ACA/health reform

Premiums stable, more choices available in 2020 ACA marketplace

Consumers will have more health insurance choices next year in the ACA marketplace and premiums will dip slightly for many, the Trump administration announced Tuesday (Source: “More choices and stable premiums for ‘Obamacare’ next year,” Associated Press, Oct. 22, 2019).

According to the Department of Health and Human Services, an additional 20 insurers will participate in ACA marketplaces in 2020, expanding consumer choice in many states. Nearly 70 percent of customers will have three or more insurers from which to pick a plan.

About 10 million people are covered through the health law’s insurance markets, which offer taxpayer-subsidized private plans for people who aren’t covered on the job. Premiums for a hypothetical 27-year-old choosing a standard plan will decline 4% on average in 2020 for states (including Ohio) served by the federal website, the Trump administration said.

Study: Employer-sponsored health insurance increasingly unafforable

Employers remain the main source of health insurance in the U.S., but premiums and deductibles are pushing employer-based coverage increasingly out of reach, according to a new national study (Source: “Employer Health Insurance Is Increasingly Unaffordable, Study Finds,” New York Times, Sept. 25, 2019).

A new analysis released Wednesday by the Kaiser Family Foundation found that the average premium paid by the employer and the employee for a family plan now tops $20,000 a year, with the worker contributing about $6,000. More than a quarter of all covered workers and nearly half of those working for small businesses face an annual deductible of $2,000 or more.

The new data on employer coverage comes as the Democratic presidential candidates debate sweeping reforms to diminish the role of private insurance in the American health system, including expanding the federal Medicare program to everyone or giving people the option to enroll in a government-run plan.

Many of the arguments for both systems center on expanding health insurance to more of the estimated 27 million people who lack it. But millions of people who already have coverage are deeply dissatisfied with the current system as well.

Census data: Uninsured rate goes up in Ohio for first time since 2009

Ohio was one of only eight states in the country to see its uninsured rate climb, according to new federal data (Source: “Ohio one of eight states to see uninsured rate rise, 58,000 more people uninsured,” Cleveland Plain Dealer, Sept. 10, 2019).  

According to the U.S. Census Bureau data, the number of people in Ohio without medical insurance rose to 744,000 in 2018, up 58,000 from the previous year. Ohio also was one of just four Medicaid expansion states to see its uninsured population increase.

The state increase is part of a national rise in the number of uninsured Americans, from 25.6 million in 2017 to 27.5 million in 2018. Of that 1.9 million increase, 22 percent were children, according to the Census data. This is the first time the national rate has increased since 2009, before the Affordable Care Act was passed in 2010.

Ohio ACA marketplace premiums drop for the first time

Ohioans who purchase insurance on the federal exchange will likely save money in 2020, as the state is reporting an average premium decrease of 7.7% compared to last year, according to the Ohio Department of Insurance (Source: “Obamacare health insurance exchange prices to drop in Ohio for first time,” Cleveland Plain Dealer, Sept. 4, 2019).

It is the first decrease for Ohioans since the health insurance marketplace was unveiled seven years ago, and it could be more evidence that the controversial Affordable Care Act is working. offers plans for people who do not get insurance through work, nor qualify for government health care programs such as Medicare and Medicaid -- including people who are self-employed. About 206,000 Ohioans obtain plans on the exchange, according to the Kaiser Family Foundation.

The average Ohio premium on the exchange was $6,161.56 in 2019. In 2020, it’ll be $5,690.26, the insurance department said.

Federal task force: All adults should be screened for illicit drug use

The U.S. Preventive Services Task Force recommended this week that that doctors screen all adults for use of illegal drugs (Source: “Health panel tells doctors: Screen all adults for illicit drug use,” Columbus Dispatch, Aug. 13, 2019).

The influential group of health experts said that health providers should attempt to determine whether their patients 18 or older are using illicit drugs, including nonmedical use of prescription drugs. But the panel said it did not have enough information to decide whether all adolescents should be screened.

The guidance is important because the Affordable Care Act requires that services recommended by the task force be covered free or with very small co-payments. The proposed recommendations are open for public comment until Sept. 9, after which the task force will consider them for final approval.

Individual mandate repeal has minimal impact on ACA enrollment

More than six months after Republicans essentially eliminated the Affordable Care Act’s individual mandate by abolishing the tax penalty for violators, the impact appears minimal (Source: “Affordable Care Act survives end of ‘individual mandate’,” Columbus Dispatch, Aug. 13, 2019).

While early indications suggest Ohio’s uninsured rate — down to 6% as recently as 2017 — has grown, policy experts say, the mandate isn’t likely the reason.

“The individual mandate was never that strong of motivating factor or forcefully enforced,” said Amy Rohling McGee, president of the Health Policy Institute of Ohio.

Meanwhile, insurance markets in Ohio and elsewhere remain stable this year. In Ohio, enrollment in the individual market dropped a bit in 2019 and premium costs have begun to level off after some bumpy years, according to federal data. Nearly 207,000 Ohioans purchased health insurance through a federally operated exchange in 2019, down 15% since 2016. It’s unclear why people dropped coverage or whether they gained insurance elsewhere.

Ohio Medicaid enrollment dropped 250k in past two years

Ohio’s Medicaid enrollment has declined more than 8% in the past two years, raising questions about whether the more than 250,000 former beneficiaries have become uninsured or found other health coverage (Source: “250,000 fewer Ohioans are on Medicaid, but even the experts don’t know why,” Columbus Dispatch, July 30, 2019).

According to the Ohio Office of Budget and Management, Medicaid enrollment has fallen in 23 of the past 24 months. More than three fourths of those leaving the rolls were adults while the rest, some 60,000, were children.

A recent analysis by the Kaiser Family Foundation found Ohio had the fourth highest drop in the nation in 2018, behind Tennessee, Missouri and Arkansas.

Medicaid Director Maureen Corcoran points to a couple of reasons enrollment has declined: an improving economy, and “systems issues,” including a sometimes-clumsy computerized renewal process that beneficiaries must complete every year to maintain coverage.

Health policy analysts say a better economy may be contributing to, but cannot account, for such a sharp decline. They believe the primary cause is a time-consuming sign-up and renewal process, which has drawn federal scrutiny, and a reduction of enrollment assistance.

U.S. Senate committee Oks bill aimed at lowering health costs

The U.S. Senate health committee approved a package of bills this week aimed at lowering the cost of medical care, from ending surprise medical bills to curbing prescription drug price surges, with a rare bipartisan vote that could vault it toward final passage (Source: “With Rare Comity, Senate Panel Advances Bills to Lower Health Costs,” New York Times, June 26, 2019).

The cost-cutting legislation is a priority of Senator Lamar Alexander of Tennessee, the health committee chairman who will retire next year and is seeking a victory after his bipartisan plan to stabilize the ACA insurance markets failed last year.

The new package includes a plan to eliminate surprise medical bills, which have become a hot political cause this year, targeted by President Trump and lawmakers from both parties. It also addresses the rising cost of prescription drugs, with a set of provisions that limit pharmaceutical companies’ ability to protect monopolies on the drugs they sell.

Other proposals seek to chip away at the opacity around medical prices, a goal that Mr. Trump also seized on with a new executive order this week intended to require insurers, doctors and hospitals to inform patients how much their care will cost before they receive it. The package also includes a measure from Senator Mitch McConnell of Kentucky, the majority leader, to raise the smoking age in every state to 21 from 18.

White House loosens HRA rules for small businesses

The Trump administration is expanding options for employers to use special accounts to help workers buy their own health insurance, upgrade job-based coverage or choose low-cost plans with limited benefits, officials said Thursday (Source: “White House Expands Health Accounts Aimed at Small Firms,” Associated Press via U.S. News, June 12, 2019).

The tax-free individual accounts are called "health reimbursement arrangements," or HRAs, and starting next year employees will be able to use them to buy their own individual health insurance plans.

Employers that offer regular workplace coverage can also set up another type of HRA account — limited to $1,800 a year — that will allow workers to get additional benefits such as dental and vision care. This second type of account can also be used to purchase lower-cost, short-term insurance that comes with limited benefits and doesn't have to cover pre-existing medical conditions.

Feds OK Ohio Medicaid work reporting requirement

The federal government approved a request from Ohio to require Medicaid expansion enrollees to prove they’ve worked 20 hours a week to receive health care, the state announced Friday afternoon (Source: “Federal government approves Ohio Medicaid work requirements,” Cleveland Plain Dealer, March 15, 2019).

Lt. Gov. Jon Husted said in an interview Friday afternoon that there isn’t a specific timeframe yet for when Medicaid expansion enrollees must begin demonstrating to the state that they’re working, going to school or exempted from the requirement, since the federal Centers for Medicare and Medicaid Services (CMS)  just OK’d the state’s request.

CMS noted that Ohio is the ninth state to receive approval to require Medicaid enrollees work. The Trump administration has been more receptive to the idea than that of former President Barack Obama.

According to the Ohio Department of Medicaid, 58 percent of expansion enrollees already work, but they are low-wage jobs that don’t offer health care. As of November, 2.8 million people were enrolled in Medicaid. About 690,000 were part of the Medicaid expansion group.