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Coffee CAHC policy round-up: February 17, 2017

Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!

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Coffee CAHC

115th Congress, 1st session

128th Maine Legislature, 1st session


February 17, 2017


Hello from DC, Mainers! How’s everything up north? I’m having quite the time down here in DC with the Families USA Health Action 2017 conference, where I’m learning tons and meeting tons of amazing folks doing fantastic health policy, advocacy, and enrollment work across the country. I actually lived in DC for almost four years, and it’s always nice to get back down here. Plus, my hotel is like two blocks from the Capitol, which means I could practically smell this week’s national updates happening as they happened. And, boy, there are some doozies since Wednesday!


National level

There have been two big developments at the national level since Wednesday: the details on that HHS rule that’s been simmering for a while, and a new contestant in the “Are You My ACA Replacement Plan?” game.

Let’s start with the rule. As expected, the rule as proposed would implement some pretty big changes to the Marketplaces. Vox (big surprise!) has a great round-up, and our friends at Families USA have already assessed what the potential damage would be. Here are some of the highlights (lowlights?).

  • Significant new restrictions on special enrollment periods, or SEPS: SEPs are how folks get insurance outside of open enrollment when they experience a life change mid-year (losing existing insurance from job loss or moving, having a baby, getting divorced). Right now, they can sign up for coverage and that coverage can start while they send documents to the feds proving that they’re eligible. The rule would change that to say the documentation has to be received and verified before the coverage starts. This is a big red flag for me, because there have been big issues in the past with folks having their documents received and correctly processed in anything like a timely fashion. I can tell you that, in my two years on our HelpLine at CAHC, I bet I personally heard from or helped deal with hundreds of cases of this. I’m also nervous about how this will impact consumers if and when we see a shift to continuous coverage requirements (for more on continuous coverage, check out the February 3 “Coffee CAHC”, where I did a deep dive on the requirement). The rule would also allow insurers to reject enrollments from consumers who have been terminated in the past for nonpayment of premiums, which is something they can only do now under limited circumstances. Which brings me to…
  • Restricting the 90 day grace period to pay premiums: right now, Marketplace enrollees who receive tax credits get a 90 day grace period to bring their premium payments current without losing their coverage (it’s slightly more complex than that, but that’s the nutshell version). The new rule would restrict that grace period. Again, this can be a real problem for consumers who miss premium payments – sometimes for reasons completely beyond their ability to control – and, say it with me, “what about if we go to requiring continuous coverage?”
  • Changing standards for the networks insurers build: The rule relaxes requirements around “network adequacy”, which is how regulators look at the networks of providers that insurers create for their plans to make sure that there are enough doctors and facilities (and the right types of doctors and facilities) in the network to actually serve their members’ needs. Sure, we can lower premiums by letting insurers craft networks that are so “skinny” that their members can never actually use their coverage, but we don’t think that’s such a great idea.
  • Allowing plans with lower actuarial values: This part gets super wonky, but to really oversimplify things, the proposed rule would let insurers design plans that are a little bit less generous than what is currently allowed while still meeting the requirements for “actuarial value”, a term that means “how much of the average member’s medical costs the plan pays”. There’s an excellent explanation of this change in the Vox article I linked to above.
  • Cutting the length of future open enrollment periods: Starting this year, open enrollment would change from November 1-January 31, to November 1-December 15. This has been getting a fair bit of noise since the rule dropped, because there’s pretty strong evidence (again, see Vox) that younger, healthier enrollees – who are critical to making the Marketplaces work – tend to sign up at the very end of open enrollment, and cutting those dates back might mean fewer of those folks get coverage. Personally, I’ve been less fazed by this piece of the proposal, because the Obama administration was already planning to change to exactly this schedule starting in 2018. This new rule pushes that up by a year, but doesn’t otherwise look like an enormous shift to me (although I think it’s fair to wonder how much of a priority, and thus how well-staffed and well-run, the federal Marketplace will be for the new administration).

So, that’s what’s in there. The commenting period for the rule is open through March 7th.

The other big national news is that there’s another possible replacement plan floating around, this time from Speaker Paul Ryan. Looks like a rehash of what he’s proposed in the past. Now, I know those of you who read Coffee CAHC are way too smart and well-informed to get all in a tizzy about any individual idea about replacement that gets floated down here in D.C. (pat yourselves on the back for being way too smart and well-informed!). Here’s the truth about this one, just like all the others: a half dozen or more “plans” is not A PLAN. There’s nothing even close to consensus between any of the important players in this drama on any one of these drafts that’s being kicked around – some in the House hate this one, some in the Senate hate this one, some in the House and Senate hate all of them…

In other words, I think it’s important to acknowledge that, yes, a serious and powerful figure has put out a new paper version of an idea, but it’s frankly getting a bit exhausting keeping up with all of these different pieces of legislative scaffolding that, if they ever get serious about repeal-and-replace down here, are gonna have to be merged into something that can get enough votes to pass. Luckily for me, I don’t have to! Our colleagues at the Kaiser Family Foundation have put together an awesome tool to help review and compare the different “plans” that have been released so far. You can add or remove different proposals to see them in a very easy-to-read, side-by-side breakdown showing you what the differences are between each one. Seriously, it’s amazing. Give it a look if you want the ‘deets on any of these things.

The other big story that I didn’t include in Wednesday’s Coffee CAHC is Humana’s announcement that they’re pulling out of the ACA Marketplaces entirely next year. No direct impact for us in Maine, since Humana doesn’t sell on our Marketplace, but plenty of folks are worried that this is a sign of things to come, as insurers look at the chaos being created right now by Congressional sturm und drang over the future of the ACA and say “nah we’re all set with that, thanks.”

I know that Seema Verma’s confirmation hearing started yesterday, but I’m afraid I didn’t get to see or hear much about it. Any of you watch? Anything exciting or interesting? Let me know!


State level

Well, as you know, I’m in D.C., so I’m afraid I’ve been a bit out of touch at the state level. You tell me! Anybody out there have any hot tips, gossip, or happenings they think I should know about? Drop me a message!


Would you like to know more?

I swear that I don’t mean for this section to turn into a geeky fanboy love letter to Sarah Kliff’s reporting every time, but she’s crushing it over at Vox. Hot on the heels of the article I linked to on Wednesday, she has this brilliant and haunting piece looking at how the elimination of lifetime benefit caps in insurance has changed, and saved, the lives of so many people. The article focuses on one kid, born sick, whose bills are coming close to $1 million in his first few years of life. Because of the elimination of caps and pre-existing condition restrictions, he’s been able to continue getting the care he needs to stay alive…for now. If caps and pre-ex restrictions come back, this kid might have already run out of insurance for his whole life. I’m not crying, you’re crying.


Until next time, friends, I remain,


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