The attached report from Covered California examines implications of Affordable Care Act (ACA) repeal on Californians who have benefited and continue to benefit from the law. By monitoring and reviewing not only the effect of proposed policies to repeal the ACA, but also the impact of the policies’ timing, Covered California concludes that coverage and premiums would be negatively affected; revenue for hospitals, integrated delivery systems, physicians and other providers would immediately and significantly drop; jobs and the economy would be substantially impacted, with California projected to lose between 209,000 and 334,000 jobs; and, potentially, the individual health insurance marketplace would collapse.
In its review, Covered California urges policy proposals advancing a replacement for the ACA to account for the significant transition from one health care financing mechanism to another, and to allow time for any necessary complementary state legislative action.
Covered California has released the attached report modeling premium increases that could occur if the federal cost-sharing reduction (CSR) subsidies were defunded, requiring health plans to build these costs into their rates. Using actuarial value calculations, Covered California calculated a 16.6 percent increase in gross premiums across all Silver plans. Covered California then modeled the consumer reaction to this adjustment and the resultant changes in enrollment, metal tier market shares, gross and net premiums, and advanced premium tax credit in both the exchange and off-exchange markets. Overall, modeling suggested that consumers who currently benefit from subsidies would shift to non-Silver metal tier plans, primarily Bronze, and that enrollment in Covered California would rise slightly. These effects vary by federal poverty level group, with larger shifts from Silver among high-income consumers. Off-exchange enrollment is projected to decrease slightly, which would increase the federal cost by approximately $226 million, or 29 percent, for the same consumer benefit.
Covered California has released the attached report analyzing attitudes toward enrolling in and renewing health insurance coverage following the 2016 election. The study, An Integrated Quantitative and Qualitative Study on Post-Election Attitudes Toward Enrolling in and Renewing Health Insurance Coverage, was conducted between Dec. 14, 2016, and Jan. 3, 2017, to evaluate whether to adjust Covered California’s marketing and outreach messaging. The research, which included focus-group testing and an online survey of 500 respondents, was conducted by Greenberg Strategy.
Covered California’s research was conducted in two parts: an online survey focused on sentiment and concerns, and focus groups with uninsured participants that also included discussions on barriers to enrollment.
A recent study by The Commonwealth Fund analyzes health plan premium growth in California’s insurance marketplaces, focusing on the policies consumers purchased, and finds that the average price paid for plans selected in 2014 was 11.6 percent less than the average price of all plans offered by insurers. The report notes that similar differences were observed in 2015 and 2016, suggesting that consumers are choosing to purchase lower-cost plans and that even small increases in plans’ premiums appear to significantly reduce the probability that consumers will select those plans.
The report’s key findings include:
For every plan metal tier (bronze, silver, gold and platinum), average purchase prices were lower than average offer prices for the years 2014–16. In 2014, the average purchase price for all plans was 11.6 percent less than the average offer price; in 2015, it was 13.2 percent less; and in 2016, it was 15.2 percent less.
Covered California will hold its next board meeting in Sacramento on Jan. 26 from 10 a.m. – 3 p.m., with an open session estimated to begin at noon. The agenda includes a report from Executive Director Peter Lee on open enrollment and federal policy, as well as from Covered California staff on the status of policies and programs. The board will discuss the proposed 2018 standard benefit plan design, 2018 qualified health plan certification policy, amendment of the plan-based enrollment permanent regulations amendment, and readopting the eligibility and enrollment emergency regulations for the Small Business Health Options Program. The Board is scheduled to take action on acknowledgment of the Contra Costa County for Partnering in Offering Service Center and emergency readoption of the individual eligibility and enrollment regulations.
Covered California will host a Plan Management and Delivery System Reform Advisory Group webinar Jan. 19 from 10 a.m. to noon (PT). The health plan advisory group provides input to the Covered California board and staff on qualified health plan contracting strategies, ongoing benefit design issues and strategies to promote health care value and drive delivery system reform.
The Jan. 19 meeting is scheduled to address membership transition, 2018 certification, 2018 benefit design, a special enrollment period request for proposal for electronic verification, future topics and next steps. Participants can register and find meeting materials in advance of the webinar online. A meeting agenda is attached.
The California Healthcare Foundation (CHCF) has produced an interactive map of California showing how many people have purchased health insurance coverage through Covered California by zip code (the map does not include those who receive coverage through the expansion of Medi-Cal). Approximately 1.4 million Californians bought insurance through Covered California in 2016.
According to CHCF, California has more than 2,300 zip codes, and those with highest Covered California enrollment are:
Covered California will host a Plan Management and Delivery System Reform Advisory Group webinar Dec. 8 from 10 a.m. to noon (PT). The advisory group provides input to the Covered California board and staff on qualified health plan contracting strategies, ongoing benefit design issues and strategies to promote health care value and drive delivery system reform. The Dec. 8 meeting is scheduled to address the 2018 certification and benefit design, provide an update on quality improvement strategy health plan meetings and address membership transition. Participants can register and find meeting materials in advance of the webinar online. A meeting agenda is attached.
Covered California will hold its next board meeting in Sacramento on Nov. 17 from 10 a.m. – 4 p.m., with an open session estimated to begin at 11 a.m.
The agenda includes a report from Executive Director Peter Lee and Covered California staff on the status of policies and programs. The board will discuss the emergency readoption of the individual eligibility and enrollment regulations and will take action on the enrollment assistance regulations. The meeting is scheduled to include an in-depth discussion on future issues for Covered California, and will include panels discussing national and state health care landscape and trends, delivery system reform, improving wellness and population health, and consumer engagement.
Panelists include John Bertko, chief actuary, Covered California; Larry Levitt, senior vice president for special initiatives, Kaiser Family Foundation; Sandra Hernandez, MD, president & CEO, California Health Care Foundation; Ezekiel Emanuel, MD, PhD, MSc, vice provost, University of Pennsylvania, and former White House adviser on health policy; Karen Smith, MD, MPH, director and state public health officer, California Department of Public Health; and Doris Peter, PhD, director, Health Ratings Center, Consumer Reports.
Information on participating by webcast or telephone is available in the attached agenda. Meeting materials will be posted in advance of the meeting on the Covered California website.
A recently released report from the Kaiser Family Foundation examines 2017 premiums and insurer participation made available through Healthcare.gov, along with data from state-run exchange sites. Health insurance premiums in the Affordable Care Act’s (ACA) marketplaces are expected to increase faster in 2017 than in previous years due to a combination of factors, including substantial losses experienced by many insurers in the market and the phasing out of the ACA’s reinsurance program.
The report examines the second-lowest cost silver plan, as it is one of the most popular plan choices and is the benchmark to determine the amount of financial assistance individuals and families receive. In California, the second-lowest cost silver premium for a 40-year-old non-smoker in 2016 was $245 in Los Angeles and increased to $258 in 2017 – representing a 5 percent change from 2016 – before accounting for the tax credit.
Covered California will host a Plan Management and Delivery System Reform Advisory Group webinar Oct. 20 from 10 a.m. to noon (PT). The advisory group provides input to the Covered California board and staff on qualified health plan contracting strategies, ongoing benefit design issues and strategies to promote health care value and drive delivery system reform. The Oct. 20 meeting is scheduled to address the fourth open enrollment period, introduce 2018 plan certification, and provide an update on the 2018 benefits workgroup and its next steps. Participants can register and find meeting materials in advance of the webinar online. A meeting agenda is attached.
Covered California has released 2017 Covered California Regional Rate and Plan Information data, which include fact sheets for its 19 rating regions. The fact sheets show contracted hospitals by carrier plan type, rate change in region, percent of enrollees receiving subsidies, post-subsidy cost to enrollees, rate change in comparing 2016 and 2017 lowest cost plans by tier, rate change for consumers who stay with their current plan, relative carrier rate positions, and additional rate and plan observations. The data — developed as a resource for certified enrollers in preparation for the next open enrollment period of Nov. 1 through Jan. 31 — represent a deeper dive of Covered California’s Health Insurance Companies and Plan Rates for 2017 Booklet.
On Sept. 30, Covered California submitted an application under Affordable Care Act (ACA) Section 1332 to U.S. Health and Human Services Secretary Burwell pursuant to Senate Bill 10 (Chapter 22, Statutes of 2016). ACA Section 1332 allows a state to apply for the waiver of certain ACA requirements for plan years beginning on or after Jan. 1, 2017. In its State Innovation Waiver application, titled California’s Proposal to Waive Affordable Care Act Requirements to Expand Access to Undocumented Individuals, Covered California requests a waiver of Section 1311(d)(2)(B)(i) of the ACA, which prohibits exchanges from making available any health plan that is not a qualified health plan (QHP).
Covered California seeks to waive this provision to offer new health insurance options, called California qualified health plans (CQHPs), to individuals ineligible to purchase QHPs because of their immigration status, with a proposed coverage effective date of Jan. 1, 2019. This waiver is necessary because QHPs are only available to qualified individuals (Section 1312(a)), defined as a “citizen or national of the United States or an alien lawfully present in the United States” in Section 1312(f)(3) of the ACA.
Covered California has released quarterly active member profiles that include enrollment data in a variety of formats by county, rating region and qualified health plan (QHP). The profiles show numbers of enrollees who have selected a plan during the open enrollment period. As additional data becomes available, Covered California will release the data on its website. The currently available data are detailed as follows:
Covered California will host a Plan Management and Delivery System Reform Advisory Group webinar Sept. 8 from 10 a.m. to noon (PT). The advisory group provides input to the Covered California board and staff on qualified health plan contracting strategies, ongoing benefit design issues and strategies to promote health care value and drive delivery system reform. The Sept. 8 meeting is scheduled to include updates on Covered California’s new enrollment system, the quality rating system for the fourth open enrollment period and the 2018 benefits workgroup, as well as an open forum. Participants can register and find meeting materials in advance of the webinar online. A meeting agenda is attached.
Covered California has announced resources for the fourth open enrollment period for certified applications counselors, certified enrollment counselors and Medi-Cal managed care plan enrollers, designed to assist certified enrollers during the 2016-17 renewal and open enrollment period. The resources include:
Open Enrollment 4 Kickoff Tour. During the tour, to be held Sept.12-29 in cities across California, Covered California will provide an update on its Open Enrollment 4 strategy plan, health plan rates, dental and vision plans, application system, renewal, Covered California for Small Business, and sales tool.
2016 Subsidy-Eligible Maps Tool Kit. The tool kit, which is designed to aid in outreach, education and enrollment efforts, identifies targeted areas of remaining uninsured or privately insured consumers, representing Covered California’s subsidy-eligible target populations. The subsidy-eligible population range was calculated by data from Covered California, California Simulation of Insurance Markets and the American Community Survey.
Recertification Training. All Covered California returning certified counselors and enrollers are required to complete the 2016-17 recertification training and pass the exam by Dec. 31.
Statewide Health Plan Regional Rate Analysis Resources. Following its Aug. 25 webinar on the 2017 Covered California Regional Rate and Plan Information Booklet, Covered California has made available a webinar recording and slide deck.
Information on a New Requirement for Health Plans. Beginning Jan. 1, Covered California health plans are required to ensure that all Covered California members either select a primary care physician or have one recommended by the health plan starting coverage year 2017 or within 60 days of the consumer’s effective date with the health plan. Covered California has developed a guide to provide an overview of this change and how it affects consumers with certain health plans.
The Centers for Medicare & Medicaid Services (CMS) has issued its annual Notice of Benefit and Payment Parameters for 2018, which proposes new standards intended to strengthen the health insurance marketplace. Beginning in 2017, the proposed policies aim to strengthen the risk adjustment program, introducing changes that make risk adjustment more effective at pooling risk and allowing issuers to focus on meeting consumers’ needs.
First, the rule proposes updates beginning in 2017 to better reflect the risk associated with enrollees who are not enrolled for a full 12 months. Second, the rule proposes to use prescription drug utilization data beginning in 2018 to improve the predictive ability of CMS’ risk adjustment models. Third, also beginning in 2018, the rule proposes to establish transfers that will help to better spread the risk of high-cost enrollees, a change that would improve the risk-sharing benefits of the program. In addition to these improvements to risk adjustment, the proposed rule contains other provisions that aim to improve the marketplace consumer experience and strengthen the individual and small group markets as a whole. More information is available at www.cms.gov/Newsroom/Newsroom-Center.html.
Today, the Centers for Medicare & Medicaid Services (CMS) released a draft list of Essential Community Providers (ECPs), developed to help qualified health plans (QHPs) identify providers that qualify for inclusion in a QHP’s network toward satisfaction of the ECP standard under the Affordable Care Act (ACA) for the 2018 benefit year. ECPs are providers who serve predominantly low-income, medically underserved individuals. They include health care providers defined in section 340B(a)(4) of the Public Health Service Act and described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act. Providers included on the draft ECP list for the benefit year 2018 submitted an ECP petition between Dec. 9, 2015, and July 11, 2016, and were approved by CMS for inclusion through the ECP petition review process.
CMS notes the draft list of ECPs for the benefit year 2018 is not exhaustive and does not include every provider. CMS encourages providers who qualify as ECPs to submit corrections and updates via the online ECP petition by Oct. 13 for inclusion on the final HHS ECP list for the 2018 benefit. To view the draft list, visit https://data.healthcare.gov/view/ecf3-gujb. The ECP petition is available at https://data.healthcare.gov/cciio/ecp_petition.
Covered California Updates Its ECP List
While the federal 340B list of ECPs is a critical category of ECPs, it does not constitute the sole source of such entities. Some provider organizations that serve the low-income and medically underserved population are not 340Bs, including some that qualify as Health and Safety Code Section 1204(a) entities under California law. Covered California’s recently revised ECP list is an attempt to create a single, non-duplicated list of ECPs that potentially could serve Covered California enrollees.
The Kaiser Family Foundation (KFF) has released the fourth and final survey in its California Longitudinal Panel Survey — a series of surveys that, over time, tracked the experiences and views of a representative, randomly selected sample of Californians who were uninsured prior to the major coverage expansions under the Affordable Care Act (ACA). After each enrollment period concluded, a survey was conducted of the same group of previously uninsured Californians who participated in the baseline. This survey followed up with these individuals after the third open enrollment period in spring 2016 to find out whether more have gained coverage, lost coverage or remained uninsured; what barriers to coverage remain; how those who now have insurance view their coverage; and what impact gaining health insurance may have had on financial security and access to care.
The Office of the Assistant Secretary for Planning and Evaluation has released an issue brief examining the effect of Medicaid expansion on marketplace premiums. According to the report, an estimated 20 million additional individuals have gained health coverage as a result of the Affordable Care Act (ACA). In states that expanded Medicaid, marketplace premiums are an average of 7 percent lower, compared to states that have not yet done so. The report’s findings suggest that implementing the ACA’s two major coverage expansions together, as intended, can benefit all three affected groups: individuals with incomes below 100 percent of the federal poverty level (FPL), who gain coverage only through expansion; individuals with incomes between 100 and 138 percent of the FPL, who gain coverage through Medicaid that is more likely to fit their budget; and individuals with coverage through the marketplace, who may benefit from the positive impact of Medicaid expansion on premiums.