Health Plan Weekly
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Feds Approve Virginia Individual Market Reinsurance Program
HHS and the Treasury Department on May 19 approved Virginia’s waiver for a state reinsurance program starting on Jan. 1, 2023. Although states have been less aggressive when it comes to applying for reinsurance programs recently, the looming expiration of enhanced premium tax credits in the individual marketplace could create renewed interest in reinsurance, policy experts tell AIS Health, a division of MMIT. That would be welcome news for insurers who are in favor of such programs because they incentivize more individuals to enroll in plans, create a more balanced risk pool and help insurers deal with large claims.
Reinsurance programs are primarily focused on lowering premiums for individuals who did not previously qualify for subsidies on the Affordable Care Act exchanges. In early 2021, the American Rescue Plan Act (ARPA) made enhanced subsidies available to people whose incomes are above 400% of the federal poverty level, the previous threshold, leading to a smaller number of people who benefited from reinsurance.
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North Carolina Sets Sights on Medicaid Expansion
Republican leaders in North Carolina, one of a dozen states that have yet to broaden access to Medicaid programs, say that they are now ready to embrace expansion, which may be a boon to its managed care organizations.
By widening Medicaid eligibility to limits allowed under the Affordable Care Act, North Carolina would enroll an additional 600,000 individuals, a sharp increase over the 2.7 million currently covered under Medicaid in the state, according to a summary of a draft bill first reported on by Axios.
In a May 25 press conference, state Senate leader Phil Berger called Medicaid expansion “the right thing for us to do,” citing the need for coverage for low-income individuals and families and the federal government’s responsibility to pick up 90% of costs for enrollees newly eligible under the expanded coverage guidelines, according to reports.
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The Vast Majority of Physicians Accept New Medicare and Private Insurance Patients
Most non-pediatric office-based physicians accepted new patients, with similar shares accepting new Medicare (89%) and privately insured patients (91%), according to a Kaiser Family Foundation analysis based on the 2019 National Electronic Health Records Survey. A smaller share of primary care physicians accepted new patients with Medicare or private insurance than physicians in other medical or surgical specialties. Across the nation, the share of physicians accepting new Medicare patients ranged from 95% in Iowa, Minnesota and Pennsylvania to 76% in the District of Columbia, similar to the range across states for privately insured patients. As of March 2022, only 1% of non-pediatric physicians formally opted out of the Medicare program, with psychiatrists accounting for 42% of these physicians opting out.
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News Briefs: Consumer Satisfaction With Plans Hits Roadblocks
While health insurers have made gains in consumer satisfaction in recent years, that progress stalled over the last year, according to a new report from J.D. Power & Associates. “Overall satisfaction has increased…during the past five years, but there is no change in 2022 from 2021, due in part to declines in satisfaction in customer service and dissatisfaction with coverage options and desired network providers,” a J.D. Power press release said. The report said that the health plans that members call “responsive” and “innovative” received the best satisfaction scores. Members also critiqued long hold times at call centers and have found decreasing satisfaction from electronic contact tools like texting and mobile apps. The highest scores for health plans, which were separated by region, were awarded to Kaiser Permanente, Humana Inc., Anthem, Inc., Geisinger Health Plan and several Blue Cross Blue Shield affiliates.
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Marketplace, MCOs Will Face a Rocky Transition When PHE Ends
When the Biden administration ends the COVID-19 public health emergency (PHE), states will disenroll millions of Medicaid beneficiaries — and insurers will have to take Medicaid MCO members off their books. Experts tell AIS Health, a division of MMIT, that carriers can take steps to retain some of those members by helping them enroll in Affordable Care Act (ACA) marketplace coverage — but say the number of people who make the switch will be far lower than the number of people who joined the Medicaid rolls during the pandemic (see infographic).
Medicaid and individual exchange enrollment have both boomed with the higher federal funding that was included in the American Rescue Plan Act (ARPA) — and both segments’ total enrollment and enrollee profiles will change significantly when that extra funding ends.
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