Insurance Coverage and Medical Care

While a federal district court struck down the Affordable Care Act as unconstitutional on December 14, the Act and the litigation will continue. The judge didn’t issue a nationwide injunction which would have had the effect of immediately ceasing all aspects of law.

Unsurprisingly, the states defending the law have stated they will appeal this ruling to the Eleventh Circuit. Particularly if the Eleventh Circuit agrees with the lower court the Supreme Court is likely to hear this case though not until its next term beginning October 2019.

The Affordable Care Act individual mandate required uninsured who didn’t purchase health insurance to pay a so-called shared-responsibility payment. In 2012 the Supreme Court held the individual mandate is a constitutional “exercise of Congress’s Tax Power because it triggered a tax.” The Tax Cuts and Jobs Act of 2017 reduced the tax to $0 as of January 1, 2019.

CSG Midwest
Wisconsin has received federal approval of changes to its Medicaid program that include requiring work for some enrollees and charging higher premiums based on the results of a health risk assessment. The approved waiver centers on childless adults applying for and receiving coverage through the public health insurance program. According to The Washington Post, Wisconsin also had originally sought to become the first state in the nation to impose drug tests on some of its Medicaid population. This requirement did not receive federal approval.

Ballot measures to expand Medicaid eligibility in Idaho, Nebraska and Utah passed in the mid-term elections. Montana voters rejected a measure to continue the expansion in their state.

On Oct. 22, the federal government issued new draft regulations concerning 1332 waivers. In a call to CSG from the Centers for Medicare and Medicaid Services (CMS), officials explained the new regulations would provide more flexibility to states, revising the “guardrails” set in the 2012 regulations. Plans previously considered non-ACA compliant could be sold on the marketplaces and could qualify for federal subsidies. 

CSG Midwest
By 2022, every hospital emergency room in Illinois must have staff that can provide specialized care to victims of sexual assault. This new requirement is the result of HB 5245, a bill passed unanimously by the General Assembly and signed into law this summer. Under the law, a trained provider will have to be present in the emergency room within 90 minutes of the patient arriving in the hospital. According to the Illinois attorney general’s office, few hospitals currently provide specialized care for sexual assault victims.
CSG Midwest
Residents living in more than half of the nation’s counties have only one insurer to choose from on their state’s Affordable Care Act health insurance exchange. This lack of options is most prevalent in rural areas: 41 percent of enrollees in non-metro counties vs. the overall rate of 21 percent, according to the Kaiser Family Foundation.
Could the creation of agricultural cooperative health plans help fill insurance gaps, offer more choices for consumers and lower costs?

Yesterday, the U.S. Census Bureau released a report with 2017 data on health insurance status in each state. In 2017, 28.5 million people (or 8.8 percent) did not have health insurance at any point during the year. The uninsured rate and number were not statistically different from 2016. In some states the uninsured rate change between 2016 and 2017 was statistically significant. In three states – California, Louisiana, and New York—the percentage of people without insurance decreased, but in 14 states the percentage increased. The states where the uninsured rates increased are Connecticut, Florida, Georgia, Illinois, Iowa, Massachusetts, Minnesota, Ohio, Oregon, South Carolina, Tennessee, Texas, Vermont and West Virginia.

Chapter 9 of The Book of the States 2018 contains the following tables:

For three days in September 2018, state legislative leaders in the health arena will meet at the CSG Medicaid Leadership Academy to hear from federal government representatives and officials from health policy organizations and state Medicaid programs about innovative programs in states that are improving health outcomes and reducing health care costs.

Presentation topics will include dementia-competent care in Virginia, a telehealth diabetes monitoring program in Mississippi, a proposal in Oklahoma to move to value-based...

The Supreme Court has long resolved whether and when state law claims against drug manufacturers are preempted by federal law. The Third Circuit ruling in Merck Sharp & Dohme Corp. v. Albrecht is very favorable to state-law claims and likely will be modified, if not reversed, by the Supreme Court.

The Food and Drug Administration’s (FDA) approval of a drug warning label does not necessarily insulate drug manufacturers from state-law failure-to-warn claims. In Wyeth v. Levine (2009), the Supreme Court held that state failure-to-warn claims are preempted when there is “clear evidence” the FDA would not have approved the warning a plaintiff claims was necessary. In Merck Sharp & Dohme Corp. v. Albrecht, Merck claims there was such “undisputed” evidence in this case but the Third Circuit improperly allowed the case go to a jury for “conjecture as to why the FDA rejected the proposed warning.”

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