Health Plan Weekly

Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign.

Nevada’s public option bill will require any carrier that participates in the state’s Medicaid managed care program or individual exchange to provide a silver- or gold-level public option plan. Premiums for those plans will be set 5% lower than the benchmark silver plan sold on the state Affordable Care Act exchange, and both individuals and small group purchasers will be able to buy into the plan.

✦ After being confirmed by the Senate, Chiquita Brooks-LaSure was sworn in as the new CMS administrator on May 27 by HHS Secretary Xavier Becerra. “Chiquita Brooks-LaSure’s historic appointment and confirmation as the first Black woman to lead the Centers for Medicare and Medicaid Services further demonstrates the Biden-Harris Administration’s commitment to bringing diverse perspectives and seasoned leaders to drive and improve the U.S. health care system,” Becerra said in a statement. Brooks-LaSure, whose past roles include deputy director for policy at CMS’s Center for Consumer Information and Insurance Oversight, House Democratic staffer and managing director at the professional services firm Manatt Health, is a longtime Affordable Care Act champion.

✦ In 2021, the average benchmark premium for Affordable Care Act exchange plans fell 1.7% year over year, a slightly larger decline than the declines of 1.2% and 3.2% in 2019 and 2020, according to a new analysis from the Urban Institute. “The stability of Marketplace premiums in recent years likely owes to both market-level factors and state policy decisions,” including states’ implementation of reinsurance programs, the report says. While the majority of states saw declines ranging from 0% to 10% (34 states) or small increases of less than 6% (seven states), 10 states saw double-digit declines in their benchmark premiums in 2021. Only one state saw a large increase in benchmark premiums in 2021: North Dakota with 23%. Insurers’ exchange participation in 2021 also increased for the third year in row, with an average of 4.3 insurers participating per rating region. In addition, the analysis suggests that its data “do not reveal a substantial increase in Marketplace enrollment” tied to COVID-19, but it says the pandemic “may have contributed toward the decline in premiums for 2021” since many insurers experienced significant surpluses due to the steep drop in routine and elective care.

by Jinghong Chen
More than half of insurers surveyed said they do not anticipate raising health plan premiums due to the pandemic, according to a recent poll conducted by eHealth, Inc. The private insurance marketplace surveyed more than 4,700 consumers and 26 insurance industry representatives on the impact of COVID-19, technology and public policy reforms. Among the respondents, 60% favor expanding the Medicare program in some form, while half of current Medicare beneficiary respondents say Medicare should continue to be run by public and private cooperation between government and insurance companies.

As health insurers gear up for the 2022 rate-filing season for Affordable Care Act exchange plans, the good news is that much of the regulatory uncertainty seen in years past has dissipated — save for a looming Supreme Court decision on the ACA’s legality. However, the pandemic’s effect on medical spending is a nebulous factor that insurers can’t escape this year, and it’s likely to have a wide-ranging impact, says David Dillon, a fellow of the Society of Actuaries.

Dillon, who works directly with insurers and regulators to develop and review health insurance rates, predicts the COVID-19 impact on premiums will be anywhere from a 5% decrease to a 5% increase. Medical cost inflation, he estimates, will increase rates by 4% to 6%, while the American Rescue Plan’s expansion of premium subsidies will decrease rates by 1% to 4%.

Lowering the Medicare eligibility age to 60 could add as many as 24.5 million individuals to the program, an analysis from Avalere finds. However, shifting people ages 60 to 64 to Medicare actually could have a mixed effect on coverage overall, since Medicare premiums may cost more than other forms of insurance, a separate analysis from the Kaiser Family Foundation (KFF) reports.

The two analyses point out the tricky dynamics that could be involved in expanding Medicare to cover those ages 60 to 64, as proposed by President Joe Biden during the 2020 campaign.