UPDATE: Thanks to Anthony Wright, Executive Director of Health Access California, for clarifying a few things on some of these bills.

A couple of months ago Louise Norris of healthinsurance.org gave me a heads up about a half-dozen or so healthcare bills, mostly ACA-related, pending in the California state legislature. Some were in the state Senate, some in the state Assembly; some were more along the lines of protecting the ACA from sabotage efforts while others were about expanding upon the law.

Well, today a whole bunch of those bills (as well as a few I didn't even know about earlier) made it a major step further along the line to becoming law. Courtesy of the Health Access CA Twitter feed:

I know this is like the third "It's on the ballot!" post I've written regarding Medicaid expansion in Idaho, but this time it appears to be for real...almost:

BOISE — A Medicaid expansion proposal has passed the signature threshold, officials confirmed on Thursday, but said further review is needed before it gets on the November ballot.

Ada County Chief Deputy Clerk Phil McGrane says county clerks across the state have verified roughly 58,000 signatures that organizers submitted earlier this month.

The effort needed at least 56,192 signatures to qualify. However, those signatures must also come from 6 percent of the registered voters in at least 18 of Idaho’s 35 legislative districts.

McGrane says it’ll be up to the state to determine if the signatures meet the legislative district requirements.

Reclaim Idaho, the group that organized the Medicaid expansion effort, did not immediately return a request for comment.

So far, only 4 states have released their preliminary 2019 ACA-compliant individual market premium rate filings: Maryland, Virginia, Vermont and Oregon.

So what's the deal with the other 46 states (+DC)? Well, Louise Norris has sent me the link for this handy 2019 Submission Deadline table from SERFF (the System for Electronic Rates & Forms Filing, a database maintained by the National Association of Insurance Commissioners).

However, it's a bit overly cumbersome for my purposes: It stretches out over 6 full pages, and includes columns for Standalone Dental Plans as well as a bunch of info regarding the Small Group Market. I did used to try tracking Small Group rates as well, but that got to be too difficult to keep up with, and I haven't really done much analysis of standalone dental plans at all. Let's face it: About 90% of the drama, controversy and confusion regarding ACA premiums is all about the individual market.

About a month and a half ago, state legislators in California introduced a bold new "All-Payer" healthcare bill which, had it become law, would have regulated the actual price of various types of medical procedures. As Sarah Kliff explained in Vox at the time:

California is exploring a bold and controversial new plan to rein in health care spending by letting the state government set medical prices.

...Still, California’s new proposal is worth examining as one that steps closer to single-payer — but doesn’t go quite all the way. It’s one plausible step a state could take without any assistance from the Trump administration, as we see more blue states looking for ways to shape the future of their own health care systems.

”I think we have appreciated how much we’ve been able to do with transparency and data, and how much we’ve been able to collect, but we reached the point where we felt like we had to tackle the issue of prices head on,” says Sara Flocks, policy coordinator for the California Labor Federation, which is backing the proposal.

I had actually already written about Vermont doing this back in March, but seeing how it was one of only 2 states (+DC) which didn't allow Cost Sharing Reduction (CSR) costs to be loaded onto premiums at all this year, I figured I should mention it here as well. Once again:

  • 20 states went the full #SilverSwitcharoo route (the best option, since it maximizes tax credits for those eligible for them while minimizing the number of unsubsidized enrollees who get hit with the extra CSR load);
  • 16 states went with partial #SilverLoading (the second best option: Subsidized enrollees get bonus assistance, though not as much as in Switch states; more unsubsidized enrollees take the hit, but they aren't hit quite as hard);
  • 6 states went with "Broad Loading", the worst option because everyone gets hit with at least part of the CSR load except for subsidized Silver enrollees;
  • 6 states took a "Mixed" strategy...which is to say, no particular strategy whatsover. The state insurance dept. left it up to each carrier to decide how to handle the CSR issue, and ended up with a hodge podge of the other three
  • 3 states (well, 2 states + DC, anyway) didn't allow CSR costs to be loaded at all. Their carriers have to eat the loss, which makes little sense, but what're ya gonna do?

For a couple of months now, I've been attempting to track a slew of state-based "ACA 2.0" bills slowly winding their way through various state legislatures. However, this is really a bit of a misnomer, since some of these bills aren't so much about expanding the ACA as they are about protecting it from various types of undermining or sabotage from the Trump Administration and Congressional Republicans.

In fact, as far as I'm concerned, they really fall into three categories, which line up nicely with my color-coded "3-Legged Stool" metaphor: Blue, Green and Red Leg bills.

Once again: The "Blue Leg" of the Stool covers everything which ACA-compliant individual health insurance carriers are required to include: Guaranteed Issue, Community Rating, 10 Essential Health Benefits, a Minimum 60% Actuarial Value rating, no Annual or Lifetime Caps on coverage, and a long list of mandatory Preventative Services at no out-of-pocket cost when done in-network.

Covered California Launches New Campaign Focused on College Graduates to Make Sure They Get Health Coverage

  • Commencement speakers will remind thousands of new graduates that “life can change in an instant” – making it important for them to have health coverage, so they can get the health care they need as they set out in life.
  • A new video distributed on social platforms will remind graduates who may be losing their health coverage to check out Covered California for affordable options.
  • Covered California Executive Director Peter Lee congratulates graduates and reminds them to protect their futures by getting health insurance.
  • Covered California provided more than 70 campus health centers with materials to educate graduating students about new health insurance options available through Covered California
  • The “special enrollment” campaign for graduates is launching amid new data showing California’s uninsured rate is at an all-time low.

SACRAMENTO, Calif. — Graduation season is in full bloom and Covered California is joining with commencement speakers throughout the state to remind the over 400,000 graduates and their families not to forget about the importance of health insurance during this busy time of year.

This just in from the Washington State Insurance Commissioner's office...

Eleven health insurers file for 2019 individual market: No bare counties

May 25, 2018

OLYMPIA, Wash. – Eleven health insurers filed 88 health plans for Washington state’s individual market yesterday, and all 39 counties will be covered in 2019.

The proposed rate changes are not public until 10 days after the OIC has determined the filings are complete. Release of the proposed rate changes is targeted for June 4. 

“We can all breathe a sigh of relief knowing consumers in every county who need coverage will have access to a health plan in 2019,” said Insurance Commissioner Mike Kreidler. “Obviously, how much premiums may change and any increases to out-of-pocket costs are still key concerns, but I’m grateful that we can assure people that coverage is available, regardless of where they live.” 

Last month I noted that New Jersey is taking a leading role regarding protecting and improving the Affordable Care Act; the state legislature has passed bills which would:

  • Reinstate the ACA's individual mandate penalty,
  • Establish a robust reinsurance program to significantly lower insurance premiums for individual market enrollees,
  • Protect people from out-of-network "balance billing", and
  • Cancel out Trump's expansion of "Association Health Plans"

(New Jersey actually already had several other "ACA protection" laws on the books in the first place, including protections against short-term plans and "surprise billing".)

In addition, new Governor Phil Murphy had alread proven that he understands and supports the ACA; within days of taking office he had already issued an executive order telling all state agencies to do everything they reasonably can to inform the public about how to enroll during Open Enrollment and so forth.

A few years ago, New York State passed a law which allows uninsured pregnant women to enroll in ACA exchange coverage outside of the official Open Enrollment Period. Here's what Louise Norris and I wrote about it at the time:

On another note, I also want to use this as an opportunity to point out that maintaining quality health insurance coverage needs to be a priority year in and year out. Jenks notes that "Pregnancies are often unplanned, making limited enrollment periods impractical for many women." But can't that be said of any medical condition? In fact, I would say pregnancy is one aspect of healthcare that's probably much more likely to actually be planned. While about half of pregnancies are planned, I doubt the same could be said for cancers, heart attacks, or car accidents.

In other words, while not all pregnancies are planned, overall it's a lot less "random" than most other expensive healthcare incidents.

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