amount – for some households currently paying full price for their coverage of well over a quarter of their income.

The plan also provides for government subsidies for the COBRA premiums until the end of September 2021. the American Recovery and Reinvestment Act provided COBRA subsidiesthat could serve as a model of how a new round of COBRA subsidies could work.

Biden’s American Recovery Plan is much more than just health insurance. But if you’re curious about how healthcare reform might go on under the new administration and congress, take a look this two-part series by Andrew Leap, this piece by Charles Gaba, and this piece by Katie Keith.

Open enrollment ends on Saturday in Massachusetts and Rhode Island

Open enrollment for 2021 health insurance is still ongoing in five states and Washington, DC (plus a COVID-related special enrollment period for uninsured Maryland residents). But the registration window ends this Saturday, January 23rd in Massachusetts and Rhode Island. After Saturday, residents of these states will need a qualifying event to enroll or make changes to their coverage for 2021.

As of this week, the confirmed total number of marketplace registrations for coverage in 2021 has been available Exceeded 11.6 million nationwide.

Partial health insurance rules finalized for 2022 by the outgoing Trump administration

Last fall, the Trump administration published the proposed performance and payment parameters for 2022. This annual rulemaking document is far-reaching and typically addresses a variety of issues related to health insurance exchanges, special admission periods, risk adjustments, etc. summarized several of the proposed rule changes that would most likely directly affect individuals with individual market health plans.

Last week the Trump administration did announced that some aspects of the proposal – including the most controversial – will be closed, but the rest of the proposed rule changes will be closed in an additional rule to be issued “at a later date”. This will be under the control of the Biden administration, which is also likely to delay the rule finalized by the Trump administration last week (currently scheduled to go into effect March 15) and reissue a new proposed rule with a new comment deadline.

A total of 542 comments were sent to CMS on the proposed rule changes for 2022. The comments on the rule changes that CMS completed last week are summarized in the final rule, along with the responses from CMS. Especially:

  • Although CMS found that “Almost all commentators on this rule-making warned of possible harmful effects on consumers“Allowing states to abandon their exchanges and rely entirely on brokers, agents and insurers to register health insurance, the proposed rule change that would allow this has been completed. In states that choose this option, an official exchange website would still play a role, but it would be minimal. And there is an ongoing concern that switching to brokers, agents, and insurers instead of exchanges will make it more difficult for Medicaid-eligible participants to understand the support and coverage available to them.
  • The Trump administration Outlook 2018 2018 1332 waivers, which have greatly relaxed the “guard rails” that apply to these waivers, will be officially incorporated into federal regulations.
  • The fee that insurers pay HealthCare.gov (and pass them on to consumers through premiums) will be reduced in 2022. In states that are completely dependent on HealthCare.gov, it is 2.25 percent of premiums; in states that operate their own exchanges but use HealthCare.gov for enrollment, it will be 1.75 percent of premiums (from currently 3 percent and 2.5 percent, respectively).

Many of the proposed rule changes are still under review and not finalized last week, including the contribution adjustment percentage (which would affect the maximum out-of-pocket and affordability threshold for disaster plan eligibility), special enrollment periods when the employer ceases to give COBRA grants or a person loses premium subsidy entitlement, and a rule change that would permanently allow insurers to grant MLR discounts earlier in the year.

At Health Affairs, Katie has Keith an excellent in-depth analysis of the partial rule of inference.

Lawsuit filed to block Georgia’s plan to abolish the health insurance exchange

Last fall, the Trump administration did Approved Georgia’s 1332 waiver proposal to deviate from HealthCare.gov and instead use a system based on brokers, agents, and insurers to enroll people without a centralized exchange (the final rule change allowing a similar approach nationwide is very reminiscent of Georgia Waiver of 1332).

Last week, Planned Parenthood Southeast and Feminist Women’s Health Center Lawsuit filed against HHS, CMS, the Treasury Department and their respective leaders for alleging the waiver was improperly approved and should be abandoned. Democracy Forward, which represents the plaintiffs in the case explained that Georgia’s renunciation of 1332 “will do immense damage to the Georgian health insurance market, force Georgians to buy insurance through private brokers and insurance companies, get more residents to sign up for junk plans, and increase premiums. “

Virginia Bills Lifting State Bans on Abortion Under Market Plans; Study Effects of Prescribed Coverage for Infertility

Virginia is one of 26 states if health insurances sold on the marketplace / stock exchange are not allowed to offer insurance cover for abortions. (Virginia’s ban includes exemptions for abortions in cases of rape, incest, or mother’s death.) legislation was introduced in the Virginia Senate last week that would lift that ban and allow insurers to offer abortion insurance if they so choose.

legislation was also introduced into Virginia, which the Virginia Health Insurance Reform Commission Conduct an impact study on requiring state health insurance for the treatment of infertility. There are currently 19 states that require at least some coverage for the treatment of infertility.

A law was introduced in Maryland and Rhode Island to create universal health commissions

legislation was launched in Maryland last week and calls on the state to create a universal health care commission. The commission would be tasked with developing a plan for the state to put in place a universal payer coverage system by 2024.

legislation was also introduced in Rhode Island last week calling for the creation of a special legislative commission to study how the state might go about implementing a one-number Medicare-for-all type of health insurance in Rhode Island.

A law was introduced in Missouri to create a Medicaid job requirement

Missouri has not yet expanded Medicaid eligibility under the ACA, however That will change this summer thanks to an election initiative that voters passed last year. legislation was launched this month in the Missouri Senate, which calls for a state Medicaid labor requirement that will take effect January 2022. Under the terms of the bill, non-exempt Medicaid members would need to work (or participate in various other community activities including volunteering, school, professional training, etc.) at least 80 hours per week to be eligible for Medicaid.

The Trump administration has approved numerous work requirement waivers in recent years, but none are currently in effect due to legal proceedings and the COVID pandemic. And the Biden government is very unlikely to approve any further exemptions, which means the Missouri legislation is unlikely to be a starter for now, even if it is passed.

Uncompensated care funding in Florida and Texas extended to 2030

Last Friday, the Trump administration renewed 1115 waivers in Texas and Floridawhich are now valid until mid-2030. These exemptions apply to Medicaid Managed Care and also provide federal funding for uncompensated care – which is more of a problem in states like Texas and Florida due to the non-expansion of Medicaid and the resulting coverage gap for low-income residents.


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

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