ByPhil Galewitz and Julie Appleby, Kaiser Health News |
After two years of double-digit price hikes, the average premium for individual health coverage on the federal health law’s insurance marketplace will drop by 1.5 percent for 2019, the Trump administration said Thursday. The announcement marked the first time average premiums have fallen since the exchanges created by the Affordable Care Act went into effect in 2014. It also comes during a bitter midterm congressional campaign season in which health care is a central issue following last year’s efforts by Republicans to repeal the ACA. Administration officials claimed credit for the price drop, saying it was due to their actions to make changes to the law. Health policy experts said it was a reaction to insurers’ huge profits following hefty premium increases on plans offered this year.
Insurers will again be able to sell short-term health insurance good for up to 12 months under a proposed rule released Tuesday by the Trump administration that could further roil the marketplace. “We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances.”
The proposed rule said short-term plans could add more choices to the market at lower cost and may offer broader provider networks than Affordable Care Act plans in rural areas. But most short-term coverage requires answering a string of medical questions, and insurers can reject applicants with preexisting medical problems, which ACA plans cannot do. As a result, the proposed rule also noted that some people who switch to them from ACA coverage may see “reduced access to some services,” and “increased out of pocket costs, possibly leading to financial hardship.”
The directive follows an executive order issued in October to roll back restrictions put in place during the Obama administration that limited these plans to three months.
The Trump administration announced Thursday it would allow states to impose work requirements on “able-bodied” adults who receive Medicaid. In New Mexico, it’s not clear if the Martinez administration will pursue such requirements, but if so, it would likely take months to go through the process. “Medicaid needs to be more flexible so that states can best address the needs of this population,” Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said in a statement. That center is part of the U.S. Department of Health and Human Services. “Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction.”
States would need to do so through a specific waiver with CMS.
New Mexico has been stopped from imposing such requirements in other programs. In 2016, a federal judge stopped the state from requiring people to work who receive Supplemental Nutrition Assistance Program (SNAP) benefits because of a long-running federal lawsuit over the state’s inability to process aid.
The Trump administration signaled Tuesday that it would allow states to impose work requirements on some adult Medicaid enrollees, a long-sought goal for conservatives that is strongly opposed by Democrats and advocates for the poor. Such a decision would be a major departure from federal policy. President Barack Obama’s administration ruled repeatedly that work requirements were inconsistent with Medicaid’s mission of providing medical assistance to low-income people. The announcement came from Seema Verma, the head of the Centers for Medicare & Medicaid Services (CMS), who was scheduled to address the nation’s state Medicaid directors Tuesday. A press release issued in advance of the speech said allowing states to have work requirements is part of her plan to help give states more flexibility.
After the Senate fell short in its effort to repeal the Affordable Care Act, the Trump administration is poised to use its regulatory powers to accomplish what lawmakers could not: shrink Medicaid. President Donald Trump’s top health officials could engineer lower enrollment in the state-federal health insurance program by approving applications from several GOP-controlled states eager to control fast-rising Medicaid budgets. Indiana, Arkansas, Kentucky, Arizona and Wisconsin are seeking the administration’s permission to require adult enrollees to work, submit to drug testing and demand that some of their poorest recipients pay monthly premiums or get barred from the program. Maine plans to apply Tuesday. Other states would likely follow if the first ones get the go-ahead.
In Washington, D.C., a Medicare beneficiary filled prescriptions for 2,330 pills of oxycodone, hydromorphone and morphine in a single month last year — written by just one of the 42 health providers who prescribed the person such drugs. In Illinois, a different Medicare enrollee received 73 prescriptions for opioid drugs from 11 prescribers and filled them at 20 different pharmacies. He sometimes filled prescriptions at multiple pharmacies on the same day. These are among the examples cited in a sobering new report released today by the inspector general of the U.S. Department of Health and Human Services. The IG found that heavy painkiller use and abuse remains a serious problem in Medicare’s prescription drug program, known as Part D, which serves more than 43 million seniors and disabled people.