State News Roundup - November/December 2021

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National Scorecard Ranks Arkansas 30th Among States in Healthcare Affordability
By Elizabeth Montgomery | Arkansas Center for Health Improvement | Nov. 30, 2021

The Healthcare Value Hub’s Healthcare Affordability State Policy Scorecard ranked Arkansas 30th out of 47 states, plus DC, in healthcare affordability, reports the Arkansas Center for Health Improvement. The scorecard gave Arkansas 29.9 out of 80 possible points and provided several recommendations to improve affordability, such as: enacting stronger price transparency requirements; pursuing coverage options for residents earning too much to qualify for Medicaid; and enacting protections against short-term, limited-duration health plans.

CMS Approves Arkansas’ Medicaid Expansion Redesign
By David Ramsey | Arkansas Times | Dec. 31, 2021

The federal government approved Arkansas’ Medicaid expansion waiver, but will only allow premiums to continue into 2022, reports the Arkansas Times. Arkansas’ new waiver does not include work requirements, which have been blocked by a federal judge, but does impose premium requirements for enrollees above 100 percent of the federal poverty level. The Obama administration originally approved the premium requirements and work requirements were approved under the Trump Administration. The Biden administration approved Arkansas’ Medicaid waiver program to begin in 2022—which purchases private insurance coverage for beneficiaries on the Marketplace—but added an addendum requiring premiums to phase out in 2022. The waiver did not request work requirements after the Biden administration revoked them in 2021.


​​​​Report Documents Continued Rise in Healthcare Costs in Colorado
By Martina Dolan | | Nov. 18, 2021

Colorado’s Center for Improving Value in Healthcare’s Community Dashboard documents the continued rise in healthcare costs for Coloradoans, reports The dashboard contains 2013-2020 data from Colorado’s APCD to document the increasing costs, despite positive trends showing less utilization of high-cost services and improved quality of care.

'Roadmap’ Points Colorado in Direction of Healthcare Equity, Improved Data Sharing
By Sara Wilson | Colorado Newsline | Dec. 6, 2021

Colorado’s Office of eHealth Innovation has released a refreshed version of the Colorado Health Information Technology Roadmap, a framework for leveraging technology to address gaps in the state’s healthcare systems, reports Colorado Newsline. The roadmap highlights three overarching goals: supporting better data sharing infrastructure; increasing access to healthcare through coordinated systems; and improving health equity. Success is defined as patients finding the care they need with doctors who are equipped to access shared clinical data, but connecting to the state’s health information exchanges can be difficult in rural communities. Implementing an electronic medical record system can be prohibitively expensive for smaller rural facilities. The roadmap also notes how COVID-19 highlighted inequities in telehealth use—the people who were most affected by the pandemic (the elderly and Black patients) could have been at a disadvantage for care, as they had lower rates of telemedicine adoption than the general population.

District of Columbia

D.C. Insurer to Set Up Fund to Address Health Disparities
By Julie Zauzmer Weil | Washington Post | Nov. 4, 2021

CareFirst—an insurance company that provides plans in D.C., Maryland and Virginia—will pay $95 million to set up a fund in D.C. to address health disparities, reports the Washington Post. This comes as the result of a years-long legal battle between the District and CareFirst over the insurer’s surplus funds. CareFirst agreed to establish a Health Equity Fund for the District and will provide grants to reduce health disparities or to address social and environmental problems that affect D.C. residents’ health.


Hawaii Ranks in Top Six States for Healthcare by Racial and Ethnic Groups
By Nicole Pasia | State of Reform | Dec. 1, 2021

Hawaii is one of six states that rank above average in healthcare for all ethnic groups, reports State of Reform. Hawaii ranked number 2 for Latinx/Hispanic groups; 5 for white; and 6 for Asian American, Native Hawaiian, Pacific Islander groups according to a Commonwealth Fund study; the study did not rank Hawaii for Black or American Indian, Alaska Native groups. Despite ranking above the national average for Latinx/Hispanic people, it ranked significantly lower than white and Asian American, Native Hawaiian, Pacific Islander groups. Hawaii’s low uninsurance rate and high rates of preventative care services may contribute to these high rankings, though the state still has rates of health disparities similar to those found across the country.


New Laws Focus on Hospital Debt, Healthcare for New Mothers
By Associated Press | Dec. 31, 2021

In 2022, two significant new healthcare laws will be taking effect in Maryland, reports the Associated Press. Firstly, Maryland Senate Bill 923 allows low-income individuals who are pregnant to receive healthcare under Medicaid for up to a year after giving birth, a substantial increase from the current coverage limit of 60 days. In addition, the Maryland Medical Debt Protection Act requires hospitals to relax debt collection practices for patients with lower incomes and may no longer charge interest or additional fees on an incurred debt. Hospitals likewise can’t sue patients over unpaid bills until at least 180 days after the initial charge.


University of St. Thomas Believes it Can Solve Healthcare Worker Shortage and Gaps in Racial Health Outcomes
By Joey Peters | Sahan Journal | Dec. 3, 2021

A new nursing program at the University of St. Thomas’ Morrison Family College of Health will focus on health equity and enroll at least 30 percent of the student body from historically excluded communities, reports the Sahan Journal. Currently, 91 percent of registered nurses in Minnesota are white and the school hopes to help create a more diverse and equity-focused nursing workforce. By relying less on academic metrics and more on an applicant’s background, St. Thomas hopes they will meet their benchmark. The nursing program will inject social justice advocacy into the curriculum by deploying nursing students on the streets of downtown Minneapolis to provide care for those experiencing homelessness through a partnership with Minneapolis Downtown Improvement District.

Minnesota’s Targeted Fix to the Family Glitch Should be an Example
By Lynn A. Blewett and Jennifer Schultz | Health Affairs Forefront | Dec. 1, 2021

Minnesota passed a law in June 2021 to implement a partial fix to the “family glitch” for low-income families by leveraging the state’s Basic Health Program—MinnesotaCare—to provide coverage to those with incomes between 133 and 200 percent of the federal poverty level, according to a post in Health Affairs Forefront. The plan provides coverage with low premiums, limited copays and no deductibles. The state will finance the entire cost of expanding MinnesotaCare to this newly eligible group with one-time general fund dollars and funds from Minnesota’s Health Care Access Fund. However, there is no federal Basic Health Plan financing, as newly eligible enrollees don’t qualify for a premium tax credit in a Marketplace Plan. The “family glitch” refers to an IRS interpretation of the premium tax credit eligibility requirement for those purchasing a Qualified Health Plan on the health insurance Marketplaces that results in some spouses and dependents being denied access to premium subsidies even when they do not have access to affordable employer coverage. An employer offer of coverage is considered affordable if the employee’s contribution toward the cost of the premium for employee-only coverage does not exceed 9.83 percent of the employee's household income, not whether the offer is affordable for a family.


Some Montana Nonprofit Hospitals Fall Short of Peers in Required Charitable Giving
By Katheryn Houghton | Kaiser Health News | Dec. 9, 2021

Montana’s richest nonprofit hospitals receive millions of dollars in tax exemptions each year to operate as charities, but Kaiser Health News reports that some fall short of other medical facilities in what they give back to their communities. Overall, Montana’s nearly 50 nonprofit hospitals directed, on average, roughly 8% of their total annual expenses toward community benefits, such as covering the treatment costs of people who can’t afford care, according to a KHN study of IRS filings ending in 2019. Notably, the state’s largest provider, Billings Clinic, spent roughly 5% of its operating costs on community benefits, while St. Luke Hospital reported 22%. Montana nonprofit hospitals face little to no oversight of their community benefit spending, though they use local needs assessments to help determine how to spend this money. A state audit estimated that hospitals combined had $146 million in tax exemptions in 2016 and reported spending $257 million on community benefits; however, the audit found that hospitals report benefits vaguely and inconsistently, making it hard to determine if they can justify their charity status.

New Hampshire

Expensive Dental Care Leads to Bad Teeth, Poor Health and Pain for Many in New Hampshire
By Karen Dandurant | Foster’s Daily Democrat | Dec. 16, 2021

For many people, basic dental care is out of reach, even for those who have health insurance, reports Foster’s Daily Democrat. Special insurance riders are needed before dentist visits will be covered by Medicaid, which only carries a dental benefit for children. Even people with dental coverage through their jobs can’t afford to pay their out-of-pocket costs. As a result, adults can be left with no access to a dentist and suffer through severe tooth pain, gum disease and worse, as well as develop serious oral diseases and other health problems. Because good dental care contributes to overall health, experts and physicians argue it should be covered by insurance. There have been efforts in New Hampshire to add adult dental benefits to Medicaid, and there are hopes a new bill will be reintroduced in 2022, after a previous version was vetoed by the governor in 2020.

New Jersey  

Governor Signs Important Telehealth Legislation
By Office of the Governor | Dec. 22, 2021

New legislation in New Jersey will require insurers to reimburse healthcare providers for telehealth and telemedicine services at the same rate as in-person services—originally enacted at the outset of the COVID-19 pandemic— with limited exceptions for the next two years, reports the Governor’s Office. The legislation also charges the state’s Department of Health with conducting an in-depth study of the use of telehealth and telemedicine and the effects on patient outcomes, quality and satisfaction and access to care in order to inform future decisions on payment structure for these services. The extension includes a requirement that audio-only behavioral healthcare services are reimbursed at the same rate as in-person services and prohibits insurance carriers from imposing geographic or technological restrictions on the provision of telehealth services, as long as they meet the same standard of care as if they were delivered in-person.

State Launches N.J. Healthcare Cost Benchmark Program
By Tom Bergeron | ROI-NJ | Dec. 22, 2021

New Jersey’s Governor signed an executive order that launched the New Jersey Health Care Cost Benchmark Program that will provide everyone in the state with a shared understanding of how much healthcare costs are growing and factors contributing to high health costs and cost growth, reports ROI-NJ. Over time, the program aims to decrease how much healthcare costs grow each year and to contribute to making healthcare more affordable. The program also offers an important opportunity to implement market-based strategies rooted in broad stakeholder commitment and industrywide collaboration.


Oregon Announces Funding Opportunity for Community-Based Organizations
By Jonathan Modie | Oregon Health Authority | Dec. 6, 2021

The Oregon Health Authority released a request for grant applications for community-based organizations that will create partnerships with underserved communities. More than $31 million in funding is available, as part of the authority’s goal to eliminate health inequities by 2030.

Many Patients Say Prescription Drug Costs in Oregon Are Still Crippling
By Liam Moriarty | Oregon Public Broadcasting | Dec. 9, 2021

Consumers in Oregon report not being able to afford their prescription drugs, despite a reduction in drug price increases, reports Oregon Public Broadcasting. Oregon lawmakers held a hearing on the results from the annual drug price transparency report and heard from consumers and advocates on their experiences affording prescription drugs. The number of drug cost increases decreased again in 2021, however the average launch price of new brand name drugs more than doubled—indicating that manufacturers may set a drug’s launch price higher to avoid making controversial price increases in following years. Findings from the report also included: 193 new “high-cost” drugs; cancer treatments make up the most of new high-cost drugs introduced; 71 drugs reporting annual price increases; the average price increase for generic drugs was 27 percent, compared to 13 percent for brand name drugs.

Oregon Prepares to Expand Coverage to Undocumented Adults
By Ben Botkin | Lund Report | Dec. 28, 2021

Oregon is preparing to offer free coverage to residents, regardless of immigration status, beginning in 2022, according to the Lund Report. The legislation, “Cover All People,” passed during the 2021 Regular Session and will go into effect in July 2022, providing an avenue for low-income undocumented immigrants to gain access to health insurance coverage. With only $100 million initially allocated, the program will be open to people regardless of immigration status who are between 19 and 25 years old and 55 and older, and will cover primary and preventive care, dental care and behavioral health services. Oregon joins six other states who have extended coverage to undocumented immigrant adults.

Rhode Island

OHIC Releases Rhode Island Market Summary Data
By Martina Dolan | | Nov. 2, 2021

Rhode Island’s Office of the Health Insurance Commissioner (OHIC) released data on trends in health insurance enrollment, enrollment demographics, cost trends, claims and other important information to highlight trends and shifts in the Rhode Island market, reports Findings included: the individual market has the highest cost-sharing; professional services represented almost one-third of the total fully insured market allowed claims; primary care allowed claims decreased in all markets except the individual market in 2020. The data from this market summary are intended to highlight the major cost drivers of health insurance premiums for advocates and policymakers.

Rhode Island Joins the Peterson-Milbank Program on Sustainable Health Care Costs
Milbank Memorial Fund | Nov. 11, 2021

Rhode Island joined the Peterson-Milbank Program for Sustainable Health Care Costs to improve the affordability of healthcare and contain unsustainable healthcare spending, according to the Milbank Memorial Fund. Rhode Island is an active player in implementing efforts to limit healthcare cost growth—with which the Peterson-Milbank program will provide technical assistance. Rhode Island aims to increase affordability gains for consumers and integrate an equity lens into their affordability work.

Rhode Island Insulin Cap to Go into Effect in 2022
By Katherine Gregg | Providence Journal | Dec. 30, 2021

Legislation capping the cost of insulin in Rhode Island will go into effect on Jan. 1, 2022, reports the Providence Journal. The law prohibits insurers from charging more than a $40 co-pay for a 30-day supply of insulin and prohibits applying a deductible to insulin drugs.


​​​​​​Utah Governor Unveils New Health Initiative to Reduce Costs and Improve Outcomes
The Office of the Governor | Nov. 18, 2021

The governor of Utah announced the formation of the Utah Sustainable Health Collaborative, according to a press release from the Governor’s Office. As part of the state’s effort to reduce healthcare costs and improve health outcomes, the collaborative will bring together stakeholder groups to pilot different models of health service delivery, access and payment.


Improved Affordability of Cascade Care Public Option Plans in 2022
By Madeline O’Brien | Georgetown University Health Policy Institute | December 2021

While the first year of Washington’s public option had higher prices than expected, the 2022 plan year is expected to offer lower rates and be available in more counties, according to the Georgetown University Health Policy Institute. In 2019, Washington’s first of its kind public option plan, Cascade Select, had premiums as much as 34 percent higher than traditional plans, and were offered in less than half of Washington’s counties, partly due to provider unwillingness to accept reduced reimbursement rates and the plans’ decreased cost-sharing. In response, the state passed legislation requiring hospital contracts and state-funded financial assistance for consumers. Now, 2022 plans are expected to be five percent lower and available in 25 counties instead of only 19, possibly influenced by state interventions, American Rescue Plan provisions and other factors.


Hospital Lawsuits Over Unpaid Bills Increased by 37 Percent in Wisconsin from 2001 to 2018
By Zack Cooper, James Han and Neale Mahoney | Health Affairs | December 2021

Hospital lawsuits to recover patients’ unpaid medical bills increased 37 percent from 2001-2018, from 1.12 per 1,000 residents in 2001 to 1.53 per 1,000 residents in 2018, according to a study in Health Affairs. In addition, these lawsuits disproportionately impacted Black patients and those living in poorer and less densely populated counties. In 2018 there were 1.86 lawsuits per 1,000 Black residents, 1.32 per 1,000 white residents, 1.10 per 1,000 Hispanic residents, 0.11 per 1,000 Asian residents and 0.44 per 1,000 residents of other races. The average size of the lawsuits was stable over the time period, varying between $2,522 and $3,939 across years, whereas the share of cases that resulted in wage garnishment increased by 27 percent (from 41 percent in 2001 to 52 percent in 2018). Furthermore, the study found that nonprofit hospitals were more likely to sue patients than for-profit hospitals, reinforcing existing evidence of the mixed relationship between hospital ownership and hospital behavior.
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