In the Health Reform Update for this week, Congress finally reaches agreement on a two-year spending plan that would authorize the Children’s Health Insurance Program (CHIP) for ten years and accelerate the closing of the Medicare Part D “doughnut hole”. The bill signed by the President also repeals the controversial Medicare cost-cutting board created by the Affordable Care Act (ACA) and further delays the ACA cuts in disproportionate share payments for safety-net hospitals.
The President’s proposes his own budget that would repeal the ACA and block grant Medicaid. However, it also signals his support for restoring the ACA cost-sharing reductions and risk corridor funding in order to stabilize Marketplaces in the interim. Republican leaders are proposing to let states again segregate costly patients into high-risk pools, in an effort to break the Congressional impasse over market stabilization packages.
Final numbers from the Centers for Medicare and Medicaid Services show that total enrollment in ACA Marketplaces for the 2018 open enrollment period nearly matched last year’s totals despite fewer weeks to enroll, a 90 percent cut in marketing and outreach, and dramatic premium spikes caused by the loss of cost-sharing reductions. The 15 Marketplaces created by states actually increased their overall enrollment.
Indiana becomes the second state to receive federal approval to impose work requirements and lock-out periods on Medicaid enrollees, leading five states to push for approval to also set lifetime limits on benefits. House Republicans in Virginia agree to drop their long-standing opposition to Medicaid expansion if work requirements are allowed. Blue Cross becomes the first Idaho insurer willing to offer plans that can increase premiums based on health status, under the discretion granted by the Governor.