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Why does the gender wage gap still exist? And what can be done to close it? We unpack the issue.

Megan Rapinoe of the United States women's soccer team, testified virtually during a House Oversight Committee hearing on Equal Pay Day. Credit... Drew Angerer/Getty Images

- Megan Rapinoe, a professional U.S. Soccer player
Megan Rapinoe is a two-time World Cup champion who has played to sold-out stadiums around the globe; what she has in common with nearly every American woman is that she's underpaid.

On Wednesday, Ms. Rapinoe testified during a hearing held by Representative Carolyn B. Maloney to examine economic harm caused by gender inequalities, particularly for women of color.

Today is All Women's Equal Pay Day, Ms. Maloney said. But it's not Equal Pay Day for all women.

Black women would have to work until Aug. 3, 2021, to earn what men made in 2020. For Latina women, the date doesn't come until Oct. 2.

"This is a disgrace," Ms. Maloney said. "And it has long-term consequences for women and families."

Wage discrimination isn't limited to any one sector or income level.

Take Ms. Rapinoe, whose fight for equal pay has become something of a calling card for the U.S. women's team, and who played a central role in the team's lawsuit on unequal pay filed in 2019.

"One cannot simply outperform inequality," she said. "Or be excellent enough to escape discrimination."

If it can happen to me, she said, "it can - and it does - happen to every person marginalized by gender."

In Her Words looked at the history of Equal Pay Day, the reasons for the wage gap and what can be done to close it.

What is Equal Pay Day?
It's a symbolic day that illustrates how far into the current year American women would need to work to earn what their male counterparts earned last year. Put another way, because there is a disparity in what women and men are paid, women would need to work 389 days to earn what men earn in just 365 days.

Race plays a part, too: For Black and Hispanic women, the numbers are worse. For Asian women, the numbers skew a bit better.

Estimates vary on how much the wage gap will cost an American woman over the course of her career. The National Women's Law Center puts it at $406,280 in lost income on average, but that number can top $1 million for Hispanic women and is just shy of $1 million for Black and Native American women.
How did it become a thing?
Equal Pay Day was established in 1996 by the National Committee on Pay Equity. Today marks the 25th. But debates around pay equity date back much further than that.

Carolyn York, secretary-treasurer of the National Committee on Pay Equity, pointed out in an email that in 1942, as huge numbers of women began replacing men in the work force, the National War Labor Board urged employers to make "adjustments which equalize wage or salary rates paid to females with the rates paid to males for comparable quality and quantity of work on the same or similar operations." But two decades on, in the 1960s, women were still earning only around 59 cents for every dollar a man made.
Do other countries have a gender wage gap?
Of course they do. According to this O.E.C.D. study, the United States falls behind Canada and ahead of Mexico. In addition to Canada, other countries that have a smaller pay gap than the United States are Romania, Colombia, Belgium, Costa Rica, Denmark, Norway ... the list goes on. And on.

Has the pay gap narrowed over time?
Yes, but not by much. We're talking pennies. This year, it's estimated that American women will earn around 82 cents for every dollar that a man earns. A decade ago in 2011, it was 77 cents. In 1996, the first "official" Equal Pay Day, it was around 74 cents. And this top-line number doesn't account for differences in earnings among different racial groups.

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Credit... By The New York Times | Sources: Institute for Women's Policy Research, U.S. Bureau of Labor Statistics

How is the wage gap number calculated?
The pay gap refers to the ratio of female to male median annual earnings for full-time workers. Think of it as a fraction: The numerator is the difference between male and female median earnings, and the denominator is male median earnings. The actual number might look different depending on the source it's coming from, because some sources factor in characteristics like age, family size, education level and industry.

"We treat this issue as if you could summarize it in one number," said Claudia Goldin, an economics professor at Harvard University. "It's the headline," not really the full picture.
Are there jobs where women are better paid than men?
Not according to C. Nicole Mason, president of the Institute for Women's Policy Research. When men enter female-dominated sectors like nursing or education, the job begins paying more, she explained. But the inverse is not true: "When women enter male-dominated spaces, they don't get paid more than men."

Credit... By The New York Times | Sources: Institute for Women's Policy Research, U.S. Bureau of Labor Statistics

How long will it take to close the pay gap if we do nothing about it?
Mark your calendars for 2059; if current trends continue, the gender wage gap is expected to close in a mere 38 years. For Black and Hispanic women, the deadline is a whole century away. If we do nothing, "my daughter, and daughter's daughter, will not see pay equity in their lives," Dr. Mason said.

So what exactly explains the gap?
There are many factors at play, according to the American Association of University Women.

One of them is that the fields in which women dominate tend to pay less than fields dominated by men. This is irrespective of education or skill required.

The "motherhood penalty" also complicates the wage gap. Moms are less likely to be hired, they receive lower salaries when they are, and are less likely to be tapped on the shoulder for promotion. (Ironic given research suggests moms are some of the most productive employees.)

And women work around two-thirds of the low-paying jobs in the United States; jobs that not only put workers at an economic disadvantage, but also tend to be more unstable.

There is also "invisible labor" - things like caregiving responsibilities and household chores - that women do in addition to their full-time work. "Women perform up to 30 percent more unpaid labor," Dr. Mason said. Not to put too fine a point upon it, but "unpaid labor is unpaid." And it's very hard - if not impossible - to do both your job and take care of the household at the same time.

There's also good old-fashioned sexism at play: Even when men and women are performing the exact same jobs, women tend to receive less compensation thanks to overt or unconscious biases, as well as stereotypes that make it more difficult for women to negotiate.

The pay gap is caused by a "layering effect" of all of these things, said Kimberly Churches, the CEO of the American Association of University Women. Ultimately, "this really is how we value women and how we value women of color in our society," she said.

Did Covid make it worse?
In a year of devastating job loss, especially for women - hence the talk of a "she-cession" - the Institute for Women's Policy Research released a piece of research that seemed, on its face, like good news. In 2020, it found the weekly gender wage gap for full-time workers shrunk to 17.7 percent from 18.5 percent. Seems positive, right? Not so fast.

As Ms. Goldin of Harvard explained, if the female labor force is reduced, but most of those reductions are from the bottom part of distribution (restaurant servers and retail workers, for instance), then women's wages relative to men's will rise.

This manifests as an overall rise in women's wages. And that's what happened here.

But underneath the top-line number, Dr. Mason pointed out, many, many lower-paid female workers are struggling.
What should companies do about it?
Closing the wage gap demands an investment of time and resources.

First, companies can audit workers' pay and collect data to determine the levels of disparity between their male and female workers, said Seren Fong, a vice president at Catalyst. Salesforce, for example, committed to reviewing all its workers' salaries in 2015, and over the following years spent more than $9 million on adjustments to give women equal pay.

Salary bands, which give the range of pay for a given role, can also help level the playing field between male and female workers in salary negotiations. (Though broadly speaking, a wide salary band can provide "too much range to pay people unequally," Dr. Mason said.)
And governments?
The Equal Pay Act, passed nearly 60 years ago, made it illegal to discriminate by sex in setting wages. But in practice, it can be hard for women to know whether they're actually being paid equally. It's not common to ask your colleagues what they make while you're chatting by the water cooler.

In the last decade, more than a dozen states and the District of Columbia have adopted legislation prohibiting pay secrecy in the workplace. Still, a 2017-18 survey found that nearly half of full-time workers were discouraged or prohibited from talking about their pay, meaning more legislation and enforcement is needed.

Ms. Churches also supports passing the Paycheck Fairness Act at a federal level, "so we can ban the use of salary history questions in the hiring process." Such questions "just compound women's lack of earnings going forward as they negotiate their salaries."
And individuals?
Ask your colleagues how much they make, as awkward as that may sound.

Negotiation is also key. Research shows that women who consistently negotiate their salaries make more than $1 million more over the course of their lifetimes, compared with those who don't. But of course, Covid hasn't helped: A new survey from AnnElizabeth Konkel of Indeed suggests women feel even more uncomfortable asking for a raise or promotion than they did prepandemic.

Charts by Lalena Fisher
In Her Words is available as a newsletter. Sign up here to get it delivered to your inbox.

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In 25 Years, the Pay Gap Has Shrunk by Just 8 Cents

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Why does the gender wage gap still exist? And what can be done to close it? We unpack the issue. - Megan Rapinoe, a professional U.S. Soccer player Megan Rapinoe is a two-time World Cup champion who has played to sold-out stadiums around the globe; what she has in common with nearly every American woman is that she's underpaid.

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National Center for Transgender Equality

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Bathroom access for transgender people has recently become a focal point of conversation and debate. This page includes information for transgender people and allies on responding to various questions and concerns regarding bathroom access.

If you need more information on what it means to be transgender, visit Frequently Asked Questions about Transgender People. For more information on how to be supportive of transgender people, visit Supporting the Transgender People in Your Life: A Guide to Being a Good Ally.
Transgender-inclusive policies are not a safety risk.
If they were, we would know by now, as transgender people have been using public bathrooms and locker rooms for decades. Policies that allow transgender people to use the correct bathroom-the bathroom that best matches the transgender person's identity-do not legalize harassment, stalking, violence, or sexual assault. Those behaviors are, and will continue to be, against the law for anyone, anywhere.

Hundreds of cities, school districts, and 18 states already protect transgender people's right to use restrooms, and none have seen a rise in incidents of people attacking anyone or of people pretending to be transgender in order to get access to restrooms.

Similarly, law enforcement officials and sexual assault advocates in states and cities that already have trans-inclusive policies in place have said over and over: the claim that these policies cause safety problems is absurd and completely false.
Forcing transgender people to use private or separate bathrooms is not the solution.
Offering separate or private bathrooms is a great way to ensure anyone can feel comfortable when they go to the bathroom, whether or not they're transgender. However, private bathrooms may be unavailable or very inconvenient to access. More importantly, forcing transgender people to use private bathrooms when other people do not have to is isolating and reinforces the idea that transgender people are somehow harmful and should be kept separate from everybody else.
Excluding transgender people from public restrooms does not protect anyone's privacy.
Lots of people feel uncomfortable in public restrooms, and that was true long before the current public debates about access for transgender people. Transgender people also want privacy in bathrooms and they use the bathroom for the same reason as everyone else: to do their business and leave. Thankfully, bathrooms have stall doors so this is not an issue. Opponents of equal rights are using a desire for privacy-without discussing what privacy truly means-as a way to harm transgender people.

We can have productive and respectful conversations about how to make restrooms and locker rooms more comfortable for everyone, without making it about transgender people.
Allowing transgender people to use the correct bathroom does not mean women will have to share bathrooms with men, or vice-versa.
Transgender-inclusive policies do allow for men's and women's rooms, and do not require gender-neutral bathrooms. Instead, transgender-inclusive policies allow all people-including transgender people-to use the bathroom that best matches their gender identity. Those who are living as women use the women's room, and those that are living as men use the men's restroom.
For many non-binary people, figuring out which bathroom to use can be challenging.
For non-binary people, who don't identify fully as either male or female, using either the women's and the men's room might feel unsafe, because others may verbally harass them or even physically attack them. Non-binary people should be able to use the restroom that they will be safest in. Learn more about non-binary people at Understanding Non-Binary People: How to Be Respectful and Supportive.
Nondiscrimination laws don't violate anyone's religious freedom.
Everyone-including transgender people-should be treated equally under the law. Like all nondiscrimination protections, trans-inclusive policies don't require anyone to change their religious beliefs: they simply ensure that transgender people can live, work, study and participate in public life according to their identities.
Transgender people may have some legal protections, but still need strong and comprehensive nondiscrimination laws and cultural acceptance to truly thrive.
Laws alone won't protect transgender people without increased public awareness, outspoken allies, and a society that values the dignity of transgender people.

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Bathroom access for transgender people has recently become a focal point of conversation and debate. This page includes information for transgender people and allies on responding to various questions and concerns regarding bathroom access. If you need more information on what it means to be transgender, visit Frequently Asked Questions about Transgender People.

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Gender Games

The Georgia Southern University stunt team in Daytona Beach, Fla. Credit... Bill Sallaz

Hundreds of thousands of high school girls put on cheerleading uniforms each year and thousands more continue on to college, taking their place in a thriving American tradition that has been around for nearly as long as football.

While cheerleading evokes images of pompoms and pleated skirts, it has relied on increasingly athletic feats of grace and strength in recent years. As participants have perfected their basket tosses and pyramids, and mounted ambitious floor routines, a complicated and emotional question has arisen: has cheerleading become a true sport?

For many women, especially those who worked at the forefront of the push for equality in college sports, the answer for a long time was no. They feared that calling it a sport sent the wrong message to women - endorsing an embarrassing holdover from a time when girls in tight-fitting outfits were expected to do little more than yell support for boys. Those women were also skeptical of high schools and universities that counted female cheerleaders as athletes as a way to evade their obligation to provide opportunities for women in more traditional sports, like softball and soccer.

But other women bristled at what felt like an insult. Why should cheerleading not be considered a sport when it required a complex set of technical skills, physical fitness and real guts?

Now, in a development that may settle the debate, two groups are asking the National Collegiate Athletic Association to recognize a new version of cheerleading as an "emerging sport" for women, a precursor to full status as a championship sport. If successful, dozens of athletic programs could begin to fully finance cheerleading teams, recruit scholarship athletes and send them to a national championship.

The implications go beyond giving cheerleading a stamp of legitimacy. If this more athletic form of cheerleading - technically known as competitive cheer - evolves into a sport with rigorous competitions and standards, college athletics programs will be able to count the new teams for the purposes of complying with Title IX, the federal law banning gender discrimination in education.

The development could provide relief to institutions that have struggled to show they are offering enough opportunities for women, who make up 53 percent of students at Division I institutions, but just 46 percent of all athletes.

Several women's sports advocates now support the idea. "As long as it's actually operating as a sport, we welcome it into the women's sports tent," said Nancy Hogshead-Makar, the senior director of advocacy at the Women's Sports Foundation. Like gymnastics or figure skating, she said, "this is another aesthetic sport that if done right could provide lots more girls with legitimate sports experiences."

Yet even as the idea has been met with enthusiasm, a fight has broken out between two groups competing to have their vision approved by the N.C.A.A. Each of the proposals calls for athletic displays that incorporate elements of traditional cheerleading, like flips and pyramids, but the groups differ over how to administer and run the new sport.

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The Oregon acrobatic and tumbling cheerleading team. Proponents are pushing to make cheerleading a championship sport. Credit... Eric Evans/University of Oregon

One group, USA Cheer, is backed by Varsity Brands, a for-profit company that sells pompoms and uniforms and has been running competitions for high school and college cheerleaders for decades. The other group is the National Collegiate Athletics and Tumbling Association, which comprises six universities that have been competing against one another for the last couple of years and have the support of USA Gymnastics.

The effort to get cheerleading declared an emerging sport began in earnest last July after a federal judge ruled that Quinnipiac University's competitive cheerleading team did not meet Title IX guidelines for being counted as a sport.

The judge, Stefan R. Underhill of the United States District Court in Bridgeport, found that Quinnipiac's team did not qualify because the team and its participants were not treated the same as other varsity athletes on campus. Athletes were recruited from among the student body, there was no playoff system, and the teams sometimes competed against high school squads.

Both groups say their versions of cheerleading have addressed those concerns, and will eventually allow programs to legitimately count cheerleaders as athletes.

"It's unique to have in essence a sport being developed out of whole cloth," said Karen Morrison, who oversees the emerging sport process for the N.C.A.A.

In 1898, a medical student at the University of Minnesota picked up a megaphone and led his football team to victory in a chant widely credited with giving birth to modern-day cheerleading: "Rah, rah, rah! Ski-U-Mah! Hoo-Rah! Hoo-Rah! Varsity! Varsity! Minn-e-so-tah!"

Cheerleading has been a colorful presence on the sidelines of football games ever since. Men did the cheering at first, and they have maintained a presence - in the early 1960s, George W. Bush was the head cheerleader at Phillips Academy in Andover, Mass. But beginning in the 1920s, women joined their ranks, and cheerleading eventually became a mostly female pastime. Around the same time, participants began adding jumps and other acrobatic stunts to their routines.

In the 1980s and 1990s, urged on by the company that would become Varsity Brands, cheerleading became a highly specialized activity. Competitive cheerleading teams popped up in private gyms and on college campuses, and the championships attracted coverage on national television.

But even as cheerleading edged closer to resembling a sport, advocates for gender equity in sports resisted calling cheerleaders athletes.

"Historically, cheerleading has been about supporting athletes, not about being an athlete," said Barbara Osborne, a scholarship basketball player who graduated from the University of Wisconsin-Parkside in 1982 and who now advises universities on gender-equity issues.

It did not help that some high schools and universities had tried to count standard sideline cheerleaders as athletes as a way to avoid being penalized for failing to deliver opportunities for women in more authentic sports.

The Georgia Southern team at the STUNT championship. Two versions of cheerleading are being considered. One, called acrobatics and tumbling, uses a scoring system similar to gymnastics; the other is a competition in a head-to-head format. Credit... Bill Sallaz

"Traditional sideline cheerleading was always one of the places that schools wanted to go, not because they suddenly felt that it was a great way of boosting equity, but because it was as great way of boosting their rosters," said Lisa Maatz, the director of public policy for the American Association of University Women.

But for women who pursued competitive cheerleading, the lack of recognition felt like disrespect.

"Guess what?" said Valerie Hagedorn, the head cheerleading coach at Adams State College in Colorado, a sideline team that competed in USA Cheer's competitive format this year. "We don't throw balls, we throw people. And we catch them."

The two proposals being considered by the N.C.A.A. share many similarities: the competitions themselves are longer and more standardized than in the past, athletes now wear uniforms more akin to those of volleyball players, and they no longer rally the crowd for another team.

However, they differ in other ways, like how to score the events and how many competitions to stage in any given season. The proposal being advanced by the handful of universities calls the new sport acrobatics and tumbling and uses a scoring system similar to that of gymnastics, with points based on degree of difficulty. The format backed by USA Cheer is called stunt and has a head-to-head format, with the competition divided into quarters.

One important distinction is the size of the teams. The proposal for acrobatics and tumbling, which was submitted to the N.C.A.A. late last year, imagines that an average squad size will number from 32 to 36 athletes, with a maximum of 12 scholarships. The proposal for stunt, which was sent in on Wednesday, envisions a squad of 20 to 30, with a maximum of 24 scholarships.

Six universities competed in the acrobatics and tumbling format this year, while teams from 22 programs competed in the stunt version.

The N.C.A.A.'s emerging sport program, which is aimed at encouraging universities to add new women's sports, has had a mixed track record. Some sports, like women's ice hockey, have gone on to become championship sports; others, like archery, have fizzled.

"It's a bit of a tryout system," Ms. Morrison said.

The N.C.A.A. committee that vets all emerging sports could decide to present both versions to the general membership, it could select only one, or it could ask the two groups to compromise and submit a unified proposal, Ms. Morrison said.

Even if competitive cheerleading is named an emerging sport, there is no guarantee that it will qualify under Title IX guidelines. The Office for Civil Rights, the federal agency that oversees compliance with the law, has said it presumes that a sport can be counted if it is recognized by the N.C.A.A. But institutions must still treat the team similarly to other varsity athletic teams, including offering comparable financial support and rigorous competition and practice schedules.

Ms. Osborne is still wary of allowing universities to count cheerleaders as athletes, but she said she was intrigued by the idea.

"What we consider sports are things that men have traditionally played," she said. But she added: "It's perfectly O.K. for girls to compete in something that is uniquely feminine. I think that we can't just say that sports exist in ways that men define it."

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Born on Sideline, Cheering Clamors to Be Sport (Published 2011)

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Gender Games Hundreds of thousands of high school girls put on cheerleading uniforms each year and thousands more continue on to college, taking their place in a thriving American tradition that has been around for nearly as long as football.

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What is Snowboarding | Snowboarding Information | Go Skiing Go Snowboarding

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What is snowboarding? Find the answer to that question, as well as a historical overview of snowboarding by visiting us now!

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President Biden signed a proclamation Wednesday to mark Equal Pay Day, a day which marks how far women must work into the new year to earn what men made on average in the previous year. U.S. soccer star Megan Rapinoe spoke at a congressional hearing.

Megan Rapinoe: "It's just unacceptable that we're still fighting for equal pay. And I feel like also we've done everything. You want stadiums filled. We filled them. You want role models for your kids, for your boys and your girls and your little trans kids. We have that. You want us to be respectful. You want us to perform on the world stage. You want us to take the Stars and Stripes, the Red, White and Blue, across the entire globe and represent America in the best way possible. We've done all of that. And simply, there's no reason why we're underpaid, for the exception of gender."

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Equal Pay Day: Soccer Star Megan Rapinoe Calls for Gender Pay Equity

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President Biden signed a proclamation Wednesday to mark Equal Pay Day, a day which marks how far women must work into the new year to earn what men made on average in the previous year. U.S. soccer star Megan Rapinoe spoke at a congressional hearing.

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Agriculture in the United States - Wikipedia

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Agriculture is a major industry in the United States, which is a net exporter of food.[1] As of the 2017 census of agriculture, there were 2.04 million farms, covering an area of 900 million acres (1,400,000 sq mi), an average of 441 acres (178 hectares) per farm.[2]

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A federal court in Florida has ruled that it is unconstitutional for schools to ban transgender students from using the restroom that matches their gender identity. Judges of the U.S. Court of Appeals for the 11th Circuit announced on Friday that they are affirming a lower court's ruling on the matter because "a public school may not punish its students for gender nonconformity."

The case was centered around Drew Adams, a 19-year-old former student of Allen D. Nease High School in Ponte Vedra, Florida. Adams, who is transgender, used the boys' restroom at Nease High School, and did so without any issues until an anonymous report was made, according to Lambda Legal. After the report, he was told by school officials that he would only be allowed to use gender-neutral restrooms.

Adams worked with Lambda Legal to sue the school board in June 2017. The U.S. District Court for the Middle District of Florida, a federal court in Jacksonville, ruled in Adams favor in 2018, but Adams' school board appealed the decision last year.

Y'all- The 11th circuit court of appeals said trans rights!! https://t.co/5O8wAzXgn2
- Andrew Adams 🏳️‍🌈✨🛡 (@andrewcodyadams) August 7, 2020

"The School Board's bathroom policy, as applied to Mr. Adams, singled him out for different treatment because of his transgender status," the judges ruled on Friday. "A public school may not punish its students for gender nonconformity. Neither may a public school harm transgender students by establishing arbitrary, separate rules for their restroom use. The evidence at trial confirms that Mr. Adams suffered both these indignities."

The judges said that the schools board did not uphold the 14th Amendment, which guarantees equal rights, and Title IX, which bans sex discrimination in education.

CBS News reached out to the St. Johns County School District for comment. The district has not yet responded.

According to Lambda Legal, this case was the first in the country to go to trial about a transgender student's right to equal access to restrooms.

Tara Borelli, an attorney at Lambda Legal, said that the court's affirmation sent a clear message "that schools must treat transgender students with the same dignity and respect as any other student."

"The trial court was correct when it ruled that the law requires that Drew Adams be treated like every other boy and be allowed to use the boys' restroom," Borelli said. "We are glad the court saw the school board's policy as unjust and discriminatory, and affirmed the inherent dignity and worth of transgender students."

Adams said he's happy to see justice prevail "after spending almost my entire high school career fighting for equal treatment."

"High school is hard enough without having your school separate you from your peers and mark you as inferior," Adams said. "I hope this decision helps save other transgender students from having to go through that painful and humiliating experience."

In 2016, then-President Obama mandated that public schools allow transgender students to use the restrooms that align with their gender identity. After taking office in 2017, President Trump rescinded those orders.
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Li Cohen

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Federal court rules that transgender students must be allowed to use bathrooms that match their gender

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A federal court in Florida has ruled that it is unconstitutional for schools to ban transgender students from using the restroom that matches their gender identity. Judges of the U.S. Court of Appeals for the 11th Circuit announced on Friday that they are affirming a lower court's ruling on the matter because "a public school may not punish its students for gender nonconformity."

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The definition of a sport is 'an activity involving physical exertion and often in a competitive nature.' Cheerleading requires a lot of skill and physical exertion, which therefore qualifies it to be a sport, just like many others.

Cheerleading has many parallels to other sports, such as gymnastics, dance and acrobatics. All of these sports, cheerleading included, require the athletes to be in shape, precise, talented and well-rehearsed.

Physical exertion in cheerleading comes into play mostly in stunting. Stunting in cheerleading includes lifting a person into the air, throwing them and being able to properly catch them. It is extremely crucial that cheerleaders are properly trained, that way they can all remain safe and prevent themselves from getting injuries. In 2012, a study was done by the American Academy of Pediatrics that said cheerleading "accounted for 65% of all direct catastrophic injuries to girl athletes at the high school level and 71% at the college level." This goes to show that cheerleading requires an immense amount of precision and practice in order to avoid injury.

Jumping is also an important and necessary aspect of cheer that requires physical exertion and skill. Jumping requires flexibility, balance and stamina. Cheer jumps put the jumper's body in unnatural positions which take a toll on the athlete if done incorrectly. It takes a lot of repetition and practice to perfect the motions, and make them look sharp for competition.

Cheerleading is often considered not to be a sport because people do not think cheerleaders compete. However, that is not the case, and it is quite the opposite seeing as most cheer teams compete more than once per season. Cheerleading competition performances take a lot of planning and rehearsing in order to pull them off correctly. The performance is based on many different things, such as stunt difficulty and creativity, jump difficulty and execution, motions, synchronization, as well as pyramid difficulty and creativity. Seeing as there are so many categories including in the scoring, you can understand why competitions are so intense.

There is more to cheerleading than just standing on the sidelines and yelling. The sport requires intense physical exertion, a high level of skill, precision, athleticism and a lot of training. This means that saying cheerleading as a whole does not meet the requirements to be considered a sport, it simply incorrect.

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The definition of a sport is 'an activity involving physical exertion and often in a competitive nature.' Cheerleading requires a lot of skill and physical exertion, which therefore qualifies it to be a sport, just like many others. Cheerleading has many parallels to other sports, such as gymnastics, dance and acrobatics.

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lechatnoir / Getty Images

Across the world and throughout the crisis, it was harder to be a woman during the pandemic than a man. According to a report from the United Nations Foundation, COVID-19 "is rapidly unraveling the limited, but precious, progress that the world has made toward gender equality in the past few decades."

Even without the virus, the world would have entered Women's History Month 2021 with the dream of gender-based pay equity still exactly that - a dream. Then came COVID-19, which forced women out of work in greater percentages than men. Women were also more likely to have their hours reduced or pay cut and missed more opportunities to advance in their careers or earn more money.

New Crisis, Age-Old Themes

Women in recent decades have entered the workforce in greater numbers, with more education and in more senior positions than at any time in history, according to the Center for American Progress. Even so, the average American woman earned 82 cents to her male counterpart's dollar even before the virus made things worse.

The reasons are as old as the hills.

"Such a trend falls back into traditional gender fault lines between men and women," said Dr. Janet Ahn, chief behavior science officer at MindGym , a firm that applies psychology and behavioral science to workplace management. "Women traditionally take on more of the physical labor at home, e.g., house chores, childcare, groceries, etc., as well as the mental labor like taking care of tasks, to-dos, reminding partners of their tasks, etc. COVID increased the demand for both these types of labor since everyone is working from home."

Dr. Ahn discussed the phenomenon of "prescriptive" gender stereotypes, whose biases are so pervasive that they're willed into reality.

" What this means is women are assumed to be nurturing, helpful and communal," Ahn said. "These assumptions have implications for prescriptions where women are expected to be nurturing, helpful and communal. For these reasons, women tend to shoulder more of the physical and mental labor at home, ultimately hindering their advancement at work."

Women Are Saddled With a Whole Bunch of 'More Likelies'

When searching for a reason why a crisis disproportionately affects a particular population, a common phrase emerges. According to the United Nations Foundation and the Harvard Business Review, women were "more likely" to be in vulnerable situations that were sure to make the experience harder.

Compared to the larger population, women are:

More likely to work in jobs that are informal, insecure and low-paying

More likely to work in industries that were hardest hit by COVID-19, like service and travel

More likely to experience wage discrimination

More likely to have fewer years experience in the workforce

More likely to shoulder the unpaid responsibilities of caring for children

More likely to serve as primary unpaid caregivers for parents or other elderly or disabled dependents

More likely to get pregnant - this one seems fairly obvious, but it's also incredibly important

The Career Consequences of Pregnancy Vary by Location

Countries like Estonia, Lithuania, Hungary, Latvia, Bulgaria, Slovakia and the Czech Republic give new mothers more than an entire year of paid maternity leave at their full salaries, according to UNICEF. Countries like Denmark, Iceland, Japan, Portugal and many others also guarantee long periods of fully-paid family leave for fathers and almost-wholly subsidized child care.

The United States is the only country in the developed world that guarantees women nothing at all. Unless they qualify for the rare jobs with exceptional benefits, new mothers in America must choose between earning an income and recovering from childbirth and nurturing their infants in those crucial first weeks and months. This reality has forced painful choices on generations of working women in the U.S. But for many women who became mothers during COVID-19, the country's failure to enforce even the most modest income protections made balancing their careers and lives an impossibility.

Fewer Women Will Be on Top When Normalcy Returns

When the discussion shifts to things getting back to normal, it's important to remember what "normal" was before the virus. A 2018 New York Times report found that there are more men named John working as Fortune 500 CEOs, Republican senators and Democratic governors than there are women in any of those positions.

With that handicap already in place, COVID-19 forced even more talented women to leave work to do the things that women have been putting their lives on hold to do for time immemorial. That means the already small sliver of women at the tippy top is almost certain to shrink even more.

"It's hard to say the immediate effect of pay equity at the moment," Ahn said. "But what probably will happen is the gender gap at senior levels will widen. This is because if women cannot advance in their performance or are being forced out of work altogether, there will be fewer women in the pipeline to hire in the future."
More From GOBankingRates
Last updated: March 23, 2021

About the Author

Andrew Lisa has been writing professionally since 2001. An award-winning writer, Andrew was formerly one of the youngest nationally distributed columnists for the largest newspaper syndicate in the country, the Gannett News Service. He worked as the business section editor for amNewYork, the most widely distributed newspaper in Manhattan, and worked as a copy editor for TheStreet.com, a financial publication in the heart of Wall Street's investment community in New York City.

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Gender Pay Equity Is More at Risk Than Ever During the Pandemic

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lechatnoir / Getty Images Across the world and throughout the crisis, it was harder to be a woman during the pandemic than a man. According to a report from the United Nations Foundation, COVID-19 "is rapidly unraveling the limited, but precious, progress that the world has made toward gender equality in the past few decades."

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Brandon Wexler helps a customer look at weapons Wednesday at Wex Gunworks in Delray Beach, Fla.. (Joe Raedle/Getty Images)

A South Carolina state senator is proposing that every citizen in the state over 17 who can legally own a gun become a member of a militia to prevent federal laws from allowing gun seizures or restrictions.

According to South Carolina's Constitution, the governor has the power to call up an "unorganized militia " comprising "all able-bodied male citizens of the State between the ages of eighteen and forty-five years."

Sen. Tom Corbin (R) is proposing expanding membership to the militia to everyone who is 17 years and older, arguing that if many residents are part of this regulated militia, it would protect them from federal restrictions on weapons.

Corbin did not immediately respond to requests for comment, but in an interview with the Associated Press he said his proposal could "prevent the federal government from ever confiscating any of your weapons because at the end of the day the federal government cannot disarm a standing army."

The bill speaks to the lengths to which legislators may go to make a political statement regarding potential federal gun laws through unorthodox local initiatives, according to experts.

Adam Winkler, a professor at UCLA School of Law who specializes in constitutional law and the Second Amendment, said the bill is part of a larger trend of conservative states pushing to make strong political statements opposing gun control, amid mounting calls for regulation.

"There is an increasing number of red states where laws are being proposed or passed to prevent federal laws from operating in those states," he said.

Support is moving in favor of gun control - but is it enough to pass new laws?

The bill, sponsored by several Republican senators, including Sens. Dwight A. Loftis, Josh Kimbrell, Billy Garrett and Tom Rice, and first introduced by Corbin in February, claims that all militia members "shall have the right to possess and keep all arms," including rifles, shotguns, handguns and magazines, acquired by South Carolina residents as of Dec. 31, 2020.

This week, a Senate subcommittee approved the bill on a party-line vote and moved it to a full committee meeting on Wednesday.

Winkler argued that however controversial the proposal may be, it lacks constitutional basis because federal laws have supremacy and Congress has the power to organize and regulate state militias.

"The problem is that you can't always do it with state law, because of the supremacy of federal laws," Winkler added. "And so some of these local initiatives are ineffective and mostly symbolic politics."

The initiative underscores the political divide surrounding gun-control debate despite recurring incidents of mass shootings across the country and pervasive gun violence. Republicans and conservatives often invoke Second Amendment rights as sacrosanct, while Democrats often call for limits on guns.

In the wake of the Boulder, Colo., shooting, the second mass shooting in a week, President Biden urged Congress to pass gun-control laws and said he may take action on his own to stop mass violence.

Yet experts and advocates argue significant federal legislation is an uphill battle, considering that no major federal legislation has been passed in decades, because of how socially divisive and partisan the issue has become.

Only last week, the day after eight people were killed at three Asian spas in the Atlanta area, South Carolina's state House approved an open-carry bill, also sponsored by Corbin, that allows people who have permission to have concealed weapons to carry them visibly out in public.

After Boulder shootings, the U.S. again ponders gun control

After hours of debate, the bill was widely supported by Republicans, with some Democrats joining in.

And on the very same day 10 people were killed at a supermarket in Boulder, the Iowa legislature passed a bill that allows state residents to purchase and carry handguns without permits.

Only 10 days before the tragedy took place, a judge blocked a ban on assault weapons in Boulder that was first pushed to prevent mass shootings from happening.

Corbin first introduced the "militia bill" in 2013 when then-President Barack Obama proposed extensive laws to end gun violence, including reinstating a ban on assault weapons. The bill did not pass.

The senator said it was not a coincidence that he had proposed it again this year after another Democrat had taken office.

"With a Republican administration in control in Washington, I didn't fear any gun confiscation," Corbin told the AP.

Mass shootings often add momentum to the push for gun reform. In the years following the Sandy Hook school shooting in Connecticut in 2012, in which 26 people were killed, including 20 first-grade children, the gun-control movement has become reinvigorated, leading 13 Democratic-run states to enact or expand background checks for new gun purchases.

But with tighter laws came an equally vigorous pro-gun rights response: More than a dozen other states passed laws that allow citizens to purchase guns with no permits at all.

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State senator wants to shield people from gun-control laws by making them all militia members

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A South Carolina state senator is proposing that every citizen in the state over 17 who can legally own a gun become a member of a militia to prevent federal laws from allowing gun seizures or restrictions.

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Gender-neutral Bathrooms Are Radical, but Not How You Think

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For decades, laws have mandated that public bathrooms be accessible; they must contain specific features, like larger stalls or lower sinks, to accommodate those whose needs aren’t met by standard bathrooms, like people who use wheel chairs. Sometimes, public places also have a bathroom that is larg…

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The extent of the human contribution to modern global warming is a hotly debated topic in political circles, particularly in the US.

During a recent congressional hearing, Rick Perry, the US energy secretary, remarked that "to stand up and say that 100% of global warming is because of human activity, I think on its face, is just indefensible".

However, the science on the human contribution to modern warming is quite clear. Humans emissions and activities have caused around 100% of the warming observed since 1950, according to the Intergovernmental Panel on Climate Change's (IPCC) fifth assessment report.

Here Carbon Brief examines how each of the major factors affecting the Earth's climate would influence temperatures in isolation - and how their combined effects almost perfectly predict long-term changes in the global temperature.

Carbon Brief's analysis finds that:

Since 1850, almost all the long-term warming can be explained by greenhouse gas emissions and other human activities.

If greenhouse gas emissions alone were warming the planet, we would expect to see about a third more warming than has actually occurred. They are offset by cooling from human-produced atmospheric aerosols.

Aerosols are projected to decline significantly by 2100, bringing total warming from all factors closer to warming from greenhouse gases alone.

Natural variability in the Earth's climate is unlikely to play a major role in long-term warming.

Animation by Rosamund Pearce for Carbon Brief. Images via Alamy Stock Photo.

How much warming is caused by humans?

In its 2013 fifth assessment report, the IPCC stated in its summary for policymakers that it is "extremely likely that more than half of the observed increase in global average surface temperature" from 1951 to 2010 was caused by human activity. By "extremely likely", it meant that there was between a 95% and 100% probability that more than half of modern warming was due to humans.

This somewhat convoluted statement has been often misinterpreted as implying that the human responsibility for modern warming lies somewhere between 50% and 100%. In fact, as NASA's Dr Gavin Schmidt has pointed out, the IPCC's implied best guess was that humans were responsible for around 110% of observed warming (ranging from 72% to 146%), with natural factors in isolation leading to a slight cooling over the past 50 years.

Similarly, the recent US fourth national climate assessment found that between 93% to 123% of observed 1951-2010 warming was due to human activities.

These conclusions have led to some confusion as to how more than 100% of observed warming could be attributable to human activity. A human contribution of greater than 100% is possible because natural climate change associated with volcanoes and solar activity would most likely have resulted in a slight cooling over the past 50 years, offsetting some of the warming associated with human activities.

'Forcings' that change the climate

Scientists measure the various factors that affect the amount of energy that reaches and remains in the Earth's climate. They are known as "radiative forcings".

These forcings include greenhouse gases, which trap outgoing heat, aerosols - both from human activities and volcanic eruptions - that reflect incoming sunlight and influence cloud formation, changes in solar output, changes in the reflectivity of the Earth's surface associated with land use, and many other factors.

To assess the role of each different forcing in observed temperature changes, Carbon Brief adapted a simple statistical climate model developed by Dr Karsten Haustein and his colleagues at the University of Oxford and University of Leeds. This model finds the relationship between both human and natural climate forcings and temperature that best matches observed temperatures, both globally and over land areas only.

The figure below shows the estimated role of each different climate forcing in changing global surface temperatures since records began in 1850 - including greenhouse gases (red line), aerosols (dark blue), land use (light blue), ozone (pink), solar (yellow) and volcanoes (orange).

The black dots show observed temperatures from the Berkeley Earth surface temperature project, while the grey line shows the estimated warming from the combination of all the different types of forcings.

Global mean surface temperatures from Berkeley Earth (black dots) and modeled influence of different radiative forcings (colored lines), as well as the combination of all forcings (grey line) for the period from 1850 to 2017. See methods at the end of the article for details. Chart by Carbon Brief using Highcharts.

The combination of all radiative forcings generally matches longer-term changes in observed temperatures quite well. There is some year-to-year variability, primarily from El Niño events, that is not driven by changes in forcings. There are also periods from 1900-1920 and 1930-1950 where some larger disagreements are evident between projected and observed warming, both in this simple model and in more complex climate models.

The chart highlights that, of all the radiative forcings analysed, only increases in greenhouse gas emissions produce the magnitude of warming experienced over the past 150 years.

If greenhouse gas emissions alone were warming the planet, we would expect to see about a third more warming than has actually occurred.

So, what roles do all the other factors play?

The extra warming from greenhouse gases is being offset by sulphur dioxide and other products of fossil fuel combustion that form atmospheric aerosols. Aerosols in the atmosphere both reflect incoming solar radiation back into space and increase the formation of high, reflective clouds, cooling the Earth.

Ozone is a short-lived greenhouse gas that traps outgoing heat and warms the Earth. Ozone is not emitted directly, but is formed when methane, carbon monoxide, nitrogen oxides and volatile organic compounds break down in the atmosphere. Increases in ozone are directly attributable to human emissions of these gases.

In the upper atmosphere, reductions in ozone associated with chlorofluorocarbons (CFCs) and other halocarbons depleting the ozone layer have had a modest cooling effect. The net effects of combined lower and upper atmospheric ozone changes have modestly warmed the Earth by a few tenths of a degree.

Changes in the way land is used alter the reflectivity of the Earth's surface. For example, replacing a forest with a field will generally increase the amount of sunlight reflected back into space, particularly in snowy regions. The net climate effect of land-use changes since 1850 is a modest cooling.

Volcanoes have a short-term cooling effect on the climate due to their injection of sulphate aerosols high into the stratosphere, where they can remain aloft for a few years, reflecting incoming sunlight back into space. However, once the sulphates drift back down to the surface, the cooling effect of volcanoes goes away. The orange line shows the estimated impact of volcanoes on the climate, with large downward spikes in temperatures of up to 0.4C associated with major eruptions.

January 3, 2009 - Santiaguito eruption, Guatemala. Credit: Stocktrek Images, Inc. / Alamy Stock Photo.

Finally, solar activity is measured by satellites over the past few decades and estimated based on sunspot counts in the more distant past. The amount of energy reaching the Earth from the sun fluctuates modestly on a cycle of around 11 years. There has been a slight increase in overall solar activity since the 1850s, but the amount of additional solar energy reaching the Earth is small compared to other radiative forcings examined.

Over the past 50 years, solar energy reaching the Earth has actually declined slightly, while temperatures have increased dramatically.

Human forcings match observed warming

The accuracy of this model depends on the accuracy of the radiative forcing estimates. Some types of radiative forcing like that from atmospheric CO2 concentrations can be directly measured and have relatively small uncertainties. Others, such as aerosols, are subject to much greater uncertainties due to the difficulty of accurately measuring their effects on cloud formation.

These are accounted for in the figure below, which shows combined natural forcings (blue line) and human forcings (red line) and the uncertainties that the statistical model associates with each. These shaded areas are based on 200 different estimates of radiative forcings, incorporating research attempting to estimate a range of values for each. Uncertainties in human factors increase after 1960, driven largely by increases in aerosol emissions after that point.

Global mean surface temperatures from Berkeley Earth (black dots) and modelled influence of all combined natural (blue line) and human (red line) radiative forcings with their respective uncertainties (shaded areas) for the period from 1850 to 2017. The combination of all natural and human forcings (grey line) is also shown. See methods at the end of the article for details. Chart by Carbon Brief using Highcharts.

Overall, warming associated with all human forcings agrees quite well with observed warming, showing that about 104% of the total since the start of the "modern" period in 1950 comes from human activities (and 103% since 1850), which is similar to the value reported by the IPCC. Combined natural forcings show a modest cooling, primarily driven by volcanic eruptions.

The simple statistical model used for this analysis by Carbon Brief differs from much more complex climate models generally used by scientists to assess the human fingerprint on warming. Climate models do not simply "fit" forcings to observed temperatures. Climate models also include variations in temperature over space and time, and can account for different efficacies of radiative forcings in different regions of the Earth.

However, when analysing the impact of different forcings on global temperatures, complex climate models generally find results similar to simple statistical models. The figure below, from the IPCC's Fifth Assessment Report, shows the influence of different factors on temperature for the period from 1950 to 2010. Observed temperatures are shown in black, while the sum of human forcings is shown in orange.

Figure TS10 from the IPCC Fifth Assessment Report. Observed temperatures are from HadCRUT4. GHG is all well-mixed greenhouse gases, ANT is total human forcings, OA is human forcings apart from GHG (mostly aerosols), NAT is natural forcings (solar and volcanoes), and Internal Variability is an estimate of the potential impact of multidecadal ocean cycles and similar factors. Error bars show one-sigma uncertainties for each. Source: IPCC.

This suggests that human forcings alone would have resulted in approximately 110% of observed warming. The IPCC also included the estimated magnitude of internal variability over that period in the models, which they suggest is relatively small and comparable to that of natural forcings.

As Prof Gabi Hegerl at the University of Edinburgh tells Carbon Brief: "The IPCC report has an estimate that basically says the best guess is no contribution [from natural variability] with not that much uncertainty."

Land areas are warming faster

Land temperatures have warmed considerably faster than average global temperatures over the past century, with temperatures reaching around 1.7C above pre-industrial levels in recent years. The land temperature record also goes back further in time than the global temperature record, though the period prior to 1850 is subject to much greater uncertainties.

Both human and natural radiative forcings can be matched to land temperatures using the statistical model. The magnitude of human and natural forcings will differ a bit between land and global temperatures. For example, volcanic eruptions appear to have a larger influence on land, as land temperatures are likely to respond faster to rapid changes in forcings.

The figure below shows the relative contribution of each different radiative forcing to land temperatures since 1750.

Land mean surface temperatures from Berkeley Earth (black dots) and modeled influence of different radiative forcings (colored lines), as well as the combination of all forcings (grey line) for the period from 1750 to 2017. Chart by Carbon Brief using Highcharts.

The combination of all forcings generally matches observed temperatures quite well, with short-term variability around the grey line primarily driven by El Niño and La Niña events. There is a wider variation in temperatures prior to 1850, reflecting the much larger uncertainties in the observational records that far back.

There is still a period around 1930 and 1940 where observations exceed what the model predicts, though the differences are less pronounced than in global temperatures and the 1900-1920 divergence is mostly absent in land records.

Volcanic eruptions in the late 1700s and early 1800s stand out sharply in the land record. The eruption of Mount Tambora in Indonesia in 1815 may have cooled land temperatures by a massive 1.5C, though records at the time were limited to parts of the Northern Hemisphere and it is, therefore, hard to draw a firm conclusion about global impacts. In general, volcanoes appear to cool land temperatures by nearly twice as much as global temperatures.

What may happen in the future?

Carbon Brief used the same model to project future temperature changes associated with each forcing factor. The figure below shows observations up to 2017, along with future post-2017 radiative forcings from RCP6.0, a medium-to-high future warming scenario.

Global mean surface temperatures from Berkeley Earth (black dots) and modeled influence of different radiative forcings (colored lines) for the period from 1850 to 2100. Forcings post-2017 taken from RCP6.0. Chart by Carbon Brief using Highcharts.

When provided with the radiative forcings for the RCP6.0 scenario, the simple statistical model shows warming of around 3C by 2100, nearly identical to the average warming that climate models find.

Future radiative forcing from CO2 is expected to continue to increase if emissions rise. Aerosols, on the other hand, are projected to peak at today's levels and decline significantly by 2100, driven in large part by concerns about air quality. This reduction in aerosols will enhance overall warming, bringing total warming from all radiative forcing closer to warming from greenhouse gases alone. The RCP scenarios assume no specific future volcanic eruptions, as the timing of these is unknowable, while solar output continues its 11-year cycle.

This approach can also be applied to land temperatures, as shown in the figure below. Here, land temperatures are shown between 1750 and 2100, with post-2017 forcings also from RCP6.0.

Land mean surface temperatures from Berkeley Earth (black dots) and modeled influence of different radiative forcings (colored lines) for the period from 1750 to 2100. Forcings post-2017 taken from RCP6.0. Chart by Carbon Brief using Highcharts.

The land is expected to warm about 30% faster than the globe as a whole, as the rate of warming over the oceans is buffered by ocean heat uptake. This is seen in the model results, where land warms by around 4C by 2100 compared to 3C globally in the RCP6.0 scenario.

There is a wide range of future warming possible from different RCP scenarios and different values for the sensitivity of the climate system, but all show a similar pattern of declining future aerosol emissions and a larger role for greenhouse gas forcing in future temperatures.

The role of natural variability

While natural forcings from solar and volcanoes do not seem to play much of a role in long-term warming, there is also natural variability associated with ocean cycles and variations in ocean heat uptake.

As the vast majority of energy trapped by greenhouse gases is absorbed by the oceans rather than the atmosphere, changes in the rate of ocean heat uptake can potentially have large impacts on the surface temperature. Some researchers have argued that multidecadal cycles, such as the Atlantic Multidecadal Oscillation (AMO) and Pacific Decadal Oscillation (PDO), can play a role in warming at a decadal scale.

While human factors explain all the long-term warming, there are some specific periods that appear to have warmed or cooled faster than can be explained based on our best estimates of radiative forcing. For example, the modest mismatch between the radiative forcing-based estimate and observations during the mid-1900s might be evidence of a role for natural variability during that period.

A number of researchers have examined the potential for natural variability to impact long-term warming trends. They have found that it generally plays a limited role. For example, Dr Markus Huber and Dr Reto Knutti at the Institute for Atmospheric and Climate Science (IAC) in Zurich found a maximum possible contribution of natural variability of around 26% (+/- 12%) over the past 100 years and 18% (+/- 9%) over the past 50 years.

Knutti tells Carbon Brief:

"We can never completely rule out that natural variability is larger than we currently think. But that is a weak argument: you can, of course, never rule out the unknown unknown. The question is whether there is strong, or even any evidence for it. And the answer is no, in my view.

Models get the short-term temperature variability approximately right. In many cases, they even have too much. And for the long term, we can't be sure because the observations are limited. But the forced response pretty much explains the observations, so there is no evidence from the 20th century that we are missing something...

Even if models were found to underestimate internal variability by a factor of three, it is extremely unlikely [less than 5% chance] that internal variability could produce a trend as large as observed."

Similarly, Dr Martin Stolpe and colleagues, also at IAC, recently analysed the role of multidecadal natural variability in both the Atlantic and Pacific oceans. They found that "less than 10% of the observed global warming during the second half of the 20th century is caused by internal variability in these two ocean basins, reinforcing the attribution of most of the observed warming to anthropogenic forcings".

Internal variability is likely to have a much larger role in regional temperatures. For example, in producing unusually warm periods in the Arctic and the US in the 1930s. However, its role in influencing long-term changes in global surface temperatures appears to be limited.

Conclusion

While there are natural factors that affect the Earth's climate, the combined influence of volcanoes and changes in solar activity would have resulted in cooling rather than warming over the past 50 years.

The global warming witnessed over the past 150 years matches nearly perfectly what is expected from greenhouse gas emissions and other human activity, both in the simple model examined here and in more complex climate models. The best estimate of the human contribution to modern warming is around 100%.

Some uncertainty remains due to the role of natural variability, but researchers suggest that ocean fluctuations and similar factors are unlikely to be the cause of more than a small fraction of modern global warming.
Methodology
The simple statistical model used in this article is adapted from the Global Warming Index published by Haustein et al ( 2017). In turn, it is based on the Otto et al ( 2015) model.

The model estimates contributions to observed climate change and removes the impact of natural year-to-year fluctuations by a multiple linear regression of observed temperatures and estimated responses to total human-induced and total natural drivers of climate change. The forcing responses are provided by the standard simple climate model given in Chapter 8 of IPCC ( 2013), but the size of these responses is estimated by the fit to the observations. The forcings are based on IPCC (2013) values and were updated to 2017 using data from NOAA and ECLIPSE. 200 variations of these forcings were provided by Dr. Piers Forster of the University of Leeds, reflecting the uncertainty in forcing estimates. An Excel spreadsheet containing their model is also provided.

The model was adapted by calculating forcing responses for each of the different major climate forcings rather than simply total human and natural forcings, using the Berkeley Earth record for observations. The decay time of thermal response used in converting forcings to forcing responses was adjusted to be one year rather than four years for volcanic forcings to better reflect the fast response time present in observations. The effects of El Niño and La Niña (ENSO) events was removed from the observations using an approach adapted from Foster and Rahmstorf ( 2011) and the Kaplan El Niño 3.4 index when calculating the volcanic temperature response, as the overlap between volcanoes and ENSO otherwise complicates empirical estimates.

The temperature response for each individual forcing was calculated by scaling their forcing responses by the total human or natural coefficients from the regression model. The regression model was also run separately for land temperatures. Temperature responses for each forcing between 2018 and 2100 were estimated using forcing data from RCP6.0, normalised to match the magnitude of observed forcings at the end of 2017.

Uncertainties in total human and total natural temperature response was estimated using a Monte Carlo analysis of 200 different forcing series, as well as the uncertainties in the estimated regression coefficients. The Python code used to run the model is archived with GitHub and available for download.

Observational data from 2017 shown in the figures is based on the average of the first 10 months of the year and is likely to be quite similar to the ultimate annual value.

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Analysis: Why scientists think 100% of global warming is due to humans - Carbon Brief

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The science on the human contribution to modern warming is quite clear. Humans emissions and activities have caused around 100% of the warming observed.

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The U.S. agriculture sector extends beyond the farm business to include a range of farm-related industries. Agriculture, food, and related industries contributed 5.4 percent to U.S. gross domestic product and provided 10.4 percent of U.S. employment; Americans' expenditures on food amount to 12.8 percent of household budgets, on average. Among Federal Government outlays on farm and food programs, nutrition assistance far outpaces other programs.

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The U.S. agriculture sector extends beyond the farm business to include a range of farm-related industries. Agriculture, food, and related industries contributed 5.4 percent to U.S. gross domestic product and provided 10.4 percent of U.S. employment; Americans' expenditures on food amount to 12.8 percent of household budgets, on average.

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Facing a pandemic, record unemployment and unknown future costs for COVID-19 treatments, health insurers selling Affordable Care Act plans to individuals reacted by lowering rates in some areas and, overall, issuing only modest premium increases for 2021.

"What's been fascinating is that carriers in general are not projecting much impact from the pandemic for their 2021 premium rates," said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University in Washington, D.C.

Although final rates have yet to be analyzed in all states, those who study the market say the premium increases they have seen to date will be in the low single digits - and decreases are not uncommon.

That's good news for the more than 10 million Americans who purchase their own ACA health insurance through federal and state marketplaces. The federal market, which serves 36 states, opens for 2021 enrollment Nov. 1, with sign-up season ending Dec. 15. Some of the 14 states and the District of Columbia that operate their own markets have longer enrollment periods.

The flip side of flat or declining premiums is that some consumers who qualify for subsidies to help them purchase coverage may also see a reduction in that aid. Subsidies are determined by a mix of a consumer's income and the cost of a benchmark plan.

Here are a few things to know about 2021 coverage:
It might cost about the same this year - or even less.
Despite the ongoing debate about the ACA - compounded by a Supreme Court challenge brought by 20 states and supported by the Trump administration - enrollment and premium prices are not forecast to shift much.

"It's the third year in a row with premiums staying pretty stable," said Louise Norris, an insurance broker in Colorado who follows rates nationwide and writes about insurance trends. "We've seen modest rate changes and influx of new insurers."

That relative stability followed ups and downs, with the last big increases coming in 2018, partly in response to the Trump administration cutting some payments to insurers.

Those increases priced out some enrollees, particularly people who don't qualify for subsidies, which are tied both to income and the cost of premiums. ACA enrollment has fallen since its peak in 2016.

Charles Gaba, a web developer who has since late 2013 tracked enrollment data in the ACA on his ACASignups.net website, follows premium changes based on filings with state regulators. Each summer, insurers must file their proposed rates for the following year with states, which have varying oversight powers.

Gaba said the average requested increase next year nationwide is 2.1%. When he looked at 18 states for which regulators have approved insurers' requested rates, the percentage is lower at 0.4%.

A study by KFF, of preliminary premiums filed this summer, had similar findings: Premium changes in 2021 would be modest, only a few percentage points up or down. (KHN is an editorially independent program of KFF.)
It's still worth it to shop around.
Actuaries and other experts say premiums vary by state or region - even by insurer - for a number of reasons, including the number and relative market power of insurers or hospitals in an area, which affects the ability of insurers to negotiate rates with providers.

For consumers who rely on subsidies to help cover premium costs, be aware: subsidies are tied to each region's benchmark plan - that's the second-lowest-priced silver plan in a region - and since those premium costs may have gone down, subsidies also could decrease.

Switching to the benchmark plan can help consumers maintain how much they spend in premiums.

Enrollees should update their financial information, particularly this year when many are affected by work reduction or job losses. "They might be eligible for a bigger subsidy," said Myra Simon, executive director of commercial policies for America's Health Insurance Plans, the industry lobbying group.

Enrollees can update their information online or call their federal or state marketplace for assistance. Insurance brokers, too, can aid people in signing up for ACA plans. When shopping, consumers should check whether the doctors and hospitals they want to use are included in the plan's network.

Premiums are just one part of the equation. Consumers should also look closely at annual deductibles, because the trade-off of going with a lower-cost premium may well be higher annual deductibles that must be met before much of the coverage kicks in.

"We encourage people to consider all their options," said Simon.
Your choice of insurers may have widened.
More insurers, including UnitedHealth Group, either stepped back into that individual market or expanded into new counties.

"Insurers are seeing a profit or potential for it," said John Dodd, an insurance broker in Columbus and past president of the Ohio Association of Health Underwriters.

Rates are down in general across his state for ACA plans, he said, and he expects agents to be busier than ever, simply because there are more plan offerings and choices to make and people want help.

Insurers, he said, like the way the ACA is working.

"People on TV who say it's not working, they don't know what they're talking about," said Dodd. "It's working well [for insurers] and every year it gets better."
What's behind the premium changes?
Enrollees in some states next year will see premium decreases, according to Gaba's website: Maine, for example, shows a 13% drop in weighted average premium prices, while Maryland's is down almost 12%. At the same time, Indiana's average is up 10%. And Kentucky is up 5%.

Both Maine and Maryland attribute the decrease to state programs that provide reinsurance payments to health insurers to help offset high-cost medical claims.

In Florida, regulators say insurance premiums will rise about 3%, while the state exchange in California is reporting just over a half-percent increase, its lowest average increase since opening in 2014. Officials in California cite factors that include an influx of healthier enrollees and a reduction in fees that insurers pay.

Other factors affecting rates include how much state regulators step in to alter initial rate filings, along with a provision of the ACA that requires insurers to spend at least 80% of revenue on direct medical care. If insurers don't meet that standard, they must issue rebates to policyholders. Many insurers were already on the hook to return money in 2020 for previous years.

Most insurers did not cite additional COVID treatment or testing costs as factors in their requested rate increase, Gaba said. Even those that did, however, mainly found them unnecessary because of reduced expenditures resulting from patients delaying elective care during the spring and summer.

Indeed, many insurers in the second quarter posted record profits.

"Some of them thought, 'We're going to make more than we thought this year in profits, so let's not be aggressive with pricing next year,'" said Donna Novak, a member of the American Academy of Actuaries' Individual and Small Group Markets Committee.

A smaller factor may be the repeal of a fee paid by insurers on premiums. Part of the ACA, the fee was permanently eliminated by the Trump administration effective for 2021.
New marketplaces in some states, and a public option.
Residents of New Jersey and Pennsylvania will buy coverage from new state-based marketplaces for 2021, after those states pulled out of the federal healthcare.gov, which now covers 36 states.

Lawmakers in those states said running their own marketplaces gives them more control and may save them money over time.

In 19 Washington state counties, insurers are offering "public option plans," which have all the standard benefits, including lower deductibles, and must meet additional quality standards.

As envisioned, the public option plans aimed to be less expensive, with the legislation tying payment rates to Medicare. Insurers offering a public option must stick to an aggregate cap of paying doctors, hospitals and other medical providers an average of 160% of what Medicare would pay for the same services.

When the premium rates came in, however, the five insurers offering the plans had varying prices. Not all parts of the state have the option, but where they do, two of the public option insurers have premiums that are either lower than other plans in the area or are the lowest-cost plan the insurer offers.

But three are more expensive.

The state's marketplace staff said the higher prices may reflect a number of things, from difficulty getting the program started during COVID-19, to a lack of incentives to get providers to participate.

It could also just be normal first-year jitters.

"It's Year 1. As with any market entry strategy, people are pretty conservative," said Michael Marchand, chief marketing officer of the Washington Health Benefit Exchange.
(Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

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The Affordable Care Act's Fate Is In Flux But 2021 Health Plan Prices Are Stable

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The Affordable Care Act's future is uncertain and there's no end in sight to the pandemic. But for the 2021 insurance year consumers can expect to see modest increases in prices, if any.

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Dive Brief:

Forty-four states have enacted pay equity laws since the federal Equal Pay Act of 1963 was signed into legislation, according to Syndio, a pay equity analytics platform, and Fair Pay Workplace, a nonprofit. But despite the "well-intentioned" laws, progress on closing the pay gap has stalled, "The State of Pay Equity Laws in the U.S.-2021," a March 11 report found. The pay equity laws are missing some of the key components to make them "effective for employees and feasible for companies to comply," according to the report.

Based on research, Syndio and Fair Pay Workplace outlined components to be included in laws to ensure fair pay and support compliance. The laws must analyze both the pay gap and pay equity; have "equal work" compare employees based on "substantially similar or comparable work"; use a broader comparison than the "same establishment" clause; and provide guidance on neutral, position-related pay policies, according to the report. The organizations also recommended laws require pay equity based on gender and race; permit underpaid employees to file lawsuits; require pay equity disclosure and reporting; provide "safe harbor protections"; and require accountability when pay equity disparities go unaddressed.

"Despite a growing number of state and federal rules encouraging pay equity, the U.S. is persistently behind in closing the pay gap," Syndio CEO Maria Colacurcio, said in a statement. "Many laws stifle employers' ability to make progress on pay equity, while others have flaws that don't fully protect the people who are not being paid fairly."

Dive Insight:

Many companies were working to move the needle on pay equity as a new law aiming to end the gender wage gap was reintroduced in Congress.

The Biden administration is expected to have an increased focus on pay equity, according to experts. The Paycheck Fairness Act was reintroduced into Congress Jan. 28. The bill would "strengthen the Equal Pay Act of 1963, help eliminate the gender wage gap, and guarantee that women can challenge pay discrimination and hold employers accountable," according to an announcement. In reference to Syndio and Fair Pay Workplace's report, Colacurcio advised that "it's important to ensure any new laws protect the rights of individuals and are feasible for companies."

A 2019 Pay Equity Practices Survey of C-suite and reward leaders produced by WorldatWork and Korn Ferry found that more than half (60%) of employers surveyed were taking action to address pay equity. However, 7% said pay equity was not a priority. "A convergence of regulatory, political, social and economic forces is causing organizations to address pay equity management; ignoring the issues will ultimately impact employee engagement and an organization's bottom line," Korn Ferry Senior Client Partner Tom McMullen said in the report.

But even if companies desire to work toward pay equity, Syndio and Fair Pay Workplace's report argued pay equity laws need to include action items such as mandatory pay equity disclosures. Government-mandated disclosures of pay disparities have been shown to narrow the gender wage gap, a 2019 research report found .

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Most pay equity laws stifle employers' ability to make progress

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Forty-four states have enacted pay equity laws since the federal Equal Pay Act of 1963 was signed into legislation, according to Syndio, a pay equity analytics platform, and Fair Pay Workplace, a nonprofit. But despite the "well-intentioned" laws, progress on closing the pay gap has stalled, "The State of Pay Equity Laws in the U.S.-2021," a March 11 report found.

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What Makes a sport a sport?

Sports play a vital role in our life. It is an incredibly increased the physical fitness and flexibility of joints and muscles that molds body easily in any pose. Sports (man or women), each train hard to get their best set of records.

Like a football team who actually compete against another team to score points and try to win the game, besides this, on the sidelines the football team's cheerleaders constantly supporting their team.

To display the perfect routine in games, a cheerleader comparatively practices hard than a football or basketball player does. Some people say cheerleading is relevant to athletic activity and cheerleading is a sport but some have a question in mind that is cheerleading a sport?

Is cheerleading a sport?

Updated: 11 April 2018
Reasons Why Cheerleading is a Sport
There are many arguments made why cheerleading is a sport, in history, the cheerleading was started after the world war two by students, against the bad attitude and harsh treatment of teachers. Students developed their own extracurricular activities to gain independence from their faculty abuses. This was the beginning of American Sports that initially started with the collegiate team. On November 6, 1869, the first intercollegiate football game was played in the United States of America with shouted a cheer of "Hurrah! Hurrah! Hurrah! Tiger! S-s-s-t! Boom! A-h-h-h!" of fans and students who were attending games. In the beginning, cheerleading involves by all-male activity but after some years it began to consider feminine activity at every school and collegiate level across the country. Professional cheerleading was started in 1950 and women were selected for two reasons to encourage their teams to compete their team by exposing visual sex appeal an ability to dance sophisticatedly

Cheerleading is a sport

So IOC (the International Olympic Committee) was given provisional status to cheerleading to become an Olympic sport in the future.

In 2016 the new York times report said, the IOC (the International Olympic Committee) executive board voted on Tuesday to recognize cheerleading as a sport but doesn't important that cheerleader will be able to participate in the year of 2018 Olympic Games in Pyeongchang or in 2020 Games in Tokyo. From IOC prospect the International Cheer Union, will receive at least $25,000 every year and get chance to apply for further endowments. This sport takes a period of three years and during this time, IOC execs can vote at any time to recognize the sport and then ICU can request to add in the Games. If the request is accepted or approved then cheerleading officially becomes part of an Olympic sport!

As the days of pom pom and claps are over and things are more complex and competitive just like "All-Star" cheerleading which is different from American football or basketball. Cheerleaders work hard to polish their steps to compete with each other in a head to head fashion. Every squad has to do physical exertion to create performance routine. It is a tough part of training as compared to any other competitive sport.

The U.S. All Star Federation organizes cheerleading competition within safety limits and dictates rules of conduct.

Why is Cheerleading the most Dangerous Sport

When you see from a cheerleader perspective, you will analyze the facts and realize how difficult for a squad to do flips, lift up another girl whose size is bigger than a ball and hold her up in the air and do a full stunt sequence without dropping her. So to throw a girl in the air and catch her is not more than the most dangerous sport. Any little mistake can put in serious injury or some time cheerleader may lose her/his body parts. Competitive cheerleading is very different that's involves dancing, jumping, trembling and creating different angles to form pyramids.

Did you know that cheerleading has more injuries and it comes after football? The reports show 2/3 catastrophic injuries amongst high school female athletes. 37,000 cheerleaders went to the emergency room in 2011.

The best way to prevent injuries is to declare cheerleading a sport and require teams to follow the same regulations and rules as any other physical spors

But why Cheerleading is not a Sport.

As the National Federation of State High School Associations and the Women's Sports Foundation define "A sport is played for a competition and have rules to follow." A sports team exists to score points not to perform or entertain the audience and it is an important factor of realization.

Many people give negative comments about cheerleading like why is cheerleading a sport? They see one end of the picture and forget other. So pay attention both ends just like a player's efforts and skills.

Well, there is no authentic statement about cheerleading is a sport. It has been debating for many years.
Cheerleaders are athletes that they require physically demanding and mentally challenging as any activity.
Updated

Congratulate! To Cheer Community that USA Cheer has announced the sport of STUNT in 2011, which is derived from traditional cheerleading. The purpose of STUNT helps to create new opportunities for female athletes at the collegiate and high school levels to meet the requirements of a sport under Title IX. This new discipline of STUNT includes all of the athletic skills from cheerleading, is re-crafted in 4 quarters games of head-to-head competition by focusing on the technical element and athletic components. The game consists of four different formats such as pyramids, basket tosses, group jumps and tumbling. In each quarter of the game, the team of cheerleaders is assessed on its difficulty level and performing skills. If a team performs its best routine will get the points.
Stunt expanding its horizon and more than 500,000 high school cheerleaders are actively participating to represent the United States of America in international cheer competitions.

At the 9th Annual College STUNT National Championship Stunt, the Oklahoma State University and Davenport University took Top Honor with the level of their talent.

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Is Cheerleading A Sport? Reasons, Statistics and Cheer Debate

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Sports play a vital role in our life. It is an incredibly increased the physical fitness and flexibility of joints and muscles that molds body easily in any pose. Sports (man or women), each train hard to get their best set of records.

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izzie Williams describes watching Netflix's new cheerleading documentary, Cheer, as surreal. It was the first time the 26-year-old British cheerleader had seen an accurate portrayal of her sport - its mechanically precise choreography, the gravity-defying tumbling, and the sheer grit required to push past exhaustion.

The six-part documentary, which aired in January, follows cheerleading champions from Navarro College in Texas as they defended their national title. It has been warmly welcomed by elite cheerleaders and coaches in the UK for putting their sport centre stage - and pushing past the idea that it's all big grins and miniskirts.

"Most people see the sideline cheer; they see the pom-poms and dance side of it. They don't understand all-star cheerleading exists and that it is a hard and challenging sport to compete in," Williams, said while practising with the Unity Allstars Black team in south London. The group, which competes on the same level as Navarro, was placed seventh in the world last year.

Lizzie Williams: 'Most people only see the pom-poms and dance side of cheerleading.' Photograph: Christian Sinibaldi/The Guardian

The series premiered as interest in cheerleading has exploded in the UK. Tori Rubin, the co-manager of the England cheerleading team and co-owner of Unity Allstar, said she started the company in 2006 with one team, but the gym now boasts 23 teams. The trend is echoed across the country, with an estimated 89,000 athletes competing at regional and national level.

"It's a great sport because it's teamwork, it's all about athletes working together in unison to create something spectacular. I used to be a gymnast and the thing I found really difficult was the individual nature of the sport," Rubin said. She praised the documentary for showing the athleticism required to be a competitive cheerleader. "It's very similar to our practices. It's indicative of what cheerleading is about; it's tough, it's hard, but once you're in it you're obsessed."

While Unity AllStar Black is the only UK team that can compete at the same level as Navarro, the sport has developed rapidly across the country. "When I first got involved with the sport 15 years ago it was, in essence, mums with kids learning things from YouTube and books and competing with other mums with kids and pushing mats together," said Joanna Gamper Cuthbert, the chair of SportCheer England, the national governing body for cheerleading in England. She added that teams have been able to dramatically increase their skill level because of the better training and education.

The Unity Allstars practise their cheerleading moves. Photograph: Christian Sinibaldi/The Guardian

Amanda Fairhall, the events director of Future Cheer, one of the country's largest cheer competition organisers, said while US teams dominate the sport, "the gulf between us and the Americans has started to close". She added: "The teams we send to compete in world championships are competing with the best of the best and holding their own."

Navarro's long road to becoming national champions is littered with broken bones, blood and tears. Williams does not shy away from the risk that comes with being a competitive cheerleader, but said: "If you trust your bases that takes away a lot of the fear factor. If they trust you to do your job and you trust them to do their job, then you've got the confidence to go for the skill that is scary to begin with."

The documentary has also received critical acclaim for its representation of male cheerleaders. Tyla Cousins, 21, who has been a cheerleader for nine years, said: "It's still at that stage where I have to explain to my dad's friends that it doesn't include pom-poms. So for the people that don't actually understand the sport, the documentary allows people to get to have a little view of what you do."

Cousins, who has previously broken his ankle in four places and cracked a rib, added it was not difficult to get people to understand the stamina required to take part.

Mya, eight, goes to the gym four times a week for gymnastics, acrobatics, tumbling and flying lessons. Photograph: Christian Sinibaldi/The Guardian

As awareness of the sport grows, children are being drawn in at a younger age. Reanne Snagg drives eight-year old Mya Benjamin-Clarke more than an hour to Unity Allstar's gym to train. Mya goes four times a week for gymnastics, acrobatics, tumbling, and flying lessons. While Snagg loves seeing Mya become a more confident child, she admits it can be nerve-racking to watch as a parent. "When they're flying, they do go very high and as a mother you can't help but think, 'Oh my God please catch my child!'"

To sustain the interest of the growing number of girls and boys who want to take part in the sport, the cheer community needs money. "Sport England recognition would meanour grassroots community programmes would have access to funding that's ringfenced for sport," Gamper Cuthbert explained. The funding would also support the pioneering work already done in the inclusion of disabled athletes in cheerleading.

SportCheer England, which operates on "glitter and a prayer", is determined to not only get recognition from Sport England, but to see the sport on the Olympic stage.

It's a dream that many hope to see realised at Unity AllStars. But, for now, the athletes remain focused on completing their routine without a single mistake. It's brutal and exhausting work that takes its toll. As the Black team gets ready to go again, they cheer each other on as Rubin shouts: "If you think you are tired, remember you're not tired."

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'It's a hard and challenging sport': inside the world of competitive cheerleading

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A new Netflix series comes amid an explosion of interest in the activity in the UK

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With a new administration and Congress in place, there will undoubtedly be some significant changes to employment laws, and pay equity is likely to be key issue for employers to watch in 2021 and beyond. During his campaign, President Biden indicated his support of the Paycheck Fairness Act (H.R.7) as the next step in building upon a pay equity law passed by the Obama-Biden administration, the Lily Ledbetter Fair Pay Act of 2009.

Passed by the U.S. House of Representatives in March 2019, the Paycheck Fairness Act (H.R.7) addresses wage discrimination on the basis of sex. It amends equal pay provisions of the Fair Labor Standards Act of 1938 (FLSA) to (1) restrict the use of the bona fide factor defense to wage discrimination claims, (2) enhance nonretaliation prohibitions, (3) make it unlawful to require an employee to sign a contract or waiver prohibiting the employee from disclosing information about the employee's wages, and (4) increase civil penalties for violations of equal pay provisions.
Potential Changes to the Equal Pay Act
Under the Equal Pay Act of 1963 (EPA), employers are prohibited from discriminating "between employees on the basis of sex by paying wages to employees in such establishment at a rate less than the rate at which [it] pays wages to employees of the opposite sex in such establishment for equal work on jobs the performance of which requires equal skill, effort, and responsibility, and which are performed under similar working conditions . . . ."

The EPA identifies four affirmative defenses: (1) a seniority system; (2) a merit system; (3) a system which measures earnings by quantity or quality of production; or (4) a differential based on any other factor other than sex.

If passed into law, the Paycheck Fairness Act would potentially make a number of changes to the EPA, including:

Significantly restricting the "factor other than sex" defense

Restrictions on employer inquiries about salary history and the use of it in setting pay rates

Expansion of employee protections against retaliation for inquiring about or publishing other employees' pay information

Expansion of available damages and permitting EPA class action lawsuits

Expansion of the statutory definition of "establishment"

Imposition of new data reporting requirements

Making changes to how the Office of Federal Contract Compliance Programs (OFCCP) identifies cases of pay discrimination

One particular area of concern for employers is H.R.7's expansion of the meaning of "establishment" under the EPA. Currently, wage comparisons among employees can only be made within the same establishment, which the EEOC has said refers to a physical place of business. H.R.7 would expand this meaning to cover pay disparities between employees working in the same "county or similar subdivision of a state," which could significantly increase an employer's litigation risk since employees would be permitted to compare their wages against other workers based on geographical factors alone.

The Obama-Biden administration made pay equity a priority and it remains to be seen if the Biden-Harris administration will do the same. Employers should continue to monitor developments in pay equity legislation in 2021 to prepare for a potential shift to more employee-friendly regulations.

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Pay Equity is a Key Issue for Employers to Watch in 2021 | Lexology

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With a new administration and Congress in place, there will undoubtedly be some significant changes to employment laws, and pay equity is likely to be key issue for employers to watch in 2021 and beyond.

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What happened in 1789? There were the births of famous painters and religious leaders such as William Turner and Edward Hawkins, the occurrence of the French Revolution and many more events. However, few people remember that 1789 was also the year that Congress accepted the first 10 amendments that we now live by.

On Sept. 25, 1789, 12 amendments to the Constitution were proposed to Congress, and 10 passed. Since then, the number of amendments has jumped to 27, yet they still serve the same purpose: to act as guidance for every American. From outlining our rights of privacy to determining righteous bails, the Bill of Rights has it all. Within this lengthy document, there is one amendment that many people have been arguing about since the day it was written.

Currently, the second amendment has caused extreme conflict all around the United States. There are primarily two types of views when referencing the second amendment. One view is that the people should not have the freedom to bear arms, while the second group of people believe that it is a right to bear arms by law.

We believe that it is a basic human right to be in possession of a legal firearm. It is a privilege to carry a weapon that can harm others, and it is our job as the people to make sure that those weapons end up in the right hands. Too many times this year and in previous years have there been incidents in which those who have fired a weapon have not obtained it legally. The issue is not the fact that we as a country are allowing people to bear arms, but that we have inadequate security regarding where or how they are obtained.

Therefore, it is easy to see that the destruction and distortion of the second amendment has lead to no good outcomes. Typically, the laws that restrict guns or that ban firearms actually bring up the demand, and therefore the price, for them. Banned weapons become popular on black markets, thus making most sales illegal. These bans often end in guns-even more dangerous than those banned-in our own towns and cities.

A prime example of what happens when firearms are restricted occurred in the city of Chicago, IL. Chicago faced a plethora of gun violence issues. Until 2010, the sale and purchase of firearms was banned, and although the ban has since been lifted, it is still quite restricting. According to The Daily Wire, 4,368 Chicagoans were killed by shooters, an enormous increase from even 2015, in which 2,988 people were killed. The Las Vegas shooting, although viewed as one of the most tragic gun-related incidents in modern times, still does not match up to the death rates in Chicago, as 59 people (the death toll of the Vegas Shooting) were killed in the city in Sept. 2017 alone. In months prior, death rates reached even higher, with 84 deaths in June 2017. We as American citizens need to understand that banning guns will actually do more harm than good in the long run.

In the end, gun violence still exists. And at the rate we are going, it's not slowing down anytime soon. What can we do to protect ourselves? The solution is simple: arm yourself. If everyone has a gun then nobody has a gun. While it may seem counterintuitive, it shows promise. The more citizens that carry a firearm with them, the less violence we will actually see. Mass shooters will be halted faster. Stick-ups and personalized crimes such as theft will see a decrease, as everyone would have a means to protect themselves by. It's time we ditch the silly intuition that guns are dangerous. In the right hands, a gun can be a hero.
Opinion articles written by staff members represent their personal views. The opinions expressed do not necessarily represent WSPN as a publication.

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What happened in 1789? There were the births of famous painters and religious leaders such as William Turner and Edward Hawkins, the occurrence of the French Revolution and many more events. However, few people remember that 1789 was also the year that Congress accepted the first 10 amendments that we now live by.

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'Cheer' Shows the Dangers of Competitive Cheerleading. So Why Isn't It Considered a Sport?

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The activity is not recognized as a varsity sport by the NCAA, and courts have ruled it doesn't meet Title IX guidelines

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Stability has long been an issue for the individual health insurance market, even before the Affordable Care Act. While reforms adopted under the ACA initially succeeded in addressing some of these market issues, market conditions substantially worsened in 2016.

Insurers exited the individual market, both on and off the subsidized exchanges, leaving many areas with only a single insurer, and threatening to leave some areas (mostly rural) with no insurer on the exchange. Most insurers suffered significant losses in the individual market the first three years under the ACA, leading to very substantial increases in premiums a couple of years in a row.

For a time, it appeared that rate increases in 2016 and 2017 would be sufficient to stabilize the market by returning insurers to profitability, which would bring future increases in line with normal medical cost trends. However, Congress's decision to repeal the individual mandate and the Trump Administration's decision to halt "cost-sharing reduction" payments to insurers, along with other measures that were seen as destabilizing, created substantial new uncertainty for market conditions in 2018.

This uncertainty continues into 2019, owing both to lack of clarity on the actual effects of last year's statutory and regulatory changes, and to pending regulatory changes that would expand the availability of "non-compliant" plans sold outside of the ACA-regulated market. These uncertainties further complicate insurers' decisions about whether to remain in the individual market and how much to increase premiums.

In " Stabilizing and strengthening the individual health insurance market: A view from ten states " (PDF), Mark Hall examines the causes of instability in the individual market and identifies measures to help improve stability based off of interviews with key stakeholders in 10 states.

The condition of the individual market

In the states studied-Alaska, Arizona, Colorado, Florida, Iowa, Maine, Minnesota, Nevada, Ohio, and Texas-opinions about market stability vary widely across states and stakeholders.

While enrollment has remained remarkably strong in the ACA's subsidized exchanges, enrollment by people not receiving subsidies has dropped sharply.

States that operate their own exchanges have had somewhat stronger enrollment (both on and off the exchanges), and lower premiums, than states using the federal exchange.

A core of insurers remain committed to the individual market because enrollment remains substantial, and most insurers have been able to increase prices enough to become profitable. Some insurers that previously left or stayed out of markets now appear to be (re)entering.

Political uncertainty

Premiums have increased sharply over the past two to three years, initially because insurers had underpriced relative to the actual claims costs that ACA enrollees generated. However, political uncertainty in recent years caused some insurers to leave the market and those who stayed raised their rates.

Insurers were able to cope with the Trump administration's halt to CSR payments by increasing their rates for 2018 while the dominant view in most states is that the adverse effects of the repeal of the individual mandate will be less than originally thought. Even if the mandate is not essential, many subjects viewed it as helpful to market stability. Thus, there is some interest in replacing the federal mandate with alternative measures.

Because most insurers have become profitable in the individual market, future rate increases are likely to be closer to general medical cost trends (which are in the single digits). But this moderation may not hold if additional adverse regulatory or policy changes are made, and some such changes have been recently announced.

Actions to restore stability

Many subjects viewed reinsurance as potentially helpful to market conditions, but only modestly so because funding levels typically proposed produce just a one-time lessening of rate increases in the range of 10-20 percent. Some subjects thought that a better use of additional funding would be to expand the range of people who are eligible for premium subsidies.

Concerns were expressed about coverage options that do not comply with ACA regulations, such as sharing ministries, association health plans, and short-term plans. However, some thought this outweighed harms to the ACA-compliant market; thus, there was some support for allowing separate markets (ACA and non-ACA) to develop, especially in states where unsubsidized prices are already particularly high.

Other federal measures, such as tightening up special enrollment, more flexibility in covered benefits, and lower medical loss ratios, were not seen as having a notable effect on market stability.

Measures that states might consider (in addition to those noted above) include: Medicaid buy-in as a "public option"; assessing non-complying plans to fund expanded ACA subsidies; investing more in marketing and outreach; "auto-enrollment" in "zero premium" Bronze plans; and allowing insurers to make mid-year rate corrections to account for major new regulatory changes.

Conclusion

The ACA's individual market is in generally the same shape now as it was at the end of 2016. Prices are high and insurer participation is down, but these conditions are not fundamentally worse than they were at the end of the Obama administration. For a variety of reasons, the ACA's core market has withstood remarkably well the various body blows it absorbed during 2017, including repeal of the individual mandate, and halting payments to insurers for reduced cost sharing by low-income subscribers.

The measures currently available to states are unlikely, however, to improve the individual market to the extent that is needed. Although the ACA market is likely to survive in its basic current form, the future health of the market-especially for unsubsidized people-depends on the willingness and ability of federal lawmakers to muster the political determination to make substantial improvements.
Read the full paper here

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Stabilizing and strengthening the individual health insurance market

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Stability has long been an issue for the individual health insurance market, even before the Affordable Care Act. While reforms adopted under the ACA initially succeeded in addressing some of these market issues, market conditions substantially worsened in 2016.

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PHOENIX - Ella Johnston was a 13-year-old cheerleader when she suffered a concussion during practice that was so severe she needed speech, occupational and physical therapy.

Months later, she returned to the mat while still working on her recovery - underlining the dangers and the joys of cheerleading.

"It's such a high leading moment. You just want to show off all of your tricks and skills," she said.

The American Academy of Pediatrics in November identified cheerleading as having one of the highest rates of concussions during practices, second to boy's football. Football's connection to concussions has been established for several years, and medical experts have been studying concussions in domestic violence victims.

But experts say reducing concussions in cheerleaders nationally has been sporadic, given the inconsistency across states over how it is classified: as an activity or a sport. Some studies have shown that some institutions do not consider cheerleading, with its jumps, tosses and other physical moves, to be a sport, which shortchanges safety protocols to avoid injuries like concussions - such as practicing in a hallway or on asphalt rather than a safer environment.

"Unfortunately, not all states recognize cheerleading as a sport - which may impact the conditions in which cheer squads may practice," the author of the study, Avinash Chandran, told Newsweek magazine in an article about the findings.

And a Sports Journal study advocated for the acceptance of cheerleading as a sport so that its athletes may benefit from the same resources that other sports receive and inclusion in concussion management and education protocols.

"Although competitive cheerleading has been recognized as a sport, cheerleading as a whole has not, putting its athletes at risk as its participants are not included in these safety programs," the Journal study said. " If considered a sport, cheerleading would be afforded the same benefits as other sports, including resources for better facilities, mandatory concussion education... baseline neurocognitive testing, and inclusion in injury surveillance systems."

A Phoenix brain expert agrees.

"All the protocols and safety measures that we institute in other sports like football should also be instituted in cheerleading if they aren't already," said Dr. Javier Cardenas, director of the Barrow Concussion and Brain Injury Center in Phoenix. "Thank goodness, they're already instituted in Arizona."

The Arizona Interscholastic Association requires every participating school must have a concussion policy that addresses three components: concussion education, removal from play and return to play.

But cheerleading continues after high school. Cardenas said the risk of injury in college is five times higher than in high school.

"You see more men participate in the college level than in the high school level. They tend to throw the athletes higher. That's where we see the most head injuries," he said.

Cardenas said that one of the ways to reduce the amount of concussions and head-related injuries in cheerleading is to limit practice times.

"What's really important to preventing these injuries is making sure these practices are not extended because what happens is that all of the athletes get fatigued, weak and that's when accidents happen."

Johnston, who has been cheerleading since the fifth grade, and returned to practice in August, said the road to recovery is long.

"Physical therapy, speech therapy and occupational therapy were very tiring, but they helped a lot," she said.

Cardenas said drastic mood changes are one effect of a concussion, and Johnson said she experienced some emotional changes.

"I'm usually a happy and perky person," she said. "I was just tired and didn't want to do anything."

Now 14, she started to feel her usual, more upbeat self within weeks, which reassured her and her family.

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Is cheerleading a sport? Some concussion experts say it should be classified as one

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PHOENIX - Ella Johnston was a 13-year-old cheerleader when she suffered a concussion during practice that was so severe she needed speech, occupational and physical therapy. Months later, she returned to the mat while still working on her recovery - underlining the dangers and the joys of cheerleading.

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In California, undocumented farmworkers have been labeled essential by the government and prioritized for vaccines. But public health officials face several challenges in reaching an unprotected population.

By Kassie Bracken, Yousur Al-Hlou and Caroline Kim

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In California, undocumented farmworkers have been labeled essential by the government and prioritized for vaccines. But public health officials face several challenges in reaching an unprotected population. By Kassie Bracken, Yousur Al-Hlou and Caroline Kim

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A health insurance death spiral describes a scenario in which premiums increase rapidly, causing healthy people to drop their coverage when they perceive that it's no longer worth the cost. That, in turn, causes premiums to increase even more, as the exodus of healthy people leaves a smaller, less healthy risk pool. As premiums continue to increase, healthier people continue to drop their coverage, and the situation continues to spiral until it reaches a point where the market simply collapses.

The collapse happens when coverage is too expensive for anyone to afford, and/or the insurers opt to exit the market altogether. Insurers generally only want to remain in markets that are fairly stable. And for an insurance market to be stable, the majority of the members in the insurance pool have to be relatively healthy, so their premiums can offset the cost of caring for the sickest members of the pool.

In a death spiral situation, the number of healthy enrollees declines sharply, leaving far fewer enrollees, but total costs that are nearly as high as they were before the healthy people dropped out, since the majority of the claims come from the sickest enrollees. When those costs are spread over the smaller remaining pool of insureds, premiums rise, and the death spiral cycle ensues.

A death spiral is the worst case scenario for an insurance market, and it results in the collapse or near-collapse of the market.

Death Spirals Are Often Misrepresented When Health Insurance Is Politicized

The term "death spiral" is often conflated with the concept of premium increases, regardless of whether the other aspects of a death spiral-dramatically shrinking enrollment and eventual market collapse-are present. And regardless of whether people fully understand the concept of a death spiral, the terminology certainly doesn't evoke pleasant images.

So it's not surprising that the term "death spiral" has frequently been used by opponents of the Affordable Care Act to describe the ACA-compliant individual health insurance market in the US. But warnings about potential death spirals have also been issued by supporters of the ACA, expressing concerns about how various legislative and regulatory changes could threaten the stability of the individual insurance markets, particularly in the most vulnerable states.

Lessons From Pre-ACA State-Based Health Care Reform

Before the ACA was implemented, the single most significant factor that individual market insurers used to keep premiums affordable (and thus avoid death spirals) was medical underwriting. Insurers in nearly every state would comb through applicants' medical history in order to determine whether the person would be a good risk or not.

Applicants whose medical history indicated that they might have substantial future claims were generally either rejected outright or offered coverage with significantly higher premiums or a blanket exclusion on pre-existing conditions.﻿﻿ In this way, insurers in the individual market were able to keep their total claims costs as low as possible, resulting in premiums that were much lower than the premiums for employer-sponsored health insurance (even before the ACA, insurers that offered employer-sponsored coverage were not allowed to reject sick employees or charge them higher premiums; in addition, individual market coverage was historically less comprehensive than employer-sponsored coverage, with correspondingly lower premiums).

When the ACA was drafted, ensuring access to individual market coverage for people with pre-existing conditions was a priority. But lawmakers knew that if they simply required insurers to accept all applicants in the individual market, with premiums not based on medical history, the market would collapse.

An individual market collapse had already happened in Washington state, a decade before the ACA was written.﻿﻿ Washington lawmakers had tackled health care reform in the early 1990s, enacting the Washington State Health Services Act of 1993. The law required insurers to accept all applicants, regardless of medical history.﻿﻿

But the individual mandate portion of the law, which had been slated to take effect in 1998, was repealed in 1995. This allowed healthy people to forego health insurance altogether, knowing that they could enroll at a later date if they became sick. It's easy to see how this creates an unsustainable market dynamic. When the Health Services Act was enacted, there were 19 insurers selling coverage in Washington's individual market. By 1999, there were zero-the market had collapsed altogether. Washington lawmakers revised the state's guaranteed-issue rules in 2000, making it harder for people to wait until they needed care to enroll in health coverage, and the market rebounded.﻿﻿

New York state also began requiring health insurers to cover all applicants, regardless of medical history, in the early 1990s. Premiums could only vary based on location and family size, so younger, healthier people were charged the same amount as sicker, older people (New York still requires insurers to charge older people the same amount as younger people, rather than the less strict 3:1 ratio that the ACA imposed).﻿﻿ But as was the case in Washington, there was no mandate requiring people to maintain coverage, and the result was sky-high premiums and very few insurers offering coverage in the state.﻿﻿

New York had various state subsidies for low-income residents,﻿﻿ and Washington's Basic Health Program offered subsidies to low-income enrollees.﻿﻿ But neither state had a mechanism to subsidize the cost of coverage for middle-class enrollees.

The ACA Was Designed to Prevent Death Spirals

The lawmakers who drafted the ACA were aware of the problems caused when coverage has to be guaranteed issue (ie, nobody can be rejected or charged more based on medical history) without other provisions to ensure that healthy people continue to purchase coverage.

So to avoid triggering a death spiral in the individual market, the ACA included:

Premium subsidies for people earning up to 400% of the poverty level. For coverage effective in 2020, that's $49,960 for a single individual or $103,000 for a family of four﻿﻿ (the 2019 poverty level numbers are used to determine eligibility for 2020 subsidies). The subsidies grow to keep pace with premiums, and they're designed to keep the after-subsidy cost of coverage at a specified percentage of income that's considered affordable.

An individual mandate that requires almost all Americans to have health insurance or pay a penalty. Under the terms of the GOP tax bill enacted in 2017, the penalty no longer applies as of 2019. But as of 2020, New Jersey, Massachusetts, Rhode Island, California, and Washington DC have their own individual mandates and associated penalties for non-compliance.

An annual open enrollment window during which people can enroll in individual market coverage (through the exchange, or directly through an insurer). The annual open enrollment window is currently November 1 to December 15 in nearly every state. Outside of that window, people cannot purchase coverage in the individual market unless they're eligible for a special enrollment period, and special enrollment period rules have been tightened in recent years. Since coverage in the individual market cannot simply be purchased at any time a person chooses, it makes it harder for people to go without coverage and then be able to buy coverage if and when they need medical care.

No Death Spiral, Even Without a Penalty for Being Uninsured

The Tax Cuts and Jobs Act, enacted in December 2017, eliminated the individual mandate penalty after the end of 2018. So people who are uninsured in 2019 and beyond no longer face a penalty unless they are in a state that imposes its own penalty.

There is no doubt that this caused premiums for 2019 to be higher than they would otherwise have been-even in states where average premiums decreased for 2019 (they would have decreased even more without the repeal of the individual mandate penalty). The Congressional Budget Office initially projected that without the individual mandate penalty, premiums in future years would be an average of 10% higher than they would otherwise have been.﻿﻿ That increase was evident in the rate filings that insurers submitted (and that regulators approved) for 2019.

Premium changes in the individual market were a bit complicated for 2019: Average premiums grew slightly nationwide, although average benchmark premiums decreased slightly across the states that use HealthCare.gov (which is the majority of the country; there are only 13 fully state-run exchanges as of 2020). But although the average premium increase across all plans was small, there would likely have been an overall average premium decrease if not for the elimination of the individual mandate penalty and the Trump Administration's efforts to expand access to short-term health insurance and association health plans (healthy people are more likely to gravitate to those plans, leaving sicker people in the ACA-compliant market, resulting in higher premiums).

But the limited enrollment window and the premium subsidies remain unchanged, and they have been the key to preventing a widespread death spiral in the individual market.

Although premiums grew sharply from 2017 through 2019, premium subsidies also grew (and grew disproportionately large starting in 2018, to account for the loss of federal funding for cost-sharing reductions; this ultimately made coverage more affordable for more people). Because premium subsidies have kept coverage affordable for the majority of the people who have coverage through the exchanges nationwide, enrollment in the exchanges was only slightly lower in 2019 than it had been the year before, despite the elimination of the penalty for being uninsured.﻿﻿ And for 2020, enrollment in the health insurance exchanges ended up almost exactly the same as it had been the year before, with 11.41 million enrollees in 2020 versus 11.44 million enrollees in 2019.﻿﻿

Out of 10.2 million people with effectuated enrollment in the exchanges nationwide as of mid-2019, nearly 8.9 million were receiving premium subsidies.﻿﻿ Premium subsidies keep pace with benchmark plan premiums, keeping the price of a benchmark plan very similar from one year to the next. [That doesn't mean, however, that the price of a particular plan will remain unchanged from one year to the next, even after accounting for subsidies. The after-subsidy price of a given plan depends on how that plan's premium changes, as well as how the benchmark premium (and thus the premium subsidy) amount in that area changes. As a result, people can end up with higher or lower net premiums just based on the change in the subsidy amounts, regardless of how much the cost of their own plan actually changes.]

But overall, the likelihood of a death spiral (ie, higher premiums resulting in healthy people dropping coverage) is muted for the population that receives premium subsidies, as they're insulated from the higher premiums.

A Death Spiral in the Unsubsidized ACA-Compliant Market?

Although enrollment in the exchanges has remained quite steady in 2019 and 2020, there has certainly been a drop in enrollment in ACA-compliant individual market plans sold outside the exchange, where enrollees are not eligible for premium subsidies.

From 2016 through 2018, individual market enrollment among people who do not receive premium subsidies declined by 2.5 million people-a drop of about 40%.﻿﻿ Most of these enrollees had previously had coverage outside the exchange, but subsidies are not available for exchange enrollees who earn more than 400% of the poverty level, are affected by the family glitch, or are in the Medicaid coverage gap.

While premium subsidies protect most exchange enrollees from steep rate increases, there is nothing to protect unsubsidized enrollees when premiums rise sharply. Unsurprisingly, the drop in unsubsidized enrollment has been particularly significant in states where rate increases have been especially large.﻿﻿

Those sharp rate increases were common in 2016, 2017, and 2018, but rates changed very little in 2019 and changed even less in 2020 (overall, there was a very slight average rate decrease for 2020﻿﻿﻿). So the exodus of people from the unsubsidized market is unlikely to continue at the rate it was happening for the last few years. But the Trump administration's new regulations that make it easier for healthy people to enroll in short-term plans (instead of ACA-compliant individual market coverage) could result in a continued decline in the number of people paying full price for ACA-compliant coverage.

What Can States Do to Prevent Death Spirals?

Although the ACA's regulations apply nationwide, individual health insurance is also regulated at the state level. The ACA sets minimum standards and requirements, but states can impose additional rules, or even make adjustments to the ACA's rules by using 1332 waivers.

There are several approaches that states can use to improve the stability of their individual insurance markets and ward off death spirals among the population that doesn't qualify for premium subsidies:

States can impose their own individual mandate.

States can offer premium subsidies to people who earn too much for the ACA's subsidies. Minnesota did this in 2017 (for one year only), and California is doing it as of 2020, for people with income up to 600% of the poverty level.﻿﻿ Washington is working on a plan to provide premium subsidies to people with income up to 500% of the poverty level as of 2021.﻿﻿

States can enact regulations and legislation to prevent widespread access to longer short-term plans and association health plans. Nearly two-thirds of the states have restrictions on short-term plans that are more strict than the federal rules.﻿﻿ By preventing healthy people from circumventing the ACA-compliant market in favor of plans that don't comply with the ACA's regulations, states help to ensure that their ACA-compliant markets continue to have a good mix of healthy people, who serve to keep the risk pool stable.

States can seek 1332 waivers in order to receive federal funding to implement reinsurance programs or other innovative approaches to keeping premiums under control. A dozen states have already established reinsurance programs, which have helped to stabilize their individual markets. In most cases, states that have created reinsurance programs have seen premium decreases as a result. These decreases apply to full-price premiums, so they make coverage more affordable for people who don't get premium subsidies. [Although in some cases, reinsurance programs can result in higher after-subsidy premiums for people who do get subsidies, as the reduction in subsidy amounts sometimes exceeds the reduction in overall average premiums. This is a Catch-22 that state regulators must keep in mind when designing reinsurance programs.﻿﻿﻿]

A Word From Verywell

The talk of death spirals in relation to the ACA applies to the individual health insurance market, and relatively few people purchase coverage in the individual market. Almost all insured Americans get their coverage either from an employer or from the government (Medicare, Medicaid, CHIP).﻿﻿ Fewer than 15 million people, out of a nation of 327 million, obtain coverage in the individual market. So worries about insurance market instability probably won't affect your coverage.

And even in the individual market, the majority of current enrollees receive premium subsidies, keeping their coverage fairly affordable. But this is little consolation to the several million people who need to buy coverage in the individual market and aren't eligible for premium subsidies. If you're in this group, you may be tempted to switch to non-ACA-compliant coverage, but it's important to understand the drawbacks of those plans before you enroll-there's a reason they're so much less expensive than real health insurance.

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What Is a Health Insurance Death Spiral?

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A health insurance death spiral describes a scenario in which premiums increase rapidly, causing healthy people to drop their coverage when they perceive that it's no longer worth the cost. That, in turn, causes premiums to increase even more, as the exodus of healthy people leaves a smaller, less healthy risk pool.

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March 1, 2002 -- The coverage snowboarding got at the Winter Olympics underlined the fact that it's one of the fastest-growing sports in the U.S.

The National Sporting Goods Association found snowboarding was the fastest-growing sport in the nation for three out the five years between 1996 and 2000, the most recent year available.

And because the sport attracts young people, it is also helping the ski industry grow. Nearly 40 percent of snowboarders are between the ages of 12 and 17, and 22 percent are between 18 and 24, according to the NSGA.

Snowboarding also looks like it's here to stay. The number of resorts that allow snowboarding far outnumber those that don't. The only four major ones that don't area Taos, N.M.; Deer Valley, Utah (located, ironically enough, next to Park City, the Olympic venue for snowboarding); Alta, Utah and Mad River Glen in Vermont.

Snowboarding on TV

Aspen Mountain finally broke down last year and allowed snowboarders on its slopes, and in fact was the site of the ESPN X Games this year from Jan. 17-20. The games will be held there again next year as well. Other major resorts are going after high-profile snowboarding events. Vail was the site of the World Snowboarding Championship just last weekend. The event will be televised on ESPN2 next week.

In general, ski resorts see so much opportunity in snowboarding that almost all of them have terrain parks and half pipes for boarders to ride. And some of the major resorts have facilities that have earned kudos from the snowboarding community. Breckenridge, in Colorado, for example, was voted as having the best half pipe in the nation by the readers of Snowboarding Magazine.

But among aficionados, the resorts that cater the most to snowboarders are not necessarily the majors but rather places such as Snow Summit, in California, a relatively small resort that has done an excellent job of marketing to snowboarders, according to John Stouffer, editor of Snowboarding Business magazine.

"The entire mountain is covered with parks and pipes," he says.

West Coast Phenom

That California would be home to one of the best snowboarding mountains makes sense. Snowboarding is hottest on the West Coast, where a culture that had already embraced surfing and skateboarding found snowboarding a natural segue.

Among the other resorts that cater heavily to snowboarders: Mountain High, Calif., Paoli Peaks, Ind,; Mount Snow, Nokemo and Killington, all in Vermont. For a comprehensive listing of resorts that love snowboarders, including major resorts as well as smaller ones, see our ski tips (above, left).

But just because the sport appeals to young people doesn't mean it's completely a new phenomenon. Snowboarding magazine is 16 years old. And Mike Allen, director of the Perfect Turn ski school at Heavenly Valley, Calif., notes one upcoming threat to the sport. He says some young people now want to ski so as to distinguish themselves from their snowboarding parents.

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March 1, 2002 -- The coverage snowboarding got at the Winter Olympics underlined the fact that it's one of the fastest-growing sports in the U.S. The National Sporting Goods Association found snowboarding was the fastest-growing sport in the nation for three out the five years between 1996 and 2000, the most recent year available.

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Snowboarding is a winter sport which involves descending on a snow covered slope using a single board (snowboard) attached to both feet. The riders wear special boots that attach to the snowboard. Snowboarding was inspired by skateboarding, sledding, surfing, and skiing - it is like a combination of each of these four sports.

The origins of snowboarding traces back to the 1960's, it was believed to have been developed in the United States. The sport is now included in the Winter Olympics.

There are different styles of snowboarding. Three common styles of snowboarding are freeride, freecarve, and freestyle.

Freeride is done in areas off the main trails. The equipment used for freeride snowboarding includes a stiffer boot and a stiffer directional snowboard. A stiffer setup should be used to maintain stability in the snow, as the snowboarder may face different kinds of snow conditions.

Freecarve, also called Alpine Snowboarding, usually takes place on hard packed snow and focuses on carving linked turns with little or no jumping.

Freestyle is basically performing various tricks while snowboarding, utilizing natural and man-made features such as rails, jumps, boxes, logs, and rocks to perform tricks. One of the freestyle snowboarding events is Slopestyle. See more about freestyle snowboarding.

Similar Sports

Freestyle Snowboarding - competitors ride on a snowboard and do tricks along while descending snow-covered slopes.

Boardercross - a snowboard competition on a course similar to motocross (also called Snowboard Cross)

Slopestyle Snowboarding - athletes on a snowboard perform on a course with a range of obstacles.

Slopestyle - involves skiing or snowboarding down a course of obstacles.

Skiboarding - like snow skiing, but with shorter and wider skis.

Snowkiting - a snow based, kite powered sport, while riding on a snowboard or on snow skis.

Sandboarding - involves sliding downhill on sand while standing on board.

Wakeboarding - riding a board and doing tricks on the wake behind a boat.

Skysurfing - a skydiver attaches a board to his feet during freefall.

Surfing - participants stand on a surfboard, and use the waves for propulsion.

Related Pages

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Snowboarding is a winter sport which involves descending on a snow covered slope using a single board (snowboard) attached to both feet. The riders wear special boots that attach to the snowboard. Snowboarding was inspired by skateboarding, sledding, surfing, and skiing - it is like a combination of each of these four sports.

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A study examining gender barriers in the U.S. military's most elite units has found restrooms to be a source of contention between male and female troops, with a third of men saying they would never use unisex bathrooms and 61% of women saying they were fine with them.

Male troops cited risk, hygiene and privacy as reasons for opposing gender-neutral bathrooms, although the study authors theorized that the resistance is tied to men wanting to preserve the status quo of the predominantly masculine special operations community.

The study, "Maintaining Male Exclusivity: Porcelain Privilege in the Military," published last month in the journal Armed Forces & Society, grew out of larger research conducted in 2013 and 2014 that sought to explore the advantages and barriers to women serving in special operations units.
Read Next: Army Denies Major's Appeal to Get Valor Award Back After Trump Pardon
At the time of the study, Special Operations Command was weighing whether to request an exemption to a policy change that allowed women to serve in ground combat specialties.

The researchers said toilets were not a focus of the project but were mentioned without solicitation more than 350 times in 27 separate focus groups with 198 participants, sparking their interest in the subject.

According to the study, which was first reported by Stars and Stripes, nearly one-third, or 33%, of men said they would "never be willing to share a unisex bathroom facility with women, while well over half, 61%, of women indicated they would use a unisex bathroom all the time."

The researchers defined a unisex bathroom as a single facility that used flip signs or had designated times for individual use.

The men raised concerns about women's hygiene requirements, citing their own perceptions of a woman's need to shower and maintain cleanliness for health reasons.

They also said they didn't want to lose access to private male-only spaces, expressing an "inherent fear that integrating women into men's bathroom space will necessarily mean a loss, not of privacy for women but of the privileged status of men-only spaces," the researchers wrote.

"There's a lot of things that you don't hold back in a team room. It's behind closed doors," a male service member told the researchers. "You do what you need to do to get whatever accomplished and you say what needs to be said. You put a female in the mix and then there's people getting offended."

"Invoking the language of hygiene, risk, and privacy, men pointed out the unique embodied differences that mark women as unfit to integrate into Special Forces while subverting other motives intended to preserve the toilet as a privileged male-only space," the authors wrote.

In discussing the bathroom politics, the participants implicitly indicated that special operations was a "workplace where women did not belong."

"Men, having the full privilege of being the default in the military, see any change to the gender hierarchy as a disruption of that system which has come to feel like the natural order."

At least one female participant was nonplussed.

"All I'm saying is the bathroom's open all the time. You have stalls. Go in the stall. The showers are closed. Grab your towel, put it on before you get out. You're not walking around the company naked, and that's all I'm saying," she said.

Women currently serve in a number of ground combat specialties that previously were closed to them, although the numbers are minuscule in the elite forces. Last year, a female Army National Guard soldier graduated from Special Forces training, earning her Green Beret and a Special Forces tab. More than a dozen women have graduated from Army Ranger school and, in 2017, a woman became a member of the 75th Ranger Regiment.

At least two women have graduated from the Marine Corps' infantry officer course, and women have made it through the second phase of the Marine Corps' Special Operations Command's assessment and selection course but weren't chosen to continue.

Roughly a dozen women have attempted battlefield courses under the Air Force's Special Warfare Training Wing.

No women have completed Navy Basic Underwater Demolition/SEAL (BUD/S), although an officer completed the SEAL Officer and Selection process and then later selected a different warfighter specialty as her top choice.

The study did not include or ask about bathroom use by transgender service members, because it was conducted before transgender individuals were allowed to serve.

The authors said their research is relevant to today's military and professions, like policing and firefighting, where issues of physicality, privacy and locker rooms are a concern.
Editor's Note: This story has been updated to clarify that the study population was Army special operations, not Special Forces. -- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime. Related: Female Air Force Pioneer's Message to Women: 'Don't Ever Accept a Barrier'
They concluded that men's discomfort with sharing toilet and team spaces with women -- and women's willingness to use such spaces -- are "an indication that the underlying logic of sexism needs to be addressed" in integrating male-dominated professions.

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Bathroom Politics: Male Special Operators Rebuff Unisex Restrooms to Keep Men-Only Status Quo, Study Finds

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A study examining gender barriers in the U.S. military's most elite units has found restrooms to be a source of contention between male and female troops, with a third of men saying they would never use unisex bathrooms and 61% of women saying they were fine with them.

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Publicly accessible toilets in England are being reviewed by the government. It says evidence shows that an increasing number are being converted into gender-neutral facilities, which "disadvantages" women who have specific needs and already face "excessive queues".

Felix, who identifies as gender-fluid, prefers to use gender-neutral toilets and has felt unsafe in men's loos.

But campaigner Susan Cunningham says women need "separate same-sex facilities for their safety and security and comfort".

Experts argue that access to public toilets needs rethinking to meet everyone's needs.

The government says its review will help "ensure there is a diversity of provision and facilities for everyone."

You can have your say at toilets@communities.gov.uk

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Toilets: Men's, Women's or Gender-Neutral?

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Publicly accessible toilets in England are being reviewed by the government. It says evidence shows that an increasing number are being converted into gender-neutral facilities, which "disadvantages" women who have specific needs and already face "excessive queues". Felix, who identifies as gender-fluid, prefers to use gender-neutral toilets and has felt unsafe in men's loos.

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The Democrats running Washington seem intent on fulfilling every other progressive dream, so why not gun control? Last week the House passed two new gun measures, and Senate Majority Leader Chuck Schumer promises they'll get a vote on the Senate floor. They'd better hope this doesn't boomerang the way rising crime has spurred gun purchases.

The first bill passed 227-203, with only eight Republicans, and would impose background checks for even person-to-person gun sales. The other bill passed 219-210, with only two Republican votes. This would extend the window for background checks to 10 days from three. The bills are aimed at making it harder to acquire and own guns.

Democrats are betting that background checks are popular, but the result in practice may be to spur more gun sales. In 2020 the National Instant Criminal Background Check System reported 21 million background checks, which translates to 8.4 million new gun owners. That's a record. There were an estimated 2.9 million new gun buyers in 2019, and the previous record was 3.4 million in 2016.

More buyers are women and minorities. "Forty percent of 2020's buyers were women and the biggest increase of any demographic category was among African Americans, who bought guns at a rate of 58 percent greater than in 2019," says the National Shooting Sports Foundation, which tracks the data.

Mr. Schumer surely knows the bills have no chance to get 60 votes in the Senate. But holding the votes will please progressives, and if there's new gun violence Democrats might benefit politically. But no one should think that pressing gun control will do anything other than spur more gun sales.

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Opinion | More Gun Control, More Gun Sales

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The Democrats running Washington seem intent on fulfilling every other progressive dream, so why not gun control? Last week the House passed two new gun measures, and Senate Majority Leader Chuck Schumer promises they'll get a vote on the Senate floor. They'd better hope this doesn't boomerang the way rising crime has spurred gun purchases.

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Climate Change Is Accelerating, Bringing World ‘Dangerously Close’ to Irreversible Change (Published 2019)

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The acceleration climate change’s effects have brought the world “dangerously close” to abrupt and irreversible changes, scientists warned.

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NORCO, Calif. (KABC) -- Norco High School cheerleaders are ready to get back on the field and rallied against state guidelines.

While football and other sports are resuming, cheerleading is still being sidelined because of the pandemic.

Cheerleaders like Yanil Menendes feel it just isn't fair.

"This is kind of our last hope, that we want to at least have some senior memories," she said.

Cheer, band and drumline are some of the activities Riverside County health officials are not allowing for now, even though cheer captain Carly Hoppock says they can practice their sport safely.

"Yes, there is a pandemic going on, but we can stay six-feet apart on our boxes with our masks on, doing every protocol that COVID needs and stay safe," said Hoppock.

The Norco cheerleaders are hoping if they can rally support they will change some minds. A petition has been started, but the clock is ticking. The football season has been reduced to just a few games and the first game is this week.

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Norco High School cheerleaders rally to allow their sport to resume

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NORCO, Calif. (KABC) -- Norco High School cheerleaders are ready to get back on the field and rallied against state guidelines. While football and other sports are resuming, cheerleading is still being sidelined because of the pandemic. Cheerleaders like Yanil Menendes feel it just isn't fair.

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Technology is proliferating into all aspects of business, and agriculture is no exception. Farms are becoming increasingly automated and data-driven. Wireless and GPS technology now helps farmers monitor their crops and livestock; it also aggregates and analyzes data to help them make better decisions.

Technology Growth

As technology has been introduced to the farm over the course of the past century, farmers have seen tangible results in productivity. According to AgClassroom.org, commercial fertilizer use has risen from about 4 million tons per year in 1900 to 48 million tons in 1990. In 1940, it was estimated that one farmer was responsible for feeding 10.7 people; a 1990 estimate shows each farmer is responsible for feeding 100 people, based on technology-driven productivity and efficiency increases.

GPS Systems

Farmers now use GPS-based technology to steer farm equipment like tractors, sprayers or harvesters. This allows farmers to control their equipment remotely from their office or wireless device. They can also calibrate equipment to run in the fields automatically and achieve down-to-the-centimeter precision. This decreases the cost of labor or time spent by farmers tending to crops, and gives them the ability to multitask in the fields.

Biotechnology

In 1994, the Food and Drug Administration granted the first approval to a crop that has been genetically engineered using biotechnology, the FLAVRSAVR tomato from Calgene Industries. Agricultural companies like Calgene and Monsanto are now developing crops that are genetically resistant to pests and weeds, providing higher crop yields for farmers.

Data Integration

A 2011 issue of "Precision Ag Resources Magazine" highlights new software products coming to the market to help agriculture professionals better manage the data and technology used on their farm. Products from companies like SST provide systems that integrate data from satellite imagery of crops, weather, equipment and from sensors placed on crops in the field. The software then shares this data with other farmers and databases of agricultural data to make forecasts and to help farmers make more calculated decisions in all aspects of their production, from product ordering to crop tending.

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Technology in the Farming Industry. Technology is proliferating into all aspects of business, and agriculture is no exception. Farms are becoming increasingly automated and data-driven. Wireless and GPS technology now helps farmers monitor their crops and livestock; it also aggregates and analyzes data to help them ...

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Many people claim that cheerleading is not a sport. The reasons for this are varied, but essentially, cheerleaders have not traditionally competed (this of course is changing and changing rapidly at that), and many people don't consider doing routines a "sport" in the same way that football or basketball is a sport. So is cheerleading a sport? Or is it merely a past time?

Arguments that Cheerleading is Not a Sport

There are many arguments made regarding whether or not cheerleading is a sport. In addition, many people distinguish between a "yell" leader versus a cheerleader who does stunting versus the competitive All Star cheerleader. Can you say that some cheerleading is a sport while other cheerleading is not? That all depends on who you ask and their definition of sports.

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Sports Require Physical Ability or Skill

One definition of sports is that they require some type of physical ability or skill that has to be learned and practiced. While no one would argue that cheerleaders practice, it can be argued that cheerleading, when it is simply yelling into the crowds, does not require a great deal of skill. Anyone can learn routines and yell into the crowd as long as they smile a lot.

Sports Require Competition

With the advent of competitive cheerleading as an activity in its own right, cheerleading can arguably require competition. However, what if the cheerleaders are just clapping and yelling at games? Perhaps the school doesn't compete. Many schools do in fact have cheerleading squads that do not attend competitions. In this case, does cheerleading qualify as a sport? Not according to the National Federation of State High School Associations and the Women's Sports Foundation's definition of a sport. Additionally, having the competitions required to be seen as a school sport would also likely mean that cheerleaders would be unable to support their teams during games.

Sports Require Strategy

Many would say that cheerleading is not a sport because it does not involve a defined strategy. Even if you are on a competing squad, the goal is to get the judges to think that you do your stunts and routine better than the other squads. However, this would also mean that competitive diving, gymnastics and other similar aesthetic activities are not sports either.

Sports Require Contact with an Opponent

Cheerleaders might make contact with their cheer team, but they don't come in contact with opponents even at competitions. This one of the criteria that makes the "not a sport" argument. However, there are other sports without physical contact like golf or swimming.

Sports Have Consistent Divisions

While schools and teams might compete against one another in cheer competitions, school-based cheerleading doesn't have specific recognized divisions like basketball or football. This, according to Deborah Slaner Larkin, Chief of Special Projects at the Women's Sports Foundation, is one of the reasons that cheerleading shouldn't be recognized as a sport.

Problems with Recognizing Cheerleading as a Sport

However, recognizing drill teams, cheerleading and similar activities as a sport gets far more complicated than whether anyone thinks that cheerleaders are athletes. In fact, the debate delves deeper into Title IX politics, and other issues.

Safety Issues

Not recognizing cheerleading as a bona fide sport means that there is no national governing agency, though the International Cheer Union (ICU) has been given provisional recognition, that determines what type of safety training coaches need to have. This also means that cheerleaders at the college level don't have on-site athletic trainers. Orthopedic experts say, after looking at the statistics, that many cheerleading injuries could be prevented with proper safety precautions. As a result, one could easily make the argument that, for the sake of the cheerleaders themselves, cheerleading deserves sport status.

The Politics of Title IX

For almost three decades, the Department of Education's Office of Civil Rights (OCR) actually told schools not to include cheerleading as a sport. Why? The OCR has the task of making sure that schools are not gender biased in their offerings. The sports offerings for schools need to be evenly distributed between girls and boys so that the school is not classified as gender biased. To even out the books, schools were told not to recognize cheerleading as a sport. Some schools have gotten around this by offering a both a spirit club and a cheerleading squad. The spirit club primarily cheers at games and the squad that attends competitions.

Competition Eligibility

Some schools are quite content to keep their status as an after-school club. Why? Because becoming an official school sport makes them ineligible to participate in some national cheerleading competitions. While being considered an official sport would increase safety, it would decrease the opportunities that the squad has to show off their skills.

Deciding Whether Cheerleading Is a Sport

Whether or not cheerleading is a real sport is a question that may never be settled. Although there are good reasons to consider it a sport and it certainly meets some accepted criteria of being a sport, there are many who will never consider it more than an after-school club. One thing is certain; cheerleading is increasing in popularity so much that it might launch itself into sport status without having to try very hard.

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Why Is Cheerleading Not a Sport? | LoveToKnow

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Many people claim that cheerleading is not a sport. The reasons for this are varied, but essentially, cheerleaders have not traditionally competed (this of course is changing and changing rapidly at that), and many people don't consider doing routines a "sport" in the same way that football or basketball is a sport.

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BRUSSELS (Reuters) - The European Commission on Thursday said it would expand financial and policy support to help achieve a goal for a quarter of Europe's farmland to be organic by 2030.

Agriculture produces roughly 10% of EU greenhouse gas emissions and is on the front line of climate change impacts, with record heatwaves and prolonged droughts reducing some European crop yields.

Organic farmland, which restricts chemical pesticides, synthetic fertilisers and genetically modified organisms, has expanded by more than 60% over the last decade in the European Union, to nearly 9% of the bloc's agricultural area.

The Commission on Thursday outlined plans to speed up this expansion and stir demand for organic products, which it said would help the EU reach its goal to eliminate net emissions by 2050. Reaching a 25% organic share of farmland this decade would also protect bees and biodiversity, the Commission said.

Agriculture emits nitrous oxide from the use of artificial fertilisers, while livestock produces potent planet-warming methane.

By curbing fertilisers, organic farming can cut emissions, although it does not necessarily tackle emissions from livestock, and lower crop yields associated with organic farming can mean more land is required, denting potential emissions savings.

The EU will spend 49 million euros ($57.94 million) on promoting organic products this year, 27% of its total budget for promoting EU agricultural products at home and abroad.

The Commission said the EU's farming subsidy programme, which is being reformed, will offer farmers 38-58 billion euros over 2023-2027 for eco-schemes, including organic production.

Organic food and farming organisation IFOAM welcomed the EU plan as "a new era for the transformation of our food systems".

Farmers' association Copa-Cogeca said in a statement further policies and product innovation would be needed to ensure organic farmers can fend off weeds and pests.

The EU is developing mandatory sustainability requirements for the public procurement of food, which could integrate organic products into school meals or public canteens.

Brussels said national measures, such as removing reduced tax rates on pesticides, could also make organic food less expensive relative to non-organic food.

(Reporting by Kate Abnett; editing by Barbara Lewis)

Copyright 2021 Thomson Reuters.

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Organic Farming Must Grow to Reach Green Goals, EU Says

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BRUSSELS (Reuters) - The European Commission on Thursday said it would expand financial and policy support to help achieve a goal for a quarter of Europe's farmland to be organic by 2030. Agriculture produces roughly 10% of EU greenhouse gas emissions and is on the front line of climate change impacts, with record heatwaves and prolonged droughts reducing some European crop yields.

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News about Fast Food Industry, including commentary and archival articles published in The New York Times.

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Abstract

In the United States, stable health insurance coverage is associated with improved health outcomes. A lack of insurance is associated with premature death from preventable causes. Although primary care clinicians are often in a position to see firsthand the impact that being uninsured has on patients, most ambulatory care clinics are not actively involved in helping patients obtain health insurance, retain their coverage, or make important health insurance coverage decisions. The magnitude and complexity of the US "uninsurance" problem, as well as recent federal initiatives to expand coverage options, inspire important questions: Can medical homes play a more active role in helping patients find and keep insurance coverage? How can basic tenets from the chronic care model be operationalized to build systems to treat the uninsurance ailment? Creating effective processes and tools within the medical home to keep a patient insured may be as important to improving population health as helping a patient maintain a normal blood pressure. Similar system-level interventions could be used to support both endeavors.

Keywords: insurance, health, medical home, primary health care, access to health care, healthcare disparities, public health

While attending on the inpatient service, I admitted a 52-year-old man with a bowel obstruction due to stage IV colon cancer. Resident physicians on the team had different hypotheses for why he came to the emergency department with advanced disease. One physician concluded it was because he had not received colon cancer screening. Another believed he had no access to primary care, and that the emergency department was his only option for care. Others were interested in his risk factors: Did he have a family history? Was he eating a high-fat diet? We obtained his prior medical records to figure out why his cancer was not diagnosed or treated sooner and to assess his risk factors for the disease. As it turns out, he had access to primary care, had a positive guaiac fecal occult blood test, and was scheduled for a colonoscopy 6 months before this admission. Unfortunately, because of its cost he did not get the colonoscopy. His biggest risk factor for this delayed diagnosis: being uninsured.

IMPORTANCE OF HEALTH INSURANCE

In the United States, health insurance coverage is associated with better access to services and improved health outcomes. Patients unable to obtain or maintain health insurance coverage report higher rates of unmet need than those with stable coverage. Compared with insured patients, uninsured patients are at higher risk for dying prematurely from preventable causes. Although primary care clinicians are often in a position to see how lack of insurance negatively affects health, most ambulatory care clinics do not have systems in place to help patients obtain health insurance, retain their coverage, or make important health insurance coverage decisions. Historically, health care financing has been separate from the delivery of health care services. Decisions about health insurance uptake and maintenance of coverage are made by employers, individuals, and/or family members. Federal and state governments also play a role in organizing and providing coverage to the elderly, disabled, poor, and other vulnerable populations.

The growing number of uninsured patients in the United States and the negative consequences of being uninsured motivated the passage of the 2009 Patient Protection and Affordable Care Act (PPACA) to enact reforms that would expand health insurance coverage options for the uninsured. For example, by 2014, the PPACA calls for expanding Medicaid to cover all Americans making less than 133% of the federal poverty level, creating state health insurance exchanges to allow individuals without employer-sponsored insurance the option to buy coverage directly, and implementing tax credits to help middle class families afford to buy insurance. The magnitude and complexity of the "uninsurance" problem in the United States and the recent events surrounding the passage and implementation of the PPACA led me to ponder the question: Can medical homes play a more active role in helping patients find and keep insurance coverage?

THE ROLE OF A MEDICAL HOME

If uninsured patients die sooner, and medical homes are to aid patients in providing and coordinating care that improves health and reduces preventable morbidity and mortality, then helping individual patients find and keep health insurance should be within a medical home's purview. Building upon the ethical foundation of beneficence, which outlines a moral obligation for clinicians to act for the good of patients, it could be argued that playing a central role in helping patients obtain and maintain insurance coverage is as important as helping a patient maintain a normal blood pressure or an optimal glycosylated (A 1c) hemoglobin level.15-18 (Or, maybe help with coverage is even more important, as it is often not possible to receive these types of medical services without insurance.) At the population level, if we consider lack of insurance to be an epidemic sweeping the country, clinicians should advocate for protecting the public's health, and health care systems should play a more active role in advocating for affordable coverage options for everyone. Although some medical organizations have a long tradition of political activity, medical professionals have not always lobbied for expanding coverage to patients. More recently, however, health care professionals have been vocal about the need for health insurance reform, and many health care systems supported the PPACA or similar legislation.

Although the PPACA may not be implemented in its entirety (due to the US Supreme Court ruling that state participation in public insurance expansions is optional), some provisions from the PPACA will likely expand coverage options. These reforms create another unique opportunity at the individual level for clinicians and health care systems to play a more direct role in ensuring that patients find and keep health insurance coverage. For example, what can medical homes do to help patients successfully navigate health insurance exchanges to gain coverage and stay enrolled? Can medical home personnel with expertise in coordinating care and managing chronic disease also be better equipped to advise patients about important insurance options and decisions? Much of what health care systems currently do to provide health insurance support for patients is done by health care systems to provide health insurance support for patients is done once a patient gets sick and needs services. Hospitals make efforts to enroll eligible inpatients in publicly available coverage programs retroactively or as soon as they become hospitalized. Medical homes can be proactive and reach these patients before they get sick.

BEING PROACTIVE: DEVELOPING SYSTEMS

Primary care medical homes can partner with patients to reduce preventable mortality by assisting them in acquiring and maintaining health insurance coverage. This partnership can be supported by systems that are based on tenets of the chronic care model: a patient-centered, proactive, planned, and population-based approach. If we can develop systems to know when a patient is due for his or her next hemoglobin A 1c test or antihypertensive medication refill, then we can develop systems to know when a patient is due to re-enroll in a health insurance program. As when transforming systems to provide better chronic disease care, a program to partner with patients to find and keep health insurance would require multicomponent practice changes in 4 categories: (1) increasing the expertise and skills of clinicians and other team members; (2) educating and supporting patients; (3) utilizing a team-based approach with more emphasis on prior planning; and (4) making better use of registry-based information systems. Powerful catalysts for implementing these changes are a robust electronic health record (EHR) and the maximal use of the best health information technology (HIT) tools available.

Increasing Expertise and Skill

How much do those prescribing care and services understand about cost sharing, formularies, covered services, maximums, carve outs, etc...? Although likely not the team member with the greatest insurance expertise, it is essential that clinicians and other prescribers increase our knowledge base regarding health insurance coverage and related information to advise patients about coverage options. Even for patients with good coverage, we must be well versed in how to make choices between equally effective diagnostic tests and treatments and be able to understand the financial impact and the population health impact of choosing high-cost, low-value options (eg, individual patients will pay more in copayments, and fewer patients in the population will have access to Medicaid coverage if others are receiving services proven to have little or no value). This knowledge is also essential to most effectively partner with patients in shared decision making about their health care. Learners from many health care disciplines should be exposed to these concepts throughout their undergraduate and postgraduate years, and this expertise should be reinforced and enhanced through continuing medical education courses and opportunities. Maintenance of certification should focus on ensuring the delivery of care that is patient centered and also evidence based.

Educating and Supporting Patients

Educating and supporting patients requires a diverse team of skilled professionals assisted by the best possible electronic resources. For example, personal health records are new, effective avenues for communicating with patients about issues relevant to their health. In addition, EHRs enable team members to stay updated about preferred medications on a patient's insurance formulary. These capabilities could be extended to include details regarding other covered services, such as colonoscopies, and required copayment amounts for referral services that are in or out of a preferred network. Currently, the complexity and variability of most payers' covered services and unique policies make this a daunting task. To fully realize this patient-centered approach, insurers must move toward simplification of policies, standardization of covered benefits, and increased transparency.

A Team-Based Approach With an Emphasis on Prior Planning

In addition to providing better support to patients, improving expertise regarding health insurance coverage among multiple team members will increase the team's ability to educate each other. It is impossible for one person to remember all the details about covered benefits for multiple insurance plans; however, having several knowledgeable team members with the ability to assist patients with individual inquiries can be valuable for everyone. If a physician orders a test, another member of the team can help to suggest alternatives or query the patient about their current insurance coverage status to ensure that they have coverage for the recommended service. Health care teams can also play a role in helping patients plan care based on available coverage options. For example, if an individual has met a high annual deductible, it might be advantageous for them to have an indicated colonoscopy before the end of the year. Finally, insurers need to be collaborative team players by creating systems that make their services more accessible to patients, being more transparent regarding covered benefits, and assisting medical home staff in obtaining high-value services for patients that will improve outcomes. Health information technology resources and EHR-based tools in the medical home designed for chronic disease management and coordination of care (eg, registries) could be harnessed to support this team-based care.

Making Better Use of Registry-Based Information Systems and Other HIT Tools

Supported by HIT tools, patient registries can be created to organize patient information by payer, coverage expiration date, or other basic coverage information. In addition to supplying information about a team's panel of patients, these data could feed into multiple electronic communications. For example, if a medical home develops a registry-based information system to keep track of patients' insurance enrollment and expiration dates, it could generate automated alerts at the point-of-care and reminders sent via e-mail or through a patient's personal health portal when a patient is nearing a required re-enrollment date. Further research should be conducted to determine the feasibility and effectiveness of adapting these types of HIT tools to facilitate inreach and outreach to patients regarding insurance coverage.

ATTENDING TO THE FIDELITY OF HEALTH INSURANCE COVERAGE

As medical homes develop better systems for managing chronic disease and keeping patients healthy, clinicians will continue to hear from patients that a lack of insurance coverage has prevented them from taking essential medications, getting preventative screenings, and completing early diagnostic tests. Thus, it seems that helping a patient find and keep health insurance is a role that should be played by his or her medical home. Gains in population health from this approach would be analogous to those achieved by ensuring the delivery of evidence-based care to all patients (ie, optimizing the fidelity of health care delivery). In fact, partnering with patients to improve the fidelity of our population's health insurance coverage, that is, ensuring that all patients have the best and most continuous coverage available to them under existing and newly expanded programs, may be as (or more) important than ensuring that all patients have optimal blood pressure control, diabetes control, or timely cancer screenings. By adopting uninsurance and underinsurance as a chronic illness and applying tenets and tools of the chronic care model to treat it, medical homes have the opportunity to improve population health and make a positive difference in the lives of patients.

Footnotes

Conflict of interest: author reports none.

Funding support: Dr DeVoe was partially supported by Agency for Healthcare Research and Quality (AHRQ) grant number R01 HS018569 and Patient Centered Outcomes Research Institute (PCORI) Cycle I (2012) Contract, Health Systems.

References

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Being Uninsured Is Bad for Your Health: Can Medical Homes Play a Role in Treating the Uninsurance Ailment?

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In the United States, stable health insurance coverage is associated with improved health outcomes. A lack of insurance is associated with premature death from preventable causes. Although primary care clinicians are often in a position to see firsthand the impact that being uninsured has on patients, most ambulatory care clinics are not actively involved in helping patients obtain health insurance, retain their coverage, or make important health insurance coverage decisions.

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How has your sense of humour sustained you during the COVID-19 pandemic? Have you been baking banana bread, yawning through webinars, and attending Zoom weddings like everyone else? I have neither baked anything, nor attended any weddings on Zoom-shoom. I have kept myself busy by creating an avatar for the social butterfly on my Instagram account and have her opine on everything from COVID-19 to Kamala Harris.

264pp, ₹499, Penguin

The pandemic year ended on a high note for you with the release of a novel titled The Impeccable Integrity of Ruby R. What made you create a fresh set of characters instead of continuing with your series of books about Lahori social butterflies who shop in London?I wanted to step out of my comfort zone and try something different. I also wanted to comment on a whole range of social and political issues that confront us at present, for which I could not use Butterfly's voice.

Author-actor Twinkle Khanna's advance praise for the book calls it "a story about Pakistan, which could be as much about India today." Would you say that these two countries are more alike than they care to admit? Many readers of this novel have found parallels in the way both India and Pakistan are fixated with celebrities, how their political parties use social media to stifle criticism, and how an entrenched patriarchy exploits and oppresses women on both sides of the border.

On your last visit to India in 2015, you were a panelist at a literary festival in Mumbai. What are your fondest memories from that trip? When will Indian readers get to hear you again? I so enjoyed that festival at Mehboob Studios in Mumbai. My highlights were meeting Twinkle Khanna; doing a hilarious panel with Kevin Kwan and Shunali Shroff on the endless Asian appetite for designer brands; being taken for a guided tour by Naresh Fernandes in his Goan neighbourhood; listening to Ali Sethi and Salima Hashmi converse about Faiz Ahmed Faiz with the legendary Gulzar Sahib and, most of all, meeting and engaging with the attendees who came to the festival. I would return in a heartbeat if the Indian government would grant me a visa.

Why do Pakistanis and Indians fantasize about authoritarian leaders? The cabbie who meets Ruby Rauf at Lahore Airport believes that nothing will ever change in Pakistan until a "strong man with a big stick" is at the helm of affairs. What do you think? I cannot speak for Indians but, having endured 30 years of martial law, few Pakistanis now fantasize about authoritarian leaders. What most people desire above all, in fact, are justice and opportunity. People in Pakistan who voted for Imran Khan did so because he held out the enticing vision of a shiny Naya Pakistan cleansed of corruption, injustice and entrenched privilege. When, instead of delivering on his promises, he went after the opposition and media, he haemorrhaged support.

Saif Haq, the politician in your book, "who inspired a messianic devotion among his followers," is loosely based on Imran Khan. Why did you give his political party an unusual name like Integrity? I have noticed that aspiring nationalist leaders at the helm of fledgling parties love emotive but vague titles like Respect and Freedom and Justice. It was in that spirit that I chose Integrity.

This character also has shades of Amitabh Bachchan. Saif Haq "had been the symbol of the righteous, angry young man" and people "had gathered to offer special prayers" when he suffered "a life-threatening injury." What made you incorporate these elements in his life story? I wanted Saif to be a genuine celebrity with an aura of glamour that women found seductive and men admirable. In the subcontinent, film stars have the sort of appeal that cuts across classes and genders. And since Saif must channel macho strength and incorruptibility into his political message I thought I'd borrow some of Amitabh Bachchan's allure as an uncompromising warrior for social justice. Readers on both sides of the border, weaned on Indian cinema of the 1970s and 80s, would be familiar with that trope.

Ruby Rauf, who is hired to mobilize Pakistani women's participation on social media and in civil society, makes me think of model Qandeel Baloch and activist Sabeen Mahmud who were murdered for speaking their mind. Why is social media so liberating and so dangerous? Ruby bears little similarity to Qandeel and Sabeen. As you say, both these courageous, outspoken women took a stand for freedom of expression, albeit in very different ways. Ruby, on the other hand, becomes a mouthpiece for Integrity and gets manipulated into quashing the very freedom that both Qandeel and Sabeen gave their lives for. Social media is a blunt tool. Since it is largely unregulated, all opinions -- from the most sober and responsible to the most inflammatory and crazy -- are given equal space. Therein lies its strength and weakness.

How does this book's concern with the #MeToo movement relate to the long tradition of women's activism in Pakistan? What does the promise of corruption-free governance under Imran Khan and Saif Haq mean for women in particular? Pakistani women have made great strides in entering public space and getting their voices heard. Today, confident professional young women like Ruby and Farah are prominent in what used to be largely male-dominated fields until very recently. However, I do not mean to say that they have an easy ride of it. They continue to face harassment and discrimination on a daily basis. But they fight on. Under Imran Khan's government, corruption has actually increased in Pakistan. According to Transparency International, Pakistan has slipped from its position of 120 in 2019 to 124 in 2020. If anything, women's lives have become harder still as inflation has sky rocketed and COVID-19 has placed huge burdens on them with regard to educating their children, hanging on to their jobs, and keeping their homes running.

Could you talk about the genesis of your new podcast Browned Off with publisher Faiza Khan, who lives in the UK and is of Pakistani heritage? In the first episode, she says, "We are non-white but far from non-judgemental." What can listeners look forward to?Since the killing of George Floyd last summer and the resultant eruption of the Black Lives Matter protests, much has been written and said in the UK about the need for diversity in contemporary culture. Faiza and I wanted to lift the lid on the can to see how much has actually changed. You can expect plenty of home truths, levity and lightness.

Who are the satirists that you like to read, hear and watch? Among Pakistanis, I enjoy Mohammed Hanif's writing, Swinery's Instagram posts, and Im the Dim, my sister Jugnu Mohsin's fictitious diary of Imran Khan. I also love Sabir Nazar's hilarious but savage cartoons.

You have spoken publicly about how, while living in the UK, you do not enjoy the same creative freedom that white writers do because you are expected to write stories that have something to do with your race or your religion. How do you intend to push back against this situation?By writing books like Tender Hooks and The Impeccable Integrity of Ruby R and doing my podcast Browned Off!
Chintan Girish Modi is a writer, educator and researcher who tweets @chintan_connect

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Interview: 'Under Imran Khan's government, corruption has actually increased in Pakistan' - Moni Mohsin, Author, The Impeccable Integrity of Ruby R

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Pakistani writer Moni Mohsin, who is best known for her long-running satirical column The Diary of a Social Butterfly, is out with a new book to regale audiences with her sparkling wit and razor-sharp social commentary. The Impeccable Integrity of Ruby R is set in a world of ruthless ambition, political propaganda, social media intrigue, and fragile relationships.

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York, Pa., can trace its beginnings back to 1741, when settlers from the Philadelphia region founded the city. And Rutter's Dairy - which is based in this area - has an origin story that goes back almost as far.

In 1747, Andrew Rutter was deeded 167 acres in York County, Pa., by Springetts Penn (the great-grandson of William Penn), the company says. This began the Rutter family's farm operations.

But it wasn't until 1921, when George and Bud Rutter began selling milk from said farm, that Rutter's Dairy was officially formed. Then known as "Crystal Spring Dairy," Rutter's got its start as a home delivery business, says Todd Rutter, president and third-generation Rutter family member.

A lot can change in a century.

In the first years of its operations, Rutter's was dedicated solely to home delivery. Then in the late 1960s, it began opening up its own convenience stores to compete with dairy-owned retails chains in the area, the company says. And Rutter's completely pivoted to retail by the 1990s.

"I think a major turning point would have been the change in focus from home delivery to retail and wholesale customers," Rutter notes.

Today the company might no longer deliver milk door to door, but consumers can find its products throughout Pennsylvania, Maryland and West Virginia.

An array of beverages

Rutter's produces 103 SKUs in the fluid milk, tea and juice categories, says Rick Miller, sales/marketing director. The company offers fluid milk in most typical variations - nonfat, fortified nonfat, low-fat, 1%, 2% and half & half - and many formats, including gallon containers, half-gallon containers and half-pint containers. It also manufactures eggnog and an array of flavored milks.

A particularly successful flavored milk launch in recent years was Chocolate Peanut Butter milk, which was originally created as part of the company's limited-time offer (LTO) program (see Product Development Spotlight sidebar). Peanut Butter fandom runs deep in Central Pennsylvania, where Rutter's is located, explains Miller, in part because Hershey's (which produces Reese's Peanut Butter Cups) also is headquartered in the area.

"Central Pennsylvania is the peanut butter capital of the world. Peanut butter here is like bacon is to the rest of the world," Rutter jokes. "You put peanut butter in or on anything here; it's very successful."

While the Chocolate Peanut Butter milk was originally going to be only an LTO, it was so popular that Rutter's decided to make it a permanent offering, Miller remarks.

"We could not make [the Chocolate Peanut Butter milk] fast enough. And then we ran out of ingredients and labels for our limited-time offer, and people were very sad," he says. "So we retooled, and six months later, we brought it out as an everyday standard item in two sizes."

Rutter's chocolate milk is another very popular offering. Miller explains that the company regularly gets phone calls from fans asking if there is a way for them to ship the product out of the mid-Atlantic area. (As Rutter's is a regional dairy, it currently does not have distribution outside of the Pennsylvania, Maryland and West Virginia areas).

"I'll get phone calls from people that have moved away from our area, begging us to ship [our] chocolate milk across the country," explains Diane Quinn, customer service manager.

Rutter's services most of the typical channels for dairy, including retail stores, its own and other convenience stores, schools, nursing homes, foodservice and colleges. It also produces products for some private label customers, explains Rutter.

"We're pretty much in most of them," says Quinn.

Local before it was 'cool'

When marketing its products, Rutter's emphasizes its local milk source and the freshness of its products, notes Miller.

"We support local farmers," he adds. "We're very proud of our producers, and a big part of our supply comes from those local producers that are within a hundred-mile radius of our facility."

Rutter explains that Rutter's has supported local farmers since its founding, and has always made products with all-natural ingredients.

"We were local before local was cool," he points out.

Another point of marketing, at least on Rutter's single-serve milks, is the protein content, says Miller. After noticing the consumer trend of increasing protein consumption, Rutter's revamped its milk packaging in 2019 to call out the amount of protein.

As far as its typical customer, Miller notes that milk tends to reach across all different demographics. The amount and type of milk its customers purchased did change a bit this year with the COVID-19 pandemic. Before last year, Rutter's had noticed a trend toward single-serve offerings.

"As people started to stay home and work from home, we saw the trend shift to our gallons and half gallons because people [returned] back to bringing the bulk sizes home," he explains. "With restaurants and convenience stores [having a] diminished amount of people coming in for their breakfast and lunch trade, it definitely changed our product offering, as far as the volume going out."

Rutter's products are available at many local retail outlets, but the company has seen the most success in expanding its footprint "through private label opportunities with other distributors," explains Rutter.

According to Miller, because today's consumers are purchasing many beverages beyond milk, Rutter's is competing with "everyone." And to compete in that crowded landscape, the company focuses on producing the highest-quality product it can.

"We stick with what we do best," Miller emphasizes. "We've been doing this a long time where we feel we're the best at what we do - making milk. Milk is our bread and butter."

'The best chocolate milk ever'

Rutter's advertises digitally, on billboards and in newspapers and also runs TV ads in its local markets, notes Miller. The company produced a TV ad in 2020 that promotes its chocolate milk as "the best chocolate milk ever." The ad highlights the special life moments into which chocolate milk fits and calls out the milk's nutritional qualities and natural ingredients.

While events have not happened recently due to the pandemic, in the past, Rutter's partnered with a local baseball team and did some promotion at the county fair as part of its marketing strategy. Additionally, Rutter's works with local news stations to host Facebook Live events on the stations' Facebook pages as part of its social media approach.

"I do a bunch of Facebook Live events every year to help promote our LTO products and also promote our seasonal products like eggnog, and those have been very successful," Miller remarks. "[It is] a very good form of advertising that is low cost and high output ... My eggnog Facebook Live got over 120,000 views in our market."

For the eggnog video, Miller demonstrated recipes to local news anchors featuring the product, including eggnog pancakes, eggnog cookies and mixed drinks.

Rutter's also promotes its products on its personal Facebook pages. Twice a month, it showcases its milk or flavored milk on the platform.

Developing talent locally

Rutter grew up working for Rutter's. He jokes that while he's officially been on staff for 43 years, he's unofficially worked for the company since he could walk. Most of the executive team also has long-term ties to the company. Quinn has been with the company for 32 years - starting in the accounting department.

"I have worked [with] and known all three generations of owners since I've been here," she says. "That's pretty outstanding, I think, to have that piece of history in my background."

Miller also has been with the company for decades. He started with Rutter's 22 years ago.

"We're very good at promoting from within," Miller points out. "We try to develop our own talent."

Rutter says this "homegrown" approach to building talent is part of the key to the staff's longevity.

"Almost all my team ... they worked their way up through from entry-level positions up into management, up different levels of management then up into key executive roles," he notes.

Rutter's "homegrown" attitude extends to its view of corporate citizenship as well. The company is very committed to giving back to its local community.

"We try very hard for our money to stay back in our market for the people that help support us; we try to help support them," explains Rutter.

For example, Rutter's gave almost $8 million in the past 16 years to local charities, says Rutter. These include local food banks and charities that focus on children's issues. The company also started its own charity called Rutter's Children's Charities.

Making lemonade

For his part, Rutter says his perspective on the dairy industry has shifted in the past year with the pandemic, as more people returned to the dairy category during shutdowns.

"I think the last year has given the dairy industry a huge opportunity, so I think our challenge is how to exploit the opportunity the situation's given us and capitalize on it," he explains.

Rutter views the increased milk sales during the "terrible" pandemic as a making "lemonade out of lemons" scenario.

"So, we've got the lemons, let's figure out how to make and sell lots of milk as our lemonade," Rutter says.

Dairy is a mainstay in home cooking in general, but especially in the breakfast category, Rutter notes. He hopes that the dairy industry can find a way to capitalize on home-cooked meals even as the pandemic subsides.

"Breakfast, especially, is fluid milk's best friend," he points out. "As all these millions of people stayed home and had breakfast for a change, hopefully they've rediscovered it. And hopefully, they appreciate the value of that quality family time, and it's a new trend."

As far as looking to the future, Rutter's is mainly focused on keeping its operations running smoothly during this challenging time, Rutter notes.

"Our biggest challenge each and every month is trying to figure out how to keep staffing," he says, "and how to keep trucks rolling, and how to keep plant rolling and get through every day.

"My team and their managers underneath them have been more creative and innovative than we've ever thought we would be," Rutter adds. "And hopefully, one of the things we've learned as a management group is that we can do this and survive. ... So, maybe we can figure out how to do it a little better next time."

Product development spotlight: A 'live' R&D department

While Rutter's doesn't have a formal research and development (R&D) department, it operates a limited-time offer (LTO) program as a low-risk way to test out new milk flavors, says Todd Rutter, president.

According to Rick Miller, sales/marketing director, the LTO program functions as a sort of "live R&D." Successful flavors are eyed to become a more permanent part of Rutter's portfolio.

"We've tried all kinds of exciting flavors over the past few years in flavored milk," notes Miller. "Anything from Pumpkin Pie milk to cookie-flavored milks, all kinds of unique flavors."

The company looks to what flavor profiles have been successful for others when choosing what to manufacture through its LTO program. The idea is that if the product isn't successful, it isn't a big loss, as the products are initially available for only an eight-week run.

"We'd pick some stuff that we feel is hot or a current, that follows a current trend, and we go with it," Miller explains.

According to Rutter, some of the "oddball flavors" the company has created have been some of its most successful LTO offerings. One unexpected success was Rutter's Pumpkin Pie milk.

"The Pumpkin Pie [milk] did better than any of us, I think, thought it was going to," notes Rutter.

The past two summers, Rutter's also released Watermelon lemonade as part of its LTO program. And the offering was so successful that it is debuting it as a new flavor this spring, says Rutter.

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Rutter's Dairy celebrates a century of local milk

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York, Pa., can trace its beginnings back to 1741, when settlers from the Philadelphia region founded the city. And Rutter's Dairy - which is based in this area - has an origin story that goes back almost as far.

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To download a spreadsheet showing estimates of the effects of full ACA repeal by state and congressional district, click .
Yesterday, despite the faulty legal reasoning of the Republican attorneys general and governors who initiated the Texas v. United States health care repeal lawsuit, as well as the clear partisan nature of the case, the U.S. Court of Appeals for the 5th Circuit ruled that the Affordable Care Act's (ACA) individual mandate was unconstitutional following enactment of the so-called Tax Cuts and Jobs Act of 2017, which zeroed out the individual mandate penalty. The 5th Circuit also remanded the case back to the U.S. District Court for the Northern District of Texas to determine what other parts of the ACA can stay in place given its decision that the individual mandate is now unconstitutional. Not only does this ruling increase uncertainty and threaten health care coverage for millions, but it also places power over the U.S. health care system back into the hands of Judge Reed O'Connor-a man who legal scholars say was handpicked "for his partisan loyalties" and who previously ruled that the entire law must be struck down.

After several failed attempts by congressional Republicans to repeal the ACA, President Donald Trump's allies-with the support of his Department of Justice-are taking a circuitous route through the judiciary to advance their assault against the ACA.

A ruling that invalidates the ACA or core features of the law would have a devastating impact on the American people. The Trump administration seems well aware of this, as it has previously said that it would request a stay to delay repeal if the courts strike down the entire ACA and may try to slow down any appeal to the U.S. Supreme Court. Yet by backing the lawsuit without any replacement plan, Trump is essentially gambling for "repeal and delay," a proposal that was too unpopular and damaging to pass Congress.

While the case continues to move through the judiciary, the uncertainty of a future Supreme Court decision will create chaos and harm throughout the health care system in the near term-especially in the individual market. Insurers price plans based on expected costs, and the added uncertainty about the fate of the ACA's marketplaces and consumer protections could drive them to hike premiums dramatically or withdraw from the individual market altogether.

Ultimately, the consequences for the U.S. health care system depend on the rulings of the district court and Supreme Court. Under the most devastating scenario, a ruling that invalidates the entire ACA would upend the health care system as Americans know it, including by eliminating coverage for millions of people, rolling back consumer protections, and increasing costs for millions more.

Repealing the ACA would lead to the loss of not only well-known coverage-related provisions such as Medicaid expansion and the health insurance marketplaces but also important ACA programs and protections for Americans with other types of coverage. For example, the district court could end federal rules preventing insurance companies from discriminating against people with preexisting conditions, as well as a rule allowing young adults to remain on their parents' employer-based insurance plans until age 26. Even seniors covered by Medicare could be harmed; some beneficiaries may see their premiums and out-of-pocket costs rise and therefore risk falling back into the prescription drug coverage gap.

Below are just five of the key consequences of the 5th Circuit's decision to remand:

Uncertainty about ACA repeal will disrupt the individual market, hike premiums, and limit plan options.

Approximately 20 million people could become uninsured.

Federal funding for health coverage could drop by nearly $135 billion.

Approximately 135 million people with preexisting conditions could face discrimination from insurers in the individual market.

Consumers could be hurt by the rollback of the ACA rule preventing insurers from overcharging for premiums, which has forced insurance companies to rebate $1.37 billion in 2019 alone.

Chaos in the insurance market

While the 5th Circuit's decision pushes back the date that possible ACA repeal would occur, it cannot prevent uncertainty about repeal from wreaking havoc in the individual market. The annual rate submission process requires insurers to lock next year's rates months ahead of open enrollment; they must file rates with their state insurance commissioner starting each spring, then submit final rates to the Centers for Medicare and Medicaid Services in August. Unless the Supreme Court resolves the case in the next few months, the ACA's financial assistance will remain in jeopardy and the regulatory environment will be in flux; insurers are likely to hike premiums for 2021 in order to hedge against scenarios in which enrollment drops, subsidies disappear, or only the sickest enrollees remain in the risk pool. As a result, consumers seeking comprehensive coverage are likely to see much higher premiums for 2021 regardless of what eventually becomes of the ACA. Moreover, subsidized enrollees who need comprehensive benefits could be stuck with unaffordable coverage if the ACA is ultimately repealed by a Supreme Court ruling.

Some risk-averse insurers may simply flee the ACA market altogether, scrapping plans to participate in 2021. When "repeal and delay" proposals were on the horizon in 2016, the American Academy of Actuaries warned Congress that "increased uncertainty and instability" could cause insurers to exit, leading to "severe market disruption and loss of coverage." If the 5th Circuit's decision and the forthcoming declaration from the lower court end up spooking insurers out of the marketplace, consumers in some areas of the country may have limited options for individual coverage other than skimpy short-term plans that charge more for preexisting conditions and set limits on benefits.

20 million Americans could become uninsured

According to an Urban Institute study, without the ACA's protections and financial assistance, an estimated 20 million Americans would become uninsured. (see Table 1) Breaking those numbers down by congressional district, the Center for American Progress estimates that an average of approximately 45,600 people would become uninsured in each district and Washington, D.C., if the ACA were fully repealed nationwide. (see downloadable spreadsheet) Another Urban Institute report finds that 5.4 million Latinx and 3.2 million Black Americans are among those who would lose coverage as a result of ACA repeal.

Many of the people at risk are lower-income individuals and families that are enrolled in Medicaid, including those covered by both preexpansion Medicaid programs and the ACA's Medicaid expansion, in which the federal government pays at least 90 percent of the costs. In fact, more than half of those projected to become uninsured have family incomes of less than 138 percent of the federal poverty level. Cutting off the ACA's tax credits and cost-sharing assistance for low- and middle-income families in the marketplace would leave enrollees without affordable options for coverage.

Federal funding could drop by $135 billion

According to the Urban Institute, a full repeal of the ACA would reduce federal funding for coverage by nearly $135 billion. This is the equivalent to losing an average of $309 million of federal funding in each congressional district. Moreover, these funding cuts translate to a 35 percent decrease in federal spending for marketplace subsidies, Medicaid, and the Children's Health Insurance Program (CHIP). These federal dollars help people obtain coverage and, without them, working-class children and families across the nation will face devastating coverage losses. Based on the Trump administration's budget for fiscal year 2020, this funding isn't likely to be redirected toward other social and economic services; rather, President Trump's fiscal focus remains on tax cuts for the wealthy and corporations.

No ACA means discrimination against people with preexisting conditions

The district court ruling could eliminate protections for the estimated 135 million nonelderly people with preexisting conditions. Under the ACA, individual market insurers cannot refuse to cover a person based on health status, a provision that nearly 3 in 4 Americans feel is "very important" to keep in place if the ACA is repealed, according to polling by the Kaiser Family Foundation earlier this year. Additionally, the ACA established community rating, prohibiting insurers from charging higher premiums for people based on their health needs or medical histories. Without these protections, however, insurers are likely to return to medical underwriting, discriminating against the less healthy when setting pricing, exclusions, and limits. Only seven states have pre-ACA laws on the books prohibiting medical underwriting.

In addition, there are other ACA provisions that are critical for people with preexisting conditions. For example, without the ACA, health plans would no longer be required to cover essential health benefits (EHBs). These 10 basic categories of services include hospitalization, maternity care, and mental health and substance use disorder services. Without the EHB requirement, insurers could refuse to cover certain costly services that many policyholders are likely to need; for example, an insurance company could refuse to cover cancer treatment in order to avoid policyholders with a history or high risk of cancer. People who needed coverage for nonincluded benefits would be forced to pay extra. In its analysis of the House's ACA repeal bill, the Congressional Budget Office estimated that adding a coverage rider for maternity care would cost an enrollee more than $12,000 annually. Surcharges for other conditions could be even costlier. According to CAP analysis of an earlier ACA repeal plan under the Graham-Cassidy bill, if the legislation had passed, enrollees with drug dependence could have been charged an extra $20,450 and those with breast cancer could have been charged an extra $28,660 on top of standard premiums in 2026.

Many people outside the marketplaces, including those with employer-sponsored coverage, would also suffer if the ACA is ultimately repealed. Millions of Americans could face the return of annual or lifetime limits on the amount of medical care their insurance will cover. Furthermore, without the ACA, insurers would not have to offer preventive services -ranging from contraception to cancer screenings to vaccinations-at no cost to the patient, a change that has implications for both individual and population health.

Despite President Trump's promises to protect people with preexisting conditions, none of the conservative options he backed in the congressional push for "repeal and replace" would have actually protected them. Insurance plans that lack basic benefits, as well as cruel tactics to keep profits in insurance corporations' already full pockets, are likely to proliferate without ACA protections. The American people-particularly the roughly half of nonelderly adults with preexisting conditions-could be hurt by this disregard for their well-being.

Without ACA rules, insurers could charge Americans more for less coverage

If a full repeal takes place, the quality of individual coverage and the stability of the market will further degrade. In addition to the return of medical underwriting, there would be no national safeguard to prevent insurers from raising premiums while providing less coverage. Under the ACA's medical loss ratio (MLR) rules, insurers must pay rebates to consumers if they overprice premiums relative to actual medical costs. Moreover, insurance companies that do not spend at least 80 to 85 percent of premium funds on medical care must issue rebates to consumers. Since 2011, insurers have returned approximately $5.3 billion in excessive premiums to policyholders, averaging $663 million per year. MLR rules protect consumers in all markets, including those covered by employer-sponsored insurance. In 2019, insurance companies have paid out a total of $1.37 billion in rebates, including rebates for 2.3 million people with large-group coverage through an employer. In Texas alone, insurers have paid $91.9 million in rebates.

Without the ACA, however, insurers could charge exceedingly high prices and use the revenue for executives' salaries, advertising, marketing, and other means of maximizing profits at the expense of enrollees. Such practices are already common among short-term, limited-duration plans that do not have to comply with the MLR rules-also known as " junk" insurance plans. For an idea of what pricing might look like without ACA protections, some junk plans spend as little as 9 cents per premium dollar on medical care. Assisted by looser rules under the Trump administration, insurers have been trying to sell more of these plans in order to benefit their bottom lines, often using deceptive marketing tactics to dupe consumers into purchasing plans they think will provide comprehensive coverage. In the absence of ACA regulations, these junk plans and their damaging impact on Americans' access to health care would only proliferate.

Conclusion
Nicole Rapfogel is a special assistant for Health Policy at the Center for American Progress. Emily Gee is the heath economist at the Center. Charles Gaba is a health care analyst and the founder of and editor for ACASignups.net.
The 5th Circuit's decision in the Texas v. United States health care repeal lawsuit furthers Trump's commitment to putting partisan rhetoric over the livelihoods and health of the American people. The Trump-backed repeal lawsuit has pushed the nation closer to a reversal of preexisting condition protections and the coverage gains made under the ACA and, even with uncertainty about the ultimate outcome, will likely have near-term effects on the stability of insurance markets. The court's decision is a brazen attack on health care. If the district court-and ultimately the Supreme Court-strikes down large portions of the ACA, there will be devastating impacts on health care for Americans across the nation.

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Court Ruling Against ACA Hurts Patients and Destabilizes Health Insurance Markets - Center for American Progress

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The appeals court in the Texas v. United States health care repeal lawsuit ruled the Affordable Care Act's individual mandate unconstitutional but left in doubt the rest of the law, fueling uncertainty that could harm markets in the near term.

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Stay up-to-date on Healthcare Reform.

Below is a summary of recent events to help you stay current on healthcare reform news all in one place.

Healthcare Reform News Update for March 24, 2021
ACA Special Enrollment Period Extended Through August 15
The Biden administration announced Tuesday that the Affordable Care Act (ACA) Special Enrollment Period (SEP) for the federal healthcare exchange has been extended through August 15.

The expansion will enable individuals and families more time to access the increased tax subsidy credits included under the American Rescue Plan stimulus, according to the Centers for Medicare and Medicaid Services (CMS).

The additional premium financial assistance will be available beginning April 1. To take advantage of the reductions, current ACA plan enrollees must submit an application update through the federal exchange on - or after - April 1. After receiving a new eligibility determination, consumers can continue their current health plan with a new lower premium, or they can choose a new plan.

Healthcare Reform News Update for March 23, 2021
Special Enrollment Period Adds Over 206,000 ACA Signups in First Two Weeks
During the first two weeks of a Special Enrollment Period (SEP), more than 206,000 consumers enrolled in Affordable Care Act plans, according to the Centers for Medicare and Medicaid Services (CMS).

Data shows that 206,236 new enrollees signed up between February 15-28 in states that use the federal Affordable Care Act (ACA) exchange.

Healthcare Reform News Update for March 19, 2021
Becerra Confirmed as Health & Human Services Secretary
The Senate confirmed Former California attorney general Xavier Becerra as the new secretary for the Department of Health and Human Services (HHS) in a 50-49 Senate vote on Thursday.

Becerra previously represented a Los Angeles district for 12 terms in the House of Representatives, serving on the Ways and Means Committee, which set healthcare policy. Becerra also helped draft the Affordable Care Act (ACA) and has defended it in court.

As HHS Secretary, Becerra will have an important voice in deciding federal policy regarding Covid-19. Becerra has said he will "work on a bipartisan basis to safeguard insurance-coverage protections for people with pre-existing conditions, reduce healthcare costs, and sustain the ACA market."

Healthcare Reform News Update for March 12, 2021
Stimulus Package Expands ACA Tax Subsidies and COBRA Coverage
President Biden signed a stimulus bill into law on Thursday that includes a temporary expansion of people eligible to receive premium tax subsidies for Affordable Care Act health plans, increased subsidy amounts for those previously eligible, and expanded COBRA coverage to those who lose their jobs.

Called the American Rescue Plan Act, the law will now enable Americans who earn over 400% of the federal poverty level (FPL) to receive premium tax credits when the premium for the silver benchmark plan in their area exceeds 8.5% of their annual income.

Those who were previously eligible for a tax subsidy will receive larger premium tax credits. The percentage of income that individuals and families are expected to contribute towards premiums for plan years 2021 and 2022 was reduced, thereby increasing the amount of premium tax subsidies available to those earning less than 400% of the FPL.

In addition, people who lose their jobs and enroll in COBRA coverage will receive a premium subsidy that will cover the total monthly cost through September 30, 2021. Those who missed their original COBRA deadlines will now have an additional 60 days to enroll.

Healthcare Reform News Update for March 4, 2021
Over 206,000 Sign Up for ACA Plans in First Weeks of Special Enrollment Period
More than 206,000 Americans signed up for Affordable Healthcare Act health insurance plans in the first two weeks of a 2021 Special Enrollment Period (SEP), according to the Centers for Medicare & Medicaid Services. The report accounts for the 36 states that use the federal exchange.

Normally only those with qualifying life events are eligible for an SEP and allowed to purchase insurance outside of the Open Enrollment Period. However this current SEP is open to anyone who needs coverage.

Healthcare Reform News Update for March 2, 2021
Study Shows ACA Subsidies Reduced Financial Burden for Low-income Adults
Low-income households eligible for both Affordable Care Act premium subsidies and cost-sharing reductions spent 17% less on out-of-pocket healthcare costs and had a 30% lower probability of catastrophic healthcare expenses than those who did not qualify for any subsidies, according to a new study published in Health Affairs.

The analysis also showed that middle-income adults eligible only for premium subsidies did not have lower-out-pocket healthcare costs or a lower probability of catastrophic healthcare expenses.
CMS Adds $2.3 Million in Navigator Funding for SEP
The Centers for Medicare and Medicaid Services announced it will provide $2.3 million in funding to Affordable Care Act Navigators in states that use the federal marketplace for the Special Enrollment Period (SEP) that runs through May.

The funds will be used by 30 eligible organizations for outreach, education, and enrollment efforts.

CMS also said that it plans to increase navigator funding for the 2022 ACA enrollment period.

Healthcare Reform News Update for February 22, 2021
Chiquita Brooks-LaSure Announced as CMS Nominee
President Joe Biden has announced Chiquita Brooks-LaSure as his nominee to head the Centers for Medicare and Medicaid Services (CMS).

Brooks-LaSure previously served as deputy director for policy at the Center for Consumer Information and Insurance Oversight within CMS and as director of coverage policy for the Department of Health & Human Services (HHS).

Healthcare Reform News Update for February 17, 2021
Aetna Plans to Re-enter ACA Marketplace in 2022
Aetna will sell plans on the Affordable Care Act exchanges in 2022, according to parent company CVS Health Corp's CEO Karen Lynch. Aetna previously withdrew from the ACA marketplace in 2018.

Lynch did not specify what exchange markets the company would reenter, but she said it would likely concentrate on areas where its 650 CVS HealthHub stores are located.

The plan will include the CVS name and may offer similar benefits as its employer plans such as no-copay visits to CVS MinuteClinics, discounts on some items sold at CVS stores, and ties to Health Hub offerings.

Healthcare Reform News Update for February 11, 2021
Biden Administration Supports ACA in Supreme Court Case
The Department of Justice (DOJ) sent a letter to the Supreme Court on Wednesday withdrawing the previous administration's push to overturn the Affordable Care Act (ACA).

Previously, the Trump administration sided with Republican challengers to the ACA who argued that the repeal of the individual mandate invalidated the entire healthcare law. President Joe Biden's position now puts the DOJ on the side of 20 Democratic states that want to uphold the ACA.

Healthcare Reform News Update for February 8, 2021
Medicare Advantage Extra Benefits Enrollment Triples in 2021
Enrollment in Medicare Advantage plans that offer special supplemental benefits for the chronically ill (SSBCI) increased from 1 million in 2020 to 3 million in 2021, according to research from Avalere Health.

Beginning last year, Medicare Advantage plans were allowed to offer non-primary health-related benefits to people with conditions such as diabetes and asthma. These plans represent 16% of all 2021 Medicare Advantage plans that were analyzed.

The most commonly offered SSBCI are meals, food and produce, and pest control.

The analysis found that 86% of Medicare beneficiaries live in a county with at least one plan that offers an SSBCI benefit. Overall, 15% of 2021 Medicare Advantage enrollees are enrolled in plans offering SSBCI, compared to 6% in 2020.

Healthcare Reform News Update for February 4, 2021
Pennsylvania and New Jersey Announce ACA Special Enrollment Periods
State Affordable Care Act exchanges in Pennsylvania and New Jersey have opened Special Enrollment Periods for any uninsured residents.

Pennsylvanians can enroll in an ACA plan from February 15 through May 15. New Jersey's exchange will remain open through May 15 with coverage starting the first day of the month after enrollment.

Healthcare Reform News Update for January 29, 2021
California Announces ACA Special Enrollment
California's state Affordable Care Act (ACA) exchange will open a Special Enrollment Period (SEP) from February 1 through May 15 for any uninsured resident.

The SEP immediately follows the state's current Open Enrollment Period (OEP), which runs through January 31 for coverage that starts February 1.

Healthcare Reform News Update for January 28, 2021
President Biden Orders ACA Special Enrollment Starting February 15
President Joe Biden signed an executive order Thursday that will open an Affordable Care Act (ACA) Special Enrollment Period (SEP) from February 15 to May 15 for the 36 states that use the federal ACA exchange.

The SEP will apply to anyone without insurance coverage who would like to sign up for a plan.

Healthcare Reform News Update for January 19, 2021
CMS Oks New Medicare Part D Drug Tier
The Centers for Medicare & Medicaid Services (CMS) finalized a rule that will allow insurance companies to create a second "preferred" specialty tier for some high-cost Medicare Part D specialty drugs.

The new preferred tier will have lower out-of-pocket costs for Medicare patients than the current "specialty" tier. Currently, all drugs on a Part D plan's specialty tier have the same level of cost sharing.

Healthcare Reform News Update for January 15, 2021
Federal Lawsuit Challenges Georgia Plan to Block ACA Exchange
A federal lawsuit has been filed against the Trump administration over a Georgia Affordable Care Act (ACA) waiver that would replace the federal exchange with private broker sites beginning in 2023.

The lawsuit argues that blocking access to the federal marketplace would increase the number of uninsured residents, weaken coverage offerings, and increase premiums. Advocates for the plan believe the waiver will increase competition and available options.

Healthcare Reform News Update for January 13, 2021
Medicare Rule Allows Faster Coverage for Innovative Technologies
The Centers for Medicare and Medicaid Services (CMS) issued a final rule that will allow innovative medical devices to be covered more quickly by Medicare.

The rule approves devices designated as "breakthrough" to be covered as soon as the same day the device is authorized by the Food and Drug Administration (FDA). Devices will receive an initial four years of Medicare coverage.

Healthcare Reform News Update for January 5, 2021

Maryland has implemented a special enrollment period that allows residents to sign up for Affordable Care Act health insurance from now until March 15.

Coverage begins depending on when a resident enrolls in a plan:

Healthcare Reform News Update for December 22, 2020
Congress Passes Spending Package That Includes a Ban on Surprise Billing
Congress on Monday passed a $900 billion economic relief package including legislation that eliminates the practice of "surprise billing" beginning in 2022.

Surprise bills result from insured patients unexpectedly using out-of-network providers, most commonly in emergency settings.

The bill applies to doctors, hospitals, and air ambulances. Ground ambulances are unaffected. An exception is made if a patient gives consent prior to visiting an out-of-network physician.

Instead of charging patients, non-network providers will work directly with insurance companies regarding payment. Disagreements will be sent to outside mediators to negotiate.

Healthcare Reform News Update for December 15, 2020
Daily Average ACA Signups Increase by 14%
The daily average number of consumers signing up for Affordable Care Act plans on the federal exchange is about 14% higher than last year, according to recent federal data.

Approximately 3.8 million people signed up for plans from Open Enrollment's start through December 5, including 2.9 million returning enrollees and 916,000 new enrollees.

Today marks the final day of enrollment for the 36 states that use the federal exchange. Final enrollment totals will be released in early 2021.

Healthcare Reform News Update for December 10, 2020
Gallup Poll: Majority of Americans Support Affordable Care Act
American's approval of the Affordable Care Act is tied with the record-high of 55%, according to a new poll from Gallup. Approval previously reached 55% in April 2017.

Some of the poll findings include:
New Study Claims Medicare Advantage Better for High-Need Beneficiaries
Americans with Medicare Advantage (MA) plans who have high needs and high costs achieve better outcomes than those with Original Medicare, according to a new study by the Better Medicare Alliance, a Medicare Advantage advocacy group.

High-need, high-cost beneficiaries, as defined by the study, include those individuals underage 65 who are disabled, the frail elderly, and those with major complex chronic conditions. The analysis compared MA to Original Medicare on a host of quality measures including preventative screenings, prescription drug use, and hospitalizations.

The study found that high-need, high-cost beneficiaries with MA plans:

Healthcare Reform News Update for November 23, 2020
Trump Administration Finalizes Rules to Lower Medicare Prescription Drug Costs
The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) finalized two new rules last week that could lower Medicare prescription drug costs for beneficiaries.

The first rule announced a Most Favored Nation (MFN) Model for Medicare Part B drugs. Drug payments will be based on the lowest price that drug manufacturers obtain in similar countries and will go into effect January 1, 2021.

The second rule eliminates Medicare Part D prescription drug rebates for insurance companies, which could provide patients up to 30% in savings and will go into effect January 1, 2022. Instead, the rebates would go directly to the beneficiaries.

Healthcare Reform News Update for November 20, 2020
Over 800,000 Enroll in 2021 ACA Plans During 2nd Week of Open Enrollment
During the second week of the 2021 Open Enrollment Period, 803,741 people signed up for Affordable Care Act (ACA) health insurance plans using the Heathcare.gov federal exchange. This includes 633,457 renewals and 170,284 new enrollees. This number does not include those who chose plans using a state-based exchange.

In total, over 1.6 million customers have enrolled in coverage using the federal exchange during the first two weeks of Open Enrollment this year.

Healthcare Reform News Update for November 19, 2020
Anthem Medicare Advantage Virtual Visits Increase Greatly in 2020
The number of virtual healthcare visits made by Anthem Medicare Advantage beneficiaries between March and May of 2020 was 136 times greater than during the same period last year, according to a new report from the company's Public Policy Institute.

The coronavirus (COVID-19) pandemic and stay at home orders are attributed with increasing the number of virtual visits from 4,400 in 2019 to 600,000 in 2020.

Some of the findings of how the company's Medicare Advantage members used virtual healthcare include:

Healthcare Reform News Update for November 16, 2020
Over 800,000 Sign Up for 2021 ACA Plans During First Week of Open Enrollment
During the first week of the 2021 Open Enrollment Period, 818,365 people signed up for Affordable Care Act (ACA) health insurance plans using the Heathcare.gov federal exchange. That includes 645,021 people who renewed coverage and 173,344 new consumers. This number does not include those who chose plans using a state-based exchange.

Healthcare Reform News Update for November 12, 2020
Medicare to Cover COVID-19 Antibody Treatment for Beneficiaries
A new coronavirus (COVID-19) monoclonal antibody treatment will be available with no cost-sharing to people on Medicare, the Centers for Medicare & Medicaid Services said Tuesday.

The drug, called bamlanivimab, was approved by the U.S. Food and Drug Administration (FDA) this week and can be administered via infusion by a variety of providers, including hospitals, infusion centers, home health agencies, and nursing homes.

Healthcare Reform News Update for November 9, 2020
Supreme Court Will Hear Affordable Care Act Case This Week
Beginning Tuesday, the Supreme Court will hear oral arguments in a case against the Affordable Care Act (ACA) brought by Republican state officials and backed by the Trump administration.

Previously, a lower court ruled in favor of the Republicans, agreeing that Congress' removal of the uninsured tax penalty invalidated the entire law.

A ruling is not expected until early next year.
2021 Original Medicare Premiums & Deductibles Rise Slightly
Premiums and deductibles for 2021 Medicare Parts A and B will marginally increase, according to the Centers for Medicare & Medicaid Services (CMS).

New rates for 2021 include:

Healthcare Reform News Update for November 2, 2020
Trump Administration Approves Georgia Plan to Eliminate Federal Exchange
The Centers for Medicare and Medicaid Services (CMS) has approved Georgia's request to eliminate the federal Affordable Care Act (ACA) exchange website as an enrollment option beginning in 2023.

Georgia's plan will direct consumers to private brokers and insurance companies instead of the federal website. The approval makes Georgia the first state without a government-run enrollment site for residents.

CMS also approved Georgia's request to establish a reinsurance program to help lower premium costs.
Survey: 78% of Current Enrollees Are Prepared for Open Enrollment
Most Americans (78%) who have healthcare coverage say they are prepared for the current Affordable Care Act (ACA) Open Enrollment Period, according to a UnitedHealthcare survey.

The company's Consumer Sentiment Survey gathers information and opinions on a variety of healthcare-related topics.

Other findings from the survey include:

Healthcare Reform News Update for October 30, 2020
New Trump Administration Rule Would Require Health Insurers to Post Costs
Health insurance companies will be required to disclose their upfront costs for the common tests and procedures, according to a new rule finalized Thursday by the Trump administration.

Under the rule, consumers could review the full costs of procedures and out-of-pocket estimates for their own plan and those of other companies through yet-to-be-developed apps.

The requirements are designed to help increase price transparency and consumer empowerment, according to government officials. However, the regulation is facing opposition from a major health insurance group that says it would raise premiums.

The new regulations are scheduled to go into effect gradually over three years, beginning in 2022.

Healthcare Reform News Update for October 29, 2020

Medicare Will Pay for Future COVID-19 Vaccine
Medicare will cover all costs for government-approved coronavirus (COVID-19) vaccines under a new rule announced Wednesday by the Trump administration.

The plan ensures that Medicare beneficiaries will receive any and all doses at no charge once they are available.

Healthcare Reform News Update for October 23, 2020
Blue Cross Blue Shield of North Dakota Launches New Medicare Advantage Provider
Blue Cross Blue Shield of North Dakota (BCBSND) has debuted NextBlue, its new Medicare Advantage health insurance affiliate.

NextBlue is initially offering Medicare Advantage products for the 2021 plan year to Medicare-eligible residents in Burleigh, Cass, Morton, Richland and Stutsman counties, with the intent to expand in the future.

Healthcare Reform News Update for October 20, 2020
Average 2021 Premiums on Federal ACA Exchange to Drop by 2%
Premiums for 2021 Affordable Care Act benchmark silver plans on the federal exchange will decline by 2 percent on average according to a report from the Centers for Medicare & Medicaid Services.

Benchmark plans are the second-lowest cost plans available in an area. The reduction marks the third consecutive year that premiums have declined.

Other information in the report includes:

Healthcare Reform News Update for October 16, 2020
Georgia Will Leave the ACA Exchange by 2023
The Trump administration has approved Georgia Governor Brian Kemp's proposals to exit the federal Affordable Care Act (ACA) exchange and enact a partial Medicaid expansion.

Georgia will be the first state to leave the federal marketplace and offer residents health insurance only through private brokers or websites. Plans that meet ACA requirements will continue to be offered to consumers, but companies will also be allowed to sell lower-priced noncompliant coverage. The plan will be phased in by 2023.

Healthcare Reform News Update for October 12, 2020
CMS: Enrollment in Unsubsidized ACA Plans Declined 45% From 2016 to 2019
Between 2016 and 2019, the number of people who purchased Affordable Care Act (ACA) plans without a tax subsidy declined 45%, representing 2.8 million Americans, according to a new report from the Centers for Medicare and Medicaid Services (CMS).

CMS attributes the drop to consumers who do not qualify for subsidies being priced out of the market due to the rising cost of health insurance premiums.

Some findings from the report include:

Healthcare Reform News Update for October 9, 2020
Report: Uninsured Rate for Children Has Highest Yearly Increase in Over a Decade
The number of uninsured American children rose by 320,000 between 2018 and 2019-the largest annual increase in more than a decade, according to a new report by the Georgetown Center for Children and Families.

Other findings in the report include:

Several factors were cited as contributors to the loss of children's health insurance coverage, including efforts to repeal the Affordable Care Act, cuts to ACA enrollment outreach, and inadequate oversight over state Medicaid programs.
Colorado 2021 ACA Rates Drop By 1.4%
Premiums on Colorado's state Affordable Care Act (ACA) exchange will drop an average of 1.4% for 2021 individual plans. Premiums for Colorado's small-group plans will increase by 3.8%.

2021 premiums for individuals and families will be about 20.8% lower than they would have been without the state's reinsurance program, according to state officials.

Healthcare Reform News Update for October 6, 2020
Aetna Broadens Medicare Advantage Plan Availability
Aetna announced its 2021 Medicare Advantage plans will be available in 115 new counties, making the plans accessible to 1.9 additional people.

Benefits under the company's 2021 Medicare Advantage (non-special needs) plans include:

The company will also offer its Dual Eligible Special Needs plans to select counties in nine new states: California, Connecticut, Kentucky, Maine, Michigan, Mississippi, Nevada, New Jersey, and New York.

In addition, Aetna will offer a new standalone Medicare Part D plan, SilverScript SmartRx. At an average of $7.15, the plan will have the lowest PDP premium available in the country.
Clover Health & Walmart Launch New Medicare Advantage Plans in Georgia
Clover Health has partnered with Walmart to offer two new Medicare Advantage plans in eight Georgia counties (Bartow, Bibb, Cherokee, Cobb, Gwinnett, Henry, Paulding, and Rockdale).

Benefits of the LiveHealthy: Clover Powered, Walmart Enhanced and the LiveHealthy LI: Clover Powered, Walmart Enhanced plans include:

Healthcare Reform News Update for October 5, 2020
UnitedHealthcare to Offer 2021 Medicare Advantage Plans in Nearly 300 New Counties
UnitedHealthcare announced its Medicare Advantage plans will be available to nearly an additional 3.2 million people in close to 300 counties in 2021, signaling the company's largest expansion in five years.

Benefits that will be available for the company's 2021 Medicare Advantage (non-special needs) plans include:

Healthcare Reform News Update for October 2, 2020
Humana Adds New Counties and Benefits for 2021 Medicare Advantage Plans
Humana's Medicare Advantage HMO plans will expand into 125 new counties for the 2021 plan year, and its Medicare Advantage PPO plans will be available in 98 new counties, according to a press release.

New benefits for the company's 2021 Medicare Advantage and prescription drug plans include:

Healthcare Reform News Update for October 1, 2020
Cigna Adds 5 States to 2021 Medicare Advantage Plans
Cigna's Medicare Advantage offerings are expanding by 22% in 2021 with the addition of five new states and 67 new counties. In total, Cigna will offer plans across 369 counties in 23 states for the 2021 plan year.

According to a press release, the company will now offer Medicare Advantage plans in select regions of the following states:

Cigna also announced new virtual physical therapy services to all Medicare Advantage enrollees and, in select areas, a program that provides an allowance of up to $30 per month for fresh fruits and vegetables.

Healthcare Reform News Update for September 30, 2020
CDC: Uninsured Americans Cite Affordability as Primary Cause
The majority of uninsured adults under 65 say that affordability was the main factor in not having health coverage in 2019, according to a new study from the Centers for Disease Control and Prevention (CDC). In 2019, 73.7% of respondents said coverage was not affordable, according to the National Health Interview Survey.

Other factors included not being eligible, not wanting coverage, difficulty in enrolling, or not finding a suitable plan.

Other findings from the study include:

Healthcare Reform News Update for September 28, 2020
Five States Extend Open Enrollment Deadlines
With the Open Enrollment Period beginning November 1, several states with their own healthcare exchanges have already decided to extend the December 15 deadline.

The following states have extended their OEP deadlines:

Effective dates for coverage will depend on when the policy is purchased.

Healthcare Reform News Update for September 25, 2020
Trump Signs Executive Order on 'Surprise' Medical Billing
President Donald Trump on Thursday signed two executive healthcare orders, one of which focuses on ending "surprise" medical billing.

The second of the two executive orders addresses "surprise" medical billing for out-of-pocket expenses not covered by a patient's health insurance. Often, these medical bills are a result of patients receiving care from an out-of-network provider in emergency situations or through nonsurgical hospital stays - instances in which patients cannot choose their healthcare provider.

The order instructs Congress to work with Health and Human Services (HHS) Secretary Alex Azar to develop a legislative solution to this issue by December 31. If Congress fails to act by that date, HHS will have the authority to pursue a regulatory approach. Azar did not offer specific details.

The first order declares it a U.S. policy to "ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates" - despite the future of the Affordable Care Act (ACA).

Healthcare Reform News Update for September 16, 2020
U.S. Census Bureau: Number of Uninsured Americans Decreased Slightly in 2019
In 2019, 8% of Americans, or 26.1 million people, did not have insurance coverage at any point during the year-a 0.5% decrease from 2018, according to a new study by the U.S. Census Bureau.

The report includes data gathered from two surveys conducted in 2019. Some of the highlights include:

Healthcare Reform News Update for September 15, 2020
New Jersey Healthcare Leaders Team Up to Launch New Medicare Advantage Plan
Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) and health network Hackensack Meridian Health have partnered to launch Braven Health, a new Medicare Advantage plan. RWJBarnabas Health will also join the plan, pending state regulatory approval.

These plans will be offered for the 2021 plan year to Medicare-eligible residents in eight New Jersey counties: Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic, and Union.

Healthcare Reform News Update for September 14, 2020
Ambetter ACA Plans Expand Into 400 New Counties for 2021
Ambetter's 2021 Affordable Care Act health insurance plans will expand into 400 new counties across 13 states in which the company currently operates. The company is also adding New Mexico and Michigan to its ACA marketplace offerings. With this expansion, there will now be 22 states offering Ambetter ACA health plans.
UnitedHealthcare & Canopy Health to Offer New Employer-Sponsored Plan in CA
UnitedHealthcare and Canopy Health are partnering to offer a new group health plan for employees in Northern California.

The California Doctors Plan includes 19 medical centers and 5,000 physicians across nine Bay Area counties. Premiums are expected to be up to 25% less than traditional PPO plans.

Healthcare Reform News Update for September 9, 2020
Cigna 2021 ACA Plans to Expand Into 80 New Counties
Cigna announced that their Affordable Care Act (ACA) health insurance plans will be available in 80 new counties in 2021, increasing their reach by 27%.

The expansion will make Cigna ACA plans available to a total of 300 counties in 10 states: Arizona, Colorado, Florida, Illinois, Kansas, Missouri, North Carolina, Tennessee, Utah, and Virginia.

Healthcare Reform News Update for September 3, 2020
Georgia Governor Requests Exit From Federal ACA Exchange
Georgia Governor Brian Kemp has applied for an Affordable Care Act (ACA) waiver from the Trump Administration that would prohibit residents from using the federal government's healthcare exchange to purchase health insurance.

Other states have left the federal exchange, but residents can still purchase ACA plans from a state-based exchange. Georgia does not plan to create a state-based exchange, which means consumers would need to shop for health insurance through web brokers or directly from insurance companies.

The proposal would also make the state responsible for determining each applicant's eligibility for enrollment and premium subsidies.

The application argues that the change would increase competition in the private insurance marketplace and provide consumers with better access and options. Critics say the proposal would cause tens of thousands to lose coverage.

Approximately 450,000 Georgia residents currently purchase ACA plans on the federal exchange, according to the state.

Healthcare Reform News Update for September 1, 2020
CMS Proposes Faster Medicare Coverage for New 'Breakthrough' Devices
The Centers for Medicare and Medicaid Services (CMS) has proposed a rule that will shorten the time between when new medical devices are approved for use by the Food and Drug Administration (FDA) and when they are covered by Medicare.

The rule will help fast-track devices designated by the FDA as "breakthrough" technology that treats unmet medical needs.

In the current process, manufacturers receive Medicare approval on a regional basis. The Medicare Coverage of Innovative Technology pathway would enable devices to receive national Medicare coverage approval concurrently with FDA approval.

Healthcare Reform News Update for August 24, 2020
Commonwealth Fund Survey: Over 43% of U.S. Adults are Underinsured
In the first six months of 2020, 43.4% of working-age adults in the U.S. were underinsured, according to the latest Biennial Health Insurance Survey by the Commonwealth Fund.

Those who are considered underinsured have a deductible that is 5% or more of household income or have out-of-pocket costs that equal 10% or more of their household income (5% for individuals living under 200% of the federal poverty level guidelines). Out-of-pocket costs do not include premiums.

This latest survey found no significant statistical changes in coverage compared to when the study was previously run in 2018, even considering the early months of the coronavirus (COVID-19) pandemic. However, researchers point out there is "persistent vulnerability" in consumers' ability to afford coverage that could worsen if the economic downturn continues.

Some of the additional findings from the survey:
Oscar Partners with South Florida Health Groups For New Medicare Advantage Offering
Health insurance company Oscar has partnered with Holy Cross Health and Memorial Healthcare System to provide a new Medicare Advantage plan for residents of Broward County, Florida.

The plan will provide enrollees access to Holy Cross Health's and Memorial Healthcare System's network of healthcare providers, dedicated care guides, and $0 unlimited virtual visits beginning January 2021.

The plan will be available during this fall's Medicare annual election period pending approval from state regulators.

Healthcare Reform News Update for August 20, 2020
Blue Cross Blue Shield of Michigan to Issue Premium Refunds, Increase 2021 Premiums
Citing fewer claims due to coronavirus (COVID-19), Blue Cross Blue Shield of Michigan plans to distribute 30% premium refunds to enrollees in its Affordable Care Act (ACA) and dental plans. The refunds are expected to be issued as credits on November invoices after approval by state regulators.

Also, the company has filed to increase 2021 premiums for its ACA and small group plans. Proposed average rate increases are as follows:
Supreme Court Sets Date for Oral Arguments in ACA Lawsuit
The Supreme Court will hear oral arguments November 10 in the case concerning a lawsuit that seeks to strike down the Affordable Care Act (ACA).

The justices will review a federal appeals court decision that the repeal of the individual tax mandate invalidated the law in its entirety.
Federal Appeals Court Backs Resumption of ACA Cost-Sharing Reduction Payments
A federal appeals court has ruled that the Trump administration unlawfully suspended Affordable Care Act (ACA) cost-sharing reduction payments to insurance companies in 2017.

The judges referred to a Supreme Court decision that resumed payments for the ACA's risk corridor program as a basis for their conclusion.

Healthcare Reform News Update for August 13, 2020
New Mexico Health Connections to Cease Operations in 2021
New Mexico Health Connections, an insurance co-op that provides Affordable Care Act plans to 14,000 residents, will cease operations on January 1, 2021.

Current customers will be covered through the end of this year but will need to find a new insurance plan for 2021. Five insurance companies are expected to provide New Mexico residents with ACA plans on the state exchange in the 2021.
Premiums for ACA Plans in Georgia to May Increase Slightly
Premium rates for 2021 Affordable Care Act plans will increase an average of 6.53%, according to initial filings with the state's insurance department. The proposed rates are expected to be finalized in September.

Most of the six insurance companies that sell ACA plans in Georgia have asked for increases of 10% or less. Kaiser Permanente has proposed a premium reduction of around 20 percent.

Healthcare Reform News Update for August 10, 2020
Maryland ACA Special Enrollment Period Reopened until December 15
Maryland has reopened its coronavirus (COVID-19) special enrollment period in response to the coronavirus (COVID-19, according to the Maryland Health Benefit Exchange . Residents will now have until December 15 to sign up for health coverage-making this the longest special enrollment period in the U.S.

Previously, Maryland's special enrollment period ran from March 16 to July 15. More than 54,000 uninsured Marylanders successfully found health plans during that time.

Healthcare Reform News Update for August 5, 2020
CMS Proposes Policies to Expand Medicare Coverage
The Centers for Medicare & Medicaid Services (CMS) on Tuesday proposed several new policies that could affect Medicare beneficiaries.

The proposals include:

CMS will accept public comments until Monday, October 5.

Healthcare Reform News Update for August 4, 2020
Trump Expands Medicare Telehealth Services
President Donald Trump issued an executive order August 3 that permanently expands Medicare telehealth services in rural communities throughout the United States, prompting the Centers for Medicare & Medicaid Services (CMS) to propose changes to the current system.

CMS previously expanded the availability of telehealth services because of the coronavirus (COVID-19); this executive order builds upon those efforts. Over the past several months, Medicare telehealth visits have grown to over 1 million per week - a significant increase from the previous thousands per week.

The executive order directs the following actions:

Healthcare Reform News Update for July 31, 2020
Oscar to Launch New $0 Virtual Visits and Enter New Markets in 2021
Health insurance company Oscar announced plans to include $0 virtual care in some areas and expand their Affordable Care Act offerings to 19 additional markets in 2021.

Virtual Primary Care will provide unlimited visits and a wide variety of services, such as Tier 1 prescriptions, labs, diagnostic imaging orders, and initial specialist referrals. Virtual Urgent Care will provide 24/7 access to providers, Tier 1 prescriptions, and labs.

$0 virtual visits are expected to be available in 10 markets within California, Colorado, Florida, New York, and Texas.

Upon regulatory approval, the company will offer ACA plans for the first time in parts of Arkansas, Iowa, North Carolina, and Oklahoma. It will also expand its existing footprint in Arizona, California, Colorado, Florida, Ohio, and Pennsylvania.

Healthcare Reform News Update for July 30, 2020
California ACA Special Enrollment Deadline Extended to August 31
California residents now have until August 31 to sign up for health coverage, according to Covered California, the state's Affordable Care Act exchange.

The special enrollment period was extended from the previous deadline of July 31 due to the ongoing coronavirus (COVID-19) pandemic and subsequent high number of Californians who have lost employer coverage.

Uninsured residents will be able to sign up for plans both on and off the exchange. Coverage will begin on September 1.
Medicare Drug Premiums to Rise Slightly in 2021
The Centers for Medicare & Medicaid Services (CMS) announced that Medicare Part D prescription premiums will only slightly increase in 2021. The average premiums will be $30.50, compared to $30 this year.

Part D premium prices continue a trend of lower costs with a 12% decline since 2017.

Healthcare Reform News Update for July 24, 2020
ACA Enrollment Remains Steady for Third Consecutive Year
Enrollment in 2020 Affordable Care Act (ACA) plans sold on the federal and state exchanges was 10.7 million, a 100,000 increase from 2019, according to a report issued Thursday by the Centers for Medicare & Medicaid Services (CMS). ACA enrollment has now remained steady for the third year in a row, according to the report.

Additional data in the report:
Aetna to Offer 2 New Employer Healthcare Plan Benefits
Aetna will offer two new employer healthcare benefit designs to help enrollees in high-deductible plans seek the care they may be avoiding due to high costs.

The Upfront Advantage benefit will provide members free access to some preventive services that cost up to $500 for individuals and $1,000 for families before their deductible is met.

The Flexible Five benefit provides five coupons per person that can be applied to a variety of services such as primary care visits, behavioral health visits, urgent care (including lab tests and X-rays), and generic drugs.

The new plan benefit designs were created in response to data that showed that 86% of high-deductible plan enrollees failed to meet their annual deductibles.

Healthcare Reform News Update for July 21, 2020
Trump Administration Sued Over ACA LGBTQ Protections
A group of Democratic attorneys general from 22 states and Washington, D.C., is suing the Trump administration over a recent rule that rolls back the Affordable Care Act's nondiscrimination protections for the LGBTQ community.

The lawsuit argues that the rule:

Attorneys general Maura Healey (Massachusetts), Letitia James (New York), and Xavier Becerra (California) are leading the lawsuit.
Clover Health to Triple Medicare Advantage Availability
Clover Health plans to expand its 2021 Medicare Advantage plan offerings to 74 additional counties, tripling its current reach.

The company's expansion adds 69 counties to states it already serves, which includes Arizona, Georgia, New Jersey, Pennsylvania, South Carolina, Tennessee, and Texas. It will also expand into five counties in Mississippi, a new market for the company.

Healthcare Reform News Update for July 20, 2020
Rule Grants Workers More Time to Enroll in COBRA Coverage
A new federal rule has given employees more time to sign up for COBRA health insurance coverage after they have been laid off or had their hours reduced.

Under the new rule, individuals can enroll in COBRA up to 120 days after the coronavirus (COVID-19) national emergency is over. That date is currently undetermined due to rising cases across the United States. Previously, workers had 60 days from the time of a layoff or reduction in hours to decide whether to continue with their employer's health plan though COBRA.

However, the COBRA enrollment extension only applies to people who:

were employed with companies that have 20 or more workers.

had employer-sponsored health coverage prior to being laid off or furloughed.

Workers who opt for COBRA coverage are still responsible for all back premium payments regardless of when they enroll.

Healthcare Reform News Update for July 14, 2020
Record Number of Americans Have Lost Health Insurance in 2020
An estimated 5.4 million Americans have lost health insurance coverage between February and March of this year because of layoffs related to the coronavirus (COVID-19), according to consumer advocacy group Families U.S.A.

The record-high increase in uninsured adults is 39% higher than the previous annual high of 3.9 million, which occurred between 2008 and 2009.

The study is a state-by-state analysis of how the pandemic has affected health insurance coverage for workers under age 65. Some of the findings include:

Healthcare Reform News Update for July 13, 2020
Analysis: New ACA Enrollment Could Reach 1 Million Due to COVID-19
Affordable Care Act marketplace plans could add more than 1 million new enrollees due to coronavirus (COVID-19) job losses, according to analysis by Avalere.

The federal ACA exchange has added 487,000 new enrollees since the close of the open enrollment period in December. This is a 47 percent increase over the same time period last year. In eight of the 12 states that run their own ACA exchanges, nearly 263,000 people have signed up for coverage since March.
Medigap Enrollees Prefer the Most Comprehensive Coverage
The majority of Medicare Supplement enrollees choose more comprehensive coverage, according to a new study from America's Health Insurance Plans (AHIP).

Around 9.3 million people were enrolled in a Medicare Supplement Plans F and G, in 2018, accounting for 70 percent of all enrollment. Plans F and G are two of the most comprehensive plans, but Plan F was discontinued to new enrollees as of January of this year.

Other finding from the study include:

Healthcare Reform News Update for July 9, 2020
Supreme Court Upholds Religious Exemptions to ACA Birth Control Mandate
The Supreme Court ruled Wednesday that employers can limit birth control coverage under the Affordable Care Act (ACA) on the grounds of religious or moral objections.

The 7-2 ruling upholds a Trump administration change that allows employers to opt-out of providing no-cost contraception required under the ACA.

Healthcare Reform News Update for July 1, 2020
Oklahoma Voters Approve Medicaid Expansion
Citizens in Oklahoma voted on Tuesday to expand Medicaid under the Affordable Care Act by amending the state constitution. Those who earn up to 138% of the federal poverty level will now qualify for Medicaid, which is approximately $17,200 for individuals and $35,500 for a family of four.

The expansion is projected to cover around 215,000 residents for an estimated total annual cost of $1.3 billion. The state is expected to increase a fee hospitals pay from 2.5% to 4% help fund the expansion.

Healthcare Reform News Update for June 30, 2020
House Democrats Pass Bill to Extend ACA Provisions
The House voted to expand the Affordable Care Act on Monday. The measure is the first significant ACA bill to pass since the law was enacted.

The legislation passed primarily along party lines, with Democrats in support and Republicans opposing. The bill is not expected to pass in the Republican-controlled senate, and the White House announced that the president would veto the measure if it comes before him.

Some of the provisions in the bill include:

Healthcare Reform News Update for June 26, 2020
Trump Administration Asks Supreme Court to Overturn Affordable Care Act
The Department of Justice filed a legal brief to the Supreme Court on Thursday night that argues the Affordable Care Act should be overturned. The brief contends that the entire health law was invalidated when its individual mandate tax penalty was struck down in 2017.

The Court is expected to hear oral arguments in the case later this year and make a ruling in early 2021.
Almost Half a Million Enroll in ACA Plans After Losing Coverage
The Centers for Medicare and Medicaid Services said that approximately 487,000 Americans signed up for Affordable Care Act plans after the open enrollment period ended in December, a 46 percent increase from last year.

The increase was concentrated in April and May, which suggests that the surge in enrollments is linked to layoffs due to the coronavirus pandemic (COVID-19).

Healthcare Reform News Update for June 9, 2020
N.Y. Insurers Request ACA Premium Hikes Averaging Almost 12%
New York insurance companies that sell health plans on the Affordable Care Act (ACA) marketplace have asked the state Department of Financial Services to raise premiums an average of 11.7% for 2021.

Some insurers said the requested rate hikes are a result of increased costs related to the coronavirus (COVID-19). Requested premium changes include:

The state should determine final rate changes in August.
Molina Waives Coronavirus Cost-Sharing Through 2020
Molina Healthcare will continue to waive customer out-of-pocket costs for coronavirus (COVID-19) testing and treatment for the remainder of the year. The initiative applies to all of its Affordable Care Act, Medicare, and Medicaid plans.

Healthcare Reform News Update for June 4, 2020
Anthem to Provide Premium Discounts up to 15%
Anthem Inc. announced that it will offer premium discounts between 10 and 15 percent in July for some customers enrolled in individual plans and fully insured employers.

The company joins other insurers that recently announced discounts for some customers, including Premera Blue Cross, Blue Cross Blue Shield of Michigan, Priority Health, and UnitedHealth Group Inc. The offerings are a response to the savings insurance companies are seeing due to a decline in surgeries and non-essential procedures during the coronavirus (COVID-19) pandemic.

Healthcare Reform News Update for June 2, 2020
Cigna Eliminates Cost-Sharing for All Plans and Increases MA Meal Benefits
Cigna announced that it is expanding and extending its cost-sharing relief initiatives for all enrollees with individual, family and Medicare Advantage plans.

Effective immediately, the company will:

These new measures will be in effect for Medicare Advantage through the end of this year. For individual and family plans, the changes will apply until the end of applicable federal and state public health emergencies.

Healthcare Reform News Update for May 27, 2020
CMS: 1,750 Medicare Advantage & Part D Plans Will Cap Insulin Costs
Beginning in 2021, more than 1,750 standalone Medicare Advantage and Medicare Part D prescription drug plans will cap monthly out-of-pocket costs for insulin at $35, according to the Centers for Medicare & Medicaid Services (CMS).

Plans in all 50 states, the District of Columbia, and Puerto Rico will participate in the program, called the Part D Senior Savings Model. The pricing will be available for a range of insulins, including pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins.

CMS projects that the average savings for consumers will be $446 per year.

Healthcare Reform News Update for May 26, 2020
Cigna Adds Digital Behavioral Health Services to Employer Plans
Cigna is expanding customer access to digital mental health support services in response to pressures caused by the coronavirus (COVID-19).

Effective immediately, Cigna's employer-sponsored plans will cover access to licensed therapists via text, phone, or video. The company also will offer virtual programs in select states for anxiety, depression, burnout, substance use recovery, and obsessive compulsive disorder (OCD).
CMS Expands Telehealth Benefits for 2021 Medicare Advantage Plans
The Centers for Medicare & Medicaid Services (CMS) released final rules for 2021 Medicare Advantage (MA) plans that allow increased flexibility to offer and discount telehealth services for specialty care.

Other finalized changes/enhancements include:

Healthcare Reform News Update for May 13, 2020
Kaiser: More Than 30% Newly Uninsured Eligible for Subsidized ACA Plans
Of the estimated 27 million Americans who have lost employer-sponsored health coverage due to the coronavirus (COVID-19) pandemic, approximately 31.11% are eligible for subsidized coverage for an Affordable Care Act plan, according to a new study released today by the Kaiser Family Foundation.

The study, which spans March 1 through May 2, estimates how many of those who lost employer-sponsored coverage plans will be eligible for other available coverage options. According to the analysis:

8.4 million (or 31.11%) are eligible for subsidized ACA plans,

5.7 million (or 21.11%) are not eligible for subsidized ACA plans. Of this number:

3.7 million (or 13.7%*) earn too much to qualify for subsidies;

1.3 million (or 4.81%*) can go on a family member's plan;

530,000 (or 1.96%*) do not meet citizenship or immigration requirements;

150,00 (less than 1%*) fall into a "coverage gap" in states that have not expanded Medicaid through the ACA.

12.7 million (or 47.04%) are eligible for Medicaid, including 6.1 million (22.6%) children who qualify for CHIP coverage.

* This is the percentage of the 27 million Americans who have lost employer-sponsored health coverage.
UnitedHealth Group to Expand ACA Plan Availability for 2021
Beginning in 2021, UnitedHealth Group will offer Affordable Care Act plans in more states-its first expansion in four years.

The company currently offers ACA plans in Massachusetts, Nevada, and New York. The company will expand into Maryland next year; more states are expected to be announced.
IRS Gives Employer Health Plans Flexibility in Enrollment, FSA Accounts
Companies now have the option to offer changes to coverage plans outside their standard enrollment period, including cancellations, adding family members, or switching plans, according to the Internal Revenue Service (IRS).

This new guidance for employer-sponsored health plans was released Tuesday in response to the coronavirus (COVID-19).

The IRS will also allow employers to offer mid-year enrollment in flexible spending accounts (FSAs), alter the amount employees can set aside for these accounts, and expand rollover exception rules.

Companies are not required to provide the new options to employees. But, these options give human resource departments flexibility when making coverage decisions.

Healthcare Reform News Update for May 7, 2020
UnitedHealth Group, Cigna Offer Discounts, Relief in Response to COVID-19
Two of country's largest health insurers, UnitedHealth Group and Cigna, have announced new measures in response to the coronavirus (COVID-19) pandemic.

UnitedHealth Group's assistance includes:

Employer and individual health plans. The company will issue premium credits ranging from 5% to 20% in June.

Medicare Advantage plans. All cost-sharing for specialist and primary care will be waived through September.

AARP Medicare Supplement plans. The company will provide both new and renewal premium price stability and support.

UnitedHealth is also expanding its Housing+Health and homeless support programs.

Express Scripts, a Cigna company, is offering its Parachute Rx SM discount program to any American who has lost coverage due to COVID-19 for a limited time. The program provides generic drugs capped at $25 for a 30-day supply and brand-name drugs capped at $75 for a 30-day supply.

The Parachute Rx SM program covers over 40 brand-name drugs and thousands of generic medication used mostly commonly to treat conditions such as asthma, diabetes, glaucoma, heart disease, migraine, non-opioid pain management, reproductive health, seizures, and thyroid conditions. Users can have drugs delivered from the Express Scripts Pharmacy or pick up at them up one of the 50,000 participating retail pharmacy locations.
Medicare Allows Special Enrollment Period for Those Affected by COVID-19
The Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries can sign up for new coverage until June 30 if they were unable to sign up previously due to the coronavirus (COVID-19) pandemic.

This Special Enrollment Period (SEP) is available to residents of all states, tribes, territories, and the District of Columbia. Beneficiaries do not have to provide proof that they were affected by the pandemic-related emergency.

Healthcare Reform News Update for May 6, 2020
Humana Waives Medicare Advantage Cost-sharing for 2020
Humana is waiving all copays, coinsurance, and deductibles for all in-network primary care, behavioral health, and telehealth visits for its Medicare Advantage customers for the remainder of 2020.

In addition, the company is sending a safety kit that includes masks and health advice information to its Medicare Advantage members to help them see their healthcare providers safely.

Last month, Humana waived all out-of-pocket expenses for coronavirus (COVID-19) treatments. The company says that this latest measure is intended to help ease financial burdens, support member safety, reopen the healthcare system, and boost the economy.

Healthcare Reform News Update for April 29, 2020
COVID-19 Is Causing Medicare Part B Enrollment Delays
Seniors transitioning from employer coverage to Medicare Part B medical insurance are likely to encounter wait times more than twice as long as normal due to coronavirus (COVID-19) office closures.

With many workers furloughed or laid off, Social Security has seen an increase in applications for Medicare Part B, which covers outpatient services such as lab tests, from workers who continued working past age 65. Many Medicare issues can be handled online. But moving from employer coverage to Medicare Part B requires contacting Social Security personnel, who are currently working from home.

Most recently, the increase in Part B applications has led to average hold times of 45 minutes. However, wait times could be up to 90 minutes for the agency's national 800 number, according to the Social Security Administration's website. Previously, the average was 20 minutes.

Acknowledging the delays, Social Security teamed up with the Centers for Medicare and Medicaid Services (CMS) to streamline the application process by temporarily waiving some signature requirements and creating a dedicated fax number for applications.

Healthcare Reform News Update for April 28, 2020
Supreme Court Upholds $12 Billion in Government ACA Risk Corridor Payments
The U.S. Supreme Court ruled Monday that the federal government owes up to $12 billion in payments to insurance companies who participated in the Affordable Care Act's temporary risk corridor program that ran from 2014 to 2016.

When the ACA was enacted, the government promised to reimburse insurers that enrolled at-risk customers. The costs were higher than anticipated, and Congress later voted to ban the payments.

The court said the congressional restrictions did not liberate the government from its original agreement to fund the program. The decision was an 8-1 ruling, with Justice Samuel Alito dissenting.

Healthcare Reform News Update for April 17, 2020
KFF: Consumers Projected to Receive an Average $420 Each in ACA Rebates
Premium rebates from Affordable Care Act plans are estimated to be an average $420 per customer this year, according to a new report from the Kaiser Family Foundation.

The analysis estimates that insurers will pay a record-high $1.97 billion in rebates to individuals who were enrolled in rebate-eligible plans in 2019. The ACA requires insurance companies to send rebates when they spend less than 80% of their premium income on claims and quality improvement over a three-year period.

This year the data is based on insurer financial data from 2017 to 2019 when premiums dramatically increased due to marketplace uncertainties and the repeal of the ACA's individual mandate.

Rebates will be paid later this year either as a lump sum or as a premium credit.

Healthcare Reform News Update for April 15, 2020
Covered California Signs Up 58,400 in Coronavirus Special Enrollment Period
Approximately 58,400 California residents enrolled in Affordable Care Act plans in the first three weeks of a Special Enrollment Period created in response to the coronavirus (COVID-19), according to data released by Covered California, the state's health insurance exchange.

The initial data includes residents who signed up in the three weeks between March 20 and April 10. The SEP continues through June 30 and is open to uninsured Californians who meet the eligibility requirements.

Healthcare Reform News Update for April 13, 2020
CMS: Insurers Must Provide Free COVID-19 Antibody Tests
Insurance companies are required to provide antibody tests for the coronavirus (COVID-19) to policyholders with no out-of-pocket costs, according to new guidance released by the Trump administration on Saturday.

The free antibody tests will be used to detect those with immunity against the virus and help determine how many Americans were infected with the virus but experienced little or no symptoms.

Health experts believe that extensive antibody testing is integral to easing social distancing protocols and will enable employees to go back to their workplaces faster.

It's not clear whether uninsured Americans will be eligible for free antibody tests.

Healthcare Reform News Update for April 10, 2020
Trump Administration Bans Surprise Bills for COVID-19 Patients
Hospitals and doctors that accept funding from the $2 trillion stimulus bill are barred from charging insured patients for out-of-network costs incurred while receiving treatment for the coronavirus (COVID-19), according to the Trump administration.

Individuals covered by individual plans, employer plans, and government programs will not receive these "surprise" medical bills. Plans for how costs for uninsured COVID-19 patients will be handled have not yet been announced.

Previously, co-pays and deductibles for testing were waived, and many insurance companies have also waived out-of-pocket costs for in-network treatment.

Healthcare Reform News Update for April 2, 2020
ACA Enrollment Remains Steady for Third Consecutive Year
Enrollment in Affordable Care Act plans has stayed steady for the third year in a row with 11.4 million Americans signed up for 2020 plans, according to a report issued Wednesday by the Trump administration.

The report also included data on the 38 states that use the federal exchange:
Health Care Services Corp Opens Special Enrollment for Fully Insured Group Plans
Due to the coronavirus (COVID-19) outbreak, Health Care Services Corporation announced a Special Enrollment Period for its fully insured group plans through April 30.

The company, which runs Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, is allowing employees who did not opt in to their group plans to enroll themselves and dependents in coverage. Currently enrolled employees may also add eligible dependents and spouses to their existing plans.

The special enrollment is for medical/pharmacy and dental coverage only and will be effective April 1.
UnitedHealthcare, Anthem Waive COVID-19 Treatment Cost-Sharing
UnitedHealthcare, Anthem, and two regional insurance companies have announced that they will waive cost-sharing for coronavirus (COVID-19) treatment.

UnitedHealthcare will waive out-of-pocket costs for its Medicare Advantage, fully insured group plans and Medicaid plans. The company is also working with self-funded employers who would like to offer the benefit.

Anthem will cover out-of-pocket costs through May 31 for individuals, Medicare Advantage and Medicaid enrollees, and fully insured employer plans. The company has also encouraged its self-funded plans to offer the benefit.

Healthcare Reform News Update for April 1, 2020
States on Federal ACA Exchange Will Not Launch Special Enrollment Period
The Trump administration will not open the federal Affordable Care Act exchange for a Special Enrollment Period (SEP) in response to the coronavirus (COVID-19) outbreak.

Recently, 11 states and the District of Columbia, which run their own ACA exchanges, launched coronavirus-related SEPs, allowing previously uninsured residents to enroll in health insurance plans. Health insurance companies and Democratic lawmakers had expected President Donald Trump to follow suit, opening an SEP for the 38 states that use the federal healthcare exchange.

A White House official said that the administration is "exploring other options."

Americans who have lost their jobs and health coverage due to the coronavirus can still enroll in ACA plans. Unemployment, along with other life events such as moving and marriage, qualifies individuals for an SEP.

Healthcare Reform News Update for March 31, 2020
Federal Ruling Allows Medicare Patients to Challenge Hospital Observation Status
Medicare patients can now appeal hospital-mandated status changes that characterize them under "observation" status instead of "inpatient," according to a March 24 ruling by a federal judge.

The decision, part of a class action lawsuit, is important because it could protect some Medicare beneficiaries from large out-of-pocket costs. Medicare Part A does not pay for costs associated with hospitalization or post-acute skilled nursing stays unless the patient has been admitted as an inpatient.

U.S. District Judge Michael Shea said patients should be allowed to challenge decisions that essentially strip them of their Medicare Part A benefits. His decision applies to Medicare beneficiaries from 2009 forward.

The ruling does not apply to patients who were initially placed into hospital "observation" status and were never admitted as inpatients.

The Centers for Medicare and Medicaid Services (CMS) is reviewing the ruling; the Department of Health and Human Services (HHS) has until late May to appeal the decision.

Healthcare Reform News Update for March 30, 2020
Cigna, Humana Waive Out-of-Pocket Costs for COVID-19 Treatment
Health insurers Cigna and Humana will not require policyholders to make out-of-pocket payments for treatment related to the coronavirus (COVID-19).

The companies' decision will affect all fully insured health policies for employer-sponsored, individual, and Medicare Advantage customers. Self-insured employers are encouraged to waive deductibles and copays but can opt out if they choose.

Cigna's waived payments are in effect through May 31. Humana has not set an end date and will evaluate the policy as needed.

Healthcare Reform News Update for March 23, 2020
More States Address Coronavirus With ACA Special Enrollments
Due to the coronavirus outbreak, health insurance exchanges in Minnesota, Vermont, and California have created or adjusted special enrollment periods, during which uninsured residents can enroll in coverage.

Minnesota's MNsure exchange has opened a special enrollment period (SEP) from March 23 to April 21. Coverage will start on April 1 for all enrollees.

Vermont Health Connect's SEP began Friday and runs until April 17. Enrollees can choose to start their coverage on either April 1 or May 1, no matter when they've enrolled.

California's Covered California exchange extended its current SEP to June 30. Coverage will begin the first day of the month following enrollment. Policies will cover all medically necessary screening and testing for COVID-19 at no charge to enrollees, including telehealth and in-person doctor visits.

George Forbids Health Insurers From Cancelling Policies During Coronavirus Outbreak

Georgia Insurance Commissioner John King has banned insurance companies from cancelling health insurance policies for nonpayment during the coronavirus pandemic. The directive is in effect until further notice.

Healthcare Reform News Update for March 20, 2020
10 State ACA Exchanges Open SEPs in Response to COVID-19
Ten states that run their own Affordable Care Act exchanges have opened Special Enrollment Periods (SEPs) in response to the coronavirus outbreak.

Uninsured residents in the following states and the District of Columbia can enroll in ACA plans from now until the deadlines listed below:

1. California - April 30

2. Colorado - April 3

3. Connecticut - April 2

4. Maryland - April 15

5. Massachusetts - April 25

6. Nevada - April 15

7. New York - April 15

8. Rhode Island - April 15

9. Washington - April 8

10. The District of Columbia - June 15

California and the District of Columbia previously opened SEPs due to other factors, but uninsured residents concerned about COVID-19 expenses have the opportunity to sign up now.

State-run exchanges in Idaho, Minnesota, and Vermont have not created SEPs. The federal ACA exchange running the remaining 38 states also has not announced an SEP.

Healthcare Reform News Update for March 19, 2020
CMS Allows Catastrophic ACA Plans to Provide Pre-Deductible COVID-19 Coverage
Insurance providers can cover COVID-19 treatment and testing for patients with Affordable Care Act catastrophic plans before the deductible is met and without requiring cost-sharing.

The Centers for Medicare & Medicaid Services made the announcement Wednesday in the release of COVID-19-related FAQs, which clarify catastrophic plan coverage for coronavirus diagnosis and treatment.

The guidance noted that "the exact coverage details and cost-sharing amounts for individual services may vary by plan, and some plans may require prior authorization before these services are covered."
Blue Shield of California to Provide Digital COVID-19 Triage Tool to Hospitals
A new digital tool from Blue Shield of California will allow its in-network hospitals to provide patients up-to-date COVID-19 triage and advice from their websites.

The result of a partnership with GYANT, the COVID-19 Screener and Emergency Response Assistant (SERA) tool will enable participating providers to manage patient demand by:

For hospitals that may not have the capacity to create an online patient tool, SERA can be deployed and customized within 48 hours to meet a facility's needs. It will be offered to hospitals free of charge for three months.
CMS Advises Delay of Non-Essential Procedures
The Centers for Medicare & Medicaid Services recommended Wednesday that all elective surgeries and non-essential medical, surgical, and dental procedures be delayed during the COVID-19 pandemic.

CMS Administrator Seema Verma said personal protective equipment, beds, ventilators, and the healthcare workforce should be preserved for COVID-19 care during this critical time.

The final decision about proceeding with non-essential procedures will be given at the local level by clinicians, patients, hospitals, and state and local health departments.

Healthcare Reform News Update for March 18, 2020
CMS Expands Medicare Telehealth Services Amid COVID-19 Spread
The Trump administration is temporarily expanding Medicare telehealth services to limit the vulnerable senior population's exposure to-or spreading of-the coronavirus.

All Medicare beneficiaries may use services such as FaceTime or Skype to connect with a healthcare professional by phone or video conference for treatment or diagnosing purposes. This also includes cases unrelated to COVID-19, said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. Previously, only seniors living in rural areas had access to telehealth.

The service will be available for Medicare patients to connect with physicians, nurse practitioners, clinical psychologists and social workers in a variety of settings-including nursing homes and hospital outpatient departments-at no additional cost.

Healthcare Reform News Update for March 13, 2020
Massachusetts Allows Special Insurance Sign-Up Period Due to Coronavirus
Residents of Massachusetts without insurance will be allowed to sign up for coverage through Massachusetts' Health Connector Affordable Care Act exchange until April 25. This special enrollment period comes in response to the spread of the coronavirus.

Last week, the Massachusetts Division of Insurance announces that insurance companies are required to cover the cost of coronavirus testing and treatment, including waiving copayments and deductibles.

Healthcare Reform News Update for March 12, 2020
High-Deductible Plans Allowed to Offer Free Coronavirus Care
The Internal Revenue Service confirmed that employers can waive the out-of-pocket costs for the testing and treatment of COVID-19 for employees on high-deductible plans, even if they have not met the minimum deductible.

Prior to the guidance, employers were concerned that waiving cost-sharing for testing or treatment for the coronavirus would affect their plans' statuses as high-deductible health plans. Losing this status would then make the plans ineligible for use with a health savings account.

Even with cost-sharing for testing waived, patients may still be responsible for out-of-pocket costs related to doctor visits or treatment.
CMS Pilot Program to Lower Medicare Part D Insulin Costs by 66%
The CMS' Center for Medicare & Medicaid Innovation will test a program for Medicare Part D enhanced plans that will cap out-of-pocket costs for insulin at $35 a month.

The Part D Senior Savings Model could potentially save beneficiaries in participating plans an average of $446 per year. The savings would apply to a broad set of formulary insulins, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins.

The goal of the Part D Senior Savings Model is to enable consistent, predictable access to medications to help improve the total cost of care for those with diabetes. The department predicts that the program could save the government more than $250 million during a five-year period, in large part due to drug companies paying additional discounts.

The pilot program will begin January 1, 2021, with participating insurers.
MA & Part D Plans Encouraged to Waive Costs for Coronavirus
The Centers for Medicare and Medicaid Services (CMS) has issued guidance to insurance companies on the out-of-pocket costs of coronavirus testing and treatment for seniors with Medicare Advantage or Medicare Part D plans.

CMS outlined some of the options available to insurance providers, including:

The Trump administration has previously said that Medicare would cover a COVID-19 vaccine if it is developed.

Healthcare Reform News Update for March 11, 2020
California Orders Christian Healthcare Ministries Group to Cease Operations in State
State insurance regulators in California served a cease-and-desist order to a Christian healthcare ministries group on Tuesday, accusing it of misleading consumers and offering health coverage without state approval.

Trinity HealthShare and Aliera, the entities that run and sell the health plans, respectively, offer health sharing plans that do not qualify as insurance and don't meet the requirements of the Affordable Care Act. California estimates that up to 11,000 might belong to their plans.

The companies are expected to contest the action, claiming that they offer lower-cost alternatives to residents who can't afford traditional insurance.
Insurers & Lawmakers Address Free Coronavirus Testing for Self-Funded Employers
Insurers and Congress moved this week to extend free conoravirus testing to those on self-funded employer plans. Most large insurance companies have previously announced that they will waive out-of-pocket costs for fully insured employer, Medicare Advantage, Medicaid, and ACA plans.

Cigna automatically signed up all its self-funded clients for the benefit this week, giving them 10 days to opt out if they choose to. Meanwhile, House Reps. Diana DeGette (D-CO) and Donna Shalala (D-FL) introduced legislation that would require insurers to cover 100 percent of coronavirus testing costs.

Until now, the Centers for Disease Control and Prevention has conducted and covered most testing. As more tests become available, private labs are expected to start billing insurance companies.

Healthcare Reform News Update for March 10, 2020
Trump Administration Rules Will Allow More Electronic Access to Health Records
Federal officials announced finalized rules that will make it easier for patients to retrieve their health records electronically from healthcare providers and insurance companies.

The new rules would require health providers to make data available free of charge to patients in a standardized format, which could then be downloaded onto smartphones. Standardized data could help public health agencies more efficiently analyze the safety and effectiveness of medications or the spread of contagions such as coronavirus. It could also make it easier for technology companies to use the data to develop artificial intelligence and other software tools.

To address concerns over privacy and security, the rules require developers to verify to plans to protect medical data. Consumers must be warned about programs that do not meet privacy standards and will be provided with clear information about how their information will be used by third parties.

The new rules also prevent hospitals, health insurers, and vendors of electronic health records from blocking access to patient data. Most of the new data provisions will go into effect by 2022.

Healthcare Reform News Update for March 6, 2020
New Hampshire Joins Defense in ACA Supreme Court Case
Republican New Hampshire Governor Chris Sununu announced that the state will join 17 others in defending the Affordable Care Act in a case recently taken up by the Supreme Court.

Sununu said he believed that repealing the ACA without a replacement healthcare plan would not benefit New Hampshire residents.

Healthcare Reform News Update for March 3, 2020
Supreme Court Will Hear ACA Appeal
The Supreme Court announced Monday that it will take up a case against the Affordable Care Act brought about by Republican attorneys general. The case argues that the repeal of the individual mandate invalidates the entire law.

The decision marks the third time that the Supreme Court will hear a challenge to the ACA. The justices upheld the law in two previous cases.

The justices did not specify a timeline, but they will likely hear the case this fall with a decision expected in 2021.

Healthcare Reform News Update for February 20, 2020
California Increases New ACA Enrollment 41%
California signed up 418,052 new Affordable Care Act enrollees during the annual enrollment period that ended January 31, a 41% increase over last year and the highest since 2016.

The increase is a result of the individual mandate and expansion of subsidies to middle-income residents. Nearly 32,000 additional Californians qualified under the new subsidy levels, which lowered middle-income premiums by an average of $504 a month.

So far, there have been 1.5 million enrollments for 2020 ACA plans in California. That number will rise with the addition of a special enrollment period that ends April 30.

Healthcare Reform News Update for February 19, 2020
New Special Enrollment Period in CA Extends ACA Signups Through April 30
California residents can sign up for Affordable Care Act coverage until the end of April, Covered California announced last week.

The state's ACA exchange created the special enrollment period for Californians who were not aware of the state's recently enacted individual mandate penalty or new tax subsidies that extended the number of people who qualified.

Residents who sign up through March 31 will not pay a penalty. Those who sign up in April will pay a pro-rated penalty of one-third the total annual fine.

Healthcare Reform News Update for February 6, 2020
CMS Proposes Changes for Medicare Advantage & Part D Plans
The Centers for Medicare and Medicaid Services released proposed rule changes for Medicare Advantage and Medicare Part D prescription drug plans on Wednesday. Some of the proposals include:

Increasing Medicare Advantage rates by 0.93% for 2021

Allowing those with end-stage renal disease on dialysis to enroll in Medicare Advantage

Enabling consumers to view real-time direct drug price comparisons between formulary options

Adding a second specialty drug tier to formularies for "preferred" medications

Revising the star ratings system to account for patient feedback.

CMS will accept comments on the proposed changes until Friday, March 6.

Healthcare Reform News Update for February 4, 2020
Republican Lawmakers Ask Supreme Court to Wait on ACA Case Review
The Trump administration and coalition of Republican-led states filed a petition with the Supreme Court, asking it to hold off on reviewing the case against the Affordable Care Act until it works its way through the lower courts.

Last month, the Supreme Court decided not to expedite the case, but the possibility of discussing it by the end of February remains. The filing argues that taking up the case during the current session would be premature.

Justices are expected to respond to the request before the end of the month.
Humana and Private Equity Firm to Develop More Medicare-centric Primary Care Centers
Health insurer Humana and private equity firm Welsh, Carson, Anderson & Stow have formed a joint venture to develop payor-agnostic primary care centers that focus on treating seniors.

The clinics will be managed by Humana's Partners in Primary Care and will more than double the number of its care centers over the next three years. Currently, it runs 47 facilities in Florida, Kansas, Missouri, North Carolina, South Carolina, and Texas.

Healthcare Reform News Update for January 28, 2020
Medicare Approves Coverage of Next Generation Sequencing Tests for Cancer Patients
Medicare will now cover diagnostic laboratory tests that use next-generation sequencing (NGS) for enrollees with inherited ovarian and breast cancers, The Centers for Medicare & Medicaid Services announced. The new tests will help determine the most effective treatments for patients with advanced cancers and their candidacy for clinical trials.

Healthcare Reform News Update for January 22, 2020
Analysis: Medicare Advantage Can Save Enrollees 40% More Than Fee-For-Service Plans
Out-of-pocket costs for Medicare beneficiaries with Medicare Advantage plans can be nearly 40 percent less than those with Original Medicare and supplement plans, according to new research sponsored by UnitedHealth Group (UHG).

Research from the Milliman consulting firm compared annual healthcare costs for enrollees with Medicare Advantage with drug coverage; enrollees with Original Medicare and a Part D plan, and enrollees with Original Medicare, a Part D plan and a Medicare Supplement plan.

The analysis found that those with Medicare Advantage plans with prescription drug coverage typically spent $1,477 less annually than those enrolled in Original Medicare and a Part D plan, and $2,328 less than those with Original Medicare, a Part D plan, and a Medicare Supplement Plan F.

UHG claims that over a lifetime, Medicare Advantage plans could save beneficiaries between $50,000 and $85,000.
Medicare to Cover Acupuncture for Chronic Low Back Pain
Medicare will now pay for acupuncture treatments for beneficiaries with chronic low back pain, CMS announced on Tuesday. Coverage includes up to 12 sessions over three months and an additional 8 sessions if symptoms improve.

The decision is part of an effort to increase the number options for non-opioid pain management.

Healthcare Reform News Update for January 21, 2020
Supreme Court Declines to Fast-Track ACA Case
The Supreme Court announced today that it will not review a legal challenge to the Affordable Care Act in its current term, which ends in June. The court did not state whether or not it will review the case in the future.

A coalition of Democrats had asked the Supreme Court to expedite a hearing after a federal appeals court sent the case back to the lower court judge who ruled that the ACA was unconstitutional.
Supreme Court to Review ACA Birth Control Exemption
The Supreme Court will consider whether employers can use religious reasons to opt out of the Affordable Care Act's requirement to cover birth control.

Federal judges have blocked new Trump administration rules that would allow more types of employers to claim exemptions from the requirement to provide no-cost birth control on religious or moral grounds.

Healthcare Reform News Update for January 17, 2020
ACA Silver Plan Premiums Decreased in 31 States for 2020
Premiums for the lowest-priced Affordable Care Act silver plans dropped in 31 states in 2020, according to a new study by the Urban Institute.

Researchers found that rates rose significantly between 2017 and 2018, but stabilized in 2019. In 2020, premiums for the lowest-priced silver plans decreased an average of 3.5 percent. The overall average premium for the lowest-priced silver plans in 2020 is $426.

The study found that states with higher average premiums for the lowest-priced silver plan usually had less competition. Wyoming has the highest average 2020 premium at $871; Minnesota has the lowest at $298.

The report suggests that increased participation in the ACA exchanges in 2019 and 2020 show that insurers believe that the marketplace is stable and potentially profitable.

Healthcare Reform News Update for January 16, 2020
Study: ACA Helped Narrow Racial Gaps in Health Coverage Access
The Affordable Care Act has reduced racial and ethnic disparities in access to insurance coverage, according to a new study from The Commonwealth Fund.

The study found that the health law's Medicaid expansion led to historic reductions in uninsured rates. However, progress has stalled since 2016, and the overall rate has started to climb. Other findings include:

Healthcare Reform News Update for January 13, 2020
Trump Administration Wants Supreme Court ACA Hearing Delayed
A Supreme Court fast-track review on the Affordable Care Act's constitutionality would be premature, according to separate filings from the Trump administration and a coalition of Republican attorneys general.

The 5th Circuit Court of Appeals struck down the ACA's individual mandate but has requested clarification from a lower court on whether the entire law should be repealed.

Democratic lawmakers have asked the Supreme Court to take up the case before its term ends in June. Republicans argue that the lower-court case needs to be decided prior to a Supreme Court review.

Healthcare Reform News Update for January 10, 2020
Kansas Proposal Sets Path for ACA Medicaid Expansion & Reinsurance Program
Kansas Governor Laura Kelly and state Senate Majority Leader Jim Denning announced a bipartisan proposal that expands Medicaid under the Affordable Care Act and creates a reinsurance program to help lower private insurance premiums.

Expanding Medicare would cover as many as 150,000 additional residents who earn up to $138% of the federal poverty level. A surcharge on hospitals will help cover the state's costs. The proposal sets a start date of January 1, 2021.

The proposal is expected to pass in the legislature, which convenes next week.

Healthcare Reform News Update for January 8, 2020
ACA Medicaid Expansion Slows Health Decline in Southern States
The expansion of Medicaid helped those in Southern states by making declines in health status 1.8 percentage points less likely, according to a new study published in Health Affairs.

The study focused on twelve Southern states and compared those that have accepted the Affordable Care Act's allowance for the expansion of Medicaid and those that have not. People in the states where Medicaid was expanded have a higher probability of maintaining their baseline health status.

Healthcare Reform News Update for January 7, 2020
ACA Market Remained Stable Despite Repeal of Individual Mandate
The Affordable Care Act's individual insurance market remained relatively stable and profitable in 2019 even without the individual mandate penalty, according to a new study by the Kaiser Family Foundation (KFF).

KFF points to the following key measure to demonstrate the marketplace's stability:

A modest growth in claims costs

A decrease in hospitalizations

The decrease in 2020 premiums by 2-3 percent on average

Steady enrollment in 2020 plans

Supreme Court Requests Quick Response from ACA Opponents
Opponents of the Affordable Care Act have until this Friday to respond to a request made by Democrats to expedite the challenge to an appeals court's decision on the constitutionality of the Affordable Care Act, according to the Supreme Court.

The Supreme Court has not yet announced if it will hear the case.

Healthcare Reform News Update for January 6, 2020
Democratic Attorneys General Ask Supreme Court to Review ACA Court Ruling
A coalition of 20 states, Democratic members of the House, and Washington D.C. have asked the Supreme Court to fast-track a review of a lower court's decision to declare the Affordable Care Act unconstitutional.

The petition requests a hearing and decision by this summer, arguing that uncertainty regarding the ACA could impact the future of the nation's healthcare system.

Healthcare Reform News Update for January 2, 2020
Costs for over 200 Prescriptions Drugs Expected to Rise in 2020
Pharmaceutical companies are expected to increase the cost of over 200 medications in the U.S. beginning in 2020. These include treatments for cancer, rheumatoid arthritis, respiratory issues, and more. The price increases are expected to all stay below 10%, most likely due to pressure from politicians and patients.
Risk Adjustment Payments Program Upheld in U.S. Appeals Court
A U.S. appeals court maintained that a risk adjustment payments program implemented under the Affordable Care Act is valid, leaving the program in effect. This reversed a lower-court ruling that led to a suspension in payments.

The risk adjustment payments program pays insurance companies who cover sicker and high-risk patients, including those with pre-existing conditions, with funds collected from insurers that enroll low-risk patients. Removing this program could have led to increased premiums and healthcare market disturbances.

Healthcare Reform News Update for December 23, 2019
2020 ACA Enrollment Remains Steady With 8.3 Million Signups
Enrollment in Affordable Care Act health insurance plans remained consistent for 2020 with 8.3 million people signing up for coverage on the federal exchange, according to preliminary data from the Centers for Medicare and Medicaid Services.

This is a slight downturn from last year. However, the final number will be released once national totals, which include enrollments from state-run exchanges, are released.

The 2020 signups include 2 million first-time enrollees, an increase of 36,000 compared to last year.
CMS Finalizes Rules on Abortion Billing & Oversight of Tax Credit Eligibility
The Centers for Medicare and Medicaid Services finalized a new rule that requires Affordable Care Act plans to send a separate bill to enrollees for the share of their premium that funds abortion coverage, which is prohibited from public funding.

The rule includes additional procedures for state-based exchanges to ensure that they correctly identify consumers who are eligible for tax credits and cost-sharing reduction subsidies. It also requires exchanges to conduct "data matching" at least twice a year for subsidized enrollees. This helps exchanges ensure they are pinpointing people who've become eligible for other coverage that might change their eligibility for federal subsidies.

The rule takes effect June 27, 2020.
Senate Passes Government Spending Package
The Senate passed a $1.4 trillion spending bill that includes the repeal of the Affordable Care Act's "Cadillac tax," health insurance tax for insurers, and a 2.3% excise tax on medical devices

President Donald Trump is expected to sign the bill to avoid a government shutdown.

Healthcare Reform News Update for December 19, 2019
Federal Appeals Court Strikes Down ACA's Individual Mandate
A U.S. Court of Appeals decided on Wednesday that the part of the Affordable Care Act that required Americans to have health coverage or pay a penalty is unconstitutional.

However, the rest of the law remains in limbo. The appeals court sent the case back to the judge who originally declared the entire ACA unconstitutional asked him to provide more specific recommendations for the remaining parts of the law. The panel also asked him to consider a Justice Department proposal to overturn the entire ACA, but only in the 18 states that filed the lawsuit against it.

California Attorney General Xavier Becerra, who is defending the ACA in court, announced that he will appeal the decision to the Supreme Court immediately.

The ruling does not affect the current implementation of the law or the coverage for consumers who have ACA plans.
Medicare Suspends Data Sharing Tool Over Technical Error
The Centers for Medicare and Medicaid announced that it has temporarily shut down access to Blue Button 2.0 due to a coding error that may have exposed beneficiaries' data.

The Blue Button data sharing tool allows Medicare enrollees to share claims data with third-party applications. The error may have unintentionally sent protected health information to the wrong user or to the wrong Blue Button 2.0 app. Any data exposure was limited to Blue Button beneficiaries or developers; the information was not compromised by outside entities.

CMS said that the issue has affected fewer than 10,000 users and 30 authorized apps.

Access to Blue Button 2.0 will remain closed until the issue is resolved.

Healthcare Reform News Update for December 18, 2019
House Passes Government Spending Package That Removes 3 ACA Taxes
The House voted Tuesday to pass a $1.4 trillion government spending package that includes the permanent repeal of three Affordable Care Act taxes.

The bill would repeal:

Also included in the package are provisions that will block the Trump administration from ending auto-enrollment or outlawing the practice of "silver loading," which is when insurers raise ACA premiums for benchmark silver plans to boost tax subsidy payments for consumers.

The Senate will vote on the bill later this week.
Maryland ACA Enrollments Reach Four-Year High
More people signed up for a Maryland's state-run Affordable Care Act marketplace plan this season than in any of the past three years, with enrollments reaching 215,150.

Signups increased in 20 of 24 state jurisdictions with a 1% total increase over last year.

Premiums for 2020 health plans decreased by an average of 10%.

Healthcare Reform News Update for December 17, 2019
Five State-Run ACA Exchanges Extend Enrollment Deadlines
The signup deadlines for several states that run their own Affordable Care Act marketplaces have been extended.

California: Residents now have until December 20 to sign up for coverage beginning January 1. Coverage for signups made between December 21 and January 31 will begin February 1.

Connecticut: The deadline for coverage has been extended to January 15. Coverage for signups made between December 16 and January 15 will begin February 1.

District of Columbia: Residents now have until December 18 to sign up for coverage that begins January 1. Coverage for signups completed between December 19 and January 15 begin February 1. Coverage for signups made between January 16 and January 31 begins March 1.

Nevada: Residents who started their enrollment application by December 15 have until December 20 to complete it.

Washington: Residents now have until December 30 to sign up for coverage that starts February 1.

The Centers for Medicare and Medicaid Services (CMS) announced yesterday that the Open Enrollment deadline dates in most states have been extended to December 18.

Healthcare Reform News Update for December 16, 2019
ACA Enrollment Deadline Extended to December 18
The deadline for signing up for coverage on the federal Affordable Care Act marketplace has been extended to December 18, according to the Centers for Medicare and Medicaid Services (CMS).

Due to a rush of last-minute enrollments, website glitches, and call center delays, some people experienced difficulties in signing up.

CMS noted that enrollees who have left their contact information with the government call center do not need to reapply during this extension; a representative will follow up with them later this week.
First-Time ACA Enrollment Increases 16% in California
Covered California, the state-run Affordable Care Act marketplace, has enrolled more than 130,000 California residents who signed up for the first time during this year's Open Enrollment Period-a 16% increase from last year. Also, more than 1.13 million Californians have renewed their coverage for 2020.

Under the state's recent subsidy expansion, around 23,000 California residents in the 400-600% range of the federal poverty level have qualified for assistance with paying their premiums.

California's new premium assistance guideline helps families who earn up to 600% of the federal poverty level. For example, a family of four with an annual household income up to $154,500 would be eligible for premium-payment help.

The enrollment deadline is January 31 in California, which is one of several states with extended Open Enrollment dates.

Healthcare Reform News Update for December 12, 2019
2020 ACA Enrollment Down Compared to Last Year
Health insurance enrollment on the federal Affordable Care Act exchange is down by 6% as compared to last year, according to Centers for Medicare and Medicaid Services.

Approximately 3.9 million Americans have enrolled in a 2020 ACA plan during the first six weeks of the Open Enrollment Period. This is a decrease of about 250,000 from the same time frame last year.

Open Enrollment ends Dec. 15 in most states. However, some states have chosen to extend Open Enrollment deadlines.

Healthcare Reform News Update for December 11, 2019
Kaiser: 28% of Uninsured Americans Qualify for $0 Bronze ACA Coverage
Because of "silver loading," 4.7 million uninsured Americans qualify for a $0 premium bronze Affordable Care Act plan in 2020 once subsidies are applied, according to a new Kaiser Family Foundation analysis.

The number represents 28% of the total 16.7 uninsured individuals in the country. That's slightly higher than last year when 27%, or 4.2 million, uninsured consumers qualified for a $0 premium bronze plan.

The analysis shows that over half of these eligible consumers live in Texas, Florida, North Carolina and Georgia.

Silver loading involves raising the premiums of benchmark silver ACA plans, which enables subsidized consumers to receive higher tax credit amounts allowing them to purchase a plan on the marketplace. In some instances, the tax credit exceeds the price of a bronze plan, triggering a $0 per month premium.
Report: IRS Push to Increase Health Coverage Saved 700 Lives
A letter sent by the Internal Revenue Service in 2016 to 3.9 million Americans without health insurance increased sign-ups and helped show that health coverage leads to fewer deaths, according to a working paper by three U.S. Department of Treasury economists.

Due to budgetary reasons, a mailing that encouraged people to sign up for coverage was sent to only a portion of the 4.5 million Americans who paid a fine for being uninsured. Approximately 600,000 people did not receive the letter. This created a randomized controlled trial, allowing Treasury Department researchers to compare the results.

For every 1,648 person between the ages of 45 and 64 who received the letter, one fewer death occurred, according to the analysis. The study estimates that the letter may have saved up to 700 lives.

Healthcare Reform News Update for December 10, 2019
Poll: Medical Costs Are Causing Americans to Delay Care for 'Serious' Conditions
One in four Americans say they or a family member decided to postpone treatment for a serious medical condition in 2019 because of the cost, according to a new Gallup poll. The percentage is the highest recorded since Gallup began asking the question in 1991.

Other findings from the poll include:
Supreme Court Hears ACA Risk Corridor Case
Oral arguments over the Affordable Care Act's risk corridor program will be heard in the Supreme Court today.

The temporary program touted reimbursement payments to insurance companies to help increase participation in the initial ACA marketplace and mitigate any losses they may incur. Republicans in Congress reduced the amount of funds available by $12 billion, calling the payments a "taxpayer-funded bailout" for insurers.

Insurance companies are suing the federal government to reinstate the full payments.

Healthcare Reform News Update for December 5, 2019
Hospital Groups Sue Trump Administration Over Price Transparency Rule
Four hospital groups have filed a lawsuit over a Trump administration rule that requires hospitals to publish the rates they negotiate with insurers.

The groups argue that the rule violates the First Amendment, would cause confusion with consumers regarding their out-of-pocket costs, and would be an administrative burden. They also claim that the Department of Health and Human Services does not have the legal authority to enforce the rule.

The suit was filed Wednesday by the American Hospital Association, Association of American Medical Colleges, the Children's Hospital Association, and the Federation of American Hospitals.

Healthcare Reform News Update for December 4, 2019
Study: Silver-Loading, CSR Cut Reduced ACA Premiums in Rural Areas
Subsidized Affordable Care Act enrollees who live in rural areas have more affordable plan options due to the elimination of cost-sharing reduction (CSR) payments than those who live in urban areas, according to analysis by Health Affairs.

After the Trump administration stopped CSR payments in 2017, some insurers responded with "silver-loading" or "silver-switching" strategies, which lowered premiums for subsidized enrollees. The study found that rural areas were more affected by the results of these actions.

The average premium for subsidized rural ACA enrollees was lowered from $288 in 2017 to $157 in 2018, a 45.5% decrease. For urban dwellers, the reduction was 34.5%, from $275 to $180.

One reason for the disparity is that rural areas have more flexibility to set premiums when there are fewer insurers available.
Humana Will Offer Remote Monitoring Services to At-Risk Medicare Advantage Enrollees
Humana is partnering with health technology company Philips on two programs that will offer remote monitoring services to Medicare Advantage members who are at high risk of hospital readmissions.

Humana will offer Philips' Lifeline medical alert service to members who are at risk for falls and a suite of remote monitoring tools to members with severe congestive heart failure.

The initiatives are intended to provide at-risk members with 24/7 access to care, increase support after a hospital stay, and encourage prevention.

Healthcare Reform News Update for December 3, 2019
Study: Most Medicare Beneficiaries Are Keeping Their Current Plans
Most Medicare Beneficiaries with Medicare Advantage prescription drug plans (MA-PDs) and Part D stand-alone prescription plans (PDPs) do not switch to different plans during the Open Enrollment Period, according to a new analysis from the Kaiser Family Foundation.

The study shows that during Open Enrollment in 2016, 8% of MA-PD enrollees switched to new 2017 plans and 10% of PDP enrollees switched to new 2017 plans.

For all the Open Enrollment periods between 2007 and 2016, enrollees who switched to new plans ranged from 6% to 11% for MA-PD enrollees and 10% to 13% for PDP enrollees.

The reluctance to change plans could be attributed to several factors. But previous analysis showed that 45% of Medicare beneficiaries never review or compare their options, and 35% said it is "very difficult" or "somewhat difficult" to compare plans.

Healthcare Reform News Update for December 2, 2019
Blue Cross of Idaho Introduces 'Enhanced' Short-Term Health Insurance
Beginning January 1, Blue Cross of Idaho will offer new comprehensive short-term health plans to state residents.

Called "Access" plans, the coverage is expected to be up to 40% less than plans sold on the Affordable Care Act marketplace. However, unlike ACA plans, enrollees who are sicker can be charged higher premiums, and people with pre-existing conditions could have a waiting period of up to 12 months.

There will be three Access plans with differing deductibles and out-of-pocket maximums. Some features of the plans include:

Deductibles for the plans range from $2,500 to $10,000 for individuals and from $5,000 to $20,000 for families.
UnitedHealthcare Opens Medicare Service Centers in Walgreens Stores
UnitedHealthcare will open service centers for Medicare beneficiaries in Walgreens stores in Las Vegas, Phoenix, Cleveland, Denver, and Memphis beginning in January.

The service centers will provide information about Medicare coverage options and the ability for enrollees of the company's Medicare Advantage plans to schedule their annual wellness visits.

Healthcare Reform News Update for November 22, 2019
Kaiser: More Insurance Companies Are Participating in the 2020 ACA Marketplace
The 2020 ACA marketplace will have increased participation, with consumers in 18 states gaining a total of 26 new insurers and an additional 54 insurance companies expanding their service areas within states, according to a new analysis from the Kaiser Family Foundation.

Additional findings about 2020 ACA participation include:
Medicare Plan Finder Tool Can Misdirect Consumers to Higher-Cost Plans
A feature in the new plan finder tool on the Medicare.gov website may be causing some beneficiaries to unintentionally choose higher-cost coverage.

The tool, used by 60 million Medicare recipients, automatically displays the lowest-premium plan at the top of the page. However, the tool does not take into consideration other out-of-pocket expenses such as copays and prescription drug costs. If a user doesn't take extra steps to filter the results, the plan with the lowest total annual cost may not be the first one shown.

Critics of the new tool say that the wrong choice could cost beneficiaries thousands of dollars per year.

Medicare is testing different methods, such as a pop-up, to direct consumers' attention to total costs.

Healthcare Reform News Update for November 21, 2019
Week 3 ACA Enrollment Down 1.5% From Last Year
During the first three weeks of the Affordable Care Act's Open Enrollment Period, 737,352 people signed up for coverage, which is 1.5% less than the same period last year.

So far, nearly 1.7 million people have enrolled in 2020 ACA plans in the 38 states that use the federal exchange. Only Mississippi has seen an increase in enrollment compared to last year's sign-ups.
Senators Say Trump Administration Is Driving ACA Shoppers to Short-Term Plans
Some consumers shopping for Affordable Care Act plans on the federal exchange are being redirected to third-party websites that promote enrollment in short-term health plans.

Nearly two dozen Senate Democrats, led by New Hampshire Senator Jeanne Shaheen, sent a letter to the Centers of Medicare and Medicaid Services voicing concern that the Trump administration is steering consumers away from ACA plans.

Short-term plans often have lower premiums than ACA plans but do not provide comprehensive coverage, such as protections for pre-existing conditions, maternity care, prescription drug coverage and emergency room service.

Healthcare Reform News Update for November 18, 2019
Trump Administration Proposes New Insurance Price Transparency Rules
The Trump administration on Friday released a new proposal that would require insurance companies to provide price and cost-sharing information to consumers before services are performed.

The Transparency in Coverage proposal would enable participants, beneficiaries and enrollees to:

The proposal builds on its newly finalized transparency rules for hospitals "to ensure consumers are empowered with the information they need to make informed health care decisions," according to a statement by the Centers for Medicare and Medicaid Services.

Healthcare Reform News Update for November 14, 2019
2020 ACA Enrollment Down From Last Year
Sign-ups for 2020 Affordable Care Act plans on Healthcare.gov during the first two weeks of the open enrollment period (OPE) were 20 percent lower than last year.

Around 932,000 people enrolled in an ACA plan on the federal exchange during the first nine days, whereas 1.18 million enrolled during the first ten days of the 2019 season, according to The Centers for Medicare and Medicaid Services.

There were 244,928 new enrollees, an increase from last year, and over 680,000 renewing consumers. The totals do not include those who signed up in states that operate their own insurance exchanges.
Google Healthcare Data Project Incites Federal Investigation
The Department of Health and Human Services' Office for Civil Rights has opened an investigation regarding the healthcare data collection partnership between Google and Ascension.

The federal probe will investigate whether the initiative is compliant with federal patient privacy laws.

Both companies have stated that the mass collection of patient data meets all HIPAA regulations regarding data privacy, security, and usage.

"We are happy to cooperate with any questions about the project," said Tariq Shaukat, Google Cloud's president of industry products and solutions.

Healthcare Reform News Update for November 12, 2019
Google to Store & Analyze Healthcare Records for Millions of Patients
Google's deal with medical system Ascension allows the tech company to collect and analyze the medical data, such as lab results, doctor diagnoses, and hospitalization records, of millions of Americans.

Google said in a blog post that patient data would not be combined with any of its consumer information.

The companies are in "early testing" for optimizing Ascension's data. Ascension claims its goal for the partnership is to use artificial intelligence to help improve clinical effectiveness and patient safety.

Ascension operates 150 hospitals and more than 50 senior living facilities in 21 states.

Healthcare Reform News Update for November 11, 2019
Original Medicare Premiums and Deductibles to Increase in 2020
Original Medicare monthly premiums, deductibles, and copayments will in increase in 2020, the Centers for Medicare and Medicaid announced on Friday.

Medicare Part B premiums will rise nearly 7 percent, increasing from $135.50 to $144.60 for beneficiaries who earn up to $87,000 per year. The Part B outpatient deductible will rise from $185 to $198.

Medicare Part A rates will also increases. Inpatient hospital deductibles will jump from $1,364 to $1,408, an increase of $44. Coinsurance for the 61st through the 90th day in the hospital will rise from $341 per day to $352.

Healthcare Reform News Update for November 7, 2019
Federal Judge Voids Trump Administration Conscience Rule
A federal court on Wednesday struck down a Trump administration rule that allowed healthcare providers to refuse to cover or perform services on religious or moral grounds.

U.S. District Judge Paul Engelmayer said the "conscience" rule was "arbitrary and capricious," conflicted with federal laws, and would threaten funding for noncompliant providers including hospitals, clinics, and universities.

The law was scheduled to go into effect November 22.
Technical Glitch Causes ACA Enrollment Decline in First Two Days
During the first two days of the Affordable Care Act Open Enrollment Period, 177,082 people signed up for coverage, according to the Centers for Medicare and Medicaid Services (CMS).

Of those who signed up, nearly 49,000 were new enrollees.

Enrollment was down compared to the 371,676 people who enrolled during the first three days of 2018. CMS attributes the lower numbers to technical issues on the federal government website.

Healthcare Reform News Update for November 6, 2019
Buttigieg Campaign Highlights Plan to Reduce Hospital Bills
Presidential candidate Pete Buttigieg's plan to lower hospital prices places a limit on how much hospitals would receive from insurance companies for services performed by out-of-network providers.

Buttigieg's "Medicare For All Who Want It" plan puts a cap on out-of-network costs at twice the amount that Medicare pays for the same service. The expectation is that the limit will lower patients' medical bills by influencing price negotiations between insurance companies and hospitals.

This approach addresses the rise of hospital prices at four times faster than physician prices and prevents hospitals from "pricing irresponsibly," according to Buttigieg's website.
Report: Number of MA Plans With Supplemental Benefits Increases Significantly
Medicare Advantage plans offering expanded supplemental benefits grew from 102 in 2019 to 364 in 2020, according to a new study from Milliman and the Better Medicare Alliance.

Some of the benefits that will become more available in 2020 are therapeutic massage, in-home support services, adult day health services, home-based palliative care, and support for caregivers of beneficiaries. In 2019, no plans offered more than one of these services; in 2020, 116 plans include more than one.

Healthcare Reform News Update for November 5, 2019
Georgia Governor Proposes Partial ACA Medicaid Expansion
Georgia Governor Brian Kemp (R.) has proposed a limited expansion of Medicaid that would provide health coverage to low-income residents who spend 80 hours per month working, volunteering, or attending job training.

The plan, called Georgia Pathways, would be available to residents with an income at or under 100% of the federal poverty level, which is around $12,490 a year for an individual. That's below the 138% federal poverty level requirement in the Affordable Care Act, which is around $17,236 per year for an individual.

Although 408,000 Georgia citizens will be eligible for Medicaid under the expansion, only about 52,000 would be enrolled in the program after five years, according to Kemp's office.

The proposal requires approval from the Trump administration before it can be implemented.
Survey: Majority of Seriously Ill Medicare Beneficiaries Incur Financial Difficulties
Over half of all Medicare enrollees who are seriously ill face financial hardships as a result of medical bills, according to a new survey published in "Health Affairs."

Drug costs are the leading cause of financial exposure, with hospital bills, ambulance rides, and emergency visits also cited.

Other findings include:

The study describes seriously ill patients as those who have conditions that require two or more hospital stays and have visited more than three doctors. Heart disease, cancer, and diabetes were the most common illnesses.

Healthcare Reform News Update for November 4, 2019
Analysis: State Reinsurance Programs Reduced ACA Premiums by Almost 17%
The 12 states that implemented reinsurance programs lowered Affordable Care Act plan premiums by an average of 16.9% in the first year of operation, according to a new analysis from Avalere Health.

Maryland had the highest decline in premiums its first year with a 43.4% reduction in 2019. Rhode Island's program had the least effect on premiums with a 5.9% reduction for 2020 plans.

The analysis also found that the reinsurance programs cost states an average of $53.7 million per year.

Healthcare Reform News Update for October 31, 2019
Number of Uninsured Children Increases to 4.1 Million
The number of U.S. children without health insurance passed 4 million in 2018, according to a new report from the Georgetown University Center for Children and Families.

Before hitting 5% in 2017, the rate of uninsured children had not increased since 2008. The jump to 5.2% in 2018 makes it in the second year of increases in a row.

States that have not implemented the Affordable Care Act's Medicaid expansion were more likely to have a high percentage of uninsured children. Texas had the largest rate at 11.2%, while West Virginia saw the greatest percentage increase in the number of insured kids.

Researchers cited several reasons for the uptick in uninsured children, including confusion over the Trump administration's attempt to repeal the Affordable Care Act; the elimination of the ACA's individual mandate; and the crackdown on immigration.

The analysis is based on data from the U.S. Census Bureau American Community Survey.
Senate Resolution to Block ACA Opt-Out Rules Fails to Pass
A Senate Democratic resolution to block waivers that allow states to opt out of Affordable care Act requirements failed to pass on Wednesday.

The new Trump administration waivers allow states to sell cheaper, less-comprehensive health insurance coverage that doesn't fully meet ACA standards, including pre-existing condition protections.

Healthcare Reform News Update for October 28, 2019
Medicare Advantage Choices Reach Highest Level in a Decade
The average Medicare beneficiary will be able to choose from 28 Medicare Advantage plans offered by seven different insurance carriers in 2020, according to new analysis by the Kaiser Family Foundation. Availability varies by location.

In total, there will be 3,148 Medicare Advantage plans available nationwide, up from 2,734 in 2019. HMOs account for 64% of all plans offered.

Other findings include:

Healthcare Reform News Update for October 25, 2019
Judge: Government Owes $1.6 Billion in ACA Subsidies
The federal government was ordered this week to pay almost 100 health insurance companies a total of $1.6 billion in unpaid Affordable Care Act cost-sharing reduction payments.

In February, U.S. Court of Federal Claims Judge Margaret Sweeney ruled in favor of a class-action suit that challenged the Trump administration's decision to end the payments at the end of 2017. As part of the ruling, Sweeney asked insurers to file reports on the subsidy amounts they were owed for 2017 and 2018.

The amounts owed to individual companies range from the tens of thousands to $220.3 million.

The government is expected to appeal the ruling.

Healthcare Reform News Update for October 22, 2019
2020 ACA Benchmark Plan Premiums Decline
Monthly premiums for 2020 Affordable Care Act benchmark plans sold on the federal exchange will be 4% less on average than this year's, according to the Centers for Medicare & Medicaid Services.

CMS also reported that the number of insurers offering ACA plans will increase by 20 carriers for a total of 175 plan sponsors on the federal exchange.

CMS Administrator Seema Verma shared the following additional information:

Healthcare Reform News Update for October 21, 2019
Arizona Postpones Medicaid Work Requirement
The state of Arizona will delay the implementation of the planned Medicare work requirement and other program changes. State officials notified the Center for Medicare and Medicaid Services on October 17 via a letter.

The requirement was intended to begin in 2020, but ongoing litigation and an "evolving national landscape" has made Arizona hold off on any major amendments to their Medicaid program.

The proposed work requirement would make Medicaid recipients between the ages of 18 and 49 report at least 80 hours of work, schooling, volunteer community service, job training, or job hunting per month to receive benefits.

Healthcare Reform News Update for October 14, 2019
More 2020 Medicare Plans Receive Higher Star Ratings
The Centers for Medicare & Medicaid Services (CMS) released Medicare star ratings for 2020, which shows an increase in the number of plans rated four stars or higher.

Some of the star-rating results:

CMS awarded five stars to 23 individual plans, including offerings from CVS Health, Humana, UnitedHealth Group, and Kaiser Foundation Health Plan.

Healthcare Reform News Update for October 4, 2019
Trump Signs Executive Order to Expand Medicare Advantage Plans
President Donald Trump issued an executive order Thursday that directs the Department of Health and Human Services (HHS) to develop regulations that will encourage Medicare Advantage plans to offer innovative services and benefits.

Medicare Advantage plans are offered by private insurance companies and serve as an alternative to Original Medicare, which is managed by the federal government.

The order asks HHS to develop proposals that will:

Healthcare Reform News Update for October 2, 2019
Cigna Rolls out Its Largest Medicare Advantage Expansion to Date
Cigna is launching its first Medicare Advantage PPO plans in 43 counties and expanding HMO plans into 37 new counties for 2020 plan year. The company is also offering both types of Medicare Advantage plans in Colorado for the first time.

Cigna's new Medicare Advantage PPO plans will be available in select counties in Alabama, Colorado, Delaware, Georgia, Illinois, North Carolina, Pennsylvania, and Tennessee.

The company's Medicare Advantage HMO plans are expanding into new counties in Arkansas, Colorado, Florida, Illinois, Kansas, Missouri, New Jersey, North Carolina, and South Carolina.

According to Cigna, most plans will include vision and dental benefits, access to fitness centers and remote access to doctors. In addition, select plans will offer additional benefits that target the social determinants of health, such as:

Healthcare Reform News Update for October 1, 2019
CMS Announces 10-State Pilot Wellness Program for ACA Marketplace
Ten states will soon offer health-contingent wellness programs in the individual market as part of the Centers for Medicare & Medicaid Services (CMS) pilot program.

Participating states will be able offer residents lower premiums or other incentives if they achieve certain health outcomes. However, states must also offer alternative programs for those whose medical conditions would keep them from participating.

To be a part of the program, states must show that the wellness program won't result in coverage losses or increase costs for the federal government.
Deceptive "Trumpcare" Ads Tout Non-existent Insurance Plans
Web ads offering low-cost "Trumpcare" insurance plans are taking advantage of consumer confusion, according to Axios. No official "Trumpcare" exists, and these advertised plans offer minimal coverage.

The ads offer health insurance plans for $59 or less, but refer to short-term plans or fixed indemnity plans do not offer comprehensive coverage and do not comply with ACA regulations. Buyers of these plans could be left financially vulnerable if they experience serious illness or injury.
Alignment Healthcare Expands California Medicare Advantage Offerings
Alignment Healthcare announced that it will double its Medicare Advantage coverage in California for 2020.

The company will offer plans in eight new counties in Sacramento and the Bay area. If approved by regulators, the expansion

Healthcare Reform News Update for September 27, 2019
New Consumer Survey Measures Open Enrollment Preparedness
A new UnitedHealthcare survey published this week gauges consumer preparedness for the upcoming Open Enrollment season.

Some of the key findings include:

75% of overall respondents felt prepared, but there were generational differences.
44% of Gen-Z respondents felt prepared compared to 69% of Millennials, 84% of Gen-Xers, and 78% of Baby Boomers.

36% said they spend less than one hour shopping for plan, 27% spend one to three hours, and 23% spend more than three hours.

77% said having vision and dental coverage options is important.

54% check if their current doctors are included in a plan's network.

Healthcare Reform News Update for September 26, 2019
2020 Medicare Advantage Plans Add New Benefit Options
Next year, Medicare Advantage plans will have the ability to add new benefits that focus on preventive care for people with chronic diseases or certain health issues.

New supplemental benefits include services such as transportation to a nutritionist, carpet cleaning to prevent asthma attacks, or food for a service animal. Many plans will also cover telemedicine visits with doctors and other health professionals.

The new benefits are part of an effort by the government and insurance companies to keep enrollees healthy.

The new benefit options will be available only for Medicare Advantage plans, not Original Medicare, and coverage will vary from plan to plan.

Healthcare Reform News Update for September 25, 2019
Medicare Advantage Rates Hit Lowest Point in 13 Years
Premiums for 2020 Medicare Advantage plans will be the lowest since 2007, according to the Centers for Medicare and Medicaid Services.

Plan premiums for 2020 will be 14.4% lower than those for 2019, with the average monthly premium set for $23 per month compared to last year's $26.87.

In addition, the average number of Medicare Advantage plans available per county will increase from 33 to 39. CMS also expects enrollment in Medicare Advantage plans to increase 9.9% for a total of 24.4 million enrollees.

Healthcare Reform News Update for September 24, 2019
Study: Removing ACA Auto-enrollment Could Increase Dropped Coverage
Eliminating the option to automatically re-enroll in an Affordable Care Act plan could increase the number of people who drop their insurance coverage by 30%, according to a new study in JAMA Internal Medicine.

It's possible that the Centers for Medicare & Medicaid Services is considering this route. Researchers cited the Trump administration's request in January for public comments on removing the auto-enrollment option.

The analysis is narrowed to California residents who had ACA plans with insurers that exited the marketplace.

It compares Californians who could automatically re-enroll in coverage after their insurer's exit to those who could not. Over 51% of people with auto-enrollment continued their coverage compared to 21.5% of those who did not have the option.

However, the study authors said their sample size is too small to predict whether the results would be similar if the elimination of auto-enrollment was due to policy changes instead of insurer exits.
Medicare Double Bills 411,000 Part B Direct Payments
Due to a processing error, the Centers for Medicare and Medicaid Services deducted Medicare Part B premiums twice for approximately 411,0000 beneficiaries who pay through the department's Easy Pay system.

CMS says that "approximately 20% of the duplicated transactions have been returned by financial institutions, and if the remaining duplications are not returned by Wednesday, Sept. 25, Treasury's Bureau of Fiscal Service will begin to reverse the remaining transactions to complete the reimbursement."

Any overdraft of fees resulting from the error should be waived by the financial institution.

Healthcare Reform News Update for September 20, 2019
Maryland Reinsurance Plan Helps 2020 ACA Premiums Drop
Premium rates for Maryland Affordable Care Act plans will be 10.3 percent lower on average in 2020, making it the second year in a row that premiums have declined. According to insurance regulators, the drop is primarily due to the reinsurance plan state leaders created in 2018.

CareFirst BlueCross BlueShield's HMO plan premium will decline by 14.7 percent; its PPO plan premium will decline by 1.45 percent. Premiums for Kaiser Permanente's plan will drop by 5 percent on average.

Healthcare Reform News Update for September 16, 2019
Premium Increases Lower Than Requested for Connecticut 2020 ACA Plans
State officials in Connecticut approved lower premium increases for 2020 Affordable Care Act plans than the ones requested by the insurance carriers.

Carriers cited rising medical costs, an older insured population and the federal Health Insurance Tax (HIT) as reasons for requesting premium increases. Lawmakers, concerned about the compounding of percentage increases each year, pushed back and approved reduced premium increases for individual plans.

Below are the percentage hikes as requested and approved for plans sold on the state's ACA exchange.

Healthcare Reform News Update for September 13, 2019
Massachusetts 2020 ACA Plan Premiums Will Increase 4%
Insurance coverage for 2020 Affordable Care Act plans in Massachusetts will rise an average of 4%, according to state officials.

The average unsubsidized silver plan premium for a 42-year-old resident will be $473 per month.

The Massachusetts Health Connector exchange will include nine insurance companies offering 56 different health plans for individuals and families.

Healthcare Reform News Update for September 11, 2019
Kaiser: MLR Rebates Will Reach a Record High in 2019
Health insurance companies will pay out a record-high total of $1.3 billion in medical loss ratio (MLR) rebates to 2019 Affordable Care Act plan enrollees, according to a new analysis from the Kaiser Family Foundation.

Insurer MLR payouts are as follows, according to the report:

This is the largest MLR rebate total since the $1.1 billion payout in 2012.

The MLR limits the amount of premium costs insurers can spend on overhead expenses, such as administrative costs, marketing, and profit. Companies exceeding the limits must issue rebates to consumers in the form of premium credits or checks.
Report: Number of Privately Insured Americans Held Steady in 2018
The percentage of people covered by private health insurance remained statistically the same between 2017 and 2018, according to a new report from the U.S. Census Bureau.

In 2018, 67.3% of Americans purchased private health insurance plans through employers, directly from insurance companies, or through TRICARE. This is a 0.4% decrease from 2017.

The overall uninsured rate increased slightly from 7.9% to 8.5%, mostly due to a decrease in Medicaid participants.

Other findings include:

The percentage of people with Medicare coverage grew from 17.4% to 17.8%.

The percentage of uninsured children increased from 4.9% to 5.5%.

States with the largest percentage of uninsured residents were Texas (17.7%), Oklahoma (14.2%), Georgia (13.7%) and Florida (13%).

Healthcare Reform News Update for September 5, 2019
Minnesota Shortens ACA Enrollment Period for 2020
This year, Minnesotans will have 20 fewer days to enroll in individual health plans on MNsure, the state's Affordable Care Act exchange. The enrollment period for 2020 plans will run from Nov. 1 to Dec. 23, with coverage beginning on Jan. 1.

In past years, residents could sign up for ACA plans in late December and early January for coverage that began on Feb. 1.

According to MNsure, the revised enrollment period will help ensure that consumers have coverage for the entire year in 2020.

Healthcare Reform News Update for August 30, 2019
Maine to Adopt State-Run ACA Exchange
Maine plans to create a state-run Affordable Care Act exchange beginning in 2021, Governor Janet Mills (D) announced Thursday.

The new state-based marketplace intends to use the federal government's enrollment platform before moving to a fully state-run system. Legislation to authorize the exchange will be introduced next year.

The shift would give the state more control to help consumers and small employers, Mills says.
Trump Administration Rejects Idaho's ACA Medicaid Expansion Request
Health and Human Services (HHS) denied Idaho's Affordable Care Act waiver request to expand its Medicaid program.

HHS said the state's waiver application was incomplete and did not demonstrate that the program would be cost neutral.

Governor Brad Little (R), who was "surprised and disappointed" by the decision, intends to resubmit the waiver with additional information.

Healthcare Reform News Update for August 28, 2019
Rhode Island Gains Approval for Reinsurance Program
Health and Human Services has approved Rhode Island's Affordable Care Act waiver application to create a new reinsurance pool.

The program is expected to lower premiums for 2020 ACA health plans by 5.9% and increase enrollment by about 1 percent.

Healthcare Reform News Update for August 23, 2019
CMS Publishes ACA Plan Star Ratings
While some major plans ranked below the national average, over 63 percent of Affordable Care Act plans received above average star ratings in new data published by the Centers for Medicare and Medicaid Services,

The average rating for ACA plans in the five-star system was 3.8 stars. The percentage of plans in each ratings category are:

The ratings are based on 38 different measures, including medical care quality management, member experience, and plan administration.
ACA Helped Reduce Racial Coverage Gaps
The Affordable Care Act helped lower racial and ethnic disparities in insurance coverage, according to new analysis from Commonwealth Fund.

Between 2013 and 2017, the coverage gap between blacks and whites fell from 11 percentage points to 5.3. During the same period, the gap between Hispanics and non-Hispanic whites dropped from 25.4 percentage points to 16.6.

In states that implemented ACA Medicaid expansion, the coverage gap for Hispanics declined by over 18 percentage points. For states that did not expand the program, the gap was reduced by 6.9 percent.
Oscar Health Plans to Offer ACA Plans in Additional States for 2020
Oscar Health announced that it will offer Affordable Care Act plans in six new states and 12 new markets to in 2020.

New markets include:

The company will also expand its services in Dallas-Fort Worth, TX and Western Michigan.

Plan details will be available after regulatory approval.

Healthcare Reform News Update for August 21, 2019
New Medicare Advantage Plan Launched for Chicago Area
Health2047 is launching a new Medicare Advantage plan in 2020 geared toward helping traditionally underserved seniors.

Zing Health, available in Cook County, will use local teams to coordinate with physicians and hospitals in order to help improve access to care.

Healthcare Reform News Update for August 20, 2019
CMS Announces Updates to Hospital Star Ratings for 2021
The way hospital star ratings are determined will change beginning in 2021, according to the Centers for Medicare and Medicaid Services.

The agency will finalize the changes after a public listening session and the formation of a technical expert panel.

In the meantime, CMS will refresh the ratings on the Hospital Compare website in early 2020 using the current methodology.
Alignment Healthcare to Expand Presence in California
Alignment Healthcare announced that its Medicare Advantage plans will be available in more California counties in 2020, doubling from eight to 16.

The company will increase its offerings from 10 health maintenance organization (HMO) plan to 22 HMO and preferred provider organization (PPO) plans.

Healthcare Reform News Update for August 16, 2019
2020 ACA Exchanges to Include CMS Star Quality Ratings
Plans sold on the 2020 Affordable Care Act exchange will display their quality star ratings to help improve transparency and quality, the Centers for Medicare and Medicaid announced yesterday.

The five-star system is based on enrollee opinions on in-network healthcare providers, the care they received, customer service, and overall experience with the health plan.

The national rollout of the quality star ratings comes after pilot programs in Virginia, Wisconsin, Michigan, Montana, and New Hampshire.
Study: Uninsured Rate Rose Between 2016-2017
Between 2016 and 2017, the uninsured rate rose for the first time since 2013, when the Affordable Care Act went into effect, with 700,000 people losing health coverage, according to a new study from The Urban Institute

The study shows that the uninsured rate fell every year between 2013 and 2016, with 18.5 million people gaining coverage. The uninsured rate then increased from 10% in 2016 to 10.2% in 2017. The increase was concentrated primarily in states that did not enact ACA Medicaid expansion.

Some of the findings:

Healthcare Reform News Update for August 14, 2019
States See Increase in ACA Marketplace Insurers
The average number of state insurers on the Affordable Care Act marketplace is rising slightly from 3.5 this year to four in 2020, according to the Kaiser Family Foundation.

Greater stability in the ACA marketplace has enabled insurers to expand into new counties and/or new states for 2020 plans.

The following states will have eight or more insurers in 2020: California, Massachusetts, Michigan, New York, Ohio, Texas, and Wisconsin.

The states with only one insurer for 2020 are Alaska, Delaware, Mississippi, and Wyoming.

Healthcare Reform News Update for August 13, 2019
ACA Exchanges Lost 2.5 Million Unsubsidized Enrollees from 2016 to 2018
Unsubsidized Affordable Care Act exchange enrollees declined by 40 percent between 2016 and 2018, a loss of 2.5 million customers, according to a new report from the Centers for Medicare & Medicaid Services.

The loss of more than a million customers in 2017 and 1.2 million customers in 2018 corresponded to premium hikes of 21 percent and 26 percent, respectively, in those years.

The number of subsidized enrollees during the same period rose slightly with a 4 percent increase.

Healthcare Reform News Update for August 8, 2019
Medicare Will Cover CAR T-cell Cancer Therapy
Medicare will now cover CAR T-cell gene therapy when it is provided in healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies program, according the Centers for Medicare & Medicaid Services.

These types of therapies use a patient's own immune system to combat certain types of lymphoma and leukemia. CMS said it will also approve the therapy for additional uses when recommended by CMS-approved medical guidelines.

Healthcare Reform News Update for August 7, 2019
New Survey Shows Consumer Neutrality on Medicare for All Plans
Close to half of adults surveyed neither support nor oppose Medicare for All and other healthcare expansion proposals, according to a new study on consumer attitudes.

Urban Institute surveyed respondents on their opinions regarding access to care, costs, and other factors. The survey differs from other recent polls in that it offered respondents the option to remain neutral, instead of being forced into giving an opinion.

Some of the findings include:

40.7% of respondents neither support nor oppose Medicare for All.

45% of respondents neither support nor oppose a public option plan.

Young adults, nonwhite and Hispanic adults and those with low incomes were more likely to support than oppose Medicare for All. Those with higher incomes were more likely to oppose.

29.8% of all respondents support Medicare for All.

27.8% of all respondents oppose Medicare for All.

Medicare for All Supporters list universal coverage and affordability as important factors influencing their support. Opponents list higher taxes, wait times, and quality of care as their top concerns.

Healthcare Reform News Update for August 1, 2019
Senate to Vote on ACA Waiver Requirements
Democratic senators will force a vote over the Trump administration's decision to make it easier for states to apply for Affordable Care Act waivers.

The new rule gives states the ability to offer tax subsidies for plans that fall short of ACA requirements, including plans that fail to protect people with pre-existing conditions.

The resolution is not expected to pass the Republican-controlled Senate.
Colorado ACA Reinsurance Program Approved
The Centers for Medicare & Medicaid Services on Wednesday approved Colorado's request to run an Affordable Car Act reinsurance program beginning next year.

The program is projected to increase 2020 enrollment by 3% and lower premiums by 16%.

Healthcare Reform News Update for July 31, 2019
2020 Medicare Part D Premiums Expected to Decrease
The Centers for Medicare & Medicaid Services has projected that premiums for 2020 Medicare Part D prescription drug plans will decline for the third year in a row.

The average Part D premiums will be $30 per month, which is 13.5% less than in 2017, according to a CMS press release issued Tuesday. The price reduction will save enrollees roughly $1.9 billion in premium costs.

CMS attributed several cost-cutting measures for the price reduction, including:
Pilot Program Enables Medicare Providers Access to Patient Claims Data
The Centers for Medicare & Medicaid Services is launching a new pilot program called Data at the Point of Care that gives healthcare providers direct access to claims data for their Medicare patients.

CMS's Blue Button computer interface will help physicians and clinicians easily access and assess a patient's medical history.

"This data gives them more information about their patients, so they are better able to impact their care, and it allows them to do the analysis about their patient population," said CMS Administrator Seema Verma.

The pilot program is scheduled to begin in September. Medicare beneficiaries will be automatically included in the program unless they contact Medicare to opt out.

Healthcare Reform News Update for July 30, 2019
Latest Kaiser Poll Shows Bipartisan Support for ACA Provisions
A majority of Americans prefer that the Affordable Care Act's provisions remain in place and that future healthcare measures build on the existing law, rather than be replaced with a Medicare for All plan, according to a new Kaiser Family Foundation poll.

A majority of both Republican and Democratic respondents believed that it's "very important" to maintain key provisions of the ACA, including protections for people with pre-existing conditions and pregnant women, no-cost preventive services, no annual or lifetime limits, and keeping young adults on their parents' plan up to age 26.

Among Democrats, 55% favor expanding the ACA, and 39% prefer a Medicare for All approach.

Support for Medicare for All plans decreased from April, with Democratic support slipping from 80% to 72%, and Republican support dropping from 27% to 15%.

Among Democrats, 55% favor expanding the ACA, and 39% prefer a Medicare for All approach.

Other findings include:
Trump Administration Rejects Utah's Partial ACA Medicaid Expansion
The Centers for Medicare and Medicaid Services denied Utah's request to partially expand its Medicaid program under the Affordable Care Act.

Under the ACA, residents earning 138% of the federal poverty level (FPL) are eligible for the program. Utah's plan would expand Medicaid only to those making up to 100% of the FPL.

CMS said it does not plan to approve funding for any state that implements limited enrollment.

Healthcare Reform News Update for July 25, 2019
Bright Health Expands Into 13 New Markets for 2020
Bright Health announced that it will double its locations in 2020 by expanding into 13 new markets in seven states for Affordable Care Act health plans and Medicare Advantage plans.

If approved by regulators, the new markets will increase the company's availability to a total of 22 markets in 12 states.

New Bright Health plan locations for ACA plans include:

New Bright Health plan locations for Medicare Advantage plans include:
Report: Medicare Could Save $57M By Providing Free Home-Delivered Meals
Medicare could save about $57 million per year by providing free meals to recently hospitalized seniors, according to a new report from the Bipartisan Policy Center.

By analyzing data from seniors with multiple chronic conditions, the study found that providing meals for one week after a hospitalization could prevent nearly 10,000 hospital readmissions every year.

The meals would cost approximately $101 million, but Medicare would save more than $158 million in payments for return hospital stays.

Currently, some Medicare Advantage plans cover meal-service delivery. The report recommends that lawmakers add the benefit to Original Medicare in limited circumstances.

Healthcare Reform News Update for July 24, 2019
Senate Committee Announces Plan to Overhaul Medicare Part D
The Senate Finance Committee announced its bipartisan legislation designed to lower drug costs.

The proposal, called The Prescription Drug Pricing Reduction Act, would overhaul Medicare Part D in significant ways, including:

Putting a cap on drug prices, which would keep drug makers from raising prices above the rate of inflation.

Lowering the threshold that activates the catastrophic phase for Medicare Part D users from more than $8,000 to $3,100 by 2022.

Revising the catastrophic coverage drug payment model so that insurance companies pay 60 percent of the costs, and the government and drug makers each pay 20 percent.

The proposal is projected to save Medicare beneficiaries $27 billion in out-of-pocket costs and $5 billion in premiums over 10 years.

Committee leaders Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) said that the committee plans to vote on the legislation on Thursday.

Healthcare Reform News Update for July 22, 2019
Federal Judge Backs Expansion of Short-Term Plans
A federal judge upheld the Trump administration's expansion of short-term health insurance plans, which don't meet Affordable Care Act standards.

U.S. District Judge Richard Leon said that extending the duration of the plans from three to 12 months with the ability to renew for up to 36 months would have minimal "potential negative impact" to enrollment in ACA plans.

The Association for Community Affiliated Plans argued against the extension and said it planned to appeal.

Healthcare Reform News Update for July 18, 2019
Coverage for Chronic Disease Treatments Expanded for High-Deductible Plans
The Trump administration announced new guidance, effective immediately, that gives chronically ill patients with high-deductible plans access to coverage for certain services before they meet their deductible amounts.

The Internal Revenue Service, Treasury Department, and Health and Human Services reclassified 14 services as preventive treatments for conditions such as asthma, congestive heart failure, and diabetes. Some of the services patients can now access without a deductible include insulin, glucometers, inhalers, blood pressure monitors, beta-blockers, statins, and antidepressants.

The guidance was in response to an executive order from President Donald Trump to expand the use of health savings accounts paired with high-deductible plans to fund care for the chronically ill.
Premiums for Michigan 2020 ACA Plans Are Expected to Drop
Proposed rates for 2020 Affordable Care Act plans in Michigan will drop. This is a reversal from the rate increases insurance companies have requested in past years.

Only two of the state's nine ACA insurers requested rate hikes. Molina Healthcare requested the largest decrease of almost 9 percent.

ACA insurer rate decrease requests include:

ACA insurer rate increase requests include:

Physicians Health Plan: 0.6% increase

Oscar Insurance: 8.3% increase

Oscar Health Will Offer Medicare Advantage Plans
Oscar Health announced Wednesday that it will enter the Medicare Advantage market in 2020 with plans available in New York City and Houston.

In New York, the company is offering plans in partnership with Montefiore Health System. In Houston, the company is pairing with several regional providers including Houston Methodist, HCA Houston Healthcare, and St. Joseph Medical Center.

Pending approval by regulators, the plans will be available during Open Enrollment this fall.

Healthcare Reform News Update for July 17, 2019
House Will Vote to Repeal ACA's Cadillac Tax
The U.S. House of Representatives is expected to pass a bill today that will repeal the Affordable Care Act's never-implemented "Cadillac tax" on high-cost employer-sponsored health plans.

The measure imposes a 40% excise tax on plans that exceed $11,200 for individuals and $30,150 for families. It's currently scheduled to begin in 2022.

The bill is sponsored by Representative Joe Courtney (D-CT) and 367 co-sponsors. The Senate's companion bill, the Middle Class Health Benefits Tax Repeal Act of 2019, has 42 signers.
Surprise Billing Proposal Could Save More Than $7B
Legislation in the Senate to eliminate surprise medical bills would save the federal government $7.6 billion over 10 years, according to the Congressional Budget Office.

The CBO projects that the proposal would increase spending by $18.7 billion and raise revenue by $26.2 billion. Savings would come from tax subsidies paid out for Affordable Care Act plans and a 1% reduction in employer plan premiums.

Details of surprise billing legislation are still being deliberated in House and Senate committees.

Healthcare Reform News Update for July 16, 2019
Medicare Considering Covering Acupuncture for Back Pain
A new Medicare proposal would cover acupuncture for beneficiaries with chronic low-back pain as an alternative to opioid treatments, which can become addictive.

Health and Human Services Secretary Alex Azar announced Monday that the coverage would apply only to patients enrolled in clinical trials or other CMS-approved studies. The agency would then use results of those trials to determine further acupuncture coverage options.

CMS is gathering public input before finalizing the proposal.

Healthcare Reform News Update for July 15, 2019
Appeals Court Blocks Trump Administration's Exemptions to ACA Contraception Rules
The 3rd U.S. Circuit Court of Appeals upheld a decision to block the Trump administration from "allowing employers with moral and religious objections" to deny birth control coverage mandated by the Affordable Care Act.

The ACA requires that employer-sponsored health plans include birth control coverage with no copays. In 2017, President Trump signed an executive order encouraging federal agencies to expand "conscience-based objections" to the mandate.

The panel of three judges sided with Democratic state attorneys general from Pennsylvania and New Jersey who argued that the new exemption rules contained "serious substantive problems."
Connecticut ACA Insurers Propose Rate Increases for 2020 Plans
Anthem and ConnectiCare, the two insurance companies on Connecticut's state healthcare exchange, have proposed premium increases for individual Affordable Care Act plans in 2020.

Anthem has requested an average 15.2 percent rate increase for individual plans sold on and off the exchange and an average 14.8 percent rate increase for small group health plans.

ConnectiCare requested a 4.9 percent rate increase for individual plans sold on and off the exchange.

The companies attributed rising healthcare costs, the aging population, and the newly reinstated Health Insurance Tax (HIT) as factors in their proposals.

Healthcare Reform News Update for July 12, 2019
Cancer Patients Face Substantial Financial Burden
A recent study from the Centers for Disease Control and Prevention shows that the annual out-of-pocket expenses for cancer survivors is increasing with 25 percent experiencing problems paying their bills and 34 percent worried about their costs.

Average out-of-pocket spending for cancer survivors is $1,000 per year compared to $622 per year for people who've never had cancer. And those costs are growing. Even with health insurance in place, cancer patients incur an additional financial burden from things such as traveling to treatment and being away from work.

Other findings from the study:
Narrow Medicare Advantage Networks Limit Access for Some Enrollees
Finding a doctor in a Medicare Advantage (MA) plan network can be difficult for many enrollees, especially if they live in rural areas.

Government audits have found that nearly half of the entries in MA directories had incorrect addresses, phone numbers, or doctors who were not accepting new patients. The American Journal of Managed Care found that a Google search for participating doctors could be more accurate than using a plan's directory.

A Kaiser Family Foundation study from 2017 found that MA plans included "46 percent of all physicians in a county, on average." Access to psychiatrists is the most restricted, with 23 percent in a county's plan on average, followed by cardiothoracic surgeons, neurosurgeons, plastic surgeons, and radiation oncologists.

Rural beneficiaries can be especially burdened by narrow MA networks. A study of California MA plans showed that some enrollees in rural areas lived over 100 miles from in-network specialists.

Healthcare Reform News Update for July 10, 2019
Appeals Judges Question Validity of ACA's Individual Mandate
A panel of three federal appeals court judges pressed the state attorneys general defending the Affordable Care Act on Tuesday over whether the law remains constitutional without its individual mandate penalty.

In the two hours of oral arguments, two Republican-appointed judges appeared skeptical about the constitutionality of the individual mandate. Judge Kurt Engelhardt suggested that severing the tax penalty from the ACA should be the job of Congress rather than the courts.

The two judges also questioned whether either side of the lawsuit had any legal standing to initially challenge the ACA or appeal the lower-court's decision.

Carolyn Dineen King, the only Democratic-appointed judge, did not ask questions during the hearing.

The judges did not indicate when they would issue their ruling, but it is expected in the coming months.
California 2020 ACA Premiums Show Record Low Increases
Proposed premium increases for 2020 ACA plans in California are the lowest in the state exchange's history, with an average hike of 0.8%, officials said. That's down from an average increase of nearly 9% for 2019 plans and a five-year average increase of 8.4%.

Proposed bronze plan rates will increase an average of 5.7%, and silver plans will decrease an average of 4.3%.

Covered California Executive Director Peter Lee said the rate stabilizations were due to new state-funded tax credits to middle-class enrollees and a new state penalty imposed on uninsured residents.

All of the state's 11 ACA insurers will return for 2020, and Anthem Blue Cross will expand into the Central Coast, parts of the Central Valley, Los Angeles County and the Inland Empire.
Minnesota 2020 ACA Premiums Show Modest Increase
Proposed 2020 ACA premiums in Minnesota show only slight increases compared to this year's rates.

Proposed average individual rate changes for the state's four ACA insurers are as follows:

In the state's small group market, the proposed rate increases were between 3 and 6%.

Final rates are scheduled to be released in early October.

Healthcare Reform News Update for July 9, 2019
Federal Appeals Court Hearing on ACA Constitutionality Begins Today
The 5th U.S. Circuit Court of Appeals will hear oral arguments today on whether a lower court ruling that declared the Affordable Care Act unconstitutional should be overturned.

The ACA is being challenged by 18 Republican-led states. The three-judge panel will also decide whether the coalition of Democratic states and the U.S. House of Representatives have standing to intervene in the case after the Trump administration declined to defend the health law.

It's unclear when the panel will make its ruling. However, it's expected that the case will ultimately be decided by the Supreme Court.
Connecticut Enacts Mental Health Parity Bill
Connecticut Governor Ned Lamont signed a bill into law that will require insurance providers to submit annual reports to state insurance commissioners, detailing their coverage of mental health and substance abuse services.

The new law intends to hold insurers accountable for complying with state and federal laws that mandate equal access to mental and physical health services.

Healthcare Reform News Update for July 8, 2019
Medicare Coverage Expanded for Blood Pressure Monitoring Devices
The Centers for Medicare & Medicaid Services (CMS) has extended coverage of Ambulatory Blood Pressure Monitoring (ABPM) devices to Medicare beneficiaries who have suspected abnormal low blood pressure readings while in a doctor's office.

Previously, Medicare covered ABPM devices only for patients with suspected "white coat hypertension," which occurs when a patient's blood pressure is elevated due to anxiety associated with a clinical setting. The 24-hour monitoring device is now also approved for "masked hypertension," the inverse of "white coat hypertension," which causes patients to have lower-than-normal blood pressure readings while in a clinical setting.

The new rule also lowers the definition of hypertension from a reading of 140/90 to 130/80 "to align with the latest society recommendations regarding the diagnostic criteria."

Healthcare Reform News Update for July 3, 2019
Federal Appeals Court Denies ACA Lawsuit Postponement
The 5th U.S. Circuit Court of Appeals rejected a request from Republican state attorneys general to delay oral arguments in the case to strike down the Affordable Care Act.

The lawyers had asked for a 20-day delay to file briefs relating to questions on whether the Democratic-led states defending the ACA have legal standing to intervene. The court allowed a two-day delay and will hear the case July 9 as scheduled.
Pennsylvania Will Switch to State-based ACA Exchange for 2021 Plans
Pennsylvania Governor Tom Wolf signed legislation Tuesday implementing a state-based Affordable Care Act exchange that's expected to begin with next year's Open Enrollment for 2021 plans.

The law also includes a new state reinsurance fund, which could help reduce premiums by as much as 10 percent, state officials say.

The Department of Health and Human Services must approve the law before it can be enacted.
Poll: Majority Support Medicare for All if Healthcare Providers Remain
A majority of voters would back a Medicare for All plan if they could keep their preferred doctors and hospitals, according to a new Morning Consult/Politico survey.

Of those surveyed, 55% of respondents backed a single-payer system that would reduce the role of private insurance companies but allow them to keep their healthcare providers.

But 46% were in favor when told the role of private insurers would be reduced, and 53% approved when not given any specifics about insurers or doctors.

The poll found that general support for a Medicare for All system comes from 77% of Democrats, 27% of Republicans and 50% of Independents.

Healthcare Reform News Update for June 27, 2019
Court Questions Democrats' Right to Defend ACA
The U.S. Court of Appeals for the 5 th Circuit has asked whether the Democrat-led House of Representatives or Democratic states have the legal right to appeal the ruling that struck down the Affordable Care Act.

It's possible that the panel could toss out the appeal on procedural grounds if it decides that the opposing side does not have the authority to appeal U.S. District Judge Reed O'Connor's decision to declare the ACA unconstitutional.

A three-judge panel requested that both sides of the lawsuit provide written arguments. Oral arguments will begin on July 9.
Senate Committee Approves Surprise Billing Package
The Senate health committee approved its healthcare package, called the Lower Health Care Costs Act, which includes a cap on how much providers can bill for out-of-network care.

Before approval, an amendment was added to the legislation. The change requires insurers to reveal all physicians and hospitals in their networks so patients can see all available options before choosing a plan.

Committee Chairman Lamar Alexander (R-TN) said that the bill will likely have more revisions before a vote in August.

Healthcare Reform News Update for June 26, 2019
New Study Shows 14% Increase in Out-of-Pocket Healthcare Costs
In 2018, out-of-pocket costs for inpatient services increased 14% over the previous year, according to a report from TransUnion Healthcare.

TransUnion tracked deductible and co-pay costs for patients with commercial insurance, Medicare Advantage, Traditional Medicare, and those who self-pay to find the annual averages.

In addition, the study found that 59% of patients had out-of-pocket expenses between $501 and $1,000, compared to 39% in 2017. Patients with expenses of $500 or less drop from 49% in 2017 to 36% in 2018.

Healthcare Reform News Update for June 25, 2019
Supreme Court to Rule on ACA Risk Corridor Suit
The Supreme Court agreed to hear a case that will decide if insurers are owed $12 billion in government payments from the Affordable Care Act's risk corridor program.

The program was created to help offset potential financial losses during the initial years of the ACA. Insurers with lower-than-expected costs would pay into the program, and those with heavy-than-expected costs would be reimbursed from this fund.

In 2014, Congress required the program to be budget-neutral and limited payments, which insurers say lead to a shortfall.
President Signs Executive Order on Healthcare Pricing Transparency
President Trump signed an executive order on Monday that will require hospitals and insurance companies to publicly disclose their negotiated pricing.

The order is meant to increase price transparency through five policies:

1. Providers must disclose the prices for insurers and patients in an easy-to-read format.

2. Providers and insurance must provide patients with the estimated out-of-pocket costs before they receive care.

3. Agencies must propose ways to simplify and improve quality measures across all healthcare programs.

4. Researchers must gain increased access to healthcare claims information, stripped of individual details.

5. The Treasury Department must look for ways to expand how health savings accounts can be used.

Before the changes can be implemented, government agencies, including Health and Human Services and the Treasury Department, must determine a rule-making process and work out the details of how the president's plan will be executed.
California Lawmakers Approve State Individual Mandate
The California Legislature voted to impose a tax on residents who do refuse to purchase health insurance.

The penalty will go into effect on January 1, 2020, if the bill becomes law. The state will use the funds collected from the tax to provide insurance premium subsidies to middle-income Californians who earn up to six times the federal poverty limit.

The bill is expected to be signed by Governor Gavin Newsom.

Healthcare Reform News Update for June 20, 2019
Senate Committee to Propose Pay Cap for Surprise Medical Bills
The Senate health committee has come to decision on how its bipartisan healthcare package will help patients with surprise medical bills. Patients often face these unexpectedly-high bills after receiving care from a provider that isn't in their insurance network.

To combat these charges, panel leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) will include a "benchmark" system as part of their new healthcare bill. The benchmark system will cap charges for out-of-network care based on a plan's median in-network rate for an area.

The announcement came right before a new Kaiser Family Foundation study found that 1 in 6 insured Americans have been affected by surprise bills after a hospital stay.

The committee expects to vote on the legislation next week.

Healthcare Reform News Update for June 14, 2019
New Rule Allows Workers to Use HRAs to Purchase Health Insurance Plans
The Trump administration has issued a new rule that will enable employees of small businesses to use tax-free health reimbursement accounts (HRAs) to purchase individual health insurance plans.

Previously, employers could set up tax-deductible HRAs to help reimburse workers for out-of-pocket medical expenses.

Beginning January 1, 2020, small employers who do not offer group health insurance can set up HRAs that workers can use to purchase ACA-compliant plans on the individual market.

Employers who offer group insurance can set up an "excepted benefit" HRA that can be used to purchase short-term health insurance plans that don't comply with the ACA. These HRAs will be limited to $1,800 per year.

White House officials said provisions have been created to block employers from using the new rule to send only their oldest and/or sickest employers to the individual marketplace.

The rule change will provide coverage to an estimated 800,000 people who currently do not have health insurance, according to the Trump administration.

Healthcare Reform News Update for June 13, 2019
House Committee Debates Medicare for All Proposals
For the first time, the House Ways and Means Committee held a hearing on the various Democratic proposals for universal healthcare.

The discussion, held Wednesday with a panel of healthcare experts and advocates, primarily served as a platform for partisan debate. Republicans were united in the belief that Medicare for All measures would cost too much, raise taxes and dilute the quality of healthcare. Democrats remain split on what type of public plans to support and whether the Affordable Care Act could be used to move those proposals forward.

Lawmakers from both parties agreed that the current healthcare system needs to be revised so that more people can have access to quality care and affordable coverage.

Healthcare Reform News Update for June 7, 2019
250K Medicare Beneficiaries Could Be Impacted by Error
At least 250,000 Medicare beneficiaries enrolled in Medicare Advantage and Medicare Part D plans could receive bills for five months of coverage due to a "processing error" within the Social Security Administration.

This error has caused some beneficiaries to be dropped from their coverage due to nonpayment.

In a notice to beneficiaries, the Department of Health and Human Services disclosed that some enrollees have not had premiums deducted from their Social Security benefit checks since February. The error has been corrected and payments will be resumed beginning this month or in July.

Insurance companies will bill customers for any shortfalls. Members will have at least two months to pay the premiums that were missed. Payment plans can be set up for beneficiaries who need them.

Neither the SSA or Medicare have said how the glitch occurred, which plans were affected, or the total amount of premiums that will need to be paid retroactively.

Healthcare Reform News Update for June 5, 2019
Medicare for All Hearing Set for Next Week
The House Ways and Means Committee has scheduled a Medicare for All hearing for June 12. It will be the first time the measure is examined by a panel that oversees healthcare issues.

The House version of the proposal is sponsored by Rep. Pramila Jayapal (D-WA) and currently has 110 Democratic cosponsors.

This hearing could encourage the House Energy and Commerce Committee, which also has control over healthcare issues, to consider the Medicare for All proposal.

Healthcare Reform News Update for June 4, 2019
Premiums for 2020 ACA Plans Trend Toward Modest Increases
States have just begun to release rate filings for 2020 Affordable Care Act plans, and so far the modest premium rate increases indicate that the market remains stable.

Some of the proposed average rate changes by state include:

Increases in premiums for 2020 are attributed to 4 to 8 percent increase in medical costs and the return of the ACA's health insurance tax.
New Poll Shows Nearly Half of Country Struggles With Paying Medical Expenses
A national survey released by Monmouth University shows that 45% of Americans have difficulty paying out-of-pocket medical expenses, and 40% have trouble paying their health insurance premiums.

In addition, the report found that 49 percent of adults believe that access to health insurance plays a significant role in their decision to pursue a new job opportunity, with 20% saying that the need to keep their employer-sponsored plan prevented them from pursuing a new job opportunity in the past 10 years.

Other poll findings:
Minnesota Will Continue ACA Reinsurance Program
Legislators in Minnesota voted to extend the Minnesota Premium Security Plan, the state's reinsurance program, which has helped stabilize ACA premium rates.

The program's initial $542 million appropriation has not been exhausted, so its continuation will not require additional funds.
Committee Starts Talks to Expand Long-Term Care in MedSupp Plans
The House Ways and Means Committee has reached out to the National Association of Insurance Commissioners for recommendations on how to expand long-term care benefits for Medicare Supplement plans.

Committee Chair Richard Neal (D-MA) wrote to NAIC President Eric Cioppa asking for ideas on how a federal policy could be crafted to "provide some relief" to families without causing adverse selection. Neal requested suggestions on lifetime and daily caps, waiting periods, eligibility requirements, and enrollment forecasts.

Healthcare Reform News Update for June 3, 2019
Studies Link ACA to Reduced Racial Gap in Cancer Care & Earlier Ovarian Cancer Diagnosis
New research suggests that the Affordable Care Act improved the racial disparities in cancer treatment and helped women with ovarian cancer get diagnosed earlier.

Before the implementation of the ACA, African Americans were 4.8 percent less likely than white patients to begin treatment for advanced cancers within a month of diagnosis. A new study shows that today, 49.6 percent of black patients receive treatment within 30 days, compared to 50.3 percent of white patients, in the states were Medicaid has been expanded under the ACA.

A second study found that since the ACA became law, more women with ovarian cancer have begun receiving treatment within one month of diagnosis.

The studies were presented at a meeting of the American Society of Clinical Oncology on Sunday.
California Governor Proposes Health Insurance Subsidies for Middle-Class
Governor Gavin Newsom has asked California state legislators to provide tax subsidies for middle class residents that would help pay the premiums on Affordable Care Act health plans. The proposal would affect an estimated 850,000 residents.

If approved, individuals who earn between $50,000 and $75,000, and families who earn between $103,000 and $154,500, would receive tax credits of $144 per month on average.

The proposal also provides some additional tax credits for individuals and families who earn between 200% and 400% of the federal poverty level.

The subsidies would be funded by a tax penalty on state residents who do not have insurance coverage, much like the original federal mandate that was recently removed from the ACA.

Healthcare Reform News Update for May 28, 2019
Senate Committee Proposes Bipartisan Fix for Healthcare Costs, Billing
The Health, Education, Labor and Pensions Committee released a draft bill last week aimed at lowering out-of-pocket costs and reforming other healthcare issues such as surprise billing and prescription drug pricing.

The proposal from Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) includes three

suggestions to stop the practice of surprise billing:

1. Require that all hospital providers, as well as corresponding labs and diagnostic tests, be "in network."

2. Use outside arbitration to resolve disputed charges higher than $750.

3. Establish a standard benchmark for physician pay.

Consumer protections in the draft legislation include a requirement that patients receive "good-faith" estimates of out-of-pocket costs within two days of a request and receive their full bills within 30 days of a procedure.

To lower drug costs, the patent process would be revised to make it faster and easier for generic drugs to be available.

The draft legislation also addresses hospital and insurer contracts, vaccine education, grants to improve maternal mortality rates, and measures to improve cybersecurity.

Alexander said that he expects a Senate vote on the bill in July.
Proposed HHS Rule Reverses ACA Transgender Protections
The Trump administration has proposed a rule that would roll back Affordable Care Act protections for transgender individuals.

The Department of Health and Human Services (HHS) says the ACA's definition of sex discrimination is too broad, and the change makes regulations more consistent with other agencies.

Critics of the proposal say the rule would impact the treatment of both LGBTQ and female patients. Legal challenges are expected when the final rule is released.
ACA Lawsuit Hearing Date Set
The 5th Circuit Court of Appeals has slated July 9 as the hearing date for Judge Reed O'Connor's ruling that the Affordable Care Act is unconstitutional.

O'Connor ruled that the Affordable Care Act became unconstitutional in 2017 when Congress eliminated the tax penalty for not having health insurance.

Healthcare Reform News Update for May 17, 2019
House Passes Bill That Strengthens ACA Measures
The Democrat-led House passed a package of healthcare bills designed to lower drug prices and strengthen the Affordable Care Act on Thursday.

The bills' ACA changes include:

Other provisions in the legislation address lowering prescription drug prices by increasing the availability of generic alternatives.

Though Republicans are in favor the drug-pricing measures, the changes to the ACA are expected to prevent the bill's passage in the GOP-led Senate.
Bipartisan Senators Create Legislation on Surprise Medical Bills
A bipartisan senate coalition introduced legislation to protect patients from unexpected out-of-pocket medical costs. The surprise bills can occur when a patient receives care from a medical provider who is not in their insurance network.

The bill would take the patient out of price disputes between out-of-network healthcare providers and insurance companies.

Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), and Maggie Hassan (D-NH) propose that insurers automatically pay out-of-network providers approximately the same rate as in-network providers. Instead of billing patients the difference in cost, hospitals, specialty physicians and insurers would use arbitration to settle any disputes with the pay rate proposed.
Trump Administration Releases Final Rule for Medicare Drug Pricing
The Centers for Medicare and Medicaid Services (CMS) released a final rule Thursday aimed at lowering costs and improving price transparency for prescription drugs.

Stipulations in the rule include:

Also, beginning in 2021:

The Part D explanation of benefits beneficiaries receive will include a notice of price hikes and any low-cost therapeutic alternatives.

Each Part D plan will use at least one electronic benefit tool that works with electronic health records.

CMS did not implement some rules it had proposed last fall, including allowing insurance companies to drop a medication from its formulary if the price soared or was a new formulation of an existing single-source drug.

Healthcare Reform News Update for May 14, 2019
Washington Creates Country's First State-Run, Long-Term Care Benefit Program
A first-of-its-kind program that will help state residents offset the costs of long-term care became a law on Monday when Washington Governor Jay Inslee signed the new bill.

Beginning in 2025, participants will receive a $100-per-day allowance that can be used for nursing home fees, in-home assistance, and reimbursement for family caretakers, up to a lifetime maximum of $36,500, indexed to inflation. To receive the funds, residents must need help with at least three "activities of daily living," such as bathing, eating, and dressing.

The program will be funded through a payroll tax that starts in 2022. Employees will pay 0.58 percent of their income into a state fund. Workers will have to pay the premium for at least 500 hours per year for three of the previous six years, or for a total of 10 years (with at least five of those paid without interruption), in order to be eligible for the benefit.

Residents who have long-term care insurance policies are exempt from paying the tax. Those who are self-employed can opt to pay into the program, but it's not required.

Healthcare Reform News Update for May 13, 2019
Washington to Become First State With a Public Healthcare Option
Washington will establish the country's first universally available public insurance option when Governor Jay Inslee signs the legislation today.

The public option, called Cascade Care, is a hybrid insurance model: the state will create the terms of the plans and private insurance companies will administer the day-to-day operations, such as enrollment and claims payments.

Premiums are expected to be up to 10 percent lower than comparable private insurance coverage. The reduced costs are made possible by capping payments to healthcare providers at 160 percent of federal Medicare rates.

The set of tiered plans will available by 2021 and will be offered to all Washington residents, regardless of income.
Uninsured in Maryland Will Get Help via State Income Tax Returns
Maryland residents will soon be able to see if they qualify for free or low-cost insurance after filing their taxes, as Governor Larry Hogan is scheduled to sign a bill today that will alter the state's income tax form.

If the new checkbox on the form is selected, Maryland's healthcare exchange will determine if the tax filer is eligible for help with insurance.

Residents who qualify for Medicaid will be automatically enrolled. Those who qualify for Affordable Care Act plans will be contacted by the exchange.

Healthcare Reform News Update for May 10, 2019
House Passes Bill Strengthening Pre-Existing Condition Protections
The House voted to overturn a new Trump administration waiver program that weakens the Affordable Care Act's pre-existing condition protections.

The waiver allows states to offer low-cost, low-coverage policies that can deny coverage to people with pre-existing conditions or charge them more for the same policy.

House Republicans said the waivers promote state flexibility and expand consumer healthcare choices.

The bill its not expected to clear the Republican-led Senate.
Study: Employer Plans Pay 241% More Than Medicare
Hospitals charged private employer-sponsored plans 240% more on average than what they billed Medicare, according to a new RAND Corp. study on healthcare pricing.

Researchers compared payment rates for 1,600 hospitals in 25 states. The charges represent the negotiated allowed amounts between hospitals and health plans.

Some of the findings include:

The study also recommends measures that employers could take to help reduce the disparity, including:

pressuring their health plan to base pricing on Medicare rates

encouraging state or federal policy intervention as a way to readjust "negotiating leverage between hospitals and employer health plans"

Healthcare Reform News Update for May 8, 2019
Study: 2018 Brought Record Financial Performance for ACA Insurers
Last year was the most profitable year for Affordable Care Act plans since they were made available, according to the Kaiser Family Foundation's recently published analysis of 2018 individual market performance.

The data also show that "financial results suggest the market is still stable and sustainable."

Some of the report's findings also include:

Insurers are expected to owe rebates totaling almost $800 million to consumers as a result of not meeting the medical loss ratio threshold.

Insurers are regaining profitability, but the Trump administration's proposed changes to the ACA make predictions for the future uncertain.

Poverty Threshold Changes Would Affect ACA Premium Tax Subsidies
The Trump administration has proposed changes to how the poverty level is determined, which would influence the number of consumers eligible for premium tax credits on Affordable Care Act health plans.

Currently, the poverty level is determined by the consumer price index. The Office of Management and Budget is considering a different measure called "chained CPI" that raises the poverty level at a slower rate. This means fewer Americans would qualify for services that are based on their incomes.

To qualify for the ACA premium tax credit, an enrollee's estimated income must fall between 100% and 400% of the federal poverty level.

Critics of the plan say the change would cause harm to low-income workers who would be stripped of benefits they are currently eligible for.

The administration notes that the poverty threshold has not changed in 40 years and "is worth re-evaluating."
Bipartisan Senators Ask Trump Administration to Defend the ACA
Senators Susan Collins (R-ME) and Joe Manchin (D-WV) wrote a letter to Attorney General William Barr asking that the Trump administration stop its attempt to dismantle the Affordable Care Act in federal court.

The senators said Congress' repeal of the individual mandate was not a move to invalidate the entire health law and that the administration's position would cause 133 million Americans to lose their health coverage.

Healthcare Reform News Update for May 7, 2019
Study: Medicare Advantage Beneficiaries Spend Less
People who switch to Medicare Advantage plans spend less on average and use fewer services than traditional Medicare beneficiaries-even before they enroll in Medicare Advantage, according to a new study from the Kaiser Family.

In the study, researchers compared the "average traditional Medicare spending and use of services in 2015 among beneficiaries who switched to Medicare Advantage plans in 2016 with those who remained in traditional Medicare that year, after adjusting for health risk."

Those who switched spent $1,253 less on average in 2015, according to the analysis.

The spending difference remained, regardless of age, gender, or health condition. Medicare Advantage users with dual-eligibility also spent less prior to their switch to Medicare Advantage.

The findings suggest that the Centers for Medicare and Medicaid Services (CMS) could be overpaying MA plans by billions of dollars per year because the department bases its payments on spending by those on traditional Medicare.

In addition, the results question whether the care management strategies of Medicare Advantage plans are responsible for the lower spending of enrollees.

Healthcare Reform News Update for May 2, 2019
Trump Administration Formally Files To Strike Down Entire ACA
The Trump administration filed its support of overturning the entire Affordable Care Act with the Fifth Circuit Court of Appeals this Wednesday. The administration, along with a coalition of Republican-led states, are asking the court to uphold U.S. District Court Judge Reed O'Connor's ruling that the ACA became invalid when the individual mandate was repealed.

Previously, the Justice Department's held the position that some provisions of the law should continue to stand, including Medicaid expansion, premium tax subsidies and health insurance markets. The administration has since reconsidered.

In the legal filing, Justice Department stated that "the remaining provisions of the ACA should not be allowed to remain in effect - again, even if the government might support some individual positions as a policy matter."

California Attorney General Xavier Becerra, who leads the group of 21 Democratic states defending the ACA, said, "Our legal coalition will vigorously defend the law and the Americans President Trump has abandoned."

Oral arguments in the case are expected to begin in July.
CBO Report Highlights Complexities of a Medicare for All System
The Congressional Budget Office released a report on Wednesday that analyzes the "opportunities and risks" of creating a Medicare for All type of healthcare system like those proposed by some Democratic lawmakers and presidential candidates.

Instead of cost estimates, "Key Design Components and Considerations for Establishing a Single-Payer Health Care System" lays out the positive and negative outcomes that lawmakers and consumers could face if current system were revised.

The report outlines ways in which Congress could address issues that may arise with a single-payer system, such as:

The analysis suggests drawbacks of single-payer healthcare could include longer wait times and decreased access to care. New taxes would also have to be established for income, payroll, or consumption to help pay for the system.

Benefits of a single-payer system, according to the report, include costs savings from administrative streamlining, and a greater focus on preventive care and increasing the nation's health as a whole.

Other considerations for legislators include whether or not to pay for undocumented immigrants and long-term care services, and what strategies should be used to maintain costs.
Democrats Reintroduce Compromise Medicare Expansion Proposal
Democratic Representatives Rosa DeLaura of Connecticut and Jan Schakowsky of Illinois presented their plan for expanding healthcare coverage on Wednesday. The Medicare for America Act is considered a more moderate approach than a single-payer models like Medicare for All.

The plan debuted last year, but now has 16 cosponsors.

The proposal would maintain employer-based health plans, but employees would have the option to enroll in Medicare coverage. Consumers who have coverage though Affordable Care Act plans, Medicaid, Medicare and CHIP would all transition to the newly expanded Medicare plans.

Premiums for the plans would be based on income, but cost would be capped at 8 percent of monthly pay. Tax subsidies would be provided to those with low-incomes. There would be no deductibles to be met before coverage begins.
CMS Seeks New Ideas for State ACA Waivers
The Centers for Medicare & Medicaid Services and the Treasury Department has issued a call for ways to improve the system states use to ask for exceptions to Affordable Care Act regulations.

"Ultimately, the goal here is to see states develop new waiver concepts and submit waiver applications that improve their health insurance markets," said CMS Administrator Seema Verma via a blog post.

Healthcare Reform News Update for May 1, 2019
President Trump Asks Senator to Restart Bipartisan ACA Stabilization Deal
President Trump asked Senator Patty Murray (D-WA) on Tuesday to renew her efforts to create a bipartisan bill that would help stabilize the Affordable Care Act.

Murray's previous proposal with Senator Lama Alexander (R-TN) stalled last year after legislators could not agree on modifications to the Hyde Amendment, which concerns abortion funding restrictions. At the time, the president waivered in his support of the bill.

Murray said through an aide that she is willing to try again, and that she is ready to work with either Democrats or Republicans to roll back any sabotage to the ACA and make healthcare more affordable.

Alexander remains firm on the issue that derailed the initial bill. "I was extremely disappointed our legislation didn't become law. If Democrats are willing to modify their position on the Hyde Amendment and renew their interest in Alexander-Murray, I would welcome the opportunity to discuss it," he said.
Medicare for All Bill Receives First Congressional Hearing
The first public congressional discussion on Medicare for All was held on Wednesday in front of the House Rules Committee. The hearing centered on a bill from Representative Pramila Jayapal (D-WA), which has over 100 Democratic co-sponsors.

Speakers included healthcare providers, a conservative economist, liberal activists with disparate opinions on how a single-payer system would operate, and Ady Barkan, a supporter with Lou Gehrig's disease who described his struggles with exorbitant out-of-pocket costs.

Jayapal's bill currently lacks support from centrist Democrats and would not be able to pass in the Republican-controlled Senate. However, she and other advocates were positive about gaining a hearing. "This was the first step, it's a big step, but we're on our way. Medicare for All is possible. It is reasonable. It can move forward, and I think it should," said the Chairman of the Rules Committee Jim McGovern (D-MA.).

Republicans remained skeptical about Medicare for All efforts. Representative Tom Cole (R-OK), the ranking Republican on the committee, said that supporters have "not told us how much this massive new program would cost, who would pay for it and how much taxes would have to go up."

Additional hearings on Medicare for All were confirmed during Wednesday's discussion: one for The House Budget Committee and another for the House Ways and Means Committee.

Healthcare Reform News Update for April 30, 2019
Florida Senate Approves New Standards for State Health Plans
On Thursday, the Florida senate passed a health benefits package that could define new standards for health insurance in the state if the Affordable Care Act is removed. The bills address pre-existing condition protections, association plans, short-term health plans, and essential health benefits.

The package will allow insurance companies to offer plans that limit or deny coverage for people with pre-existing conditions, as long as policies without these restrictions are actively marketed. No limits would be set on the differences in premiums for the two types of plans, which means that the state would allow insurance companies to charge those with pre-existing conditions higher rates.

The package will also allow association health plans and three-year short-term plans to be sold in the state. Part of the package allows for the defining of a new list of essential health benefits.

Senators who sponsored the package said that they believed the new standards will help in lowering premiums.

Healthcare Reform News Update for April 25, 2019
New Poll Shows Americans Concerned About Drug Costs and Pre-Existing Condition Protections
Americans believe the top healthcare priorities for Congress should be lowering prescription drug costs, pre-existing condition protections, and protecting people from surprise medical bills, according to a new Kaiser Family Foundation poll released Wednesday. The poll gathered opinion data on the Affordable Care Act, healthcare concerns and future healthcare legislation.

While 54% of Americans do not want the Affordable Care Act overturned, opinions are split between political parties. Of Republicans, 73% support striking down the entire ACA. Conversely, 83% of Democrats are against eliminating the ACA. However, a majority of Democrats, Republicans, and Independents (67%) believe the government should require health insurance plans to cover a designated set of benefits and pre-existing conditions.

In addition, a majority of respondents are worried that they or a family member could lose, or not be able to afford, coverage if the Supreme Court overturns the ACA or pre-existing condition protections.

Other findings from the poll include:

Healthcare Reform News Update for April 23, 2019
Two Republican Bills Address Pre-Existing Condition Protections
Two similar bills introduced by Republican legislators seek to protect patients with pre-existing conditions in the event that the Affordable Care Act is struck down. Senator Thom Tillis of North Carolina and Representative Greg Walden of Oregon have authored similar proposals.

The bills would prohibit insurance companies from denying coverage on the basis of health status, but they are missing some of the protections available under the current law. Insurance companies would be allowed to charge women higher premiums and put lifetime limits on benefits.

Democrats say that the bills fall short in their promise to protect insurance beneficiaries. "You could theoretically buy insurance if you have a pre-existing condition, but it is very deceptive because the bill will still allow insurers to set premiums based on health status." said Representative Frank Pallone Jr. (D-NY) chairman of the Energy and Commerce Committee.
CMS Announces New Medicare Payment Models for Primary Care Practices
Health and Human Services Secretary Alex Azar on Monday announced two new voluntary Medicare programs for primary care physicians that will reward practices based on their patients' health improvements instead of the traditional fee-for-service payments.

The initiative will "move [the nation] toward a system where providers are paid for outcomes rather than procedures, and free up doctors to focus on the patients in front of them, rather than the paperwork we send them," Azar said.

The CMS Primary Cares initiative, set to launch in 2020, contains new payment models where physicians and hospitals assume varying levels of financial responsibility for reducing costs and improving services.

The first model, aimed at small, primary-care practices, gives two payment options that include a flat monthly fee per patient, with bonuses and penalties based on patients' health.

Larger practices and health systems have three payment options within this initiative:

The "Professional Option:" Providers would receive a fixed monthly payment and assume 50% of the financial risk.

The "Global Option:" Providers would assume the full risk of the cost of caring for patients.

The "Geographic Option:" Health systems or insurance plans take on the full risk for the primary care cost for communities within a specific region.

CMS Primary Cares was designed to promote new technologies such as telehealth and remote patient monitoring. "Providers will have greater flexibility to spend these resources how they want, allowing them to come up with innovative ways to care for patients - and receive significant savings if they keep patients healthier than expected," Azar said.

Azar said he expects around one-fourth of primary care practices to sign up for CMS Primary Cares.
Medicare and Social Security Funds Face Uncertainty
A new report from the board of trustees for Medicare forecast that the Medicare Supplementary hospital insurance fund will be depleted by 2026, which is the same date projected last year.

In addition, costs for the Medicare Supplementary Medical Insurance (SMI) fund, which covers drug cost in Part B and D, are expected to grow gradually from 2.1 percent of gross domestic product in 2018 to about 3.7 percent of GDP in 2038. However, trustees report that the fund will be sufficiently financed by general revenues and beneficiary premiums.

Social Security also faces an uncertain financial future, as its total cost is predicted to exceed its total income in 2020, which will be the first time it's happened since 1982.

The report requests that legislators "take action sooner rather than later to address these shortfalls, so that a broader range of solutions can be considered and more time will be available to phase in changes while giving the public adequate time to prepare."

Healthcare Reform News Update for April 22, 2019
Congressional Budget Office Revises its Insurance Estimate Model
The Congressional Budget Office announced that it will change how it estimates the financial impact of new health insurance legislation, beginning with its budget projections later this spring. The new model will consider consumer and employer preferences.

The revisions were made to address Republican criticism of how the nonpartisan agency makes estimates, specifically regarding the repeal of the Affordable Care Act and its individual mandate.

"The new model better captures underlying relationships among individuals, families, employment, income, and insurance coverage because it incorporates new data and includes refinements in modeling insurance choices," said CBO Director Keith Hall.
Kansas Governor Allows Farm Bill to Pass
The Kansas Farm Bureau will be allowed to offer health coverage that does not meet Affordable Care Act standards, as Governor Laura Kelly declined to block the law.

The new association health plan is not considered insurance, so it will be exempt from state and federal insurance regulations. It does not include protections for people with pre-existing conditions, nor does it include the ACA's ten essential benefits, such as coverage for prescription drugs, maternity care, or mental health services.

In a statement, Kelly mentioned reservations about the law, but chose not to block it as a demonstration or compromise. "I believe the potential risks of this legislation can be mitigated if they are coupled with a stable, secure, proven health care option: Medicaid expansion," said Kelly.

Healthcare Reform News Update for April 19, 2019
Changes to 2020 ACA Plans Announced by CMS
The Centers for Medicare and Medicaid Services (CMS) released its finalized rule for 2020 Affordable Care Act health plans on Thursday.

The agency will reduce user fees to plans on the federal exchange from 3.5 percent of premiums to 3 percent. User fees for plans sold on state exchanges will drop from 3 percent to 2.5 percent.

CMS Administrator Seema Verma said in the announcement that "The rule issued today will give consumers immediate premium relief for 2020 by reducing the federal exchange user fees thanks to successful efforts to improve the efficiency of the exchange. At CMS, we have improved the operations of the exchange to deliver a better consumer experience at a lower cost."

Other changes include:

Healthcare Reform News Update for April 18, 2019
Colorado Pushes Forward on Government-Run Insurance Option
The Colorado Senate moved closer to the creation of a state public-option health insurance plan by endorsing a study that will examine the impact of such a plan.

The proposed bill asks state agencies to present recommendations for a healthcare plan in November that could compete with plans available on Colorado's Affordable Care Act exchange in 2021.

Supporters of the measure say the public-option plan would reduce premiums in areas that have some of the highest costs in the nation.

Republican Senator Jim Smallwood, an opponent of the bill, suggests that instead of creating competition, a public healthcare option would cause private insurers to abandon the Colorado market.
Connecticut House Passes Pre-Existing Condition Protections for Short-Term Plans
A bill to protect consumers with pre-existing conditions from being denied coverage or charged more for short-term health insurance plans was passed by the Connecticut House of Representatives.

According to the Kaiser Family Foundation, approximately 522,000 Connecticut citizens under 65 have a pre-existing condition.

The bill is opposed by the Connecticut Conference of Municipalities, which stated that the measure would raise insurance premiums for municipal employers. However, analysts with the Office of Fiscal Analysis say the bill has no financial impact on the state.

Healthcare Reform News Update for April 11, 2019
Bernie Sanders Debuts Revamped Medicare for All Bill
Senator Bernie Sanders (I-VT) debuted an updated version of his Medicare for All bill on Wednesday with the support of 14 Democratic cosponsors.

In his proposal, Sanders calls for replacing private insurance with a single-payer, government-run system with no premiums or deductibles. Certain services would come with small copays, and copays for brand-name prescription would be capped at $200. This new version of the proposal adds coverage for long-term care.

"The American people are increasingly clear: They want a health care system which guarantees healthcare to all Americans as a right," said Sanders.

Sanders did not outline how the program would be funded, but did offer general suggestions.

In response, White House press secretary Sarah Huckabee Sanders called the plan a "total government takeover of health care that would actually hurt seniors, eliminate private health insurance for 180 million Americans, and cripple our economy and future generations with unprecedented debt."

Healthcare Reform News Update for April 10, 2019
House Democrats Seek Justification for ACA Lawsuit Strategy
Democratic House committee chairmen are insisting that the Trump administration reveal documents and information that explain why the Department of Justice came to the decision to not defend the Affordable Care Act in the lawsuit against it.

The five committees involved have sent letters to the White House, the Justice Department, and Health and Human Services, requesting the legal justification for the administration's decision to seek the elimination of the healthcare law. They also request that the DOJ allow four of its attorneys to testify.

Judiciary chairman Jerry Nadler (D-NY) told reporters on Tuesday that "The Judiciary committee will hold those responsible for this complete abdication of the department's legal duty. They are in contempt of the law in the way they are carrying out their intentions."

During testimony in front of a House appropriations subcommittee on Tuesday, Attorney General William Barr defended the administration's strategy. "When we face a legal question, we try to base our answer on the law. If you think it's such an outrageous position, you have nothing to worry about. Let the courts do their job," he said.
Wisconsin Allowed to Withdraw From Remaining ACA Lawsuit
The 5th District Court of Appeals has agreed to dismiss Wisconsin from the appeal of the Affordable Care Act ruling that declared the healthcare law unconstitutional.

Last week, the court allowed the state to withdraw from two related cases. This latest court decision removes Wisconsin from all the federal lawsuits filed against the ACA.
ACA Medicaid Expansion Approved in Idaho
Idaho Governor Brad Little signed voter-approved legislation to expand Medicaid to approximately 90,000 residents by covering those earning up to 138 percent of the federal poverty level.

The bill also includes requests for two federal waivers. One requires Medicaid recipients to be employed in order to receive benefits. The other will allow Medicaid-eligible residents to stay on the state's health insurance exchange instead of moving to the government plan.

Expanded Medicaid coverage is created via provisions of the ACA. Idaho is the 37th state to adopt the expansion.

Healthcare Reform News Update for April 9, 2019
ACA Lawsuit Timeline May Be Accelerated
The Department of Justice filed a motion to begin oral arguments in the appeal of a lower-court ruling against the Affordable Care Act the week of July 8. The Democrat-led opposition defending the law did not oppose the DOJ's request.

Healthcare Reform News Update for April 8, 2019
Kansas Lawmakers Approve Bill That Permits Farm Bureau Health Plan
Both the Kansas House and Senate passed a Republican-backed bill that allows the Farm Bureau to offer health coverage that doesn't meet Affordable Care Act provisions.

Because the plans would not be considered insurance, people with pre-existing conditions could be refused coverage or have to pay more than other enrollees.

The Farm Bureau estimates that 42,000 Kansas residents who currently have no healthcare or who have problems affording an ACA plan would enroll in the new lower-cost option.

Democratic Governor Laura Kelly has not announced if she will sign the legislation.
Trump Administration Plans Future Healthcare Policy at Camp David Meeting
Acting White House Chief of Staff Mick Mulvaney met with White House aides and administration officials at Camp David on Saturday to discuss President Trump's plan to replace the Affordable Care Act with a Republican option.

Attendees included Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma.

Mulvaney stressed that he'd like to see a proposal in place to put in front of voters prior to the 2020 elections. "I do think you'll see a plan here fairly shortly," he said.

Healthcare Reform News Update for April 3, 2019
Plan to Postpone ACA Replacement Came From Senate Majority Leader
Senate Majority Leader Mitch McConnell (R-KY) said that it was his consultation that prompted President Trump to announce that a Republican replacement to the Affordable Care Act would not occur until after the 2020 elections.

"We had a good conversation yesterday afternoon and I pointed out to him the Senate Republicans' view on dealing with comprehensive healthcare reform with a Democratic House of Representatives," said McConnell on Monday.

Instead of attempting to repeal and replace the ACA, McConnell said that Republican senators would focus on trying to lower prescription drug prices and other less comprehensive measures.
Wisconsin Withdraws From Two ACA Lawsuits
A federal judge granted permission for Wisconsin to drop out of two lawsuits against the Affordable Care Act at the request of Wisconsin Attorney General Josh Kaul.

The first lawsuit argues that the entirety of the ACA is unconstitutional. A federal Judge's ruling that declared the ACA unconstitutional is currently being heard in a U.S. Appeals court, where Wisconsin is still party to the case. The state has also requested to be removed from the appeal and is awaiting a decision.

The second lawsuit challenges the ACA's protections for transgender individuals and women seeking abortion. Arizona, Kentucky, Nebraska, and Mississippi continue to be listed as plaintiffs in that case.

Healthcare Reform News Update for April 2, 2019
President Moves Republican ACA Replacement Plan to After 2020
In a series of three tweets, President Trump said that a Republican replacement for the Affordable Care Act would be put up for a vote after the 2020 elections.

"The Republicans...are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare," said Trump on Monday night. "Vote will be taken right after the Election when Republicans hold the Senate & win...back the House."
GOP Attorneys General in Two States Ask Court to Uphold ACA
Republican attorneys general in Ohio and Montana filed a brief in the 5th U.S. Circuit Court of Appeals arguing that the federal judge that ruled that the Affordable Care Act unconstitutional was incorrect.

Dave Yost of Ohio and Timothy Fox of Montana say they support the elimination of the mandate, but believe that "...the District Court's ruling is wrong, and its errors threaten harm to millions of people."

As part of the appeal process, the court will review the ruling that declared that the elimination of the ACA's individual mandate means the entire law should be struck down.

Healthcare Reform News Update for April 1, 2019
Senators to Debut Revised "Medicare X" Plan
Democratic Senators Tim Kaine (VA) and Michael Bennet (CO) will introduce a new "Medicare X" healthcare plan next week, which would create a public health insurance option.

The proposal retains employer health plans, but also allows consumers to purchase Medicare plans through the individual or small-business ACA exchanges.

"180 million people in America get their insurance through an employer-based plan and Medicare X gives people the opportunity to decide whether they want to stay on that plan," said Bennet.

Features of the Medicare X plan include:

The plan would be gradually phased in over a five-year period, beginning in rural areas, then nationwide, and lastly to small businesses.

The proposal has no Republican cosponsors, although Bennet and Kaine are optimistic about the idea catching on.
House Resolution Criticizes President's Position on ACA Lawsuit
The House will vote this week on a resolution that denounces President Trump's decision to support a lawsuit that would eliminate the Affordable Care Act in its entirety.

The effort is led by Rep. Colin Allred (D-TX). According to the resolution, Trump has publicly claimed to support protections for those with pre-existing conditions while ordering the Department of Justice to "actively pursue the destruction" of the ACA and its protections in federal court.

Mick Mulvaney, the president's acting chief of staff, said on Sunday that no Americans would lose healthcare coverage, even if the ACA is struck down. Currently, no replacement healthcare law has been proposed.
Republican Senator Asks Attorney General to Reverse ACA Decision
Sen. Susan Collins (R-ME) has sent a letter to Attorney General William Barr asking that he reverse the Department of Justice's decision to support the removal of the Affordable Care Act.

"Rather than seeking to have the courts invalidate the ACA, the proper route for the administration to pursue would be to propose changes to the ACA or to once again seek its repeal," Collins writes in the letter. "The administration should not attempt to use the courts to bypass Congress."

In addition, Collins criticizes the DOJ's refusal to defend the healthcare law in court. "The administration should reconsider its decision and defend the remainder of the ACA," wrote Collins.

Healthcare Reform News Update for March 29, 2019
Federal Judge Rejects Association Health Plan Expansion
U.S. District Judge John D. Bates on Thursday blocked the Trump administration's attempt to expand access to association health plans (AHPs).

The new rule enabled groups of employers, including the self-employed, to create associations to form health plans that are not required to meet all Affordable Care Act requirements.

Bates said the Trump administration's final rule was an "end-run around the ACA" and "stretches the definition of 'employer'" under the Employee Retirement Income Security Act (ERISA).

Since expanding AHPs, around 30 associations have formed and are scheduled to begin on Jan. 1, 2020. An appeal of Bates' ruling is expected. If successful, the appeal could allow the plans to continue.
Insurers Request Change to Out-of-Pocket Limits for Grandfathered ACA Plans
Insurance groups have asked the Centers for Medicare and Medicaid Services (CMS) to allow them to increase out-of-pocket charges for grandfathered ACA plans.

The change would take into account the increase in prescription drug prices. The new methodology is needed because "prescription drug inflation exceeds medical inflation," according to The American Benefits Council.

Instead of calculating out-of-pocket charges based on the Consumer Price Index's medical inflation numbers, insurers would like to base them on CMS' "average per enrollee private health insurance premiums for the National Health Expenditure Accounts."

An increase in deductibles and maximum out-of-pocket limits would affect approximately 1 million people who are enrolled in lower-cost grandfathered ACA plans, which don't provide the law's 10 essential health benefits.

Healthcare Reform News Update for March 28, 2019
Republican Lawmakers Pressed to Create an ACA Replacement Plan
Following the Department of Justice's decision to argue for the elimination of the Affordable Care Act, President Trump has put pressure on Republicans to create replacement legislation.

"If the Supreme Court rules that Obamacare is out, we'll have a plan that is far better than Obamacare," President Trump said during an event on Wednesday.

The DOJ's decision took some lawmakers by surprise and created some concern about its timing. "Repealing the entire law - or knocking it down in the court system with no plan to address the impasse - leaves millions of Americans in harm's way, and they didn't do anything. We owe it to the American people to have a solid plan in place before that occurs," said Rep. Tom Reed (R-NY).

According to Marc Short, Vice President Pence's chief of staff, "the president will be putting forward plans this year that we hope to introduce into Congress."

A few Republican members of Congress spoke to the president about creating new legislation, including. Senator John Barrasso (R-WY). "He wants to preserve people being able to get their insurance through work . . . and focused on people with preexisting conditions. He is 100 percent committed to ensuring that people with pre-existing conditions get covered, and I understand that . . . and the president is also focused on lowering the cost of drugs," said Barrasso.

Senator Susan Collins (R-ME) is drafting a letter to the Trump administration, arguing against the DOJ's decision. "I believe that he's sort of got the cart before the horse, that you need to have a plan for what a replacement would be that would improve upon the ACA," she said. "There are some very important, good provisions of the ACA that have helped expand health insurance for low-income Americans . . . I would not want to see those abandoned."

Republicans believe that the legal battle at the center of the issue could take up to a year to go through the court system, so they have some time to consolidate disparate ideas into a single GOP plan.
Senate Democrats Move to Block DOJ Funds for ACA Lawsuit
Senate Minority Leader Charles Schumer (D-NY) said on Wednesday that he will try to force a vote on a measure that would block the Department of Justice from using federal funds in the lawsuit against the Affordable Care Act. The measure would be part of an amendment to the disaster aid bill currently being considered in the Senate.

The move would force Republicans to go on record regarding their support of DOJ's declaration that the ACA should be struck down in its entirety, including its protections of people with pre-existing conditions.

"It will very simply prohibit the Department of Justice from using any funding to litigate the downfall of the ACA in the Circuit Court," said Schumer. "Let's see if all of our Republican colleagues who have said they don't want to take away protections for pre-existing conditions. Let's see how our Republican colleagues will vote on this."

Healthcare Reform News Update for March 27, 2019
House Dems Reveal New Healthcare Package to Expand Coverage
Speaker of the House Nancy Pelosi (D-Calif.) on Tuesday presented a legislation package designed to stabilize the Affordable Care Act marketplace.

The package will "strengthen protections for pre-existing conditions, reverse the GOP's healthcare sabotage, and lower Americans' health costs," according to Pelosi.

Some of the legislation's proposals include:

House Democrats expect to begin putting sections of the package up for votes individually beginning in May.
Centene's Purchase of WellCare to Create Large Share of ACA Enrollees
Health insurer Centene announced today that it will buy WellCare Health Plans, which also provides government and ACA health insurance, for $17.3 billion.

If approved, the merger will cover almost 9 million people with ACA plans and 13 million Medicare Advantage and Medicaid enrollees.

Healthcare Reform News Update for March 26, 2019
Department of Justice Agrees With Ruling to Nullify ACA
In a two-sentence legal filing to the 5th U.S. Circuit Court of Appeals, the U.S. Department of Justice on Monday affirmed a district court judge's December ruling to eliminate the Affordable Care Act.

The agency says it agrees with U.S. District Judge Reed O'Connor's decision that the repeal of the ACA's individual mandate invalidated the entire law. The DOJ's brief stated: "With the amount of the tax set at zero, the remaining minimum coverage provision becomes simply precatory-precisely as the amending Congress intended. It is no more constitutionally objectionable than the 'sense of the Congress' resolutions that Congress often adopts."

Prior to this position, the Trump administration showed support for some ACA provisions, including protections for people with pre-existing conditions and Medicaid expansion.

Shortly after O'Connor's ruling, a coalition of Democratic attorneys general appealed it. The law remains in place while the case moves through the court system.

The DOJ must file a full brief within 30 days.
CMS: State ACA Enrollment Rises, Federal Enrollment Dips Slightly
States running their own healthcare exchanges are maintaining enrollment levels better than the federal exchange, according to 2019 enrollment data released Tuesday by the Centers for Medicare and Medicaid Services (CMS).

In 2019, 11.4 million Americans enrolled in ACA plans. That is a 2.6 percent overall decrease from 2018. States that run their own exchanges saw a 1 percent increase in enrollment, while states on the federal exchange dropped 3.8 percent.

Regarding the report, CMS Administrator Seema Verma tweeted: "Steady enrollment through (the) exchanges, confirming another successful enrollment period at a time when premiums are stabilizing after years of substantial increases."

Healthcare Reform News Update for March 25, 2019
New Jersey Will Operate a State ACA Exchange Starting in 2021
New Jersey will establish its own health insurance marketplace beginning in 2021. Governor Phil Murphy sent a letter to the Trump administration on Friday declaring that the state would no longer be using the federal exchange to enroll participants in Affordable Care Act insurance.

The move away from the federal exchange will allow the state to extend its open enrollment period. The break from the marketplace is a continuation of Murphy's efforts to support several provisions of the law, including the creation of a state reinsurance program and a state individual mandate.

Murphy said funding for the state exchange would come from redirecting its current federal exchange user fee, which is a 3.5 percent assessment on insurance premiums.
New Study Confirms $30 Billion Cost for Federal Reinsurance Program
A national reinsurance program would cost $30.1 billion over three years, according to a new study published in the Journal of Health Care Organization, Provision and Financing last week. The findings align closely with the $10 billion per year supporters of the program are asking from Congress.

A reinsurance program helps protect insurers from its highest-use enrollees, and would cost the federal government $9.5 billion in 2020, or $30.1 billion from 2020-2022.

The study reviewed data from the 2007-2016 Medical Expenditure Panel Survey and state demographic and health insurance coverage data from the 2015-2017 Current Population Survey Annual Social and Economic Supplement.

A recent report conducted by Georgetown University's Center on Health Insurance Reforms found that state reinsurance programs in Alaska, Minnesota and Oregon have helped stabilize the states' ACA insurance marketplaces.

Healthcare Reform News Update for March 12, 2019
Trump's Budget Proposal Slashes Spending for Medicaid and other HHS Programs
The White House proposed a $4.7 trillion budget for 2020 on Monday. Included in the budget request is a 12 percent cut to Health and Human Services funding.

The " Budget for a Better America " proposal endorses repealing the Affordable Care Act and converting the law's funding into state block grants. The proposal also calls for a ban on exchange plans that do not require customer to pay a premium.

The new budget would cut Medicaid funding by almost $1.5 trillion over nine years and repeal the ACA's expansion of the program. Medicare spending would be reduced by roughly $845 billion over 10 years.

The president's budget is expected to be rejected by Congress.

Healthcare Reform News Update for March 7, 2019
CMS Requests Recommendations for Selling Health Insurance Across State Lines
The Centers for Medicare & Medicaid Services (CMS) has asked the public for suggestions on how to facilitate the sale of health insurance plans across state lines.

The Affordable Care Act includes a provision that allows such sales through state agreements called "healthcare choice compacts." However, few states have passed legislation that would take advantage of the opportunity.

CMS Administrator Seema Verma said in a statement that "Americans are in desperate need of more affordable health insurance options. Eliminating the barriers to selling health insurance coverage across state lines could help provide access to a more competitive and affordable health insurance market."

While campaigning, President Trump said that interstate sales could be one way to help improve the ACA. However, the American Academy of Actuaries reported that premiums are determined by the cost of local care, not where the policies are sold, so savings would be limited.

CMS will accept public comments on the issue for the next 60 days.

Healthcare Reform News Update for March 5, 2019
Kaiser Study: ACA Affordability Most Challenging for Middle-Income Earners
A new study of ACA premiums released by the Kaiser Family Foundation highlights the financial burden placed on middle-class, older consumers who earn too much to receive tax subsidies.

The report speaks to the "subsidy cliff," the point where people earning over 400 percent of the federal poverty level no longer qualify for tax credits. The cliff is especially hard on people over 50, whose premiums are allowed to be up to three times higher than younger enrollees.

On average, a subsidized ACA premium for a 40-year-old who makes $45,000 per year is $227. For a 50-year-old who makes $50,000, the same plan without a subsidy is $340. Plan premiums vary widely based on location.

"For older people living in very high-premium counties, the affordability gap is much more stark," according to the report. "In the 28 Nebraska counties with the highest premiums, a 60-year-old making $45,000 would pay nothing in monthly premiums and the same person making $50,000 would pay $1,314 (32% of income) for the lowest-cost plan."

Healthcare Reform News Update for March 1, 2019
BCBS Association Asks Congress to Stabilize ACA Markets
The Blue Cross and Blue Shield Association submitted a legislative proposal on Thursday designed to stabilize the Affordable Care Act exchanges. The suggestions focus on expanding eligibility for tax subsidies and encouraging younger consumers to sign up for coverage.

"We think this is a pragmatic, incremental step," said Justine Handelman, the association's senior vice president in the Office of Policy and Representation. "We believe it's important to build on what's working.

The proposal asks Congress to:

The association says that the plan would lower premiums by an average of 33 percent and increase enrollment by 4.2 million consumers, but cost more than $10 billion annually.

Healthcare Reform News Update for February 28, 2019
Centrist Democrats Ask for Revival of ACA Stabilization Talks
A group of 101 moderate House Democrats has called for a bipartisan effort to help stabilize the Affordable Care Act marketplace.

On Wednesday, two hours after progressives in the party held a press conference announcing a new Medicare for all proposal, the centrist New Democrat Coalition unveiled its plans to revive last year's talks to lower ACA premiums and stop the Trump administration's proposals that "sabotage" the law.

In a letter to key committee leaders, the group wrote to urge those committees "to deliver on the promises made to our constituents by prioritizing strengthening the ACA and continuing the path toward universal affordable coverage."

The coalition said it promotes:
HHS Secretary Azar Pushes Plan for ACA Subsidies to Fund HSAs
Health and Human Services Secretary Alex Azar promoted the concept of depositing Affordable Care Act tax subsidies into health savings accounts (HSAs) to pay for insurance premiums and other out-of-pocket expenses.

"This is just one possible way to help use insurance design to drive value by empowering patients as consumers of healthcare," Azar said during a meeting of the National Association of Health Underwriters. "Plans with HSAs, especially funded HSAs, can protect Americans from the risk of catastrophic healthcare costs while encouraging them to be price-conscious consumers."

The Trump administration is also considering a proposal that would redefine preventive services. The change would allow those on high-deductible health plans use HSA funds to pay for items like insulin.

Healthcare Reform News Update for February 27, 2019
Progressive Democrats Unveil Far-reaching Medicare for All Bill
Rep. Pramila Jayapal (D-WA) introduced an ambitious Medicare for All proposal today that would move all Americans to Medicare plans, entrusting private insurers only with supplemental coverage.

The Medicare for All Act of 2019 has over 100 House cosponsors, most of whom are progressive Democrats. It would transition consumers to a government-run plan over two years, revise how healthcare providers are reimbursed, and eliminate the requirement for premiums, deductibles, or copays in order to receive care.

"Americans are literally dying because they can't afford insulin or they can't get the cancer treatment they need," said Jayapal. "There are some things that should not be provided through the for-profit market."

House Speaker Nancy Pelosi has not endorsed the health-care plan. Without support from centrist House Democrats, the bill may not come up for a vote.

Insurance industry lobbying groups have come out against Medicare for All proposals. "The vast majority of Americans are satisfied with the coverage they have today. They have choice and control over their coverage, options, and treatment," said America's Health Insurance Plans in a statement.

Healthcare Reform News Update for February 21, 2019
CMS Projects 5.5% Annual Rise in Healthcare Spending Over the Next Decade
The Centers for Medicare and Medicaid Services projects that government spending on healthcare will increase an average of 5.5 percent annually over the next 10 years.

The department's Office of the Actuary projected that healthcare spending will exceed $5.9 trillion in 2027, representing 19.4 percent of the gross national product, according to a CMS report released Wednesday.

The CMS analysis also projected the following:

The report also projects that the repeal of the Affordable Care Act's individual mandate will increase the uninsured population from 29.9 million in 2018 to 31.2 million this year.

Healthcare Reform News Update for February 15, 2019
House Democrats Allowed to Defend ACA in Federal Lawsuit
A federal appeals court ruled on Thursday to allow House Democrats to join 16 Democratic states and the District of Columbia in defending the Affordable Care Act in a lawsuit filed by 20 Republican attorneys general.

The Trump administration has declined to defend the healthcare law in the case. In his ruling, Circuit Judge Leslie Southwick said, "In the absence of any other federal governmental party in the case presenting a complete defense to the Congressional enactment at issue, this court may benefit from the participation by the House."

The case has been in appeal since a federal district judge in Texas ruled the ACA unconstitutional. Southwick declined the Democrats' request to expedite the appeal.

Healthcare Reform News Update for February 14, 2019
New Bill Proposes Selling Medicare to People Age 50 to 65 on ACA Exchanges
Congressional Democrats introduced a new bill on Wednesday that would allow anyone over 50 to buy Medicare plans on the health insurance marketplace. Plans would include Medicare Part A, Part B, Part D prescription plans and Medicare Advantage plans.

Sponsors of the "Medicare at 50" bill said that the premiums from the new enrollees will pay for the plan, and those premiums would cost an estimated 40% less than gold plans on the exchanges. Enrollees would also be eligible for Affordable Care Act tax credits and cost-sharing subsidies.

Supporters say that the plan will lower ACA plan premiums by removing the older enrollees from the risk pool, and also lower Medicare premiums through the addition of younger, healthier enrollees.

The Federation of American Hospitals criticized the bill, saying low Medicare margins makes the higher reimbursements they receive from private insurers necessary in order to provide quality care.
House Committee Proposes Four Bills to Combat Recent Changes to ACA
The House Energy and Commerce Committee held hearings on four separate bills on Wednesday that would reverse or revise some of the recent changes by the Trump administration to the Affordable Care Act.

1. A bill by Anna Eshoo (D-CA) would require insurers to put consumer warnings on their short term health plans, bringing attention to the fact they offer limited benefits and provide no protections for pre-existing conditions.

2. A bill by Kathy Castor (D-FL) would completely cancel the recent expansion of short-term health plans, which extended their duration up to 12 months and allowed renewal for up to three years.

3. A bill by Ann Kuster (D-NH) would revoke the ability for states to seek waivers that would allow customers to use the ACA's tax subsidies to pay for plans that do not meet ACA requirements.

4. A bill by Lisa Blunt Rochester (D-DE) would restore ACA navigator and marketing program funds that the Trump administration cut by 90 percent.

Healthcare Reform News Update for February 12, 2019
Utah Lawmakers Decrease Voter-Backed ACA Medicaid Expansion
On Monday, Utah Governor Gary Herbert signed legislation that shrinks an Affordable Care Act Medicaid expansion measure approved by voters in November.

The voter-passed expansion would have covered 150,000 residents with incomes up to 138% of the federal poverty level. The new legislation cuts the eligibility number nearly in half, covering an estimated 90,000 residents with incomes of up to 100% of the poverty level and adds employment conditions.

Before implementation, the state must file waivers with the Trump administration to approve the partial Medicaid expansion. If the waivers are rejected, the measure would revert back to one resembling the voter-approved version.

Healthcare Reform News Update for February 8, 2019
White House Report Says ACA Changes Don't 'Sabotage' Law
A new report from the White House's Council of Economic Advisors claims that the Trump administration's changes to the Affordable Care Act help increase effectiveness and don't damage the overall law.

The report reviews the administration's extension of short-term health plans, increased availability of association plans, and the repeal of the individual mandate.

"These reforms do not 'sabotage' the ACA but rather provide a more efficient focus of tax-funded care to those in need," says the report.

The report acknowledges that some consumers may drop their ACA coverage due to the newly available alternatives, but argues that the federal exchange will continue to stay afloat due to premium subsidies received by nearly 90 percent of enrollees.

The Republican-lead lawsuit against the ACA is not addressed. However, the report's analysis concerning the individual mandate repeal could have some bearing on case, as it contradicts the plaintiffs' arguments that the penalty is central to the law.

The report says that "removing the tax penalty and opening up more affordable options was able to save taxpayer dollars, give families more choice, without destabilizing the exchanges."
New Poll Shows Majority Want Private Insurance Option in 'Medicare for All' Plans
A new Hill-HarrisX survey on universal healthcare coverage found that 87 percent of respondents preferred a healthcare system that includes private plans.

When registered voters were asked about the government's role in healthcare:

Healthcare Reform News Update for February 7, 2019
House Democrats Plan Hearings on Proposals to Overturn Recent Healthcare Changes
In a meeting of the House Energy and Commerce Subcommittee on Wednesday, House Democrats announced they will hold hearings next week concerning proposals that address Trump administration changes that affect the Affordable Care Act.

The subcommittee plans to review legislation that would:

Any legislation of this nature initiated and passed by the House will face tough battle in the Republican-led Senate.
Bipartisan Senators Question Medical Industry on 'Surprise Billing' Practices
A bipartisan group of six senators sent letters to insurance industry and medical groups on Tuesday asking about their balanced billing practices, which can lead to surprise out-of-pocket costs for consumers.

The letter requested information from hospitals regarding:

Insurers were asked to disclose what they pay for out-of-network care compared to average in-network rates and Medicare rates.

"We want to protect patients from costly surprise bills while preventing undue disruption in the health care system," said the senators in the letter. "To meet this goal, it is critical that we receive additional data and more complete feedback in order to refine and inform our legislative proposal."

Healthcare Reform News Update for February 4, 2019
Judge Dismisses Lawsuit Maryland Filed to Protect the ACA
Late last week, a Maryland federal judge dismissed a lawsuit from the state that demanded the Trump administration cease its perceived " sabotage " of the Affordable Care Act and declare it constitutional.

The plaintiffs in the case used the administration's halting of cost-sharing reduction payments, the Department of Justice's decision to not defend the law in a current lawsuit, and President Trump's own comments as evidence that law was in danger of not being enforced.

U.S. District Judge Ellen Lipton Hollander called the lawsuit speculative and a "request for an advisory opinion."

"The president's profound disdain for the ACA cannot be seriously disputed," wrote Hollander. "But, the state's allegations do not create a plausible inference of a substantial or certainly impending risk that the Trump administration will cease enforcement of part or all of the ACA. Neither the president's zealous attempts to repeal the statute, nor his derisive comments about it, support an inference that he will fail to enforce the law."

Healthcare Reform News Update for January 31, 2019
Consumers Searching for Coverage Directed to Short-Term Plans That Lack ACA Protections
A new study by Georgetown University's Center on Health Insurance Reforms found that the those searching for health insurance online last fall were often directed to websites and brokers that sell short-term plans that do not meet Affordable Care Act consumer protection requirements.

In their report, the researchers noted that "lead-generating sites that point consumers to short-term plans or other non-ACA compliant insurance products were the most common search result in every state, representing more than half of all search results before and during open enrollment."

The search results and the lead-generation led the researchers to two web brokers: Agilehealthinsurance.com and eHealthinsurance.com. Agilehealthinsurance.com only sells non-ACA compliant plans. Ehealthinsurance.com sells short-term plans, ACA-compliant plans and other coverage, but appeared in the search results half as often as agilehealthinsurance.com.

The research team analyzed the top four results, including paid ads, for the search terms "cheap health insurance," "Obamacare," "ACA enroll," and "short-term health insurance." The study investigated online marketing practices in Colorado, Florida, Idaho, Maine, Minnesota, Missouri, Texas and Virginia in the weeks before and during the ACA's open enrollment period in November and December.

Researchers also created a profile of a subsidy-eligible 29-year-old female and interacted with six brokers. Half of the brokers recommended ACA-compliant plans, while the remaining three recommended non-ACA compliant coverage, even after learning the consumer was eligible for tax credits.

Sabrina Corlette, the lead author of the study said that "it was disturbing, but not unexpected, to find such a high proportion of misleading ads and come-ons. That raises the risk that consumers could be duped into buying health insurance that they think offers comprehensive and secure coverage, but does not."

Late last year, the Trump administration extended the term limits of short-term plans from three to 12 months. The low-cost plans are not required to cover consumers with preexisting conditions and do not have to cover services such as maternity care, prescription drugs, or mental health care. Tax subsidies are not available for these plans.

"These plans are different, and consumers do need to know what they are purchasing, which is why we now require more robust warnings about the limits of these plans than before," said Seema Verma, the administrator of the Centers for Medicare & Medicaid Services.
New Study Shows ACA Did Not Reduce Employer Health Insurance
A new study from the University of Minnesota found that launch of the Affordable Care Act did not cause a reduction in employer-sponsored health insurance plans. Researchers reviewed federal data before and after the law's implementation and found that employer coverage was mostly unaffected.

The study found "no evidence that employer offers, takeup rates, or out-of-pocket premiums paid by workers changed signiﬁcantly" due to the launch of the ACA or Medicaid expansions.

Jean Abraham, a professor of health care administration at the University of Minnesota, said that company coverage may not have changed for several reasons, including the desire to attract higher-income employees who aren't eligible for subsidies or Medicaid, the ACA's employer mandate, and the uncertain future of the individual insurance marketplace.
New California ACA Sign-ups Drop Significantly
Covered California, the state's Affordable Care Act insurance exchange, announced that the number of consumers who renewed their ACA plans in 2019 increased by 7.5 percent, but new enrollees dropped by 23.7 percent.

For 2019, there were 295,980 new enrollees, compared to 388,344 last year. Total ACA enrollment in California dipped slightly to 8.4 million, down from roughly 8.7 million last year.

Covered California official s say that the drop in new enrollments is due primarily to the Trump administration's repeal of the ACA's individual mandate, which required individuals to have health insurance coverage or pay a fine.

California's recently elected governor has called for a state individual mandate, which will have to be approved by the state's legislature.

Healthcare Reform News Update for January 25, 2019
Wisconsin Governor's Attempt to Withdraw From ACA Lawsuit Denied
Newly elected Wisconsin Governor Tony Evers' request to leave the 20-state lawsuit against the Affordable Care Act was rejected by the state's attorney general.

Attorney General Josh Kaul said in a letter to Evers that the state's department of justice "does not have statutory authority to withdraw the State from the ACA litigation absent approval from the Joint Committee on Finance."

The ability to withdraw the state from lawsuits was taken from the governor and given to the Joint Finance Committee last month in legislation signed by the previous governor, Scott Walker. Kaul has asked this committee to withdraw from the lawsuit.

Healthcare Reform News Update for January 24, 2019
Uninsured Rate at Highest Level Since ACA Implementation
In the fourth quarter of 2018, the number of uninsured Americans was at its highest point since the Affordable Care Act went into effect four years prior, according to a new survey from Gallup.

The overall uninsured rate was at 13.7 percent, compared to 13.4 percent in the first quarter of 2014. Groups with the fastest-growing uninsured rates were women, young adults, and those with a lower-income. The data shows that in the fourth quarter of 2018:

The uninsured rate is still lower than the peak rate of 18 percent, which occurred in 2013 before the ACA was launched.

Gallup cited several factors that could have contributed to the rise in the uninsured rate, including higher premiums, slashed advertising funds, the elimination of cost-sharing reduction subsidies, negative political rhetoric and the repeal of the ACA's individual mandate.
Colorado to Have New State Office Devoted to Healthcare Costs
Jared Polis, the newly elected governor of Colorado, signed an executive order on Wednesday to create The Office of Saving People Money on Health Care.

The office will focus on lowering the costs of insurance, hospital stays, and prescription drugs. It will also tackle price transparency and efficiency improvements.

"So right now, cost is a barrier to access. By reducing costs we'll help businesses, we'll help the state, we'll help the health care system, and, most importantly, we'll help the patients," said Lt. Gov. Dianne Primavera, who will oversee the office.
President Trump Addresses His Concern Over Surprise Medical Bills
On Wednesday, President Trump asked administration officials to investigate how to eliminate surprise medical bills.

In a White House round-table discussion with Health Secretary Alex Azar, Labor Secretary Alex Acosta, and guests who have been hit with exorbitant out-of-network costs, President Trump vowed to tackle the issue.

"The healthcare system too often harms people with some unfair surprises ... medical bills and the like. We're going to stop all of it, and it's very important to me," he said.

Healthcare Reform News Update for January 23, 2019
Kaiser Poll Shows Fluctuating Support for Medicare for All Plans
A new poll released by the Kaiser Family Foundation shows mixed support for Medicare for All plans, with approval varying depending on the information provided.

The poll showed that 56 percent of respondents indicated they supported a national health plan like Medicare for All when initially asked. However, support increased when respondents were told that the program would:

Guarantee health insurance as a right. (71 percent)

Eliminate premiums and out-of-pocket costs. (67 percent)

Support for a Medicare for All plan decreased when respondents were told that the plan could:

Require more taxes. (37 percent)

Lead to delays in treatment. (26 percent)

The poll also found that 77 percent of Americans support Medicare buy-in plans for people aged 50-64, and 74 percent support optional Medicare buy-in plans for people of any age.

Healthcare Reform News Update for January 22, 2019
Trump Administration Proposes Changes to Out-of-Pocket Limit Calculations
Patients on Affordable Care Act plans could face higher costs if they use brand-name prescription drugs when generics are available, if the proposed changes from the Trump Administration go into effect.

The proposal would allow insurers to only credit the price of a generic drug in a patient's annual cost-sharing limits, even if the patient purchased the brand-name version. For example, if a patient pays a $30 co-pay to fill a prescription for a brand-name drug when a $10 generic is available, only $10 will be applied toward the patient's annual out-of-pocket limit.

Similarly, the value of coupons or other cost-lowering assistance from drug manufacturers for brand-name drugs would not count toward the out-of-pocket limit if generics are available.

"The availability of a coupon may cause physicians and beneficiaries to choose an expensive brand-name drug when a less expensive and equally effective generic or other alternative is available," said the Trump administration.

Critics, including representatives from the AIDS Institute, the National Multiple Sclerosis Society, and the Diabetes Patient Advocacy Coalistion (DPAC), say that the proposal harms patients with conditions that require expensive treatments. These patients often rely on coupons and copay assistance for both brand-name and generic drugs.

"In theory, copay coupons could encourage people to take higher-priced drugs. In reality, people use them to get the medicines that their doctors prescribe, despite astronomically high deductibles," said Leyla Mansour-Cole, the policy director of DPAC.

Healthcare Reform News Update for January 18, 2019
Trump Administration Proposes Raising ACA Premiums, Cutting Exchange Fees
On Thursday, the Centers for Medicare and Medicaid Services issued proposed rule changes to the Affordable Care Act that would slightly increase premiums and reduce fees for insurers using the exchange.

CMS says that the proposed rule changes detailed in the 331 page document reflect the Trump Administration's aim to lower premiums for enrollees and reduce the regulatory burden on insurance companies.

Some of the proposals include:

The document says that the proposals would save an estimated $900 million per year on tax subsidies, but also estimates an enrollment decrease of 100,000. The proposal is currently open for public comment.

Healthcare Reform News Update for January 15, 2019
Judge Issues National Block on New Contraception Rules
Pennsylvania District Court Judge Wendy Beetlestone issued a nationwide block on a Trump administration rule that would allow more companies to opt out of providing free birth control coverage to employees.

The ruling came one day after a California judge made a similar ruling that applied to 13 states and the District of Columbia.

Beetlestone said that the new rules went beyond the scope of the Affordable Care Act, which she said specifically prohibits the U.S. Department of Health Human Services from allowing these kind of exceptions. Beetlestone also said the rules would put the burden on states to pay for birth control and could result in 70,500 women losing contraception coverage.

It's likely that the Department of Justice will appeal the ruling. "Religious organizations should not be forced to violate their mission and deeply held beliefs," it said in a statement.

Healthcare Reform News Update for January 14, 2019
Judge Blocks Changes to ACA Contraception Rules in 13 States
The Trump administration's decision to expand employer exemptions to the Affordable Care Act's birth control rules has been blocked from taking effect in 13 states and the District of Columbia.

The new policy, scheduled to go into effect today, allows more companies to opt out of providing no-cost birth control on religious or moral grounds.

Washington D.C., California and 12 other plaintiffs requested an injunction to keep the new rules from going into place while a lawsuit against them moves through the courts. U.S. Judge Haywood Gilliam sided with the plaintiffs, saying that the new rules could cause a "substantial number" of women to lose birth control coverage. However, his decision applies only to the plaintiffs who filed the suit, not nationwide.

Gilliam's ruling applies to California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia.
ACA Lawsuit Appeal Suspended Due to Government Shutdown
U.S. Court of Appeals Judge Leslie Southwick has temporarily halted the appeal of the Affordable Care Act lawsuit due to the partial government shutdown.

Attorneys for the Department of Justice are unable to work until the government is reopened. They requested that the proceedings be paused so upcoming deadlines would not be missed.

Healthcare Reform News Update for January 11, 2019
Bipartisan Bill Filed to Eliminate ACA Health Insurance Tax on Insurers
Senators Kyrsten Sinema (D-AZ), John Barrasso (R-WY), and Cory Gardner (R-CO) filed legislation on Thursday to repeal the Affordable Care Act's health insurance tax, saying that its implementation would raise premiums.

The tax, which is levied on health insurers, has been delayed numerous times but is currently scheduled to go into effect next year.

Healthcare Reform News Update for January 10, 2019
House Passes Measure to Intervene in ACA Lawsuit
The House passed a measure 235-192 to legally intervene in the lawsuit aiming to strike down the Affordable Care Act. All Democrats and three Republicans voted their support on Wednesday.

Last week, a similar intervention measure was passed as part of a broad rules package. Yesterday's vote isolated the issue so that the Democratic majority could put Republicans on record as voting against the ACA and its protections for Americans with pre-existing medical conditions. During the midterm campaigns, many Republicans promised to protect insurance coverage for people with pre-existing conditions.

"A campaign is part of forming a government, and no issue resonated with the American people in the last election like the issue of pre-existing conditions," said House Ways and Means Committee Chairman Richard E. Neal (D-MA).

Healthcare Reform News Update for January 9, 2019
Democratic Lawmakers in CA, WA & NYC Announce New Health Insurance Programs
The Democratic governors of California and Washington and the mayor of New York City have all started their 2019 terms with proposals for major health insurance initiatives.

In California, Governor Gavin Newsom began his first day in office with proposals that would: create a state individual mandate that requires residents to purchase insurance or pay a penalty; expand Affordable Care Act tax subsidy eligibility to people above the 400% poverty limit; and allow undocumented young adults up to age 26 to be covered by Medicaid.

In Washington, Governor Jay Inslee said that he will introduce a bill for a state public health insurance option for all residents on its state healthcare exchange. "Under the Obama administration and the Affordable Care Act, Washington was able to make tremendous progress in expanding coverage and start bringing down costs in our health care system. Under the Trump administration, all that progress is at risk," said Inslee.

In New York City, Mayor Bill de Blasio announced he will expand the city's low-income healthcare program to an additional 600,000 uninsured, including undocumented immigrants. The "NYC Care" plan will provide residents access to physicians and hospitals at reduced cost or no cost, depending on ability to pay. The program will begin the Bronx this summer and roll out citywide by 2021.
Democratic Congress Members Seek Answers Regarding New Short-term Insurance Rules
Democratic lawmakers in the House and Senate have sent a letter to the Trump administration about its decision to expand the length of short-term insurance plans from three to 12 months and allow renewals for up to three-year renewability. This is the third letter sent to the administration asking for additional information about the short-term plans' economic analysis.

"We believe allowing for renewal or extension of short-term policies for up to 36 months is contrary to law, and that the creation of an entirely unregulated parallel market competing against the market for Qualified Health Plans goes against Congressional intent in enacting the comprehensive consumer protections embodied in the Affordable Care Act," they said in the letter.

The administration believes that the short-term plans are a good alternative for healthy individuals looking for lower-cost insurance. The plans do not follow the Affordable Care Act restrictions, which means they can omit some health services and deny coverage of pre-existing conditions.
Committee Chairman Asks for Single-Payer Healthcare Budget Report
House Budget Committee Chairman John Yarmuth (D-KY) has requested Congressional Budget Office (CBO) analysis of single-payer healthcare proposals.

"The House Budget Committee will soon schedule hearings to review potential ways to achieve affordable, high-quality health care coverage for everyone, including Medicare for All. To begin that work, I have requested that the Congressional Budget Office provide a report on the design considerations that policymakers should consider in developing proposals to establish a single-payer system in the United States," said Yarmuth in a statement.

Healthcare Reform News Update for January 8, 2019
ACA Individual Mandate Repeal Could Set Back Insurance Coverage Gains
A new study found that the repeal of the Affordable Care Act's penalty for not having insurance could reverse the recent increases in coverage for Hispanics, younger Americans, the healthy, those with a lower income.

The study, published earlier this week in the journal Health Affairs, is based on a 2017 survey of 3,000 California residents. Nineteen percent of respondents said that they would not have purchased health insurance in 2017 if there was no penalty.

Findings in the study include:

The elimination of the individual mandate went into effect on January 1. The penalty still applies to those who went without health coverage in 2018.

"Especially for lower-income consumers who are potentially eligible for subsidies, it's really important to try to understand how eliminating the penalty might affect their choices," said Vicki Fung, assistant professor of medicine at Harvard Medical School and lead author of the study.
Poll Shows Strong Democratic Support for Public-Option Healthcare Plans
A new Harvard/Politico poll shows that 71 percent of Americans support a Medicare buy-in option for people under 65. Of these respondents, 83 percent are Democrats and 60 percent are Republicans.

A public health insurance option that would compete with private insurance companies is supported by 65 percent of respondents (70 percent Democrats and 51 percent Republicans).

Other findings from the poll:

Healthcare Reform News Update for January 4, 2019
2019 Federal ACA Exchange Enrollment Falls Slightly
Final data from CMS shows that 8.4 million people signed up on the healthcare.org site during the 2019 Open Enrollment Period, a 3.8 percent decrease from last year.

Additional data from the report:

CMS says it will release a report that includes state exchange enrollment figures in March.
Democratic Attorneys General Appeal ACA Decision
A coalition of 17 Democratic states on Thursday filed to appeal a federal judge's decision declaring the Affordable Care Act unconstitutional. The lawsuit will now go to the 5th U.S. Circuit Court of Appeals in Louisiana.

Led by California Attorney General Xavier Becerra, the attorneys general expect a decision within a year. Last week, Judge Reed O'Conner ruled that the ACA will remain in place during the court process.
Medicare for All to Get Hearings from House Democrats
House Democrats plan to hold hearings on universal healthcare legislation after House Speaker Nancy Pelosi (D-CA) gave her support.

Representative Pramila Jayapal (D-WA), the sponsor of the Medicare for All proposal, expects to release a bill this month and hold hearings in a number of committees.

"It's a huge step forward to have the speaker's support," she said.
Maine's new Governor Orders ACA Medicaid Expansion
Janet Mills, the newly installed governor of Maine, called on state health officials to move ahead with implementing Affordable Care Act Medicaid expansion that was approved by voters over a year ago.

The state's previous governor, Paul LePage, blocked expansion efforts, saying the program was not adequately funded. Mills has asked the state Department of Health and Human Services to work with lawmakers to find a method of "sustainable" funding.

Healthcare Reform News Update for January 3, 2019
New Democratic House to Vote Next Week on Defending ACA in Lawsuit
The House of Representatives plans to hold a vote next week on whether to defend the Affordable Care Act in the federal lawsuit that's set to be heard in the appellate court.

Last week, the federal judge who ruled that the ACA as invalid allowed the appeals process to proceed. The law continues to be in effect while it moves through the appeal process.

The new House Democratic majority intends for the vote to put pressure on Republicans, who campaigned on their support of pre-existing conditions protections as currently outlined in the ACA. "Republicans who survived the election on their tardy promises to protect pre-existing conditions will have to explain why they have once again been complicit in trying to strike down those life-saving protections," said a spokesman for House Speaker Nancy Pelosi (D-CA).

Though legal experts on both sides do not expect the ruling against the ACA to be upheld, President Trump predicted yesterday that the Supreme Court will side with the decision. "We should win at the Supreme Court, where this case will go. When we do, we will sit down with the Democrats and we will come up with great healthcare," he said.
Insurance Lobbying Groups Ask for Changes to Proposed HRA Rule
America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association warned the Trump administration that allowing the use of HRA funds to purchase short-term insurance plans could weaken the individual market and raise premium rates.

In October, the Centers for Medicare and Medicaid Services announced a proposed rule that would allow employees to use money in HRA accounts to buy insurance from the individual marketplace beginning in 2020.

The Blues Cross and Blue Shield association cautioned that also allowing employees to use the HRA funds for short-term plan insurance plans that do not adhere to the ACA requirements "runs the risk of upending the individual market and dramatically increasing costs."

Both groups also recommended that implementation of the rule be delayed until at least 2021 to help ensure effective administration.

Healthcare Reform News Update for January 2, 2019
ACA Remains in Effect While Appeal Efforts Move Forward
U.S. Judge Reed O'Connor finalized his decision against the Affordable Care Act and allowed the case to go the 5 th U.S. Circuit Court of Appeals. The law continues to remain in place as it goes through the appeal process.

In his order, O'Connor said that his stay of the law will prevent Americans from facing "great uncertainty" and that he was confident that the appellate court will side with his ruling.
Colorado Legislators to Propose State Public Health Insurance Option
Two lawmakers in Colorado will propose bills that would establish the country's first state-run, public health insurance option.

Rep. Dylan Roberts will introduce a bill that will create the infrastructure to create the program and gain approval from the federal government. Sen. Kerry Donovan's bill will set up a pilot program to offer the option to counties with limited insurance choices and high premiums.

The program would offer Colorado residents the option to purchase an insurance plan from the state. "This is not free insurance. You're still going to pay a monthly premium," said Roberts.

The lawmakers believe that the program could increase competition and reduce overall premiums for residents.

Healthcare Reform News Update for December 26, 2018
Republicans Urge Judge to Allow Appeal on ACA Ruling
U.S. District Judge Reed O'Connor ruled that the Affordable Care Act was unconstitutional on December 14, and the Democratic attorneys general defending the law vowed to immediately appeal the decision. On Friday, the Republican attorneys general who originally filed the lawsuit asked O'Connor to move forward with the appeal process.

The Republicans said that they hoped the 5th U.S. Circuit Court of Appeals, and potentially the Supreme Court, will uphold O'Connor's ruling so that states would be able to regulate their own individual insurance marketplaces.

"When that happens, the states will be able to enact policies and regulations accomplishing what the ACA promised but could never provide: affordable health insurance for all Americans," they wrote.

Currently, the ACA remains the rule of the land while the appeal process continues.

Healthcare Reform News Update for December 20, 2018
ACA Enrollment Stays Relatively Steady
Total enrollment for 2019 health insurance plans on the Affordable Care Act federal exchange is currently 8.5 million, which is 4 percent lower than last year. The data does not yet include enrollees who signed up within three hours before the deadline or those who were put on a waitlist. The final tally is due next week.

During the final week of open enrollment, 4.3 million people signed up for insurance, which is 318,000 more than the final week in 2017.

States that run their own healthcare exchanges have mostly seen an increase in enrollees:
Senate Democrats' ACA Resolution Blocked
A resolution drafted by Senate Democrats to intervene in the federal lawsuit against the Affordable Care Act was blocked by Senator John Barrasso (R-WY).

The resolution requested unanimous consent for the Senate's legal counsel to defend the ACA in court. Last week, a federal judge ruled that the law was unconstitutional, but this decision is in the process of being appealed.

Barrasso claims that the resolution was a political ploy. "Regardless of what happens in this legal process, we look to protect people with pre-existing conditions," Barrasso said.

Democrats argued that the best way to protect those with pre-existing conditions is to defend the law and its provisions.

"If people say we all have sympathy and empathy for people with pre-existing conditions, if you want to protect then ... at least allow us to move forward on a unanimous consent so we can fight and have a fighting chance, as this thing will be appealed to the higher courts," said Senator Joe Manchin (D-WV).

Healthcare Reform News Update for December 18, 2018
State AGs Ask Federal Judge for Clarification on ACA Ruling
A coalition of 17 Democratic attorneys general have asked Judge Reed O'Connor to clarify ambiguities surrounding his ruling that declared the Affordable Care Act unconstitutional. They've requested that O'Connor either issue a stay on the motion pending appeal or an order that declares that the law is still in effect.

Lead by California's Xavier Becerra, the coalition said that the ruling caused confusion about the current state of the law. It is unclear what will occur on January 1, which is when the repeal of the individual mandate goes into effect. They also requested that O'Connor certify his opinion so that it can be appealed.

"The district court's ruling poses a dangerous threat to the healthcare of millions of Americans. We're asking the court to make clear that the ACA is still the law and ensure that all Americans can continue to access affordable healthcare under it," Becerra said in a statement.

A spokesperson for the Department of Health and Human Services said on Monday that it "will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision."

Healthcare Reform News Update for December 17, 2018
Judge Rules ACA Unconstitutional, 2019 Enrollment Unaffected
U.S. District Judge Reed O'Connor ruled the Affordable Care Act unconstitutional, siding with 20 Republican lawmakers who said that the repeal of the individual mandate, which imposed a penalty on the uninsured, invalidated the entire law.

The 17 Democrat attorneys general who defended the law plan to appeal the ruling, and the case is expected to ultimately be decided by the Supreme Court.

O'Connor's decision does not impact 2019 health insurance policies, nor does it immediately affect areas that are guided by the law, such as Medicare, Medicaid, prescription drugs, and public health policies.

"There is no impact to current coverage or coverage in a 2019 plan," said Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, in a tweet.

White House press secretary Sarah Sanders also confirmed the law's continued enforcement. "We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place," she said in a statement.

House Democrats, who will be the majority party beginning in 2019, promised to fight the ruling. "We will take immediate action in the new Congress to intervene in this case and appeal this decision. House Democrats will do whatever it takes to make sure the protections enshrined in the Affordable Care Act endure," the House Ways and Means Committee Democrats said in a statement.

Senate Minority Leader Chuck Schumer (D-NY) also promised to take action. In an interview, Schumer said he plans to push for a vote to have the Senate to intervene in the case.
California Extends Insurance Enrollment Deadline
Covered California, the state's Affordable Care Act healthcare exchange, announced that it has extended the deadline to purchase an insurance policy that will start on January 1.

The new enrollment schedule:

Residents who enroll by Friday, December 21 will have coverage that begins January 1.

Residents who enroll between December 22 and January 15 will have coverage that begins February.

"We have seen tens of thousands of people flood into Covered California over the past week, and we want to make sure everyone can start the new year off right by being covered," said Covered California's Executive Director Peter Lee in a statement.

Healthcare Reform News Update for December 14, 2018
Vox Analyzes 8 Democrat Universal Health Care Proposals
The idea of creating a "Medicare-for-all" healthcare system has become a major issue for many in Congress, especially with Democrats taking over the House in 2019. However, lawmakers differ on the solution. There are currently six different universal health care bills in Congress and two proposals from Democratic think-tanks.

Vox reporters researched these eight plans, spoke to their authors, and published their analysis yesterday. Here are the plans and some of Vox's findings about them:

1. Sen. Bernie Sanders' (I-VT) Medicare-for-all bill: This Senate bill guarantees that every American has health coverage with no premiums. Employer-sponsored insurance would be eliminated. Income taxes would have to increase. All expenses would be covered, but prescriptions might have copayments.

2. Rep. Premila Jayapal (D-WA) and the House Progressive Caucus' Medicare-for-all bill: This House bill is similar to Sanders' proposal. Some of the provisions may be currently under revision to more align with Sanders' version.

3. Rep. Jan Schakowsky (D-IL) and Sen. Sheldon Whitehouse's (D-RI) CHOICE Act: This bill would make enrollment into a Medicare expansion plan optional. Enrollees would pay premiums. Employer-sponsored plans would still be available, but small businesses could opt-in to the Medicare plan. Income taxes would not need to be increased. Plans would cover between 60 and 80 percent of expected medical expenses.

4. Sen. Michael Bennet (D-CO), Sen. Brian Higgins (D-NY) and Sen. Tim Kaine's (D-VA) Medicare X: This is similar to the CHOICE Act, but plans would be available in two tiers: one covers 70 percent of medical expenses, the other covers 80 percent.

5. Sen. Jeff Merkley (D-OR) and Sen. Chris Murphy's (D-CT) Choose Medicare Act: This is also similar to the CHOICE Act, but employees could only opt-in if their employers allow it. Plans would cover 80 percent of medical expenses.

6. Sen. Brian Schatz (D-HI) and Rep. Ben Ray Lujan's (D-NM) Medicaid Buy-in bill: This plan would give residents in all 50 states the option to buy-in to a Medicaid program. States would determine the premiums, copayments, and deductibles. Employer-sponsored plans would still be available. Income taxes would not be increased.

7. The Center for American Progress' Medicare Extra for All proposal: The proposal guarantees that every American has health coverage, with higher-income enrollees paying premiums. Employer-sponsored plans would still be available, but employers will have the option to stop offering coverage and instead pay a payroll tax roughly equivalent to what they currently spend on health insurance. Income taxes would be increased.

8. The Urban Institute's Healthy America proposal: This plan doesn't set universal coverage standards, but hopes to reduce the number of uninsured by 16 million in its first year. A new market would be established that combines Medicaid and ACA enrollees. Employer-sponsored plans would be available and untouched. Premiums would be a maximum of 8.5 percent of income. Plans would cover 80 percent of medical expenses.

All plans include government regulation of healthcare prices. While the Democrats do not believe they will pass Medicare-for-all with this Congress, they do believe that now is the time for working out the plans and building support.

Healthcare Reform News Update for December 13, 2018
Sign-ups For ACA Plans Down by 11.7%
Around 930,000 people enrolled in an Affordable Care Act health insurance plan on the federal exchange during the sixth week of open enrollment. It was the busiest week yet, but enrollments continue to lag behind last year.

So far, around 4.1 million people have signed up for 2019 ACA plans, which is down 11.7 percent from the same time period in 2018.

Florida continues to have the highest enrollment numbers, with over 999,000 people signed up for coverage to date.

Healthcare Reform News Update for December 12, 2018
New Study Show 4.2 Million Could Purchase ACA Health Plans for $0
A new analysis by the Kaiser Family Foundation found that 4.2 million people without insurance are eligible for $0 premium bronze plans on the Affordable Care Act exchange.

Bronze plans with a $0 premium are available to enrollees who qualify for subsidies that equal or exceed the price of the plan. The study finds that of the 15.9 million Americans without insurance, 27 percent are eligible for the plans.

Availability of $0 plans varies by location. Only 5 percent of uninsured consumers in Washington and Indiana have access to the plans; however, more than 45 percent have access in Delaware, Iowa, Nebraska, and Utah.

The study also suggests that premiums are not the only expense enrollees should take into account. The average deductible for 2019 bronze plans is $6,258, while silver plan deductibles range from $239 to $3,169. Those who qualify for subsidies can purchase silver plans for $20 to $130 per month, depending on income.
ACA Signups Spiked on Monday
With the enrollment period in its last week, the Affordable Care Act's healthcare.gov site received its highest traffic on Monday.

Due to the high volume, some users were placed into a "waiting room" to help the website adjust.

According to the Centers for Medicare and Medicaid Services, enrollees who call to enroll may be asked to leave their contact information and wait for a callback. Those that do may not be contacted before the December 15, but they will still be eligible for coverage that begins on January 1.
Judge Upholds Religious Groups' Position Against ACA Birth Control Mandate
A federal judge issued an order this week that blocks the federal government from forcing religious groups to cover contraception-related drugs, devices, and related counseling as required in the Affordable Care Act.

Judge Philip Brimmer sided with the plaintiffs, six religious colleges and organizations that requested a permanent injunction against the mandate. The government did not fight against the lawsuit.

Healthcare Reform News Update for December 11, 2018
Groups Call for Legislation Tackling Surprise Medical Bills
Nine organizations sent a joint letter to Congress on Monday that called for federal legislation to protect consumers from surprise medical bills issued by to out-of-network providers.

Although several states have passed laws to prevent patients from receiving unexpected charges while inadvertently visiting an out-of-network doctor or facility, there are no federal protections.

The nine organizations represent health insurance, employers, and consumer groups. They asked lawmakers to stop providers from billing a patient for medical costs not covered by insurance when the choice of provider is not the patient's fault. However, they also stressed that any new laws should not cause a rise in insurance premiums or deter providers from joining a health plan's network.

The groups include Blue Cross and Blue Shield Association, America's Health Insurance Plans, the National Business Group on Health, Consumers Union, American Benefits Council, The ERISA Industry Committee, Families USA, the National Association of Health Underwriters, and the National Retail Federation.

CEOs from the American Hospital Association responded, blaming inadequate provider networks as a major cause of surprise medical bills.
Obama Urges Americans to Enroll in ACA Plans
Former President Barack Obama posted a video on Twitter Monday in which he encourages the uninsured to enroll in Affordable Care Act plans.

The post received over 500,000 views within the first hour it was released.

As he has in past years, Obama stressed the importance of health insurance and signing up before Saturday's deadline.
Blue Shield of California to Limit Out-of-State Coverage
Beginning January 1, Blue Shield of California will cut back on its out-of-state coverage for members with individual health plans.

The plans will continue to cover out-of-state emergency services, urgent care, and some limited primary care. The company said it will work with member who currently use out-of-state providers and will allow telephone consultations with out-of-state physicians.

"We're trying to focus on affordability and part of that is focusing on our provider network in California. We're able to manage our costs better," said Blue Cross Spokesperson Amanda Wardell.

The change will only affect members in California with individual health plans, not those with employer or Medicare plans.

Healthcare Reform News Update for December 10, 2018
ACA Risk-adjustment Program to Continue Normal Operations
A final rule was issued by The Centers for Medicare and Medicaid (CMS) that allows normal operation of the Affordable Care Act's risk-adjustment program to continue for the 2018 benefit year.

The risk-adjustment program moves money from health insurance plans with healthier enrollees to plans with sicker, more expensive enrollees. The rule comes during ongoing litigation regarding the formula the CMS uses to determine insurance companies' payment responsibilities. Currently, the CMS uses a statewide average premium in the methodology instead of an insurer's own premium.

"Today's final rule continues our commitment to provide certainty regarding this important program, to give insurers the confidence they need to continue participating in the markets, and, ultimately, to guarantee that consumers have access to better coverage options," CMS Administrator Seema Verma said in a statement.
House Reps Ask for Details on Administration's Pre-existing Conditions Stance
Four Democratic House Representatives have sent a letter to President Trump's administration looking for explanations concerning its decision to not defend Affordable Care Act's pre-existing condition protections in court.

Frank Pallone Jr. (D-NJ), Richard Neal (D-MA), Bobby Scott (D-VA) and Jerrold Nadler (D-NY) addressed the letter to Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma.

The lawmakers requested any analysis the administration may have performed to determine its position, and details of how the administration will respond if the protections are eliminated.

"In declining to defend these provisions, the Trump Administration is seeking to invalidate these critical patient protections, and once again subject millions of Americans with preexisting conditions to the discrimination they faced before the ACA," the letter said.

Healthcare Reform News Update for December 7, 2018
Enrollment for 2019 ACA Plans Fall Behind Last Year By 11%
With one week left in the Affordable Care Act's 2019 open enrollment period, the total number sign-ups continue to trail behind to last year.

The first five weeks of enrollment saw 3.2 million enrollments, compared to 3.6 million last year-a drop of 11 percent. New customer sign-ups are down 17 percent.

Industry experts cite several reason for the drop, including:

Healthcare Reform News Update for December 6, 2018
Majority of 2019 ACA Plans Have Narrow Provider Networks
New analysis from consulting firm Avalere shows that 72 percent of 2019 Affordable Care Act plans sold on the federal exchange have narrow provider networks. A plan with a narrow provider network only covers the care members receive from a small list of approved providers.

The number of narrow-network plans remained steady compared to last year. In 2018, 73 percent of plans had a narrow network.

Of all plans on the 2019 ACA exchange:

Chris Sloan, a director at Avalere, said that the trend toward lower-cost narrow networks is expected to continue. "Narrow network doesn't mean it's bad, or that patients in the network are getting sub-quality care. You can have a narrow network that's great and that's high quality," he said.

Insurers prefer the narrow-network plans because they help control enrollee spending and keep premiums lower. Critics argue that provider directory inaccuracies could leave patients with unexpectedly large medical bills and that the lack of choice may also require members to drive long distances to receive care.
Reinsurance Plan in Minnesota Could Lose $100M in Funding
Minnesota lawmakers will debate the future of its reinsurance program after the estimate for federal funding was reduced from $183.9 million to $84 million. The estimate is based on the amount of premium tax credits the federal government would have paid out to residents if this waiver-based program was not in place.

The program helps insurers cover the costs of residents with the highest medical bills, and has helped the state lower the growth rate of premiums over the last two years.

Healthcare Reform News Update for November 30, 2018
New CMS State Waiver Concepts Expand Use of ACA Tax Subsidies
The Centers for Medicare & Medicaid Services (CMS) recently issued four state Affordable Care Act waiver concepts to "promote more affordable, flexible health insurance coverage options."

The concepts allow states to bypass current ACA regulations and suggest alternate uses of tax credit subsidy programs. Any state programs developed using the waivers must be approved by the CMS and are are required to meet the law's "guardrails" of comprehensiveness, affordability, coverage, and federal deficit neutrality.

The state concepts suggested include:

1. Setting up "account-based subsidies." States could use federal ACA subsidies to create accounts that work much like health savings accounts. Residents could then use the funds in the account to pay for health insurance premiums or out-of-pocket expenses.

2. Adopting "state-specific premium assistance." These state-administered plans could adjust the way subsidies are distributed in an attempt to attract young, healthy consumers and help individuals whose higher income makes them ineligible for federal tax credits.

3. Creating "adjusted plan options" that allow tax subsidies to be used for non-ACA marketplace plans, short-term plans, association health plans or catastrophic plans.

4. Forming "risk stabilization strategies" to help insurers pay medical bills for patients with high healthcare costs. Suggestions from CMS include reinsurance programs and high-risk pools.

CMS also encouraged states to "couple waiver concepts with other ideas" to meet the needs of their residents.

Critics of the concepts point out that the measures: might fall under legislative rule and need to go through Congress before being implemented; could create rules that vary widely by state; and could harm consumers with "skimpy" coverage that's not required to include pre-existing condition protections.

Healthcare Reform News Update for November 29, 2018
ACA Enrollment Continues to Trail Last Year's Numbers
About 350,000 fewer people have signed up for healthcare on the federal exchange compared the same period last year.

In the first four weeks of open enrollment, over 2.4 million people have signed up for ACA plans, a drop from nearly 2.8 million in 2017. The numbers only include enrollments through the national federal exchange and do not yet include automatic renewals.

A new Kaiser Family Foundation poll suggests that one reason for the drop could be lack of awareness. According to the survey:

About 69 percent of Americans who purchase individual plans did not know that enrollment ends on December 15 for most states.

Only 25 percent of respondents are aware of seeing any ACA-related advertising.

Some state exchanges are seeing an increase in ACA signups. For example, New York is currently 10 percent above last year's enrollment figures, with 36,000 new enrollees and 870,000 renewals.
Number of Uninsured Children Increased for First Time Since 2008
A new report by Georgetown University's Center for Children and Families shows that the number of uninsured children in the country rose by 276,000 in 2017. This increase follows almost a decade of steady decline.

In 2017, there were 3.9 million uninsured children in the U.S., compared to 3.6 million in 2016. Some findings from the study include:

The study suggests that one reason for the increase could be that 25 percent of minors in the country have a parent who is an immigrant; these parents might avoid enrollment for fear of deportation.

Healthcare Reform News Update for November 28, 2018
State ACA Reinsurance Programs Successful in Lowering Premiums
The first three states to implement Affordable Care Act reinsurance programs were able to stabilize their markets and boost enrollment, according to a study by Georgetown University's Center on Health Insurance Reforms.

Alaska, Minnesota and Oregon implemented the programs last year, which reimburse insurers for eligible high-cost claims. The study found that in 2018:

The study also found that the programs did not attract additional insurers to the state ACA exchanges. Alaska and Minnesota retained the same number of insurers; Oregon saw a decrease.
Illinois Limits Short-Term Health Insurance to Six Months
Illinois Governor Bruce Rauner vetoed a bill that limited short-term health insurance to six months, but the state legislature overrode his decision on Tuesday.

The bill was drafted in response to new rules from the Trump administration, which allow customers to stay on short-term plans for up to twelve months and renew them for up to three years. However, consumer advocates say these cheaper plans provide less comprehensive coverage, don't include pre-existing condition protections, and expose consumers to higher out-of-pocket costs than insurance plans covered by ACA regulations.

Illinois joins several states, such as California, New York, New Jersey, and Washington, that have limited or banned the new, expanded short-term plans.
California Uninsured Projected to Increase Drastically Without State Intervention
The number of uninsured Californians could increase by 800,000 in five years if the state fails to expand coverage, according to a report by the UC Berkeley Labor Center and UCLA Center for Health Policy Research.

The report projects there will be 4.4 million uninsured Californians in 2023, which would represent 12.9 percent of the population.

The number of uninsured residents is projected to increase primarily due to the repeal of the Affordable Care Act's individual mandate, which levied a penalty against people without coverage.

The report says that policies such as a state individual mandate, state-funded financial assistance, and expansion of the Medi-Cal program could help keep people from dropping their coverage.

"Unless the state takes action, the number of uninsured will start creeping back up. Our uninsured rate did go down significantly because of the ACA, and we're estimating it could climb up. But the state does have some policy options and policy levers it could pull to try to get to universal coverage," said Miranda Dietz, the lead author of the report.

Healthcare Reform News Update for November 26, 2018
ACA 2019 Benchmark Plan Premiums Decrease, Choices Increase
Nineteen states are seeing lower premiums for 2019 Affordable Care Act benchmark silver plans compared to last year, with many areas also experiencing an increase in the number of insurers.

Premiums for the cheapest available plans have been reduced by 10 percent on average for more than half of the counties that use the federal health exchange. Nationally, premiums for the average benchmark silver plan decreased about one percent.

Tennessee leads the country in reducing benchmark premiums, with an average 26 percent decrease. In 2018, a 40-year-old Tennessee resident paid $743 on average for a benchmark plan; this year it's $548. Competition has also increased; over 82 percent of Tennessee counties had only one insurer selling ACA plans in 2018. For 2019, it's under 52 percent.

Arizona is another newly competitive market. In 2018, the Phoenix area had a single insurer selling ACA plans. For 2019, that insurer has lowered its most affordable silver plan by 12 percent and is joined by three competitors.
ACA Enrollment Down on Federal Exchange, Up on Some State Exchanges
In the first three weeks of the Affordable Care Act's open enrollment period, over 1.9 million people have signed up for 2019 coverage on the federal exchange. That is down from 2.3 million last year.

Though enrollment has lagged on the federal exchange, several state exchanges have seen increases compared to 2018 sign ups. Minnesota is up 6.9 percent with almost 98,000 enrollments during the first two weeks of open enrollment. Colorado is up 13.1 percent with around 25,600 enrollees during the first two weeks of open enrollment.

Other details on Week 3 of the federal exchange enrollment:

Healthcare Reform News Update for November 20, 2018
House Democrats Plan to Investigate DOJ's Decision Over ACA Lawsuit
When Democrats take over the House in January, they plan to investigate why the Department of Justice Department declined to defend the Affordable Care Act in federal court, according to Rep. Jerrold Nadler (D-NY).

Twenty Republican-governed states have sued the federal government in an attempt to end the ACA. In June, the DOJ refused to defend the healthcare law in the suit.

Nadler, the expected upcoming chair of the House Judiciary Committee, sent a letter to acting Attorney General Matthew Whitaker, asking him to respond to letters previously sent to former attorney general Jeff Sessions about the decision.

"This committee expects to examine the department's refusal to defend a duly enacted federal statute, the abrupt resignation of veteran department employees and an apparent determination by this administration to undermine affordable healthcare coverage for millions," Nadler wrote.
Maryland Lawmakers to Propose State Individual Mandate
Some legislators in Maryland are backing a plan that would require state residents to be covered by health insurance or pay a fine.

Unlike the federal individual mandate that was repealed earlier this year, the state proposal would enable the uninsured to use the fine amount as down payment on a health insurance policy sold on the state's Affordable Care Act exchange.

"Our 'down-payment plan' helps get the uninsured to contribute. They get the care they need while we shrink uncompensated care, holding down insurance costs for everyone," said state Democratic representative Joseline Peña-Melnyk in a radio ad.

Passage of the bill is uncertain, as Governor Larry Hogan has expressed his disapproval. "While we are always open to ideas to make healthcare more accessible and affordable for Marylanders, the governor favors incentives over penalties," said Amelia Chassé, a spokeswoman for Hogan.
Connecticut ACA Exchange to Oppose New Abortion Billing Proposal
The Trump administration's proposal to require separate billing for abortion coverage is being challenged by Connecticut's Affordable Care Act exchange.

Access Health CT will submit public comment to protest, with lawmakers arguing that the regulation would be a burden on insurance companies. "This proposed rule will impact our carriers...and we are committed to helping our carriers in any way we can," said James Michel, CEO of Access Health CT.

The proposal was introduced earlier this month by the Centers for Medicare & Medicaid, who said that separate billing would ensure that no federal funds would be used to pay for abortion services.

Healthcare Reform News Update for November 16, 2018
Over 20 Million More Americans Insured Since Passage of the ACA
There are now 20.1 million fewer Americans without health insurance than when the Affordable Care Act was enacted in 2010, according to data released by the Centers for Disease Control and Prevention.

Findings in the data include:

In the first half of 2018, there were 28.5 million uninsured Americans, compared to 48.6 in 2010.

About 70 percent of adults age 18-64 are currently covered by private health insurance. Four percent of the insured (almost 8 million people) purchased plans on an ACA exchange.

Most likely to be insured are adults aged 25-34; only 16.5 percent do not have coverage.

States that have expanded Medicaid coverage have an average uninsured rate of 9.1 percent, compared to 18.1 percent for states that have not.

House Democrats Split on Medicare for All
Democrats, soon to be the majority in the House of Representatives, are debating whether to vote on legislation regarding single-payer insurance coverage.

Progressives, such as Raúl Grijalva of Arizona and Pramila Jayapal of Washington, are pushing to introduce a revised bill in January.

Centrists, including Ron Kind of Wisconsin and Frank Pallone Jr. of New Jersey, believe that a vote is not realistic since a bill would not get through the Republican-controlled Senate.

"I've always been an advocate for Medicare for all or single-payer, but I just don't think that the votes would be there for that, so I think our priority has to be stabilizing the Affordable Care Act, preventing the sabotage that the Trump administration has initiated," said Pallone.

Healthcare Reform News Update for November 15, 2018
Insurance Company Participation in ACA Marketplace is Rising
New analysis from the Kaiser Family Foundation finds that more insurance companies are participating in the Affordable Care Act's 2019 Health Insurance Marketplace than in 2018.

After reviewing data by state and county, their findings show that:
ACA Signups Continue Slow Start
Signups for Affordable Care Act plans during the early weeks of open enrollment trail last year by about 300,000 people.

During the first ten days of enrollment, about 1.2 million people have signed up for ACA plans, compared to the estimated 1.5 million who signed up during a similar period last year.

An industry analyst from the Kaiser Family Foundation says it's too soon to predict whether the slow start indicates an overall reduction in ACA enrollment.

Healthcare Reform News Update for November 14, 2018
Expansion of Short-term Health Plans Getting Push-back From States
Delaware is the latest state to initiate new rules on short-term health insurance policies in response to new federal government regulations. State officials announced that the coverage period will be limited to three months.

The new regulations from the Trump administration increase the maximum duration of short-term plans from three months to 364 days and allow consumers to renew plans for up to 36 months. Worried about the plans' exemption from ACA minimum standards and their potential to create marketplace instability, state regulators have begun responding with rules of their own.

Other recent state responses to short-term plans:

Vermont requires that the plans cover all ten ACA essential benefits.

California has banned their sale.

Washington limits the coverage period to three months, prohibits renewals, and bans their sale during the ACA open enrollment period if coverage will begin in the upcoming year.

Some states, including New York, Massachusetts, New Jersey, South Carolina, Hawaii, and Michigan have existing regulations that limit or ban the sale of the plans.

Healthcare Reform News Update for November 13, 2018
New Association Health Plans Provide Comprehensive Coverage
New association health plans (AHPs) offered by farmer-owned cooperative Land O'Lakes in Nebraska, several Nevada chambers of commerce, and the National Restaurant Association are offering benefits comparable to Affordable Care Act plans for premiums up to 35 percent lower.

The plans are able to offer lower premiums because of several factors, including their ability to set premiums based on gender and industry, which is not allowed with ACA plans. The current plans are not charging people with pre-existing conditions higher rates or denying them coverage.

"AHPs can offer comprehensive coverage and still be cheaper than marketplace plans if they either serve a population that is less costly than the average of the marketplace and/or they somehow are able to pay less for services," said Katherine Hempstead, a health insurance coverage director for the Robert Wood Johnson Foundation.

Those who qualify for tax subsidies may still be able to purchase comparable plans for less on the ACA exchange than with the AHPs. However, Bruce Ramge, insurance director for Nebraska, claims the plans "will offer another really good choice for individuals who either don't receive a subsidy and cannot afford coverage on the exchange, or for some reason prefer not to purchase that coverage."

Some states, fearing that the expansion of AHPs will destabilize the market or lead to increased fraud, have issued new rules and guidance limiting their scope. Democratic attorneys general in 11 states and the District of Columbia filed a lawsuit to block the new Trump Administration rule that allows the expansion of AHPs; the case is still pending.

Healthcare Reform News Update for November 9, 2018
New Democratic House Majority Could Quickly Move to Defend ACA Protections
House Democrats could soon intervene in a lawsuit that attacks the Affordable Care Act and its protections for people with pre-existing conditions.

Using its power as the soon-to-be majority, Democrats may have the House vote on a measure to step in and defend the ACA's constitutionality. If passed, the measure would not require approval by the Senate or President Trump.

A spokesman for House Democratic Leader Nancy Pelosi said that "the new Democratic House Majority will move swiftly to defend the vital protections for people with people with pre-existing conditions still under legal assault by the GOP."

The lawsuit was brought by GOP-led states arguing the legality of the ACA. The Trump administration declined to defend the law. The judge's ruling is expected soon, though the decision is likely to be appealed.

Healthcare Reform News Update for November 8, 2018
Democratic House Majority Will Change Congress' Healthcare Agenda
The results of the midterm elections last Tuesday will give Democrats the majority in the House of Representatives in 2019, which dramatically alters political healthcare priorities.

In a news conference on Wednesday, Senate Majority Leader Mitch McConnell (R-KY) remarked that Affordable Care Act repeal and replace efforts are over. "I think it is very obvious that a Democratic House is not going to be interested in that," he said. Instead, McConnell believes that addressing drug prices will be on the agenda.

Democratic leader Nancy Pelosi also said that they "will take real, very strong legislative action" on drug prices. Democrats had made healthcare a primary issue in their campaigns. "Healthcare was on the ballot, and healthcare won," said Pelosi.

President Trump also weighed in, saying he thinks that bipartisan efforts to improve healthcare is possible. "We want to do something on healthcare; they want to do something on healthcare. There are a lot of great things that we can do together."

With repeal and replace efforts tabled, the next healthcare clash between Democrats and Republicans- and a certain topic in the 2020 presidential election-will be the issue of Medicare for All. Progressive Democrats have increasingly supported the idea of expanding Medicare to all working-age Americans, but Republicans claim it will harm Medicare for seniors.
First Week of ACA Open Enrollment Lags Behind Last Year's
During the first three days of the open enrollment period, about 371,700 signed up for insurance through the Affordable Care Act federal exchange. That's a slower start compared to the first four days of last year's enrollment period, which saw 601,500 signups.

According to the Centers for Medicare and Medicaid Services, approximately 75 percent of the enrollees had previously purchased an ACA policy, and the remaining were new consumers.

The enrollment period for 2019 ACA plans this year is November 1 through December 15.
New Rules for Employer Contraception Coverage Issued by Trump Administration
On Wednesday, the Department of Health and Human Services issued two new rules that will expand the types of businesses that are allowed to deny birth control coverage to employees due to religious or moral objections.

HHS officials said in a statement that the Affordable Care Act does not include a contraception requirement and that it does "not require the government to violate religious or moral objections to providing or purchasing such coverage."

Currently, only churches, religious orders, and organizations that received financial support from religious organizations could be exempted from contraception coverage. The new rules add nonprofit organizations, small businesses, and individuals that morally object to providing contraceptive services.

Publicly-traded companies and government entities will not be allowed to claim the exemption.

HMS estimates that the new exemption rules will affect around 200 employers and potentially 6,400 women. However, civil liberty groups and women's rights advocates have argued that the number is higher.
CMS Proposes Separate, Add-on Billing for ACA Plans That Cover Abortion
The Trump administration has proposed a rule that would require insurers to identify and issue a separate surcharge to enrollees on any Affordable Care Act plan that covers abortion.

The ACA requires that plans on the exchange charge an additional surcharge if elective abortions were covered. Insurers are currently allowed to include the surcharge in monthly premiums-a provision granted under the Obama administration.

The new proposed rule states that "individual market exchange issuers must determine the amount of, and collect, from each enrollee, a 'separate payment' for an amount equal to the actuarial value of the coverage for abortions for which public funding is prohibited, which must be no less than $1 per enrollee per month."

The rule would affect individual market insurers operating in 24 states and the District of Columbia.

Healthcare Reform News Update for November 7, 2018
Insurers Lose Appeal Over ACA Risk-Corridor Program Payments
Insurers looking to collect part of $12.3 billion in risk-corridor payments faced a serious setback when the U.S. Court of Appeals for the Federal Circuit declined to rehear a petition in a 9-2 ruling. The petition was filed by Moda Health Plan and Illinois' Land of Lincoln Mutual Health Insurance Co., who are looking to collect Affordable Care Act program subsidy payments from the U.S. Department of Health and Human Services.

The risk-corridor program was created for the early years of the ACA. The intent was for insurance companies who were successful on the ACA exchange to help cover the losses of companies who were not.

In 2017, Moda initially won its case seeking $214 million in payments, but the judgement was overturned by an appellate court earlier this year. That ruling stated that the government doesn't have to make the $12.3 billion in payments because of budget-neutrality requirements, which means that the government cannot pay out more than it made through the program.

Any future recourse will have to be heard by the U.S. Supreme Court.
Medicaid Expansion Approved in Three States
Voters in Utah, Nebraska, and Idaho have voted to expand their Medicaid programs in accordance with the Affordable Care Act. The measures will extend coverage for low-income residents, which could include 150,000 people in Utah, 90,000 people in Nebraska, and 62,000 in Idaho.
Judge Shuts Down Insurer Selling Deceptive Plans
A federal judge ordered a Florida insurance company to temporarily shut down after the Federal Trade Commission (FTC) discovered that it allegedly made more than $100 million selling "TrumpCare" plans. The plans were marketed as comprehensive, government-sponsored insurance, but in reality did not provide many of the benefits promised.

According to the FTC, Simple Health Plans enrolled tens of thousands of people through deceptive websites that falsely claimed their plans covered pre-existing conditions and prescription drugs. The sites also featured logos for insurance companies that were not affiliated with the plans. Customers were charged an enrollment fee and premiums that ranged from $40 to $500 per month for what amounted to a medical discount program.

"Many consumers were misled into thinking they had purchased comprehensive health insurance, but when they needed to rely on that insurance, they learned they had none of the promised benefits," said the director of the FTC's Bureau of Consumer Protection, Andrew Smith.

In actuality, the plans sold by the Simple Health provided $50 per visit to a physician (capped at three per year); a $100 maximum per day benefit for hospitalization; and a maximum total benefit of $3,200 per person, per year, and only if the beneficiary was hospitalized for 30 days.

Healthcare Reform News Update for October 29, 2018
ACA Navigator Cuts Cause Some Areas to Go Without Them
Funding for Affordable Care Act Navigator programs has been cut by more than 70 percent this year, which has left almost one-third of the counties who participate in the federal exchange without insurance counselors, reported the New York Times.

Last year, the Trump administration cut the funding for the program from $63 million to $36 million. This year, the budget is $10 million. Centers for Medicare and Medicaid Services Administrator Seema Verma said the cutbacks were appropriate since consumers are now more aware of the program and other sources of help are available.

Effects of the cuts include:

Iowa, Montana, and New Hampshire will have no navigator programs because they did not apply for funding.
Judge Requests That Insurers Drop Short-Term Plan Challenge
Federal Judge Richard Leon of the United States District Court for the District of Columbia asked the Association for Community Affiliated Plans (ACAP) to withdraw its request to block the rule that allows the expansion of short-term health insurance policies.

The ACAP claims that the low-cost plans, which don't include the ACA's consumer protection provisions, could cause the loss of at least 10,000 enrollees and a financial loss of up to $100 million for insurance companies selling ACA-compliant plans on the individual market exchanges. Leon was skeptical of the estimates, noting that there is currently no data to support the ACAP's claim.

Charles Rothfeld, counsel for ACAP, argued that "the purpose of this rule is to create an alternative insurance market to compete with the ACA. The more you draw out young and healthy people, the more it becomes economically impossible to cover people with pre-existing conditions."

Leon disagreed, saying that the short-term plans help consumers "fill in a gap, as opposed to forcing them to choose between no insurance and the ACA."

Leon said that the group's request came too late to make a ruling prior to the start of the open enrollment period on November 1. He said he could have an opinion early next year if ACAP backs out of its request for a preliminary injunction and instead seeks a trial.

Healthcare Reform News Update for October 25, 2018
Report: Millions Could Lose Coverage if ACA is Deemed Unconstitutional
More than 15 million people could lose their health insurance or face rate hikes due to pre-existing conditions, age, or gender if a federal judge rules in favor of a Trump administration-backed lawsuit to declare the Affordable Care Act unconstitutional, according to a report from Democrats on the House Oversight Committee.

The lawsuit was filed by 20 GOP state attorneys general and seeks to overturn the ACA, including its protections for people with pre-existing conditions. Attorney General Jeff Sessions chose not to defend the law "with the approval of the President of the United States."

The report examined Americans who receive their coverage from the individual insurance market. The findings showed that, if the lawsuit succeeds:

More than 10 million people could lose their insurance or face rate hikes due to lack of consumer protections. Of this group, more than 4.8 million could be denied coverage due to the severity of their pre-existing condition.

More than 9 million women who rely on the individual market for insurance could face gender discrimination.

Poll Shows Majority of Young Americans Support Single-Payer Healthcare
Sixty-nine percent of U.S. residents between the ages of 15 and 34 support a single-payer healthcare system, according to a new poll by The Associated Press-NORC Center for Public Affairs Research and MTV.

Eighty-eight percent of Democratic respondents and 40 percent of Republican respondents said they support the government-run system.

In addition, 62 percent of voting-age respondents said that healthcare is a very important issue for the midterm elections next month, making it the most popular issue for young Americans.

Healthcare Reform News Update for October 23, 2018
CMS Expands ACA Subsidies to Cover Short-Term & AHP Plans
States will soon be able to use federal funding to subsidize premiums for short-term health insurance plans and association health plans, the Trump administration announced on Monday. Affordable Care Act restrictions previously prevented the use of waivers for these plans as they do not include the law's consumer protections.

CMS Administrator Seema Verma said that the change gives states more flexibility and give consumers more choices. Consumers will still be able to purchase ACA plans with the subsidies, which do not deny coverage for people with pre-existing conditions or charge them higher premiums.

The approach allows states "to provide consumers plan options that best meet their needs, while at the same time ensuring that those with pre-existing conditions retain access to the same coverage as today," Verma said.

Verma also said that states could apply for waivers that would increase subsidy amounts for young adults to encourage them to sign up for health insurance. Additional waivers will be announced in the near future, she said.

States must first apply for the waivers, so the expanded subsidies won't be available to consumers until 2020.

Critics of the change say that drawing the younger, healthy customers away to the cheaper, less-comprehensive plans may increase the premiums for individuals who need the protections provided in the ACA marketplace insurance plans.
Trump Administration Expands Employer HRA Rules
Proposed expanded options for health reimbursement arrangements (HRAs) used by small-to-midsized companies were announced by the Trump administration.

The new regulations will allow employees to use funds in their HRAs to purchase their own individual health coverage. Companies could also allow workers to use HRAs to pay for optional benefits, such as dental insurance. The new rules would allow workers to be reimbursed up to $1,800 in premiums, as long as the company also offers traditional employer-sponsored coverage.

Trump administration officials say the move will increase the number of Americans who have insurance. Opponents say it would shift less-healthy, higher-risk workers off employer plans and into the public marketplace and undermine traditional employer-provided coverage.
ACA "Family Glitch" Solution Could be Midterm Issue
The outcome of next month's elections could determine how the "family glitch" of the Affordable Healthcare Act is addressed, according to Kaiser Health News.

The issue relates to how eligibility for insurance premium subsidies is calculated. In order to be eligible, individuals must not have access to "affordable" coverage through their employer or their spouse's employer. The ACA calculates "affordable coverage" based on the rates for a single family member rather than the whole family, which can result in a denial of subsidies. This means some families can't afford to cover spouses or children using an employer plan or an ACA Marketplace plan.

If Democrats overtake Republicans in the midterms, analysts believe they may try to revise the calculations, though doing so could increase federal spending by as much as $10 billion. Republicans are more likely to suggest the use of lower-cost, lower-coverage options, such as short-term or association plans.

Healthcare Reform News Update for October 18, 2018
Senate Majority Leader May Restart ACA Repeal and Replace Efforts
On Wednesday, Senate Majority Leader Mitch McConnell said that Republicans might try to rekindle their attempts to repeal the Affordable Care Act if they prevail in next month's midterm elections.

Attempts to dismantle the healthcare law failed to pass last year, which McConnell called "the one disappointment of this Congress from a Republican point of view." McConnell said that if Senate Republicans "had the votes to completely start over, we'd do it. But that depends on what happens in a couple weeks ... We're not satisfied with the way Obamacare is working."

In the interview with Reuters, McConnell also said that he believes that the long-term drivers of national debt are social programs like Social Security and Medicare.

Democratic lawmakers such as Senate Minority Leader Chuck Schumer shot back at McConnell's statements. "If Republicans retain the Senate they will do everything they can to take away families' health care and raise their costs. Americans should take Senator McConnell at his word," said Schumer.
Healthcare Tops Midterm Election Concerns
A new Kaiser Family Foundation survey shows that healthcare continues to be the main issue for voters in the upcoming midterm elections.

Over seventy percent of respondents said that healthcare was "very important" in their election decisions, with nearly 40 percent of Democrats and 15 percent of Republicans saying it was their most important issue.

Healthcare Reform News Update for October 17, 2018
CMS Chief Says 'Medicare For All" Would Harm Physician Networks
In a speech to insurers on Tuesday, Medicare and Medicaid Services Administrator Seema Verma warned that Democratic "Medicare for all" proposals "would decimate physician networks, creating a permanent physician shortage."

Verma pointed out that Medicare covers only 80 percent of physicians' expenses on average, which could cause doctors to exit the program and leave patients struggling to find care. Without private insurance patients to offset Medicare patients, "there is no relief valve for physicians facing up to 40 percent payment cuts," she said.

Creating a single-payer healthcare system has become a campaign issue during the midterm elections. However, Verma says that she will deny waivers to any state that tries to implement such a program.
2019 ACA Plans in Virginia to Increase 9%
State regulators in Virginia announced on Tuesday that 2019 premiums for individual plans sold on the Affordable Care Act marketplace will rise about 9 percent on average, somewhat less than the 13 percent predicted earlier this year.

The increase is significantly less than last year, which saw an average spike in premiums of 69 percent, creating some of the highest rates in the country. For 2019, fewer counties have only a single provider, which contributed to more competitive rates.

Healthcare Reform News Update for October 12, 2018
Premiums for 2019 ACA Silver Plans Will Drop for the First Time
For the first time since the Affordable Care Act has been in effect, average premiums for benchmark silver plans will decrease by 1.5 percent in 2019.

Centers for Medicare and Medicaid Services Administrator Seema Verma credits the Trump administration for the rate drop. She says measures taken, such as the repeal of the individual mandate and the expansion of short-term plans, have helped stabilize the market.

Other insurance experts say that the decrease is a price correction. Average premiums increased 37 percent last year, which helped increase profits for insurance companies.

Only ACA silver plans will see an average premium decrease. Overall, average rates will increase slightly for 2019 ACA policies.

Healthcare Reform News Update for October 11, 2018
President Trump Criticizes 'Medicare for All' in Controversial Op-Ed
In an Oct. 10 opinion article for USA Today, President Trump attacked Democrats for proposing to expand Medicare to all Americans.

The president wrote that an expansion of the healthcare program "means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised," and that "the Democrats' plan also would mean the end of choice for seniors over their own healthcare decisions."

The article was criticized for a number of inaccurate claims, including health insurance premium rates, Medicare revenue numbers, and inaccess to physicians.

Senator Bernie Sanders (I-VT) stated that the op-ed piece was dishonest. "Bottom line is he's trying to frighten seniors and suggest that Medicare for all would cut back the benefits they have. The truth is it would expand the benefits that they have," said Sanders to reporters.
Centene Expands ACA Offerings for 2019
Centene Corporation announced on Wednesday that it will expand the reach of its health plans sold on the Health Insurance Marketplace under its Ambetter brand.

The company will enter four new markets in 2019: Pennsylvania, North Carolina, South Carolina, and Tennessee. It will also expand the number of counties it sells to in Florida, Georgia, Indiana, Kansas, Missouri, and Texas.

Healthcare Reform News Update for October 10, 2018
Maintenance Schedule for ACA Website Unchanged From Last Year's
The Centers for Medicare and Medicaid Services is planning to shut down the healthcare.gov website for maintenance a maximum of 60 hours during the 2019 Affordable Care Act open enrollment period.

The maintenance schedule is the same as last year's. The site may not be available for sign-ups from midnight to noon ET each Sunday during the enrollment period, except for Dec. 9, the final Sunday. Last year, the website's actual maintenance downtime totaled 21.5 hours.

For most states, the open enrollment period is Nov. 1 through Dec. 15.
Senate Vote Fails to Overturn New Short-Term Health Plans
A resolution presented by Senate Democrats to prevent the expansion of short-term health insurance plans narrowly lost by a 50-50 vote. Senator Susan Collins of Maine was the only Republican to vote in favor of the measure.

The Democrats oppose new rules that allow these plans to deny coverage to people with pre-existing conditions and do not require them to cover the Affordable Care Act's ten essential benefits, including maternity care, prescription drugs, and mental health care. They believe the plans hurt consumers and provide sub-par coverage.

Republicans say the plans provide consumers with more choices and lower-cost alternatives to ACA plans.

The legislation was sponsored by Senator Tammy Baldwin (D-WI) and was supported by all 49 members of the Senate Democratic Caucus.

Healthcare Reform News Update for October 8, 2018
2019 ACA Premiums in Illinois & Ohio See Modest Increases
Finalized insurance rates for 2019 Affordable Care Act plans in Illinois and Ohio will rise by single digits.

In Illinois, premiums for silver plans will increase by 4 percent on average. Bronze and gold plans will rise by 6 percent. Jennifer Hammer, director of the Illinois Department of Insurance says that rates for many plans will decrease.

In Ohio, overall premiums will increase by 6.3 percent on average. In addition, residents will have more choices. The number of insurers offering plans in the state has risen from eight to 10. Only 16 counties will have a single insurer, down from 42 this year.
ACA Rate Increases for 2018 Plans Drove Record Insurer Profitability
A new Kaiser Family Foundation study of Affordable Care Act financial performance shows that insurance companies in the individual market experienced their highest levels of profitability in the first six months of 2018 since passage of the health law.

Policy changes from the Trump administration, including the cancelation of cost-sharing subsidy payments, contributed to significant premium increases in 2018. Some of these rate hikes resulted in overpricing and larger profits. Subsequently, rates for 2019 plans are projected to increase modestly and, in some cases, even decrease.

The study results showed that "despite significant challenges, the individual market remains stable and insurers are generally profitable."

Healthcare Reform News Update for October 5, 2018
New Iowa Farm Bureau Health Benefit Plans Will Not Protect Pre-Existing Conditions
People with pre-existing conditions could be denied coverage or pay higher premiums under the new "health benefit plans" available on November 1 from Iowa's Farm Bureau.

The plans do not meet the requirements of the Affordable Care Act. As such, the plans are not considered insurance and will not be regulated by the Iowa Insurance Division.

Applicants will be questioned about 16 conditions, including blood pressure, mental health, reproductive and pulmonary disorders, and others. Positive responses will require the submission of detailed explanations about treatments, medications, and current status.

Farm Bureau Vice President Steve Kammeyer confirmed that some people could be charged more or declined coverage, but did not say which conditions would trigger those outcomes.

The plans lack the ACA's consumer protections, but will cover maternity services, mental health care, addiction treatment, and prescription drugs. Because the plans don't meet federal requirements, they are expected to cost less than plans sold on the ACA exchange.
Senators Ask CBO to Test Health Insurance Simulation Model
The Congressional Budget Office (CBO) has received a request from Republican members of the Senate Budget Committee to test its health insurance simulation model using outside validation. The lawmakers want to ensure that the model correctly estimates Affordable Care Act spending and enrollment.

The senators argue that the CBO used faulty data last year and overestimated the number of ACA enrollees who would lose coverage if the health law was repealed. They believe that a test could help "determine whether the agency's estimate would have been closer to the actual, observed amounts since (the ACA's) enactment," according to a letter written by the committee, led by Chair Mike Enzi (R-WY).

"This type of real-world testing not only could serve to validate the model, but would help further the goal of developing a new model that is capable of producing more accurate estimates for Members of Congress and the public," the letter states.
Colorado 2019 ACA Plans Rise 5.6 Percent for Individuals
The Colorado Division of Insurance announced that 2019 ACA premiums will increase 5.6 percent on average for individuals.

Specifically, individual gold plans will increase 3.8 percent, silver plans will increase nearly 12 percent, and bronze plans will increase by less than 1 percent.

Coloradans who qualify for premium tax credits will see a premium decrease of 24 percent on average if they continue with their current plan, but have the potential to reduce their rates up to 50 percent if they switch to the lowest-cost plan in the same tier.

For small businesses, the market rates will increase 7.28 percent on average.
Employee Healthcare Deductibles Double Over Past Decade
The Kaiser Family Foundation annual employer health benefits survey shows that deductibles for employer health plans have more than doubled since 2008.

The average deductible for an employer plan in 2018 is $1,573, compared to $735 in 2008. In addition, more employer plans include a deductible. In 2018, 85 percent of plans include deductibles, compared to 59 percent a decade ago.

Other findings from the employer-plan survey:

2018 premiums rose 3 percent for individuals

2018 premiums rose 5 percent for families

Healthcare Reform News Update for October 3, 2018
2019 ACA Individual Premiums in Minnesota Drop Dramatically
State officials in Minnesota announced that premiums for 2019 Affordable Care Act benchmark plans for individuals will decrease by as much as 22 percent, one of the largest drops in the country.

"On average, rates are going down in the individual market because of lower utilization rates, lower costs per service, Minnesota's reinsurance program, and a strong Minnesota economy," said Minnesota Commerce Commissioner Jessica Looman.

For the small group market in Minnesota, rates are expected to increase between 3 and 12 percent.
House Republicans Vow to Uphold Protections for Pre-existing Conditions
On Tuesday, Representative Pete Sessions (R-Texas) introduced a nonbinding resolution with several Republican cosponsors that supports insurance protections for people with pre-existing medical conditions.

"To cement these protections, I proudly introduced this resolution to ensure that patients with pre-existing conditions are protected from the erroneously high costs and the limited options they are experiencing now," said Sessions.

Sessions and other House Republicans have been criticized by Democratic counterparts for their past support of repealing the Affordable Care Act, including the law's pre-existing condition protections. The issue has become a frequent midterm election talking point.
Covered California Begins its ACA Renewal Period
On Monday, California began its annual renewal period for residents who currently have coverage under the state's ACA health exchange, Covered California.

Those looking to renew can reduce their premiums up to 6.9 percent by choosing the lowest-cost health plan in their tier, according to Covered California. "Healthcare is local, and the price of coverage varies by health plan and region, so consumers will be encouraged to shop when they renew this fall," said Covered California Executive Director Peter V. Lee.

The renewal period for Covered California continues through January 15. The enrollment period for new enrollees begins October 15.

Healthcare Reform News Update for October 2, 2018
Michigan Business Groups Form Association Health Plan
The Small Business Association of Michigan and MichBusiness have joined forces to TranscendAHP, a new association health plan (AHP).

The nonprofit Transcend AHP is expected to offer 10 plans from Blue Cross Blue Shield of Michigan and Blue Care Network to its combined membership of around 52,000 small-business owners. Other associations and chambers of commerce will also be eligible to join.

AHPs are not required to meet Affordable Care Act standards, including protections for people with preexisting conditions and essential health benefits such as maternity care, mental health care, and prescription drugs. Critics say the plans leave enrollees underinsured.

The Trump administration defends its new AHP rules, saying the lower-cost plans help keep businesses competitive. "Many of our laws make healthcare coverage more expensive for small businesses than large companies. Association Health Plans are about more choice, more access, and more coverage," said Department of Labor Secretary Alexander Acosta in a statement.

Healthcare Reform News Update for September 28, 2018
HHS Secretary Touts 2% Drop in 2019 ACA Silver Plan Premiums
Premiums for benchmark silver plans sold on the national Affordable Care Act exchange will decrease by 2 percent in most states next year, said Health and Human Services Secretary Alex Azar.

The number of insurers selling ACA plans will increase for the first time since 2015, he said.

Azar credited President Donald Trump for the news, saying that he "has proven better at managing it than the president who wrote the law." As examples, he referred to the expansion of consumer healthcare choices and increased marketplace efficiency.

In addition, Azar criticized single-payer health plans as too expensive for taxpayers and unfair to seniors. "The main thrust of 'Medicare for All' is giving you a new government plan and taking away your other choices."

Healthcare Reform News Update for September 27, 2018
Democrats Hope for ACA Battle With Trump Administration
Congressional Democrats say that if they overpower Republicans in the midterm elections this November, they will work to defend the Affordable Care Act and "undo" some changes to the law made by the Trump administration.

"I think healthcare will be one of the very first things that we address," said Illinois Representative Jan Schakowsky. "There's a lot of fear out there, and we need to calm people who are so afraid they're going to lose their healthcare or not be able to afford their healthcare. I think that will be a big agenda item." Schakowsky said she would like to make the efforts bipartisan.

"What they've done is try to dismantle [the ACA] through the regulatory process," said Massachusetts Representative Richard Neal. "I think if we were so lucky as to be the majority, I think we would certainly be in the position to stop that."

If Democrats become the majority party in power, they would be able to:
2019 Healthcare Premiums for Federal Employees to Increase 1.5%
Federal employees and retirees will pay 1.5 percent more on average for their health insurance premiums in 2019. It's the smallest increase for the program since 1995.

Considered the largest employer-sponsored health insurance program in the nation, the Federal Employees Health Benefits Program comprises 265 local health maintenance organizations and 16 nationwide plans.

Healthcare Reform News Update for September 25, 2018
California Challenges Trump Administration's ACA-exempt Insurance Options
Jerry Brown, governor of California, has signed a healthcare package that includes bills banning the Trump administration's new healthcare options that don't meet the requirements of the Affordable Care Act.

The bills in the package include:

Healthcare Reform News Update for September 24, 2018
Maryland 2019 ACA Premiums Will Decrease by 13.2%
State insurance regulators in Maryland finalized dramatically lower rates for 2019 plans sold on the Affordable Care Act than originally requested by insurance companies. The new premiums will be lower by 13.2 percent on average due to a recently approved state reinsurance program.

In May, CareFirst Blue Cross and Blue Shield and Kaiser Foundation Health Plans, Maryland's two ACA insurers, requested rate increases that averaged 30.2 percent. Instead, the reinsurance program enabled the state to "lessen the significant burden" of rising costs, said Maryland Insurance Commissioner Al Redmer.

Finalized rates for 2019 ACA plans in Maryland include:

State officials also project that the lower rates will increase 2019 ACA enrollment by 5 percent.
Bipartisan Senators Move to Eliminate Surprise Out-of-Network Costs
Last week, a group of six bipartisan senators created draft legislation to protect patients with insurance from extra charges from doctors and hospitals that are not in the insurance company's network.

Often called "surprise bills," the charges stem from non-network emergency room doctors who work in network facilities. Patients receive bills from the non-network provider that are over their deductible or co-pay limits.

The proposed bill tackles three areas:

"No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency," said Tom Carper (D-DE), one of the sponsors of the bill. "The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider."

Healthcare Reform News Update for September 17, 2018
Trump Administration Sued Over New Short-Term Health Plan Rules
A group of seven healthcare organizations filed a lawsuit Friday against the Trump administration, seeking to block implementation of short-term health insurance plans that do not meet Affordable Care Act requirements.

The short-term plans, scheduled to be available October 2, are not required to cover people with existing conditions or the 10 essential health benefits available with ACA plans.

The lawsuit argues that the extension of the plans from three months to 12 months with the ability to renew up to three years does not meet the definition of "short term" and that the agencies did not disclose the extension in its proposed rule.

The suit also alleges the plans are harmful to those with pre-existing conditions and puts them "into a loophole that would permit the creation of a parallel individual insurance market consisting of plans that are not subject to the ACA's consumer protection standards. This result cannot be reconciled with the text, structure, or purpose of the ACA."

The Department of Health and Human Services (HHS) defended its position in a statement from a spokesperson: "Short-Term Limited Duration plans are an important option for people in certain circumstances, and the Trump administration is committed to delivering greater access to more affordable choices to the men and women left out by Obamacare."

Plaintiffs in the suit include: the National Alliance on Mental Illness, the American Psychiatric Association, Little Lobbyists, Association for Community Affiliated Plans, Mental Health America, AIDS United, and National Partnership for Women & Families.

Healthcare Reform News Update for September 14, 2018
Maryland Attorney General Sues Trump Administration Over ACA
Brian Frosh, Maryland's attorney general, has filed a lawsuit in U.S. District Court against the Trump administration, asserting that it is attempting to "sabotage" the Affordable Care Act and move people away from its health coverage.

Frosh is looking for a declaratory judgment that the ACA is constitutional and that further measures to dismantle the law must stop. The lawsuit says repealing the ACA would cause "immediate and long-term harm" to Maryland.

"We are taking action to protect and ensure healthcare coverage for every Marylander and all Americans," Frosh said in a statement.
2019 ACA Premiums in CA, MA & CT Could Rise an Average of 4%
Proposed premiums for 2019 Affordable Care Act plans in California, Massachusetts and Connecticut will rise an average of 4 percent.

Covered California says small businesses will receive rate increases that average 4.6 percent.

Premiums for Massachusetts' Connector plans will increase an average of 4.7 percent.

Connecticut premiums will rise an average of 2.72 percent for individuals and 3.14 percent for small-group coverage.

Rates will be finalized before the Open Enrollment Period later this fall.

Healthcare Reform News Update for September 13, 2018
ACA Navigators Asked to Do More With Less Funding
The Center for Medicare and Medicaid Services (CMS) announced Wednesday the 39 navigator programs that will share $10 million in funding to promote and enroll consumers into healthcare plans.

CMS Administrator Seema Verma said the 2019 program kicks off a "new direction." Instead of exclusively enrolling uninsured residents in ACA plans, grantees are encouraged to enroll them in association health plans, short-term plans, Medicaid, and CHIP.

"This new direction will increase accountability and ensure the grants are effective in helping consumers find health coverage that meets their needs," she said. Verma also encourages navigators to rely more heavily on volunteers and partnerships with other organizations.

These are drastic cuts compared to last year's grants of $36 million to 90 organizations. Overall, navigators have been cut 84 percent since 2016.
2018 Tax Returns Won't Require Proof to Claim ACA Hardship Exemption
Individuals who have opted out of healthcare coverage in 2018 will not have to provide documentation or a written explanation on their 2018 tax return to claim a hardship exemption.

Late last year, Congress repealed the individual mandate that required uninsured Americans to pay a fine. However, the change does not go into effect until 2019. For this year, the penalty is $695 or 2.5 percent of overall income, whichever is higher.

Taxpayers can avoid the penalty via the hardship exemption under some circumstances, including bankruptcy, homelessness, or a natural disaster. CMS' new guidance requests that people who are eligible for the exemption retain all paperwork as proof in the event of an audit, but it does not need to be included with their tax form.
Census: Uninsured Rate Steady Between 2016 to 2017
The number of uninsured Americans in 2017 was 28.5 million people or 8.8 percent, the same as in 2016, according to new data from the Census Bureau.

The numbers have remained steady after the Affordable Care Act significantly reduced the uninsured rate in 2014.

Healthcare Reform News Update for September 12, 2018
CBO: House Bill Revising ACA Employer Regulations Would Cost Over $51 Billion
A bill proposed by House Republicans to change provisions of the Affordable Care Act as it relates to employers will cost the federal government $51.6 billion over the next 10 years, according to a Congressional Budget Office (CBO) report.

The bill, titled the Save America's Workers Act, seeks to postpone or repeal several portions of the ACA. Lawmakers will meet tomorrow to prepare the package for a vote.

Some of the bill's proposals and the CBO's estimated costs include:

Retroactively suspending the employer mandate penalty from 2015 to 2019. The CBO estimates this will cost $25.9 billion over the next decade.

Increasing the full-time hours per week required for workers to receive mandatory employer-paid health coverage from the current 30 hours to 40 hours. The CBO estimates this measure will cost $9.8 billion through 2028.

Postpone the start date of the "Cadillac tax" on high-cost health benefits packages to 2023. The CBO estimates this to cost $15.5 billion.

Healthcare Reform News Update for September 10, 2018
New Jersey 2019 ACA Premiums Could Decrease by 9.3%
Rates for 2019 Affordable Care Act health plans in New Jersey are expected to fall by an average of 9.3 percent, Governor Phil Murphy announced Friday.

Murphy attributed the decrease to a reinsurance program approved last month and the passage of a state individual mandate requiring all residents to have health insurance or pay a penalty.

Final rates will be announced prior to the Open Enrollment Period this fall.

Healthcare Reform News Update for September 6, 2018
Montana Health Prevails in $5.3 Million CSR Payment Lawsuit
Montana Health Co-op won its case in the first lawsuit against the Trump administration's decision to cut off cost-sharing reduction (CSR) payments to insurers.

U.S. Court of Federal Claims Judge Elaine Kaplan decided the government was in violation of an Affordable Care Act provision. Through the provision, the government must reimburse insurance companies for decreasing low-income enrollees' out-of-pocket medical expenses associated with ACA plans.

The government argued it had a right to eliminate the payments because funds were never set aside specifically for CSR reimbursement.

"The statutory language clearly and unambiguously imposes an obligation on the Secretary of HHS to make payments to health insurers that have implemented cost-sharing reductions on their covered plans as required by the ACA," Kaplan said in her order.

Montana Health was seeking $5.3 million in unpaid CSR payments. Several similar lawsuits by other healthcare organizations are currently in progress.
Federal Judge Hears Arguments on Overturning ACA
U.S. District Court Judge Reed O'Connor said he would make a ruling as soon as possible in the lawsuit filed by 20 Republican attorneys general to strike down the Affordable Care Act. The plaintiffs argued Wednesday that last year's repeal of the individual mandate nullified the entire healthcare law.

The Trump administration chose not to defend the ACA, so a group of Democratic attorneys general have stepped in to argue for the law. They say overturning the ACA would cause tens of millions of Americans to lose their health coverage.

Lawyers representing the Justice Department asked O'Connor to postpone a decision until after the Open Enrollment Period to prevent confusion. "The last thing we want is for chaos in the market," said Brett Shumate, an attorney for the Justice Department.
2019 ACA Premium Rates to Drop Slightly in New Mexico
Premiums for 2019 health plans sold on New Mexico's Affordable Care Act exchange are expected to decrease an average of 1 percent.

Requested rates for Molina Health Care could decrease an average of 6 percent, Blue Cross and Blue Shield requested that rates remain unchanged from this year, and Christus Health Plan has asked for rates 4 percent higher than in 2018.

Final rates will be announced by state regulators before the Open Enrollment Period begins November 1.

Healthcare Reform News Update for September 5, 2018

Poll Shows Most Americans Favor Pre-Existing Conditions Protections
A new Kaiser Family Foundation poll found that 72 percent of respondents believe that it's "very important" that insurance companies do not charge higher premiums to people with pre-existing conditions, and 75 percent do not want people denied coverage due to their medical history.
Other findings in the poll:

Healthcare Reform News Update for September 4, 2018
Analysis: Overall 2019 ACA Premiums Could Increase up to 4%
Premiums for 2019 healthcare plans sold on the Affordable Care Act marketplace are expected to increase by less than 4 percent nationwide, according to an analysis by Charles Gaba of ACASignups.net.

While a few states such as Kentucky and Connecticut will experience increases of 12 percent, other states such as Tennessee and New Hampshire will see declines, according to the findings.

Gaba also found that the Trump administration's actions prevented additional drops in premium costs. Eliminating the individual mandate penalty, dropping cost-sharing reduction (CSR) payments, and offering "skimpy" short-term insurance have contributed to weakening the marketplace.

Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, agrees that rates will rise modestly. She also points out that insurance companies selling ACA policies are expanding into new markets.

"The news about the marketplace this year is very good, both in terms of the premium increase and extent of carrier participation," Hempstead said.
Court Fight Over Legality of ACA Begins Wednesday
A group of Republican state attorneys general will present their oral arguments September 5 for a preliminary injunction to halt enforcement of the Affordable Care Act. U.S. District Judge Reed O'Connor will determine if the law should be put on hold while their case proceeds.

The Republicans, led by Texas' Ken Paxton, claim the ACA became unconstitutional last year when Congress eliminated the individual mandate penalty. Democratic attorneys general led by Xavier Becerra of California disagree.

Healthcare Reform News Update for August 30, 2018
Senate Democrats Move to Overturn New Short-Term Health Insurance Rule
Senator Tammy Baldwin (D-WI) introduced legislation to force a vote to block a Trump administration rule that expands short-term health insurance plans from three months to one year.

The plans fall short of Affordable Care Act protections for people with pre-existing conditions and don't require essential benefits such as prescription drugs, maternity care, and mental health coverage.

In a statement, Baldwin called the plans "junk insurance" and said that they "could increase costs and reduce access to quality coverage for millions, force premium increases on older Americans, and harm people with pre-existing conditions."

The bill would require the support of two Republicans to pass in the Senate. Passage in the House is unlikely, as the Republican majority has shown strong support for the extension, saying that the plans are a cost-effective alternative for consumers who aren't able to afford comprehensive health coverage.

Healthcare Reform News Update for August 29, 2018
ACA Has Helped Reduce Number of Uninsured by 58%
The number of uninsured dropped from 29.3 million in 2017 to 28.3 million the first quarter of 2018, according to new data from the Centers for Disease Control and Prevention show.

That compares to 48.6 million uninsured in 2010, prior to the enactment of the Affordable Care Act-a 58.2 percent reduction.

Other findings in the data show:
NY & MN to Receive $465.5 Million in Lost Low-Income ACA Funds
The Centers for Medicare and Medicaid Services (CMS) will pay New York and Minnesota a combined $468.5 million in response to funding losses for Affordable Care Act programs to 822,000 low-income residents.

The two states created Basic Health Programs under the ACA for people who earned too much for Medicaid but not enough to receive federal subsidies to purchase plans on the healthcare exchange. After the Trump administration cut off funding for cost-sharing payments, the programs lost funds.

The states prevailed in a lawsuit against the administration earlier this year and received a combined $168.2 million as an interim payment. The finalized payment of $422,206,235 to New York and $46,276,090 to Minnesota compensates for the cost-sharing payment losses.

Healthcare Reform News Update for August 28, 2018
CMS Approves Opioid Addiction Treatments for 2020 Illinois ACA Plans
Beginning in 2020, Affordable Care Act plans sold in Illinois must cover the treatment and prevention of opioid addiction.

The Centers for Medicare and Medicaid Services (CMS) on Monday approved the state's request to expand the required medical services for Illinois ACA plans.

Plans will cover prescriptions for the opioid overdose antidote naloxone, telepsychiatry services for addiction and mental health issues, and alternative therapies for chronic pain.
New CA Coalition Will Fight Single-Payer Healthcare
California-based business and healthcare organizations have joined forces as a coalition to oppose single-payer healthcare initiatives.

The coalition, Californians Against the Costly Disruption of Our Health Care, believes the estimated $400 billion per year needed to pay for a single-payer system would be too costly to maintain.

The group will urge state legislators to propose alternative bills, including the expansion of health insurance subsidies, opening Medi-Cal to undocumented adult residents, and requiring all Californians to have health coverage.

Healthcare Reform News Update for August 27, 2018
GOP-Backed Bill Offers ACA Pre-Existing Condition Protections; Critics Call It a 'Mirage'
In response to a lawsuit challenging the legality of the Affordable Care Act, Senator Thom Tillis (R-NC) and 10 Senate Republican co-signers have introduced a bill to preserve the law's protections for people with pre-existing conditions.

The lawsuit was filed by 20 Republican state attorneys general and will be heard by a federal judge next month.

The proposed bill would require insurance companies to cover all individuals regardless of health status and ensure that premiums are not revised based on health.

But some critics believe the bill creates a loophole that enables insurance companies to revive the kinds of activities that prompted ACA talks in the first place. The bill holds insurers to guaranteeing access to coverage on the individual market; however, insurance companies could still use exclusions to limit coverage for pre-existing conditions and related ailments.

"If the goal is to protect people with pre-existing conditions, the bill is a bit of a mirage," said Larry Levitt, senior vice president for health reform at the bipartisan Kaiser Family Foundation.

Healthcare Reform News Update for August 24, 2018
Georgia Sees First-Time Decrease in ACA Premiums
Two of Georgia's Affordable Care Act plan providers, Blue Cross Blue Shield of Georgia and Alliant Health Plans, are proposing 2019 rate decreases that together average 5.15 percent. This is the first time since the implementation of the health law that the state has seen a rate reduction.

Georgia's two other ACA carriers, Ambetter and Kaiser Permanente, have proposed rate increases that together average around 12 percent. The increases are significantly lower than 2018 plans, which saw rates rise 50 percent, one of the nation's steepest premium hikes.

Finalized rates will be announced prior to the Open Enrollment Period, which begins in November.
Maine Court Orders Implementation of ACA Medicaid Expansion
Maine's Supreme Court ruled Thursday that Republican Governor Paul LePage's administration must implement the state's voter-mandated Medicaid expansion -even if they continue fighting the plan in court.

LePage, who is opposed to the expansion, has attempted to block the measure. Thursday's ruling denied LePage's latest request to delay implementation. The ruling also lifted a temporary stay and sent the case back to Superior Court.

Healthcare Reform News Update for August 23, 2018
Report Critiques Trump Administration's First ACA Signup Year
The nonpartisan Government Accountability Office has released a report that examines how the Trump administration managed the 2018 Affordable Care Act Open Enrollment Period and makes recommendations for improvements.

The report credits Health and Human Services (HHS) for improving the reliability of the federal enrollment site and reducing call center wait times.

However, the following areas are lacking and need addressing, according to the watchdog group:

The report also found that states using the government site for enrollments had a 5 percent reduction, while states that run their own exchanges maintained enrollment levels. It also confirmed that the Trump administration's discontinuation of cost-sharing reduction (CSR) payments contributed to "substantial increases" in premiums.
Tennessee 2019 ACA Premiums Get Decreases
Most premiums for Affordable Care Act plans in Tennessee will be noticeably lower for 2019.

BlueCross BlueShield of Tennessee has requested decreasing its rates an average of 14.8 percent, and Cigna has requested decreasing its rates an average of 12.9 percent. Oscar Health has requested increases that average between 7.2 percent and 10.84 percent. Rates will be finalized by September 25.

In addition, the state will have two new insurers selling ACA plans, Bright Health and Celtic Insurance.

Healthcare Reform News Update for August 22, 2018
Maryland Reinsurance Program Gains Approval
The Trump administration has consented to a federal waiver for a state reinsurance program, Maryland lawmakers said.

The bipartisan-supported plan will take tax revenue imposed on insurance companies and use it to subsidize the most expensive claims sold on Maryland's Affordable Care Act marketplace.

The reinsurance program will eliminate the predicted 40 percent increase in 2019 ACA premiums for more than 200,000 enrollees and ensure that CareFirst BlueCross BlueShield continues to sell ACA plans in the state.
Delaware ACA Premiums to Rise 3%, Small Groups Get Rebates
Affordable Care Act plans for individuals in Delaware will see premium increases of 3 percent on average in 2019. Highmark Blue Cross Blue Shield of Delaware, the only insurer offering ACA plans in the state, asked regulators for a 5.7 percent increase.

State regulators also announced that, due to an excess of administrative fees, Highmark will provide $5 million in rebates to small group market members.
Study: Ohio ACA Medicaid Expansion Reduced Uninsured by 50%
Ohio's expansion of Medicaid through the Affordable Care Act has cut the number of uninsured by half since the program began four years ago, according to an independent study conducted by Ohio's Department of Medicaid.

The study also found that:

The expansion has enabled 653,000 residents to gain health coverage, though some state lawmakers believe the costs are not sustainable.

Healthcare Reform News Update for August 21, 2018
Trump Administration Will Distribute $8.6 Million to States for Healthcare Initiatives
The Centers for Medicare and Medicaid Services (CMS) will award $8.6 million in unspent Affordable Care Act funding to 30 states and the District of Columbia to help stabilize their insurance exchanges.

The two-year grants range from $225,000 to $290,000 and can be used to expand consumers' healthcare options. All states that applied for the funds received them.

The grant funds come from money set aside as part of the Affordable Care Act for states to review health insurance proposals.

In a statement, CMS Administrator Seema Verma said, "These grants build on CMS's ongoing efforts to give states the tools and flexibility they need to help people struggling to afford the year-over-year premium increases caused by Obamacare regulations. We recognize that states are in the best position to assess the needs of their consumers and develop innovative measures to ensure access to affordable health coverage. These grants make yet another down payment on our work to enhance states' ability to stabilize and improve their respective health insurance markets."
California Bill Would Ban Short-Term Health Insurance
California's Legislature has approved a bill that bans short-term health insurance from being sold in the state.

Governor Jerry Brown must sign off on the bill for it to become law. If signed, the law will become effective January 1, 2019.

The Trump Administration expanded short-term insurance availability rules earlier this month, allowing consumers to maintain policies for up to three years. The plans cost less than comprehensive Affordable Care Act plans. However, the plans fail to cover essential benefits and can limit or deny policies to people with pre-existing conditions. States have the flexibility to alter the new regulations.

New Jersey, Massachusetts, and New York have also restricted or banned short-term health plans.
Three Groups in Nevada to Offer Association Health Plans
Three chambers of commerce in Clark County, Nevada, are the first small business groups in the country to take advantage of the Trump administration's new rules for association health plans.

The groups will offer plans beginning September 1 to 2,000 small businesses that have 10 or fewer employees.

The plans are not required to meet the Affordable Care Act's essential health benefit requirements or other consumer protections, such as accepting people with pre-existing conditions.
ACA Medicaid Expansion Fought in 3 States, Helps LA Cut Uninsured Rate by 50%
Maine, Nebraska, and Kentucky are working to sort out how, or if, they will expand Medicaid availability though the Affordable Care Act. Meanwhile, Louisiana's expansion lowered the number of uninsured in the state by half.

Though Maine voters have approved ACA Medicaid expansion in the state, Governor Paul LePage's administration has not been clear on whether it intends to enforce it. The state's high court will decide whether the state will accept Medicaid applications.

In Nebraska, a petition to put ACA Medicaid expansion on the November ballot has collected enough signatures. However, the proposal is being challenged in court. The hearing is set for early next week.

Kentucky Governor Matt Bevin lost his legal battle over the requirement that Medicaid recipients be employed to receive benefits. Ultimately, the legality of the plan is likely to be determined in a separate case filed in Washington, D.C.

Louisiana's Medicaid expansion program dropped the uninsured rate from 22.7 percent in 2015 to 11.4 percent in 2017, according to a new survey.

Healthcare Reform News Update for August 17, 2018
Nevada Will Switch to a State-Run ACA Healthcare Exchange
Nevada Health Link, the state's insurance marketplace, will open its own state exchange in 2020 to sell Affordable Care Act plans.

Nevada Health Link cited lowering costs as the main consideration. For example, the state exchange will cost about $5.1 million to run in 2020 compared to $13.2 million to lease the federal exchange website.

In a statement, Nevada Health Link Executive Director Heather Korbulic said, "This transition will save Nevada more than $18 million for the duration of the contract, offer a better consumer experience and provide the Marketplace with timely and efficient access to data that will improve marketing efforts."
Trump Administration Approves NJ Reinsurance Program
The Centers for Medicare and Medicaid Services (CMS) has approved New Jersey's reinsurance plan.

The program will help insurance companies pay for their sickest enrollees. Partial funding will be provided through revenue from the state's new law that fines residents without health insurance.

The state estimates that the program will lower 2019 ACA premiums by up to 15 percent.
Massachusetts ACA Premiums to Rise 4.2%
Rates for 2019 Affordable Care Act plans in Massachusetts are expected to rise an average of 4.2 percent. Some premiums will decrease, while others will increase from about 2 percent to 13 percent, depending on the plan.

Massachusetts Health Connector, the state's insurance exchange, will finalize the rates next month.

Healthcare Reform News Update for August 8, 2018
2019 ACA Premiums in New Hampshire Could Drop an Average of 6.7%
The three health insurers in New Hampshire that sell Affordable Care Act coverage have proposed an average 6.75 percent premium reduction for 2019 plans.

Several factors are responsible for the rate drop, including the expansion of Medicaid, which moved low-income New Hampshire residents from ACA plans into the Medicaid program.

Rates for the Ambetter, Anthem, and Harvard Pilgrim ACA plans will be finalized by state regulators before the Open Enrollment Period begins in November.

Healthcare Reform News Update for August 7, 2018
Nevada 2019 ACA Premiums Could Increase an Average of 1.9%
Health insurance companies in Nevada have proposed increasing premiums for 2019 Affordable Care Act plans an average of 1.9 percent, the lowest rate increase in the history of the law.

Both SilverSummit and Health Plan of Nevada will continue to sell ACA plans in the state, with SilverSummit increasing its offerings from four to six plans in every county.

Final rates will be approved by state regulators in October.

Healthcare Reform News Update for August 3, 2018
Senate Democrats Try to Block Short-Term Health Plans
In response to the Trump administration's new final rule on short-term healthcare plans, Senate Democrats are planning to introduce a resolution to upend it. However, the measure to overturn the rule is unlikely to pass since the legislation would need to be signed by President Donald Trump.

The lawmakers say that, since the plans are not required to cover people with pre-existing conditions or adhere to the Affordable Care Act's essential benefits, the plans are "nothing short of junk insurance."

"We cannot let the Trump administration rewrite the rules on the guaranteed healthcare protections that people depend on because no family should be forced to choose between helping a loved one get better or going bankrupt," said Tammy Baldwin (D-WI), one of the senators leading the measure.

Senate Minority Leader Charles Schumer (D-NY) will force a vote under the Congressional Review Act, which means Republicans will be unable to block it.

"This is an issue the American people should know where everyone stands," Schumer said. "Let them, instead of saying they're for it, actually do something to preserve pre-existing conditions."
Study: NY Single-Payer Bill Could Lower Costs for Most Residents
A New York bill to create a state single-payer health plan could lower out-of-pocket medical costs for residents earning less than $290,000 but would significantly raise taxes on those who earn more, according to an analysis from the Rand Corporation and the New York State Health Foundation.

The bill proposes expanding healthcare to all New York residents with no copays or deductibles.

The plan would need to raise $139 billion in additional taxes to fund the program, which could be funded with a three-tiered tax income bracket ranging from low-earning families paying 6.1 percent and high-earners paying 18.3 percent, according to the study.

Though taxes would be increased, those earning less than $290,000 would have reduced medical costs. For example, a person who earns up to $185,200 would pay about $3,000 less per year.

To be enacted, the bill would need to be approved by a Republican-controlled state Senate and receive a waiver from the Centers for Medicare and Medicaid Services (CMS), neither of which is likely.

Healthcare Reform News Update for August 2, 2018
Four Cities Sue Trump for Undermining the ACA
The cities of Chicago, Columbus, Cincinnati, and Baltimore filed a lawsuit today in Maryland federal court against President Donald Trump, claiming he has not faithfully executed the Affordable Care Act, which is in violation of the Constitution.

The complaint charges that Trump "waged a relentless effort to use executive action alone to undermine and, ultimately, eliminate the law," according to a draft of the lawsuit obtained by NBC News.

The suit cites measures such as the expansion of association plans, attempt to eliminate cost-sharing reduction payments, reduction of funds for navigator programs, reducing the Open Enrollment Period, and urging the court to remove pre-existing condition protections.

The lawsuit seeks to stop practices that allow ACA exchanges to strip tax credits from enrollees with no notification, increase oversight of brokers, and strengthen oversight of the law.

"The overall picture here is one of sabotage that drives up the rates of uninsured and underinsured and leaves cities and counties holding the bag," said Adam Grogg, senior counsel at Democracy Forward and the lead litigator in the lawsuit.
2019 ACA Premiums in Missouri to Rise Less Than 6%
Insurance companies in Missouri have requested premium increases for small group and individual plans that average just under 6 percent for 2019 ACA plans.

Ambetter, Centene, Cigna and Medica will all return to the Missouri ACA marketplace. There will be coverage available in every county.

Final rates are expected to be approved by state regulators next month.
Molina May Re-Enter Utah, Wisconsin ACA Marketplaces
Health insurance company Molina is weighing a return to selling Affordable Care Act plans in Utah and Wisconsin. The company left both states this year and is currently studying the profitability of coming back.

Company CEO Joseph Zubretsky said a decision would be made by the end of the summer.
Senate Fails to Stop DC Individual Mandate Funding
Senator Ted Cruz (R-TX) failed in his attempt to include an amendment to a funding bill that would have barred the District of Columbia from using money to impose an individual health insurance mandate. The senate voted 54-44 to table the provision.

Healthcare Reform News Update for August 1, 2018
Trump Administration Allows 12-Month Short-Term Plans
The Trump administration released a final rule today on new short-term health insurance policies, which will go into effect in October.

The rule extends the current 90 days of coverage up to 12 months, and policies have the option to be renewable for a maximum of three years.

Premiums for the short-term policies could cost half as much as comprehensive coverage. However, these policies have the choice to skirt many Affordable Care Act provisions, such as coverage for maternity care, prescription drugs, or mental health care. These plans can also set annual and lifetime caps on benefits, deny coverage, or charge more for people with pre-existing conditions.

"We make no representation that it's equivalent coverage," said James Parker, a senior adviser to Health and Human Services Secretary Alex Azar. "These policies will not necessarily cover the same benefits or extend coverage to the same degree, but what we do know is that there are individuals today who have been priced out of coverage because of the way the ACA has been implemented and the effects that it's had on the market."

Critics fear the availability of the plans could cause ACA premiums to rise due to lower enrollment. An analysis by lobbying group America's Health Insurance Plans estimates a 1.7 percent increase next year due to the short-term plan expansion.

The administration estimates that about 600,000 people will enroll in a short-term plan next year. Of that 600,000, officials estimate between 100,000 and 200,000 people will switch from ACA plans to enroll in short-term options.

Plans could be available in about 60 days but first must be approved by insurance regulators.
Report: Individual Insurance Enrollment Dropped by 12%
Enrollment in individual health insurance policies declined by 12 percent to 14.4 million in the first quarter of 2018 as compared to 2017, according to a new analysis from the Kaiser Family Foundation.

The study indicates that Affordable Care Act premium increases for unsubsidized enrollees was a key factor in the decrease, with 38 percent of people who were not eligible for subsidies dropping their coverage.

Even with the drop-off, overall enrollment in plans sold on the ACA exchanges continues to be stable, with 10.6 million enrolled compared to 10.3 million this time last year.
North Carolina Insurer to Reduce 2019 ACA Premiums by 4.1%
Blue Cross and Blue Shield of North Carolina has proposed lowering its premium rates for 2019 Affordable Care Act plans by 4.1 percent.

The company cited several factors in its decision, including a $120 million reduction in healthcare costs from newly negotiated hospital and doctor agreements, the suspension of the health insurance tax, and proceeds from last year's federal income tax cut.

There are about 475,000 North Carolina residents enrolled in the company's ACA plans.

Healthcare Reform News Update for July 31, 2018
NY Governor Requests Denial of Some ACA Premium Increases
New York Governor Andrew Cuomo has asked the state's Department of Financial Services to reject any portion of Affordable Care Act premium increases attributed to the repeal of the individual mandate.

Premium increase requests for 2019 plans in New York average 24 percent, of which half is credited to the elimination of the ACA provision that required individuals to have health coverage or face a penalty.

"If we allowed that rate increase to go through, it would be hundreds of millions of dollars as a bonanza to the private insurance companies. It would increase the cost to normal hardworking families. We're not going to let it happen," Cuomo said at a rally on Monday. He added that "insurance premiums must be based on actual cost, and not political manipulations."

Cuomo said the current proposed rates would raise premiums an average of $1,500 for each enrollee.
Maine Gains OK for Reinsurance Program
The Centers for Medicare and Medicaid Services approved Maine's request to establish a reinsurance program to help stabilize Affordable Care Act insurers in the state.

CMS' decision comes one day after approving a similar request from Wisconsin. The two states join Minnesota, Alaska, Oregon, and Hawaii with approved reinsurance programs.
New Jersey 2019 ACA Premiums to Rise 5.8%
Premiums for 2019 ACA plans in New Jersey are expected to rise an average of 5.8 percent.

Insurance requests in the state ranged from an increase of 0.8 percent to 9.2 percent. Governor Phil Murphy said the state's individual mandate law prevented much higher price hikes.

Rates will be finalized prior to the open enrollment period this fall.

Healthcare Reform News Update for July 30, 2018
Analysis: Sanders' Single-Payer Plan Could Cost $32.6 Trillion
Vermont Senator Bernie Sanders' "Medicare for All" healthcare plan would increase government spending by $32.6 trillion over a decade, according to an analysis by the libertarian Mercatus Center at George Mason University in Virginia.

Sanders' plan would cover all Americans with no copays or deductibles. Tax increases would be required to replace premium costs that are currently paid by consumers and employers.

The plan could lower prescription costs by $846 billion over 10 years and administration costs by $1.6 trillion, according to the report. However, spending would rise due to:

If corporate and individual income taxes were doubled, it would still not be enough to pay for the plan, according to the analysis.

Sanders calls the report a "misleading and biased" response to the growing popularity of a single-payer system. "If every major country on earth can guarantee health care to all, and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States cannot do the same," he said in a statement.
Trump Administration Approves Wisconsin Reinsurance Program
The Centers for Medicare & Medicaid Services (CMS) on Sunday approved Wisconsin Governor Scott Walker's reinsurance program.

Called the Health Care Stability Plan, the $200 million program will lower insurance rates for Affordable Care Act plans by providing government funds to insurance companies for their most expensive enrollees.

The plan is expected to lower 2019 ACA premiums by 3.5 percent.

Healthcare Reform News Update for July 27, 2018
Trump Administration Sued Over Association Health Plans
Attorneys general for 11 states and the District of Columbia have sued to block the Trump Administration's regulation that expands access to association health plans (AHPs).

AHPs enable small businesses and groups to join together to purchase health insurance. The coverage does not have to meet the requirements of the Affordable Care Act, so the premiums are lower, but the plans do not cover essential benefits such as prescription drugs, maternity care, or mental health.

According to the complaint, the rule "upends a decades-old understanding of a foundational employee benefits law for the purpose of exempting a significant portion of the health insurance market from the Affordable Care Act's consumer protections."

The complaint also contends that the rule "increases the risk of fraud and harm to consumers, requires states to redirect significant enforcement resources to curb those risks, and jeopardizes state efforts to protect their residents through stronger regulation."

The lawsuit is signed by the attorneys general of California, Delaware, District of Columbia Kentucky, Maryland, New Jersey, New York, Massachusetts, Oregon, Pennsylvania, Virginia and Washington.
HHS Secretary Criticizes ACA in Speech to Conservative Organization
Health and Human Services (HHS) Secretary Alex Azar spoke out against the Affordable Care Act on Thursday in a speech to the conservative Heritage Foundation.

Azar said the healthcare law was an example of government overreach that caused consumers to pay higher prices and "imposed a new tax or regulation, or sometimes both, on just about every moving part in our healthcare system."

Azar believes the healthcare exchanges, in particular, have failed to attract younger enrollees, placing a financial burden on the older people left behind.

"The only factor keeping the individual markets alive is the tens of billions in subsidies supplied directly to insurers each year. The fundamental flaw of the Affordable Care Act is that it narrowed the competition for insurance options and laid down heavy-handed controls on the prices that could be charged," he said.

Azar also shared his disapproval of the ACA's Medicaid expansion, saying the federal government now pays more for the expansion population than it does for those who traditionally qualified for benefits. He said the Trump administration will support work requirements for beneficiaries who are neither disabled nor have children.

Healthcare Reform News Update for July 26, 2018
CMS Administrator Rejects Single-Payer Healthcare System
In a speech delivered Wednesday, Centers for Medicare and Medicaid Services Administrator Seema Verma said that a government-run, "Medicare for all" healthcare system would not work and she would likely deny states seeking waivers for single-payer programs.

Verma believes expanding Medicare would drain funding and put seniors at risk. "Ideas like 'Medicare for all' would only serve to hurt and divert focus from seniors," she said.
Kaiser Poll: Pre-Existing Condition Protections Top Healthcare Concerns
A candidate's position on continuing protections for people with pre-existing conditions is the leading healthcare concern for the majority of voters, with 63 percent of respondents ranking it their "most important" or "very important" healthcare issue, according to a new poll from the Kaiser Family Foundation. The topic ranked high with both Democrats and Republicans.

Other healthcare findings in the poll:
House Passes Bill to Delay ACA Health Insurance Tax
The House on Wednesday passed a bill to extend the delay of the Affordable Care Act's health insurance tax for 2020 and 2021. The tax was previously suspended for 2019.

The bill also expands eligibility for ACA catastrophic plans and expands eligibility and use of health savings accounts (HSAs).

Healthcare Reform News Update for July 25, 2018
Trump Administration Will Resume ACA Risk-Adjustment Payments
Centers for Medicare and Medicaid Services (CMS) issued a final rule Tuesday to restart the Affordable Care Act's risk-adjustment payments to insurance companies.

Risk-adjustment payments are made by insurance companies with healthier enrollees to help offset companies with sicker enrollees. This process helps stabilize the marketplace. Earlier this month, the department halted the $10.4 billion program due to a federal judge's ruling.

Halting the payments set off fears that the move would increase 2019 premiums or cause some insurance companies to leave the ACA exchanges.

"This rule will restore operation of the risk-adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation," said CMS Administrator Seema Verma in a statement. "Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today. Alleviating concerns in the market helps to protect consumer choices."
ACA Critic Paul Mango to Serve Trump Administration in CMS Role
Paul Mango, a strong critic of the Affordable Care Act, has been appointed chief principal deputy administrator and chief of staff at the Centers for Medicare and Medicaid Services (CMS).

Mango, a former Pennsylvania gubernatorial candidate, previously worked on healthcare issues for consulting firm McKinsey & Company.

"I have known Paul for more than 10 years and look forward to having his support as we deliver on President Trump's agenda and execute on our strategy on behalf of the American people," said CMS Administrator Seema Verma in a statement.
House Passes Bill to Repeal ACA Medical Device Tax
The house voted Tuesday to repeal a 2.3 percent tax on medical devices. The vote garnered support from both Democrats and Republicans.

The tax has been delayed twice, but the current bill would make the repeal permanent. It is uncertain whether or not the bill will be taken up in the Senate.
GOP Senators Push to Repeal DC's Individual Mandate Penalty
Six Republican senators, led by Ted Cruz (R-TX), have introduced an amendment to an appropriations bill that would prevent the District of Columbia from using federal funds to impose a penalty on residents who don't have health insurance. Last week, the House passed the amendment in a spending bill.

Healthcare Reform News Update for July 24, 2018
House to Vote on ACA Revisions, HSA Expansion
The House will vote this week on several Republican-backed healthcare measures, including:

If approved, the measure would cost $92 billion over 10 years, according to Congressional Budget Office (CBO) estimates.
PA Insurers Lower 2019 ACA Rate Proposals
Pennsylvania insurance companies have reduced their rate requests for 2019 Affordable Care Act plans from an average increase of 4.9 percent to an average increase of 1 percent.

The state cited several factors for the change, "including lower insurer expenses for cost-sharing reduction payments covering deductibles, co-payments, and co-insurance for lower income customers, the department lowered the amount of a standardized factor."

The state will finalize the rates prior to the Open Enrollment Period later this year.

Healthcare Reform News Update for July 23, 2018
Payment Structure for Medicare Office Visits Could Change
The Trump administration would like to change the way doctors charge Medicare patients for office visits beginning in 2019 by establishing one set rate for new patients and a lower set rate for established patients.

Medicare patients are currently billed between $76 and $211 for new patients and between $45 and $148 for established patients, depending on the complexity of the service. The Trump administration has proposed a set rate of about $135 for new patients and about $93 for established patients.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), says the change would help lessen doctors' paperwork, giving them more time with patients. She says the change would help fulfill the president's promise to "cut the red tape of regulation."

Critics of the proposal say it could increase the risk of fraud and would result in a patient with a cold being charged the same as a patient with Stage 4 cancer. In addition, they fear that physicians in more specialized fields, such as dermatology and rheumatology, would be underpaid and that many could stop taking Medicare patients.

The proposal has the potential to affect the broader healthcare community, as private insurance companies often mirror Medicare rules.

The administration's proposal is expected to be published in the Federal Register on Friday with a public comment period scheduled through September 10.
Connecticut 2019 ACA Premiums Could Rise 12.3%
Proposed health insurance premiums for 2019 Affordable Care Act plans in Connecticut will rise an average of 12.3 percent, with requests ranging from a 10.9 percent reduction from CTCare Benefits Inc. to an increase of 31 percent from Anthem Health Plans.

Final rates will be announced this fall after a review by state insurance regulators.

Healthcare Reform News Update for July 20, 2018
CMS May Restart of Risk-Adjustment Payments
The Centers for Medicare and Medicaid Services (CMS) sent an interim final rule to the Office of Management and Budget on Wednesday that is likely to enable the agency to resume billions in Affordable Care Act risk-adjustment payments.

The rule, titled "Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act," could go into effect immediately. The contents of the rule will not be disclosed until it has been reviewed.

CMS stopped payments to the program last week due to conflicting legal rulings. The payments, which totaled $10.4 billion in 2017, go from insurance companies with heathier enrollees to those with sicker enrollees. This process helps balance the marketplace. Insurance companies feared that halting the payments could trigger premium increases.
Removing Pre-Existing Condition Protections Will Hurt States Challenging ACA the Most
Almost half of the states that have launched a legal challenge against the Affordable Care Act would be negatively impacted the most if protections for people with pre-existing conditions were eliminated, according to an analysis by the Kaiser Family Foundation.

A coalition of 20 Republican-led states filed a lawsuit in February challenging the legality of the ACA and its provision that people with pre-existing conditions can get health coverage without being charged higher premiums.

The study found that nine of the states in the lawsuit have residents with the country's highest rates of pre-existing conditions among adults under 65. For example, West Virginia has the country's highest rates with 36 percent of its population - or 1 in 3 adults under 65 - who would qualify as having a pre-existing condition.

"These states have been opposed to the ACA from the beginning. They're hurting their most vulnerable citizens," said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research.

Studies have shown that, prior to the Affordable Care Act, between 27 percent and 50 percent of adults under 65 had at least one pre-existing condition.
Poll: Half of Americans Believe Healthcare is More Expensive in 2018
Nearly half the country finds that healthcare is more difficult to afford than last year, according to a new poll by Democratic messaging firm Navigator Research.

Respondent opinions mostly transcended party affiliation with 54 percent of Democrats and 46 percent of Republicans saying it's more difficult to afford prescription drugs, insurance premiums, and doctor visits this year as compared to last year.

The poll also showed that 78 percent of respondents believe the government should do more to make healthcare more affordable.
California 2019 ACA Premiums to Increase 8.7%
Affordable Care Act health plans sold on California's healthcare exchange, Covered California, will rise an average of 8.7 percent in 2019, ending the double-digit increases seen in the state the previous two years. Covered California singled out the repeal of the individual mandate penalty as the reason for the increases.

All 11 insurance companies that sell ACA plans in the state will return next year. Rates are subject to review by state regulators before becoming final this fall.
House Passes Two Measures Blocking D.C.'s Individual Mandate
House Republicans passed measures on Thursday that would repeal the District of Columbia's requirement that all residents have health insurance coverage.

Democratic Mayor Muriel E. Bowser was against the decision, saying the House ignored the wishes of residents.

The measure was introduced by Representative Gary Palmer (R-AL) who said in a statement that "individuals should be allowed to make their own decisions about the type of insurance they want to purchase without being subjected to punishment from the government. The D.C. individual mandate would restrict patient choice and force people to purchase insurance that they may not need, desire, or be able to afford."

Healthcare Reform News Update for July 19, 2018
Association Health Plans Get Tepid Reception From Key Business Group
The National Federation of Independent Business (NFIB), which has lobbied for almost 20 years for association health plans, says the new insurance initiative allowing them is impractical for its membership.

The Trump administration will allow the plans to be sold beginning September 1. The NFIB objects to the rule that businesses can join together to purchase health insurance only if they share an industry or are within the same state.

"We can't set up an AHP under the new rules any more than [we] could under the old rules," said NFIB Spokesman Adam Temple.

Other trade groups such as the National Retail Federation and the National Association of Realtors have also voiced concerns about the new rules and have no intentions of setting up AHPs in the near future.
House Democrats Form New Medicare for All Caucus
Democrats in the House are launching a new caucus today that will focus on endorsing single-payer healthcare.

The Medicare for All Caucus will comprise approximately 60 Democratic members led by Representatives Pramila Jayapal (WA), Debbie Dingell (MI), and Keith Ellison (MN).

Healthcare Reform News Update for July 18, 2018
States: 'Silver Loading' ACA Plans Helped Subsidized Consumers
Eighteen states and the District of Columbia have asked a judge to put their lawsuit concerning the Trump administration's cuts to Affordable Care Act subsidies on hold.

The states filed suit last year after President Donald Trump ended government payments to insurance companies that provided discounts to low-income consumers. As a workaround to counter the payment cutoffs, insurance companies raised premiums on silver plans. That move helped trigger increased tax credits for subsidized enrollees.

The states say that the workaround was successful in protecting lower-income consumers from premium increases. According to the filing, the decision "provided some stability to help ensure a functioning insurance market."

The states are requesting a hold instead of dropping the suit entirely in the event the administration disallows the "silver loading" workaround.
Idaho Voters Will Decide on ACA Medicaid Expansion in November
Idaho residents will vote on expanding Medicaid through the Affordable Care Act in November, after a petition included enough signatures to put the measure on the ballot.

If approved, the expansion will enable 62,000 additional residents to qualify for coverage.

Healthcare Reform News Update for July 17, 2018
Lawmakers Press HHS to Restart ACA Risk Adjustment Payments
Congressional Democrats and a House GOP chairman on Monday addressed reinstating the $10.4 billion in risk adjustment program payments that Health and Human Services (HHS) recently suspended.

In a letter to HHS, Democrats on Congress's healthcare committee asked the department to reconsider. "We ask that you take immediate action to reverse this destructive decision that will further destabilize the individual and small group markets that millions of Americans rely on for health insurance," according to the letter.

The letter was signed by Democratic Representatives Frank Pallone Jr. (NJ), Richard Neal (MA), Bobby Scott (VA), and Senators Patty Murray (WA) and Ron Wyden (OR).

House Ways and Means Committee Chairman Kevin Brady (R-TX) said he is working with HHS officials to restart the payments. "The administration wants to restore those payments, so we're looking at ways that we can help them do that," he said.

Risk insurance payments are collected from insurance companies with healthier enrollees to help companies with sicker enrollees cover costs. Last week, the Trump administration suspended the payments citing a court ruling.

Healthcare Reform News Update for July 16, 2018
Colorado's 2019 ACA Premiums Could See Average Increase of 5.94%
In Colorado, health insurance companies have requested to raise rates on 2019 Affordable Care Act plans by an average of 5.94 percent.

Broken down by plan type, the state filings reflected an average increase of:

All seven insurance companies that sell ACA plans in Colorado will remain on the exchange in 2019, and every county will have at least one insurer. Final rates will be announced prior to this fall's open enrollment period.

Healthcare Reform News Update for July 13, 2018
House Committee Approves ACA Employer Mandate, Tax Credit Bills
Two bills advanced by the House Ways and Means Committee on Thursday address several provisions of the Affordable Care Act.

The first bill suspends ACA employee mandate penalties through 2019 and delays implementation of the "Cadillac tax" on high-deductible employee-sponsored health plans until 2022. The bill is sponsored by representatives Devin Nunes (R-CA) and Mike Kelly (R-PA).

The second bill would allow individuals to use ACA tax credits to purchase health plans not sold on the ACA exchanges. It will also allow people over the age of 30 to purchase catastrophic plans. The bill is sponsored by Peter Roskam (R-IL) and Michael Burgess (R-TX).

Healthcare Reform News Update for July 12, 2018
Bright Health Increases ACA Reach Into 9 New Markets
Startup insurer Bright Health announced that it will sell Affordable Care Act plans in nine additional markets in 2019, upping its reach to 12 markets in six states.

The company's health plans are currently available in Colorado, Phoenix, and Birmingham, Alabama. New markets include:

Healthcare Reform News Update for July 11, 2018
ACA Navigator Program Funding Reduced to $10 Million
The Centers for Medicare and Medicaid Services (CMS) announced Tuesday that it will cut funding for the Affordable Care Act navigator program reducing it to $10 million.

Last year, the Trump administration slashed the federal grants for the program from $62.5 million to $36 million.

Each of the 34 states that use the federal ACA exchange will be awarded a minimum of $100,000 to help residents sign up for health coverage. In addition to promoting the government's healthcare website, CMS says that it wants navigators to raise awareness of the association health plans and short-term plans that provide coverage for up to 12 months.

CMS Administrator Seema Verma said, "it's time for the navigator program to evolve, which is why we are announcing a new direction for the program today."

The agency says that the program's sign-up performance in the past has been disappointing. After the 84 percent funding cut since 2016, navigators enrolled less than 1 percent of all ACA enrollees. Insurance agents and brokers signed up 42 percent.

Healthcare Reform News Update for July 10, 2018
Analysis: Insurance Companies Could Expand Into More ACA Exchanges
More insurance companies might sell Affordable Care Act plans in 2019, according to projections from a new analysis by the Robert Wood Johnson Foundation.

The analysis points to several factors that could increase the number of companies selling health plans on the exchanges:

The analysis was prepared prior to last weekend's announcement by the Trump administration that it will suspend risk-adjustment payments to insurance companies. That decision, plus a lawsuit that questions the validity of the ACA, could potentially upset market stability, raise premiums, and affect insurers' confidence to enter new markets.

Sabrina Corlette, a research professor at Georgetown University's Health Policy Institute, addressed the issue. "There seems to be a little more confidence in the sustainability of the ACA market. It remains to be seen whether underserved rural areas will get more competition and choice next year. But with the administration's risk-adjustment decision and the Texas lawsuit, we're not out of the woods yet," she said.
Maine ACA Medicaid Expansion Blocked by State House Lawmakers
The Maine House was unable to get the votes necessary to override Republican Governor Paul LePage's veto of a bill that funded a voter-approved expansion of Medicaid. The bill would have garnered more than $500 million in federal funds and $60 million in state funds to more than 70,000 low-income residents.

A hearing next week before the Maine Supreme Judicial Court will determine how and if the state can implement the voter-approved expansion without funding approved by the Legislature.

Healthcare Reform News Update for July 9, 2018
Trump Administration Suspends ACA Risk Adjustment Payments
Citing conflicting court rulings, the Centers for Medicare & Medicaid Services (CMS) announced Saturday that it will halt $10.4 billion in risk adjustment payments to insurers until legal issues are resolved.

The Affordable Care Act's risk adjustment program takes payments from insurers with healthier customers and redistributes that money to companies with sicker enrollees. A court in Massachusetts upheld the risk adjustment payments; however, a New Mexico court decided in February that the rules were unfair.

A statement from CMS Administrator Seema Verma said that the "ruling prevents CMS from making further collections or payments under the risk adjustment program. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold."

Verma's statement also noted that the agency is "seeking a quick resolution to the legal issues raised and will inform stakeholders of any update to the status of collections or payments at an appropriate future date."

Insurance trade groups say that halting the payments will cause premiums to increase this fall.

Insurance trade group America's Health Insurance Plans said the following in a statement: "This decision comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own."

"Risk adjustment is a mandatory program under federal law. Without a quick resolution ... this action will significantly increase 2019 premiums for millions of individuals and small business owners. ... It will undermine Americans' access to affordable coverage, particularly for those who need medical care the most," said Blue Cross Blue Shield Association President Scott Serota.

Democratic lawmakers and ACA advocates, including House Energy and Commerce Committee Representative Frank Pallone (D-NJ), say the decision is one more step in the Trump administration's plan to sabotage the healthcare law.

Healthcare Reform News Update for July 6, 2018
Nebraska Voters Could Have ACA Medicaid Expansion on Fall Ballot
Advocacy group Insure the Good Life garnered more than 135,000 signatures to allow Nebraskans the chance to vote for expanding Medicaid through provisions of the Affordable Care Act.

The petition included about 60 percent more signatures than required to qualify for the ballot. If enacted, the measure would insure approximately 90,000 people in Nebraska who earn up to $16,753 for a single person or $34,638 for a family of four.

Nebraska Governor Pete Ricketts opposes Medicaid expansion, and previous proposals have failed in the state's predominately Republican legislature over the past six years.

Election officials have until mid-August to review the signatures collected and certify the ballot initiative.

Healthcare Reform News Update for July 5, 2018
Number of Brokers, Agents Selling ACA Coverage Drops Almost 25%
Insurance agent and broker participation in Affordable Care Act enrollment decreased by 24.8 percent in 2018, according to a report released by the Centers for Medicare & Medicaid Services (CMS) earlier this week.

Currently, 42 percent of ACA enrollees receive help through insurance agents or brokers. Last year, 65,300 agents and brokers helped Americans sign up for coverage. This year, the number dropped to 49,100.

According to CMS, the drop is due to several factors, including fewer insurance companies offering ACA plans, high premiums for people without subsidies, and limited commissions.

In 2016, the agency issued guidance to insurance companies to be consistent in their commission structures by the first of this year to help encourage agent and broker participation. Groups representing agents and brokers claim that it has not happened.

"Without a viable compensation structure for agents and brokers, it may be difficult for CMS to improve or stabilize agent and broker retention and achieve significant enrollment gains, leaving consumers with diminished access to insurance specialists willing to help them in their local communities," according to the CMS report.
Vermont Prepares to Regulate Association Plans
Vermont will regulate association health plans that could be available in the state as soon as September, said Michael Pieciak, commissioner of the Vermont Department of Financial Regulation.

Last month the Department of Labor announced the expansion of the plans to the self-employed and a larger swath of small businesses. The plans are able to skirt many of the Affordable Care Act essential benefits, including mental health services, maternity care, and prescription drugs.

Pieciak said Monday that his department "aims to craft regulations that ensure Vermonters are protected and well-served by these health plans. In the past, similar plans that operated in other states were poorly run, and many were fraudulent."

Healthcare Reform News Update for July 3, 2018
Percentage of 2018 ACA Enrollees Who Keep Plans Rises Slightly
The Centers for Medicare and Medicaid Services (CMS) released enrollment data Monday for 2018 Affordable Care Act Plans.

According to the report, 10.6 million of the 11.8 million who signed up for ACA plans paid their first month's premium.

Almost 1.1 million, or about 9 percent, dropped their coverage as of February 2018. That percentage is lower than in 2017, when 1.9 million of 12.2 million enrollees-about 15.5 percent-dropped their coverage.

Enrollees without subsidized coverage dropped their coverage at a much higher rate than those with subsidies. From 2016 to 2017, only 3 percent of subsidized enrollees dropped coverage. In that same time frame, 20 percent of those without subsidized coverage dropped their plans.

Other findings in the study:

Healthcare Reform News Update for July 2, 2018
Trump Administration Could Slash Funding for ACA Outreach Groups
The Department of Health and Human Services (HHS) has made an initial proposal to cut funding for Affordable Care Act navigator groups from $36 million to $10 million, though the final funding amount has not been announced.

Navigators help consumers, especially those with limited English skills and citizens in rural areas, understand and find ACA plans. The groups have yet to receive any information from HHS on their funding levels for the upcoming open enrollment period.

Last year, the Trump administration reduced funding for navigators from $63 million to the current $36 million, asserting that the outreach programs were ineffective. Democratic lawmakers said the reduction was designed to sabotage the healthcare law.
Oregon 2019 ACA Premiums to Increase up to 10%
In Oregon, individual premiums will increase between 5 and 10 percent next year, according to preliminary rate decisions for 2019 Affordable Care Act plans issued Friday by state insurance regulators. Small group insurance plans will experience rate changes from a 4 percent drop to a 9.4 percent increase.

The relatively small increases are credited to the state's reinsurance program. Final rates are expected to be announced by the end of the month.
Kentucky's Medicaid Work Requirement Struck Down
U.S. District Judge James E. Boasberg on Friday blocked Kentucky's new requirement that all Medicaid recipients have jobs. The decision, which is likely to be appealed, could reduce the number of states that expand their Medicaid programs through the Affordable Care Act.

Kentucky's work requirement was the first of its kind in the country. It required 80 hours of work, job training, education, or volunteer service per month for nondisabled enrollees. Exemptions included pregnant women, full-time students, primary caregivers, and those considered medically frail.

Arkansas, Indiana, and New Hampshire have also passed Medicaid work requirements, and seven additional states have federal approvals pending. It's unclear if Boasberg's ruling applies to them as well.

Healthcare Reform News Update for June 27, 2018
Poll: Most Americans Back Pre-Existing Condition Protections
Majorities of Republicans, Democrats, and independents say it's "very important" to retain the Affordable Care Act's protections for people with pre-existing conditions, according to a Kaiser Family Foundation poll released today.

The poll asked 1,492 adults whether insurance companies should deny coverage based on someone's medical history and whether those with pre-existing conditions should pay higher premiums. Currently, the ACA prohibits these practices. However, the Trump administration, in a legal challenge, recently said it would not defend these provisions.

Eighty-eight percent of Democrats, 58 percent of Republicans, and 77 percent of independents responded that it is "very important" that insurance companies cannot deny coverage because of a person's medical history.

Similarly, 85 percent of Democrats, 58 percent of Republicans, and 70 percent of independents, responded that it is "very important" that health insurance companies cannot charge sick people more.
Medica Expands ACA Coverage to Oklahoma and Kansas City
Health insurer Medica announced that it will sell 2019 Affordable Care Act coverage in all 77 counties in Oklahoma and add four additional counties in the Kansas City, Missouri, area.

In Missouri, the company will expand into Cass, Clay, Jackson and Platte counties. This year, the company sold policies only in Johnson and Wyandotte counties.

Proposed pricing for Medica's ACA plans in both states will be available at a later date.

Healthcare Reform News Update for June 26, 2018
Smaller Insurers Expanding ACA Marketplace Coverage
Some smaller health insurance companies are planning to increase their presence on the Affordable Care Act marketplace for 2019, despite a decline in ACA carriers across the country in recent years.

Last week, Oscar Health announced its growth into three states and three new markets in existing states. Now, Bright Health has determined it will expand into Tennessee, and Presbyterian Healthcare is returning to the ACA marketplace to sell plans in New Mexico.

"It's still early, but we haven't seen any exits, and we are certainly seeing new insurers enter markets and expand where they are doing business," said Larry Levitt, a senior vice president at the Kaiser Family Foundation. "If not for the still significant political and legal uncertainty, we'd be seeing a very robust market right now."

Seven states will gain ACA plan choices next year, but premiums will be higher. Rates will increase from an average of $642 per month this year to $740 in 2019.

Healthcare Reform News Update for June 25, 2018
2019 ACA Premiums Could Rise by 8.2% in Ohio
Insurance companies in Ohio have submitted proposed rates for 2019 health plans sold on the Affordable Care Act marketplace.

If approved by state regulators, premiums will rise an average of 8.2 percent. Last year, premium increases averaged 20 percent.

Ohio's Department of Insurance also noted that residents in every county will have access to ACA coverage from at least one insurance company.

Healthcare Reform News Update for June 21, 2018
NY, MA Will Fight Trump Administration Over AHPs
The Democratic attorneys general for New York and Massachusetts will file a lawsuit against the Trump administration over its recent rule to expand access to lower-cost association health plans (AHPs).

The rule, finalized Tuesday, will allow self-employed individuals to join AHPs. In addition, the plans will not have to provide the 10 essential health benefits required under the Affordable Care Act, including emergency care, prescription drugs, and maternity care.

New York Attorney General Barbara Underwood and Massachusetts Attorney General Maura Healey say that the decision will "invite fraud, mismanagement, and deception."

"We believe the rule, as proposed, is unlawful and would lead to fewer critical consumer health protections," they said in a statement.
Kaiser Estimates ACA Eligibility Among the Uninsured
The Kaiser Family Foundation released an analysis that provides national and state-by-state estimates of how many uninsured Americans are eligible for Affordable Care Act healthcare coverage.

Of the 27.5 million nonelderly uninsured people in the country in 2016, the analysis found that:
Oscar Health ACA Plans Expand Into 3 New States
Oscar Health is expanding its coverage area and will sell Affordable Care Act plans in Florida, Arizona, and Michigan in 2019. The company will also serve three new metropolitan areas in Ohio, Tennessee, and Texas, where it already offers insurance. In total, the company will sell 2019 ACA coverage in nine states.

Currently, there are 240,000 people signed up for Oscar plans, which is more than double last year's enrollment.

Healthcare Reform News Update for June 20, 2018
Trump Administration Releases Final Rule on Association Health Plans
The Trump administration on Tuesday announced its finalized rules on expanding access to association health plans (AHPs).

AHPs allow small businesses to purchase health insurance across state lines at a lower cost. The new rules permit self-employed individuals to join AHPs, which will not be required to offer some essential health benefits outlined in the Affordable Care Act (ACA).

The plans can't set premium rates based on pre-existing conditions, but they can vary rates based on age, occupation, or place of business.

"You're going to save massive amounts of money and have much better health care. It's going to cost you much less," Trump said in a speech to the National Federation of Independent Business.

Labor Secretary Alexander Acosta said the plans could be available to millions of new enrollees as soon as September 1.

"As the cost of insurance for small businesses has been increasing, the percentage of small businesses offering health care coverage has been dropping substantially," Acosta said. "Today, the Trump administration helps level the playing field between large companies and small businesses."

Critics believe AHPs are "junk health insurance" and will cause healthy people to leave ACA plans, destabilizing the ACA marketplace. Some point out that, in the past, similar plans committed insurance fraud; therefore, more protections should be put in place.

As a reaction to the expected decrease in enrollment, the Congressional Budget Office (CBO) projects 2019 ACA premiums to rise by 2 to 3 percent.
Conservative Policymakers Release New ACA Repeal and Replace Plan
A coalition of conservative groups, led by the Heritage Foundation, the Galen Institute, and former Senator Rick Santorum (R-PA), unveiled a new plan Tuesday to repeal and replace the Affordable Care Act.

The plan states: "After efforts to repeal and replace Obamacare fell short last year, many in Congress seem resigned to accepting the status quo or even willing to bail out and prop up the program. But Obamacare is broken, can't be fixed, and continues to do great harm."

Proposals in the plan include eliminating the ACA's essential health benefits and providing block grants to states instead of the current use of insurance subsidies and Medicaid expansion.

The plan is not expected to pass in Congress this year, as lawmakers have other priorities.

Healthcare Reform News Update for June 19, 2018
Report: ACA Helped Reduce Number of Uninsured Children
Uninsured children in the U.S. dropped by 2.2 million after the enactment of the Affordable Care Act in 2014, according to a study from the State Health Access Data Assistance Center (SHADAC).

The study compared insurance coverage from 2013 to 2016 overall and by individual factors such as income, race/ethnicity, and education levels.

The largest reduction of children without insurance was from families that were low-income, Hispanic, and non-white. Children in families with low education levels also benefitted.

The study examined coverage at the national and state levels, and the results include individual data for each state. For example, Georgia saw a decrease of more than 85,000 uninsured children, and Texas lowered the rate of uninsured children by 23.1 percent during the study period.
Bipartisan Governors Pledge Support for ACA Consumer Protections
A bipartisan group of nine governors issued a joint statement Monday speaking out against a Trump administration decision that could jeopardize access to healthcare for people with a history of medical problems.

In a recent legal brief, the Justice Department said it will no longer defend the portion of the Affordable Care Act that relates to pre-existing conditions.

"We're asking the Administration to reverse their decision and instead work with Congress and Governors on bipartisan solutions to protect coverage and lower health care costs for all Americans, all while protecting those with preexisting conditions," according to the statement.

Governors from the following states signed the statement: Colorado, Ohio, Alaska, Pennsylvania, Nevada, Montana, Maryland, Washington, and North Carolina.
Younger People Willing to Trade Privacy for Lower Premiums
The majority of people between 18 and 34 would be willing to share their social media information in exchange for lower health insurance premiums, according to a recent poll by software company MuleSoft Inc.

When 8,000 global respondents were asked if they'd be "happy for insurers to use third-party data" from sources such as Facebook, Fitbits, and smart-home devices to lower insurance costs, here's how the age groups answered:

The survey also found spit opinions on digital offerings from insurance companies with 58 percent saying the systems don't work adequately, and 56 percent saying they would drop their provider if the digital service was poor.
Maine Governor Continues to Fight ACA Medicaid Expansion
A Maine judge denied a motion filed by Republican Governor Paul LePage to delay the voter-approved expansion of Medicaid under the Affordable Care Act. Superior Court Justice Michaela Murphy said LePage's administration must file the paperwork to begin the process. The governor said he would also fight this latest order.

Healthcare Reform News Update for June 18, 2018
2019 ACA Premiums to Rise in Washington DC, Fall in Minnesota
Health insurance companies in the District of Columbia and Minnesota have filed their premium rate requests for 2019 Affordable Care Act plans.

In D.C., the average request increases premiums about 15 percent compared to 2018 plans. In Minnesota, the rates are reduced about 12 percent on average.

Minnesota's rate reductions are due to the state's new reinsurance program, which offsets 80 percent of annual medical claim costs between $50,000 and $250,000 for individuals.

Actual rates will be finalized by insurance regulators before the annual enrollment period this fall.

Healthcare Reform News Update for June 15, 2018
Federal Court: Government Doesn't Have to Pay ACA Risk Corridor Payments
A federal appellate court ruled Thursday that that the U.S. government does not owe health insurers over $12 billion sought in unpaid Affordable Care Act risk corridor funds.

Because Congress made the risk corridor payments budget neutral, the three-judge court agreed that the government could not tap other sources of money to pay for insurers' losses.

The temporary risk corridor program was set up in the early years of the ACA for insurance companies that were making a profit to help companies that were struggling. However, too many insurers requested risk corridor money, and too few paid into the fund.
Healthcare Groups Oppose Justice Department's ACA Decision
Eleven friend-of-the-court briefs have been filed by a variety of interested parties regarding the Justice Department's decision not to defend some Affordable Care Act provisions, including protections for people with pre-existing conditions. All but one brief is against the decision.

Groups opposed to the decision represent insurance companies, medical schools, hospitals, and patient advocacy. The one brief filed in favor of the Trump administration's position was from a coalition of gun-owner's groups and the conservative organization Citizens United.

Healthcare Reform News Update for June 14, 2018
Actuary Group: Government Policies Are Driving ACA Premium Increases
Affordable Care Act premium hikes are being caused primarily from the increase of healthcare costs and policy changes from the Trump administration, according to a report released by the American Academy of Actuaries on Wednesday.

"The individual market, which had shown signs of stabilizing, now faces a potential deterioration of the risk pool due to policy changes that reduce incentives for healthy individuals to enroll in ACA marketplace plans. This deterioration and other factors could drive premiums higher for 2019," said Cori Uccello, the group's senior health fellow.

According to the report, national policy changes driving the increases include the:

Healthcare actions by individual states are also a factor in the expected premium increases. In addition, policy changes are affecting insurance company assumptions for 2019 plans.

The group found that healthcare costs for 2019 are projected to rise between 5 to 8 percent.
House Democrats Question HHS & CMS Leaders About ACA Protections
A letter from House Democratic lawmakers to Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma asks if they were involved in the Justice Department's decision to not defend central protections of the Affordable Care Act, including those for people with pre-existing conditions.

Signed by several ranking members of House committees, the letter asks about the existence of any analysis that may have been conducted that could have affected the decision and if they had plans to address any confusion the decision may cause.

"In declining to defend these protections in the Texas v. United States lawsuit, the Trump Administration is seeking to invalidate these critical patient protections, and once again subject tens of millions of Americans with pre-existing conditions to the discrimination they faced before the ACA," the lawmakers wrote.

Healthcare Reform News Update for June 13, 2018
Azar, McConnell Affirm Support of Pre-Existing Condition Safeguards
Health and Human Services Secretary Alex Azar told the Senate Health, Education, Labor, and Pensions Committee he believes that the Affordable Care Act's protections for people with pre-existing conditions should be maintained.

Azar said the Justice Department's position that the law's protections should be nullified is "a constitutional position ... not a policy position." When asked if he would urge the administration to revise its opinion, Azar said, "we do believe in finding solutions on the matter of pre-existing conditions and the matter of affordability, regardless of the litigation."

Senate Majority Leader Mitch McConnell (R-KY) on Tuesday also expressed his support of the protections. "Everybody I know in the Senate - everybody - is in favor of maintaining coverage for pre-existing conditions. There is no difference in opinion about that whatsoever," he said.

Healthcare Reform News Update for June 11, 2018
California AG & AHIP to Fight Government's ACA Case
California Attorney General Xavier Becerra and the insurance company lobbying group America's Health Insurance Plans (AHIP) have separately made statements that they will defend the Affordable Care Act against measures taken by the Trump administration.

The Justice Department on Thursday requested that a federal court invalidate some provisions of the law, including the individual mandate and protections for pre-existing conditions. Becerra is leading an effort by several Democratic attorneys general to defend the ACA in the case.

"It's, simply put, an attack on the healthcare that millions of Americans have come to count on [...]," Becerra said about the Justice Department's decision.

AHIP announced Friday that it would file an amicus brief to provide specifics on the damage that could come from invalidating the ACA measures.

"Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019," AHIP said in a statement.
KFF Tracks 2019 ACA Premium Changes
As it's done since 2014, the Kaiser Family Foundation is monitoring and compiling insurance company filing information for next year's Affordable Care Act plan premiums.

The analysis displays 2019 proposed premium rates for a major city in each state. The charts provide rates for a 40-year-old nonsmoker for the lowest-cost bronze plan and the second-lowest cost silver plan, which is used to determine subsidy rates. In addition, a tracker shows the number of insurance companies offering ACA plans in each state and the average difference in rates compared to 2018.

KFF will update the information as it becomes publicly available.

Healthcare Reform News Update for June 8, 2018

Trump Administration Reviewing ACA Consumer Protections, Individual Mandate

The Justice Department told a federal court Thursday that it would no longer defend key parts of the Affordable Care Act, including provisions that protect people with pre-existing conditions, saying they are part of an unconstitutional scheme.

In a brief filed in a Texas federal court, the department said the individual mandate was unconstitutional. It also said that the protections for people with pre-existing conditions should be eliminated.

The brief said that other portions of the law, including Medicaid expansion, health insurance marketplaces, and premium subsidies could remain as-is.

If a federal court agrees with the Justice Department, ACA consumer protections could be abolished. Any court rulings regarding the brief could take months to decide.
NC Farm Bureau Requests Association Health Plan
Following the lead of groups in Tennessee and Iowa, the North Carolina Farm Bureau has asked the state Senate to approve an association health plan that does not meet Affordable Care Act consumer protections.

Details of the plan have not been released, but the president of the bureau said premiums would vary based on an enrollee's pre-existing conditions or medical history.
VA Governor Signs Medicaid Expansion Bill
Virginia Governor Ralph Northam (D) signed a bill into law Thursday allowing about 400,000 low-income residents to enroll in Medicaid, making it the 33rd state to do so under the Affordable Care Act.

"As a doctor and a public servant, I believe making sure all Virginians have the access to the care they need to be healthy and productive is both a moral and economic imperative," said Northam.
Medicare Advantage Plans Could Skirt Chronic Care Act Benefits
Insurance companies that offer Medicare Advantage plans may not offer new benefits outlined in the Chronic Care Act to avoid enrolling seniors with fragile health conditions, according to a new analysis in the New England Journal of Medicine.

The new law expands nonmedical services that MA plans can cover, such as scooters, grab bars, hearing aids, and personal care services. The analysis warns that insurance companies may fail to offer these extra benefits to keep costlier, severely ill seniors from joining the plans.

Representatives from insurance companies dispute the analysis. For example, they say the authors did not take into consideration Medicare Advantage Dual Eligible Special Need Plans (D-SNPs), which enroll chronically ill beneficiaries.

"The argument being made by these authors is speculative and does not recognize some of the important realities of the Medicare Advantage program," said AHIP spokesperson Cathryn Donaldson.

Healthcare Reform News Update for June 7, 2018
HHS to Allow Insurance Companies to Practice 'Silver Loading'
Health and Human Services Secretary Alex Azar said Wednesday that his department will continue to allow insurance companies to practice "silver loading" for 2019 Affordable Care Act policies.

During a hearing before the House Education and Workforce Committee, Azar said banning silver loading was not possible for 2019 because it would "require regulations, which simply couldn't be done in time."

Silver loading raises the premiums of midlevel silver plans, which causes subsidy rates to rise accordingly. The practice can lower the out-of-pocket costs for enrollees eligible for tax subsidies, in some cases making low-level bronze plan premiums $0 per month. However, the practice increases the amount the government pays and can make premium prices for higher-income enrollees a burden.

Healthcare Reform News Update for June 6, 2018
Medicare Financials Worsening Due Partly to ACA Mandate Repeal
Medicare program trustees said Tuesday that Medicare Part A, which covers inpatient hospital stays, could run out of money by 2026, three years sooner than estimated a year ago.

In their annual report, trustees said Medicare's insurance trust fund for hospital expenses is not sufficiently financed because of lower payroll taxes, Social Security tax cuts, the repeal of the Affordable Care Act's individual mandate penalties, and the repeal of an ACA board responsible for overseeing spending.

The repeal of the individual mandate is expected to increase the number of uninsured Americans, which could leave hospitals with increased rates of uncompensated care. A Medicare fund helps hospitals with high numbers of uninsured patients cover those costs.

Treasury Secretary Steven Mnuchin says that efforts by the Trump administration will help reduce the financial outlook for both Medicare and Social Security. "Robust economic growth will help to ensure their lasting stability," he said.

Medicare Part B, which covers doctor visits and outpatient care, is expected to remain solvent.
ACA's Risk Adjustment Program Affects Plan Rates for Low-, High-Risk Insurers
Because of the way the Affordable Care Act's risk adjustment program is structured, insurance companies that don't anticipate a large drop in ACA plan enrollment for 2019 are proposing premium increases.

The risk adjustment program requires plans with low-risk younger, healthier enrollment to help offset plans with older, sicker members.

The Trump administration's repeal of the ACA's individual mandate is expected to cause low-risk people to drop their coverage. With fewer enrollees in the plan, insurance companies that pay into the risk adjustment plan will either have to increase their risk adjustment dollars or pay less into the system, which in turn affects high-risk plans.

"Even if any given insurer doesn't actually expect their members to dis-enroll, they still have to raise premiums because this is a community-rated market," said Erin Trish, a health policy professor at the University of Southern California.
Senate Democrat Vows to Force Healthcare Votes in August
After Senate Majority Leader Mitch McConnell (R-KY) canceled a scheduled August recess, Senate Majority Leader Chuck Schumer (D-NY) announced that he wants to use that time to put five Democratic-backed healthcare proposals up for a vote.

In a letter to McConnell, Schumer wrote, "We believe this previously unscheduled session time can be put to good use to finally help Americans secure the affordable health care the President and Congressional Republicans have thus far failed to deliver."

Healthcare Reform News Update for June 5, 2018
New York, Washington Propose 2019 Double-Digit ACA Premium Hikes
Health insurance companies in New York and Washington have submitted double-digit rate hike requests for 2019 plans sold on the Affordable Care Act exchanges.

Fourteen insurers in New York have asked state regulators to raise rates an average of 24 percent due to the repeal of the ACA's individual mandate. State regulators estimate that premium requests would have increased 12 percent without the repeal.

In Washington, rate hikes averaged 19.08 percent, citing the Trump administration's recent proposals for short-term insurance and association plans as the cause.

The rate requests must be approved by the states prior to being implemented.
Judge Orders Maine Governor to Implement ACA Medicaid Expansion
In November, Maine voters approved the expansion of Medicaid through the Affordable Care Act, but Republican Governor Paul LePage has delayed implementation. A state judge on Monday gave LaPage a deadline of June 11 to submit details to the federal government.

The expansion would provide 70,000 low-income residents with health coverage.

Healthcare Reform News Update for June 4, 2018
Business Coalition Objects to IRS's Handling of ACA Employer Mandate
Business trade groups, including the U.S. Chamber of Commerce and the National Retail Association, have sent a letter to the Trump administration objecting to the Internal Revenue Service's tactics in collecting assessments for the Affordable Care Act's employer mandate.

The coalition believes the IRS has not followed due process requirements in collecting approximately $4.3 billion in 2015 taxes. The letter states that the assessments should be suspended due to the "cost, complexity and confusion surrounding compliance with the employer mandate."

More than 30,000 employers owe taxes due to the ACA regulation mandating that companies with 50 or more full-time employees provide health insurance, according to the IRS.
Texas Insurance Company Delays New ER Payment Policy
Blue Cross and Blue Shield of Texas will delay its new emergency room payment policy for 60 days while the state's insurance department seeks clarification on how the company's process will be implemented.

The company plans to charge its 500,000 HMO plan members 100 percent of ER costs if it's determined that the visit was not related to a serious or life-threatening condition.

Texas Insurance Commissioner Kent Sullivan requested information on the company's denial process, patient appeal rights, and communication methods to new members.
Medicare Beneficiaries Paying More for Brand-Name Drugs
Throughout a five-year period, Medicare beneficiaries decreased their Part D brand-name prescriptions by 17 percent but spent 40 percent more in out-of-pocket costs due to rising prices, according to a new report released today by the Health and Human Services inspector general's office.

Between 2011 and 2015, the annual cost of brand-name drugs rose on average from $161 to $225. These costs will continue to rise, according to the report.

Other findings include:

Healthcare Reform News Update for May 31, 2018
NJ Governor Signs State Individual Health Insurance Mandate
New Jersey Governor Phil Murphy has enacted an individual mandate law that requires all state residents to have health insurance or pay a penalty.

Similar to the recently repealed Affordable Care Act individual mandate, the state's penalty is 2.5 percent of household income or $2,085 per person, whichever is higher. The maximum penalty will be the average annual cost of a bronze plan. Residents who cannot afford health coverage could receive a hardship exemption determined by the state treasurer.

The law goes into effect January 1, 2019. The expected $90 to $100 million collected in penalties from the law will be used to fund a state reinsurance program.

The new law is the second state individual mandate in the country. Massachusetts enacted its law in 2006.
Virginia to Enact ACA Medicaid Expansion
The Virginia legislature voted Wednesday to expand Medicaid to as many as 400,000 residents under the Affordable Care Act. The state becomes the 33rd to adopt the program.

Virginia's program includes a work requirement and a mandate that enrollees who earn wages over the federal poverty line must pay more out-of-pocket for medical services.
Majority of Healthcare Groups Critical of President's Insurance Proposals
More than 95 percent of healthcare groups oppose two recent proposals from the Trump administration, according to a Los Angeles Times' analysis of comments submitted to federal agencies.

More than 300 groups representing patients, consumers, physicians, nurses, hospitals, clinics, and insurance companies have left public comments in letters filed with federal agencies about proposed rules to expand short-term coverage plans and loosen association health plan regulations.

The review found that:

Healthcare Reform News Update for May 25, 2018
Bipartisan Bill Proposes Delay of ACA's Health Insurance Tax Until 2021
A bill introduced Thursday by bipartisan House members proposes to delay the Affordable Care Act's health insurance tax until 2021.

The tax was enacted in 2014, but it was suspended last year and for 2019. Insurance companies are required to pay the tax for this year.

A delay of the tax could help prevent premium increases of up to 2.8 percent; however, it could also lead to a decrease in federal revenue by $144.7 billion over 10 years.

Healthcare Reform News Update for May 24, 2018
CBO Report: ACA Premiums, Number of Uninsured to Rise Through 2028
The Congressional Budget Office (CBO) issued a report Wednesday projecting a 15 percent rise in silver plan premiums and an additional 3 million uninsured people next year. The report projects continued increases through 2028, with premiums rising about 7 percent each year and the number of uninsured rising to 35 million people.

The increases are due to the repeal of the Affordable Care Act's individual mandate and other alterations of the law by the Trump administration, according to the report.

The CBO also estimates the total cost of subsidies for ACA health plans and other individual health coverage will be $55 billion this year.

Healthcare Reform News Update for May 22, 2018
CDC Survey: 2017 Uninsured Rate Remained Steady at 9.1%
In 2017, the uninsured rate remained flat at 9.1 percent, which is just over 29 million people, according to a new survey from the Centers for Disease Control and Prevention (CDC).

Although the overall numbers were statistically unchanged from the end of the Obama administration into the beginning of President Donald Trump's presidency, some groups are seeing a rise in not having insurance coverage. The CDC's data show that:

The middle-class uninsured rate rose to 8.2 percent possibly due to rising premiums and no subsidized coverage.

Uninsured rates rose to an average of 19 percent in states that did not expand Medicaid coverage per the Affordable Care Act.

The survey also found a rise in the use of high-deductible health plans with almost 44 percent of insured Americans with deductibles that are at least $1,300 for individuals and $2,600 for families.

Healthcare Reform News Update for May 21, 2018
Four Healthcare Bills in Virginia Rejected by Governor
Virginia Governor Ralph Northam (D) on Friday vetoed four separate pieces of healthcare legislation that he said would destabilize the marketplace.

The vetoed bills sought to establish association plans, create nonprofit "benefits consortiums," allow the purchase of short-term policies for up to a year, and allow more people to purchase catastrophic health plans.

In each of his veto statements, Northam said, "this legislation would place consumers at risk of being underinsured and would fragment Virginia's federal marketplace risk pool, leading to rapidly increasing premiums."

Northam would prefer to lower healthcare costs by expanding Medicaid to the state's low-income adults. In each veto statement, he said, "we are fortunate to have a better opportunity to expand healthcare to people who need it and make it more affordable for all Virginians."
Maryland Reinsurance Program Delayed
A $462 million reinsurance program proposal created by Maryland has been delayed, and acceptance is uncertain due to a disagreement from the two insurance companies that sell plans on the state's Affordable Care Act exchange.

Kaiser Permanente of the Mid-Atlantic States claims that the reinsurance plan would favor CareFirst BlueCross BlueShield through "double dipping" the reinsurance program and a separate federal risk adjustment plan.

The state's ACA marketplace, The Maryland Health Benefit Exchange, has asked for an independent analysis, which will not be complete until June 30. This poses a problem for the state as the deadline to file an application with the Centers for Medicare & Medicaid Services is May 31.

Healthcare Reform News Update for May 18, 2018
Insurance Companies Selling ACA Plans Received Highest Profits in 2017
Companies selling individual health plans on the Affordable Care Act marketplace posted their strongest financial year in 2017, according to a new Kaiser Family Foundation report.

The findings are based on two different financial indicators:

The average share of health premiums paid out in claims fell to 82 percent in 2017. In 2016, it was 96 percent. In 2015, it was 103 percent.

Average premiums collected in excess of claims were $79 in 2017 per member per month, compared to $14 in 2016 and $9 in 2015.

The analysis indicates that future profitability is unclear. "These new data from 2017 offer further evidence that insurers in the individual market are regaining profitability, even as political and policy un

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Below is a summary of recent events to help you stay current on healthcare reform news all in one place. ACA Special Enrollment Period Extended Through August 15 The Biden administration announced Tuesday that the Affordable Care Act (ACA) Special Enrollment Period (SEP) for the federal healthcare exchange has been extended through August 15.

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Newswise - ITHACA, N.Y. - A Cornell University animal scientist studying relationships between insulin and milk production in dairy cows has received a three-year, $500,000 grant from the U.S. Department of Agriculture National Institute of Food and Agriculture.

Joseph McFadden, associate professor of dairy cattle biology in the College of Agriculture and Life Sciences, will use the funds to identify mechanisms that control insulin resistance in lactating cows. Under normal circumstances, insulin resistance in cows is an adaptation that helps channel glucose and other key nutrients towards making milk in early lactation. Unfortunately, insulin resistance may become uncontrolled postpartum, leading to the breakdown of fats and metabolic disease.

The grant will look specifically at the role of ceramide, a sphingolipid formed by saturated fatty acids, which has been associated with the development of Type 2 Diabetes in non-ruminants. With the grant, McFadden will investigate possible roles that ceramide plays in cows.

"Our goal is to define the mechanisms that mediate insulin resistance in dairy cows," McFadden said. "This animal science research is important because increases in milk production efficiency and improvements in animal health are needed to support a sustainable dairy industry."

The hormone insulin helps regulate blood sugar, while also affecting fat and protein metabolism. Insulin resistance in early lactation rises to deliver the proper nutrients for making milk while also breaking down stored fats. Healthy cows in mid-lactation will experience improvements in insulin sensitivity, which redirects nutrients towards building fat in the body and away from the mammary glands, leading to less milk production.

Historically, one approach that was developed to keep milk flowing at higher volumes, was to utilize recombinant bovine growth hormone (i.e., somatotropin), which lowers insulin sensitivity to promote efficient milk production with less environmental impact; however, the consumer acceptance of this biotechnology has decreased its use on farms in recent years.

Previous research in McFadden's lab suggests the synthesis and accumulation of ceramide in response to the breakdown of fat in early lactation inhibits insulin sensitivity in order to spare glucose and direct it to mammary glands for milk production. McFadden's research has also hinted that ceramide mediates somatropin's ability to inhibit insulin and promote lactation.

In the study, McFadden will use approved pharmacological approaches to block ceramide synthesis to determine if ceramide causes insulin resistance and promotes the use of glucose for milk production in dairy cows.

The grant has two objectives: First, to determine whether inhibiting ceramide synthesis enhances insulin sensitivity and metabolic health in early lactation cows; and second, to test whether ceramide mediates somatropin's ability to spare glucose for milk production.

"By characterizing the mechanisms of insulin resistance in cattle, we can then work towards developing nutritional approaches to target these mechanisms and thus enhance milk production and health in cattle," McFadden said.
For additional information, see this Cornell Chronicle story.
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USDA grant seeks to enhance milk production and cow health

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Newswise - ITHACA, N.Y. - A Cornell University animal scientist studying relationships between insulin and milk production in dairy cows has received a three-year, $500,000 grant from the U.S. Department of Agriculture National Institute of Food and Agriculture.

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Cows and their basic needs

Left to their own devices, cows live in herds of around 20 individuals together with their young, establishing a clear hierarchy with an alpha cow. They spend most of their time grazing, covering several kilometers per day. Their other main pastime is rumination, during which they lie down and rest.

Cows are intelligent and emotional individuals

Cows are extremely inquisitive and intelligent animals. They have long-term memories and can learn from one another. Cows have distinct personalities and forge close, lifelong friendships. The bond between a mother cow and her calves is particularly strong. Like humans, they mourn the loss of friends and family members. Cows are affectionate mothers and share the responsibility of watching over their playful calves with other females in the herd.

Cows in the dairy industry

On today's industrial dairy farms, cows are bred specifically to maximise milk production. As a result of this breeding, the average milk yield per cow has risen dramatically over the years. Calves naturally require about eight litres of milk per day for healthy growth. In contrast, modern breeds of dairy cows on industrial farms produce up to 12,000 litres of milk per year, bout 20 litres per day on average. The lactation period of a cow (the time in which a cow produces milk) is about 305 days. Within the first 100 days 50% of milk and up to 50 liters per day are produced. As a result, while the number of cows on dairy farms in Europe has declined over the years, the volume of milk produced has increased. In order to produce a single litre of milk, a cow's body must pump half a tonne of blood through her udder.

Living conditions and treatment of dairy cows

Pasture feeding

Contrary to popular belief and what industry advertisers would like people to believe, even pasture-fed dairy cows do not spend all their time in pastures. The exact grazing time in the EU is unknown. The available estimates indicate great variability on grass access; from 98% of cows in Ireland, that have access to grass on seasonal bases, to 10% in Greece and almost zero in Bulgarian dairy farms. The rest of the year, they usually live in either tie stalls or cubicles. Cows seen grazing outside are typically beef cattle or young dairy cows before their first calving.

Tie stalls

On many commercial dairy farms, cows live in cramped stalls, tied in place with a chain or rope. Many people never heard or read anything about tie stalls These conditions are so restrictive that, for much of their lives, cows in tie stalls are unable to walk, turn around, groom, look to the side, or interact with other herd members in a natural way.

Cubicles

In another common farming system, dairy cows live in 3.4 to 4.0 m² cubicles, with functional areas for resting, walking, feeding, and milking. In most cases, cubicle floors consist of concrete slats, making it slippery and stressful for cows to move around.

Cow's milk is mother's milk

Newborn calves are separated from their mothers within a few hours of birth since the mother's milk is reserved for human consumption. The separation is traumatic for both the mother and h er calf. For constantly giving milk, dairy cows have to calve once a year which means that they will be inseminated again six to e

Dehorning of dairy cows

However, most modern farms dehorn calves to save space and reduce the risk of cows injuring each other due to the stress of their living conditions. Dehorning is a painful procedure in which the nerve endings and blood vessels from which the horns grow are burned off, usually without anaesthetic.

Calves as a 'byproduct' of the dairy industry

Most female calves born to dairy cows face the same fate as their mothers. They are isolated in small pens for the first eight weeks of their life , then spend the remainder of their lives producing milk for the dairy industry.

In total, more than 300 million cows are slaughtered and well as

Dairy cow slaughter

Between 10% and 20% of cows are pregnant when they are slaughtered. Because the stunning bolt affects only the mother cows, in many cases the unborn calves are conscious during the ordeal. Afterwards, they are killed by the workers.

Health risks of dairy consumption

Dairy products are among the most consumed animal products around the globe, with more than 110 kg per person consumed each year, most of it in European countries or North America.

Symptoms of lactose intolerance may include bloating, diarrhoea, gas, nausea, and pain in the abdomen. Another reason is cow's milk allergy (CMA). CMA is the most common form of food allergy in infants and children, and is the result of an immunological reaction to certain proteins in cow's milk, particularly β-lactoglobulin and casein, which can cause immediate hypersensitivity reactions. Chemical contaminants in milk and dairy products, such as antibiotics, hormones, and pesticides, also play a role in consumer choices.

Milk alternatives are growing in popularity

More and more consumers are questioning the consumption of cow's milk and the effects that our diets have on animals, the environment, and our health. This is also reflected in the increasing demand for non-dairy milk. Plant milks have been consumed for centuries in various cultures, but their popularity has skyrocketed over the past decade. People choose plant milks over dairy milk for a variety of reasons. Whether it is for their nutritional value, animal welfare reasons, lower environmental impact, to avoid lactose or dairy milk allergens, or simply out of preference, there are many delicious options to try.
Read the ProVeg Plant Milk Report to learn more about non-dairy milk alternatives.
ProVeg supports the availability of plant-based milk alternatives

ProVeg does not only point out healthy, cruelty-free alternatives but also makes them more readily available. ProVeg supports and facilitates a range of vegan events throughout the year, from annual happenings such as VeggieWorld and VegMed to important one-off events such as CEVA trainings and legal and political symposiums. Furthermore, ProVeg advises and supports innovative companies that want to enrich the veggie market with their products. This ranges from mentoring early-stage start-ups to consulting for major international supermarket brands and administering the V-Label, which guarantees that a product is either vegan or vegetarian. Find out more about what we do to help the world transition to a more plant-based society and economy that are sustainable for humans, animals, and our planet.

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Treatment of cows in the dairy industry - ProVeg International

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Left to their own devices, cows live in herds of around 20 individuals together with their young, establishing a clear hierarchy with an alpha cow. They spend most of their time grazing, covering several kilometers per day. Their other main pastime is rumination, during which they lie down and rest.

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Needpix/Pxhere
We've heard a lot about what Americans think about things this election year.
From who they're going to vote for, to their opinions on issues from climate change to health care, opinion polls have spent countless hours and dollars trying to get inside the mind of the average American adult.

And with election day just around the corner, an old survey has come to light that has the potential to divide voters like nothing else: chocolate milk.

tracy benjamin/Flickr

According to an official survey, a disturbingly high number of Americans aren't quite sure where chocolate milk actually comes from. When asked by the Innovation Center for Food and Dairy, 48% of respondents admitted that they didn't know.

Even more worryingly, 7% of people said that they thought chocolate milk came from brown cows.

The survey was conducted in 2017 with 1,000 people aged 18 and over, but IFLScience worked out that if you multiply that figure for the whole US population, that's an alarming 16.4 million Americans who potentially believe chocolate milk comes from brown cows.

PA Images

The survey also saw respondents own up in large numbers to secret milk-drinking habits. A shocking 37% of people said they drank milk straight out of the container, with 29% saying they used their kids as an excuse to buy chocolate milk to drink for themselves. There's no shame in drinking chocolate milk, you guys.

With only 5% saying they don't drink milk at all, if this survey tells us anything, it's that Americans love their dairy products, and they don't really care about where they come from.

Of course, as The Conversation points out, we shouldn't take the original survey entirely at face value, as it's impossible to know how the respondents were selected or how the survey was carried out - online, over the phone, or face to face, for example. We also don't know if there were options given to respondents to answer, or the wording of the questions.

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Millions Of Americans Think Chocolate Milk Comes From Brown Cows

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We've heard a lot about what Americans think about things this election year. From who they're going to vote for, to their opinions on issues from climate change to health care, opinion polls have spent countless hours and dollars trying to get inside the mind of the average American adult.

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Elianna Corruption of presidential votes

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Elianna Corruption of presidential votes

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https://www.loc.gov/classroom-materials/elections/issues-from-past-presidential-campaigns/opposition-to-corruption/

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Elianna False advertising is the food industry.

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Elianna False advertising is the food industry.

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https://sites.udel.edu/understand-de-ag/2019/11/04/misleading-marketing-in-the-food-industry/

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There are many possible health benefits of milk. These include bone and heart health.

Milk is a natural food source for mammals. Animals, including humans, produce milk to feed their young until they are ready for solid food.

As such, milk contains valuable nutrients that help support a growing body, including calcium and protein.

Research about milk is conflicting, however, with different studies claiming milk is either good or bad for the body.

Due to rising concerns about health, lactose intolerance, and animal welfare, plant-based milk, and dairy alternatives are gaining popularity.

This article looks at the potential health benefits of cow's milk and discusses alternatives.

Official sources, such as the Dietary Guidelines for Americans 2015-2020, recommend that adults eat about 3 cup-equivalent of low fat or fat-free dairy each day as part of a healthful diet.

This amount can include milk, yogurt, cheese, and fortified soy beverages.

The following sections look at the possible benefits of milk for human health.

Calcium is an essential nutrient for strong bones and teeth, muscle movement, and nerve signals. Health authorities recommend getting enough calcium to help prevent bone fractures and osteoporosis.

Milk offers a rich source of calcium. Manufacturers fortify cow's milk with vitamin D, another nutrient that benefits bone health.

While calcium is important, not all studies agree that milk is good for preventing osteoporosis or fractures, as a 2019 review discusses. Due to this discrepancy, scientists still need to do more research.

Milk is a source of potassium, which can help the blood vessels dilate and reduce blood pressure.

Getting more potassium while also reducing sodium (salt) intake can lower blood pressure, reducing the risk of heart disease and stroke.

Many people in the U.S. do not get their recommended daily requirement for potassium of 3,400 milligrams (mg) in males and 2,600 mg for females.

Other potassium-rich foods besides milk include:

Cow's milk also contains a high amount of saturated fat and cholesterol, which can increase the risk of heart disease, so people should eat dairy in moderation.

Milk contains calcium and vitamin D, two nutrients that may help protect against cancer.

Calcium may the gut lining to reduce the risk of colon cancer or rectum cancer. However, research has linked too much calcium with prostate cancer.

Vitamin D might play a role in cell growth regulation. It protect against colon cancer, and possibly prostate and breast cancer. However, research has also linked high vitamin D levels to an increased risk of pancreatic cancer.

Many factors affect cancer risk. Likewise, cancer can take a long time to develop, so it is difficult to study its causes and risk factors.

Scientists still need more long-term research to establish the facts with any certainty.

Adequate vitamin D levels the production of serotonin, a hormone people associate with mood, appetite, and sleep.

Research, including a 2020 review, has linked vitamin D deficiency with clinical depression.

Manufacturers often fortify cow's milk and plant milk with vitamin D.

Cow's milk helps baby cows grow fast, so it makes sense that cow's milk can aid muscle growth. Cow's milk is a rich source of high quality protein, containing all essential amino acids.

Whole milk is also a rich source of energy in the form of saturated fat, which can prevent muscle mass from being used for energy.

Low fat milk can provide the benefits of milk while supplying less fat.

Osteoarthritis of the knee currently has no cure, but researchers say they have linked drinking milk every day to reduced progression of the disease.

Their research appeared in the American College of Rheumatology journal Arthritis Care & Research.

According to the Dietary Guidelines for Americans 2015-2020, the dairy group includes cow's milk and soy milk. The group contains the following key nutrients:

The nutritional breakdown of milk depends on the fat content.

A 100-gram (g) serving of whole milk with 3.25% fat :

A 100-g serving of low fat milk :

43 calories

4.97 g of carbohydrates

0.97 g of fat

3.48 g of protein

A 100-g serving of soy milk :

33 calories

1.67 g of carbohydrates

1.67 g of fat

2.92 g of protein

Some important nutrients that all milk provides include:
Calcium
Dairy products, including milk, are among the richest dietary sources of calcium. Calcium is essential for bone and tooth health, blood clotting, and blood pressure.

Pair calcium-rich foods with sources of magnesium and vitamin D, as vitamin D supports calcium absorption in the small intestine, and magnesium helps the body incorporate calcium into the bones.
Choline
Choline is an important nutrient for sleep, muscle movement, learning, and memory. It also helps with nerve signals, fat absorption, and inflammation.
Potassium
Potassium is vital for heart health, which includes reducing the risk of stroke, heart disease, and high blood pressure.

A 100-g serving of cow's milk contains around 162 mg of potassium, slightly more than in many soy milk beverages.

In the case of lactose intolerance, however, a symptom such as diarrhea can lead to potassium depletion.
Fortified vitamins and minerals
Manufacturers fortify most milk, including cow's, soy, almond, and others, with additional vitamins and minerals that are not present naturally. These added nutrients include vitamin A, riboflavin, vitamin B-12, and pyridoxine.

Exposure to light destroys some vitamins, especially A and riboflavin, so milk that people store in transparent containers will have lower nutrient levels.

The following sections look at the possible adverse health effects of drinking milk.

Saturated fats

Dairy is high in saturated fats. The American Heart Association (AHA) point out that eating too many saturated fats can increase cholesterol levels, raising the risk of heart disease and stroke.

The AHA recommend that people get no more than of their total calories from saturated fats.

Lactose intolerance

Lactose intolerance is a condition where the body does not produce lactase, an enzyme it needs to break down a sugar called lactose that occurs in milk.

An estimated 65% of people have a reduced ability to digest lactose after infancy. It is most common in people of East Asian descent, affecting 70-100% of these populations.

Milk allergy

A milk allergy, or hypersensitivity, is different from lactose intolerance. In an allergy, the body reacts to the proteins, not the sugars, in milk.

A cow's milk allergy can cause symptoms, such as wheezing and asthma, diarrhea, vomiting, and gastrointestinal distress. Severe allergies can lead to anaphylaxis, a life threatening allergic reaction.

Too much potassium or phosphorous

Getting too much of certain nutrients can be harmful. Overconsumption from diet alone is rare, but certain medications or medical conditions can make it more likely.

If a person has kidney problems, too much potassium or phosphorous can be harmful. Too much potassium is known as hyperkalemia.

Too much calcium

Too much calcium, or hypercalcemia, can cause constipation, kidney stones, or kidney failure. It is rare for this to happen from diet alone, but it can be a risk when a person is taking calcium supplements.

Hormones and antibiotics

Cow's milk may contain residues of hormones and antibiotics, as well as dioxins and polychlorinated biphenyls (PCBs).

These residue substances can have a negative impact on human health, including adverse effects on the nervous system, reproductive system, and immune system. They may potentially raise the risk of certain types of cancer.

While calcium and vitamin D from cow's milk can benefit bone health, there is also some evidence that animal proteins in the diet, for example, from cow's milk, have an acidifying effect.

According to Harvard researchers, this could harm bone health by causing the body to pull calcium from the bones to restore optimal blood pH levels. Not all agree with this, however.

As such, the net benefit of calcium in cow's milk may be lower than expected.

For infants

The Centers for Disease Control and Protection (CDC) say that infants should not drink cow's milk before 12 months of age. This is because cow's milk has too many proteins and minerals for an infant's kidneys to handle and may put them at risk of intestinal bleeding.

Anyone who has an allergy or intolerance to cow's milk, or who is considering avoiding cow's milk for ethical or environmental reasons, can try milk alternatives.

A range of substitute milks, such as almond, soy, coconut, hemp, and oat, are available.

According to the Dietary Guidelines for Americans, soy beverages fortified with calcium, vitamin A and vitamin D are part of the dairy food group as they have similar nutritional composition to milk.

Other milk alternatives made from plants may contain calcium but are not part of the dairy group as their nutritional profile is not similar to soy milk or cow's milk.

Read a comparison guide to different milks, including almond, hemp, oat, soy, and cow, here, and a guide to dairy alternatives, including cheese, yogurt, and butter, here.

Cow's milk is a good source of calcium, protein, and other important nutrients that can have benefits for health.

According to one Harvard researcher, however, dairy is not necessary for optimal health. Many others recommend it, though, and many people find cow's milk an easy way to get essential nutrients, including calcium, vitamin D, and protein.

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Milk is rich in vital nutrients, but some research shows it can be harmful, too. This article looks at the benefits and risks of milk and explores alternatives.

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Being a Cheerleader - Is Cheerleading a Sport?

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Every cheerleader gets fired up when someone sparks the "Is cheerleading a sport?" debate. Whether it's a football player in one of your classes, a teacher who talks down about cheerleading, or a friend who doesn't understand why you're not involved in something else "more athletic," you want people to know that cheerleaders are athletes.

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News about health care reform. Commentary and archival information about health care reform from The New York Times.

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News about Snowboarding, including commentary and archival articles published in The New York Times.

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Got chocolate milk? A popular choice among both children and adults, the beverage is not only yummy but also good for you. All milk, flavored or not, has the same unique combination of essential nutrients. Plain and flavored milk include three out of the four nutrients of concern for kids: calcium, vitamin D and potassium. Check out more reasons why chocolate milk is a good choice:

Kids need the nutrients. Milk drinkers meet their needs for calcium, magnesium, potassium and vitamin A much quicker than non-milk drinkers. The Dietary Guidelines for Americans recommends three servings of low-fat or fat-free dairy for children every day.

Kids who drink flavored milk consume more nutrients than - yet have a comparable body weight to - children who don't drink milk.

Kids who drink flavored milk are less likely to drink soda or juice, which are empty calories with almost no nutritional value.

Kids drink more milk when it's flavored. Children are more likely to get their three daily servings if flavored milk is an option.

In schools, 70 percent of milk kids choose is flavored, low-fat chocolate being the most popular choice.

Studies have shown that removing flavored milk from schools results in a dramatic drop in milk consumption, which means these kids miss out on essential nutrients.

Added sugar is minimal. There has been worry that flavored milk at school contributes to high intake of added sugars in kids, but research shows that flavored milk only contributes 3 percent of added sugars in kids' diets.

An 8-ounce serving of chocolate milk has 12 grams of naturally occurring lactose (milk sugar), and chocolate milk in schools has only 8-12 grams of added sugar.

Dairy companies have worked with schools to reduce the amount of sugar by 38 percent - making nearly all of the chocolate milk served in schools less than 150 calories for an 8-ounce serving. In fact, flavored milk only has 31 more calories than white milk.

So go ahead and enjoy the chocolate milk - and encourage your kids to do the same at school. They'll get the essential nutrients they need to grow strong and focus well in school.

1. Murphy MM, Douglass JS, Johnson RK, Spence LA. Drinking flavored or plain milk is positively associated with nutrient intake and is not associated with adverse effects on weight status in US children and adolescents. J Am Diet Assoc. 2008 Apr;108(4):631-9.

2. Frary CD, Johnson, RK, Wang MQ. Journal of Adolescent Health 2004;34, 56-63

3. The impact on student milk consumption and nutrient intakes from eliminating flavored milk inschools. 2009. MilkPEP research conducted by Prime Consulting Group. Presented at the SchoolNutrition Association Annual National Conference, 2010.

4. National Health and Nutrition Examination Survey, NHANES (2003-2006), ages 2-18

5. 2011-2012 Projected School Milk Product Profile, MilkPEP School Channel Survey, conducted by Prime Consulting Group. This is a joint project of the Milk Processor Education Program (MilkPEP), the National Dairy Council and the School Nutrition Association, conducted July, 2011. Reponses were received from processors who collectively serve over 51,000, or 53% of all K-12 public schools.

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3 Reasons to Keep Chocolate Milk in Schools

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Got chocolate milk? A popular choice among both children and adults, the beverage is not only yummy but also good for you. All milk, flavored or not, has the same unique combination of essential nutrients. Plain and flavored milk include three out of the four nutrients of concern for kids: calcium, vitamin D and potassium.

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Freeriding is defined by the use of natural terrain, and it tackles nature and natural challenges head-on. It eschews artificial obstacles such as rails and halfpipes that freestylers rely on, and it does not require remote regions associated with backcountry riding. It can take place almost anywhere, from tree-lined glades on the side of ski trails to wide-open faces. While a good deal of freeriding takes place outside of judged events, there is a Freeride World Tour series of events.

Because the goal is to be able to handle all terrain and snow types, freeride boards tend to be longer and stiffer and are matched with stiffer boots in order to give riders more float over deep and varied conditions. The boards are generally directional in style (with a distinct nose and tail, differentiating them from twin-tipped boards that can be ridden either way).

Backcountry and big mountain

Focused entirely on riding outside a resort's boundaries, backcountry and big mountain snowboarding takes the fluid flow of freeriding to more remote wilderness locations. While riders often use resorts to access out-of-bounds terrain, there are no artificial features or elements in backcountry snowboarding. Riders access wilderness terrains in various ways, from hiking, snowshoeing, and splitboarding (in which a snowboard can be converted to alpine skis) to the use of snowmobiles and even helicopters.

The goal is to ride untouched lines, and the backcountry journey often leads riders to peaks and locations deep in the wilderness. Riding in these situations demands high attention to mountain safety and usually a slower, more strategic approach to descending a mountain. Competitive backcountry riding is virtually nonexistent.

Because of the deeper snow and rugged conditions, backcountry riders use some of the longest and stiffest snowboards available, with stiff boots and bindings to match. Increasingly popular are splitboards, traditional snowboard decks that have been cut in half in order to double as Alpine-approach skis for accessing the backcountry. Snowboarders can now climb a slope like an Alpine skier, which involves transporting a snowboard on one's back and then descending as a snowboarder.

Backcountry freeride competitions

There is limited formal competition for this style of snowboarding, which spectators mostly encounter via films and video documentaries.

These backcountry freeriders might snowboard down a pitch that has never before been negotiated or jump off a cliff that has never before been attempted. They may snowboard on mountains that have already been ridden but do so with a level of technical difficulty or style that establishes a new benchmark for the sport and that venue.

Some backcountry and freeride competitions have found some measure of success, most notably the annual "King of the Hill" competition that was held in the Chugach Mountains of Alaska in the 1980s and '90s. Riders descended ridiculously steep faces while a panel of judges watched and awarded scores based on the riders' command of the terrain. Though this competition no longer exists, the newer Freeride World Tour draws an international class of riders who take turns descending a predetermined section of a mountain while judges rank them on line choice, degree of difficulty, style, and control.

Alpine snowboarding

Alpine snowboarding, often called freecarving, was the most popular style of snowboarding in the mid-1980s during the infancy of the sport, when snowboarders used the existing infrastructure of ski resorts and the venues of ski racing. By the end of the 1990s, however, most die-hard snowboarders had rejected alpine snowboarding as little more than skiing on boards. It continues to share many characteristics with skiing, especially in its slalom varieties, where the emphasis is not on jumps and tricks but expert carving, often at great speeds.

Slalom racing

In common with ski racing, snowboard slalom races involve weaving down courses made up of offset poles, or "gates," protruding from the snow, which the athletes must navigate around as fast as they can. These are considered technical contests because of the required tightness of the turns.

Each athlete's run through the course is timed, and the rider with the fastest time wins. The spacing of the gates in a slalom race is relatively close together (25 to 50 feet [8 to 15 metres] apart), forcing snowboarders to make dramatically quick tight turns. As the name implies, the giant slalom is the same type of race but with the space between the gates roughly doubled (80 to 105 feet [24 to 32 metres] apart), compelling riders to execute longer and less-frequent turns but at faster speeds. The gates are still farther apart in the Super-G (100 to 130 feet [30 to 40 metres] apart), with riders often reaching speeds of 60 miles (97 km) per hour. The parallel versions of these races (the "parallel slalom" and "parallel giant slalom") pit riders in head-to-head competition on side-by-side tracks.

Snowboard cross (boardercross)

Snowboard cross (originally and still frequently called boardercross) is an event where multiple riders (four in Olympic competition) race simultaneously down the same inclined course with banked turns, jumps, berms, drops, and other artificial features that test the competitors' balance and control at maximum speeds. Collisions among the competitors are not uncommon. The first rider to the end of the course is the winner in snowboarding's version of motocross racing.

Typically a field of 40 to 60 competitors will each take one timed run down the course alone to establish a seeding order and to allow competitive brackets to be created. Once these brackets are established, racers will go head-to-head, with the top three in each heat advancing to the next bracket. In this way, the field is narrowed to a final group of racers. In the final heat, the first rider to cross the finish line is the winner of the competition.
Torah Bright

Olympic Games: Nagano, Japan, 1998

Two new sports, curling and snowboarding, were added to the Winter Olympic program. Snowboarding made a somewhat ignominious debut when Canadian Ross Rebagliati, the sport's first Olympic gold medalist, tested positive for marijuana use; he was promptly disqualified. A day later the decision was overturned on appeal, and Rebagliati was...

Originally, snowboarding competitions were governed by the International Snowboarding Federation (ISF), which was formed in 1991 and began holding world championships in 1992. The FIS recognized snowboarding as a sport in 1994 and began holding its own world championships in snowboarding in 1996. Shortly afterward, the...

Nagano 1998 Olympic Winter Games

Two new sports, curling and snowboarding, were added to the Winter Olympic program. Snowboarding made a somewhat ignominious debut when Canadian Ross Rebagliati, the sport's first Olympic gold medalist, tested positive for marijuana use; he was promptly disqualified. A day later the decision was overturned on appeal, and Rebagliati was...

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Snowboarding - Snowboarding - Freeriding: Freeriding is defined by the use of natural terrain, and it tackles nature and natural challenges head-on. It eschews artificial obstacles such as rails and halfpipes that freestylers rely on, and it does not require remote regions associated with backcountry riding.

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Abstract

Universal health coverage has become a rallying cry in health policy, but it is often presented as a consensual, technical project. It is not.

A review of the broader international literature on the origins of universal coverage shows that it is intrinsically political and cannot be achieved without recognition of its dependence on, and consequences for, both governance and politics.

On one hand, a variety of comparative research has shown that health coverage is associated with democratic political accountability. Democratization, and in particular left-wing parties, gives governments particular cause to expand health coverage. On the other hand, governance, the ways states make and implement decisions, shapes any decision to strive for universal health coverage and the shape of its implementation.

Universal health coverage (UHC) has become a focal point in global health conversations. In the spirit of previous unifying concepts such as Health for All, basic health needs, and the Alma-Ata declaration, it presents a vision in which all citizens will enjoy (1) a strong and efficient health system that spans preventive and curative medicine, (2) affordable access to that health system, (3) access to relevant medicines, and (4) sufficient human resources for the health system. The 2010 World Health Report presented UHC as an objective and a strategy for its member states to reform, or design, their health systems. 1 UHC has been the focus of much research and policy prescription since then. Various authors have shown its implications for the health workforce and its governance, 2,3 health financing, 4 and management. 5

But is UHC likely to be attained? We draw on political science and public health literature to argue that politics and governance have been undervalued as key drivers for universal health coverage.

UNIVERSAL HEALTH COVERAGE IS POLITICAL

It is a political victory that UHC is discussed at all, and still more so that it has any veneer of consensus. UHC is a highly political concept. In the world of global health governance, it is part of an ongoing debate about the relative importance of "vertical" priorities such as disease eradication and broader "horizontal" system-strengthening proposals. 6,7 Given the momentum behind disease-specific interventions and the appeal of solving particular problems (e.g., antiretrovirals or polio eradication), it is always difficult to argue for more amorphous health system goals that are part of UHC or predecessor agendas. 8

The contentiousness of global health politics is nothing like the domestic politics of UHC or universal health care access by any other name. The US State Department has even objected to a World Health Organization fact sheet on the right to health. 9 Observation of politics in the United States, 10,11 or reading about the history of health politics anywhere, supports this point. UHC is expensive and redistributive; that is enough to make it contentious. 12,13 As if that were not enough, UHC also builds in additional contentious goals such as efficiency or access and medicines. 14-16 It is unwise to assume that UHC goals are entrenched in the countries that have broadly achieved them, to overstate the influence of health ministries or advocates committed to UHC, or to overstate the degree of consensus among governments that have adopted them on paper. 17,18

If any generalization about UHC holds, it is that democratization promotes it. Middle-income countries can broadly afford to aim for UHC, but they are most likely to enact access expansions when they have governments that are accountable to the population. 19-21 The effects of widespread democratization from the 1970s to the late 1990s help to explain the expansion of UHC in middle-income countries today. 22-25 Authoritarian regimes, by contrast, are less responsive to the broad population, can discourage or repress organized challenges, and therefore often focus benefits on a narrower set of people who are part of the regime or who can threaten it (e.g., by striking or staging a military coup). The result has been the historical pattern of segmentation that southern Europe and Latin America have had to confront, in which a few crucial sets of workers (especially the public sector and key strategic industries) enjoy extensive health and other benefits and groups without the capacity to threaten the regime receive less. 19,26-28

Partisan politics are one of the most promising avenues for explaining UHC. In particular, left-wing parties are more likely to enact redistributive policies such as UHC. 27,29-31 Socialist parties enacted universal health care across southern Europe when they came to power after democratization, 32 despite major recessions that might be expected to block health access expansion, and later it was the left that universalized health care in Latin American countries such as Brazil and Chile. 33,34 Conservative parties have also at times expanded health coverage for their own political purposes. 20,35 Otto von Bismarck created the first social health insurance in response to socialist challenges, Japan's health insurance expansion came about as a response to a left labor challenge to the dominant conservative Liberal Democratic Party, and the expansion of health care access in Mexico was partly a strategy to maintain the popularity of its once-dominant Party of the Institutional Revolution. 36,37

Democracy and partisanship do not automatically produce UHC; UHC still needs organized support and faces organized opposition. 38-40 Unorganized voters are unlikely to have their preferences reflected in any political system. The complexities of organization, political coalitions, and parties, a long-standing issue in comparative politics, therefore demand attention; the relationship between left-party success and UHC policies is not simple, 31 and part of the reason is the interaction between politics and governance.

GOVERNANCE

"Good governance" is a widely supported goal, but there is great disagreement about what it is and how it is to be attained. 41,42 Governance discussion often mixes governance as a phenomenon (how decisions are made) with normative policy advice (how decisions should be made and implemented, i.e., good governance). Governance as a phenomenon is the institutional framework of the decisions and policy implementation. 43 A review of components of governance in the health and broader policy literatures by authors associated with the European Observatory on Health Systems and Policies found that diverse authors focused on the same five areas in which governance can affect health systems: transparency, participation, accountability, integrity (management and anticorruption measures), and policymaking capacity. 44

Governance shapes the likelihood that UHC will be adopted and actually implemented for three reasons. First, it is a prerequisite for some policies. Just as policies for UHC can cost too much for a given state, they can also demand a level of expertise, accountability, and good public administration that is not always available. In particular, elaborate public-private, market-based, and personal insurance schemes can overwhelm the capacity to design, regulate, and operate them. 44

Second, governance, particularly political institutions, can shape the likelihood of pro-UHC forces winning in politics. Veto points at which a policy can be blocked include bicameralism, referenda, strong supreme courts, and some forms of federalism; they are correlated with slower increases of expenditure, less redistribution, and less programmatic coherence, although they also slow retrenchment. 29 Among the rich countries, the United States and Switzerland stand out for the expense, slow development, and inegalitarianism of their health systems and for their particularly high number of veto points. Their many veto points make opposition easier, demand larger political coalitions, and allow interest groups to extract a higher price for their support. 45-48

Third, governance affects the likelihood that programs will be entrenched by affording programs greater or lesser real effectiveness and greater or lesser political defenses. Although the post-Communist states have shown that it is politically very difficult to take away UHC, 19 their experiences also show that a system that only formally delivers UHC can engender effective privatization through exit from the system (into private provision) or informal payments. Ineffective programs engender less loyalty. Alternatively, governments can lock in UHC achievements by making the systems transparent and accountable to affected groups who will in the future be able to ward off efforts to reduce government commitments or undermine achievements. 49 A well-crafted policy includes governance changes that promote its own political survival by biasing policymaking toward groups who defend UHC. Just as Latin American's military regimes left institutional safeguards for their interests, 50 UHC advocates should pay attention to ways they can create institutional safeguards for a right to health. "Policies create politics," after all. 51

CONCLUSIONS

There is a strong tendency to discuss UHC as though it were a settled goal that only requires technical follow-up. This approach contradicts or at least underplays a large body of evidence suggesting that UHC is potentially transformative and intensely political, and depends on the features of a country's governance. Without support in domestic politics, a redistributive policy such as UHC is unlikely to happen. Without political support in the international arena, it can be undermined by advocates of other attractive goals such as programs focused on single diseases. Decision-making and implementation-governance-can support or hinder UHC advocates and deserve attention for the ways in which they can bias decisions and improve or hinder implementation.

For researchers, this means that we need to apply ourselves to better understanding the mechanisms connecting governance, political forces, and UHC decisions; although studies have pointed to the interplay of parties and institutions under democratization, much still remains to be understood about the coalitions and political strategies that shape UHC politics. For UHC advocates, this means that technical skills and advice should be regarded as resources to be used in what are ultimately political fights within countries, that the commitment to UHC by member states is a resource for political argument rather than a binding obligation, and that attention to health governance should come with an explicit objective of strengthening those who seek UHC.

Human Participant Protection

No protocol approval was necessary because this work was not considered human participant research.

References

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Universal Health Coverage: A Political Struggle and Governance Challenge

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Universal health coverage has become a rallying cry in health policy, but it is often presented as a consensual, technical project. It is not.A review of the broader international literature on the origins of universal coverage shows that it is intrinsically ...