Week in Washington: Stabilization Efforts, Mergers, and Waivers

 

March 8, 2018

ACA Stabilization Efforts – If an ACA Stabilization bill is to be passed this year, the best and probably only path is for it to be part of the omnibus spending bill, scheduled to be completed in two weeks. According to Politico, House leaders are demanding that the bill be finalized by the middle of next week. Currently the bill is at an impasse over a number of issues including abortion.

Mega-Merger- Reports circulated today that Cigna would acquire Express Scripts in a deal worth in excess of $50 billion. The merger is similar to the deal between CVS and Aetna with a goal of creating an integrated pharmaceutical/medical benefit model.

Policy news from HHS - HHS/CMS announced a number of policy initiatives this week: increased emphasis on alternative payment models, data sharing, and prescription drug discounts. Scott Gottlieb, head of the FDA, blamed profit taking along the supply chain as one reason for high out of pocket costs.

Medicaid Waivers – Arkansas become the third state to receive approval to have a work requirement as part of their Medicaid program. CMS indicated that 8 other states have applied for Medicaid work requirements and 9 more have expressed interest (17 total) so there is every expectation that Medicaid work requirements will become a bigger part of the Medicaid landscape. 

CMS did not approve (or at minimum delayed in approving) Arkansas’ ask to reduce Medicaid expansion down to 100% FPL (i.e., shift 100-138% individuals to the Marketplace). Some thought that if CMS approved this request, it may encourage other states to expand their Medicaid programs.

Iowa: - Iowa’s senate approved a bill that would allow Wellmark and Iowa’s Farm Bureau to sell non-ACA compliant plans. It is expected to pass Iowa’s House. If Iowa follows through on this proposal it would join Idaho in attempting to allow non-ACA products to compete with ACA non-group products. It is distinctly possible that other states would join this growing trend.

Florida also is expanding consumer access to non-ACA products. Today their legislature made it easier to purchase Health sharing Ministry coverage. This kind of coverage is not technically insurance and therefore ACA regulations do not apply. 

New Modeling- Covered California released its estimate on premium increases for 2019 and beyond. It also released which states were most vulnerable to high premium increases.  Overall they expect premiums to increase between 12 and 32% next year. They found that 17 states could be at higher risk for cumulative premiums in excess of 90% over the next 3 years.