State News

Delaware's Office of Value-Based Health Care Delivery has issued the annual progress report, available on the Insurance Commissioner of the State of Delaware’s website. The report concentrates on the implementation of value-based care in the state, which aims to shift the focus from the quantity of care to the quality of care provided, ultimately reducing costs for patients.

Colorado Governor Jared Polis signed legislation eliminating co-pays for pharmacy and other health care services for Colorado’s Medicaid program, reports State of Reform. Colorado residents with Medicaid coverage will have services such as hospital services, physician services, and prescription drugs covered without any cost-sharing, beginning in July. Additionally, the legislation will enable the state to pay providers more and access additional federal funding to make up the difference from the lost co-pay revenue.

North Dakota has passed a new law capping the cost of insulin for state employees, reports AARP. The law caps the out-of-pocket cost for a 30-day supply of insulin, as well as copayments for diabetic supplies, at $25 per month for employees covered by the state’s Public Employees Retirement System. The high cost of insulin has been a significant financial burden for many diabetes patients in the state, where the average price of insulin tripled between 2002 and 2013.

New Mexico has passed a law to reduce consumer prescription drug costs, according to the Los Alamos Daily Post. Senate Bill 51 stipulates that insurers must apply any discounts enrollees
receive to their cost-sharing obligation for prescription drugs, ensuring that pharmacies pass on discounts to consumers.

A health equity analysis of data from Colorado’s APCD found that social factors such as income, housing, race, and education are strongly associated with potentially preventable visits to the emergency department, according to the Center for Improving Value in Health Care. In urban areas, all five social factors evaluated (income, education, employment, housing/transportation, and race/ethnicity/language) were all strongly correlated to greater preventable emergency department visits and adults not receiving preventive care. However, in rural areas, only income and education levels impacted potentially preventable emergency visits and only income levels influenced adults not getting preventive care. Statewide, the social factors analyzed did not show an impact on children and adolescents receiving preventive health care.

South Carolina policymakers passed legislation exempting feminine hygiene products from sales tax, reports The Hill. Approximately 200,000 women in South Carolina are impacted by period poverty, and the repeal of the tax aims to improve health care affordability and access for women across the state by reducing the financial burden of menstrual products.

Health care spending in Connecticut has eclipsed economic growth in recent years, according to Connecticut Public Radio. Spending increased 6 percent between 2020 and 2021, which exceeded the state benchmark target of 3.4 percent, and was driven primarily by increases in commercial health insurance spending.

The basic health program (BHP) in New York and Minnesota succeeded in helping low-income consumers access affordable care and reducing administrative complexity, but those results may not be replicable in other states, based on state-specific factors such as regulation and provider reimbursement, according to a report from the Urban Institute. While only two states implemented a BHP after the ACA was enacted, several states have recently begun considering their own programs: Oregon, Kentucky, Illinois, and West Virginia. However, the fiscal impact of a BHP can vary based on the coverage provided, Marketplace premiums, and provider reimbursement rates. One factor in New York’s success has been the state’s ban on age rating in the individual market. New York and Minnesota both reported stable markets with many insurers participating in their BHP, but it is difficult to predict how insurers in other states will react.

Oregon established Medicare reference-based pricing for hospitals for its state employee health plans in 2017, and a 2021 audit found over $112 million in savings, reports NASHP. Payments for in-network and out-of-network services are not to exceed 200 and 185 percent of Medicare reimbursements, respectively; average reimbursements went from 215 percent of Medicare reimbursement amounts prior to the legislation’s enactment in 2017, to 163 percent in 2021.