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Health Exchange Alert Weekly Report - 10/18/2017

  • Details Of Market Stabilization Agreement Emerge

    Senate health committee Chair Lamar Alexander (R-TN) and ranking Democrat Patty Murray (WA) reached a deal to fund the cost-sharing reduction payments for two years, allow all Americans to purchase catastrophic plans, restore ACA marketing funding via state outreach grant and provide "significant" changes to the Section 1332 waivers that would expand choices and speed up the approval process, according to Alexander's office. The deal also includes a mechanism to ensure that issuers who have increased premiums to mitigate the loss of the CSRs pass any benefit from the restoration of the payments along to consumers, but details are being worked out, according to Senate Minority Leader Charles Schumer (D-NY).

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  • Avalere Says CSR Loss Deals $1B Blow To Issuers; Dems Seek WH Docs

    The Trump administration's decision to stop cost-sharing reduction payments will result in a significant fourth-quarter financial blow to health insurance plans, with issuers in Florida, California, Texas, North Carolina and Virginia facing the largest hit, a new Avalere study finds. President Trump announced he would cut off the funding last Thursday, saying that a Department of Justice review of the payments concluded they were unconstitutional since they lacked a congressional appropriation. Meanwhile, key House and Senate Democrats are demanding to see the documents DOJ used as a basis for its findings.

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  • Dem AG Suit Argues Administration Legally Required To Pay CSRs

    The suit that more than a dozen Democratic attorneys general filed Friday (Oct. 13) to block President Donald Trump from cutting off the Affordable Care Act's cost-sharing reduction payments argues that the law requires the government to pay those subsidies. Insurance companies also might have legal recourse, though it's not clear yet whether they'll also sue the administration.

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  • Trump Pushes Short-Term Market Fix After Ending CSR Payments

    Throughout the day Monday, the president declared the Affordable Care Act "dead" and claimed his move to abruptly end the law's reimbursements to insurers for reducing out-of-pocket costs sparked bipartisan work on a short-term market fix that he now supports. He also said he believes the Senate has the votes to repeal and replace the ACA and expects that to happen in March or April. Democrats blasted the chaos caused by the White House's decision to cut off the cost-sharing reduction payments, but said they still stand ready to support a bipartisan stabilization solution that has been in the works for some time.

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  • CMS Extends Kansas Medicaid Managed Care Program For A Year

    Trump's CMS on Friday (Oct. 13) approved a one-year extension of Kansas' Medicaid managed care program, KanCare, after an earlier request to do so was denied by the Obama administration.

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  • PA Insurance Office Approves Higher Rates After CSRs Axed

    Pennsylvania's insurance commissioner on Monday (Oct. 16) announced it has approved rate increases that average 30.6 percent, or 23 percent more than the 7.6 increase issuers sought under the assumption the cost-sharing reductions would be paid. Like several other states, Pennsylvania also asked issuers to limit the hikes to the silver-level plans, which will increase the amount of the tax credits available for eligible consumers since the subsidies are linked to the those plan costs.

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  • Sen. Johnson Lays Out Principals For Alternative ACA Market Fix

    Sen. Ron Johnson (R-WI) is working on an alternative fix to the Affordable Care Act that follows five principals, including improved transparency, expanded insurance choices, strengthened consumer-directed plans, and lower premiums in exchange for cost-sharing reduction funding. His proposal would also delay enforcement of the employer mandate through 2019.

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  • Wyden Asks HHS, Treasury To Explain Failure To Approve 1332s

    Senate Finance Committee Ranking Democrat Ron Wyden (OR) on Tuesday (Oct. 10) sent a letter to then-HHS Acting Secretary Don Wright and Treasury Secretary Steven Mnuchin requesting more information about why the Trump administration did not approve Oklahoma's 1332 reinsurance waiver, and he asks whether other states will face similar delays when applying for reinsurance waivers.

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  • Eyes Turn Bipartisan Talks After Trump Abruptly Ends CSR Payments

    All eyes turned back on the market stabilization negotiations between Senate health committee Chair Lamar Alexander (R-TN) and ranking Democrat Patty Murray (WA) as lawmakers from both parties and key health care lobbying groups call on Congress to quickly fund the ACA's cost-sharing reductions following President Trump's abrupt move to stop the payments late Thursday (Oct. 12). Alexander was close to reaching a deal with Democrats on a plan that included two years of CSR payments and 1332 waiver reforms, but Friday press reports suggest that Trump may be hoping to use CSR payments as a bargaining tool as the health care debate moves forward to gain more concessions from Democrats.

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  • Democratic AGs Ready To Sue As Administration Scraps CSRs

    The White House late Thursday announced it would immediately stop providing insurers the Affordable Care Act's cost-sharing reduction payments, prompting backlash from Democratic lawmakers and a lawsuit from the Democratic Attorneys General Association. The move could lead to some insurers pulling out of the individual markets, which may be allowed under the "exit clauses" for insurers in states using healthcare.gov, however many insurers priced their products under the assumption the CSRs would not be funded this year and it is still possible for Congress to act.

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  • Trump Order Calls For AHPs, HRAs, Longer-Duration Short-Term Plans

    President Donald Trump Thursday signed an executive order that asks HHS, Labor and Treasury to expand health care coverage options by allowing cross-state association health plans (AHPs), extending the duration of short-term plans and boosting healthcare reimbursement arrangements. Some health experts worry the order will undermine consumer protections and destabilize the market, while others back the idea of creating more choices.

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  • CT, WA State Exchanges Adopt New Decision-Support Tools

    State-based exchanges in Connecticut and Washington will integrate decision-support technology from web-broker GetInsured into their platform for 2017, the company announced Wednesday (Oct. 11). For the past two years Covered California and Your Health Idaho have been using the tools, which help consumers choose among health plan offerings, and they will be introduced into the additional exchanges in November.

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  • With No Commitment On CSRs, California Increases Silver Rates

    The California health insurance exchange on Wednesday (Oct. 11) told issuers they can place a "surcharge" on silver-level plans in 2018 to account for the federal government's failure to commit to funding the Affordable Care Act's cost-sharing reduction payments. The increases will apply to on-exchange plans only, and range from 8 percent to 27 percent, with a 12.4 percent average, according to the exchange.

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