December 23 Update

In This Week’s Update:

  • Ruling in Texas v. Azar
  • Health Policy in Federal Spending Bill
  • Exchange Program Integrity Rule
  • State Updates: CA, KY, MA, NE, NV, PA & VA
  • Implementing a Statewide Health Care Cost Benchmark
  • Interactive Childhood Obesity Data
  • New Medicaid and CHIP Data Book Published


Ruling in Texas v. Azar

Last week, the U.S. Court of Appeals for the Fifth Circuit in Texas v. Azar ruled the Affordable Care Act’s (ACA) individual mandate unconstitutional, but did not invalidate the entire law. Instead, the court returned the case to the lower court judge to reconsider how much of the remaining ACA can stand. Katie Keith wrote a post for the Health Affairs blog that analyzes the ruling.


Health Policy in Federal Spending Bill

Also last week, Congress passed a spending bill to fund the federal government through September 2020. It includes a number of health policy provisions, including several public health initiatives and the repeal of three ACA taxes. The Kaiser Health News podcast What the Health (discussion starts at 11:35) walks through the major health care features.


Exchange Program Integrity Rule

Last week, the administration released the final Exchange Program Integrity rule, which lays out new requirements for marketplace oversight. Beginning in 2021, state-based marketplaces (SBMs) must conduct biannual data checks of enrollees to determine whether they are eligible for other public coverage programs. However, SBMs that have a single, shared eligibility platform with Medicaid will be deemed compliant.


State Updates: CA, KY, MA, NE, NV, PA & VA

  • California – In a reminder to residents to sign up for health insurance, Covered California’s Executive Director Peter Lee highlighted that nearly half a million Californians have signed up to date. Lee identifies new state subsidies and the restoration of the individual mandate penalty as key reasons why new plan selections are up 16 percent over last year, with 133,092 plan selections through December 7, compared to 114,306 for the same time period a year ago. Open enrollment for those seeking coverage through the state-based marketplace runs through January 31, 2020.
  • Kentucky – Governor Andy Beshear’s administration notified the Centers for Medicare and Medicaid Services (CMS) that the state is ending its Section 1115 demonstration project, known as Kentucky HEALTH, that required Kentuckians to meet certain work requirements to be eligible for Medicaid. The governor effectively ended Kentucky’s litigation involving the waiver in federal court and has asked the court to dismiss Kentucky from the lawsuit. Governor Beshear also signed an executive order protecting the state’s Medicaid expansion program.
  • Massachusetts – The Massachusetts Health Policy Commission issued a request for proposals seeking providers and community-based organizations to collaborate on social determinants of health as part of the state’s Moving Massachusetts Upstream initiative. The state expects to grant three or four awards totaling up to $2 million.
  • Nebraska – The Nebraska Department of Health and Human Services’ Division of Medicaid and Long-Term Care submitted a new Section 1115 waiver demonstration application proposing to implement a two-tiered benefit package to expand coverage to its new adult group. By completing certain wellness, personal responsibility, and community engagement activities, beneficiaries can earn additional Prime benefits, which consist of dental, vision, and over-the-counter medications. Everyone who meets underlying eligibility criteria will receive the Basic benefits package. The federal public comment period is open through January 17, 2020.
  • Nevada – Governor Steve Sisolak announced the appointment of 11 members and an executive director to the Patient Protection Commission (PPC). The PPC will take a comprehensive look at the state of health care in Nevada and identify areas for improvement to ensure every Nevadan has access to affordable and quality health care. Under the direction of the chair and executive director, the PPC will begin meeting early next year.
  • Pennsylvania – Governor Tom Wolf announced that the state will allocate another $5 million in federal funding to a loan repayment program for health care practitioners, providing medical and behavioral health care and treatment for substance use disorder and opioid use disorder in areas where there is high opioid use and a shortage of health care practitioners. The funding comes from the $55.9 million Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid Response grant meant to help states increase access to medication-assisted treatment of opioid use disorder, reduce opioid overdose-related deaths through prevention, treatment, and recovery, and reduce unmet treatment needs.
  • Virginia – Governor Ralph Northam presented his budget for fiscal years 2020-2022. His budget proposal includes funding to combat maternal and infant mortality, develop a state-based marketplace, and develop a state reinsurance program.


Implementing a Statewide Health Care Cost Benchmark

Seeking methods to better understand and control health care costs, many states are taking a careful look at a state-defined spending target, or “benchmarking” model, that originated in Massachusetts and has since been adopted, in varying forms, by three other states. In a new white paper, written with support from the Robert Wood Johnson Foundation, Manatt Health examines the four state benchmarking programs, but focuses primarily on how the Massachusetts program has evolved over the past seven years, how Oregon intends to implement its program, and key considerations for other states considering similar reforms. The paper illustrates how benchmarking programs can vary significantly in scope and focus as each state pursues its own path to offer policymakers a new level of insight and transparency into their health care systems. It also discusses seven areas that states should consider in developing their own benchmarking programs.


New State-By-State Childhood Obesity Data

The Robert Wood Johnson Foundation has published new data on childhood obesity rates from the Centers for Disease Control in an interactive format, including a breakdown by state. Obesity rates have dropped among young children from lower-income families. But the latest data show that obesity continues to be a major threat to children’s health, such that roughly one in every seven children ages 10 to 17 has obesity. The data also illustrate significant disparities by race: obesity rates for black and Hispanic youth are significantly higher than their white and Asian peers. As the data illustrate, obesity is one symptom of larger, more systemic problems regarding health and equity in our society.


MACPAC Releases 2019 Edition of MACStats: Medicaid and CHIP Data Book 

The Medicaid and CHIP Payment and Access Commission (MACPAC) released the 2019 edition of the MACStats: Medicaid and CHIP Data Book, with updated data on national and state Medicaid and state Children’s Health Insurance Program (CHIP) enrollment, spending, benefits, and beneficiaries’ health, service use, and access to care. A notable trend in this year’s data book is the decrease in national enrollment in Medicaid and CHIP for the second year in a row: 1.4 percent from July 2018 to July 2019 and 1.2 percent over the same period in the previous year. Although enrollment increased in some states, it declined in 34 states and the District of Columbia.