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Health Exchange Alert Weekly Report - 09/19/2018

  • Wide Range Of Stakeholders Sue Administration Over Short-Term Plan Rule

    A group of seven health industry stakeholders, including health plans and patient and providers groups, are asking a federal district court to declare the Trump administration's short-term limited plan rule unlawful, arguing it undercuts the Affordable Care Act and arbitrarily reverses earlier limits on the products. Meanwhile, 16 health groups came out in support of Sen. Tammy Baldwin's (D-WI) effort to reverse the final rule through the Congressional Review Act -- an effort that now has support from 45 senators that caucus with the Democratic party.

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  • Maryland Sues Administration Over ACA Attacks

    Maryland's attorney general on Thursday (Sept. 13) filed suit against the federal government for its ongoing attacks against the Affordable Care Act, and asked the court to declare the law constitutional. Maryland's suit comes after the Trump administration refused to fully defend the ACA from a constitutional challenge by 20 GOP-led states -- a suit on which a federal judge in Texas recently heard oral arguments.

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  • Red States Hoping to Apply Fed STLD Rules Must Tweak State Law

    Several Republican-led states will have an urgent policy dilemma weighing on them at the beginning on the 2019 legislative session: change their state laws or don't fully implement the Trump administration's short-term plan alternative to the Affordable Care Act.

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  • Drastically Reduced Navigator Grants Go To Many Returning Organizations

    Advocates remain upset the agency has slashed funding for the navigator program, but are relieved to see CMS allocated money Wednesday (Sept. 12) to community-based organizations, many of which had previously been awarded grants, rather than a centralized entity with no local presence.

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  • Senate Passes Bill To Ban Pharmacy Gag Orders

    The Senate voted 98-to-2 for legislation to stop all health plans and pharmacy benefit managers in the commercial market from using gag orders to prevent pharmacists from telling customers, unless asked, when it is cheaper to buy drugs without insurance. The bill also requires that drug companies file biosimilars patent settlements with the Federal Trade Commission in order to give the FTC more visibility into so-called pay-for-delay agreements between makers of brand biologics and biosimilars.

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  • Individual Market Rates In Washington To See 13.8 Percent Average Hike

    Consumers buying coverage through Washington state's health insurance exchange will see average increases of about 13.8 percent, down 6 percent from the 19.8 proposed rates in the individual market, the Washington Health Benefit Exchange (WHBE) announced last week. The WHBE board certified 40 qualified health plans (QHPs) and six qualified dental plans and further said that plans will be available in every county and 92 percent of consumers will be able to choose among two or more plans.

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  • Justice Approves Cigna/Express Scripts Merger Without Conditions

    The Justice Department's antitrust division approved, without conditions, Cigna's proposed $67 billion purchase of Express Scripts, despite concerns that allowing the insurer and pharmacy benefit manager to merge could lead to higher drug prices.

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  • National Uninsured Rate Unchanged During Trump's First Year

    The national uninsured rate held steady at 8.8 percent from 2016 to 2017 despite federal uncertainty surrounding the Affordable Care Act, according to new data from the U.S. Census Bureau. Although the national uninsured rate didn't change, there was some variation in individual states -- the uninsured rate increased in 14 states from 2016 to 2017.

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  • Judge Retains Control Over 2nd Lawsuit Challenging Work Requirements

    The same federal judge who blocked Kentucky from implementing Medicaid work requirements in July will preside over the recently filed lawsuit challenging Arkansas' similar work-requirement program.

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  • MACPAC Alarmed By Initial Data On Arkansas Medicaid Work Requirements

    Congressional Medicaid advisers expressed dismay Thursday (Sept. 13) at early numbers out of Arkansas showing low compliance rates with and significant coverage losses as a result of the state's new Medicaid work requirements. Members of the Medicaid and CHIP Payment and Access Commission urged the commission to convey their concerns to CMS, and a few suggested the early numbers are so worrisome that the agency should force the state to put the work requirements on hold.

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  • Labor/HHS Conference Bill Rejects House Language On ACA

    The Labor/HHS conference bill agreed to late Thursday (Sept. 13) includes $90.3 billion in discretionary program funds for HHS, or $2.3 billion more than in 2018, invests more in medical research than the president's request, devotes nearly $4 billion to mental health and opioid treatment and omits cuts in the House version that would have blocked CMS' ability to administer the ACA.

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  • States Seek To Block Collection Of ACA Tax On Medicaid Plans

    Six states engaged in litigation over an Obamacare tax on Medicaid plans filed papers this week asking a Texas federal judge to block the IRS from collecting that tax on Oct. 1. The states argue that federal regulations are illegally forcing the states to cover the cost of the tax by paying higher capitation rates to the managed-care companies that operate the states' Medicaid programs.

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  • Verma: Too Early To Judge Arkansas' Medicaid Work Requirements

    CMS Administrator Seema Verma said Monday (Sept. 17) that it is too early to draw conclusions about Arkansas' newly enacted Medicaid work requirements, after more than 4,000 beneficiaries lost coverage for failing to show they met the requirements in the program's first three months.

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  • Rules Committee Clears $51.6B ACA Employer Relief Bill

    The House Rules Committee on Wednesday cleared a $51.6 billion legislative package to provide employers relief from several Affordable Care Act taxes and other mandates, but a final floor vote, which was slated for Friday, will now occur later this month due to the congressional work week being cut short by the East Coast hurricane. The House is on recess next week.

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  • Final CT Rates Average 2.7 Percent In Individual Market, Less Than Proposed

    Connecticut's Department of Insurance on Thursday (Sept. 13) announced that consumers in the individual and small business exchanges will see average increases significantly lower than what the issuers initially requested. Final rates in the individual exchange market will go up an average 2.72 percent, down from the 12 percent average issuers proposed, and small business plans will see increases of 3.14 percent, down from the proposed rate of just over 10 percent, the department said.

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  • More Than 4K Arkansans Lose Medicaid Coverage

    Arkansas has kicked 4,353 people off Medicaid for not complying with the state's new work requirements -- nearly four times more than the number of beneficiaries who successfully reported to the state that they satisfied the new rules. Gov. Asa Hutchinson (R) said he wishes fewer beneficiaries were losing coverage, but he touted the program as "compassionate" and said the reduction in the Medicaid rolls would save the state $30 million.

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  • CA Insurance Chief Sues AbbVie For Alleged Kickbacks To Promote Humira

    California is suing AbbVie for allegedly offering providers kickbacks to prescribe Humira, an expensive arthritis drug that has also come under fire on Capitol Hill due to steep price increases. AbbVie says the allegations "are without merit."

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  • CMS Allows More Individual Mandate Exemptions On Tax Forms

    CMS announced that for 2018, the final year the individual mandate is in effect, the agency will make it easier for individuals to apply for hardship exemptions absolving them from paying the Affordable Care Act's individual mandate penalty. The guidance allows individuals to claim hardship exemptions on their 2018 federal income tax returns, as opposed to having to obtain an exemption certificate number (ECN) from the exchange to be relieved of the penalty for not having health insurance.

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  • Nebraska Supreme Court Green-Lights Medicaid Expansion Referendum

    The Nebraska Supreme Court cleared the way Wednesday (Sept. 12) for the state's voters to decide in November whether to expand Medicaid under the Affordable Care Act. The court upheld a trial judge's dismissal of a lawsuit challenging the legality of the Nebraska ballot referendum, which is one of four referendums on Medicaid expansion being held in red states this year.

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  • Court Dismisses Non-Discrimination Suit Over Hearing Aid Coverage

    A federal Judge on Friday dismissed a suit against Kaiser Permanente that charged the issuer's decision to cover cochlear implants but not hearing aids violated the Affordable Care Act's 1557 non-discrimination provisions, which bars plans from discriminating on the base of race, disability, color, national origin, sex, or transgender status. Clinton-appointed Judge Robert Lasnik, senior judge with the U.S. District Court for the Western District Of Washington at Seattle, scrapped the case after agreeing with the defendants that the plaintiff did not meet the threshold for a disability claim.

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