The Scoop: Health Insurance News – November 5, 2021 Edition

The open enrollment period is now underway in the United States

Open enrollment for medical insurance 2021, both individual and family, began last Sunday and has now begun nationwide. This window is only for people who wish to buy their own medical insurance. They don’t receive protection through an employer, or a government program like Medicaid or Medicare.

The 2021 Open Registration Information is all you need to know about enrolling in a reasonably priced health plan for individuals.

Open enrollment for Medicare can continue, but it is on a slightly different schedule.

If you have any questions about the open enrollment period for individuals and families, we can provide a comprehensive guide that will likely answer them.

Washington DC, 10 states and most states will end open enrollment on December 15; however, Washington DC, Washington D.C., and other states may have later deadlines.

You should know that you’ll only be able to purchase individual main medical insurance for 2021 if you do not experience a qualifying event throughout the year.

Georgia will no longer have an alternative medical insurance plan as of 2023

The Trump administration officially approved Georgia’s proposal on Sunday, two days before the elections and the same day as open enrollment started, to stop offering a medical insurance alternative in 2023. Georgia will be using a 1332 exemption for this change, and will also be incorporating a new reinsurance program that can go into effect in 2022. All the states that have been approved for 1332 waivers are using them to apply for reinsurance, but Georgia’s plans will be more important.

Georgia will no longer use after 2023. Georgia, unlike other states (Nevada Pennsylvania and New Jersey), which have recently transitioned from, has no plans to build a state-run alternative platform for medical insurance. Georgia will rely on existing internet brokers, insurance companies, and local brokers and agents to help Georgians enroll.

Most of the public comments submitted on this change were against it. Consumer advocates are concerned that Georgia residents may enroll in non-ACA compliant plans, such as short-term health insurance. (Quick-term insurance plans will not be available through but will be offered by many of the internet brokers, insurers and brokers/brokers that will operate the only enrollment platforms in Georgia starting 2023. These enrollment entities may also have little incentive to help people enroll in Medicaid and CHIP because there are no commissions.

Five states elect insurance commissioners

In the United States, every state has an insurance commissioner. This person is in charge of the regulatory department that oversees the insurance policies within their state. This includes medical insurance and other types of insurance. Insurance coverage commissioners were on the ballot in 5 states yesterday. Here’s a breakdown of the results:

  • Delaware: Trinidad Navarro was re-elected as the incumbent Democrat.
  • Troy Downing is the Republican who won the election to be Montana’s Commissioner of Securities and Insurance Coverage, State Auditor. Matt Rosendale, the current commissioner of Montana, did not run for reelection. He ran to fill Greg Gianforte’s vacant seat in the U.S. House of Representatives, which was vacated when he decided to run for governor. Rosendale and Gianforte each received their respective races.
  • North Carolina: Mike Causey won re-election in North Carolina, beating Democrat Wayne Goodwin a second time. Causey stated last month that “I favor competition and free markets more than government management of insurance, but I believe the Affordable Care Act has brought many people relief.”
  • North Dakota: Jon Godfread was the only Republican candidate and won reelection without any opposition.
  • Mike Kreidler was re-elected as the incumbent Democrat in Washington. Kreidler was instrumental in implementing strong consumer protections for Washington’s short-term health plans. He also ensured that coverage availability in the ACA-compliant Washington market remained constant over the past few years, and he shepherded the implementation of Washington’s new standardized plans and public choice plans.

Three healthcare poll measures were rejected by voters and one was accredited

Last week, we told you what healthcare polling measures to consider in this election. Here’s the way voters chose these points:

  • Oklahoma State Query No. 814 has been rejected by voters. The measure would have changed the way in which the state uses tobacco settlement money to provide the legislature with additional funding to be used to pay for the state’s portion of the cost of Medicaid expansion, which will take effect next summer (thanks to another poll measure that voters approved earlier this year). Emma Morris, of the Oklahoma Coverage Institute, explained earlier this year that the legislature has a variety of funding options.
  • Colorado Proposition 118 has been approved by the voters. It will create a program for paid medical and household leave that is likely to be funded through a tax reduction between employers.
  • Colorado Proposition 115 has been rejected by voters. The law would have prohibited abortions beyond 22 weeks. Colorado is the only state in all of seven that does not limit abortions based on gestational age.
  • California Proposition 23 has been rejected by voters. The Service Staff Worldwide Union – United Healthcare Employees West (SEIU – UHW West) supported the proposition, which would have imposed new laws in California on dialysis centers.

A federal judge has vacated the public cost rule, but it was upheld on appeal and can be implemented.

A federal judge in Illinois vacated the Trump administration’s updated “public cost” rule, which was implemented in February this year. The order of the judge is applicable nationwide. The change, however, was only temporary, as the Seventh Circuit Court of Appeals stayed its decision two days later. This allowed the Trump administration to continue to implement the new “public cost” rule while the litigation in the case continues.

Here’s more information about the public price rule change, as well as details on the administration’s separate requirements for medical insurance for immigrants. These have also been blocked by courts.
According to the Trump administration’s public cost rule Medicaid, SNAP and TANF benefits have been added as advantages that could lead an immigrant to be labeled a “public cost” and denied legal everlasting residence or entry into the US. The list of public benefits does not include premium subsidies for CHIP and the exchange. However, there is a “closely weighed positive factor” in favor of immigrants who do not depend on subsidies. The public cost rule is intended to reduce various public benefits, including health protection for immigrants.

The Trump administration’s Healthcare Transparency Rule aims to make pricing information public

The Trump administration released a final rule last week on price transparency in healthcare. The new rule will allow customers to know their out-of pocket costs before a procedure is performed, instead of waiting for proof of benefits afterward. Insurers are also required to publish the rates they pay out-of network providers, the amount of money that is paid for their invoices and how much it costs them over a certain period, as well as prescription drug prices. Katie Keith, at Well being Affairs has an excellent, detailed overview of this new transparency rule.

The transparency rule will be implemented in phases, starting from 2022 and ending 2024. It would cover all private medical insurance plans, including employer-sponsored and individual market plans. The rule does not apply to grandfathered or grandmothered insurance plans. It also doesn’t cover protection not covered by the Affordable Care Act. This includes healthcare sharing ministries, short-term health plans and insurance that isn’t regulated. This new rule is based on ACA Part 1311 (e) (3), which deals with transparency and reporting. While issuing this new rule, the Trump Administration is simultaneously working to overturn the entire ACA in court, in a suit that the Supreme Courtroom is hearing next week.

The new transparency rule was designed to help customers avoid shock medical costs, make comparison shopping easier, drive them to suppliers that offer the best value, increase competition and reduce healthcare costs. America’s Health Insurance Plans (AHIP), however, quickly expressed opposition to this new transparency rule. They argued that the public disclosure of privately negotiated prices would drive healthcare costs higher rather than lower. As this thread by Nisha Kurani of the Kaiser Family Foundation illustrates, consumers have been slow to take advantage of existing price transparency tools that some states already have created.

The Trump administration has long been committed to promoting transparency in pricing for healthcare. This rule is a follow-up of a similar rule issued last fall that required hospitals to publish their costs. The American Hospital Association sued to stop that rule and is currently appealing the case. If it is not overturned by appeal, the rule would come into effect in January 2021.

What is next for the ACA?

In many areas, the results of the presidential elections are still pending. However, the likely scenario we’re experiencing as of January is that of a Biden/Harris White House, a Democratic led Home of Representatives and a Republican led Senate. This divided structure – and the ever-widening gulf between both political parties – is unlikely to result in any significant healthcare reform legislation being passed anytime soon. Andrew Sprung says that the Biden administration can do a great deal to improve access to affordable health care and protection.

If you are interested in where we go next – with the federal government that is likely to remain divided and the urgent need for healthcare reform – then you may also want to read this article by Charles Gaba, this one by Dave Anderson and this tweet thread from Larry Levitt.