October 30, 2017
CMS releases new rules for 2019
On Friday, CMS released new rules for the 2019 ACA exchanges that could lead to the loosening of essential benefits. Under the rules, states can choose from coverage levels in another state, which could include less generous benefits. The changes also cover subsidy eligibility rules, how insurers are reimbursed and could make it more difficult for states to enforce additional benefit mandates. Insurers could begin designing their plans and sorting out provider networks for 2019 as early as December. They will likely need to submit this information to the federal government next spring. If insurers are still facing uncertainty at that time, it could lead to another year of premium increases.
Many factors could lead to rise of uninsured rate
A shorter enrollment period, cuts to advertising and navigator programs, and increased premiums could lead to fewer enrollees this year. Competition will also impact enrollment numbers as just 45 percent of enrollees live in areas with three or more competing insurers, down from 75 percent in previous years. Roughly 30 percent of people who get coverage through the ACA will only have one insurance company to choose from.
Some groups could be impacted more than others. The coverage gains seen in the past few years among Latinos are poised to drop as cuts to navigator programs are impacting the Hispanic community, which prefers to enroll in person.
In addition, a Kaiser Health tracking poll found that a majority of target individuals are unaware of key dates. Only 15 percent of the uninsured are aware of when open enrollment begins and six in 10 marketplace enrollees gave an incorrect answer or said they didn’t know when open enrollment is set to start.
Amazon contributes to industry uncertainty
Speculation that Amazon may enter the prescription drug business has forced many existing health care organizations to revisit their business strategies. Analysts believe the internet retailer would disrupt the existing landscape by introducing strong competition for existing pharmacies and weakening others’ leverage with PBMs and drug companies. CVS’s talks to purchase Aetna and Anthem’s decision to launch its own PBM are two major shifts in the health care industry that experts attribute to concern over Amazon’s entry into the market.
Maine voters could overrule governor’s decision on blocking Medicaid expansion
Maine voters will decide in a November 7 referendum if they will overrule the governor and expand the state’s Medicaid program. If voters decide to expand Medicaid, about 80,000 additional Mainers would become eligible for the program, according to the Maine Office of Program and Fiscal Review. Advocates argue expanding the program would help rural hospitals, create jobs and provide care for vulnerable people.
Potential assistant secretary for HHS may have conflicts
Stephen Parente was nominated as HHS assistant secretary of planning and evaluation (ASPE) in April and is waiting for his confirmation hearing. In the role, Parente would be the principal advisor to the HHS secretary on policy development and responsible for major activities in policy coordination, legislation development, strategic planning, research, evaluation and economic analysis. But Parente has long maintained close ties to UnitedHealth and other insurers. The relationship with the country’s largest insurer is causing some concerns about Parente’s ability to be impartial, while some argue that Parente’s experience in health care consulting and close ties to the industry demonstrate his knowledge of the industry.
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