Health Policy News December Edition


As in years past, the primary focus of the December edition is highlighting some of the important topics we wrote about in 2018, while also foreshadowing policy trends that we believe will be of particular importance to states in 2019. Before many of you take a break to spend time with family and friends, we offer a brief recap of the past year and our predictions for 2019.

In addition to our recap and prospective policy predictions, we have three new articles this month. We provide you with an analysis on the recent Texas vs U.S. decision that raises new questions about the future of the Affordable Care Act (ACA). This edition also contains two articles that focus on how states are responding to health policy and market developments. First is a deep dive into approaches to Association Health Plans (AHPs) in two states. Second is an article dedicated to examining the impact on health insurance rates in two states.

The Health Policy New team wishes all of our readers a wonderful new year. We will be back next year with continued updates on and analysis of policy and regulatory developments,  webinar events and deep dives into the impact of many policy developments from this past year.

2018 Retrospective & Looking Forward to 2019

This year brought increased flexibility for states related to both public health care programs and commercial health plans, with the Federal administration announcing numerous policies to give states more control over the design / regulation of the coverage offered to consumers. We saw first-of-their-kind waivers approved at the Federal level, including community engagement / work requirement Medicaid waivers in states across the country and Medicaid drug cost control measures in Oklahoma, as well as a flurry of late-breaking activity related to Section 1332 State Innovation / State Relief and Empowerment Waivers that is likely to spur further activity in 2019. We saw regulatory changes designed to increase the types of health insurance plans that can be sold, and we expect to see continued state activity in response in the new year.  We also tracked key court decisions and regulatory proposals that could impact our health insurance markets and Medicaid programs, and that will continue to play out in 2019. Health Policy News covered a broad range of topics this past year, and we will continue to be a source for all things health policy in the upcoming year. Click here to read more about key topics from 2018 and our thoughts on 2019.

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A Preliminary Decision in the Newest Lawsuit Challenging the Affordable Care Act

Just last Friday, a decision was published in the Texas vs. U.S. case challenging the validity of the ACA. The case—which was brought by 20 states and later joined by two individuals—contends that the “zeroing out” of the shared responsibility penalty through the 2017 tax bill (Tax Cuts and Jobs Act) made the individual mandate, and in turn the entire ACA, unconstitutional. Judge O’Connor, who presided over the case, held that, as it no longer triggers a tax, the individual mandate is no longer constitutional and, therefore, the entirety of the law is invalidated.

While a significant and sweeping ruling, it has no practical impact at this point, as the ACA is expected to remain the law of the land pending an appeal, and enforcement continues. For more on the decision and next steps, click here.

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A Look at Two States’ Responses to the Association Health Plan Final Rule

Implementation of the new Federal AHP Rule—and new options for associations seeking to offer health insurance coverage—is well underway. Implementation began on September 1st and the second key implementation date comes on January 1st, at which point the new rule and new options will be in effect for all fully-insured AHPs and existing self-insured AHPs seeking to operate under the new rule.

While some states took action immediately upon—or even prior to—the new rule being finalized, others continue to weigh their options and the needs within their markets related to the increased flexibility offered at the Federal level. In this article we take a deeper dive into the responses of two neighboring states—New Hampshire and Vermont—to this final rule, which were divergent in several ways.

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Two Insurance Markets, Similar Stories to Tell

This past fall, Massachusetts and New Hampshire held public meetings aimed at providing insights into the factors affecting health care costs in their respective states. Both states had similar stories to share: health insurance rates are complex, and the long-standing practices of provider contracting and recent Federal guidance and policy directives have made price forecasting even more difficult. As open enrollment wraps up, consumers in many states will be seeing the impact of complex health care rate-building in the form of a monthly premium. With states all over the country putting rising health costs on the top of their 2019 legislative agendas, the reports out of New Hampshire and Massachusetts provide interesting insights into areas other states may also want to study this coming year. To read more about cost trend hearings and reports, click here.

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