Health Insurance / uninsured

Federal ban on surprise medical bills on track for Jan. 1 rollout, officials say

The Biden administration on Thursday put final touches on consumer protections against so-called “surprise” medical bills (Source: “Ban on ‘surprise’ medical bills on track for Jan. 1 rollout,” Associated Press, Sept. 30).

The ban on unexpected charges to insured patients is on track to take effect Jan. 1, officials said.

Patients will no longer have to worry about getting a huge bill following a medical crisis if the closest hospital emergency room happened to have been outside their insurance plan’s provider network. They’ll also be protected from unexpected charges if an out-of-network clinician takes part in a surgery or procedure conducted at an in-network hospital. In such situations, patients will be liable only for their in-network cost-sharing amount.

The rules released Thursday spelled out for the first time a key part of the new system: a behind-the-scenes dispute resolution process that hospitals, doctors and insurers will use to haggle over fees, without dragging patients into it.


Biden administration revokes permission for Ohio Medicaid work requirements

The federal Centers for Medicare and Medicaid Services told the Ohio Department of Medicaid this week that it cannot proceed with its plans to require some people on the health coverage program to work to keep their coverage (Source: “Biden administration nixes Ohio’s Medicaid work requirements,” Cleveland Plain Dealer, Aug. 11).

In a 23-page letter, sent to the state on Tuesday, CMS says that work requirements do not “ promote the statutory objectives of Medicaid” because they would likely result in thousands of people losing coverage.

This is a change from the administration of former President Donald Trump, which had approved the state’s work requirements program in 2019. The Ohio Department of Medicaid was directed to submit a work requirement program by the Ohio General Assembly in the 2017 budget bill.

Work requirements were supposed to begin Jan. 1, but were postponed because of the coronavirus pandemic.


Deadline for Ohio Medicaid managed care bids is today

 

Bids are due today for insurance companies that want to be a part of Ohio Medicaid’s overhaul  (Source: “Insurance company bids due today for Ohio Medicaid overhaul,” Dayton Daily News, Nov. 20).

The state is overhauling how the health insurance program for people who are disabled or have low incomes operates and picking new insurance companies as contractors to manage those insurance claims. By rebidding the contracts, the state can update the conditions for getting and spending Medicaid dollars and can re-select which insurers it trusts to meet its goals.

In 2019, Ohio paid about $17 billion to Medicaid HMOs and about 90% of the 3 million Ohioans who are covered by Medicaid get an insurance plan managed by an insurance company. These insurers get a payment per member per month and use that money to pay for their member’s health care.


Supreme Court justices signal likely support for keeping ACA

Statements made by Supreme Court justices during the latest challenge to the Affordable Care Act indicate that the law is likely to be upheld (Source: “‘Obamacare’ likely to survive, high court arguments indicate,” Associated Press, Nov. 10).

Meeting remotely a week after the election and in the midst of a pandemic that has closed their courtroom, the justices on Tuesday took on the latest Republican challenge to the Obama-era health care law, with three appointees of President Donald Trump, an outspoken critic of the law, among them.

But at least one of those Trump appointees, Justice Brett Kavanaugh, seemed likely to vote to leave the bulk of the law intact, even if he were to find the law’s now-toothless individual mandate that everyone obtain health insurance to be unconstitutional.

“It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place,” Kavanaugh said.

Chief Justice John Roberts, who wrote two earlier opinions preserving the law, stated similar views, and the court’s three liberal justices are almost certain to vote to uphold the law in its entirety. That presumably would form a majority by joining a decision to cut away only the mandate, which now has no financial penalty attached to it. Congress zeroed out the penalty in 2017, but left the rest of the law untouched.


Ohio Medicaid enrollment spikes amid pandemic

The number of Ohioans enrolled for Medicaid coverage has increased more than 250,000 since the start of the pandemic, according to new state data (Source: “Ohio Medicaid rolls increase during pandemic,” Dayton Daily News, Oct. 29).

The state- and federally funded insurance program as of September covered 3.05 million Ohioans, with the increase primarily from covered families and children, according to the latest data reported by Ohio Department of Medicaid.

The Medicaid rolls have steadily shrunk for years as the economy improved in Ohio. But amid the disruption of the pandemic and related restrictions, many people have lost income and Ohio’s unemployment rate rose to 8.4% in September.


HHS finalizes price transparency rules

Health insurers will be required to publicly post, in advance, the price for the most common services and procedures, under a rule finalized by the federal Department of Health and Human Services on Thursday (Source: “New Trump policy will force insurers to disclose prices up front,” The Hill, Oct. 29).

Patients will eventually have access to new information about cost, including an estimate of their cost-sharing liability, through an online self-service tool. Currently, this is information that patients typically receive only after they get those services, through an explanation of benefits form.

Beginning in 2022, insurers will be required to make available data files on the costs of various procedures, to better allow for research studies, and to help developers design tools to let patients compare costs across insurance plans. The requirement will take effect for 500 of the "most shoppable" services beginning in 2023, and then for all services starting in 2024.


Workers facing higher out-of-pocket costs, premiums for employer-sponsored coverage

A new survey from the Kaiser Family Foundation shows annual premiums for a family now top $21,000, and deductibles have more than doubled since 2010 (Source: “Workers With Health Insurance Face Rising Out-of-Pocket Costs,” New York Times, Oct. 8).

The high cost of health care is persisting during the pandemic, even for people who have maintained job-based insurance.

The average annual cost of a health plan covering a family rose to $21,342 in 2020, according to the latest survey by the Kaiser Family Foundation, a nonprofit group that tracks employer-based coverage. Workers paid about a quarter of the total premiums, or $5,588, on average, with their employers picking up the rest of the cost.

While premiums rose only slightly from the 2019 survey, the increase in premiums and deductibles together over the last decade has far outpaced both inflation and the growth in workers’ earnings. Since 2010, premiums have climbed 55 percent, more than double the rise in wages or inflation, according to the foundation’s analysis.


Medicaid facing unprecedented strains amid pandemic, unemployment surge

As COVID-19 roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed (Source: “Medicaid Nearing ‘Eye of The Storm’ As Newly Unemployed Look For Coverage,” Kaiser Health News, April 3, 2020).

That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers. The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and health care in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.


Insurance premiums to spike in 2021 because of COVID-19, report forecasts

The cost of COVID-19 testing and treatment is likely to squeeze U.S. health insurers' profits, which could lead to higher premiums in 2021 (Source: “COVID-19 could prompt higher 2021 insurance premiums, benefit cuts,” Modern Healthcare, March 23, 2020).

A new report from Covered California, the state's Affordable Care Act marketplace, projected that commercial insurers and employers across the United States could face a $34 billion to $251 billion bill for coronavirus testing and treatment this year. Their best estimate is $103 billion.

Absent any federal action, those costs could prompt commercial health insurers to increase premiums between 4% to 40% in 2021 to make up for increased medical claims and stay solvent, according to the report.

The report by Covered California's chief actuary John Bertko focuses on costs for the commercially insured, which includes about 170 million Americans who receive coverage through their jobs and the individual market. It doesn't address the separate and likely significant costs to Medicare, Medicaid or other public programs, though Bertko said those costs would be "huge."


CMS unveils plan to allow states to cap Medicaid spending, shift to block grants

The Trump administration said last week that it would allow states to cap Medicaid spending for many adults with lower incomes, a major shift long sought by conservatives that gives states the option of reducing health benefits for millions who gained coverage through the program under the Affordable Care Act (Source: “Trump Administration Unveils a Major Shift in Medicaid,” New York Times, Jan. 30, 2020).

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said states that sought the arrangement — an approach often referred to as block grants — would have broad flexibility to design coverage for the affected group under Medicaid, the state-federal health insurance program for the poor that was created more than 50 years ago as part of President Lyndon B. Johnson’s Great Society.

The CMS announcement comes as the agency’s efforts to let states require adults on Medicaid to work or train for a job — which led to 17,000 people in Arkansas losing coverage in 2018 — are mired in court battles.

“Government has a solemn responsibility to provide for the most vulnerable among us,” Ms. Verma said in a morning call with reporters. “Part and parcel of that responsibility is making sure the Medicaid program is sustainable.”