On this version
- Delaware approves 1% common lower in premiums for particular person market
- Maine approves 13% common lower in premiums for particular person market
- Rhode Island approves 4.2% common enhance in premiums for particular person market
- HHS awards federal Navigator funding to 30 organizations
- California lawmakers ship psychological well being parity invoice to Gov. Newsom
- Insurers start receiving danger hall funds
- Georgia’s proposed insurance coverage market modifications possible can’t adjust to federal guidelines for 1332 waivers
Delaware approves 1% common lower in premiums for particular person market
Delaware’s insurance coverage commissioner introduced this week that common full-price premiums in Delaware’s particular person market will lower by 1 p.c for 2022. Highmark, the lone insurer in Delaware’s particular person market, had initially proposed a median fee lower of half a p.c, however the negotiation course of with the state resulted in a barely extra vital discount in common premiums.
Maine approves 13% common lower in premiums for particular person market
Maine’s Bureau of Insurance coverage has additionally finalized premiums for 2022, approving the revised filings that insurers submitted in July. Throughout the three particular person market insurers, the authorized fee modifications quantity to a median lower of 13.1 p.c. The speed lower is due largely to the state’s reinsurance program, which took impact in 2022.
Maine is awaiting federal approval to transition to a state-based alternate that makes use of the federal enrollment platform (HealthCare.gov) as of this fall, and the state is working to implement a number of different reforms that have been referred to as for in laws enacted earlier this 12 months. This consists of the opportunity of merging the state’s particular person and small-group medical insurance markets beginning in 2022, and increasing the present reinsurance program to incorporate the small-group market. (It presently solely applies to the person market).
An actuarial evaluation of this proposal was printed final week, indicating that the merged market would possible lead to a small common fee lower for the small-group market and a small common fee enhance for the person market (in contrast with the present establishment of separate markets and a reinsurance program that solely applies to the person market).
Rhode Island approves 4.2% common enhance in premiums for particular person market
Rhode Island’s Workplace of the Well being Insurance coverage Commissioner introduced authorized fee modifications for 2022 final week – and within the particular person market, the general authorized common fee enhance quantities to 4.2 p.c. It is a smaller common enhance than the insurers had proposed, and the Workplace of the Well being Insurance coverage Commissioner touted this as a win for shoppers, amounting to a premium financial savings of almost $13 million.
However Rhode Island’s lawyer common had beneficial a lot smaller common fee will increase primarily based on an impartial actuarial evaluation, and expressed disappointment when the authorized charges have been introduced. Legal professional Basic Peter Neronha famous that whereas the Workplace of the Well being Insurance coverage Commissioner persistently approves fee will increase which are smaller than Rhode Island’s insurers request annually, “asking for the solar and getting the moon when the moon is admittedly what you need anyway is a win, plain and easy.”
HHS awards federal Navigator funding to 30 organizations
Final week, HHS introduced it’s awarding $10 million in Navigator funding to 30 organizations throughout the nation that may present Navigator providers to assist folks enroll in well being plans by way of the federally run market over the approaching 12 months. Navigator funding grants was once a lot bigger – upwards of $60 million in 2021 and 2021 – however have been sharply decreased below the Trump administration. By 2022, Navigator funding had dropped to solely $10 million, though it has remained at that degree since then.
The 30 organizations awarded the latest funding are all present Navigator entities, returning for the upcoming 12 months. Though the whole funding quantity has remained the identical, there have been 34 Navigator organizations that obtained federal funding final 12 months. However 4 of them will not be on this 12 months’s record: South Carolina’s Navigator entity withdrew from this system, and the three Navigator entities in Maine and Virginia will not be federally funded as of this fall, since Maine and Virginia plan to transition to state-based exchanges utilizing the federal enrollment platform.
California lawmakers ship psychological well being parity invoice to Gov. Newsom
California lawmakers have handed a invoice designed to enhance entry to psychological well being care, significantly inpatient substance abuse remedy. Though state and federal psychological well being parity legal guidelines are already in place, shopper advocates word that they typically don’t go far sufficient in guaranteeing that folks can truly get the assistance they want.
Gov. Gavin Newsom has not indicated whether or not he’ll signal the invoice into regulation. But when he does, it might require broader protection of psychological well being and substance abuse remedy, together with remedy within the earlier phases of an issue and limitations on declare denials and prior authorization denials primarily based on the insurer’s dedication that the remedy just isn’t medically obligatory. It will additionally incentivize insurers to develop their psychological well being supplier networks.
Shopper advocates see the laws as a win, however the California Affiliation of Well being Plans has expressed robust opposition to the invoice.
Insurers start receiving danger hall funds
Earlier this 12 months, the Supreme Court docket dominated that the federal authorities needed to honor its obligation to pay well being insurers $12 billion that was owed to them below the ACA’s danger corridors program. This system, which ran from 2014 by way of 2021, was speculated to take cash from worthwhile insurers and distribute it to insurers that have been struggling financially within the early days of ACA implementation.
Initially, the plan was to have the federal authorities step in to cowl losses if there wasn’t sufficient funding from worthwhile insurers, however GOP lawmakers retroactively eliminated that provision in late 2014 (after the primary 12 months of claims was within the books and charges have been finalized for the second 12 months). As a result of only a few insurers have been financially profitable within the early years of ACA-compliant protection, their funds into the chance corridors program have been solely ample to cowl a small fraction of what the unprofitable insurers have been owed.
However now insurers are beginning to obtain these long-delayed danger hall funds from HHS, due to the Supreme Court docket’s ruling. Quite a few CO-OPs needed to shut down on account of the chance hall shortfall. And though the cash is just too little too late for them, their collectors can nonetheless obtain funds from the chance hall funds below their liquidation agreements.
Georgia’s proposed insurance coverage market modifications possible can’t adjust to federal guidelines for 1332 waivers
Georgia is searching for federal approval for a 1332 waiver that may permit the state to cease utilizing HealthCare.gov with out establishing its personal state-based medical insurance alternate platform. As an alternative, the state needs to depend on its present internet brokers and insurance coverage corporations to enroll shoppers, even if these entities could be allowed to show non-ACA-compliant well being plans alongside the ACA-compliant choices.
Georgia’s present proposal is a scaled-back model of what the state had initially proposed. However a brand new evaluation from Christen Linke Younger and Jason Levitis explains why the state’s present waiver proposal would nonetheless run afoul of the federal tips for 1332 waivers. HHS is accepting public touch upon Georgia’s proposal by way of September 16.
