Health Plan Weekly

With the passage of the American Rescue Plan (ARP), states that haven’t expanded Medicaid have an extra reason to do so: the COVID-19 relief bill offers financial incentives to states that increase Medicaid eligibility under the Affordable Care Act (ACA). Some states where Medicaid expansion has historically been a nonstarter to conservative elected officials are reconsidering their status — and the biggest states that haven’t yet expanded Medicaid, Florida and Texas, may even change their tune in coming years.

The ARP gives states that expand Medicaid a 5 percentage-point increase in their Federal Medical Assistance Percentage (FMAP) for the first two years of expansion. That’s in addition to the 6.2 percentage-point FMAP increase that all states are getting for the duration of the COVID-19 public health emergency, and the 90% federal funding match rate that Medicaid expansion states receive under the ACA.

✦ Blue Cross and Blue Shield of Minnesota President and CEO Craig Samitt, M.D., will retire on May 3, the insurer said in a March 31 press release. Kathleen Blatz, who has served on the Blues plan’s Board of Trustees for more than a decade and is a former Minnesota Supreme Court justice, will serve as interim CEO effective April 1 while the board conducts a search for Samitt’s replacement. Samitt, the release noted, “was one of the first health care executives to declare racism as a public health crisis, and he made racial and health equity the cornerstone of Blue Cross’ initiative to make health care more equitable.” Read more at https://bit.ly/3sEFUNU.

✦ HHS said on April 1 that after advance payments of tax credits that have been bolstered by the American Rescue Plan, an average of three out of five eligible uninsured Americans can access zero-premium plans and an average of four out of five current HealthCare.gov consumers will be able to find a plan for $10 or less per month. Marketplace customers will see their premiums decrease, on average, by $50 per person per month and $85 per policy per month thanks to expanded subsidies in the COVID-19 relief legislation, the department said. HHS also said it will spend an additional $50 million on advertising to boost its outreach campaign promoting the pandemic-related special enrollment period, which runs through Aug. 15. Read more at https://bit.ly/3dohVw5.

Payers should look at the looming interoperability mandate as a chance to gain a lasting advantage over their competitors, according to two health care information technology (IT) experts.

In a March 26 webinar hosted by America’s Health Insurance Plans (AHIP), IBM Vice President Michael Curry of Watson Health and Jeff Rivkin, research director for payer IT strategies at IDC Insights, said payers should do more than meet the minimum interoperability standards.

When the Affordable Care Act banned individual market insurers from denying coverage to people with pre-existing conditions or charging them higher rates, it created a new option for patients with end-stage renal disease (ESRD), who previously could not access affordable plans in that market. But the ACA’s reforms also opened the door to a practice that has stirred up controversy in the health care sector: dialysis facilities steering patients to higher-reimbursing private plans by indirectly subsidizing their premiums. While attempts to ban such behavior have failed so far, a new study offers reasons why policymakers may want to take another shot at addressing the issue.

The study, published in JAMA Internal Medicine, examined 2016 data from ACA-compliant on- and off-exchange health plans, finding that patients with ESRD comprised just 0.10% of individual market member months but 3.3% of spending. For such patients, average monthly spending on dialysis and other services was 33 times that of patients without ESRD, “underscoring the incentive for [dialysis] facilities to encourage individual market enrollment,” the study stated.