DOL Regulations on Health Plans
The Trump Administration continued its assault on the Affordable Care Act. On Friday, January 5, the Department of Labor published a proposed regulation to broaden the definition of group health plans for small businesses. The regulation is seen by ACA advocates as an attempt to circumvent some of the provisions of the ACA—especially the requirement to provide the ten essential benefits in any insurance policy. Those benefits require coverage of critical services including maternity coverage and mental health and substance use services.

The Administration touted it as an effort to “expand the opportunity to offer employment-based health insurance to small businesses through Small Business Health Plans, also known as Association Health Plans.” It is argued such flexibility will allow businesses to purchase cheaper plans because they will be more restrictive in coverage then what health insurance will be covered now under the ACA. Comments are due by March 6, 2018.

Medicaid Work Requirements and Youth Formerly in Foster Care
Also on Thursday there were news reports that the Administration would use the general waiver authority that exists under Title XIX to allow states to impose new work requirements for Medicaid patients. The goal is to target a specific population of adults who could potentially lose health insurance coverage due to the new requirements. According to an analysis of the Kaiser Family Foundation:

“…among the nearly 25 million non-SSI adults (ages 19-64) enrolled in Medicaid in 2016, 6 in 10 (60%) are working themselves. A larger share, nearly 8 in 10 (79%), are in families with at least one worker, with nearly two-thirds (64%) with a full-time worker and another 14% with a part-time worker; one of the adults in such families may not work, often due to caregiving or other responsibilities.”

Under the ACA, young people who aged out of foster care are eligible to age 26 for Medicaid coverage—at least in the state they lived while in foster care. These young people, at least according to some surveys, are frequently unemployed at least part of their lives. Some of these same surveys indicate these young people are more likely to lack a high school degree. Looking at the Kaiser Foundation information about 38 percent of these non-elderly adults under 26 years of age are unemployed. In addition, 42 percent lack a high school degree.

Among those reporting on the potential new Medicaid waiver guidance, the Hill newspaper highlighted a speech by CMS Commissioner Seema Verma that criticized the ACA for expanding Medicaid to able-bodied adults. Under the ACA Medicaid can be expanded to adults and families at 138 percent of poverty ($16,642 for an individual). It became a state option instead of mandate because of the Supreme Court decision in 2012. Currently 32 states have taken this option with Maine voters approving the expansion this past November election.

Enrollment Finals
The ACA final adjusted number for 2018 enrollments was set by HHS to a total of 8.7 million people. Less than the 9.2 million for 2017 but significantly better than the earlier projections. HHS shut down open enrollment on Friday, December 15 converting what had been a 12-week enrollment period down to 6 weeks.
Many observers were projecting that enrollment numbers would fall off by as much as 20 percent due to the shortened open sign-up period. That would have meant nearly two million fewer people. The HHS-CMS numbers do not include sign ups through state exchanges.

State sign-up deadlines for states running their own health care exchanges: California, New York, Washington, D.C.: Jan. 31, – Massachusetts: Jan. 23, Washington: Jan. 15, Minnesota: Jan. 14, Colorado: Jan. 12, Rhode Island: Dec. 31 and for Connecticut and Maryland, December 22.

Collins Commitment
With the tax bill dealing a blow to the Affordable Care Act by doing away with the individual mandate, one issue that may be addressed this week is how Senate Majority Leader McConnell will fulfill his commitment to Senator Susan Collins (R-ME). One her requirements for her vote was that a repeal of the mandate through the tax bill would result in Congress acting on two bills: her bill sponsored with Senator Bill Nelson (D-FL) and the Alexander-Murray bill. The first bill provides some backup to coverage of high catastrophic costs for some insured individuals. The Alexander-Murray bill continues the subsidies (CRS) for two more years.
There was no vote on the Collin’s commitment in December. As a result, will Senator McConnell seek a vote, when and will the House and the President go along.