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 October 20, 2014

About 7.3 million consumers began getting notices last week from the federal government advising them that they should be returning to their online marketplace to renew their coverage for next year. The news included some eagerly sought direction on how the re-enrollment process would work, though some questions remain. Federal officials said insurers would not receive termination notices, but insurers could assume that an individual’s coverage ends on December 31 unless told otherwise by the government. The federal marketplace is expected to send enrollment files to insurers in late December indicating whose coverage has been renewed for 2015. In addition, the administration has just begun to notify insurers of its preliminary decisions approving health plans for sale on the federal exchange. The schedule will not permit insurers to send renewal notices to customers in time to meet the requirements of the law in some states.


According to a report released last week by the Centers for Medicare and Medicaid Services (CMS), Medicaid enrollment reached 67.9 million in August, representing an increase of 8.7 percent since before open enrollment began under the ACA last October. As of August 2014, 26 states and the District of Columbia had implemented the expansion of Medicaid under the ACA to cover adults under age 65 with incomes up to 133 percent of the federal poverty level in 2014. There is no deadline for when a state must decide whether to expand Medicaid, and states are continuing to consider their options. The number of people impacted by the Medicaid expansion varies. Some of these states had previously expanded coverage to parents and other adults at income levels above the level required under federal law before the ACA.

The Department of Health and Human Services (HHS) announced last week that Medicare Part B monthly premiums and deductibles will remain the same as the last two years, at $104.90 and $147, respectively. Approximately 49 million Americans are currently enrolled in Medicare Part B. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.


CALIFORNIA: The increasing use of surcharges on customer bills by California restaurants is helping to spotlight the rising cost of health care coverage. In Los Angeles late last year, a restaurant began charging a 3 percent surcharge on checks to pay the cost of employees’ health care coverage. Ten months later, 12 restaurants joined in, and more restaurants are expected to follow suit. San Francisco started a program called Healthy San Francisco that provides health insurance coverage to adult residents who earn too much to qualify for the state’s Medicaid program but not enough to purchase private insurance. Healthy San Francisco is run by placing a surcharge on patrons’ bills.

Covered California, the state-based insurance exchange, is in the news for awarding $184 million in contracts without using the traditional competitive bidding process that most state contracts require. When Covered California was created in 2010, the board was given broad authority to award no-bid contracts to meet tight federal guidelines for getting the exchange up and running. California Common Cause is raising concerns about the size of the no-bid contracts and the continued use of the process.

NEW HAMPSHIRE: New Hampshire has become the 49th state to establish a prescription drug monitoring program intended to help address substance abuse problems. The state’s system went live last week, allowing prescribers across the state to log in and access prescription data for their patients. The goal of the program is to curb prescription drug abuse by allowing doctors and others to see more details about patients’ prescription histories. The system includes data from Rite Aid, Walgreens and CVS locations across the state, as well as from about 26 independent pharmacies. Most of the data will be updated on a weekly basis, though some participants have elected to send in data every day.

OKLAHOMA: Governor Mary Fallin reiterated last week her opposition to Medicaid expansion as proposed in the ACA after the Oklahoma Health Care Authority reported it would need an additional $164 million just to maintain Medicaid at its current level. With 818,000 Oklahomans on Medicaid, Fallin said Oklahoma and other states are increasingly struggling just to keep these individuals covered. “I am committed to finding the resources we need to ensure that none of our current Medicaid recipients lose their coverage,” she said. Fallin went on to call the idea of a dramatic expansion of Medicaid “downright irresponsible.”

UTAH: The Insurance Department last week released the individual and small employer health insurance rates for 2015 on its website. The information includes non-tobacco rates for individuals listed by: carrier name, plan name, plan ID, plan type, level of coverage, county and market (individual exchange, individual off-exchange, small employer exchange and small employer off-exchange). In addition, a new plan comparison feature on the department's transparency website enables an individual to compare all individual plans, on and off exchange, selecting by county, age, tobacco use, and level of coverage. The information on the transparency website, including the plan comparison, is also available via an app for iOS or Android devices (search Utah health rates).


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