Archive for Affordable Care Act


Azar: Budget Proposes Reducing Medicaid Matching $

The federal government would reduce its financial commitment to state Medicaid programs under the FY 2021 budget the Trump administration proposed earlier this month.

While testifying before the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services and Education, Health and Human Services Secretary Alex Azar acknowledged that the administration’s proposed FY 2021 would eliminate the enhanced rate at which the federal government matches state funds used to serve individuals who enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion provision.  That enhanced rate calls for the federal government to pay 100 percent of the costs associated with the Medicaid population during the first year of Medicaid expansion, eventually scaling down to 90 percent after 2020.  Nationally, the federal government’s matching rate for the pre-expansion population is 57 percent; that matching rate would not be affected by this proposal.

This aspect of the administration’s proposed FY 2021 budget has mostly flown under the radar since the budget’s release and has received little public attention.

In explaining the proposal, Azar said that enhanced funding for the Affordable Care Act’s Medicaid expansion population was biased against the disabled, women, and children.

Learn more about what Secretary Azar said about federal …

CMS Introduces New Approach to Medicaid Block Grants

States would be able to convert part of their Medicaid programs into block grants under a new program introduced by the federal government.

The program, which the Centers for Medicare & Medicaid Services calls “Healthy Adult Opportunity,” would encompass services only for adults under the age of 65 who are not eligible for Medicaid because of disability or the need for long-term care, services, and supports and who are not otherwise eligible for the pre-Affordable Care Act Medicaid program.

Under the program, states can develop either a total expenses model or per enrollee model for their block grants and would have expanded opportunities to introduce co-pays and deductibles, impose work requirements, expand eligibility criteria, and waive retroactive coverage and hospital presumptive eligibility requirements.  To save on the cost of prescription drugs, they would be empowered to implement limited drug formularies.

The new program appears to be targeting states that did not expand their Medicaid programs under the Affordable Care Act.  It also appears to be CMS’s attempt to introduce the block grant concept in a limited way in the hope that it will be successful and lead to demand to expand block grants to the entire Medicaid program and not …

States Not Waiting for Feds to Act on More Affordable Health Insurance

Frustrated over the inability of the federal government to develop and implement policies that make health insurance more affordable, a number of states are taking matters into their own hands in a variety of ways.

In 2018 and 2019 at least a dozen states enacted policies designed to make health insurance more affordable.  Among the steps they took where:

  • premium stabilization programs
  • requirements to maintain adequate coverage
  • financial assistance to improve coverage affordability
  • regulation of non-Affordable Care Act-compliance coverage
  • rules to promote marketplace competition
  • state coverage options
  • standard plan designs
  • open enrollment extensions
  • transitional policies

Learn more about what states are doing to make health insurance more affordable and whether such measures are working in the Commonwealth Fund report “States Work to Make Individual Market Health Coverage More Affordable, But Long-Term Solutions Call for Federal Leadership.”…

Medicaid Expansion Slows Opioid Deaths

Opioid deaths are less likely to occur in states that expanded their Medicaid programs under the Affordable Care Act, according to a new study.

According to the study,

Adoption of Medicaid expansion was associated with a 6% lower rate of total opioid overdose deaths compared with the rate in nonexpansion states… Counties in expansion states had an 11% lower rate of death involving heroin… and a 10% lower rate of death involving synthetic opioids other than methadone… compared with counties in nonexpansion states.

In addition, Medicaid expansion, the study found, has made treatment for substance abuse disorders more widely available.

Learn more about the impact Medicaid expansion appears to be having on opioid use and abuse in the JAMA Open Network study “Association of Medicaid Expansion With Opioid Overdose Mortality in the United States.”

Pennsylvania Moves to Establish its Own Health Insurance Exchange

Pennsylvania plans to move away from participating in the federal health insurance exchange and to establish its own exchange in time for the 2021 open enrollment season.

The shift away from using the federal exchange and developing a state-based exchange was approved by Pennsylvania’s General Assembly earlier this year.  That shift took a major step forward recently when the state hired a contractor to create the site’s platform.

State officials estimate that once the state’s site is up and running it will costs $25 million a year to operate; currently, Pennsylvania pays $95 million a year to participate in the federal exchange.  In addition, the state will be able to collect the three percent of premiums that insurers pay to appear on the federal site.  Those seeking insurance on the new state site should  benefit, too, with state officials estimating that purchasing reinsurance will enable consumers to save five to ten percent on premiums.

For an update on the status of the development of Pennsylvania’s health insurance exchange, see the Fierce Healthcare article “Pennsylvania takes another step toward launching state-based insurance exchange.”