Health Policy News October 2017

The editors of Health Policy News spent this week at the annual National Academy for State Health Policy (#NASHPCONF17) in Portland, Oregon and had the opportunity to meet with many of our readers in person. #NASHPCONF17 provides the opportunity for state leaders from all aspects of health policy, including legislative and administrative leaders and other subject matter experts, to work together on timely health topics states across the country are facing. We have included some insights and resources we distributed at #NASHPCONF17 in this edition for those readers who may not have had the chance to attend.

As usual, we are tracking movement on Section 1332 State Innovation Waivers. Below we share a quick update on recent developments in Oregon, Iowa, and Massachusetts and debut new PCG resources for states as they think through waiver options.

This edition also includes updates and analysis regarding a number of recent federal developments including the Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States, the announcement that the administration will no longer fund Cost Sharing Reductions (CSRs) and the bipartisan effort to stabilize health insurance markets known as the Alexander-Murray bill.

As always, you can contact us at for more information on any of these pieces.

Insights from #NASHPCONF17

PCG subject matter experts were in Portland, Oregon this week at the 30th annual #NASHPCONF17. With a focus on guiding state policy makers though the changing health policy landscape, #NASHPCONF17 provided a break from the day to day, reactionary work to adjust to federal policy. The conference served as an opportunity for state health policy leaders to learn from their colleagues and collaborate on problem solving the tough issues facing health policy; rising prescription drug costs, the opioid epidemic, providing affordable health care, and measuring and improving public health.

#NASHPCONF17 also provided PCG’s team an opportunity to debut some new materials of particular relevance to the conference and the prevailing themes in health policy, including a Section 1332 State Innovation Waiver toolkit. This toolkit aims to guide states through the pre-waiver decision making process as well as all aspects of the drafting process. It is an interactive resource that includes insights from previously filed waivers, federal regulations, and aggregates all federal regulations for state health policy leaders.

Click here to access the Section 1332 toolkit and to continue reading about insights from #NASHPCONF17, including updates on the progress made by the Pharmacy Cost Work Group to tackle rising prescription drug costs.

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Developments in Section 1332 State Innovation Waivers

Another state – Oregon – seeking a Section 1332 Waiver was granted waiver approval this month. Oregon may now move forward with implementing its state-based reinsurance program with Federal support. Following the Center for Consumer Information and Insurance Oversight letter to Iowa, explaining that pass-through funding the state’s proposed waiver must be limited to gross Federal savings under the program, the state withdrew its waiver request to support its Proposed Stopgap Measure (PSM).

Also this month, Massachusetts’ recently submitted Section 1332 Waiver to support a Premium Stabilization Fund in lieu of CSR payments was determined incomplete because there was not sufficient time to complete Federal review ahead of the 2018 Open Enrollment Period. The Commonwealth later announced that it would consider pursuing the waiver for 2019.

Click here to access PCG’s new interactive Section 1332 State Innovation Waiver toolkit.

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Federal developments

There were several significant health policy developments at the Federal level this month.

As expected, the President signed the Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States. As an Executive Order, it does not implement changes itself, but directs Federal agencies to explore targeted policy changes including:

  • Expanding access to Association Health Plans (AHPs)
  • Expanding the coverage period for Short-Term Limited-Duration Insurance (STLDI)
  • Expanding the use of Health Reimbursement Arrangements (HRAs)

Under the Executive Order, the Departments are also required to report on existing law that fails to conform with the Executive Order and actions that could promote the Executive Order.

On the same day as issuing the Executive Order, the administration announced that it will cease making payments to fund cost-sharing reductions (CSRs), effective immediately. There has been controversy about the CSRs since implementation, centered around an ongoing legal dispute over the whether CSR payments were appropriated. The administration is now pointing to the debate over appropriation as a basis to end payments.

Shortly after the administration’s CSRs announcement, Senator Lamar Alexander (Chair of the Senate Committee on Health, Education, Labor and Pensions [HELP] Committee) and Senator Patty Murray (ranking minority member of the HELP Committee) announced that they had reached agreement on a bipartisan market stabilization package which – among other things – more clearly authorizes Federal funding CSRs for two years. If that provision, specifically, advances, it would eliminate the administration’s basis for stopping required payments.

PCG subject matter experts explore these recent Federal health policy developments in more detail here.

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