Executive Order Could Mean Trouble in 2018

UrgentAlthough it has no immediate effect, the executive order the President signed yesterday morning instructs several federal agencies to consider proposals that could destabilize the individual insurance markets established under the Affordable Care Act (ACA).

The executive order instructs relevant agencies to propose regulations that would:

  • Expand the use of association health plans, which allow small businesses to group together to purchase health insurance;
  • Allow more people to enroll in short-term limited duration insurance, which are exempt from ACA consumer protections, for longer periods of time; and
  • Allow the sale of health insurance across state lines.

The expansion of association and short-term limited duration health plans would both create loopholes for younger, healthier consumers to purchase one of these plans instead of plans offered through the Marketplace. If younger, healthier people leave the Marketplace, premiums will rise for consumers that remain and may become unaffordable.

Selling insurance across state lines presents a different problem, especially for states like New York. New York has worked really hard to pass insurance regulations that protect consumers. Insurance sales across state lines would essentially allow insurance companies to choose their regulators, which would make insurance less available and less accountable to the needs of New Yorkers and consumers across the country.

If federal agencies do propose these rules as the President instructs, there will be an official notice of proposed rulemaking and at least a 30-day comment period before any new regulation would go into effect. It is therefore unlikely that any changes will take place before 2018.

This does not affect the upcoming open enrollment period, which will begin on November 1. If you or someone you know needs help enrolling in health insurance, please call (888) 614.5400 for in-person assistance in your area. Don’t forget, consumers enrolling in Medicaid, the Essential Plan, and Child Health Plus can enroll year-round.

You can check out additional resources on the executive order here.

CHP PictureIn the midst of the chaos being caused by the most recent effort to repeal and replace the Affordable Care Act, there is another very important program at risk: the Children’s Health Insurance Program (CHIP). CHIP covers more than 9 million children nationwide and more than 630,000 in New York State alone. Without Congressional action, federal funding for CHIP will expire on September 30 of this year. New York will exhaust its share of CHIP funds in March 2018.

But there is some good news! This morning, the Senate Finance Committee released a bill that would extend federal funding for CHIP for an additional five years – through 2022. The bill keeps the additional federal matching funds (or “the 23% bump”) for states through 2019. The bill would also extend other provisions of CHIP such as:

  • Child Enrollment Contingency Fund – this is for states that predict a CHIP funding shortfall because of higher than expected enrollment
  • Qualifying State Option – this is a rule that allows states to use CHIP funding to pay for the difference between Medicaid and CHIP reimbursement to providers who care for higher-income children in Medicaid expansion versions of CHIP
  • Express Lane Eligibility – this option allows states to use eligibility for other public programs to make eligibility determinations for CHIP. This makes it much easier for kids to get covered!
  • Affordability Standards – Premiums for CHIP cannot cost more than 5 percent of income for families earning less than 300 % of the Federal Poverty Level

New York’s kids and children across the country who rely on CHIP need this bill to make it across the finish line. Please join HCFANY for a webinar on Thursday, September 21 at 2PM to hear from Judith Arnold, Director, Division of Eligibility and Marketplace Integration at the New York State Department of Health, and some of our advocates here at HCFANY on CHIP, what it means for New York, and how you can get involved.

Check out HCFANY’s latest fact sheet on CHIP here.

orange-light-alarm-mdA new proposal from Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) that would devastate New York and the nation could pass as early as next week. An updated analysis from the Center on Budget and Policy Priorities (CBPP) estimates that New York State would lose more than $33 billion by 2027 under the Graham-Cassidy amendment – a last-ditch effort by the Senate to repeal and replace the Affordable Care Act (ACA) before September 30. CBPP says that beginning in 2027, Graham-Cassidy “would likely be even more damaging” than repealing the ACA without a replacement, which would have caused an estimated 32 million people to lose their health coverage.

The Graham-Cassidy amendment would:

  • End Medicaid Expansion and Advanced Premium Tax Credits (APTCs) that help make insurance more affordable in 2020 and convert all funds to a block-grant.
  • Require a state match to use any block-grant funds.
  • End the Medicaid program as we know it, by capping how much states can spend on each Medicaid recipient.

Graham-Cassidy would replace the federal funding for Medicaid Expansion and APTCs with a block-grant to states. According to CBPP, this block-grant would include a 17 percent cut to current federal funding levels by 2026 and would not be adjusted based on the size of a state’s Medicaid population or changes in a state’s funding needs. New York would experience the second largest funding cut in the nation. There is also no requirement in the amendment that states use this money on health coverage. This block-grant would completely disappear in 2027.

Your Representatives in Congress need to hear from you. Please call 844.898.1199 and tell your Representative to vote “NO” on this devastating proposal.

The Congressional Budget Office's logo

The Congressional Budget Office’s logo

Earlier this week, the non-partisan Congressional Budget Office (CBO) released a report on the effects of ending the Cost Sharing Reductions (CSRs), which help make out of pocket costs more affordable for consumers with incomes between 100 and 250 percent of the Federal Poverty Level. In New York, the CSRs also provide funding for the Essential Plan, which covers more than 665,000 New Yorkers. If the CSRs were eliminated beginning in January 2018, the CBO estimates:

  • One million Americans would become uninsured in 2018.
  • Five percent of Americans would live in counties where there are no insurers are offering Marketplace plans.
  • Premiums for the second-lowest-cost silver plans (the plans consumers must purchase in order to be eligible for CSRs) would increase 20 percent in 2018 and increase by 25 percent by 2020.
  • The federal deficit would increase by $6 billion in 2018, $21 billion in 2020, and $26 billion in 2026; and
  • There would be a net increase of one million more people with coverage by 2020.

However, the CBO report relies on three important assumptions to arrive at these estimates: (1) the decision to end CSR payments would be made in time for insurers to adjust the premiums they will charge consumers in 2018; (2) the Administration will continue paying CSRs each month from now until January 2018; and (3) insurers will absorb the loss of CSR payments by raising only the cost of the second-lowest-cost silver plan. If any of these assumptions are not met, the outcomes for consumers could differ dramatically from the CBO projections. For more details, check out this analysis from Health Affairs.

Recent reports say that the Trump Administration will make CSR payments for the month of August, but this does not provide consumers or insurers, who must finalize their 2018 premiums by early September, certainty for the next plan year. Here in New York State, the Department of Financial Services adjusted health insurance rates for silver plans by an average of 0.6 percent to account for the potential loss of CSRs.