October 10, 2017
Trump’s health care executive order said to come this week
The White House is finalizing an executive order that would allow individuals to form association health plans and empower those health plans or individuals to buy insurance outside their own state. The executive order also exempts association health plans from certain ACA protections. The Trump Administration claims the move will lower costs by giving consumers greater leverage during negotiation with health insurers. Critics argue the move could destabilize the market by drawing healthy consumers away from the individual market to cheaper association health plans with fewer protections, leading to a sicker risk pool and a spike in premiums.
Medicare Advantage star ratings are almost here
This Wednesday, CMS will unveil its annual star ratings for Medicare Advantage plans. Medicare awards a 5 percent bonus payments to insurers that have at least four out of a possible five stars. In 2017, 68 percent of Medicare Advantage beneficiaries were enrolled in a plan with at least four stars, down from 71 percent in 2016. The 68 percent figure is expected to go up for 2018. ACHP plans traditionally do well in Medicare advantage ratings; last year, six members earned 5 stars from CMS and 27 plans operated by ACHP members received a 4 star rating or higher.
Cuts to ACA enrollment efforts
As they cope with funding cuts, navigator organizations across the country are struggling to stay afloat. Many of the organizations have scaled down their operations and cut staff, and some navigators have been forced to shut down altogether. The Administration announced earlier this year it would be reducing funds for navigators by 41 percent. Navigator organizations assist consumers as they compare health plans, sign up for coverage and use their insurance correctly, and some experts are concerned the funding cuts could hamper enrollment efforts. These cuts come at a time of turmoil in the insurance market with more consumers needing help navigating the health care system.
CMS awards research and outreach contracts
CMS has awarded up to $45 million to contractors to perform market research and outreach efforts for its various programs and initiatives including the ACA, Medicare and the rollout of MACRA. The companies are tasked with researching, strategizing and performing outreach to target those enrolled in Medicare, Medicaid, CHIP or who buy plans sold through HealthCare.gov, as well as those who may be eligible for those programs.
Healthy people hit hardest by premium hikes
People who receive premium subsidies through the ACA’s exchanges are largely shielded from the effects of double-digit premium hikes, but individuals that don’t qualify for subsidies will be forced to pay the entire premium increase. In some parts of the country, premium hikes caused by an unstable market could be as high as 50 percent. Those who do not qualify for subsidies tend to be better off economically compared to those who receive the premiums, but many will have difficulty covering thousands of dollars in added health costs. In some cases, coverage could be so unaffordable that families without subsidies won’t have to pay the individual mandate’s tax penalty if they choose to go uninsured instead.
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