University to Students on Medicaid: Buy Private Coverage, or Drop Out

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Emily and Kullen Langston were enrolling in classes for the winter semester at Brigham Young University-Idaho when they hit an unexpected roadblock.

The school, like many others, requires all students to have health coverage. But this month, the university made an unusual announcement: It would no longer accept Medicaid.

Ms. Langston, 20, enrolled in the free government insurance program last year after becoming pregnant with the couple’s daughter, who is now 4 months old. Mr. Langston, 22, was planning to sign up for Medicaid in January, when it is set to expand in the state.

To remain in school, they would have to buy private coverage. The cheapest option available is the university’s student health plan, which does not comply with the Affordable Care Act’s consumer protections and would require the Langstons to pay a $3,125 annual premium.

Ms. Langston said her family, which relies on the income her husband earns as a call-center operator, cannot afford that. She had hoped to become a teacher, but now intends to drop out of school, and her husband is unsure whether he will attend.

“I’m disappointed that they’re showing prejudice against those of us who are poor right now,” Ms. Langston said. “I’m disappointed that I’m not going to be able to finish school.”

The decision on the eastern Idaho campus has confused and angered students. The change is set to go into effect on Jan. 1, the same day Idaho will expand Medicaid coverage to about 70,000 low-income residents, including college students.

In an email last week to its 19,000 students in Idaho, the university appeared to tie its decision to the Medicaid expansion. It’s not clear how many students currently have Medicaid coverage, but the state projects that about 2,400 more people in Madison County, where the school is, would enroll with the expansion. The university warned that having too many students sign up for the public program “would be impractical for the local medical community,” an assertion a local hospital official rejects.

The policy change is likely to push more students into a health plan administered by Deseret Mutual Benefits Administration, which, like the university, is owned by the Church of Jesus Christ of Latter-day Saints.

That plan limits annual benefits and doesn’t cover birth control — provisions that would violate the Affordable Care Act, but for a little-noticed Obama-era exemption for universities that fund their own health plans.

“It seems like a loophole, and is pretty misleading to students,” said Erin Hemlin, who oversees health policy at Young Invincibles, a nonprofit that focuses on issues affecting college students and young adults. “It’s called a student health plan, so you would think it’s going to be comprehensive coverage, and it isn’t.”

The church has been vocal on aspects of the Affordable Care Act, including religious freedom and the health law’s birth control mandate, but it has remained quiet on Medicaid expansion. It has never taken a public position on the issue, a church spokesman confirmed. The university’s Idaho campus and the church both declined to comment on the policy change.

Before the Affordable Care Act, student health plans across the country varied significantly from one campus to another. Some offered robust health benefits, while others had maximum annual benefits as low as $5,000.

The Obama administration required that most university plans comply with the new law by covering a wide array of essential health benefits, including maternity care and prescription drugs, and eliminating annual benefit caps.

The rules, issued in 2013, included a carve-out for a small number of universities that “self-funded” their health plans, meaning they used student premiums to cover costs — and accepted responsibility for any large bills that might cost even more. At the time, about 30 universities had such plans.

Most were big institutions with large endowments, such as the University of California, Johns Hopkins and Princeton. Those three, and some others, chose nevertheless to make their self-funded student plans comply with the Affordable Care Act.

But Brigham Young University campuses in Utah, Idaho and Hawaii did not. The university publicly opposed the law’s requirement to cover contraceptives. And its plans limited the maximum annual benefit. At the time, a university spokesman told the campus newspaper in Utah, “There are numerous government-imposed requirements that we don’t believe are necessary to provide good health care to our students.”

The Idaho campus’s plan has a $4,750 deductible that must be met before it will cover maternity care for the spouse of a student. It does not cover certain major medical services, such as residential mental health care and care related to an organ transplant.

These restrictions, along with the premium costs, are central reasons the Idaho students with Medicaid coverage object to buying the university’s student plan. “It feels like they’re forcing us into a noncompliant health plan when the one we have is already compliant with Obamacare,” said Amanda Emerson, a 26-year-old student. “They’re making it really difficult to do anything otherwise.”

Deseret Mutual Benefit, the plan administrator, says that limiting benefits helps keep premiums down. “The purpose is to try to provide a plan as inexpensively as possible to the students,” said Andy Almeida, the company’s chief operating officer.

The Idaho campus is the only Brigham Young site that will no longer accept Medicaid as a substitute for the student health plan, a decision that university officials would not explain. The school’s Utah and Hawaii campuses allow students with Medicaid to waive private coverage.

Utah voters agreed to a Medicaid expansion last year, and a partial version of the program took effect in February. The state does not provide data on how many of the 33,000 students at the Provo campus are enrolled in Medicaid. The Hawaii campus has just 2,500 students; the number on Medicaid is not disclosed.

Idaho had long resisted participating in the Affordable Care Act’s expansion of Medicaid, which provides coverage to Americans who earn less than 133 percent of the federal poverty level ($16,612 for an individual, and $34,248 for a family of four).

The state legislature twice voted down bills that would have added Idaho to the program, which currently covers 36 states and the District of Columbia. In 2018, local activists secured a ballot initiative on the issue. The proposal passed with a double-digit margin, and after a State Supreme Court challenge, the program will start in January.

In announcing its new stance on Medicaid, Brigham Young University-Idaho cited a worry about overwhelming local health care providers. The local hospital, however, said it had no such concerns and had not raised the issue with the university.

“We have some great providers here, and we feel like we’re able to handle any growth that the university and the community would need,” said Doug McBride, executive director of business development at Madison Memorial Hospital, a county-owned facility.

Since the school announced the new policy this month, students have organized Facebook groups and circulated petitions opposing the change.

Ms. Emerson, one of the students with Medicaid, is planning to enroll in a private plan in addition to her public coverage. Her husband, also a student at the Idaho campus, plans to do the same. They said they had discussed their options with a local insurance broker and found that the student plan would be the cheapest, but hadn’t yet made a decision.

“We only have a few weeks until we have to be registered for new classes, so this kind of dropped a bomb on us,” Ms. Emerson said. “We only have one semester to go, so we’re willing to dip into our savings.”

 

 

 

Tennessee becomes first state to ask permission for Medicaid block grants

Posted on by • Posted in 2020 Election Issues, ACA, Health Policy, Medicaid, Medicaid Block Grants, Medicaid Expansion • Leave a comment

Tennessee becomes first state to ask permission for Medicaid block grants

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Tennessee on Wednesday formally asked the Trump administration for permission to convert its Medicaid program into a limited, block grant–type model, a controversial plan that, if approved, could be the first in the nation.

The proposal will test the Trump administration’s ability to allow states the flexibility to make drastic changes to Medicaid.

Imposing block grants in Medicaid has long been a major conservative goal and has been encouraged by the Trump administration, but it is not clear if the administration alone has the legal authority to allow such drastic changes.

Administration officials had drafted a guidance that would make it easier for states to apply for a capped payment or block grants, but the document was quietly removed from the White House Office of Management and Budget last week.

No states have been granted permission to date, but if Tennessee’s plan is approved, it would likely embolden other Republican-led states. The proposal will also mobilize opposition from patient advocacy groups, who have already been protesting since the state passed a bill

“This proposal represents a significant opportunity for the federal government to test a potential innovative, national solution at how to incentivize states’ performance in maximizing the value of taxpayer dollars,” the state said in its application.

Republicans say policies like block grants allow for more state flexibility and are more fiscally sustainable.

Critics fear a block grant would ultimately lead to states kicking people off their rolls or pulling back services. But Tennessee’s proposal is a novel one that departs from some of the more traditional block grant ideas, even as it imposes financial caps on federal spending.

Under Tennessee’s proposal, the state would receive a nearly $7.9 billion block grant from the federal government, which is based on projected Medicaid costs. The amount would be adjusted for inflation, but unlike a traditional block grant, it could increase in the future based on enrollment.

If enrollment drops, the block grant amount would not decrease. The state said no current TennCare members would experience a loss or rollback of benefits.

Also unlike a traditional block grant, if the state spent less in a given year than it would have under the traditional Medicaid system, Tennessee would split those savings with the federal government.

 

 

Critics say ‘junk plans’ are being pushed on ACA exchanges

Posted on by • Posted in 2020 Election Issues, ACA, Center for Medicare and Medicaid Services (CMS), Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, Out of Pocket Expenses, Preexisting Conditions, Short Term Health Insurance, Skinny Health Plans • Leave a comment

https://www.washingtonpost.com/health/2019/11/20/critics-say-junk-plans-are-being-pushed-aca-exchanges/

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The Trump administration has encouraged consumers to use private brokers, who often make more money if they sell the less robust plans.

The Trump administration is encouraging consumers on the Obamacare individual market to seek help from private brokers, who are permitted to sell short-term health plans that critics deride as “junk” because they don’t protect people with preexisting conditions, or cover costly services such as hospital care, in many cases.

Consumers looking at their health insurance options on the website for the federal marketplace, called healthcare.gov, may be redirected to other enrollment sites, some of which allow consumers to click a tab entitled “short-term plans” and see a list of those plans, often with significantly cheaper premiums. Short-term plans were once barred from the exchanges because they were considered inadequate coverage and do not meet the insurance requirements laid out under the Affordable Care Act. If consumers select a short-term plan, they are directed to call a phone number to finish signing up, according to screenshots provided to The Post.

Critics say that both the sale of short-term plans through private brokers and consumers’ ability to select such plans are the latest examples of Trump administration efforts to weaken the ACA after failing to repeal and replace the law in Congress. The president has repeatedly contended that short-term plans provide “relief” from expensive individual market insurance plans that are unaffordable to many consumers. The rule allowing the sale of such plans was finalized late last year, just weeks before open enrollment, so this is the first year they are widely available.

In addition to these efforts, the administration is also seeking to void the law in court, siding with a group of Republican state attorneys general who argue it is unconstitutional since Congress zeroed out the penalty for not having insurance in its 2017 tax overhaul legislation. A trial court in Texas ruled the entire law invalid late last year, and an opinion is expected at any time from the U.S. Court of Appeals for the 5th Circuit. The law is likely to end up in front of the Supreme Court for a third time, possibly amid the 2020 presidential election.

Under the ACA, all health insurance plans have to cover 10 essential health benefits, including maternity and newborn care, prescription drugs, emergency room services and mental health. Short-term health plans do not have to cover those services, can discriminate against those with preexisting conditions and set caps on how much they are willing to pay, which is prohibited for Obamacare plans.

Brokers often make higher commissions on short-term plans, health policy experts said, which gives them an incentive to sell them. They are supposed to present ACA-compliant plans to consumers, but are allowed to provide other options, including short-term plans. Some brokers make clear that such plans are not as comprehensive as ACA plans, but experiences differ.

“The whole business model is signing people up for coverage and getting a cut of what they sell, and the place they’re going to make their money is selling these short-term plans,” said Nicholas Bagley, a professor of law at the University of Michigan and proponent of the ACA. Consumers “don’t fully understand the lack of protections if they go over some annual or lifetime [insurance] limit. These plans don’t cover preexisting conditions.”

The administration’s use of outside brokers has prompted nearly two dozen Senate Democrats, including Democratic presidential candidates Elizabeth Warren, Kamala D. Harris and Amy Klobuchar, to send a letter to CMS on Wednesday expressing their concern over the promotion of short-term health plans.

“We are concerned that [CMS] is not only failing to conduct sufficient oversight to protect customers, but is actively emailing consumers to encourage them to obtain coverage through third-party agents and brokers instead of the HealthCare.gov website,” the senators wrote in a letter. Democratic New Hampshire Senator Jeanne Shaheen orchestrated the effort.

Such plans were previously available for periods of three months or less and could not be renewed, but the administration late last year finalized a rule that allowed for the plans’ availability for up to 12 months, with the option to renew them for up to three years. A federal judge sided with the administration in a court challenge to their expanded availability and upheld the rule in July. Consumers still cannot use government subsidies to purchase short-term plans, however.

“For most of the people buying on the exchanges, this would be worse than what they’ve been buying, especially because the majority of people who buy on exchanges get help with their premiums,” said Allison Hoffman, a law professor at the University of Pennsylvania Law School.

The Centers for Medicare and Medicaid Services has sent at least five emails so far to individual market consumers encouraging them to use outside brokers, including through a service called Help on Demand, to sign up for health insurance, according to emails obtained by The Post from a recipient of ACA market emails. The agents and brokers must be registered with the federal exchanges, CMS said in a statement, and they help consumers sign up for individual market plans.

“While agents and brokers are required to provide assistance with Exchange, Medicaid and CHIP coverage and are directed to enroll consumers in such coverage options whenever possible, they are not prohibited from sharing information on other coverage options, such as those offered off-Exchange,” a CMS spokeswoman said.

Some critics of the policy say the expanded sale of short-term plans may be one of the factors depressing enrollment in Obamacare plans, which dropped 13 percent in the first three weeks of the sign-up period, compared to the same period last year, according to federal data released Wednesday. During the 2019 open enrollment, 1,924,476 people signed up for individual market plans in the first two weeks of enrollment, compared to 1,669,401 for 2020. Open enrollment ends on Dec. 15.

CMS said it has used Help on Demand for three years, but the agency has increasingly encouraged consumers to seek their advice through emails directing them to the service’s website.

The Trump administration has drastically cut federal funding for “navigators” — grass roots organizations that help people sign up for ACA plans, including those who may not otherwise know they are eligible for coverage. .

Premiums for the most common type of Obamacare plan dropped by 4 percent for 2020, CMS said last month, and the vast majority of consumers on the individual market qualify for government tax subsidies that help cover the cost of their insurance. However, consumers complain about high deductibles and premiums in individual market plans.

 

Catch up quick: Upcoming health care regulations

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https://www.axios.com/newsletters/axios-vitals-fca251e2-81eb-4bea-bd8d-e37ced8516e1.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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The federal government yesterday updated its list of in-progress health care regulations, Axios’ Bob Herman reports.

A few worth highlighting:

  • A rule that would formally allow pharmacists and drug distributors to import some drugs from Canada.
  • The Trump administration’s idea of tying the prices of certain drugs in Medicare to lower international rates is getting closer to an actual proposal, perhaps coming out as soon as this month.
  • A proposal that would speed up Medicare’s coverage of “breakthrough technologies.”
  • A requirement that a patient’s health information be shared more easily among doctors and other providers.

Threat level: Many of these regulations are not formal proposals yet, so it’ll be years before they get enacted — if they get enacted at all after industry groups lobby.

  • Policies driven by the executive branch often have squishy timelines, or can be squashed altogether.
  • For example: An Obama-era regulation that addressed charities paying insurance premiums for dialysis patients is still on the docket to come out any day now.
  • And the Trump administration has already spiked one of its own rules that would’ve reduced nicotine levels in cigarettes, Bloomberg reported.

Other regulations, like Medicare’s payment rules for hospitals and updated policies on Medicare Advantage, have to come out at certain times every year. That’s where a lot of the action remains.

 

 

The Tricky Politics of Healthcare

Posted on by • Posted in 2020 Election Issues, ACA, Health Policy, Medicare, Medicare for All • Leave a comment

https://www.latimes.com/politics/story/2019-11-20/elizabeth-warren-medicare-all-healthcare-democrats

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Last spring, at the dawn of the endless Democratic primary debates, it seemed as if presidential candidates couldn’t wait to endorse the idea of “Medicare for all.”

It was a fine slogan, even if they didn’t agree on what it meant. Everyone likes Medicare; every Democrat wants to move toward universal health coverage. What could go wrong?

Only this: Bernie Sanders had already written a detailed healthcare bill — and in it, Sanders laid claim to sole ownership of Medicare for all.

Sanders’ version of national healthcare is expensive and ambitious. It would abolish private health insurance, cover much more than Medicare does now, and raise middle-class income taxes to pay for it. It’s hard to imagine Congress considering it.

Other candidates were hit with a predictable question: Do you support Sanders’ bill, including the abolition of private insurance?

Elizabeth Warren boasted of having a plan for everything else, but she outsourced this one.

“I’m with Bernie,” she said.

Kamala Harris agreed, saying she wanted to “eliminate” the hassle of dealing with insurance companies.

Cue the backlash. It turned out that progressive activists who attend Democratic town halls are ready for Canadian-style government insurance, but millions of other voters aren’t.

Polls found that most voters thought Medicare for all meant everyone would be allowed to opt into Medicare if they wanted, not that private health insurance — the kind most Americans buy through their employers — would disappear.

They also weren’t keen on paying more in federal taxes, even though Sanders and other advocates argued that they’d save money on premiums and other healthcare costs in the end.

The moderate candidates pushed back. Joe Biden proposed a more gradual route toward universal coverage, a government-run public option that anyone could choose to buy, and that he said would be “like Medicare.”

Pete Buttigieg proposed a similar plan and dubbed it “Medicare for all who want it.” Both said they’d allow people to keep private insurance.

After weeks of waffling, Harris came up with hybrid: a government-run plan with private insurance as an option, similar to the role “Medicare Advantage” plays in the current Medicare system.

Oddly, Harris’ plan resembles present-day Medicare more closely than Sanders’, which would change Medicare into something much bigger.

On Nov. 1, Warren belatedly offered details of how she’d finance a Sanders-style Medicare for all through more than $15 trillion in new taxes on businesses and the rich. But that didn’t stop the criticism.

So last week, she backpedaled.

In the great debate between Sanders’ big leap to a single government-run health plan and Biden’s incremental steps toward broader coverage, Warren declared herself in favor of both.

She’s still in favor of Sanders’ plan. But she acknowledged that it would take a while to get through Congress. That’s if she can pass it at all — although she doesn’t say that part out loud.

So Warren proposed fast-track legislation in the interim to make traditional Medicare available to everyone over 50 and create a Biden-style public option plan available through Obamacare. She calls this the “Medicare for all option,” which sounds a lot like Buttigieg.

Meanwhile, she promises, she’ll try to pass a full Sanders-style bill later, probably in the second half of her first term.

By then, she said, “the American people will have experienced the full benefits of a true Medicare for all option,” and public support will be stronger. Never mind that most new presidents have more sway in their first two years in office, rarely years three and four.

Needless to say, Warren took flak from both sides.

Sanders, in Los Angeles, said he’d turn his plan into law right away — implying that Warren’s strategy is too slow.

A spokeswoman for Biden accused Warren of “double talk.” A spokeswoman for Buttigieg said Warren still “wants to force 150 million people off their private insurance, whether they like it or not.”

It’s true that Warren’s plan calls for abolishing private insurance and imposing huge new taxes — and voters aren’t sold on those ideas.

But Warren’s new plan is smart for one big reason: None of these proposals was ever going to sail through Congress — not even the relatively moderate Biden plan.

The Democrats’ debate on healthcare has suffered from a bad case of fairy dust.

They’ve argued plenty about policy — about how they want to change the nation’s health system and how they’d pay for it.

But their progressive candidates sometimes sound as if they’ve forgotten basic politics: Which proposal will help them win the White House? And how will they get it through a Congress in which Republicans might retain a majority (or at least a near-majority) in the Senate?

No president’s agenda survives its encounters with Congress unscathed. Barack Obama arrived in the White House in 2009 with big majorities in both houses, and his Affordable Care Act — less ambitious than even Biden’s current plan — barely survived.

In that sense, what Warren has done is useful. She’s tacitly acknowledged that she can’t get everything she wants on Day One, and she needs a backup plan. She doesn’t admit that Medicare for all will be hard to pass — “I’ll fight my heart out at each step,” she promises — but that’s what she means.

It’s a nod toward realism. It’s a step forward in the Democrats’ debate on voters’ top domestic issue.

And it’s an intriguing step forward in the still-brief political career of Elizabeth Warren. She’s no head-in-the-clouds Harvard professor. She’s become a cannier, more practical politician.