Health Reform Weekly

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country.


Week of September 22, 2014

A story in Forbes last week reported that companies turning to new private exchanges for employee health care coverage are seeing lower health care costs than trends for most other employers. The benefits consultant Aon Hewitt reported saving more than $750 per worker for 2015. Aon Hewitt said rates increased an average of 5.3 percent for 2015 across companies on its private exchange, compared to industry averages for large self-insured employers of between 6 and 8 percent. The lower rate for 2015 is significant because it includes various new costs associated with the Affordable Care Act (ACA).


A report released last week by the Government Accountability Office (GAO) found that and its related systems continue to show weaknesses that threaten sensitive personal information if the system is breached by unauthorized users. According to the report, had weaknesses when it was first deployed, including “incomplete security plans and privacy documentation, incomplete security tests, and the lack of an alternate processing site to avoid major service disruptions.” The report notes that the Centers for Medicare and Medicaid Services (CMS) has taken steps to address some of these weaknesses but has not fully mitigated all of them.

The Obama administration announced last week that tax subsidies for about 360,000 people will be discontinued if proof of income is not submitted to the government in the next two weeks. CMS also announced last week that about 115,000 people will lose their health insurance coverage at the end of September because the government does not have proof of their immigration or citizenship status.


ILLINOIS: Legislators introduced a bill last week that would require health plans providing prescription drug coverage to ensure that any required copayment or coinsurance for drugs on a specialty tier not exceed $100 per month for up to a 30-day supply of any single drug. The measure also states that a beneficiary's annual out-of-pocket expenditures for prescription drugs should not be more than 50 percent of the dollar amounts in effect under ACA. Health plans would also be required to implement an exceptions process allowing enrollees to request an exception to the tiered cost-sharing structure. Health plans also would be prohibited from placing all drugs in a specialty class on a specialty tier.

NEVADA: The Silver State Health Insurance Exchange Board voted unanimously to halt the procurement of a new state-based exchange system for the 2016 open enrollment period. Staff cited concerns over the financial viability of the system, given the number of enrollees expected (less than 50,000) and the challenges in releasing an RFP and negotiating contracts by November 14, 2014. The date marks the grant application deadline and the start of the 2015 open enrollment. Exchange staff reported that end-to-end testing will begin with CMS for qualified health plans (QHPs) on October 7. QHPs will be certified by the Division of Insurance on or before October 10.

NEW HAMPSHIRE: A new website ( provides a novel way to examine what the health of state residents could look like in 2020 and 2030. MapNH Health is designed to inform both public policy and community conversations about how New Hampshire can best prepare for the future health and health care needs of the state’s residents. The MapNH Health project was developed by the NH Citizens Health Initiative and the Institute for Health Policy and Practice at the University of New Hampshire. The user-friendly website provides information mapped geographically by county and health care service area and allows users to view projections of demographics, health behaviors and health outcomes. The ultimate goal is to examine what might happen, given the data, in order to formulate plans and public policy that will address New Hampshire’s future health needs.

NEW JERSEY: Following a legislative hearing on opioid addiction and treatment options, the legislature announced a wide range of bipartisan legislation intended to stem the rising tide of abuse and overdoses. The 21-bill package includes proposals requiring health insurance plans to cover medically necessary behavioral health care services, as determined by a health care provider; increasing Medicaid reimbursements for some behavioral health care; and requiring doctors and other prescribers to participate in the state program monitoring opioid prescriptions. Other measures would require state colleges and universities to provide substance abuse housing recovery options. They also would force the state Department of Education to reevaluate its drug prevention curriculum and increase funding to substance abuse prevention efforts. The Assembly and Senate will consider the legislation over the next several weeks. Given Governor Chris Christie’s public support for many of the measures, enactment of these bills in some form is likely.

NEW YORK: The state-based insurance exchange – nystateofhealth – has scheduled a series of regional outreach and enrollment summits scheduled for locations around the state in the coming weeks. These summits will bring together community leaders and stakeholders to examine best practices from the first year and prepare for the upcoming open enrollment season. Summits are scheduled on Long Island, the Southern Tier, Queens and the Hudson Valley. Separately, the exchange released county level enrollment data on the nearly 1 million New Yorkers who enrolled in health plans, including Medicaid, through April 15, 2014. The data provides enrollee demographic information by county.

VERMONT: Governor Peter Shumlin announced steps last week to address ongoing issues with the health exchange website and change the way the exchange is managed. The governor authorized personnel to take Vermont Health Connect offline to remedy persistent problems with the website’s functionality and operation. The goal is to have a more functional, robust state-based health exchange portal ready, with sufficient time for testing, prior to the start of the next open enrollment season in mid-November. The governor also announced the Department of Vermont Health Access will no longer oversee Vermont Health Connect. Under a new management structure, Governor Shumlin’s senior advisor Lawrence Miller is taking over operational leadership of Vermont Health Connect. Vermont Health Access Commissioner Mark Larson will run the department’s other programs.

VIRGINIA: The General Assembly convened a special session last week to debate the proposed expansion of Medicaid eligibility but instead took action on the budget. The House and the Senate did debate several Medicaid proposals, but it is highly unlikely that the General Assembly will agree to an expansion of Medicaid that qualifies for federal funding under the ACA. Governor Terry McAuliffe, Democratic legislators and a handful of Republican legislators support Medicaid expansion while a significant majority of Republican legislators are opposed. Legislators used the special session to address the budget crisis and passed legislation signaling an agreement between the governor and House and Senate leadership. In August, the governor projected a state general fund shortfall of more than $345 million in fiscal year 2015 and more than $535 million in fiscal year 2016 – on top of the $1.5 billion shortfall forecast for the adopted 2014-16 biennial budget. The governor has asked state agencies to prepare 5 percent budget reduction plans for fiscal year 2015 and 7 percent for fiscal year 2016. The governor is now reviewing the state agency reduction plans.


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