September 7 Update: Litigating the Affordable Care Act; Data to advance health equity; Mapping pre-existing conditions

The Affordable Care Act (ACA) was back in court this week in two separate cases. On Wednesday, oral arguments were presented in Texas v. Azar, a lawsuit brought by state attorneys general in 20 states who are seeking a preliminary injuction against some or all of the ACA. The Kaiser Health News podcast What the Health? opens this week with an analysis of the case (starts at 1:06). Also this week, a federal judge ruled that the Montana Health Co-Op is entitled to $5.2 million that it would have received in the final quarter of 2017 if the Trump administration had not eliminated cost sharing reduction payments. The implications of this decision are discussed in a Health Affairs blog post by Katie Keith.

Also this week, in case you missed it, State Health and Value Strategies hosted a webinar, Using Hospital Admission, Discharge, and Transfer Data to Coordinate Care: Lessons from Tennessee and Washington. We have posted the slide deck on our website for those of you who would like to review the slides. Updates follow.

  • District of Columbia – Mayor Muriel Bower signed the individual mandate this week, as part of the FY2019 Budget Support Act. D.C. follows Massachusetts and New Jersey in implementing an individual mandate. SHVS has model legislation for states interested in developing their own individual mandate.
  • Maine – Governor Paul R. LePage sent a letter to Secretary Azar and Administrator Verma encouraging the Centers for Medicare & Medicaid Services (CMS) to reject the State Plan Amendment to implement Medicaid expansion that the Maine Department of Health and Human Services is being required to submit pursuant to a recent court order.
  • Massachusetts – Staff from Massachusetts Health Connector penned a blog post for Health Affairs this week that shares the policy choices and program design approaches they implemented that have successfully kept premiums low.
  • New Jersey
    • Governor Phil Murphy announced today that individual market health insurance rates will on average decrease by 9.3 percent for plan year 2019. The Governor attributed the decrease in rates to the establishment of the state’s individual mandate and the implementation of a reinsurance program.
    • Public comments are being accepted by CMS on New Jersey’s request to amend their New Jersey FamilyCare waiver to implement the New Jersey Home Visiting pilot program for high-risk pregnant/postpartum women, infants and young children up to age two, among other changes.
  • New York – Comptroller Thomas DiNapoli released a report documenting enrollment trends in Medicaid and other public health insurance programs in New York.
  • South Carolina – The state is requesting a new section 1115 demonstration to assist in the transition toward a “preconception care model” for the delivery of family planning services. The full “preconception care model” would include services like regularly managing diabetes, hypertension, heart disease, and depression, and substance abuse. CMS is accepting public comments through October 7.

Capturing Detailed Data to Advance Health Equity

The Robert Wood Johnson Foundation (RWJF) partnered with PolicyLink to identify the needs and gaps in how ethnic and racial data are collected, analyzed, and reported for each of the major aggregated ethnic and racial groups. The resulting report, Counting A Diverse Nation: Disaggregating Data on Race and Ethnicity to Advance a Culture of Healthis a first step toward identifying solutions for improving data and, ultimately, achieving health equity in the United States. In addition to the report, RWJF commissioned six reviews by leading research experts who explored data disaggregation for health among different population groups. RWJF and PolicyLink will be hosting a webinar on September 11 where they will be discussing the findings in the Counting the Nation report, the pros and cons of disaggregating data, and what researchers need to move the field forward.

New Coverage Data from the American Community Survey and Community Population Survey

Our friends at State Health Access Data Assistance Center (SHADAC) are hosting a webinar that will provide an overview of the 2017 health insurance coverage estimates from two key, large-scale federal data sources: the American Community Survey (ACS) and the Current Population Survey (CPS). The webinar will examine the new estimates with technical insight from experts at the U.S. Census Bureau, which administers both the ACS and CPS, and from SHADAC researchers. Attendees will learn about the new 2017 national and state coverage estimates, when to use which estimates from which survey, and how to access state-level estimates from the ACS using SHADAC tables

Mapping Pre-existing Conditions in the United States

The Kaiser Family Foundation released an issue brief that provides new estimates of variation in the prevalence of pre-existing conditions across communities in the United States among non-elderly adults. Estimates are based on a review of pre-ACA underwriting manuals used by insurers in the individual market. The issue brief finds that the prevalence of pre-existing conditions can vary by 10 percent or more between cities in the same state. While a large share of people with pre-existing conditions have coverage through an employer or public coverage where they do not face medical underwriting, the estimates in the Kaiser issue brief quantify how many people could be ineligible for individual market insurance under pre-ACA practices if they were to ever lose their current coverage.