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Aug. 2, 2018: Trump Administration Expands Access To Short-Term Plans That Do Not Meet ACA Requirements

Trump Administration Expands Access To Short-Term Plans That Do Not Meet ACA Requirements.

The New York Times  (8/1, Pear) reports that on Wednesday, the Trump Administration unveiled “a final rule...that clears the way for the sale of many more health insurance policies that do not comply with the Affordable Care Act and do not have to cover prescription drugs, maternity care or people with pre-existing conditions.” These new options “will help people struggling to afford coverage under the 2010 law, said James Parker, a senior adviser to” HHS Secretary Alex M. Azar II.

        On its front page, the Washington Post  (7/31, A1, Goldstein) reports that these policies, which are intended “to fill brief gaps in coverage, will be available for 12 months at a time, up from a current limit of three, and customers will be able to renew them for additional years.” The article says these “new rules are the second tool the administration has devised lately to foster low-price insurance that circumvents the Affordable Care Act’s coverage requirements and consumer protections. In June, the Labor Department issued rules that will make it easier for small companies to buy a type of insurance known as association health plans and, for the first time, allow them to be sold to people who are self-employed.”

        USA Today  (8/1, Alltucker, O'Donnell) reports that “unlike the so-called” ACA “plans, the short-term plans can deny or limit coverage based on an individual’s medical history. Experts say the plans may appeal to healthier adults who don’t need coverage for a chronic disease but want to spend less on health insurance premiums.”

Legislation and Policy

Majority Says Government Should Be Involved In Providing Healthcare Coverage, Poll Finds.

Contributor John Zogby writes in a Forbes  (8/1) piece that according to a new poll conducted by John Zogby Strategies, “57% of likely voters in the United States prefer some form of direct government involvement in providing health insurance to Americans.” About 36 percent of respondents said they believe access to good healthcare is a right for Americans, while 32 percent said the government should not be involved in healthcare.

McCaskill Says Medicare Could Save $2.8 Billion Per Year By Negotiating Drug Prices.

Fierce Pharma  (8/1, Liu) says that Sen. Claire McCaskill (D-MO) issued a report which found that if the federal government negotiated drug prices with pharmaceutical companies, Medicare Part D could save up to $2.8 billion per year on “just the 20 most commonly prescribed brand-name drugs.” Sen. McCaskill said, “Getting bulk discounts is something every business does, and the fact that the federal government is prohibited from doing it for Medicare is unconscionable.” The article adds that the FDA is “also brewing several measures to help bring down drug prices,” such as “allowing importation of drugs approved outside of the U.S. to challenge off-patent drugs with no rivals.”

        The Washington Examiner  (8/1, King) reports the Trump Administration “has not embraced giving Medicare direct negotiating power.” The Examiner adds, HHS Secretary Azar has previously “cited a 2007 report from the nonpartisan Congressional Budget Office that found that negotiation wouldn’t generate any savings because private insurance plans already do negotiate.”

Public Health and Private Healthcare Systems

Medicare Extends Enrollment Prohibition For New Home-Health Agencies, Nonemergency Ambulance Providers.

Bloomberg BNA  (7/31, Swann) reported that “elevated fraud and abuse concerns” in six states “recently led Medicare to extend an enrollment prohibition for new home-health agencies and nonemergency ambulance providers.” The extension covers Florida, Texas, Illinois, Michigan, Pennsylvania, and New Jersey and will last six months.

Transitional Care Management Services Reduce Mortality And Medicare Costs, Research Indicates.

Healio  (8/1, Tedesco) reports a study  published in JAMA Internal Medicine found that “significant reductions in mortality and Medicare costs occurred in the month after transitional care management services were provided.” Andrew B. Bindman, MD, from the Agency for Healthcare Research and Quality at HHS, and Donald F. Cox, PhD, retired from the Office of the Assistant Secretary for Planning and Evaluation at HHS, wrote, “Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities.” They concluded, “We found that TCM is a promising delivery model innovation that has the potential to improve health outcomes and costs among Medicare beneficiaries discharged to the community from medical facilities.”

Insurers Seek Smaller Rate Hikes On ACA Plans.

The Wall Street Journal  (8/1, Mathews, Walker, Subscription Publication) reports that after years of double-digit increases, premiums on Affordable Care Act plans in several states may go up by smaller rates or even go down in some states next year, according to insurers’ state filings.

        Insurers In Kansas Propose Smaller Premium Increases For ACA Marketplace Plans In 2019. The Topeka (KS) Capital-Journal  (8/1, Chilson) reports that health insurers in Kansas selling plans on the ACA marketplace submitted proposed rates for next year that include small decreases to increases in excess of 22 percent. The average increase is nearly six percent.

Blue Cross & Blue Shield Proposes To Lower Premiums On Some ACA Plans Offered In Illinois.

The Chicago Tribune  (8/1, Schencker) reports Blue Cross and Blue Shield of Illinois, the state’s largest health insurer, is seeking to lower premiums on many of the individual plans it sells on the ACA exchange in 2019. While other insurers are proposing increases, Blue Cross is asking to lower rates by anywhere from 0.84 percent to 1.5 percent.

        ACA Premiums Down By 6.4 Percent In Louisiana In 2019. The Baton Rouge (LA) Advocate  (8/1, Karlin) reports that premiums on Louisiana’s Affordable Care Act individual exchange will drop in 2019 by an average of 6.4 percent. Until 2019, “Louisiana’s individual market has weathered years of rising premiums, including a jump of 18.5 percent on average for 2018.” Blue Cross and Blue Shield of Louisiana, the largest insurer in the state, and Vantage Health Plan, a “small, north Louisiana-based insurer, are the only insurers in the state left offering health plans on the individual exchange.”

        The AP  (8/1) also covers the story.

Cigna Announces ACA Rate Hikes In Missouri Amid Centene Decreases And More Competition.

The Kansas City (MO) Star  (8/1) reports that in Missouri, Cigna Health and Life Insurance Co. requested rate hikes on its ACA plans averaging 7.3 percent across all plans, but with some specific premium increases of 25.7 percent. Cigna faces more competition in the market in 2019 as Medica will begin offering plans in some counties. Centene subsidiary Ambetter, under the name Celtic Insurance Co., has “asked the state insurance department for rate decreases averaging about 8.6 percent, and some Ambetter rates could drop by almost 20 percent.”

Molina Healthcare Shares Jump Following Q2 Results.

Modern Healthcare  (8/1, Livingston, Subscription Publication) reports Molina Healthcare announced that its second quarter net income reached $202 million, compared with a net loss of $230 million for the second quarter of 2017. Shares of the company jumped 17 percent Wednesday morning. The company “also recorded a medical loss ratio – the amount per premium dollar an insurer spends on medical care – of 85.3%, a big improvement over the 94.8% recorded a year ago thanks to cost-cutting measures,” according to the article.

        Molina Considering Return To ACA Markets In Utah And Wisconsin In 2019. The Washington Examiner  (8/1, Leonard) reports health insurer Molina is mulling a return to the ACA marketplace in Wisconsin and Utah in 2019 after taking a “one-year hiatus from these states,” according to executives during an earnings call Wednesday. Molina left the markets after seeing $230 million in losses in 2018. Molina CEO Joseph Zubretsky said, “I’m inclined to say that we would re-enter, but we have until the end of the summer to decide.”

Jeff Sopko