YEAR-END REPORT - 2020 Published 21-Dec-2020 HPTS Issue Brief 12-21-20.16 Health Policy Tracking Service - Issue Briefs Healthcare Reform Insurance Market Reform This Issue Brief was written by a contributing writer. 12/21/2020 Introduction The state health insurance exchanges and the federal government responded to the coronavirus epidemic differently, with many state exchanges reopening enrollment while the federal government changed some regulations but declined to reopen enrollment in the federally run health insurance exchange. A key committee in Connecticut approved legislation that would create a public option for health insurance in the state in response to the coronavirus pandemic. Vermont governor Phil Scott and the Department of Financial Regulation (DFR) announced an emergency regulation requiring commercial health insurers to cover the cost of the diagnosis and treatment of COVID-19 without cost-sharing to beneficiaries. The health insurance exchange in Nevada announced that it would extend open enrollment to May 15 in response to the COVID-19 pandemic. Over 10,000 Colorado residents signed up for health insurance coverage through the state's health insurance exchange during the special enrollment period created in response to the COVID-19 pandemic. The U.S. Supreme Court ruled that the federal government owes insurance companies $12 billion under a provision in the Affordable Care Act (ACA). Over 10,000 Colorado residents signed up for health insurance coverage through the state's health insurance exchange during the special enrollment period created in response to the COVID-19 pandemic. According to a recent analysis by the Kaiser Family Foundation, an estimated 26.8 million people throughout the United States will lose health insurance coverage because of a loss of job-based health coverage due to the COVID-19 pandemic. The health insurance exchange in Massachusetts, the Massachusetts Health Connector, saw a surge of 45,000 people who enrolled in health plans or updated their health insurance coverage during a two-month period of the special enrollment opened due to the COVID-19 pandemic. The health insurance exchange in California, Covered California, announced that 123,810 people had enrolled in health insurance coverage during the special enrollment period opened in response to the COVID-19 pandemic. The Silver State Health Insurance Exchange, Nevada's health insurance exchange, enrolled over 6,000 state residents in health insurance coverage through the online marketplace during a special enrollment period due to the COVID-19 pandemic. Over 89,0000 Idaho residents enrolled in health insurance plans for 2020 via the state health insurance exchange. Fewer residents enrolled in private plans due to Medicaid expansion in the state. Maine Governor Janet Mills, Maine Senate President Troy Jackson (D-Allagash) and House Speaker Sara Gideon (D-Freeport) introduced a bill that would allow the state to create a state-run health insurance exchange. The Virginia legislature is considering several bills aimed at preserving protections now provided by the Affordable Care Act. New Jersey Gov. Phil Murphy signed several bills into law aimed at protecting access to health insurance for state residents in the face of federal attacks on the Affordable Care Act. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -1- Washington Attorney General Bob Ferguson filed a lawsuit challenging a new Trump Administration rule that would require insurance companies to send consumers two separate monthly bills per plan, charging consumers separately for the cost of abortion coverage. The New York health insurance exchange extended open enrollment for 2020 plans an additional week for state residents. The new deadline is February 7. The New Mexico House approved legislation that would give the state's health insurance exchange increased autonomy to help poor and uninsured residents gain health insurance coverage. Enrollment in health insurance plans through Covered California, the state's health insurance exchange, increased by hundreds of thousands of people. Colorado Gov. Jared Polis (D) updated a proposal to implement a state public option health plan increasing reimbursement rates for hospitals to 155% of Medicare payment rates. Connecticut saw a decrease in the enrollment of state residents through the health insurance exchange, Access Health CT. Enrollment in the New York health insurance exchange reached a record high of 4.9 million people. Kentucky Governor Andy Beshear announced that the state would return to the state-run health insurance exchange, Kynect. The Centers for Medicare & Medicaid Services (CMS) released a report showing trends of people signing up for health insurance coverage through HealthCare.gov under a special enrollment period (SEP) exception during the COVID-19 pandemic. The Maryland Health Connection announced that almost 58,000 Maryland residents enrolled in individual health insurance plans through the state's health insurance exchange during the Special Enrollment Periods (SEPs) opened due to the COVID-19 pandemic. According to a new report from Avalere, the Affordable Care Act (ACA) exchanges have experienced significant increases in enrollment during the COVID-19 pandemic, particularly from people losing employer-sponsored insurance plans and those who were uninsured. The Colorado Division of Insurance (DOI) announced that the cost of premiums for individual and small group health plans for 2021 would not increase significantly. According to a new report on the health insurance exchange market, it is expected to grow significantly by 2025. Recent market trends show the current value of the global online health insurance marketplace at 2 billion dollars. The cost of health insurance plans through Maine's health insurance exchange will decrease an average of 13.1 percent, according to the Maine Bureau of Insurance (BOI). The Pennsylvania Insurance Commission announced the 2021 requested rate filings for health insurance plans available through the ACA health insurance exchange. The average rate requests would lead to lover premium costs in the individual market for Pennsylvania residents. New Mexico Superintendent of Insurance Russell Toal announced that the cost of individual coverage through the state's health insurance exchange, beWellnm, will decrease significantly for individuals and families purchasing coverage. Pennsylvania announced the launch of its new state-based health insurance exchange for 2021 coverage, Pennie. The Centers for Medicare & Medicaid Services (CMS) announced that Georgia has requested a waiver for its individual health insurance marketplace through a section 1332 State Relief and Empowerment Waiver. The Pennsylvania Department of Insurance announced that it had approved health insurance rates representing a decrease in individual market rates. Due to job losses related to the COVID-19 pandemic, the Nevada health insurance exchange expects increases in enrollment with the upcoming open enrollment period for health insurance plans beginning in 2021. New federal data released prior to the start of open enrollment on November 1 showed that Maine is among the states where health insurance premiums decreased for health coverage obtained through the ACA exchanges. The open enrollment period for Idaho residents needing to access plans through the individual market will be the first enrollment period since the beginning of the COVID-19 pandemic. Two days prior to Election Day, the Trump administration approved Georgia's plan to exit the federal health insurance exchange beginning in 2023 without setting up its own state-run health insurance exchange for Georgia residents. Maine Considers State-Run Exchange Maine Governor Janet Mills, Maine Senate President Troy Jackson (D-Allagash) and House Speaker Sara Gideon (D-Freeport) introduced a bill that would allow the state to create a state-run health insurance exchange. The bill is focused on expanding access to private health insurance by reducing costs for individual consumers and small businesses. “It will help prevent anyone who is seeking coverage from falling through the cracks, whether they're eligible for Medicaid or a subsidized plan under the Affordable Care Act,” stated Alison Weiss, communications director for Maine Equal Justice. “This plan © 2021 Thomson Reuters. No claim to original U.S. Government Works. -2- underscores how important it is to improve and defend the ACA, because we should be making more affordable care available in Maine, not less.” The bill is called “The Made for Maine Health Coverage Act.” Other states that have chosen a state-based marketplace for ACA-compliant plans for individuals and small groups are expected to have premiums that cost slightly less this year. From 2015 to 2018, the cost of premiums increased significantly. The largest increase was 28% in 2018. Plans available through the exchanges can be expensive and confusing to consumers. Details vary by policy, including the cost of deductibles, physician networks, and covered pharmaceuticals. “Three insurance companies offered plans on healthcare.gov charged 20 different prices for primary care visits across four different plans,” Mills indicated. “It is beyond confusing.” According to Maine House Speaker Sara Gideon, “With ongoing uncertainty at the federal level, it's critical that we create lasting state policies that ensure stability and predictability for consumers here is Maine.” Healthcare advocates support a state-run exchange in Maine, along with Medicaid expansion, to improve access and slow increasing costs. Currently, 62,000 Maine residents obtain health insurance coverage through the federal ACA exchange. Advocates indicated that a state-based exchange could help reduce the number of Maine residents lacking health insurance. “If somebody loses their Medicaid because they're suddenly earning more money and they can easily go into the private marketplace, or vice versa, obviously, that's an important step in terms of reducing our uninsured numbers,” asserted Ann Woloson, director of Consumers for Affordable Health Care. In 2018, 106,000 Maine residents lacked health insurance. Maine voters passed Medicaid expansion in 2017, increasing access to many in the state. However, the affordability of insurance remains a barrier. The pending bill has bipartisan support. If passed, Maine will begin marketing, outreach and advertising for plans available through the exchange. Under the plan, beginning in 2021, all individual and small business plans in Maine would cover the first primary care visit and behavioral health visit without cost to the beneficiary. The subsequent two visits would be subject only to a copay. “We want to get people in the door,” Mills indicated. “Get them into the primary care system as early as possible without the deterrent of [FN2] copays and deductibles that really do prevent people from seeking help.” Idaho Exchange Enrollment Down Due to Medicaid Expansion Over 89,0000 Idaho residents enrolled in health insurance plans for 2020 via the state health insurance exchange. Fewer residents enrolled in private plans due to Medicaid expansion in the state. The insurance exchange, Your Health Idaho, closed open enrollment on December 16, 2019. Enrollment was lower by about 14,000 plans from the same period last year. State officials indicated that the decrease was due to Medicaid expansion. They had expected the decrease since 2020 is the first open enrollment year after expanding Medicaid in Idaho. The Idaho exchange officials originally estimated a decrease of about 18,000 individuals who are newly eligible for Medicaid. According to Your Health Idaho executive director, Pat Kelly, he is encouraged by the final enrollment numbers and interest in the health plans available through Idaho's marketplace despite the decline. “We always knew Medicaid expansion was a possibility, and that as a result, enrollments on the exchange would be impacted. We've planned for this change and do not expect to see any material adjustments to our long-term sustainability,” noted Kelly. “What we are most excited about at Your Health Idaho is the number of Idahoans who are new to the exchange. Many of these individuals and families now have comprehensive health insurance for this first time, and most are eligible for a tax credit and lower monthly premiums with Your Health Idaho.” About 75% of the 89,000 Idaho residents who enrolled in health insurance plans for 2020 renewed coverage they had in 2019. New [FN3] enrollments were 25% of the total. NJ Healthcare Legislation Passes New Jersey Gov. Phil Murphy signed several bills into law aimed at protecting access to health insurance for state residents in the face of federal attacks on the Affordable Care Act. The nine new laws focus on protecting certain health insurance benefits for residents of New Jersey even if they lose federal protections if the Affordable Care Act is repealed or reformed. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -3- “We're too exposed if we're relying on an unsettled, if not hostile, reality in Washington. We have to protect ourselves,” Murphy indicated. He stated that New Jersey residents should not “wake up one day and find out their health care has been stripped away from them.” The new laws became effective immediately. They require health insurers to cover basic services under any plan the state regulates. The protected services include emergency room visits, maternity care and mental health treatments. Insurers will not be able to exclude patients with preexisting conditions or charge them more for plans. Children will be able to remain on their parents' plans until age 26. Insurers will be required to spend at least 85% of the cost of premiums in health care costs. Assemblywoman Joann Downey (D-Monmouth), sponsored the bill aimed at protecting people with preexisting conditions. She praised the ACA for changing the lives of millions of people with medical conditions. “We cannot go back to a world where people had less access to critical medications or treatments because of poor insurance coverage,” said Downey. “With this law, we ensure that will never happen in New Jersey.” Murphy indicated that the legislation will protect access to health insurance for approximately 1.7 million New Jersey residents. The state already works to expand ACA enrollment outreach. The state is working to take control of the health insurance exchange, now run by the federal government for state residents. In early January, officials chose two private companies to transition New Jersey to a state-run exchange. GetInsured will build the website, scheduled to be open later in 2020. Customer assistance for the state-run health insurance exchange will be provided by MAXIMUS. Murphy pointed to his goals of protecting and improving the quality of health care in New Jersey and aiming to control the cost of healthcare. He discussed the goals with HMH CEO Robert C. Garrett. Murphy praised the quality of New Jersey's hospitals and medical research facilities but noted that many residents of the state still find access to healthcare unaffordable. He stated, “Our job is, collectively, to still keep the quality high and to make sure New Jersey is still the place where people come to get [FN4] treatment and do research, and to make sure we can make [health care] a right, and not a privilege, for everybody.” Virginia Considers Legislative Protections for Healthcare The Virginia legislature is considering several bills aimed at preserving protections now provided by the Affordable Care Act. According to a recent report from Altarum Healthcare Value Hub, 79% of Virginia residents who purchase private health insurance coverage are concerned that health insurance will become too expensive in the future. Virginians who do not qualify for a federal tax subsidy that covers part of the cost of individual plans have faced large increases in costs for plans in recent years. The cost of premiums decreased only slightly in 2020. One pending bill would allow the state to create its own health insurance exchange. Virginia does not currently fully run the exchange serving its residents. A state-run exchange would give Virginia complete access to enrollee information and set its own open enrollment period. The legislation is budget neutral. The state would need an initial loan to create the exchange, but the exchange would not be an ongoing cost. The fee that insurers currently pay to the federal government for the federal exchange would go to the state-run exchange. Some states' exchanges are less expensive for the states than using the federal health insurance exchange. Any savings would be redirected to outreach and enrollment programs. The state could encourage more people to enroll in health insurance coverage, which is especially important for black and Latinx populations that make up 40% of the Virginia residents who are currently uninsured and earn too much to qualify for a federal subsidy. Other pending legislation would create a reinsurance program. It would provide insurers with federal and state funds to help pay for the cost of health care for their most expensive beneficiaries. The state would receive federal matching funds to help cover the cost of the program. The program would lower premiums by allowing insurers to base premium costs on healthier populations by removing the cost of high risk consumers. The legislation would increase taxes on tobacco products by 30 percent to help cover the cost of the reinsurance. With this program, the costs of insurance premiums for plans available through the state's exchange could decrease by 20%. [FN5] The legislation is part of the state budget and would not require a separate bill. NY Open Enrollment Extended The New York health insurance exchange extended open enrollment for 2020 plans an additional week for state residents. The new deadline is February 7. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -4- Over 4.8 million state residents enrolled in coverage through the state's exchange. Most of the enrollees are Medicaid beneficiaries. Over 259,000 residents signed up for private individual health insurance plans through the exchange. Approximately 60 percent of those enrolling in individual plans are eligible for federal tax subsidies to help cover the cost of coverage. [FN6] Enrollment through the NY health insurance exchange is available online or by phone. Federal Rule Will Require Two Health Insurance Bills Per Plan, Washington AG Sues Washington Attorney General Bob Ferguson filed a lawsuit challenging a new Trump Administration rule that would require insurance companies to send consumers two separate monthly bills per plan, charging consumers separately for the cost of abortion coverage. According to Ferguson, the new rule is unlawful. It would affect over 200,000 people in Washington and could lead to confusion over bill payment and the risk of losing coverage. Ferguson noted, “This rule would cause unnecessary confusion for people who are likely to assume the second bill is a scam, an error or an optional fee that doesn't apply to them. In fact, this second bill would be a part of the overall monthly premium for everyone enrolled in the plan, and a failure to pay it could result in a loss of insurance benefits.” The lawsuit was filed in U.S. District Court for the Eastern District of Washington. Ferguson argued that the rule goes against Washington law that requires insurers to send only one monthly bill for insurance plans. The Affordable Care Act (ACA) does not allow federal agency rules to preempt state laws. The rule is set to go into effect on June 27. “This unlawful rule is yet another Trump Administration attempt to erode access to health care ? particularly to women,” Ferguson indicated. “This is a transparent attack on reproductive care that jeopardizes coverage for hundreds of thousands of Washingtonians. We will continue to defend the right to unbiased, affordable health care.” “This scheduled federal rule will cause unnecessary confusion for consumers and is another attempt to chip away at reproductive health services,” Gov. Jay Inslee said. “I stand with Attorney General Ferguson and Insurance Commissioner Kreidler in their efforts to protect Washingtonians.” The rule applies to qualified health plans sold to individual through state-run health exchanges. The Washington Health Benefit Exchange is run by the state. Over 200,000 Washington residents obtain health insurance plans through the exchange. The Affordable Care Act prohibits federal funds from being used to cover the cost of abortions. The law requires insurers to charge individual health plan enrollees a separate payment for coverage for those services. Under a 2015 federal regulation, insurers were permitted to separate those charges on a single monthly itemized bill. Under the new regulation, insurance companies must send a separate bill via the mail or email for those charges for every insurance plan. One bill would cover abortion services and another bill would cover all other medical services. Insurance companies must request separate payments for the abortion coverage bill and the remainder of the coverage in a “separate transaction.” Frequently, insurance plans charge less than a dollar for coverage of abortion services. Under the new rule, insurance companies must charge at least a dollar for abortion coverage. Every enrollee in a plan obtained through the insurance exchange will receive a separate bill for abortion coverage, regardless of whether they obtained those services. Ferguson argued that the regulation will unnecessarily confuse Washington healthcare consumers who might think the second bill is a scam, an error, or an optional fee that does not apply to their plan. Consumers who do not pay the bill risk losing their coverage. Forty percent of qualified health plans purchased through the Washington exchange can lose coverage within 30 days of missing a payment. Ferguson indicated, “The rule is highly likely to increase the number of uninsured Washingtonians who must rely on the state for their health care ? particularly in parts of the state where many residents depend on individual qualified health plans. In five Washington counties, 40 percent or more of the population have enrolled in a qualified health plan. Four of those counties are in Eastern Washington.” The risk of losing coverage for missing a payment is real in Washington. In 2018, thirteen percent of consumers who purchased qualified health plans through the Washington exchange lost healthcare benefits due to a failure to pay premiums. Consumers are more likely to miss payments and lose insurance coverage if they receive more than one bill for a payment cycle. If more people lose coverage because of failure to pay premiums on time, premium costs are likely to increase for people who remain enrolled due to the smaller pool of paying insured consumers. According to the Trump Administration, the rule will increase the cost of health insurance by more than $400 million in 2020. Insurance companies in Washington predict that the rule will increase their administrative costs by $100,000 to $500,000 each, or $3.5 million [FN7] total within the state. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -5- California Enrollment Surges with Individual Mandate Enrollment in health insurance plans through Covered California, the state's health insurance exchange, increased by hundreds of thousands of people. The state has new policies that penalize residents for failing to obtain health insurance coverage and provide financial aid to help people afford the cost of premiums. According to Covered California Executive Director Peter Lee, the health insurance exchange was allowing state residents who had not yet obtained health insurance coverage another chance to enroll. A special enrollment period will last until April so residents who did not know about the new individual mandate or the financial aid could sign up for coverage. California residents can sign up for health insurance plans through Covered California, the state's Affordable Care Act health insurance marketplace. Individuals, families, and small businesses can purchase plans through the exchange. Some consumers are eligible for federal tax subsidies to help cover the cost of premiums. Now, California is also offering eligible enrollees state-based subsidies. Eligibility is based on income level. “This has proven the case that the Affordable Care Act, as designed and not kneecapped, works and works well,” Lee noted. Lee credited the new state individual mandate with motivating people to investigate their options through the insurance exchange. He said the new state subsidies encouraged consumers to purchase plans. Approximately 418,000 Californians chose new individual or family plans through the state's exchange by the Jan. 31 deadline. Those numbers increased by 41% from the same time last year. It is the highest enrollment in the state since 2016. An additional 1.1 million California residents renewed individual or family plans through the exchange by Jan. 31. The total number of enrollees for the state stands at over 1.5 million. California has focused on investing in the exchange and expanding access to more state residents. Meanwhile, the Trump administration has cut funding for marketing and outreach for the federally run health insurance exchange that serves states without their own state-run exchanges. The Trump administration also shortened the open enrollment period for the federal health insurance exchange. For 2020, approximately 8.3 million people enrolled in new plans or renewed plans through the federal exchange. In 2019, that number was higher at 8.4 million. California, along with five other states and the District of Columbia require residents to obtain health insurance coverage. Congress cancelled the federal tax penalty for failing to obtain coverage beginning last year. California's penalty is expected to raise $317 in the first year, earmarked to help cover the cost of state subsidies. Lee indicated that state officials would rather see people obtain insurance than pay the penalty. “The penalty is on the books but nobody wants the money,” he stated. “We want it to be an economic nudge to get people to get covered.” California is the first state to offer subsidies to help pay for insurance to people with middle incomes between 400% and 600% of the federal poverty level. Individuals earning between $51,000 to $76,000 a year and families of four making $104,800 to $157,200 will now be eligible for state subsidies in California. People earning that much do not qualify for the federal subsidy. According to Lee, the state subsidy will provide an average of $500 per month in assistance to people earning at these higher levels. Lee indicated that approximately 625,000 people qualified for the new state subsidies. 32,000 of those people had middle income [FN8] levels. New Mexico House Approves Bill for State Exchange Autonomy The New Mexico House approved legislation that would give the state's health insurance exchange increased autonomy to help poor and uninsured residents gain health insurance coverage. The vote was 44-23 along party lines. House Bill 100 will now go to the New Mexico Senate for consideration. State Reps. Debbie Armstrong, D-Albuquerque, and Micaela Cadena, D-Mesilla, sponsored the bill. The legislators called the bill a necessary action to protect New Mexico's state insurance exchange from the Trump administration's actions to weaken and repeal the Affordable Care Act. Cadena indicated that the bill would separate the state's nonprofit Health Insurance Exchange from the federal system. “This will allow New Mexico to administer our own exchange,” she indicated. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -6- According to Jeffery Bustamante, chief executive officer of the exchange, beWellnm, the legislation would help “protect New Mexico in [FN9] the event the Trump administration does something drastic in terms of the [federal] exchange.” New York Exchange Enrollment at Record High Enrollment in the New York health insurance exchange reached a record high of 4.9 million people. Open enrollment in the exchange ended February 7. Enrollment numbers in the state for plans available through the exchange increased by over 150,000 people from 2019 enrollment numbers. Approximately 3.4 million of the 4.9 million New York residents signing up for health insurance coverage through the exchange enrolled in Medicaid. Almost 797,000 chose the Essential Plan, a health insurance program for people with low incomes who do not qualify for coverage under Medicaid or Child Health Plus. Over 415,100 residents enrolled in Child Health Plus. The program provides free or reduced-price coverage for children under the age of 19. The remaining enrollees, 273,000, enrolled in private health insurance plans through the New York exchange. The open enrollment period in the state was seven weeks longer than the open enrollment period for the federal health insurance exchange. [FN10] The rate of uninsured people in the state was an all-time low of 4.7%. Connecticut Sees Decrease in Enrollment Connecticut saw a decrease in the enrollment of state residents through the health insurance exchange, Access Health CT. The state's open enrollment period ended in January. For 2020, 107,833 people chose health insurance plans, represent a three percent decrease from last year's 11,066 enrollment. Enrollment in the state began on Nov. 1 and ended Jan. 15. Access Health board members were not disappointed with the final enrollment numbers considering the uncertainty of the Affordable Care Act at present. The Supreme Court will hear arguments on the ACA in the Fall. Approximately 77 percent of enrollees in Connecticut, or 82,553, renewed policies that they had in 2019. The most popular insurance provider was ConnectiCare Benefits Inc. with 77 percent of enrollees selecting plans with the company. The remaining 23 percent of enrollees chose Anthem Health Plus. According to Robert Blundo, director of technical operations and analytics for Access Health, and increasing number of people in the state seem to be signing up for employer-sponsored health insurance plans. He also indicated that other people are enrolling in Medicare or Medicaid, known as HUSKY in Connecticut. Blundo also noted that some former enrollees have moved away from the state. A significant issue, Blundo indicated, was affordability of health insurance plans available through the exchange. A survey of over 12,000 former exchange customers revealed that 16 percent reported choosing to become uninsured due to cost. Almost 187,000 Connecticut residents lacked insurance last year. Access Health initiated a campaign in the fall to try to reach them. Workers used tools that analyze census tracts to identify neighborhoods within cities where most uninsured people live in Connecticut. They canvassed homes in those neighborhoods beginning in October. Workers visited almost 30,000 homes in Hartford, Bridgeport, Norwalk and Fairfield. They spoke with thousands of people and signed up over 300 new customers as a result of the campaign. Hundreds of people workers spoke with renewed coverage through plans with [FN11] Access Health. Colorado's Public Health Option Proposed Reimbursement Rates Increased Colorado Gov. Jared Polis (D) updated a proposal to implement a state public option health plan increasing reimbursement rates for hospitals to 155% of Medicare payment rates. A May 2019 law directed the state to create a public health insurance option. Colorado's Department of Health Care Policy and Financing (HCPF) and Department of Regulatory Agencies released a proposal in November that would create a public option as a public-private partnership requiring all insurers selling plans in the state to offer a public health insurance option. All Colorado residents who purchase their own health insurance plans would be eligible to purchase the public option plans. Federal subsidies to help purchase health insurance would apply to the plans. The public option health plans will be available on the individual market by January 2022 and will be expanded later to the small group market. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -7- All hospitals in the state will have to participate in the public option plans. The hospital reimbursement rate will be 155% of Medicare payment rates. The rate is subject to increase due to certain criteria and annual data from state hospitals to the Colorado Hospital Association and the Colorado Healthcare Affordability Sustainability [FN12] Enterprise board. State Exchanges Respond to Coronavirus Pandemic The state health insurance exchanges and the federal government responded to the coronavirus epidemic differently, with many state exchanges reopening enrollment while the federal government changed some regulations but declined to reopen enrollment in the federally run health insurance exchange. The coronavirus pandemic has highlighted shortcomings in the healthcare system in the United States, leading the federal government to make some immediate changes to improve access to testing and treatment for COVID-19. Approximately 27 million people in the United States lack health insurance coverage. Open enrollment in 2020 health insurance plans via the state and federal exchanges ended several weeks or months ago. Open enrollment in most employer-sponsored plans also ended, mostly last year. Almost all state-run health insurance exchanges have reopened enrollment due to the coronavirus pandemic. These special enrollment periods (SEPs) allow people without insurance to enroll in ACA-compliant plans for a limited time. States with SEPs include Rhode Island, New York, Nevada, Connecticut, Vermont, Minnesota, Colorado, Washington State, Massachusetts, Maryland, California, and District of Columbia. Consumers without insurance coverage will be able to choose plans during these SEPs. However, people who already have plans through the exchanges will not be able to choose a different plan due to the SEP. People with plans that are not ACA-compliant are considered uninsured for purposes of the SEPs. The federal government has not chosen to reopen enrollment in the federal health insurance exchange. The 38 states that use the federal exchange cannot create special enrollment periods for residents. Michigan, New Jersey, and Pennsylvania have asked to federal government to reopen the federal exchange. As of the end of March, President Trump had declined. Consumers have always been able to quality for special enrollment periods for plans available through the exchanges if they lose existing health insurance coverage. Also, they might be eligible for Medicaid coverage in states that have chosen to expand the program to people with household incomes below 138 percent of the federal poverty level. New Mexico, which has a state-run exchange but depends on the federal exchange for enrollment, cannot open a special enrollment period. It has created a work-around by opening eligibility to the state's high-risk pool to uninsured residents if they cannot access other insurance and believe that they are infected with COVID-19. Illinois is working on a federal waiver to allow uninsured COVID-19 patients to gain Medicaid coverage. Idaho is the only state running its own exchange to keep enrollment closed. State officials pointed to the program for “enhanced” short- [FN13] term health plans that are always available for state residents as a solution. Public Option Legislation Pending in Connecticut A key committee in Connecticut approved legislation that would create a public option for health insurance in the state in response to the coronavirus pandemic. Under the legislation, small businesses and nonprofits would be eligible to join a state health plan administered by Comptroller Kevin Lembo. “If there's ever been a question about why we need everyone covered, it should be now,” Lembo indicated. “People who ignore symptoms, people who don't have a medical home ? it creates real challenges, not only from a payor perspective, but certainly from a health care delivery perspective.” During the last legislative session, a similar bill failed to move forward after insurer Cigna threatened to leave the state if a public option were approved. “If folks in the insurance industry, who have had a very good deal for a very long time, can't adapt to change, then that tells us something about them and their ability to anticipate, as Gretzky said, where the puck is going to be versus where it is right now,” Lembo stated. The Connecticut state Senate will next consider the legislation. Republicans in the state are opposing the bill, arguing that it puts the state at risk. According to Governor Ned Lamont, the legislation fails to fully contemplate the underlying costs of healthcare in the state. Lembo indicated that the coronavirus pandemic “tells me that we need this more now than ever.” He pointed to “the importance of a good basis of medical care, a good provider who knows you, and knows how to deal with you, and your symptoms, and your other sort of things you have going on,” particularly now when the country is facing a widespread outbreak. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -8- Lembo argued that people without adequate insurance coverage are more likely to ignore symptoms, creating a challenge for payers and for the health care delivery system. He pushed back on Lamont's assertion that allowing a public option would treat insurers as “bad actors.” He said, “I think it's weak. And the reason I think it's weak is that you have a delivery system of health care that includes who pays and who actually provides the care.” He emphasized the need for the insurance industry to adapt to change and the importance of creating a more complete delivery system [FN14] for healthcare in the state. Vermont Requires Coverage of COVID-19 Diagnosis and Treatment Vermont governor Phil Scott and the Department of Financial Regulation (DFR) announced an emergency regulation requiring commercial health insurers to cover the cost of the diagnosis and treatment of COVID-19 without cost-sharing to beneficiaries. Insurers will not be able to charge consumers co-payments, coinsurance or deductibles for the cost of treatment or diagnosis of the virus. Governor Scott declared a State of Emergency on March 13, 2020. The emergency regulation will apply retroactively to that date. 'During this unprecedented emergency, Vermonters deserve access to the care they need to stay safe and healthy,” said Governor Scott. “As we work to expand testing to more Vermonters with symptoms of COVID-19, it is critical that our efforts to help control the spread of the virus are not affected by insurance costs.” The regulation will apply to fully funded health insurance plans, including plans sold through the health insurance exchange and plans sold to large group employers. DFR rules require insurers to cover out-of-network services for beneficiaries if in-network providers are not available. “The COVID-19 pandemic has evolved quickly and is impacting the economic lives of so many Vermonters,” said DFR Commissioner Michael Pieciak “Accordingly, we have been working closely with our health insurers to eliminate financial barriers to testing and treatment of the disease.” DFR previously undertook a series of actions addressing the COVID-19 outbreak: March 6, 2020: DFR issued an emergency bulletin requiring insurers to cover the cost of COVID-19 testing. March 20, 2020: DFR issued guidance to insurers to provide additional grace periods to Vermonters who are struggling to pay their health insurance premiums. [FN15] March 30, 2020: DFR issued an emergency regulation to expand the coverage of telehealth and audio-only medical visits. Nevada Extends Open Enrollment in Response to COVID-19 The health insurance exchange in Nevada announced that it would extend open enrollment to May 15 in response to the COVID-19 pandemic. The Silver State Health Insurance Exchange decided to extend its limited-time Exceptional Circumstance Special Enrollment Period (SEP) for qualified residents of Nevada to purchase health insurance coverage through the marketplace. Governor Sisolak declared an emergency in Nevada on March 12. In response, the state-run health insurance exchange decided to extend open enrollment to April 15. The special enrollment period will now extend an additional month. Consumers enrolling in a plan through the exchange before April 30 will receive coverage beginning May 1, 2020. Consumers enrolling between May 1-15 will have coverage begging June 1, 2020. “COVID-19 does not discriminate. Anyone, regardless of age, income or health can become infected,” said Gov. Steve Sisolak. “If you or your family don't have health insurance, now is the time to get it. Don't wait for a health crisis, particularly this one, to affect you personally. Take advantage of this opportunity to enroll in a plan for which you may even qualify for subsidies. There is no time like the present.” All health insurance plans available through Nevada Health Link cover the ten essential health benefits mandated by the Affordable Care Act. Coverage includes emergency care and hospitalization. Care related to COVID-19 is covered by all plans offered through the Nevada exchange. By purchasing health insurance plans through Nevada Health Link, eligible consumers can access federal subsidies to help cover the cost of insurance premiums. Over 80 percent of Nevada consumers who access plans through the exchange are eligible for some amount of federal subsidy. “Unprecedented times call for unprecedented measures like Nevada Health Link's exceptional circumstance special enrollment period, and everyone who is uninsured or didn't obtain coverage during the normal open enrollment period should jump now at the opportunity © 2021 Thomson Reuters. No claim to original U.S. Government Works. -9- to get health insurance,” said Dr. Florence Jameson, chair of the board for Silver State Health Insurance Exchange. “As a longtime practicing Nevada physician, I have treated patients from all walks of life and know first-hand the value of insurance, which becomes glaringly more evident during a pandemic like the novel Coronavirus. With the uncertainty that comes with this virus, we encourage all uninsured Nevadans to explore one of the plans offered on Nevada Health Link to not only prevent possible financial burden, but more importantly to ensure a higher quality of care if it is needed.” According to Executive Director for Silver State Health Insurance Exchange, Heather Korublic, “Gov. Sisolak has encouraged everyone to continue to “Stay Home for Nevada,' so we are extending our Special Enrollment Period to allow uninsured and underinsured Nevadans extra time to purchase comprehensive insurance plans on Nevada Health Link. As experts anticipate the number of positive COVID-19 cases in our state to soon reach its peak, we want to remind Nevadans of the critical importance of protecting themselves and their families from financial ruin if a medical issue or accident occurs, especially during these uncertain times. Peace of mind to have your health needs taken care of is invaluable, and Nevada Health Link is here and ready to help you secure a healthcare plan for [FN16] you and your family.” Colorado Special Enrollment Period Over 10,000 Colorado residents signed up for health insurance coverage through the state's health insurance exchange during the special enrollment period created in response to the COVID-19 pandemic. The emergency special enrollment period began March 20 and will end on April 30, 2020. Coverage will begin on May 1 for Colorado residents signing up for plans before the special enrollment period ends. ”We created this enrollment opportunity to relieve some stress for thousands of families who are trying to figure out their health coverage needs during this time.” said Chief Executive Officer Kevin Patterson. “I encourage residents who are uninsured to sign up before the April 30 deadline.” Special Enrollment periods are available through Connect for Health Colorado for state residents who have a change in job, income, or living situation. Residents can contact the exchange to learn more about enrollment periods and available financial assistance. Special Enrollment Periods triggered by a change in situation last for 60 days. During a Special Enrollment period, residents can sign up for a new health insurance plan or change their current plan. The state encouraged business owners who are ending employee insurance benefits to direct their employees to Connect for Health Colorado for health insurance options. Plans available through the exchange are often more affordable than COBRA coverage. Financial assistance in the form of federal tax subsidies to help cover the cost of insurance premiums are also available through the exchange. Plans sold via Connect for Health Colorado include full coverage of essential benefits. Only Qualified Health Plans are available through the exchange. Plans available from other sources are not required to cover essential benefits. The Colorado Division of Insurance warned consumers that some marketing organizations and agents are trying to sell products that are not Qualified Health Plans in a misleading manner. Connect for Health Colorado encouraged Colorado residents to contact their trained and certified brokers and assisters to access [FN17] health insurance coverage. Brokers and assisters are available through virtual and/or phone appointments. Supreme Court Rules Insurance Companies Due Money Under ACA The U.S. Supreme Court ruled that the federal government owes insurance companies $12 billion under a provision in the Affordable Care Act (ACA). The funds were promised to assist insurers with start-up costs of Obamacare for the first three years after the federal law was implemented. Under the ACA, profits and losses were to be limited for insurance companies for the first three years of the program. Insurers that made more money than permitted owed money to the federal government. Other companies lost money during those years for participating in Obamacare. The federal government owed those companies money under the provisions of the ACA. In the first year of full implementation of the ACA, 2014, Congress, controlled by Republican legislators, decided not to fulfill the provision in the ACA promising the insurers money for their losses. The following two years, Congress also denied the payments by adding a rider to appropriation bills preventing the government from distributing the funds. President Trump's administration continued to refuse to pay for the insurance companies' losses. The insurance companies owed the payments filed a lawsuit. The Supreme Court recently ruled that the federal government owed the money. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -10- Justice Sonia Sotomayor wrote for the majority, indicating that the decision is based on a principle “as old as the nation itself. The government should honor its obligations.” The decision was 8 to 1. According to Sotomayor, the language of the ACA allowed the filing of a lawsuit for enforcement of provisions. The provision in dispute stated that the government “shall pay” for the insurers' losses if they participated in the ACA at the relevant time. Justice Samuel Alito dissented, calling the ruling “a massive bailout” for insurers. He argued that the companies “took a calculated risk and lost.” The decision was the third time the Supreme Court has considered the legality of the Affordable Care Act. The Trump administration and other conservatives have repeatedly attempted to eliminate the law. The Supreme Court will again consider the constitutionality of the law next year. The Affordable Care Act has continued to be popular in spite of efforts to repeal the law. It has helped millions of Americans access [FN18] health insurance coverage, especially people with pre-existing conditions who don't have insurance through their employers. Colorado Special Enrollment Period Sees Higher Enrollment, Ends Soon Over 10,000 Colorado residents signed up for health insurance coverage through the state's health insurance exchange during the special enrollment period created in response to the COVID-19 pandemic. The emergency special enrollment period began March 20 and will end on April 30, 2020. Coverage will begin on May 1 for Colorado residents signing up for plans before the special enrollment period ends. “We created this enrollment opportunity to relieve some stress for thousands of families who are trying to figure out their health coverage needs during this time.” said Chief Executive Officer Kevin Patterson. “I encourage residents who are uninsured to sign up before the April 30 deadline.” Special Enrollment periods are available through Connect for Health Colorado for state residents who have a change in job, income, or living situation. Residents can contact the exchange to learn more about enrollment periods and available financial assistance. Special Enrollment Periods triggered by a change in situation last for 60 days. During a Special Enrollment period, residents can sign up for a new health insurance plan or change their current plan. The state encouraged business owners who are ending employee insurance benefits to direct their employees to Connect for Health Colorado for health insurance options. Plans available through the exchange are often more affordable than COBRA coverage. Financial assistance in the form of federal tax subsidies to help cover the cost of insurance premiums are also available through the exchange. Plans sold via Connect for Health Colorado include full coverage of essential benefits. Only Qualified Health Plans are available through the exchange. Plans available from other sources are not required to cover essential benefits. The Colorado Division of Insurance warned consumers that some marketing organizations and agents are trying to sell products that are not Qualified Health Plans in a misleading manner. Connect for Health Colorado encouraged Colorado residents to contact their trained and certified brokers and assisters to access [FN19] health insurance coverage. Brokers and assisters are available through virtual and/or phone appointments. More People Eligible for ACA Subsidies as Unemployment Increases According to a recent analysis by the Kaiser Family Foundation, an estimated 26.8 million people throughout the United States will lose health insurance coverage because of a loss of job-based health coverage due to the COVID-19 pandemic. Over 31 million workers filed unemployment claims between March 1 and May 2. Most of the people losing employment will become eligible to access health insurance coverage under the Affordable Care Act (ACA). Not all eligible people will sign up for plans. 5.7 million are not eligible for government-sponsored health insurance programs or tax subsidies to help pay for coverage. Researchers estimated that, due to income levels and other factors, 79% of people losing employer coverage and becoming uninsured will likely be eligible for tax subsidies that cover some of the cost of coverage or for coverage under Medicaid. 12.7 million of the unemployed will become eligible for Medicaid. 8.4 million will likely be eligible for subsidies for health insurance purchased through the ACA marketplaces. Almost 78 million people are in families experiencing job loss since early March. Some of those people have coverage that is not employer-dependent. Others can access coverage through a spouse's employer or through their parents' health insurance plans. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -11- Approximately 150,000 newly unemployed people will fall into the coverage gap of being ineligible for Medicaid while at the same time not making enough to qualify for tax subsidies under the ACA. The coverage gap exists in states that have chosen not to expand eligibility for Medicaid to cover low-income adults without children. In January 2021, when workers' unemployment benefits expire, the number of people falling into the coverage gap is expected to increase to 1.9 million. “Unlike in past recessions, most of those who lose their job-based coverage will be eligible for health coverage because of the Affordable Care Act, though some may find coverage unaffordable even with subsidies,” Executive Vice President for Health Policy Larry Levitt said. “As unemployment benefits expire, however, about two million more people in states that did not expand their Medicaid programs under the ACA will move into the Medicaid coverage gap and have no affordable option.” The following eight states account for almost half of all people losing employer health insurance coverage and becoming uninsured: California (3.4 million), Texas (1.6 million), Pennsylvania (1.5 million), New York (1.5 million), Georgia (1.4 million), Florida (1.4 million), Michigan (1.2 million) and Ohio (1 million). These states have large populations with workers in industries that have been affected by the pandemic. Researchers looked at workers' incomes, family status, and state of residence. They also looked at the expected unemployment benefits, including the additional $600 per week provided by the federal government through the end of July. About 6.1 million children are estimated to lose employer health insurance coverage. Most of those children, 5.5 million, are eligible for coverage through Medicaid or the Children's Health Insurance Program. Children are generally eligible for those programs at higher family income levels than adults. In January 2021, researchers estimate that approximately 16.8 million people who lost employer health insurance plans will be eligible for coverage under Medicaid. Congress has not yet decided on the amount of aid to the states to help cover the influx of eligible [FN20] Medicaid beneficiaries due to the pandemic. Massachusetts Health Insurance Exchange Sees Surge in Enrollment The health insurance exchange in Massachusetts, the Massachusetts Health Connector, saw a surge of 45,000 people who enrolled in health plans or updated their health insurance coverage during a two-month period of the special enrollment opened due to the COVID-19 pandemic. The deadline for signing up for coverage that begins on June 1 is May 23. The extended enrollment period will be open through May 25. The special enrollment period was created “In order to help residents who lose their employer-sponsored coverage during the economic crisis created by the coronavirus. . . so that anyone who needs health insurance can come to the exchange and get into coverage. Additionally, current Health Connector members are encouraged to update their income information if they lost their jobs or working hours have changed, to ensure they are in the plan that provides appropriate financial help paying for their coverage.” Over 12,000 people reported a change in income and switched to a new Health Connector plan type. Additionally, 11,600 Health Connector members updated their information and now receive coverage under MassHealth. More than 20,000 people have enrolled in new plans through the Health Connector since the beginning of March. “The economic impact of the coronavirus has extended to thousands of Massachusetts residents, and we all want to minimize the harm it has done to health coverage for people who have lost their job or lost hours at work,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “Massachusetts has worked over the years to create a health coverage structure to reach all of our residents, and the Health Connector remains at the ready to support current members and those newly seeking health insurance.” Enrollment is usually only open from November through January in Massachusetts each year. However, the public health emergency due to the coronavirus and the increased public interest in adequate health coverage, the Health Connector opened a special [FN21] enrollment period. California Health Insurance Exchange Sees Special Enrollment Surge The health insurance exchange in California, Covered California, announced that 123,810 people had enrolled in health insurance coverage during the special enrollment period opened in response to the COVID-19 pandemic. The pace of enrollment was almost 2.5 times higher than the level of enrollment during the same period last year. “When the worst is happening in people's personal economic lives, we want to make sure that Californians know they can have the peace of mind that comes with quality health care coverage,” said Peter V. Lee, executive director of Covered California. “Whether Californians have lost job-based health insurance coverage, or they were uninsured when this pandemic began, our doors are wide open to help them get coverage through either Covered California or Medi-Cal.” The data came from the period of March 20 through May 16. Covered California opened the health insurance exchange to eligible individuals without health insurance coverage because of the pandemic. The special enrollment period will end June 30. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -12- The eligibility requirements during the special enrollment period are similar to requirements during the annual open-enrollment period. Special enrollment periods are available to California residents year-round if they are eligible and experience a qualifying life event. The events include losing health care coverage, moving, getting married, or having a child. Earlier in 2020, Covered California held a special enrollment period for consumers to account for the new state financial assistance for health insurance coverage and the new state penalty for going without insurance. From the end of the regular open-enrollment period in the state on January 31 through May 16, 191,380 California residents signed up for coverage, almost two times as many who signed up during the same period last year. The health insurance exchange created a new fact sheet to educate consumers about their health insurance options if their employment or coverage has been affected by the COVID-10 pandemic. It contains information about Covered California, Medi-Cal and COBRA. It also educates consumers about the enrollment process. Coverage for people who sign up through Covered California begins on the first day of the following month. People eligible for Medi-Cal are covered retroactively on the first day of the month they applied. Consumer assistance is also available via phone from a team of Certified Insurance Agents through Covered California. “In this time of social distancing, people should know that health insurance is only a phone call away,” Lee said. “Consumers can get free and confidential assistance from certified agents or one of Covered California's trained professionals while remaining safe and protecting themselves and their families.” The website offers a Shop and Compare Tool to help consumers choose a plan based on ZIP code, income, and ages of people in the household needing health insurance coverage. The website also helps consumers determine if they are eligible for Covered California [FN22] or Medi-Cal. Nevada Health Link Enrolls Over 6,000 During Special Enrollment Period The Silver State Health Insurance Exchange, Nevada's health insurance exchange, enrolled over 6,000 state residents in health insurance coverage through the online marketplace during a special enrollment period due to the COVID-19 pandemic. The limited Exceptional Circumstance Special Enrollment Period (SEP) ran from March 17 through May15. Enrollment included 5,479 new consumers. The remaining 538 enrollments were due to loss of Minimum Essential Coverage (MEC). Governor Sisolak's March 12 Emergency Declaration led to the opening of the SEP to eligible Nevada residents to access health insurance coverage. Consumers enrolling April 30 or before obtained coverage beginning on May 1. Consumers enrolling between May 1 and May 15 received coverage beginning June 1. “I am pleased to see so many Nevadans take advantage of the limited-time Special Enrollment Period to get comprehensive, qualified health insurance they need to safeguard themselves and their families, especially during these unprecedented times,” said Gov. Steve Sisolak. “While it's always important to be insured, regardless of age, health, income or life circumstances, the global coronavirus pandemic has certainly magnified the importance of healthcare coverage and the invaluable peace-of-mind that comes with knowing you are covered and protected should you or someone in your family become ill or injured.” Nevada operates its own health insurance exchange under the Affordable Care Act, which allowed the state to open a special enrollment period for state residents. Nevada and 12 other states operate their own exchange, allowing the option of a special enrollment period that was not available to states depending on the federal government to run a health insurance exchange for their residents. The plans available through the Nevada exchange cover the diagnosis and treatment of COVID-19 as well as the ten essential health [FN23] benefits mandated under the Affordable Care Act. Kentucky to Return to State-Run Exchange Kentucky Governor Andy Beshear announced that the state would return to the state-run health insurance exchange, Kynect. “We have been paying more over the last four years to get less. So today, I'm announcing that I've submitted a declaration of intent letter to the Centers for Medicare & Medicaid Services to transition to a state-based exchange beginning Jan. 1, 2022,” the Governor said. Kynect first began in 2013. Approximately 500,000 Kentucky residents who were newly eligible for Medicaid and Qualified Health Plans enrolled through the marketplace. It became one of the most successful state-based health insurance exchanges in the United States. Gov. Matt Bevin ended Kynect in 2017, forcing the state to fall back on the federal exchange. According to Gov. Beshear, Kentucky residents pay about a 3% user fee for the federal exchange. Fees totaled $9.8 million in 2018. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -13- The one-time cost of launching the state-based marketplace will be $5 million, Gov. Beshear indicated. Yearly operating costs will run between $1 million and $2 million. In the first year, the state-run exchange will save $2.8 million to $3.8 million the first year of operation. After initial start-up costs, the yearly savings will be between $7.8 million and $8.8 million. “In the last four years, we moved backward in health care. The rate of uninsured and uninsured children grew,” Gov. Beshear said. He pointed to the benefits of a state-run exchange beyond cost savings from eliminating federal user fees. The program will also reduce the cost of health insurance premiums for Kentucky residents. It will increase access to Medicaid and increase flexibility and autonomy for state residents seeking access to coverage. The program will also return local control to health insurance for Kentucky residents, allowing state officials to make more insurance- related decisions. “We have an opportunity to be better, to get healthier, to save money and ultimately to provide that basic human right that is health care,” the Governor said. “It also allows us greater flexibility and autonomy than the federal exchange, where we can extend the annual open enrollment period and offer special open enrollment periods. It finally offers us local control. I believe we can do this much better than the federal government. We proved that many years ago, and as we go forward, this is just going to be one part of a larger set of [FN24] announcements on health care that we anticipate we will be making in August.” 500,000 People Enroll in Health Insurance Plans via Special Enrollment Periods The Centers for Medicare & Medicaid Services (CMS) released a report showing trends of people signing up for health insurance coverage through HealthCare.gov under a special enrollment period (SEP) exception during the COVID-19 pandemic. Data showed that 500,000 people who qualified for a personal SEP enrolled in health insurance coverage. The economic disruption due to the global pandemic led to many people experiencing life events that triggered an SEP, such as changes in employment. Those people were eligible to sign up for health insurance coverage through HealthCare.gov. Enrollment data for April and May showed that a significant number of Americans lost job-related health insurance coverage due to the pandemic. Many of those people enrolled in coverage available due to the resulting SEP. According to CMS, “As Americans consider their health insurance options during this crisis and as the country re-opens, CMS will continue to provide assistance to help inform those choices. CMS strongly encourages individuals to visit HealthCare.gov to explore their coverage options.” The report showed the following key findings: · The number of consumers gaining coverage in states with Exchanges using the HealthCare.gov platform through the loss of MEC SEP is higher for the 2020 coverage year than for any of the prior coverage years in this report with approximately 487,000 consumers gaining coverage through the loss of MEC SEP, an increase of 46 percent from the same time period last year. · By month, the largest gain in loss of MEC SEP enrollments occurred in April 2020, with enrollments increasing by 139 percent when compared to April 2019. · The number of consumers gaining Exchange coverage through the loss of MEC SEP dropped by about one-third from April 2020 to May 2020, but continued to be significantly higher?by 43 percent?than in May of 2019. · Looking at enrollments across all SEP types, there was a 27 percent increase in total SEP enrollments from the end of OE through May from 2019 to 2020. The percentage change was actually higher during the period from 2017 to 2018, with an increase of 33 percent. However, the higher increase in SEP enrollments from 2017 to 2018 could be attributed to the longer open enrollment period for 2017, which extended to January 31 and substantially shortened the period of time Researchers indicated that the full impact of COVID-19 job losses on the need for SEPs was unclear. Millions of Americans have lost jobs due to the pandemic and have lost associated health insurance coverage. Anyone losing job-based minimum essential coverage is [FN25] eligible for an SEP. There is typically a 60-day period to enroll in coverage. MD: 58,000 Enroll During SEP The Maryland Health Connection announced that almost 58,000 Maryland residents enrolled in individual health insurance plans through the state's health insurance exchange during the Special Enrollment Periods (SEPs) opened due to the COVID-19 pandemic. The two SEPs began in February and March and ended July 15. On February 26, the agency launched the Maryland Health Insurance Easy Enrollment program, the first such program in the United States. The state tax return included a check box asking tax filers if they were uninsured and wished to share their status with the Maryland Health Benefit Exchange. Maryland's program has motivated other states to consider a similar initiative. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -14- Since the beginning of the program in February, over 41,000 Maryland tax filers indicated that they were uninsured. Over 3,700 uninsured people enrolled in health insurance coverage by July 13. Final numbers will be available after calculating data received through the July 15 tax filing deadline. Maryland residents will have several weeks to enroll. The special enrollment period due to the coronavirus pandemic opened on March 16 in the state. Gov. Larry Hogan and participating insurers supported one of the longest SEPs in the United States. According to Michele Eberle, executive director of Maryland Health Benefit Exchange, “Maryland Health Connection was quickly able to respond to this global crisis and help our Maryland families get the health coverage they need.” 54,028 Maryland residents have enrolled in health insurance coverage through the exchange since March 16, the beginning of the SEP. Among the enrollees: • 35 percent purchased individual private plans • 65 percent enrolled in Medicaid • 90 percent received coverage for free or at a reduced cost • the highest enrollment with 10,897 was in Prince George's County • Montgomery Count had enrollment of 10,594 • 35 percent of enrollees were between ages 18 and 34 • almost 1/3 of enrollees were Black/African American Maryland residents who have lost health insurance due to a job loss or other major life changes will still be eligible to enroll through the Maryland Health Connection for 60 days after they lose coverage. [FN26] Enrollment in Medicaid is always open for eligible people. Enrollment is available online or over the phone. Report: Exchanges Could Add 1 Million Enrollees Due to Pandemic According to a new report from Avalere, the Affordable Care Act (ACA) exchanges have experienced significant increases in enrollment during the COVID-19 pandemic, particularly from people losing employer-sponsored insurance plans and those who were uninsured. Researchers found that different approaches to special enrollment periods (SEPs) led to fluctuating enrollment numbers for different states. Enrollment in health insurance plans via the exchange has remained steady for several years. Almost 11 million people enrolled in plans via exchanges at the start of the year. The exchanges are seeing significant increases mid-year, particularly since March. Researchers noted, “The health, economic, and employment effects of COVID-19 and the Public Health Emergency (PHE) are leading tens of millions of individuals to consider new coverage options. With unemployment rates at or near 10% in almost all states, many consumers have been separated from their previous employer-sponsored plans. The economics of Medicaid eligibility in many states and the recent boost to unemployment assistance indicate that many are turning to the exchanges for coverage.” Avalere looked to its proprietary COVID-19 enrollment model to estimate the enrollment increases. Researchers predict that the increased enrollment will stay for some time considering the nature of exchange coverage and the current eligibility for premium subsidies. The increased enrollment will increase the market size. Researchers also predict that this increase will lead insurers to expand offerings in the individual market. Data from the federal government showed increases in enrollment of 487,000 during SEPs since December 18, the close of regular open enrollment for the 38 states using the federal health insurance exchange. The total enrollment due to SEP during this year through HealthCare.gov is 892,141. Twelve states and Washington D.C. operate their own state-based health insurance exchanges. During SEPs, nearly 263,000 individuals have enrolled in health insurance plans in those exchanges since March. Enrollment numbers have not been released for all state-based exchanges, so enrollment is likely higher. In California alone, almost 250,000 people have newly enrolled since its open [FN27] enrollment period ended January 31. 175,000 of those enrollees signed up since March. Reinsurance Credited for Keeping Premiums Costs Down The Colorado Division of Insurance (DOI) announced that the cost of premiums for individual and small group health plans for 2021 would not increase significantly. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -15- The low increases were credited to the effect of reinsurance in the state. Information about the preliminary plans and premiums for 2021 are available through the DOI's Health Insurance Plan Filings website. Governor Jared Polis referenced the coronavirus pandemic in his remarks about the new rates. “Saving people money on health care has never been more important and I'm proud the reinsurance program will help bring more relief to hardworking people during this challenging time for many individuals and families across our state by keeping premiums down by an average of 17% in the individual insurance market,” said Governor Jared Polis. “We keep working to prevent Coloradans from being ripped off on health care costs and I'm excited to have worked with the legislature to extend and build on the success of the bipartisan reinsurance program.” The reinsurance program will continue through 2021 for individual health insurance plans. According to the DOI, the program will save Colorado residents an average of 17.4% compared with the estimated cost of health insurance plans if the reinsurance program did not exist. The reinsurance program was created by 2019 legislation and approved by the federal government that same year. New legislation continued the reinsurance program for five years. Through the program, the state pays a portion of high-cost insurance claims, leading to lower prices for premiums for individual health insurance plans. The lowered cost for premiums also lowers the cost of federal tax subsidies saving money. The federal government returns those savings to the state to fund the reinsurance program to continue the lower premiums. Premiums will increase an average of 2.2% in 2021 for plans available through the Colorado health insurance exchange. Connect for Health Colorado operates under the ACA. “Our reinsurance program continues to save people money on health care,” said Colorado Insurance Commissioner Michael Conway. “While our current situation makes many aspects of our lives uncertain, we continue our work to keep premiums down for Coloradans. The reinsurance program is keeping premiums more affordable, particularly in the higher cost areas in the mountains, Western Slope and Eastern Plains. And over the summer, the DOI team will thoroughly review this information, especially the assumptions around COVID-19 that the insurance companies have built into these premiums.” The insurance companies participating in the Colorado exchange have requested the rate changes, but the changes have not yet been approved. The Division will review the requested rates during the summer to ensure that the changes are justified and that the plans comply with requirements from the state and federal governments. The approved plans will be available in early fall. The eight companies offering plans to Colorado residents via the exchange in 2020 will remain. Two of the companies will expand to new counties. In 2020, 22 Colorado counties had only one insurance company offering health insurance plans via the exchange. In 2021, only 10 counties will have plans from one insurer. [FN28] A total of 16 companies will offer Colorado residents 755 individual and small group plans in 2021. Report: Insurance Exchange Market to Grow Significantly by 2025 According to a new report on the health insurance exchange market, it is expected to grow significantly by 2025. Recent market trends show the current value of the global online health insurance marketplace at 2 billion dollars. Researchers indicated that key drivers of the health insurance exchange market include federal health insurance mandates and policies under the Affordable Care Act, as well as multiple instances of funding from the federal government. The report was released by HTF MI and was called “Global Health Insurance Exchange (HIX) Market Size, Status and Forecast 2019-2025.” Researchers pointed to the shift in the trend towards a contributing model as a driver for reducing the cost of health care for consumers. They also pointed to the growing application of IT in the health sector and the move toward integrated environments as creating opportunities for growth in the health insurance exchange market. Researchers considered the health insurance exchanges set up under the Affordable Care Act (ACA) as a key factor in this market. The exchanges brought together insurers competing for market share by offering qualified health insurance plans to American consumers. They noted, “These qualified plans are designed to meet standards that are set by the ACA. Stiff competition between the providers is [FN29] also likely to encourage them to provide improved quality and pricing of the offered plans.” Maine Insurance Premiums to Decrease, State Considers State-Based Exchange © 2021 Thomson Reuters. No claim to original U.S. Government Works. -16- The cost of health insurance plans through Maine's health insurance exchange will decrease an average of 13.1 percent, according to the Maine Bureau of Insurance (BOI). BOI approved the rates requested by the three insurance carriers that participate in the state's health insurance exchange for plans that will be available in 2021. The monthly premiums will decrease overall by a weighted average of 13.1 percent. 'The coronavirus pandemic has reinforced how important it is that every person has access to affordable health insurance and the ability to see a doctor,' indicated Governor Janet Mills. ‘These insurance rates are most welcome news and will make health care more accessible for more people. Our Administration will continue to fight for health care for Maine people.’ Anthem Health plans of Maine, Harvard Pilgrim Health Care, and Maine Community Health Options requested health insurance rates with decreases of between 4.3 percent and 26.5 percent. Rates vary based on age, county of residence, and tobacco use. Individual health insurance plans purchased through the exchange are eligible for federal tax subsidies for those who qualify under the ACA. In 2020, 85 percent of Maine residents purchasing insurance in the individual market through the exchange qualified for lower premiums. People earning 400 percent or more of the Federal Poverty Level do not qualify for the subsidies. 'The average decrease in the individual rates in 2020, and now for 2021, reflect the stabilizing of what was once a fairly unstable marketplace,' Insurance Superintendent Eric Cioppa stated. The agency credited the lowered cost of premiums to the effect of the Maine Guaranteed Access Reinsurance Association (MGARA). This program was reinstituted in 2019. It is a reinsurance program that covers the cost of beneficiaries with high-cost conditions for the insurance companies. 'The MGARA program, which works behind the scenes, has given Maine more control over its Individual Market and has made a significant difference in the premiums that insurers need to charge,' Cioppa indicated. Last year, Governor Mills announced a plan that would give Maine more control over the individual health insurance market, and possibly the small group market. Maine will transition to a State Based Marketplace on the Federal Platform (SBM-FP). This move will give the state more control over promoting health insurance coverage and supporting local consumer assistance programs. It will allow the state to continue using the federal platform for the exchange. “This gives Maine more flexibility to improve the shopping experience for the more than 65,000 Mainers who currently purchase health insurance for themselves and enables Maine to invest and target resources otherwise going to the federal government to enroll uninsured Mainers in affordable coverage. This is especially important now with the loss of jobs and job-based health insurance due to COVID-19,” noted the agency. The transition plan is through the Made for Maine Health Coverage Act. The application is pending for Blueprint to become a State-Based Marketplace on the federal platform beginning November 1, 2020. The agency is in the process of setting up a system of navigators who will help Maine residents acquire health insurance through the marketplace. The state plans on launching a public awareness campaign with the open enrollment period in the fall. Maine is considering becoming a full State Based Marketplace (SBM), where it would run its own platform for a completely state-based [FN30] exchange. The state is also considering merging the individual and small group markets and is exploring options for that idea. Pennsylvania Insurance Requested Rates Announced The Pennsylvania Insurance Commission announced the 2021 requested rate filings for health insurance plans available through the ACA health insurance exchange. The average rate requests would lead to lover premium costs in the individual market for Pennsylvania residents. According to Insurance Commissioner Jessica Altman, ‘Overall, Pennsylvania continues to have a healthy and competitive health insurance market and insurers are committed to providing the ACA coverage options Pennsylvanians deserve. As filed, of Pennsylvania's 67 counties, no county will lose an on-exchange insurer, and 13 counties will gain at least one new insurer. This marks the third year where Pennsylvania is seeing increased competition and decreasing or moderately increasing premiums, demonstrating that Pennsylvania's efforts to stabilize and improve affordability in this market have been working.” Insurers requested an average statewide decrease of 2.6 percent for plans available through the individual health insurance exchange. Insurers selling plans in the state's small group market requested average statewide increases of 2.2 percent. “Pennsylvania has taken the necessary steps to ensure ACA-compliant health care coverage is accessible, and continues to work towards making it more affordable,” noted Altman. “Under Governor Wolf's leadership, Pennsylvania is now switching to a state-based health insurance exchange later this year and establishing a reinsurance fund that will directly pay some of the health care costs for high-cost individuals.” © 2021 Thomson Reuters. No claim to original U.S. Government Works. -17- The agency credited the key initiatives for lowering the cost of premiums for 2021 for the individual market. The reinsurance program [FN31] will lower premiums by 5.3% compared to the cost of premiums if the program were not in place. Pennsylvania Launches State-Run Health Insurance Exchange Pennsylvania announced the launch of its new state-based health insurance exchange for 2021 coverage, Pennie. The website will be available to Pennsylvania residents seeking health insurance in the individual market and residents seeking financial assistance to reduce the cost of health insurance coverage. Both chambers of the Pennsylvania General Assembly passed Act 42 in 2019. Governor Tom Wolf signed the measure in July 2019, allowing for the creation of the state-run exchange. “My Administration has made it a priority to ensure all Pennsylvanians have health care that is accessible and affordable, and it is my hope that Pennie, as our state-based health insurance marketplace, works to make that priority a reality,” Governor Tom Wolf said. “I encourage Pennsylvanians to explore their health insurance options with Pennie.” Open enrollment for Pennie will begin on November 1, 2020. Health and dental coverage will be available through the exchange. The 2021 open enrollment period will run through January 15, 2021. Currently, Pennsylvania residents can access individual health insurance plans through the federal exchange, HealthCare.gov. Those plans will be transitioned to Pennie for 2021 coverage. The state aims to facilitate access to health insurance coverage through Pennie by offering education, assistance, and better customer service. “This is an exciting step forward for Pennsylvania. By transitioning from Healthcare.Gov to a state-based marketplace, Pennie will have the flexibility to react to changes and serve individuals and families in the way best suited for their needs. Through local control of our operations, outreach and customer service, we aim to simplify the purchasing process and enable shoppers to find the right plan,” indicated Zachary W. Sherman, Pennie Executive Director. Sherman previously worked for Rhode Island's marketplace, HealthSource RI. He noted, “Affordability is one of the largest barriers prohibiting people from accessing quality coverage and through the Pennsylvania Reinsurance Program, Pennie will generate millions in premiums savings for individual market customers.” The Pennsylvania exchange aims to work with insurers to encourage a competitive marketplace. The Department of Human Services will support the transition of coverage between Medical Assistance, CHIP and the marketplace. The exchange will work with local leaders and the community to educate residents about the new marketplace. Thousands of Pennie-Certified Producers were trained to help match consumers with coverage during the 2021 open enrollment period. “We are excited and proud to bring Pennie to the citizens of Pennsylvania,” noted Pennsylvania Insurance Commissioner Jessica Altman. “Our mission is to help Pennsylvanians access the health insurance they need to live a healthy life. This is now more important than ever. We strive to support all Pennsylvanians and understand many who lost employer-sponsored coverage as a result of COVID-19 may be new to the individual market and unaware our marketplace is a resource for assistance and financial help to pay for coverage.” Pennie will assist current exchange customers with the transition in early October to prepare for the open enrollment period from November through mid-January. Eligible Pennsylvania residents will be able to obtain financial assistance for monthly premiums [FN32] through Advanced Premium Tax Credits and Cost-Sharing Reductions for out-of-pocket costs. New Mexico Rates Decrease New Mexico Superintendent of Insurance Russell Toal announced that the cost of individual coverage through the state's health insurance exchange, beWellnm, will decrease significantly for individuals and families purchasing coverage. The average cost of bronze, silver and gold plans throughout the state decreased. The most purchased plan level, silver, will decrease in cost between an average of 8.1 and 13.5 percent. Small businesses will also see decreased costs for plans purchased through the health insurance marketplace. Costs will drop an average of 6.7 percent. “After a rigorous review of health insurance filings, our office is pleased to report that premiums are going down in 2021,” said Superintendent Toal. “Not only are rates decreasing, but New Mexico will have more health plans competing in the marketplace than ever before.” The Office of Superintendent of Insurance (OSI) annually oversees determining if health insurance premium rates are reasonable and fair. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -18- “These premium reductions will come as a relief to New Mexico's families and small businesses who are facing economic hardship during the global pandemic,” said Governor Michelle Lujan Grisham. “It is vital that every New Mexican have affordable quality health insurance during a public health crisis.” “BeWellnm is proud to work with the Superintendent's office to make sure every New Mexican can find and enroll in health insurance,” said Jeffery Bustamante, CEO of beWellnm. “As we approach November 1, which marks the beginning of open enrollment, I encourage anyone who needs insurance to start looking at what option is best for their budget and lifestyle. Especially right now, health insurance is more important than ever.” Even though New Mexico Health Connections left the health insurance exchange, the total number of insurers participating increased [FN33] from four to five with new insurers offering plans through the marketplace. Pennsylvania Announces Lower Insurance Rates The Pennsylvania Department of Insurance announced that it had approved health insurance rates representing a decrease in individual market rates. The new lower rates for 2021 individual and small group Affordable Care Act (ACA) health insurance plans were attributed to the new state-based exchange and the reinsurance program. 'This individual plan rate decrease means more affordable plan options for those who seek coverage via the ACA,' Insurance Commissioner Jessica Altman said. ‘Without the affordable coverage that the ACA provides, millions of people would be without health care coverage during a time when health is top-of-mind for every Pennsylvanian and having coverage to maintain good health is even more critical.’ All health insurers currently offering coverage through the health insurance exchange in Pennsylvania will continue offering plans next year. The plans statewide average a decrease of 3.3 percent for individual market plans and a 2.1 percent average increase for the small group market. 'The absolute effect of COVID-19 on health care costs has yet to be realized,' Commissioner Altman said. ‘However, as Pennsylvanians maneuver and assess the impact, the Insurance Department has worked diligently to keep rate increases low for consumer in the individual and small group markets. Last year's enactment of Act 42 creating the state exchange and Pennsylvania reinsurance program played a significant role in driving individual market premiums down for 2021 in fact, the reinsurance program is the reason individual market rates are decreasing rather than increasing this year. 'Increased options and lower costs will play a major role in helping consumers shop around for the plan that best suits their needs and these two positive changes are more reasons why the ACA must be protected.' Increased unemployment due to COVID-19 will likely lead to more Pennsylvania residents seeking coverage through the state-run exchange as an alternative to more expensive continuation of employer plans through COBRA. Consumers who are eligible can receive tax subsidies to cover some of the cost of premiums through the ACA exchange. The tax subsidies can significantly lower the cost of health insurance for consumers. Currently, almost nine out of every ten Pennsylvania residents enrolled in a plan through the exchange receives some amount of tax subsidy toward the monthly premium cost. Some consumers receive financial assistance to decrease out-of-pocket costs including co-pays and deductibles. Pennsylvania recently introduced Pennie, the state-run health insurance exchange for 2021 health insurance plans. The marketplace is open to all Pennsylvania residents. It is focused on improving access to health insurance and affordability to consumers of individual health insurance plans. Open Enrollment will begin November 1, 2020 for health and dental coverage for 2021. Open enrollment will be extended for Pennsylvania residents through January 15, 2021. Residents with plans through HelathCare.gov will be automatically transitioned to the new exchange, Pennie. 'Pennsylvanians will be able to shop for and purchase 2021 coverage through Pennie this Open Enrollment Period. Transitioning from HealthCare.gov to Pennie, the new state-based marketplace, gives us the flexibility to serve individuals and families in the way best suited for their needs,' says Zachary W. Sherman, Pennie Executive Director. ‘In service to Pennie's goals of increasing access and affordability, we will generate millions in premiums savings for individual market customers through the Pennsylvania Reinsurance Program. Customers looking to learn more about Pennie and their options for shopping, financial qualification, and purchasing 2021 [FN34] health coverage can visit pennie.com.’ Georgia Requests Approval of State-Based Exchange Waiver The Centers for Medicare & Medicaid Services (CMS) announced that Georgia has requested a waiver for its individual health insurance marketplace through a section 1332 State Relief and Empowerment Waiver. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -19- CMS reviewed the 1332 waiver request and is working with state and federal officials to finalize the terms and conditions for approving it. The goal of the waiver is to reduce the cost of premiums, increase access to health insurance and promote a more competitive private insurance market in Georgia. From 2016 to 2017, the year Congress repealed the individual mandate from the Affordable Care Act, enrollment in individual health insurance plans in Georgia decreased significantly. About 94,000 Georgia residents left the individual market. The uninsured rate in Georgia is 14.8 percent, one of the highest rates in the nation. The state requested a waiver for the implementation of a two-phase approach addressing the high rate of uninsured Georgia residents. The first phase involves a state-based reinsurance program beginning in Plan Year 2022. The reinsurance program is aimed at using government funds to cover the most expensive beneficiaries for private health insurance companies. The insurance companies are required, through regulation, to pass some of the savings on to consumers in the form of premium cost reduction. The reinsurance program is expected to reduce premiums in Georgia by an average of 10 percent. The plan focuses on bringing savings to rural areas. The second phase of the waiver request involves transitioning Georgia from the federal exchange to a state-based exchange, Georgia Access Model by 2023. The model will allow consumers to shop for plans through private sector companies, including web brokers, health insurance [FN35] companies, and traditional agents and brokers. Maine Among States with Decreasing Insurance Premiums New federal data released prior to the start of open enrollment on November 1 showed that Maine is among the states where health insurance premiums decreased for health coverage obtained through the ACA exchanges. Coverage will begin in 2021 for plans purchased during the upcoming open enrollment period. According to the Maine Department of Health and Human Services, most residents shopping for health insurance through the exchange will qualify for coverage that costs $75 or less per month. Sixty percent of Maine consumers seeking health insurance plans through HealthCare.gov are eligible for coverage that costs under $75 per month. Forty percent of exchange consumers in Maine are eligible for plans that will cost them under $10 per month. The average cost of health insurance through the individual market health insurance exchange in Maine will be 13 percent lower in 2021. Maine will join three other states were the average cost of premiums in 2021 will decrease by over 10 percent from 2020. This open enrollment period marks the third year of decreasing premiums for the Maine exchange. Maine uses the federal health insurance exchange where the open enrollment period runs from November 1 through December 15. Information about coverage options are available at CoverME.gov. People who are eligible for MaineCare (Medicaid) can sign up at any time during the year. 'No one should have to live in fear of not being able to see a doctor, fill their prescriptions, or receive life-saving care, especially in the middle of a pandemic,' said Governor Mills. ‘I encourage Maine people who need affordable insurance to visit CoverME.gov to learn about coverage options, find local assistance, and consider applying when open enrollment begins on Sunday.’ 'As we continue to respond to the COVID-19 pandemic, health insurance is more important than ever,' said Maine Department of Health and Human Services Commissioner Jeanne Lambrew. ‘We encourage anyone in need of affordable health insurance to visit CoverME.gov to explore their options. Even if you may only need coverage temporarily or your employment or coverage situation remains uncertain, it's worth signing up to make sure you and your family can get a checkup, afford your medications, and access other needed health care.’ For the first year, Maine will take over enrollment assistance and outreach for the federal health insurance exchange, though the state still uses the federal marketplace website for eligibility information, comparison shopping, and enrollment. The Maine Department of Health and Human Services (DHHS) will run education and enrollment assistance under the Made for Maine Health Coverage Act of 2020. The law had bipartisan support. The transition allowed Maine to receive double the funding for Navigators, who assist consumers in enrolling for health insurance coverage through the exchange, including MaineCare coverage. Maine is working toward the option of transitioning to a fully state-run exchange in the future. The new law also regulates private insurance plans in Maine, requiring full coverage of the first primary care visit and the first behavioral health visit with no cost-sharing. The second and third visits must be covered without a deductible. [FN36] Three insurance companies will offer 56 plans through the exchange to Maine residents for 2021. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -20- Nevada Exchange Expects Increase in Enrollment Due to job losses related to the COVID-19 pandemic, the Nevada health insurance exchange expects increases in enrollment with the upcoming open enrollment period for health insurance plans beginning in 2021. The Nevada Health Exchange implemented enhancements with the predicted increase in enrollment in mind. According to Heather Korbulic, executive director of the exchange, the marketplace has prepared for an increase in website traffic. The state allowed for an extension of the open enrollment period to January 15. “At Nevada Health Link, we are targeting all sorts of Nevadans who are eligible for exchange this year, including people who are newly unemployed and have lost access to their employer-sponsored coverage,” she indicated. The exchange is especially attempting to educate people who do not have employer-sponsored health insurance plans and are not eligible for Medicare or Medicaid. “We know that there's lots of people who have fallen off over the last several months, and so we're certainly reaching out to them and trying to help them navigate this world of insurance,” she noted. The state has 700 certified brokers and navigators to assist Nevada residents in choosing health insurance coverage through the [FN37] individual health insurance exchange. Federal Government Approves GA Plan to Leave Health Insurance Exchange Two days prior to Election Day, the Trump administration approved Georgia's plan to exit the federal health insurance exchange beginning in 2023 without setting up its own state-run health insurance exchange for Georgia residents. Consumers will have to access individual health insurance plans through private brokers, insurance companies, agents, and commercial websites. Republican Georgia Gov. Brian Kemp supported the plan, asserting that private entities would gain an opening in the fall of 2022 to advertise and compete for health insurance customers. The public comment period for the plan revealed significant opposition to it. Skeptics argued that the plan would bring Georgia back to the chaotic marketplace prior to the implementation of the ACA. Individual brokers were incentivized to sell policies with the largest commissions, regardless of the price or coverage of the plans. “The payoff doesn't strike me as being there,” said Joseph Antos, a health care expert at the American Enterprise Institute, a right- leaning think tank in Washington, D.C. “I'm sure people in Georgia, just like everyone else, have had the federal website URL [healthcare.gov] pumped into their heads. The people who would be newly interested in exchange coverage are clearly not going to know where to go.” The federal exemption for Georgia, known as a 1332 waiver, will likely face legal challenges, especially now that Joe Biden has been elected President. Under the ACA, states may attempt different methods of access to individual health insurance plans only if they lead to an equal number of insured people. According to the Kemp administration, the new plan will increase enrollment by 6.8% beginning in 2023. Those increases would only partially make up for the losses in coverage in Georgia during the Trump administration. Georgia lost 21% enrollment overall, which was two times the decrease on average nationally. Laura Colbert, executive director at Georgians for a Healthy Future, a nonprofit advocacy group, indicated that the declines in the state were due to increased cost of premiums and cuts in education efforts. Enrollment declined in 39 states during the Trump administration. Seema Verma, administrator of the federal Centers for Medicare & Medicaid Services, indicated in the letter approving Georgia's plan that the enrollment outreach set up by the Obama administration, known as the Navigator program, “has simply had limited impact on reducing the overall uninsured rate in Georgia, suggesting there may be a more effective way to reach and engage consumers. In fact, one of the key criticisms of HealthCare.gov and the implementation of the Navigator program is that it has squeezed local agents and brokers out of the market with government-funded competition.” The lack of support for the plan has even come from people within Georgia's insurance and brokerage industries. Of the 75 organizations commenting during the open comment period, 72 opposed the plan. 1,746 of 1,751 individual letters were in favor of the format of the federal health insurance exchange, where all available plans are listed and can be compared easily. “Even though I was educated at an elite university, it is still difficult to be certain I am choosing the best option for my situation,” one commentator wrote. “I am certain that the proposal to force me off the exchange and into the hands of for-profit insurers or brokers will [FN38] benefit them and not me.” Idaho Open Enrollment to be First Since COVID-19 Pandemic Began © 2021 Thomson Reuters. No claim to original U.S. Government Works. -21- The open enrollment period for Idaho residents needing to access plans through the individual market will be the first enrollment period since the beginning of the COVID-19 pandemic. Unlike other states, Idaho did not choose to hold special enrollment periods earlier in the year to assist consumers looking for health insurance coverage in the face of the global health emergency. Idaho, along with eleven other states and Washington, D.C., operates its own health insurance exchange. It was the only state not to open its exchange for a special enrollment period. Under the Affordable Care Act, people facing a defined life-changing event, such as losing previous health insurance coverage that was provided through an employer, getting married, or gaining U.S. citizenship, can qualify for a special enrollment period for plans available through the exchange. Gov. Brad Little and Dean Cameron, the director of the Idaho Department of Insurance, declined to open a general special enrollment period, even though they had the authority. Instead, they encouraged Idaho residents to sign up for health plans that do not meet federal coverage standards and so are not considered health insurance under the ACA. These plans are not eligible for federal tax subsidies. They also do not have to cover essential health benefits, such as doctor visits or prescription drugs related to pre-existing conditions for half a year. Pregnancy is considered a pre-existing condition. The plans limit lifetime benefits to maximums of between $1 million and $2 million. The open enrollment period beginning in November will allow Idaho consumers a choice of seven different insurance carriers. [FN39] Health insurance plans will begin on Jan. 1. Open enrollment ends on Dec. 15. © Copyright Thomson/West - NETSCAN's Health Policy Tracking Service [FN2] . Neumann, Dan, “Advocates welcome plan for state-based ACA marketplace as important step,” Beacon, January 9, 2020, available at http://mainebeacon.com/advocates-welcome-plan-for-state-based-aca-marketplace-as-important-step/. [FN3] . Press release, “Your Health Idaho enrolls 89,000 Idahoans for 2020 health insurance coverage Idaho exchange sees increase in new customers as overall enrollments decline amid Medicaid expansion,” Your Health Idaho, available at https://www.yourhealthidaho.org/ your-health-idaho-enrolls-89000-idahoans-for-2020-health-insurance-coverage. [FN4] . Stainton, Lilo H., “Murphy signs nine bills to protect N.J.'s health insurance gains from federal attack,” WHYY, January 18, 2020, available at https://whyy.org/articles/murphy-signs-nine-bills-to-protect-n-j-s-health-insurance-gains-from-federal-attack/. [FN5] . “Three Steps Toward Making Private Health Coverage More Affordable,” Blue Virginia, January 17, 2020, available at https:// bluevirginia.us/2020/01/three-steps-toward-making-private-health-coverage-more-affordable. [FN6] . Mulder, James T., “NY residents get extra week to sign up for health insurance,” Syracuse.com, January 28, 2020, available at https:// www.syracuse.com/health/2020/01/ny-residents-get-extra-week-to-sign-up-for-health-insurance.html. [FN7] . Press release, “AG FERGUSON SUES TRUMP ADMINISTRATION OVER HEALTH INSURANCE RULE TARGETING REPRODUCTIVE HEALTH COVERAGE,” Washington State Office of the Attorney General, January 31, 2020, available at https:// www.atg.wa.gov/news/news-releases/ag-ferguson-sues-trump-administration-over-health-insurance-rule-targeting. [FN8] . Bluth, Rachel, and Samantha Young, “Surge In Covered California Enrollment As Californians Avoid Penalty, Receive State Aid,” February 18, 2020, available at http://www.capradio.org/articles/2020/02/18/surge-in-enrollment-as-californians-avoid-penalty-receive- state-aid/. [FN9] © 2021 Thomson Reuters. No claim to original U.S. Government Works. -22- . Nott, Robert, “House approves state health insurance exchange changes,” Santa Fe New Mexican, February 11, 2020, available at https://www.santafenewmexican.com/news/local_news/house-approves-state-health-insurance-exchange-changes/ article_f0ca77e6-4d0c-11ea-99f7-974f155bdbc2.html. [FN10] . Mulder, James, “NY health insurance exchange enrollment hits record 4.9M,” Olean Times Herald, February 21, 2020, available at http://www.oleantimesherald.com/news/local/ny-health-insurance-exchange-enrollment-hits-record-m/article_d0b82207-baed-5d84- b137-73e18c17647c.html. [FN11] . Carlesso, Jenna, “Access Health sees dip in enrollment,” Hartford Business, February 21, 2020, available at https:// www.hartfordbusiness.com/article/access-health-sees-dip-in-enrollment. [FN12] . “Colorado's public option health plan would pay hospitals 155% of Medicare rates,” Advisory Board, February 26, 2020, available at https://www.advisory.com/daily-briefing/2020/02/26/colorado-public-option. [FN13] . Norris, Louise, “State and federal efforts to improve access to COVID-19 testing, treatment,” healthinsurance.org, April 2, 2020, available at https://www.healthinsurance.org/obamacare/state-and-federal-efforts-to-improve-access-to-covid-19-testing-treatment/. [FN14] . Dankosky, John, “Connecticut Considers Public Option Bill During Health Crisis,” New England Public Radio, March 17, 2020, available at https://www.nepr.net/post/connecticut-considers-public-option-bill-during-health-crisis#stream/0. [FN15] . Press release, “VERMONT DEPARTMENT OF FINANCIAL REGULATION REQUIRES INSURERS TO COVER COVID-19 DIAGNOSIS AND TREATMENT WITH NO COST SHARING,” Vermont Official State Website, April 15, 2020, available at https:// dfr.vermont.gov/press-release/vermont-department-financial-regulation-requires-insurers-cover-covid-19-diagnosis. [FN16] . Press release, “Silver State Health Insurance Exchange Extends Exceptional Circumstance Special Enrollment Period on Nevada Health Link,” Nevada Health Link, April 13, 2020, available at https://d1q4hslcl8rmbx.cloudfront.net/assets/uploads/2020/04/SSHIX- extended-final.pdf. [FN17] . Press release, “10,000 Coloradans Covered during Emergency Special Enrollment Period So Far; Marketplace Open to Those with Life Changes,” Connect for Health Colorado: Colorado's Official Health Insurance Marketplace, April 21, 2020, available at https:// connectforhealthco.com/10000-coloradans-covered-during-emergency-special-enrollment-period-so-far-marketplace-open-to-those- with-life-changes/. [FN18] . Totenberg, Nina, “Supreme Court To Government: Pay Obamacare Insurers,” NPR, April 27, 2020, available at https:// www.npr.org/2020/04/27/846750295/supreme-court-to-government-pay-obamacare-insurers. [FN19] . Press release, “10,000 Coloradans Covered during Emergency Special Enrollment Period So Far; Marketplace Open to Those with Life Changes,” Connect for Health Colorado: Colorado's Official Health Insurance Marketplace, April 21, 2020, available at https:// connectforhealthco.com/10000-coloradans-covered-during-emergency-special-enrollment-period-so-far-marketplace-open-to-those- with-life-changes/; Patterson, Kevin, MURP, MPA, “COVID Special Enrollment Period Has Ended,” Connect for Health Colorado: Colorado's Official Health Insurance Marketplace, May 1, 2020, available at https://connectforhealthco.com/covid-special-enrollment- period-has-ended/. [FN20] . Press release, “As Unemployment Skyrockets, KFF Estimates More than 20 Million People Losing Job-Based Health Coverage Will Become Eligible for ACA Coverage through Medicaid or Marketplace Tax Credits,” Kaiser Family Foundation, May 13, 2020, available at https://www.kff.org/coronavirus-covid-19/press-release/as-unemployment-skyrockets-kff-estimates-more-than-20-million-people- losing-job-based-health-coverage-will-become-eligible-for-aca-coverage-through-medicaid-or-marketplace-tax-credits/. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -23- [FN21] . Press release, “Massachusetts Health Connector continues extended enrollment as nearly 45,000 people enroll in new plans, update current coverage,” Massachusetts Health Connector, April 28, 2020, available at https://www.mahealthconnector.org/health-connector- continues-extended-enrollment. [FN22] . Press release, “Covered California Sees More Than 123,000 Consumers Sign Up for Coverage During the COVID-19 Pandemic,” Covered California Newsroom, May 20, 2020, available at https://www.coveredca.com/newsroom/news-releases/2020/05/20/covered- california-sees-more-than-123000-consumers-sign-up-for-coverage-during-the-covid-19-pandemic/. [FN23] . “Silver State Health Insurance Exchange enrolls 5,479 during Exceptional Circumstance Special Enrollment Period in Response to COVID-19,” Nevada Health Link, May 19, 2020, available at https://d1q4hslcl8rmbx.cloudfront.net/assets/uploads/2020/05/SSHIX- ECSEP-enrollment-numbers-release_Final-5.19.20.pdf. [FN24] . “Gov. Beshear Provides Update on COVID-19,” Kentucky.gov, June 17, 2020, available at https://kentucky.gov/Pages/Activity- stream.aspx?n=GovernorBeshear&prId=218. [FN25] . Press release, “CMS Issues Special Trends Report on Health Insurance Exchange Enrollment Data During COVID-19,” CMS.gov, June 25, 2020, available at https://www.cms.gov/newsroom/press-releases/cms-issues-special-trends-report-health-insurance- exchange-enrollment-data-during-covid-19; “Special Trends Report: Enrollment Data and Coverage Options for Consumers During the COVID-19 Public Health Emergency,” available at https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/ Downloads/SEP-Report-June-2020.pdf. [FN26] . News release, “NEARLY 58,000 MARYLANDERS GAIN HEALTH COVERAGE DURING TWO SPECIAL ENROLLMENT PERIODS,” Maryland Health Benefit Exchange Newsroom, July 16, 2020, available at https://www.marylandhbe.com/wp-content/uploads/2020/07/ End-of-SEPs-Press-Release.pdf. [FN27] . Brooker, Chad, Kate Sikora, Katie Patton, “Exchanges May Add More than 1 Million New Enrollees due to COVID-19,” Avalere, July 8, 2020, available at https://avalere.com/insights/exchanges-may-add-more-than-1-million-new-enrollees-due-to-covid-19. [FN28] . Press release, “Reinsurance Keeps Premiums Down for 2021,” Colorado Department of Regulatory Agencies, available at https:// www.colorado.gov/pacific/dora/news/reinsurance-keeps-premiums-down-2021. [FN29] . Press release, “Health Insurance Exchange Market Size, Share & Trends Analysis Report By Application, Regional Outlook, Competitive Strategies, And Segment Forecasts, 2019 To 2025,” Grand View Research, available at https:// www.grandviewresearch.com/industry-analysis/health-insurance-exchange-hix-market. [FN30] . Press release, “Maine Bureau of Insurance Announces 13.1 Percent Overall Average Decrease in Individual Health Insurance Rates for 2021,” State of Maine, August 26, 2020, available at https://www.maine.gov/pfr/insurance/press-release.shtml?id=3172927. [FN31] . Press release, “Insurance Department Releases 2021 ACA Plans Offering Consumers More Affordable Options,” Pennsylvania Pressroom, August 7, 2020, available at https://www.media.pa.gov/Pages/Insurance-Details.aspx?newsid=434. [FN32] . Press release, “Pennsylvania launches new state-based health insurance marketplace, Pennie,” Pennie, September 22, 2020, available at https://agency.pennie.com/launchrelease/. [FN33] © 2021 Thomson Reuters. No claim to original U.S. Government Works. -24- . Press release, “New Mexico Superintendent of Insurance Announces Premium Decreases for 2021,” New Mexico Superintendent of Insurance, September 15, 2020, available at https://www.osi.state.nm.us/wp-content/uploads/2020/09/Press-release_2021- Rates_FINAL.pdf. [FN34] . Press release, “Insurance Department Announces Lower ACA Individual Plan Health Insurance Rates, Attributes Them To New State- Based Exchange And Reinsurance Program,” Pennsylvania Pressroom, October 15, 2020, available at https://www.media.pa.gov/ Pages/Insurance-Details.aspx?newsid=437. [FN35] . Press release, “Trump Administration Approves Innovative State-Led Health Reform to Expand and Strengthen Coverage for Georgia Residents,” CMS.gov, October 15, 2020, available at https://www.cms.gov/newsroom/press-releases/trump-administration-approves- innovative-state-led-health-reform-expand-and-strengthen-coverage. [FN36] . Press release, “New, More Affordable Health Coverage Options Available Starting November 1,” State of Maine Department of Health and Human Services, October 27, 2020, available at https://www.maine.gov/tools/whatsnew/index.php?topic=DHS+Press +Releases&id=3525664&v=dhhs_article_2020. [FN37] . Puppel, Doug, “Health Exchange Opens Enrollment With New Customers Expected,” Nevada Public Radio, October 29, 2020, available at https://knpr.org/knpr/2020-10/health-exchange-opens-enrollment-new-customers-expected. [FN38] . Rau, Jordan, “Feds Approve Fractious Georgia Plan to Change ACA Marketplace,” KHN, November 3, 2020, available at https:// khn.org/news/just-2-days-before-election-feds-approve-fractious-ga-plan-to-change-aca-marketplace/. [FN39] . Dawson, James, “Idaho Health Insurance Exchange Opens Up For First Time During Coronavirus Pandemic,” Boise State Public Radio, October 30, 2020, available at https://www.boisestatepublicradio.org/post/idaho-health-insurance-exchange-opens-first-time- during-coronavirus-pandemic#stream/0. Produced by Thomson Reuters Accelus Regulatory Intelligence 14-Mar-2021 © 2021 Thomson Reuters. No claim to original U.S. Government Works. -25-