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 15, 2014

How consumers fared this year in the individual market under the Affordable Care Act (ACA) varied widely depending on decisions made in the states, according to new research from the Brookings Institution. Individuals in five states (Alabama, Missouri, Oklahoma, Texas and Wyoming) considered most resistant to implementing the ACA who purchased their own health insurance paid $245 more annually when compared to enrollees in all other states. The report suggests that these states were not as successful as others in attracting healthier consumers. But states that tried to set up their own exchanges only to experience significant technical problems (Hawaii, Maryland, Massachusetts, Minnesota, Nevada and Oregon) fared even worse. Participants in these states paid about $750 more per participant annually compared to participants in states with successful exchanges. Enrollees in the smoothly functioning exchanges experienced increased costs but below trend, suggesting these exchanges had pulled in more healthy people. The research also looks at the numerical impact of Medicaid expansion decisions in the states and the impact of extending non-ACA-compliant plans in some states.


By a vote of 247 to 167, the House approved legislation last week that would allow non-ACA-compliant health insurance coverage offered in the group market in 2013 to be treated as grandfathered coverage and sold for the next five years. The bill essentially would extend the Obama administration’s “keep what you have” transition policy, which is in effect through 2016 in states that agreed to go along with the policy. The House bill was approved with support from 222 Republicans and 25 Democrats. However, the legislation faces an uphill battle in the Senate. Also, the White House issued a statement earlier in the week indicating that the President would veto the bill if it reaches his desk.


CALIFORNIA: A new poll released last week found that 41 percent of voters support Proposition 45 – a significant decline since a mid-August field poll found 70 percent support for the measure. Proposition 45 would give rate review oversight in the individual and small group markets to the California Department of Insurance and its Commissioner. The new poll also found that 26 percent stated they would vote no against the initiative, while 33 percent of voters remain undecided just eight weeks out from the November vote. The opponents of Proposition 45 recently started radio ads and are expected to release television advertising this week.

Covered California, the state’s health insurance exchange, has announced that people who have purchased insurance on the exchange will be automatically re-enrolled for their plans for 2015. However, Covered California is urging members to log on to to shop and compare health plans to ensure that their plans are still the right type of coverage for them. Covered California, also announced that they will share additional details about the re-enrollment process, increased premiums and subsidies in the next few weeks. The enrollment period runs from November 15, 2014 to February 15, 2015.

CONNECTICUT: The Department of Children and Families (DCF) has released a draft plan to improve children’s access to behavioral health services. The report was mandated by the General Assembly following the Sandy Hook tragedy in 2012. The report calls on the Department of Insurance to lead a collaborative effort to review data and input from carriers on the lack of coverage for certain services and conditions, networks, medical necessity criteria, and cost shifting to the state. The draft report recommends collecting, analyzing and reporting of integrated behavioral health data, including development of the Children’s Behavioral Health Utilization & Quality Measure Set. DCF plans to finalize the report and submit it to the General Assembly this year.

MAINE: The federal Department of Health and Human Services (HHS) has announced the 2014 Maine grant recipients to serve in the navigator role for the federally facilitated marketplace. Western Maine Community Action was granted $520,376 to serve as the lead for a state-wide consortium of eight community action agencies collectively referred to as the WMCA Community Action Navigator Consortium. WMCA will continue targeting low and moderate income individuals, including the under-insured and uninsured and young adults, for enrollment in health insurance coverage. Fishing Partnership Health Plan was granted $79,624 to coordinate with the Maine Lobstermen's Association in undertaking a series of community health navigation activities, including outreach; social marketing; and distribution of material describing the program, the ACA, and the health insurance enrollment process.

NEW HAMPSHIRE: The New Hampshire Insurance Department has issued a report analyzing changes to health insurance markets in the state since the Jan. 1, 2014 implementation of many of the ACA’s provisions. Performed by Wakely Consulting Group, the analysis shows the number of insured people in New Hampshire grew by 22,000 – and the state’s uninsured population was reduced by about 14 percent – between Dec. 31, 2013 and May 1. The numbers reflect both those who signed up for coverage on the state’s federally facilitated marketplace and those who signed up for coverage through Medicaid. The analysis further shows that the ACA had the most significant impact on the individual market, which grew by 75 percent, or 26,000 members.

The Insurance Department issued a bulletin last week to all licensed health carriers and dental insurers regarding annual redetermination notice requirements. In addition to federal requirements, New Hampshire is adding notification obligations for a significant change in the provider network and specific language regarding the recalculation of tax credits in the individual exchange. Renewal notices must be sent 60 days prior to the new plan year in the small group market, and individual market notices must be sent at least 30 days before open enrollment.

NEW JERSEY: Both houses of the legislature have resumed their meeting schedules for the fall portion of the legislative session, which runs through the year-end holidays. Health-related matters expected to be addressed include: coverage of non-covered dental services; prescribing of opioids and treatment for opioid addiction; health care charges at out-of-network facilities; and analysis of behavior health networks. Additionally, Governor Chris Christie is likely to renew his call for legislative action to reform health care benefits for public employees to reduce the significant budget impact of pensions and health benefits.

UTAH: Governor Gary Herbert has announced that the state is close to an agreement with HHS for implementing a “Utah-style” alternative to Medicaid expansion. The Healthy Utah Plan would use the approximately $258 million dollars earmarked by the federal government for providing subsidies to the 54,000-75,000 residents who are ineligible for Medicaid or the exchange subsidies. One of the primary sticking points was the governor’s desire to make benefits contingent upon a recipient’s agreement to accept a work requirement. With HHS opposed to such a requirement, the state has refashioned the provision as offering assistance in obtaining employment. A final agreement is expected to be reached within a month. Both the Senate President and a member of the legislative Health Reform Task Force reacted positively to the news. Once the proposal is finalized, the measure must be vetted either in a special session or in the 2015 general session.

VIRGINIA: Governor Terry McAuliffe unveiled a new Medicaid reform plan last week that is essentially a two-year demonstration waiver program providing primary, specialty, behavioral health and substance-abuse services for people who are uninsured and have a serious mental illness. As forecasted, the plan outlines a state-designed and administered program and not an expansion of Medicaid eligibility matching the coverage parameters incentivized by the ACA. The plan also includes several aspirational public health and educational goals, for example, educating people about access to programs already in place. A special legislative session is scheduled to convene September 18, and Medicaid expansion is the primary agenda item. It is not yet clear how House and Senate leadership will react to the governor’s Medicaid proposal.


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