For the first time since Colorado opened its health insurance exchange, people will see a drop in coverage prices, according to the Canon City Daily Record. Coverage costs across the state will drop by an average of 20.2 percent. In western Colorado, which has some of the highest health insurance premiums in the U.S., a family of four will save an average of $10,000 per year, according to the Colorado Division of Insurance. The main reason for the price cut is the state’s new reinsurance program, which uses $260 million in state and federal funding to cover some of the most expensive medical costs for those who purchase plans through the marketplace.
The Wisconsin Office of the Commissioner of Insurance reports that people in Wisconsin who purchase health insurance on the ACA exchange will have more choices in 2020, according to the Milwaukee Journal Sentinel. The number of insurers selling health plans will increase to five, up from three in 2017. Officials believe that the increased competition on the exchange will keep price increases in check and could even lead to price decreases for the following year.
Thousands of former patients at Deaconess and Valley hospitals will have medical debts erased as part of a major legal settlement with Community Health Systems (CHS), a struggling for-profit hospital chain, according to The Spokesman-Review. The settlement comes more than two years after the Empire Health Foundation sued CHS, alleging the company failed to provide the levels of charity care that it had promised when buying the hospitals from Empire Health Services in 2008. CHS also agreed to pay the foundation $20 million to create a political lobbying arm, the Empire Health Community Advocacy Fund.
With enrollment for Minnesota’s health plans set to begin, many are watching to see the effects of insurers’ recent announcements of insulin out-of-pocket caps, according to the Star Tribune. Those who purchase coverage through MNsure or from Medica and UCare will have their out-of-pocket spending on each insulin prescription capped at $25 per month, regardless of annual deductibles. When asked, insurance companies have explained that an amendment in the state’s recent omnibus healthcare spending law makes it illegal for Minnesota insurers to profit from selling insulin. Consumers who use insulin note that it is an important necessity for them, but that other medical necessities are still expensive, like insulin pumps and glucose monitors.
The Michigan Department of Health has proposed removing pharmacy benefit managers (PBMs) from overseeing prescription drug claims and negotiating prices for the state’s Medicaid program in a hope to save Medicaid dollars, according to Modern Healthcare. The department expects the proposal will save the state about $40 million, streamline administrative processes and ensure uniform drug coverage for Medicaid enrollees. Other states have stopped outsourcing prescription drug services to PBMs after studies found that PBM prices often exceed Medicaid fee-for-service drug prices. While PBMs defend their practices by stating that they address high drug prices by negotiating payment rates from pharmaceutical companies by leveraging formularies and utilization management tools; critics assert that PBMs have an incentive to prioritize high-priced drugs over more cost-effective alternatives.
Nexus Montgomery, a collaboration between six competing Maryland hospitals, has created a cross-continuum of care partnership that includes skilled nursing facilities, according to Home Health Care News. The goal of this pilot is to leverage non-medical home care to help consumers live safely and independently in their homes. As hospitals are subject to financial penalties for high readmission rates, especially within Maryland’s global budget system, pilots such as this one may help keep people healthier and out of the hospital.
The New Jersey Department of Banking and Insurance will offer $2 million for health navigators to help enrollees and re-enrollees with the transition from a federally-facilitated exchange to a state-based exchange on a federal platform, and eventually to an autonomous state-based exchange, according to HealthPayerIntelligence. Because the state remained on the federal platform but will facilitate the exchange itself, New Jersey has access to more funding for health navigators since it can use it's own funding, adding over six times the previous amount to the enrollment fund. The state is now responsible for approving qualified health plans, setting up assisters to help with the enrollment process and conducting outreach to the population looking for insurance. It seems likely that the state will remain on the federal platform for a year before transitioning toward complete autonomy from the federal exchange.
The New Jersey Department of Banking and Insurance announced that premiums sold on and off the ACA exchange will increase by an average of 8.7%, according to the Burlington County Times. State officials believe that rising medical costs were largely responsible for the increase, but also point to the reinstatement of a federal tax surcharge that had been suspended in 2019. Had this surcharge not been reinstated, the state's rate increases would have been 2.7% lower. Despite this increase, state officials say that on average, prices remain lower than they were in 2018.
North Carolina’s Medicaid 1115 waiver allows the state to spend up to $650 million in state and federal Medicaid funding on “Healthy Opportunities Pilots,” designed to cover select services related to housing, food, transportation, and interpersonal violence that directly impact enrollees’ health outcomes, according to Managed Healthcare Executive. The state’s Medicaid managed care plans, known as Prepaid Health Plans (PHPs) have been set up in four regions of North Carolina to address these social determinants of health. Typically, Medicaid funds are not used to pay directly for non-medical interventions targeting social determinants of health, so this pilot will offer insights to how addressing social determinants of health may impact costs and health outcomes.
Medicare cut payments to nine Montana hospitals as part of a program that aims to drive hospitals to reduce unnecessary patient readmissions, according to the Bozeman Daily Chronicle. This is the largest number of hospitals in the state penalized in a single year for failing to meet the federal standard, reports a Kaiser Health News analysis.