December 24 Update: Texas v. Azar; Preliminary Enrollment Numbers; Agenda for Advancing Health Equity; Top Resources of 2018

Even though the end of the year is near, last week was not a slow news week. Late Friday the 14th, a federal district judge in Texas issued a highly anticipated decision in Texas v. Azar, ruling that the Affordable Care Act’s (ACA) individual mandate to maintain health coverage is unconstitutional, and as a result the entire ACA is unconstitutional. Despite the ruling, the ACA is still the law of the land and most legal experts agree that this is only the first step in what is likely to be a long legal road that may end in the Supreme Court; consumers should be assured that if they enroll now they will have coverage in 2019. Heather Howard answers some burning questions related to the ruling and its implications in the latest Woodrow Wilson School Reacts post. Additionally, check out this Health Affairs blog post for a summary of the decision.

Also last week, the Centers for Medicare and Medicaid Services (CMS), announced preliminary enrollment numbers through the December 15 deadline for the 2019 open enrollment period. The preliminary data show enrollment remained steady and that open enrollment for 2019 coverage ended with approximately 8.5 million people enrolled compared to 8.8 million people at the same time last year. Updates follow.

  • Arkansas – The Department of Human Services launched the DHS Helpline last week which Arkansas Works enrollees can use to report their work and community engagement activities over the phone.
  • California – Covered California, the state’s official health insurance marketplace, extended the deadline to obtain health insurance effective January 1 in response to a surge of interest in enrollment and to ensure consumers have ample time to enroll following the announcement of the Texas decision. While December 15 marked the original deadline, consumers in California had until the end of the 21st to select a plan that will start on January 1.
  • Maryland – The Maryland Health Benefit Exchange, the state’s official health insurance marketplace, announced that a total of 156,963 Marylanders enrolled in private health coverage for 2019 during open enrollment, an increase of two percent compared to last year when 153,571 enrolled. The exchange also reported that young adults make up 30 percent of enrollments for 2019 health plans and that enrollment among adults ages 18 to 34 increased by four percent from a year ago.
  • Minnesota – Following the first deadline for 2019 coverage, MNsure, the state’s official health insurance marketplace, reported that 113,000 Minnesotans signed up for private health coverage and 11,000 for dental. Minnesotans have until January 13 to sign up for coverage starting February 1, 2019.
  • Nebraska – To keep Nebraskans up to date regarding the status of Medicaid expansion, approved by the voters this past November, the Division of Medicaid and Long-Term Care at the Nebraska Department of Health and Human Services launched the DHHS Medicaid expansion blog and posted a timeline with implementation targets and a frequently asked questions resource.
  • New York  – NY State of HealthNew York’s official health insurance marketplace, announced that enrollment reached 4.7 million at close of business on December 15, the deadline for January 1, 2019 coverage. Enrollment volumes in Qualified Health Plans and the Essential Plan continue to outpace last year’s levels and combined enrollment in these two programs now totals more than 1 million consumers, the highest level to date.
  • Oklahoma – CMS is accepting comments on Oklahoma’s application to amend its 1115 demonstration waiver to add community engagement requirements as a condition of Medicaid eligibility for certain individuals between the ages of 19 and 50. The federal public comment period is open through January 18, 2019.

A National Agenda to Advance Health Equity Through System Transformation

As a follow-up to a framework produced earlier this year, Families USA released a new policy agenda that prioritizes 19 recommendations to build a more equitable, efficient, high-value, and affordable health care system. The recommendations are aimed at making key changes at the federal and state level, and fall within the six domains identified in the framework: payment systems, the safety net and small community providers, community partnerships, the evidence base, measurement, and workforce.

Checklist for Implementing a Two Generation Focus Within Medicaid

Gretchen Hammer, who recently stepped down from her role as Colorado’s Medicaid Director, created, along with her staff, the Healthy Families Checklist. The Checklist uses a two-generation (2Gen) framework to focus attention on supporting the social capital, health and well-being, educational attainment, and economic security of children and families within the Medicaid program to maximize their health outcomes. Specific Medicaid policies and design choices adopted in Colorado to implement a 2Gen approach to improve the lives of children and families are profiled in the Checklist. A recent webinar, hosted by the Aspen Institute, featured the Checklist as well as a new report published by Georgetown University’s Center for Children and Families, Promoting Young Children’s Healthy Development in Medicaid and the Children’s Health Insurance Program.

Top Resources for States in 2018

It was a busy year in health policy, and it’s interesting to look back on all that happened. Here are the top five resources visited on, the hub for RWJF-funded work on state health policy, in 2018. Spoiler alert: Medicaid was the hot topic!

  1. Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Outcomes, State Health and Value Strategies
  2. Changes in Health Insurance Coverage 2013-2016: Medicaid Expansion States Lead the Way, Urban Institute
  3. How States Address Social Determinants of Health in Their Medicaid Contracts, National Academy for State Health Policy
  4. Safeguarding Financial Stability of Provider Risk-Bearing Organizations, State Health and Value Strategies
  5. The Effects of Medicaid Expansion Under the ACA: Select Articles Published Between January 1, 2018 and August 31, 2018, State Health and Value Strategies

We wish you and your families a safe and joyous holiday, and look forward to connecting in the new year!