Blogs

The seventh open enrollment for the Affordable Care Act’s health insurance Marketplaces runs through December 15 in most states. Following up on the November 1 blog post, here are five more things to know about where the health care reform law stands now:

1. Reading the Fine Print Is More Important than Ever: Funding for “Navigators” who provide enrollment assistance to ACA Marketplace customers has been reduced significantly since the early years of the ACA, so there is less access to personalized assistance that could help people distinguish between comprehensive plans and skinnier alternatives. Experts at Georgetown’s Center on Health Insurance Reforms (CHIR) have found 15 states trying to warn consumers of fraud, deceptive marketing, and the limitations of non-ACA-compliant forms of coverage. State regulators are alarmed by a growing trend of robocalls and deceptively designed websites pushing unsuspecting people toward plans with big coverage gaps.     
2. Health Care, Immigration, and the ACA: The “public charge” rule would make Medicaid and several other non-cash programs count against applicants for lawful permanent residence (a “green card”). While the rule was blocked by the courts before it could take effect, it may have already had the effect of depressing enrollment in some health care programs. Soon after the public charge rule was finalized, the President issued a proclamation—also temporarily blocked by the courts—barring prospective immigrants from entering the U.S. if they cannot prove they can pay for reasonably foreseeable health care expenses or get health insurance within 30 days. Short-term plans would count as health insurance, but subsidized ACA Marketplace coverage would not.
3. Redefining Nondiscrimination Under the ACA: Originally designed to ensure nondiscrimination under the ACA, Section 1557 is another part of the health care reform law that the Administration is working to revise. A federal judge has blocked parts of the Obama-era Section 1557 rules that have to do with transgender- and abortion-related protections, but a new regulation that could be finalized soon would go further, reinterpreting the entire regulation so Section 1557 no longer applies to most health insurance companies’ activities. For example, it would remove language prohibiting discrimination in health plan marketing and benefit design.
4. “Right-Sizing” Medicaid: Questions about the size and shape of Medicaid—including whether to take up the ACA’s Medicaid expansion—are dominating health policy debates in many states. In Idaho, Nebraska, and Utah, which passed Medicaid expansion ballot measures in 2018, lawmakers delayed implementation or added new conditions like work-reporting requirements, resulting in narrower expansions than the voters intended. With encouragement from the Administration, some states are implementing policies to control Medicaid growth. Tennessee is moving forward with a block grant proposal. Right now, federal funding is open ended, available to match any expenditure states choose to make. Block grants would provide a lump sum that is limited. And, although Medicaid work-reporting requirements in Kentucky, Arkansas, and New Hampshire have been blocked by a federal judge, several states are still pursuing work-reporting requirements of their own.
5. Coming Soon: A New Study on Hab and Rehab in ACA Plans: AOTA commissioned Stateside Associates to produce a follow up to our 2014 and 2016 “Analysis of Rehabilitation and Habilitation in Qualified Health Plans” reports, which evaluate the rehab and hab benefits offered in the ACA Marketplace. The new report is expected to be completed later this month. The previous versions of the report influenced CMS’ decision to establish an AOTA-endorsed definition of habilitation for ACA marketplace plans and to revise the Summary of Benefits and Coverage (SBC) to make information about OT coverage clearer.