Federal Healthcare Reform

In December 2018 a federal district court declared the Affordable Care Act (ACA) individual mandate unconstitutional. It also declared the remaining provisions of the act “inseverable,” meaning also invalid. The court didn’t issue a nationwide injunction which would have had the effect of immediately ceasing all aspects of law.

In the district court litigation the Department of Justice (DOJ) didn’t defend the individual mandate. But it did argue that other provisions of the ACA, excluding the guaranteed-issue and community-rating requirements, which were intended to provide affordable health insurance for those with pre-existing conditions, were severable. Now DOJ has informed the Fifth Circuit that it has changed course and agrees with the lower court that the entire ACA was properly invalidated.

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. 

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.

Virginia Legislature Votes for Expansion

On May 30, the Virginia Senate voted, with 4 Republicans supporting the measure, to expand Medicaid eligibility to all individuals with income at or below 138 percent of the federal poverty line, according to the Washington Post. Later in the day, the House of Delegates approved the bill by 67 to 31. Gov. Northam, a pediatrician who campaigned in 2017 on expanding Medicaid, is expected to sign the bill.

Both chambers in Wisconsin have passed a $200 million reinsurance plan that would provide funds to insurers for high-cost patients’ expenses to prevent ACA marketplace premium increases in 2019. The Governor has come out in support of the program and is expected to sign the bill, according to the Journal Sentinel.

Open enrollment for health insurance policies sold under the Affordable Care Act marketplaces ran for 6 weeks the end of 2017. Enrollment was down from 2017 – by 3.7 percent – but nonetheless 11,760,533 Americans selected a health insurance plan for 2018.

President Trump signed an executive order today that will allow businesses and individuals to buy association health plans that will not have to comply with the Affordable Care Act. See the official White House release about the provisions of the executive order here

The Georgetown University Center on Health Insurance Reforms has released a...

President Trump signed an executive order today that will allow businesses and individuals to buy association health plans that will not have to comply with the Affordable Care Act. See a video of the signing ceremony at the White House here. Read Washington Post coverage...

Today, NBC news published a report that President Trump has said he is about to sign an executive order to allow Americans to purchase health insurance policies across state lines. The ACA already has a provision for selling insurance across state lines so long as the plans meet certain minimum standards of coverage and five states have such laws on the books already. However, no insurer currently sells such policies.

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