New HHS Secretary: President Trump, according to the Washington Post, will nominate Alex Azar to head up the agency. Azar previously worked for Lilly USA and for HHS under President George W Bush.
Elections: While an off-year election there were a number of ballot initiatives related to healthcare. The largest one was a Maine referendum to approve Medicaid expansion. The initiative was decisively approved by voters. Although currently there are disagreements between the Governor and the legislature on implementation, eventually Maine will become the 33rd state (including the District of Colombia) to expand Medicaid. It is expected that usage of referendums to expand Medicaid will be attempted in other states.
The Virginia election (election of a Democratic Governor/reshaping of their House of Delegates) also makes Medicaid expansion more likely there.
Waivers: Seema Verma, CMS Administrator, announced changes to the 1115 Medicaid waiver process. The new waiver process makes it easier for states to have their waivers approved, for approval to happen faster, and for the 1115 waivers to be place longer (up to 10 years). CMS specifically focused on making it easier to have work requirements included in the waivers.
Open Enrollment- ACA Open Enrollment started 11/1 with the early returns being generally positive. HHS announced that in the first few days over 600,000 signed (which is well above last year’s first few days’ total). SBMS have announced similarly high totals the first few days also. A few things to remember:
- Since Open Enrollment (for most states) is only half as long, sign ups per day must be far higher to match last year’s total.
- Last year HHS had approximately 9.2 million plan selections and the total number of plan selections was 12.2 million. Most analysts project enrollment by the end of January to be between 10.2 million and 11.4 million.
- Off-Exchange enrollment is not tracked in real time. The Off-Exchange market is still part of the single risk. Off-Exchange enrollment may be difficult to predict as the combination of high premium increases and (for some states) relatively cheaper Silver plans could produce wide variation in enrollment patterns.
Executive Actions: The American Academy of Actuaries, weighed in on potential executive actions on short-term duration plans and association plans. They raised concerns on how the policies could negatively affect the risk pool and consumers. They also raised the question on whether insurers would be able to re-rate midyear if changes were made during the year.