Health Plan Weekly

The 2021 Proposed Notice of Benefit and Payment Parameters (NBPP) — which CMS released on Jan. 31 after insurers grew increasingly impatient to see the annual Affordable Care Act exchange regulations (HPW 2/3/20, p. 4) — suggests a change to the automatic reenrollment process that some experts worry will be a big problem for certain near-poor enrollees.

Under the ACA, exchange plan enrollees are typically automatically reenrolled in their current plan (or a similar plan if it’s no longer available) during each open enrollment period if they fail to notify the exchange of any eligibility change — like a higher income — or don’t actively select or disenroll from a plan.

Health insurers continued to struggle with their medical loss ratios in the fourth quarter of 2019, with Humana Inc. and Centene Corp. each posting MLRs that missed analysts’ expectations and indicated higher medical expenses in specific segments.

Centene joined Anthem, Inc., in blaming costs from an early flu season in part for its elevated MLR, while Humana tagged shifts in its Medicare business for its own raised MLR. Anthem reported its earnings on Jan. 29 (HPW 2/3/20, p. 6).

An earlier version of this article incorrectly stated that all Blue Cross Blue Shield affiliates joined a partnership with Civica Rx. As of Feb. 17, 18 Blues plans had joined the agreement. This version has been corrected.

The high price of prescription drugs has frustrated payers for years. Recently, that frustration has led some insurers to enter the drug production business — and states could follow their lead.

✦ On Jan. 27, the Supreme Court lifted an injunction blocking implementation of a Dept. of Homeland Security rule that makes obtaining a green card or entering the United States more difficult for legal immigrants who would otherwise qualify for federal benefits, including Medicare and Medicaid. A September 2019 Kaiser Family Foundation (KFF) report on the then-pending rule predicted that, if implemented, it could cause 2 million to 4.7 million people to disenroll from programs like CHIP and Medicaid “due to fear and confusion about the changes.” According to the report, “decreased participation in Medicaid would increase the uninsured rate among immigrant families, reducing access to care and contributing to worse health outcomes.” Read the KFF report at https://bit.ly/36yqsa9 and view the ruling at https://cnn.it/316FtPz.

✦ Covered California, the state’s individual marketplace, reported that 2020’s open enrollment period, which ended Jan. 31, has already yielded more new enrollees than 2019. As of Jan. 23, around 318,000 people new to the market had signed up for plans, beating last year’s total for the entire open enrollment period. California has stepped up efforts to advertise the individual marketplace and created a state individual mandate after Congress zeroed out the federal penalty for going without health insurance. Read more at https://bit.ly/2U5d0YK.

The Affordable Care Act (ACA) has significantly reduced racial disparities in access to health care since 2014, according to a recent analysis by The Commonwealth Fund. The gap between uninsured rates for black adults and white adults declined 4.1 percentage points, while the gap between Hispanic and white adults dropped 9.4 points. All three racial groups saw lower uninsured rates and larger coverage improvements in Medicaid expansion states between 2013 and 2018. The report also compared the uninsured rate changes in Louisiana, which expanded Medicaid in 2016, and in Georgia, which did not expand the program. Both white and black adults with incomes under 200% of the federal poverty level (FPL) saw coverage improvements from 2013 to 2015 in both states. Yet while Louisiana’s Medicaid expansion led to lower uninsured rates, Georgia’s rates remained flat after 2016.