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Nov. 1, 2018: ACA Open Enrollment Expected To Provide Stable Premiums, More Choices For Consumers

ACA Open Enrollment Expected To Provide Stable Premiums, More Choices For Consumers.

The AP  (10/31, Alonso-Zaldivar) reports that ACA open enrollment starts today “amid stabilizing premiums and more choice for consumers.” The article says overall, “average premiums are going up only by low single-digit percentages for 2019. In some states, and for some types of plans, premiums will decline.” Meanwhile, fewer consumers are expected to see higher premiums, and several insurers are expanding to new cities and/or states. The AP adds that it may “be more difficult finding help in enrolling, after the Trump administration sharply scaled back funding for sign-up counselors known as ‘navigators,’” although “independent community groups still guide consumers through the paperwork.” Another important change is the fact that the ACA’s individual mandate will no longer be in effect as of January 1, 2019.

        Likewise, the Washington Post  (10/31, Goldstein) reports that the next ACA open enrollment season will feature “more stable health plan choices and rates, plus significant tests of the effects of recent Republican moves to undercut parts of the law.” The article says this will be the first time since the law took effect that consumers will not be penalized for not having healthcare coverage. In addition, this will be the first enrollment season “since the Trump administration has been taking steps to circumvent the ACA’s insurance requirements, making it easier for individuals to buy two inexpensive types of insurance that cover less care and lack certain popular consumer protections.” The Post quotes CMS Administrator Seema Verma as saying, “We have been working tirelessly to fulfill the promises we made to stabilize the market.”

        Bloomberg News  (10/31, Tozzi, Dodge) reports that consumers seeking to purchase ACA plans this year will “find that health-care coverage prices are high but largely stable, after months of tinkering by the Trump administration.” The article says although many of the ACA’s “core elements remain intact, other pieces have been weakened or removed.” President Trump vowed “to ‘let ObamaCare implode,’ and cut some of the law’s subsidies,” while Congress repealed “a mandate to buy coverage, and the administration has promoted cheaper plans with fewer benefits.” Overall, “the premium for typical plans in the 39 states that use the federal website will drop 1.5 percent in Trump’s third year in office, the administration said.” HHS Secretary Alex Azar is quoted as saying the President “took decisive action to stabilize insurance markets and expand choices for American consumers.”

        NPR  (10/31, Kodjak) reports that “the shopping and buying experience will vary widely, depending on where people live. In California, for example, where political leaders have always been supportive of the Affordable Care Act, legislators have allocated $100 million for outreach.” However, “in states that rely on the federal government’s insurance exchange – mostly conservative states whose leaders opposed the ACA – there won’t be nearly as much outreach to potential customers.”

        The New York Post  (10/31, Fredericks) also covers the story.

Legislation and Policy

CMS Gives Approval For Wisconsin To Implement Medicaid Work Requirements.

The Washington Times  (10/31, Howell) reports the Administration has “approved Wisconsin’s request to impose work requirements on some Medicaid enrollees, making it the fourth state to condition benefits on seeking a job or volunteering in the community.” Wisconsin will require “able-bodied, childless adults under age 50 to log 20 hours of work or community engagement per week.” Centers for Medicare and Medicaid Services Administrator Seema Verma said, “This is a thoughtful and reasonable policy, and one that is rooted in compassion.”

        The Hill  (10/31, Weixel) reports that Democratic gubernatorial candidate Tony Evers does not support the work requirements, adding that the race is “tight” between Evers and the state’s Republic Gov. Scott Walker. The article says that “the approval marks the first time a non-expansion state has been given permission to impose work requirements,” and it would require Medicaid recipients to work 80 hours per month to continue their coverage. The Hill also adds that the Trump Administration is facing “a lawsuit in Arkansas over similar [work] requirements,” and in Kentucky, a federal judge struck down a work requirement proposal.

HHS Seeks To Proceed With Implementation Of 340B Ceiling Price Rule.

Modern Healthcare  (10/31, Dickson, Subscription Publication) reports that HHS seeks “to cancel its plans to postpone imposing new ceiling prices for the 340B drug discount program.” The department “issued a proposed rulemaking on Wednesday that suggested the long-delayed rule will now be effective Jan. 1, instead of July 1, 2019 as originally announced earlier this year.” The article says the rule “would cap the prices drugmakers can charge hospitals that participate in 340B.” HHS has already postponed it five times.

        Fierce Healthcare  (10/31, Minemyer) reports HRSA explained that “the delays were necessary as it needed more time to implement the rule properly and wanted to fully explore possible alternatives or supplemental regulations.” The article says several hospital groups have sued HHS over the delays.

        HealthLeaders Media  (10/31, Porter) reports that HHS’ attorneys “have asked a federal judge to place the hospitals’ legal challenge on hold in light of the proposal; otherwise, the government has a November 13 deadline to respond to the complaint.”

CMS May Start Recouping Payments To Medicare Advantage Plans.

Modern Healthcare  (10/31, Livingston, Subscription Publication) reports that in a proposed rule issued last week, CMS “said it wants to stop applying a ‘fee-for-service adjuster’ to its audit findings, which historically has been used to ensure traditional Medicare and Advantage plans receive actuarially equivalent payments.” CMS also “warned that it wants to start recouping payments to Medicare Advantage plans based on a methodology it proposed back in 2012.”

New York Health Care Act May Gain Traction If Democrats Flip State Senate.

The Syracuse (NY) Post-Standard  (10/31, Mulder) reports that the New York Health Act, which would create statewide single-payer healthcare, “has been approved in each of the last five years by the Democrat-controlled Assembly, but rejected in the GOP-controlled Senate.” However, the bill has the chance of becoming law “if Democrats flip political power in the Senate where the GOP is clinging to a one-seat majority.”

Ohio Department Of Medicaid To Cover Treatment For Early Stages Of Hepatitis C.

The Cleveland Plain Dealer  (10/31) reports that the Ohio Department of Medicaid “announced that it will begin paying for the treatment of patients with Hepatitis C at an earlier stage of the disease.” Starting in 2019, “the department will cover care for individuals when they first develop the disease instead of waiting until it progresses further.” Tom Betti, Press Secretary for the Ohio Department of Medicaid, said, “If we can treat this as soon as possible, we think that we can stop or mitigate the spread of this disease.”

Public Health and Private Healthcare Systems

Anthem Predicts Better 2019 Than Forecasts.

Reuters  (10/31, Mathias, Babu) reports Anthem said on Wednesday that it is boosting its 2018 profit forecast and “said its own expectations for 2019 earnings are ahead of current Wall Street estimates.” Anthem CEO Gail Boudreaux said in a conference call, “We’re entering 2019 in a position of strength.” While rivals Aetna and Cigna have signed deals to merge with pharmacy benefit managers, “Anthem has decided to take its pharmacy benefits business in-house in 2020, when it will start managing billions of dollars of patient prescriptions under its IngenioRx brand in a bid to cut costs.”

        The Wall Street Journal  (10/31, Prang, Mathews, Subscription Publication) reports Anthem disclosed net income of $960 million, up 29 percent year-over-year, on total quarterly revenue of $23.25 billion.

        Modern Healthcare  (10/31, Livingston, Subscription Publication) reports Anthem’s quarterly figures show that it “grew Medicare Advantage membership, raised premiums to cover medical costs and spent less money on claims.” Boudreaux observed, “Our third quarter 2018 results reflect solid operating performance and ongoing positive momentum across our businesses” and “we have made significant progress towards improving execution and are focused on advancing our consumer, clinical and digital capabilities.” Anthem increased its Medicare Advantage membership by 17.8 percent compared to last year, and now has almost 1.8 million members.

        Contributor Bruce Japsen writes in Forbes  (10/31, Japsen) that “Anthem’s decision to leave certain individual markets under the Affordable Care Act to focus on its government business helped increase third quarter profits, continuing a trend for the nation’s second-largest health insurer.” Japsen points out that enrollment in the company’s insurance plans has declined by 750,000 to 39.5 million compared to last year, but those losses were “offset somewhat by growth in its Medicare business, which increased by 267,000 members thanks to acquisition and seniors flocking to popular Medicare Advantage plans.” The shift away from ACA plans “helped Anthem increase profits by 29% to $960 million , or $3.62 per share, compared to $747 million, or $2.80 per share, in the year ago period.”

        Healthcare Finance News  (10/31, Morse) also reports.

Task Force Recommends More Consumer Input Into Health Plan Designs.

Modern Healthcare  (10/31, Meyer, Subscription Publication) reports the Health Care Transformation Task Force, which includes insurers such as Aetna and providers like Cleveland Clinic, issued a “new set of health insurance benefit design principles” that stress the “need for engaging consumers to improve health outcomes.” The task force “laid out broad concepts to encourage greater incorporation of the consumer’s voice into health plan design.” It also “encouraged the development of ‘high-performance’ networks based not just on cost but also on higher quality of care.”

Premiums For Employer-Sponsored Coverage Rose By 3.6% This Year, Analysis Shows.

The Richmond (VA) Times-Dispatch  (10/31, Balch) reports, “Employer-sponsored health insurance costs continue to rise moderately, with the average health benefit cost per employee rising by 3.6 percent in 2018,” according to an analysis conducted by Mercer, a New York-based consultant group. Data show “smaller employers, with 10 to 499 employees, saw a greater average cost increase – 5.4 percent – than larger employers.” In Virginia, health plan costs per employee rose by 5.2 percent this year.

Short-Term Health Plans Have Lower Premiums Than ACA Due To Limited Coverage For Pre-Existing Conditions.

Kaiser Family Foundation  (10/31) found that “by screening out people with pre-existing conditions and providing less comprehensive benefits, insurers may be able to offer short-term plans at premiums 54% lower than ACA-compliant plans.” Short-term plans limit coverage of pre-existing conditions “by denying insurance altogether to people with pre-existing conditions, and by excluding coverage of pre-existing conditions for people who are offered a policy.” Short-term plans also “often exclude or severely limit benefits that ACA-compliant plans are required to cover, including prescription drugs, maternity care, mental health, and substance use treatment.”

Consumer Directed Healthcare News

More Than 90% Of Americans With Employer Insurance Choose Same Benefits Each Year, Poll Indicates.

CNBC  (10/31, Mercado) reports on its website that a survey from Aflac found over 90 percent of workers covered by employer health insurance “simply choose the same benefits each year, rather than making any changes during open enrollment.” Additionally, the poll indicated that “76 percent of workers said there were at least some portions of their current coverage that they didn’t understand, Aflac found.” The article encourages consumers to “review your out-of-pocket maximums, your copayments, your coinsurance...and your deductible,” and to consider any health changes or life changes that may impact their coverage needs.

Also in the News

Most Americans Support “Medicare For All” But Are Divided On What The Policy Means.

The Washington Examiner  (10/31, King) reports that a poll released by Survey Monkey and Axios found that while most Americans support “Medicare for all,” there is a divide on what the policy means. According to the poll, “52 percent of voters surveyed think that ‘Medicare for all’ refers to a single-payer, government-run system where Medicare covers everyone in America.” In addition, “34 percent said they would prefer a single payer system,” while “another 33 percent would prefer an optional public plan alongside private insurance, which would resemble the ‘public option’ that was considered for Obamacare but was eventually scuttled.”

Jeff Sopko