YEAR-END REPORT - 2021 Published 20-Dec-2021 HPTS Issue Brief 12-20-21.1 Health Policy Tracking Service - Issue Briefs Access to Health Insurance Access to Health Insurance This Issue Brief was written by a contributing writer. 12/20/2021 Introduction Early indications regarding enrollment numbers for health insurance plans through the ACA exchanges showed that the number of new people signing up for health insurance was similar to new enrollments last year, despite significantly increased unemployment due to the COVID-19 pandemic. The Centers for Medicare & Medicaid Services (CMS) released the enrollment trends for Medicaid and the Children's Health Insurance Program (CHIP) showing continued increases in enrollment in the programs during the COVID-19 pandemic. Illinois is the first state to give low-income noncitizen seniors access to public health insurance even if they are undocumented. The Competitive Health Insurance Reform Act became federal law on January 13. The legislation repeals the McCarran-Ferguson antitrust exemption for health insurance companies. A new law in California took effect in the beginning of January that will require parity for the coverage of mental health conditions and make it harder for insurance companies to find loopholes for the requirement. A recent survey showed that 39% of Americans reduced or eliminated some form of insurance coverage with health insurance policies the type of insurance most decreased or dropped. U.S. Sen. Mark R. Warner (D-VA) recently introduced legislation that aims to increase access to health insurance to help counter the effects of the COVID-19 pandemic. The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced a Special Enrollment Period (SEP) for the federal health insurance exchange in response to President Biden's Executive Order to reopen enrollment in response to the ongoing pandemic. U.S. Senators Michael Bennet (D-Colo.) and Tim Kaine (D-Va.) recently reintroduced legislation that would create a public option for health insurance by expanding the Affordable Care Act (ACA) and Medicare. The House Committee on Energy and Commerce released legislative recommendations for budget reconciliation that would add significant funding to expand Medicaid coverage throughout the United States. The Michigan Department of Insurance and Financial Services (DIFS) recently announced that it would extend the special enrollment period for state residents to sign up for health insurance coverage to plans available outside of the state's health insurance marketplace exchange. Proposals in the pending COVID-19 federal relief package include measures that would expand assistance for health insurance coverage. The $1.9 trillion COVID-19 relief bill includes a measure that would increase federal subsidies to help consumers purchase individual health insurance plans through the ACA marketplace. Those subsidies would also be available to more people based on income levels. U.S. Senator Jeanne Shaheen (D-NH) announced that she is introducing new legislation aimed at improving access to health care through decreasing the cost of premiums and deductibles for families in the low- and middle-income ranges. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -1- The Maryland Citizens' Health Initiative (MCHI) expressed support for the moving forward of three pieces of legislation in the Maryland General Assembly aimed at strengthening the health care system in the state and expanding access to health insurance coverage and healthcare. Democrats in Colorado announced the introduction of a public healthcare option bill aimed at decreasing insurance costs for individuals and small businesses. The bill was partially in response to the economic impact of the coronavirus pandemic. A new report by the Kaiser Family Foundation indicated that over five million people fall under the ‘family glitch” in the Affordable Care Act, making them ineligible for financial assistance through the health insurance exchange because their employer offers them affordable coverage as defined by the law. U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced that over 500 thousand consumers enrolled in health insurance coverage through the federal health insurance exchange, HealthCare.gov, during the Special Enrollment Period (SEP) that President Biden opened in response to the COVID-19 Public Health Emergency. The Centers for Medicare & Medicaid Services (CMS) announced new provision to lower maximum out-of-pocket costs owed by consumers by $400 for consumers who purchase health insurance through the Federal Health Insurance Marketplaces for plan year 2022. A proposal in the California state legislature by Assemblyman Miguel Santiago would allow parents to join their adult children's health insurance plans. President Biden has proposed the extension of the expanded Affordable Care Act premium tax credits in the American Rescue Plan. A recent study showed that a high number of people in the United States who died from COVID-19 lacked health insurance coverage. The Biden Administration announced that gay and transgender people will be protected from discrimination in health care, a decision that reversed a Trump-era policy that allowed discrimination in health care. The White House announced that one million Americans had signed up for health insurance coverage during the Special Enrollment Period (SEP) opened due to the coronavirus pandemic. U.S. Senator Patty Murray (D-WA), Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, announced plans to create legislation with Congressman Frank Pallone, Jr. (D-NJ), chair of the House Energy and Commerce Committee that would establish a public option for health insurance coverage. The Centers for Medicare & Medicaid Services (CMS) encouraged companies that rely on gig workers to share information with them about enrolling in health insurance coverage through the federal and state health insurance exchanges during the 2021 Marketplace Special Enrollment Period (SEP). Under the provisions of the American Rescue Plan (ARP), more people, including those receiving unemployment benefits, can qualify for health insurance coverage at a cost of as low as $1 a month in California. The Centers for Medicare & Medicaid Services (CMS) announced that $20 million in funding is available to help improve access to quality health insurance coverage for residents of states with State-based Marketplaces (SBMs). The United States Supreme Court decided to uphold the Affordable Care Act against a challenge by several Republican states and the former Trump administration. The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, announced an interim final rule aimed at preventing surprise billing for medical care. According to a study from AARP, a significant number of older working Americans lost jobs, and consequently, lost health insurance coverage during the COVID-19 pandemic. The Centers for Medicare & Medicaid Services (CMS) announced that Oklahoma expanded eligibility for Medicaid to individuals between the ages of 19-64. The California legislature recently approved a new state budget, including a measure that will help people enrolled in both Medi-Cal and Medicare stay covered based solely on income. The Centers for Medicare & Medicaid Services (CMS) is proposing actions to address health care inequities in the United States. The New York State Department of Financial Services announced 2022 health insurance premium rates, indicating that it decreased many of the rate increases requested by insurers. U.S. Senators Ben Ray Luj?n (D-N.M.) and Brian Schatz (D-Hawai“i) brought back bicameral legislation that would create a public option for health insurance that would work alongside the Affordable Care Act. The Centers for Medicare & Medicaid Services (CMS) released new data indicating that returning consumers purchasing health insurance through the state or federal health insurance exchanges can save an average of 40% off the cost of monthly premiums due to the enhanced tax credits under the American Rescue Plan (ARP). © 2022 Thomson Reuters. No claim to original U.S. Government Works. -2- Insurance regulators in New Mexico announced that health insurance coverage will become significantly less expensive for consumers through the state's health insurance exchange due to federal pandemic relief, more people in the state signing up for coverage, and funding from a new state tax. According to data released by the Census Bureau, the number of people who were uninsured and the uninsured rate remained steady in 2020. Among employers choosing to charge employees more for health insurance coverage if they or their close family members choose to remain unvaccinated for COVID-19 are Louisiana's largest nonprofit health care provider and Delta Airlines. The Centers for Medicare & Medicaid Services (CMS) announced that about 275,000 Missouri residents had become eligible for health insurance coverage through the expansion of Medicaid in the state. California became the first state to allow some parents to join their adult children's private health insurance plans as dependents. New legislation aimed at simplifying health care enrollment for Americans would give people the opportunity to enroll in health insurance through their federal income tax returns. The Democrats' $1.75 trillion social spending and climate change plan would make at least 2.2 million adults with low incomes eligible for government-funded health insurance coverage. The U.S. Department of Health and Human Services (HHS) released a new report showing that access to Medicaid and health insurance plans available through the Affordable Care Act federal Marketplace helped to prevent major coverage losses in 2020 and 2021. Illinois Allows Senior Undocumented Immigrants Access to Health Insurance Coverage Illinois is the first state to give low-income noncitizen seniors access to public health insurance even if they are undocumented. Advocates for the policy are hopeful that other states will follow with the same change, adding to efforts to provide coverage to undocumented children and young adults. In California, Democratic legislators support legislation to expand coverage to all low-income undocumented immigrants in the state. 'The fact that we're going to do this during the pandemic really shows our commitment to expansion and broadening health care access. It's an amazing first step in the door,” said Graciela Guzm?n, campaign director for Healthy Illinois. The organization is in favor of universal coverage. Healthy Illinois wanted the legislature to offer health benefits to all immigrants with low incomes. Instead, lawmakers decided to pass a smaller program covering people 65 and older who are undocumented or have been legal permanent residents, green card holders, for under five years. These groups are not likely to qualify for government health insurance without the new program. Seniors with incomes at or below the federal poverty level are eligible. That means people earning $12,670 or less for an individual or $17,240 per couple. The program will allow access to hospital and physician visits, prescription medication, and dental and vision care. It does not cover nursing facilities. Patients are covered without cost-sharing. The new program goes along with other expansions of government health coverage to undocumented immigrants in the state. It was the first state to cover care for undocumented children. A few other states and the District of Columbia now offer government insurance for undocumented immigrant children. Illinois also offers coverage of organ transplants for unauthorized immigrants. California was the first state to offer public coverage to undocumented adults by opening eligibility for its Medi-Cal program for all low- income residents under the age of 26. Federal law does not allow undocumented people to be eligible for Medicare, nonemergency Medicaid and the ACA health insurance exchange. States offering government coverage to undocumented people use state funding for the coverage. Nearly 4,000 undocumented seniors live in Illinois. By 2030, that number is expected to increase to over 55,000. According to a study by Rush University Medical Center and the Chicago demographer group Rob Paral & Associates, 16% of Illinois immigrants 55 and older live in poverty. Approximately 11% of seniors in the state born in the United States live in poverty. The program is expected to initially cover 4,200 to 4,600 immigrant seniors, costing the state approximately $46 million to $50 million per year, John Hoffman, a spokesperson for the Illinois Department of Healthcare and Family Services indicated. Most of the seniors expected to be covered by the program are undocumented. Supporters of the program indicated that many unauthorized immigrants pay taxes without benefits such as eligibility for programs like Medicare and Medicaid. They also pointed out that spending on preventive care ends up saving money for the state by reducing [FN2] expensive emergency care. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -3- Enrollment in Government Health Program Increased During COVID-19 Pandemic The Centers for Medicare & Medicaid Services (CMS) released the enrollment trends for Medicaid and the Children's Health Insurance Program (CHIP) showing continued increases in enrollment in the programs during the COVID-19 pandemic. According to CMS, ‘This latest summary report captures impacts of the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE) by tracking total Medicaid and CHIP program enrollment trends for adults and children over a 12-month period.” The trend of increased enrollment in Medicaid and CHIP during the pandemic first showed up in the Enrollment Trends Snapshot in September 2020. The latest release included a summary of the total number of applications submitted for the programs for the first time. Early in the pandemic, applications declined for months. Applications began increasing in June. Applications began to significantly increase between July and August 2020. From February 2020 to August 2020, enrollment in Medicaid and CHIP increased by almost 5.9 million people, or nearly 8.3%. Medicaid enrollment increased by over 5.8 million people, 9.1%, and CHIP enrollment increased by 33,000 people, 0.5%. The COVID-19 public health emergency and the enactment of the Families First Coronavirus Response Act (FFCRA) continuous enrollment (maintenance of effort) requirement largely drove the increase in enrollment. The requirement temporarily allows for a 6.2% increase in federal matching funds through Federal Medical Assistance Percentages (FMAP) for some state expenses associated with the programs. It also requires states to maintain Medicaid enrollment for beneficiaries in most circumstances. The data on the trend in applications showed that new enrollment was not the largest impact on the overall increase in Medicaid and CHIP numbers during the pandemic. Enrollment was growing at a significantly greater rate than applications. The key driver of enrollment increases is likely existing enrollees remaining eligible for and enrolled in the programs. CMS attributed the trend to maintenance of effort requirements and indicated that it would continue to monitor enrollment. 'Over the last four years, the Trump Administration has shined a bright light on the Medicaid program because we know that transparency promotes accountability.” said CMS Administrator Seema Verma. ‘In the midst of a pandemic of generational scope and fury, it has never been more important to understand the underlying drivers of enrollment trends and the impact of new congressional requirements.” According to CMS, ‘Medicaid and CHIP play a vital role in helping states and territories respond to public health events, like COVID-19. To assist states and territories in their response to COVID-19, CMS developed numerous strategies to support Medicaid and CHIP operations and enrollees in times of crisis, including granting states more flexibility in their Medicaid and CHIP operations.” CMS pointed to the importance of both programs for providing health insurance coverage during the pandemic. The increased flexibility and policy options, including presumptive eligibility and continuous eligibility were implemented to keep enrollment steady and retention [FN3] high. Job Loss Levels Higher than Loss of Insurance Early indications regarding enrollment numbers for health insurance plans through the ACA exchanges showed that the number of new people signing up for health insurance was similar to new enrollments last year, despite significantly increased unemployment due to the COVID-19 pandemic. According to Karen Pollitz of the Kaiser Family Foundation, a reason that the number of people losing health insurance is lower than predicted is ‘most of the people who have lost jobs during the pandemic didn't have health insurance to begin with.” Many of the jobs lost were in the restaurant and service sector that commonly do not offer employer-sponsored health insurance coverage. Pollitz indicated that many people who lost employer coverage were able to find coverage through government programs. ‘People have been figuring out if they did lose job based coverage and if they still make too much for Medicaid, but they did have a qualifying event, [FN4] they're figuring out how to sign up for marketplace coverage.“ Survey: Health Insurance Most Commonly Dropped Insurance Coverage in 2020 A recent survey showed that 39% of Americans reduced or eliminated some form of insurance coverage with health insurance policies the type of insurance most decreased or dropped. Researchers found that 45% of people decreasing or eliminating coverage did so to save money. Twenty-nine percent or respondents said they could not afford the policy. A large percentage of people used the money that would have gone to premiums to pay for groceries, housing, or other necessities. Sixty-three percent of respondents regretted decreasing or eliminating their policies. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -4- Most people surveyed indicated that they were reluctant to cut insurance, saying that they would cut expenses in other areas before dropping insurance coverage. Over half of the people who reduced insurance coverage planned to resume coverage levels. Health insurance was the most decreased or eliminated insurance policy. Forty-two percent of women and 23% of men who eliminated or decreased insurance indicated that they could not afford it. Respondents cited groceries, savings, debt payments, and housing costs as expenses they paid with funds they would have otherwise used for insurance. Lack of employment due to the pandemic was related to consumers cutting back on insurance. Fifteen percent of people who remained employed during the pandemic cut insurance. Fifty-nine percent of people who became unemployed or furloughed decreased or eliminated at least one kind of insurance. [FN5] Forty percent of people reducing insurance chose to reduce or eliminate their health insurance plans. California Law Requires Insurance Parity for Mental Health A new law in California took effect in the beginning of January that will require parity for the coverage of mental health conditions and make it harder for insurance companies to find loopholes for the requirement. State Sen. Scott Wiener, D-San Francisco, wrote the bill, SB 855. California Governor Gavin Newsom signed it in September. Under the law commercial insurance companies must fully cover treatment of all mental health conditions, including substance use disorders. Prior state and federal laws requiring parity had limitations and loopholes that insurance companies used to avoid providing coverage. California's prior mental health parity law only required coverage for medically necessary treatment for nine severe mental illnesses. It did not require coverage for any substance use disorders. It also allowed insurance companies to define ‘medically necessary.” State Sen. Scott Weiner indicated that the prior law allowed insurance companies to deny care to patients. 'SB 855 sends a powerful message to the nation that California prioritizes the mental health of its residents,' Wiener stated. ‘I'm proud of my colleagues and the Governor for getting it and enacting this legislation into law.’ The new law requires coverage of all mental health conditions and substance use disorders the American Psychiatric Association defines, including substance use disorders, addiction disorders, eating disorders, dissociative disorders, anxiety disorders, and depressive disorders. The law also requires insurance companies to cover treatments and pharmaceuticals to prevent, diagnose, or treat a mental health [FN6] disease. Companies can no longer define ‘medically necessary” to limit these treatments. Competitive Health Insurance Reform Act Becomes Law The Competitive Health Insurance Reform Act became federal law on January 13. The legislation repeals the McCarran-Ferguson antitrust exemption for health insurance companies. According to the American Dental Association, the law is ‘culmination of a multi-year effort by several organizations, including the American Dental Association, to persuade Congress that health care insurance, including dental plans, should no longer be protected from some of the federal antitrust laws.” The goal of the law is to improve transparency and competition in the health insurance marketplaces, including dental and vision insurance. As a result of the law, the Federal Trade Commission and the Department of Justice might investigate health insurers for anticompetitive practices. 'Over time, we will expect to see some changes in the dental plan marketplace that would benefit all,” said ADA President Daniel J. Klemmedson, D.D.S., M.D. ‘If dental plan companies are compelled to compete fairly and transparently, we should begin to see increased innovation and choice for consumers and providers as the dental plan market place changes over time.” The organization was hopeful that the new law will lead to improvements in coverage and decreased premiums costs and copayments, as well as increased provider networks and covered services. Some experts believe that the antitrust exemption for health insurance coverage has suppressed the dynamic of the health insurance market. Advocates for the law are hopeful that the law will encourage new insurance companies to enter the market competitively to offer improved coverage to consumers and better terms for health care providers. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -5- 'Ultimately, expanding choices under health and dental insurance plans will mean better plans for consumers, and improvements for health care professionals who seek to provide health care to patients within a more consumer-friendly framework,” ADA President [FN7] Daniel J. Klemmedson, D.D.S., M.D. indicated. The Justice Department released a statement on the passage of the Competitive Health Insurance Reform Act of 2020. The law will limit the antitrust exemption available to health insurance companies under the McCarran-Ferguson Act. Rep. Peter DeFazio sponsored the bill that passed the House of Representatives on Sept. 21, 2020 and passed the Senate on Dec. 22, 2020. 'We thank the President, the Senate, and the House of Representatives for recognizing the importance of competition in American health insurance markets,” said Assistant Attorney General Makan Delrahim of the Department of Justice's Antitrust Division. ‘Limiting the scope of conduct exempt from the antitrust laws will strengthen the Antitrust Division's ability to investigate and prosecute anticompetitive behavior. Americans deserve competition in health insurance markets just as they do in any other industry.” Under the McCarran-Ferguson Act exempts insurance companies received and exemption from federal antitrust laws for certain conduct that constitutes the ‘business of insurance.” According to the Justice Department, ‘This exemption has sometimes been interpreted by courts to allow a range of harmful anticompetitive conduct in health insurance markets. The Competitive Health Insurance Reform Act amends the McCarran-Ferguson Act and will assist the Antitrust Division in its mission to enforce the antitrust laws by narrowing this defense and clarifying that, except for certain activities that improve health insurance services for consumers, the conduct of health insurers is subject to the federal antitrust laws.” The Justice Department noted that it has successfully enforced antitrust laws against health insurers. During the last five years, it has enforced antitrust laws against health insurance companies in transactions totaling over 160 billion dollars. The Justice Department indicated, ‘The Act will help the department build upon those successes by requiring health insurers to play by the same rules as competitors in other industries. It will end distracting arguments about when health insurers qualify for the McCarran-Ferguson exemption, and it will enable the Antitrust Division to spend resources more efficiently to achieve results that make [FN8] a difference for American consumers.“ COVID-19 Pandemic Prompts Reopening of Federal Health Insurance Exchange The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced a Special Enrollment Period (SEP) for the federal health insurance exchange in response to President Biden's Executive Order to reopen enrollment in response to the ongoing pandemic. The pandemic has left millions of Americans with uncertainty about health coverage and many have experienced new health issues needing treatment. The new enrollment period will allow for enrollment in 2021 health insurance plans. The period will run from February 15, 2021 through May 15, 2021. The marketplace will accept new applications and updates to existing applications. The federal government is allowing state-based marketplaces to choose to reopen enrollment for a special enrollment period as well. 'The Department is committed to ensuring that we deploy every available resource during the Public Health Emergency. This Special Enrollment Period will ensure that more individuals and families have access to quality, affordable health coverage during this unprecedented time,” said HHS Acting Secretary Norris Cochran. Enrollment is available through the call center and through direct enrollment channels. Coverage will begin the first day of the month following plan selection. CMS will implement a paid advertising campaign and direct consumer outreach. It will join with community and stakeholder organization in multiple languages. Special Enrollment Periods may be available for additional reasons for some consumers and for consumers eligible for Medicaid and [FN9] the Children's Health Insurance Program (CHIP). Enrollment eligibility information is available through healthcare.gov. Pending Legislation Aims to Increase Access to Health Insurance U.S. Sen. Mark R. Warner (D-VA) recently introduced legislation that aims to increase access to health insurance to help counter the effects of the COVID-19 pandemic. The economic crisis brought on by the pandemic has resulted in a high number of people in the United States without health insurance coverage. The Health Care Improvement Act of 2021 aims to protect health care coverage for people with preexisting conditions and expanding access to affordable coverage. 'Due to the COVID-19 pandemic, millions of Americans have lost their employer-provided insurance. Amid one of the most unprecedented health and economic health crises our country has faced where an alarming number of Americans already lack health © 2022 Thomson Reuters. No claim to original U.S. Government Works. -6- insurance, now is the time to deploy tools to meet the demands on our health care system. As the Biden administration readies its executive orders to expand health care coverage ? including reopening the enrollment period for the Affordable Care Act? I'm also introducing legislation that would support the administration's effort to get more families affordable health care coverage,” said Sen. Warner. The bill focuses on decreasing the cost of health insurance with the following methods. It would cap health care costs on the ACA exchanges at 8.5 percent of total household income. Currently, people making over 400 percent of the federal poverty level receive no assistance to purchase health insurance through the exchange. In 2020, this number was $51,040 per year for an individual. The bill would extend eligibility to people making more than the current cutoff amount and it would cap the cost of health insurance for all individuals and families. The legislation would also create a low-cost public health care option for individuals who are eligible to enroll for health care coverage through the ACA exchanges. According to Sen. Warner, ‘Establishing a public health care option will increase competition and ensure an added lower cost health care option for more American families.” The bill would authorize the federal government to negotiate prescription drug prices. Current law prohibits the federal government from negotiating with pharmaceutical companies for lower prices. The legislation would allow the government to wield its purchasing power to reduce drug prices for seniors on Medicare. The Health Care Improvement Act of 2021 would also allow insurers to offer health insurance plans across state boundaries. Warner indicated that this permission would increase competition and decrease costs of health insurance premiums while keeping quality and consumer protections. The bill would support state-run reinsurance programs. It would create a new ‘State Health Insurance Affordability and Innovation Fund” for state run reinsurance programs aimed at lowering the cost of premiums. According to the Congressional Budget Office, reinsurance programs can reduce the cost of premiums by 8 percent in one year. The pending legislation would also incentivize states to expand Medicaid. If the remaining states that have not yet expanded eligibility for Medicaid would choose to do so, the number of people lacking insurance in the United States would decrease by 2 million. It would temporarily increase federal matching funds to states choosing to expand Medicaid. At the same time, the legislation would reduce existing administrative payments to states that do not expand the program. It would also retroactively pay an increased amount to states like Virginia that recently expanded Medicaid. The bill would also allow states to provide Medicaid eligibility to new mothers up to 12 months postpartum. This provision is aimed at improving maternal health outcomes by allowing mothers free access to health services after giving birth. Another goal of the bill is a simplification of enrollment for Medicaid coverage. Currently, over 7 million Americans are currently eligible but not enrolled. The bill would permanently authorize the successful Medicaid Express Lane Eligibility program and expand it to include adults. The Department of Health and Human Services would be required to study the effect of auto-enrollment for Medicaid and CHIP. The Health Care Improvement Act of 2021 would increase Medicaid funding for states with high levels of unemployment. It would create a counter-cyclical Medicaid matching payment to the states so that states with higher unemployment receive higher federal matching funding. The funding is aimed at helping these states cover the cost of increased Medicaid enrollment. This aspect of the bill is focused on helping states maintain affordable health care coverage during economic downturns. Currently, health care providers in rural areas receive a lower rate of compensation than health care providers in urban settings. The bill would change that dynamic, creating a rural floor for the Area Wage Index formula to reimburse rural providers. This tactic would increase access to coverage in rural and medically underserved communities. The bill would address burdens on small businesses by reducing the ACA employer reporting requirements. 'As Americans continue to face a once in a century public health crisis, Senator Warner is working to make health care more accessible and affordable for the American people. Senator Warner's bill would take bold steps to reduce costs, expand coverage, and strengthen protections for people with pre-existing conditions at a time when access to affordable health care has never been more critical. Mitch McConnell and Senate Republicans should work with Senate leadership to prioritize the health and well-being of Americans by building on the success of the Affordable Care and abandoning their health care sabotage agenda,” said Brad Woodhouse, Executive Director of Protect Our Care. 'The pandemic has exacerbated the deep, structural problems in our health care system: namely, cost is far too big of a burden and not enough people have adequate protection. We must make real reforms to health care, and Third Way applauds Senator Mark Warner for the leadership he has shown in the Health Care Improvement Act of 2020,” said Gabe Horwitz, Senior Vice President for the Economic Program at Third Way. ‘Among its very important provisions, this legislation would expand coverage by making enrollment in Medicaid automatic whenever a low-income uninsured patient accesses health care. As Third Way has long called for, automatic enrollment makes health care easier for people to navigate and is an important step to achieve universal coverage. The Warner legislation also builds on the Affordable Care Act and makes coverage affordable for millions of middle-class families who currently fall © 2022 Thomson Reuters. No claim to original U.S. Government Works. -7- through gaps in the program. And it provides financial relief to states during economic downturns like the one we're experiencing now by increasing the federal share of Medicaid payments to the states. Americans need far more security and stability in their health care, and we are excited about the vision shown in Senator Warner's bill.” Rich Shinn, Director of Government Affairs for the Virginia Community Healthcare Association, also spoke in favor of the bill. His organization represents over 150 health center sites that serve over 350,000 individuals in Virginia. The organization's focus is access to primary care for Virginia residents. Shinn pointed to the increased need for quality health care coverage during the COVID-19 pandemic, indicating that it is ‘more critical [FN10] than ever.“ Michigan Extends Special Enrollment Period to Plans Outside of Marketplace The Michigan Department of Insurance and Financial Services (DIFS) recently announced that it would extend the special enrollment period for state residents to sign up for health insurance coverage to plans available outside of the state's health insurance marketplace exchange. The special enrollment period was in response to the COVID-19 pandemic. 'As we continue to fight the COVID-19 pandemic, we are committed to using every tool at our disposal to ensure that every Michigander has access to affordable, high quality health coverage,” said DIFS Director Anita Fox. ‘By allowing ACA-compliant off-Marketplace health plans to be sold during this new special enrollment period, consumers will have more choices when it comes to getting the health coverage they need.” Residents of Michigan can normally only sign up for Affordable Care Act (ACA) compliant health plans during the annual open enrollment period. They can purchase these plans either through the Health Insurance Marketplace or off the Marketplace directly from health insurance companies. The plans are available for purchase during individual special enrollment periods when consumers have a qualifying event, such as a loss of employment. Under the new special enrollment period due to COVID-19, Michigan residents are able to enroll in health plans through the Marketplace. Under the recent bulletin from DIFS, insurers can also sell ACA-compliant plans directly to consumers. 'We are working to ensure that, during the pandemic, every Michigander is aware of this special enrollment period and the importance of getting themselves covered,” said Fox. ‘If you do not have health coverage, now is the time to check out plan options and pricing either off or on the Marketplace. The vast majority of Michigan residents who sign up through the Marketplace receive subsidies for no or low cost coverage.” Consumers purchasing plans through the Marketplace can access federal subsidies to help cover the cost of premiums if they qualify based on household income levels. They can also learn if they are eligible for government coverage such as Medicaid or the Healthy Michigan Plan. Plans sold directly to consumers and not through the Marketplace do not qualify for federal subsidies. Opening enrollment for all ACA-compliant plans will increase coverage choices for consumers. 'Consumers are, of course, encouraged to remain vigilant about the potential for fraudsters to try to take advantage of the public with fake insurance scams,” said Fox. ‘We strongly encourage consumers to research and verify all companies, agents, and plans before [FN11] sharing your personal information or sending money. Call DIFS if you have any questions or concerns.“ Democrats Push for Significant Boost to Medicaid in Stimulus Package The House Committee on Energy and Commerce released legislative recommendations for budget reconciliation that would add significant funding to expand Medicaid coverage throughout the United States. An important part of the proposal would address the federal cap on rebates that pharmaceutical manufacturers pay Medicaid programs for drugs when the price of those medications increase at a rate faster than inflation. This cap would be removed in 2023. If implemented, drug companies will likely have to pay states to provide some medications under Medicaid. The proposal also would create new incentives to encourage the states that have not yet expanded Medicaid eligibility to agree to expansion. Those states would receive a 95 percent funding match for a two-year period to cover the cost of expansion. The funding match would increase by 5 percent. The proposal would extend for five years the policies of giving women Medicaid eligibility for 12 months after giving birth and giving prisoners Medicaid coverage beginning 30 days prior to their release. The cost of COVID-19 vaccines would be covered for Medicaid beneficiaries and participants in the Children's Health Insurance Program for up to one year after the end of the public health emergency. The proposal would additionally increase funding for Medicaid programs supporting mobile crisis intervention care for people with mental health and substance use disorders. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -8- Increased funding would also go toward improving the federal health system, including testing and vaccine distribution efforts throughout the nation. According to Energy and Commerce Chairman Frank Pallone, Jr., D-NJ, ‘We are here today to address this Committee's top priorities ? combating the COVID-19 pandemic, providing relief to struggling families, and rebuilding our economy. 'Our nation and our people are hurting. It is essential that Congress act quickly to provide the resources and support needed to bring an [FN12] end to the COVID-19 pandemic.” Pending Legislation: Public Option Health Insurance U.S. Senators Michael Bennet (D-Colo.) and Tim Kaine (D-Va.) recently reintroduced legislation that would create a public option for health insurance by expanding the Affordable Care Act (ACA) and Medicare. The legislation, the Medicare-X Choice Act, would allow families, individuals, and small businesses to purchase low-cost health insurance. It also aims to decrease the number of Americans without health insurance coverage, lower the cost of health care, and increase competition in the health insurance market. According to Bennet, ‘The Coronavirus Disease 2019 (COVID-19) pandemic has underscored the need to expand access to high- quality and affordable coverage. Bennet and Kaine's bill would help achieve universal health care by making coverage more affordable and accessible. The bill also updates previously introduced versions.” 'The Affordable Care Act dramatically improved coverage and affordability for health care in America,” continued Bennet. ‘As we continue to face a devastating pandemic where millions of Americans are uninsured or underinsured, we are committed to working with the Biden Administration to strengthen the ACA. Medicare-X is the best way to cover everyone, reduce health costs, and improve the quality of health insurance for all Americans, including those who've historically suffered the most from poor access to quality coverage and care. We have a responsibility to create the best health care system possible and achieve universal coverage in our country. We can do that through Medicare-X.” 'With massive job losses, exacerbated health disparities, and increasing health care costs, the COVID-19 pandemic has further reinforced the urgent need for us to expand access to quality, affordable care,” said Kaine. ‘At a time when health care is a top concern for so many people, we must pass this legislation to offer more Americans, particularly in rural communities, more quality, affordable health care choices and help people get the care they need.” While the ACA increased the number with health insurance coverage in the United States, gave people with preexisting conditions access to coverage, and standardized essential health benefits for all qualified health plans, many Americans still have high health care costs and limited options for coverage. Approximately 10% of counties only have a single insurer offering health insurance plans in 2021. Bennet noted, ‘Under Medicare-X, the public option would initially be available on the individual exchange in areas where there is a shortage of insurers or higher health care costs due to less competition—including rural communities in Colorado and Virginia. By 2025, the Medicare Exchange plan would expand to every ZIP code in the country and be added as another option on the Small Business Health Options Program Marketplace.” The legislation would expand the network of health care providers under Medicare. It would also guarantee essential health benefits [FN13] under the ACA, including maternity care and mental health services. Legislation Introduced to Lower Cost of Health Insurance U.S. Senator Jeanne Shaheen (D-NH) announced that she is introducing new legislation aimed at improving access to health care through decreasing the cost of premiums and deductibles for families in the low- and middle-income ranges. The Improving Health Insurance Affordability Act would expand access to health insurance coverage to over 4 million Americans currently without insurance coverage. It would reduce the cost of premiums and deductions for millions of additional people who already have health insurance. Shaheen indicated that increasing accessibility of health insurance coverage is particularly important during the COVID-19 pandemic. 'Expanding access to affordable health care has never been more critical than during the COVID-19 public health crisis, especially as we recently marked a grim milestone of 500,000 American lives taken by this deadly virus,” said Shaheen. ‘To help families afford life-saving care, I'm introducing a common-sense bill to reduce costs of premiums and deductibles ? putting quality health care within reach for millions of low- and middle-income families. My top priority in the Senate is strengthening our health care system and helping Americans get the care they need without breaking the bank.” The legislation would expand eligibility for federal tax subsidies available through the Affordable Care Act (ACA) health insurance exchanges to help cover the cost of health insurance premiums for consumers purchasing individual health insurance plans. It would also increase the amount of tax subsidies for people who are already eligible for the subsidies. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -9- Under the bill, the value of the tax credits would increase for people with incomes between 100 and 400 percent of the federal poverty level (FPL). Those people are already eligible for some level of tax subsidy. The pending legislation would also expand eligibility for the tax subsidies to people earning over 400 percent of FPL. The bill would change the benchmark plan upon which the amount of tax credits is based to the second lowest Gold plan. The Gold plan has lower deductibles and out-of-pocket costs than the current benchmark plan, the Silver plan. People with income between 100 and 250 percent of FPL would receive a larger reduction in cost-sharing assistance. Cost-sharing reduction would become available to people with incomes up to 400 percent of FPL. The same premium tax credit enhancements are included in the American Rescue Plan Act. However, those enhancements are temporary. Shaheen's bill would make the changes permanent. Shaheen also wrote a letter encouraging the legislature to expand the ACA premium tax credits as part of the COVID-19 relief legislation. According to a February 2021 Urban Institute analysis of changes included in Senator Shaheen's legislation, the bill could lead to over 4 million uninsured people gaining health insurance coverage. The average total premium and out-of-pocket costs per person could be reduced by $1,390. The analysis shows an over 37 percent reduction in monthly premium costs per person. It also shows an over 16 percent reduction in cost-sharing and out-of-pocket costs. A portion of health insurance consumers would be newly eligible for CSR assistance or increased CSR assistance would likely experience even larger savings due to the reduced cost of deductibles. Families USA, Protect Our Care and the National Partnership for Women & Families support the bill. Cosponsors of the legislation include Senators Bob Casey (D-PA), Michael Bennet (D-CO), Maggie Hassan (D-NH), Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Jack Reed (D-RI), Catherine Cortez Masto (D-NV), Debbie Stabenow (D-MI), Tina Smith (D-MN), Jon Tester (D-MT), Chris Murphy (D-CT), Ben Cardin (D-MD), Jacky Rosen (D-NV), Amy Klobuchar (D-MN) and Tim Kaine (D-VA). [FN14] Pending COVID-19 Relief Package Expands Health Insurance Assistance Proposals in the pending COVID-19 federal relief package include measures that would expand assistance for health insurance coverage. The $1.9 trillion COVID-19 relief bill includes a measure that would increase federal subsidies to help consumers purchase individual health insurance plans through the ACA marketplace. Those subsidies would also be available to more people based on income levels. The bill also includes incentives to encourage the 12 states that have not yet expanded eligibility for Medicaid to sign on to the expansion under the Affordable Care Act. Additionally, the bill would direct the federal government to temporarily cover the cost of health insurance for people who have lost their jobs and employer-sponsored health insurance plans due to the pandemic. Experts predicted that expanding Medicaid, implementing more generous subsidies, and making other changes under the legislation to increase access to private health insurance coverage would increase the number of Americans with coverage by 5.3 million or more. The Congressional Budget Office and the Kaiser Family Foundation performed studies that corroborated the prediction. According to the Center on Budget and Policy Priorities, the legislation would increase federal funding by almost $22.8 billion over two years to the remaining 12 states if they expanded Medicaid. According to the House Joint Committee on Taxation, the cost of increased subsidies and other changes for private health insurance would cost the federal government $45.6 billion over two years. Other healthcare-related measures in the bill include extending eligibility for Medicaid coverage to new mothers after giving birth and incarcerated people preparing to be released. The Biden administration announced it would reverse the permission the Trump administration gave to states to impose work requirements on Medicaid qualifications. President Biden is expected to sign the COVID-19 relief package if it is approved by the Senate and the House. Congress is using a legislative mechanism for budget reconciliation so the bill will not be subject to a filibuster, requiring only a simple majority for passage. Biden promised during his campaign not to replace the Affordable Care Act but to expand it. This legislation would fall in line with that promise. The Congressional Budget Office indicated that the bill could increase the number of Americans with health insurance by 1.3 million based on the increased federal subsidies and other changes to private health insurance coverage. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -10- The proposed subsidy changes would make health insurance purchased through the exchange free for people earning less than 150% of the federal poverty level. People earning less than 100% of the federal poverty level or over 400% of the federal poverty level would also be eligible for subsidies through the exchange. The changes to subsidies would be temporary, lasting only for two year under the legislation. Health care advocates support making the changes permanent. 'This is a safety net for everyone,” said Frederick Isasi, executive director of Families USA, which advocates for affordable health care. ‘It says that no matter who you are or where you live, if you haven't got employer health insurance you should not have to pay more than 8.5% of income for a good plan.” Another measure under the bill would allow people losing their jobs to qualify for the largest subsidies through the health insurance exchange as if they were on the lower part of the income scale. People losing their jobs would also qualify for a full subsidy of the cost of COBRA health insurance through September so they could continue employer-sponsored health insurance without cost during the pandemic. The incentive for states to expand Medicaid eligibility is a 5 percent increase in the traditional program federal cost matching rate for [FN15] two years. Colorado Lawmakers Introduce Public Option Bill Democrats in Colorado announced the introduction of a public healthcare option bill aimed at decreasing insurance costs for individuals and small businesses. The bill was partially in response to the economic impact of the coronavirus pandemic. Under the bill, the commissioner of insurance would create a standardized health benefit plan that health insurance carriers would offer to consumers in the individual and small group markets. The standardized plan would offer coverage at the bronze, silver, and gold levels. It would be available through the Colorado health benefit exchange. The standardized benefits of the plan would be developed after a stakeholder engagement process. The plan would offer first-dollar, predictable health insurance coverage for specific high value services and would comply with state and federal health insurance laws. Starting January 1, 2023, and continuing each year, carriers would be rewarded for offering a standardized plan in the individual market and a standardized plan for the small group market. The 2023 carrier goal is a standardized plan premium that costs at least 10% less than the premium rate for health benefit plans offered by the carrier in the 2021 calendar year in the individual and group markets. In 2024, the carrier goal would advance to a standardized plan premium that costs 20% less than the premium rate for health benefit plans offered by the carrier in 2021 for both the individual and group markets. In subsequent years, insurance carriers are encouraged to limit increases of premium rates for the standardized plans to less than the consumer price index plus one percent compared to the previous year. If carriers do not meet the established premium rate goals, the Colorado option authority, created by the legislation, would mandate prices for the standardized plan as the Colorado option. The authority would be a nonprofit, unincorporated public entity. The Colorado option authority would implement a provider fee schedule created by the commissioner and the executive director of the department of health care policy and financing. Health care providers would be required to accept consumers enrolled in the public option plan. Under the bill, the commissioner would be directed to apply to the United States Department of Health and Human Services for a waiver to use federal funding to capture savings through the implementation of the public option in Colorado. The legislation would also protect against carriers raising the cost of other health insurance plans to cover the cost of the public option plans. If the United States subsequently establishes a national public option program with the same or better premium rate goals, the Colorado public option would be withdrawn under the bill. The bill is part of Colorado Gov. Jared Polis' agenda to make healthcare more affordable and accessible. It was sponsored by Reps. Dylan Roberts and Iman Jodeh and Sen. Kerry Donovan. The plan is aimed at creating more competition in the health insurance market in rural areas of the state where consumers have few options for coverage. The bill would give insurers, health care providers, and drug manufacturers an opportunity to lower prices on their own before the government mandates the changes. Another pending bill addresses prescription drug costs. It would create a state board to look at price increases and set limits on the cost of the most expensive drugs. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -11- Pending legislation would expand the state's ability to import cheaper prescription drugs and would require pharmacy benefit managers to competitively bid for state contracts to provide medications for state employee prescription plans. Lt. Gov. Dianne Primavera spoke in favor of the pending legislation, indicating that it would allow industry partners to innovate. 'We can't just rely on promises,' said Primavera, who also heads the Office of Saving People Money on Health Care. The state health department released a report in 2020 showing that Colorado hospitals' per-patient profits were at the highest level in ten years in 2018. The average per-patient profit was $1,518 in 2018. It was $538 in 2009. Inflation and expenses could not account for the increase, according to researchers. Hospital associations argued that profits are needed for equipment upgrades, debt payments, and sustaining services during the pandemic. The pandemic has reduced the number of elective procedures and treatments, leading to budget concerns for many hospitals, particularly in rural areas. Other healthcare initiatives under Colorado's Democratic-controlled government have included a reinsurance market to pay private insurers government money to cover their costliest beneficiaries, mandated hospital price transparency, and consumer protections for [FN16] surprise medical billing. Maryland Legislation Aims at Improving Access to Healthcare The Maryland Citizens' Health Initiative (MCHI) expressed support for the moving forward of three pieces of legislation in the Maryland General Assembly aimed at strengthening the health care system in the state and expanding access to health insurance coverage and healthcare. The trio of legislation would assist young adults in obtaining more affordable health insurance coverage, facilitate enrollment in affordable health insurance coverage for people who are unemployed, and expand high-quality healthcare in communities that do not currently have adequate access to care. 'The Affordable Care Act has been enormously successful across the nation and in Maryland, driving down the number of people without health insurance dramatically and strengthening our system so more people are receiving the high-quality care they need to lead healthy lives,” said MCHI President Vincent DeMarco. 'As we mark the 11th anniversary of the ACA, the General Assembly is on track to passing major bills to improve our state's health care system. These bills will help ensure that Maryland remains a national leader in health care coverage and public health.” The pending legislation includes: Health Insurance Premium Subsidies: Senate Bill 729, sponsored by Sen. Brian Feldman, and House Bill 780, sponsored by Del. Ken Kerr. This bill would authorize the Maryland Health Benefit Exchange to provide new health insurance coverage subsides for lower-income young adults, which is vital in making insurance more affordable. Expand Insurance Enrollment for the Unemployed: Senate Bill 893, sponsored by Sen. Jim Rosapepe, and House Bill 1002, sponsored by Del. Lorig Charkoudian. This bill would assist people who file for unemployment insurance with enrolling in health insurance coverage through the Maryland Health Benefits Exchange. It aims to keep people insured even if they lose their employment. The legislation adds to Maryland's successful first-in-the-nation Easy Enrollment law that connects people to health insurance when they file their state taxes. Health Equity Resource Communities: Senate Bill 172, sponsored by Senator Antonio Hayes and House Bill 463, sponsored by Delegates Erek Barron and Jazz Lewis. This bill would create Health Equity Resource Communities that would receive new funding to reduce racial disparities in health outcomes by improving access to care. 'We are hopeful that the General Assembly will give final approval to these three measures, giving a boost to our statewide health care system,” DeMarco said. ‘By enacting these new public health measures, we would expand health coverage to thousands of additional Marylanders who are eligible for free or low-cost health coverage but not now enrolled and address the long term problem of health [FN17] disparities by creating Health Equity Resource Communities. “ 500,000 Enroll in Health Insurance Coverage During Special Enrollment Period U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced that over 500 thousand consumers enrolled in health insurance coverage through the federal health insurance exchange, HealthCare.gov, during the Special Enrollment Period (SEP) that President Biden opened in response to the COVID-19 Public Health Emergency. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -12- The American Rescue Plan (ARP) increased the financial assistance available to purchase health insurance plans through the health insurance exchanges. This assistance, along with the SEP, allowed individuals and families to enroll in health plans at reduced premiums and increased savings. 'Access to quality, affordable health care is essential ? especially as we tackle the COVID-19 pandemic and its aftermath,” said HHS Secretary Xavier Becerra. ‘Since the beginning of this Special Enrollment Period's availability on HealthCare.gov, more than 500,000 Americans have already signed up for coverage on HealthCare.gov. Now, thanks to the American Rescue Plan, health care coverage is more affordable and millions of Americans are seeing their premiums reduced. At HHS, we are going to build on the Affordable Care Act (ACA) and work tirelessly to ensure Americans have the chance to sign up for quality, affordable health care coverage that meets [FN18] their needs.“ The increased federal tax subsidies for plans purchased through the federal and state health insurance exchanges began on April 1. The SEP will remain open until August 15. Under ARP, taxpayer subsidies are more generous and are open to a wider group of people based on income. The expanded subsidies will be available through the end of 2022. Consumers who were already signed up for a plan through the exchange should update their information online or over the phone to receive the increased subsidies throughout the year. According to the federal government, consumers could save an average of $50 per month. The data released by CMS indicated that 528,005 people enrolled in new plans through the federal exchange from February 15 to March 31. Those numbers do not include states that run their own health insurance exchanges, only the 36 states served by the federal exchange. The report also indicated that over 870,000 people visiting the federal website or calling the call center were determined to be eligible for Medicaid. At the end of Trump's term, over 20 million people received health insurance coverage through the ACA exchange and the expansion of Medicaid under the federal healthcare reform law. Due to the COVID-19 pandemic, and the resulting downturn in the economy, the number of people without health insurance coverage has been increasing. Biden opened the SEP and implemented the expansion of subsidies to combat that increase. Some of the states where enrollment during the SEP was strong were states that voted for Trump in the last election, including Florida, Texas, and North Carolina. Florida topped the gains of all states with over 146,000 new enrollments. According to the nonpartisan Congressional Budget Office, approximately 33 million Americans lack health insurance coverage. That number is smaller than the number of uninsured people in the United States before the implementation of the ACA. However, it is a change to the trend of steady decreases in the rate of uninsured people throughout the nation. The CBO reported that approximately 3 million people in the United States became uninsured because of the COVID-19 pandemic. [FN19] Other experts have estimated the losses at 5 million to 10 million. Five Million Fall Under ACA “Family Glitch' A new report by the Kaiser Family Foundation indicated that over five million people fall under the ‘family glitch” in the Affordable Care Act, making them ineligible for financial assistance through the health insurance exchange because their employer offers them affordable coverage as defined by the law. Health insurance is available through the ACA exchanges for people who do not qualify for coverage under a public program and are not offered coverage through their employer. There are some exceptions to this rule, including people whose employers offer coverage that is considered unaffordable or of insufficient value. Employer-sponsored health insurance is considered unaffordable if the premium costs over 9.83% of the employee's household income. However, the affordability is based on the cost of the employee's self-only coverage, not the cost of a family premium that would cover the employee's dependents. Family coverage through an employer could cost more than 9.83% of the employee's income. If the cost of the employer plan for the employee only is less than 9.83%, the employee would not qualify for subsidized family coverage through the ACA exchanges. Defining affordable coverage in this way is known as the ‘family glitch.” The Biden administration has issued an executive order calling for federal agencies to review whether administrative policies could potentially remedy the family glitch. Researchers at the Kaiser Family Foundation estimated that 5.1 million people in the United States fall into the family glitch. Most of these people are children. Female adults are more likely to fall into the family glitch than male adults. Researchers noted, ‘We explore demographic characteristics of people who fall into the family glitch, present state-level estimates, and discuss how many people may benefit from policies aimed at addressing the family glitch. While estimates of the cost of eliminating the family glitch are beyond the scope of this analysis, the Congressional Budget Office (CBO) has previously projected it would cost the © 2022 Thomson Reuters. No claim to original U.S. Government Works. -13- federal government $45 billion over 10 years. Our estimate includes people with incomes above 400% of poverty, who are temporarily eligible for Marketplace financial assistance under the American Rescue Plan Act of 2021 (ARPA) passed in March 2021.” People affected by the family glitch fell into three groups including, dependents with employer coverage, those with individual market coverage, and those without health insurance. Researchers excluded people who were eligible for government coverage through Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). The most recent data available was from a 2019 survey. Researchers noted that economic circumstances have changed significantly since then due to the coronavirus pandemic. They estimated that approximately 2-3 million people lost employer-sponsored health insurance coverage between March and September 2020. Other people likely lost employer-sponsored coverage and joined the employer-sponsored plan through another household or family member. 'It is therefore difficult to know whether or how pandemic-related coverage changes have affected the current number of people falling into the family glitch as more recent data are not yet available,” stated the authors. Of the 5.1 million people falling into the ACA family glitch, 4.4 million of them (85%) currently purchase health insurance through their employers, likely at a significantly increased cost when compared with people with similar incomes who are eligible for financial assistance through the ACA exchanges. If the people who fall into the family glitch could qualify for subsidies and purchase plans through the ACA Marketplace, they would likely spend less on premiums. On average, people who fall into the family glitch spend 15.8% of their income on employer-based coverage. Six percent (315,000) of people who fall into the family glitch purchase unsubsidized health insurance plans through the exchanges. The remaining nine percent (451,000) are uninsured. Over half of the people falling into the family glitch (2.8 million) are children. Approximately 0.5 million people are ages 18 to 26. Under the ACA, employers must offer coverage to dependents up to age 26. However, that coverage does not have to meet affordability standards as defined in other parts of the ACA. Most people (54%) falling into the family glitch are female. Among adults falling into the family glitch, 59% are female. Texas (671,000), California (593,000), Florida (269,000), and Georgia (206,000) are the states with the largest number of people falling [FN20] into the family glitch. Biden Proposes Extension of Increased ACA Subsidies President Biden has proposed the extension of the expanded Affordable Care Act premium tax credits in the American Rescue Plan. The White House indicated, ‘Health care should be a right, not a privilege, and Americans facing illness should never have to worry about how they are going to pay for their treatment. No one should face a choice between buying life-saving medications or putting food on the table.” The White House also pointed to President Biden's plans to improve the Affordable Care Act by: -lowering prescription drug costs for everyone by letting Medicare negotiate prices -reducing health insurance premiums and deductibles for those who buy coverage on their own -creating a public option and the option for people to enroll in Medicare at age 60 -closing the Medicaid coverage gap to help millions of Americans gain health insurance. According to the White House, ‘The American Families Plan will build on the American Rescue Plan and continue our work to make health care more affordable.” The administration called the American Rescue Plan a historic investment in reducing Americans' health care costs. It asserted that the American Rescue Plan is the largest improvement in the affordability of health care since the Affordable Care Act was passed in 2010. Under the American Rescue Plan, the price of health insurance premiums was lowered for many people who buy their own health insurance plans for two years. It is saving families an average of $50 per person per month. The American Families Plan would make those premium reductions permanent, representing a $200 billion investment. Nine million people would benefit from the increased savings on monthly premiums. An estimated four million uninsured people will gain health insurance coverage if the legislation passes. The legislation would also implement improvements in maternal health and support the families of veterans receiving health care [FN21] services. CA Legislation Would Allow Parents to Join Adult Children's Insurance Plans © 2022 Thomson Reuters. No claim to original U.S. Government Works. -14- A proposal in the California state legislature by Assemblyman Miguel Santiago would allow parents to join their adult children's health insurance plans. The proposal passed its first committee hearing recently. If the proposed legislation becomes law, California would be the first state to allow parents to join their children's plans. The policy proposal is meant to increase access to health insurance coverage for low-income undocumented people living in California who are not eligible for government-funded coverage. The Affordable Care Act allowed parents to keep their children on their health insurance plans until age 26. The change was aimed at helping young adults after the Great Recession when unemployment was high. Due to a high approval of the change, some states allowed parents to keep children on their plans until age 30. The new California proposal could help older people who are transitioning to retirement after the coronavirus pandemic by allowing them to access health insurance coverage through their children. Insurance Commissioner Ricardo Lara was in favor of the bill, indicating that it would save money for families. It would also limit out-of- pocket expenses for people able to take advantage of the change by allowing them to share out-of-pocket maximum limits. 'When we were young, our parents were there for us and took care of us,' Lara said. ‘Now we can take care of them when they need it the most.’ Some business groups opposed the proposal, arguing that adding older people to their large group insurance plans would increase the cost of premiums overall. Depending on the number of people signing up for the change, employer premiums could increase between $200 million and $800 million per year. '(This bill) will exacerbate the health care affordability issue and strain struggling small employers' budgets at a time when they are finally beginning to recover,' said Preston Young, a policy advocate for the California Chamber of Commerce. The change would only apply to people with low incomes. To be eligible, parents would have to meet the IRS definition of a dependent, relying on their children for at least 50% of financial support. Some Democrats in the legislature expressed concern over the cost increases for employers and employees. Assemblyman Jim Wood, a Democrat from Santa Rosa and chairman of the Assembly Health Committee voted for the bill but was unsure if it would ultimately pass. 'I think the bill is likely to increase health care access and may offer affordable coverage options,' he said. ‘But I feel like there may be more work that needs to be done here to figure out what the cost increase means to employers and ultimately employees.’ Advocates for the bill said it was a way to allow uninsured people in the state, mostly undocumented people, to access health insurance when they are not eligible for Medicaid and Medicare. Undocumented people are also not eligible to purchase health insurance coverage through the state's health insurance exchange. Federal subsidies are available only through the exchange. According to an analysis by the California Health Benefits Review Program, between 20,000 and 80,000 parents would join their children's plans. The California legislature is also considering expanding state Medicaid benefits to undocumented adults 65 and older. Families with parents who are eligible for Medicaid are more likely to choose the government-sponsored program over allowing parents on their private plans due to cost. The analysis also pointed to a potential issue of attracting parents who currently do not live in the United States with the prospect of health insurance coverage. 'The opportunity to receive care in the US would be very attractive, especially for those with high-risk conditions,' the analysis said. Lara's office countered, noting, ‘this is always an argument that is raised whenever we expand health care options.’ The Medicaid program in California has covered undocumented children living in the United States since 2016. There has not been an increase in immigrants related to the availability of health insurance for children. 'The reality is that expanding health care choices helps Californians, pure and simple,' Lara stated. ‘The existing requirement in state [FN22] law that someone ‘live, work and reside’ in California would apply.' CMS Reduces Maximum Out-of-Pocket Expenses The Centers for Medicare & Medicaid Services (CMS) announced new provision to lower maximum out-of-pocket costs owed by consumers by $400 for consumers who purchase health insurance through the Federal Health Insurance Marketplaces for plan year 2022. According to CMS, ‘These actions demonstrate a strong commitment by the Biden-Harris Administration to protect and build on the Affordable Care Act (ACA), reduce health care costs, and make our health care system easier to navigate and more equitable.” © 2022 Thomson Reuters. No claim to original U.S. Government Works. -15- The second 2022 Notice of Benefit and Payment Parameters final rule (the '2022 payment notice”) also includes provisions to assist consumers in choosing plan options and increase opportunities for consumers to qualify for future special enrollment periods (SEPs). 'Families deserve to have access to health care coverage that doesn't break the bank. That's why today we're acting to lower consumers' maximum out-of-pocket costs by $400 and why President Biden has a plan to reduce families' health care costs for the long run,” said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. ‘Health care access is personal to me as it is for families across the country. The Department of Health and Human Services is committed to building on the ACA to make sure our [FN23] health care system is more accessible for every American.“ One Million Enroll in Coverage During SEP The White House announced that one million Americans had signed up for health insurance coverage during the Special Enrollment Period (SEP) opened due to the coronavirus pandemic. According to a statement from President Biden, ‘Health care is a right, not a privilege — and ensuring that every single American has access to the quality, affordable health care they need is a national imperative. Since it became law more than a decade ago, the Affordable Care Act has been a lifeline for millions of Americans. The pandemic has demonstrated how badly it is needed, and how critical it is that we continue to improve upon it.” The SEP opened on February 15 to allow Americans the opportunity to enroll in health insurance coverage. Not even three months after the enrollment period opened, one million people had signed up. Biden noted, ‘That's one million more Americans who now have the peace of mind that comes from having health insurance. One million more Americans who don't have to lie awake at night worrying about what happens if they or one of their family members gets sick. Through this opportunity for special enrollment, we have made enormous progress in expanding access to health insurance.” Biden urged more people to sign up for health insurance coverage through the federal health insurance exchange, HealthCare.gov. The SEP will remain open until August 15. President Biden also encouraged people who already have coverage to help family members and friends who are uninsured to enroll. Biden also noted that increasing the number of people covered is an important part of the equation. However, the United States also needs lowered health costs. He pointed to the American Rescue Plan, the law that decreased premium costs for nine million Americans who purchase health plans through the exchanges. It also lowered out of pocket costs for those plans. Biden indicated, ‘Since April 1, the median deductible for Americans signing up for new coverage on HealthCare.gov has dropped by nearly 90 percent, to just $50.” He continued, ‘The American Families Plan will build on this work to make health care more affordable — including by making the American Rescue Plan's premium reductions permanent. Today's milestone demonstrates that there is a need and a demand for high quality, affordable health insurance across this country. It is up to Congress to hear them, and act quickly to pass the American [FN24] Families Plan.“ Reversal on Gay and Transgender Healthcare Discrimination The Biden Administration announced that gay and transgender people will be protected from discrimination in health care, a decision that reversed a Trump-era policy that allowed discrimination in health care. The Department of Health and Human Services announced the change in policy that affects the interpretation of the provision in Section 1557 of the Affordable Care Act. This provision prohibits health care providers and insurance companies from discriminating against people because of ‘race, color, national origin, sex, age or disability in certain health programs and activities.” HHS indicated that the rule will be interpreted to prohibit discrimination against people based on sexual orientation or gender identity in health care. 'Fear of discrimination can lead individuals to forgo care, which can have serious negative health consequences,” HHS Secretary Xavier Becerra noted. ‘It is the position of the Department of Health and Human Services that everyone — including LGBTQ people — should be able to access health care, free from discrimination or interference, period.” HHS stated that the change updates the agency's interpretation of the law to align with the Supreme Court ruling in Bostock v. Clayton County finding that LGBTQ people are protected from discrimination on the basis of sex under the Civil Rights Act of 1964. 'It is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex,' Justice Neil Gorsuch wrote in the ruling. Last year, the Trump administration created a rule removing discrimination protections from LGBTQ people in health care. A number of courts issued preliminary injunctions blocking parts of the rule. 'The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation. That's why today HHS announced it will act on related reports of discrimination,' Becerra stated. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -16- On his first day in office, President Biden signed an executive order, ‘Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation” prompting similar action in government agencies, including the departments of Housing and Urban Development and Justice and the Pentagon. HHS indicated that it will investigate discrimination complaints. 'We are open for business,” Robinsue Frohboese, acting director in the HHS Office for Civil Rights, indicated. ‘Ensuring the protections of individuals, of non-discrimination based on their gender identity and sexual orientation, is a critical part of our civil rights mission.” The Biden administration is expected to submit a formal rule on the issue. 'This is a policy announcement by the administration to say that this is the way that they read the statute and the way that they'll enforce it — and they can begin doing that without a rule,” said Valarie Blake, a law professor at West Virginia University. ‘But I anticipate that they'll promulgate a new rule anyway that gives a little more shape to what sex discrimination means.” The rule from the Trump administration reversed an executive action from the Obama administration. The Trump administration worked to prevent LGBTQ people from having discrimination protections throughout the government. 'Our mission as the Department of Health and Human Services is to enhance the health and well-being of all Americans, including LGBTQ individuals and everyone. Everyone needs access to health care. No one should be discriminated against in this. This change in rules and regulations will help us do that,' said Dr. Rachel Levine, assistant secretary for health, the first openly transgender person [FN25] to be confirmed by the Senate. Study: High Number of People Dying from COVID-19 were Uninsured A recent study showed that a high number of people in the United States who died from COVID-19 lacked health insurance coverage. A Families USA report showed that nearly 40% of Alabama residents who died from COVID-19 were uninsured. Alabama state health officer Dr. Scoot Harris was not surprised that there was a correlation between deaths and lack of coverage. Approximately ten percent of Alabama residents do not have health insurance coverage. Researchers found that almost half of all COVID-19 cases in the state were people without insurance coverage. They represented 38% of deaths from the virus. In 21 of Alabama's counties, more than half of the COVID-19 cases were people who lacked insurance, including in Dekalb, Franklin, Jackson, Lawrence, and Marshall counties. In DeKalb County, 63% of COVID-19 cases and 52% of COVID-19 deaths were people who did not have health insurance. According to Jane Adams with Alabama Arise, the pandemic highlighted the need for more people in Alabama to have access to health insurance. 'This report is so important because it highlights when you have these large areas where people are uninsured, large county populations where people are uninsured, the virus is more likely to spread around because people aren't going to seek the care because they are worried about the cost,” said Adams. ‘So then, you see higher death rates and case rates in those communities.” [FN26] According to Harris, ADPH has traditionally worked with at-risk populations to educate them about access to coverage. CMS Encourages Companies to Promote Coverage for Gig Workers The Centers for Medicare & Medicaid Services (CMS) encouraged companies that rely on gig workers to share information with them about enrolling in health insurance coverage through the federal and state health insurance exchanges during the 2021 Marketplace Special Enrollment Period (SEP). Online digital platform companies are participating in ‘Gig Workers' Week of Action” to promote Marketplace healthcare plans to their workforces. They include Delivery Drivers, Inc., DoorDash, Lyft, Postmates, StyleSeat, Uber, and Wonolo. People in the United States who do not receive health insurance coverage through their employers, such as gig workers, are now eligible for reduced premiums and increased savings for coverage purchased through HealthCare.gov. Many people facing unemployment due to the COVID-19 pandemic turned to gig work. The American Rescue Plan Act of 2021 (ARP) is offering reduced monthly premiums for the cost of health insurance through federal tax subsidies. New consumers enrolling in plans through the federal health insurance exchange during the SEP will pay an average monthly premium 25% less than last year. In February and March, the average monthly cost of coverage through the exchange was $117. In April, monthly costs fell to $86 after the federal tax subsidy. Under the ARP, out-of-pockets costs will also be lower for new enrollees by making plans with lower deductibles more affordable because of the higher federal tax subsidies for monthly premiums. The median deductible during the SEP decreased by almost 90% from $450 to $50. 'As millions of Americans have relied on gig economy work to sustain their incomes and support their families during the pandemic, we want these hardworking men and women to know they can purchase quality, affordable health coverage through HealthCare.gov,” said HHS Secretary Xavier Becerra. ‘And thanks to the American Rescue Plan, these gig workers may be eligible for increased financial © 2022 Thomson Reuters. No claim to original U.S. Government Works. -17- help to reduce the cost of their monthly premiums, making the health insurance plans on the Marketplace more affordable than ever before. I encourage everyone to go to Healthcare.gov to see if they are eligible for lower costs coverage today.’ The companies joining in the Gig Workers Week of Action agreed to provide their workforce with information about health insurance coverage through the Marketplace. They pledged to inform drivers and couriers about the availability of coverage, host information blog posts, and share stories about the benefits of signing up for coverage. Communications will target a wider audience of both English and Spanish-speakers. Many online platform companies have also coordinated with CMS-approved direct enrollment partners to incorporate access to enrolling in Marketplace coverage into their workers' smart phone apps. The apps give gig economy workers direct access to enroll in Marketplace health insurance coverage. The SEP will remain open through August 15, 2021. Consumers can use the online Marketplace to enroll in coverage, compare plan offerings, and learn if they qualify for affordable premiums. They can also check options directly through their companies' phone apps. Current enrollees can review their applications and make changes or select a new plan or confirm their current plan to receive increased savings available due to the American Rescue Plan. [FN27] Consumers can also access the Marketplace via telephone. Democrats Push for Public Option U.S. Senator Patty Murray (D-WA), Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, announced plans to create legislation with Congressman Frank Pallone, Jr. (D-NJ), chair of the House Energy and Commerce Committee that would establish a public option for health insurance coverage. The plan focuses on decreasing health care costs and increasing access to quality, affordable health care. Murray and Pallone issued a Request for Information (RFI) as they began working with legislators who support a public option. They hope to craft new comprehensive legislation that would create a public option. 'This pandemic has underscored why it's so important to patients, families, and communities across the country that health care is truly a right, not a privilege. No one should suffer or die because quality health care was too expensive or too hard to get. I believe we must take bold steps to lower health care costs and move toward universal coverage by creating a federal public option available to everyone —and a clear majority of Americans agree. A federal public option will help guarantee that no matter where you live, who you are, or what your income—if you live in America, you can get the quality health care you need without worrying about cost,” said Senator Murray. 'I'm grateful to our colleagues who have already put forward thoughtful proposals on dramatically expanding coverage—and President Biden who has always been clear that this is a priority for his Administration. I look forward to working with everyone in the weeks and months ahead as we work to craft bold legislation and finally getting this done for families across the country,” Senator Murray indicated. The RFI letter to the public requested input as the Committee leaders began drafting the legislation for the public option. The Senator requested input by July 31, 2021. Murray indicated that a national public option would particularly affect families in Washington state. 'Even before COVID-19, I was hearing from people across Washington state about how hard it was to get, and afford, the health care they needed—but this pandemic has made things so much worse. I'm proud Washington state has been a leader when it comes to establishing a state public option and working to make sure everyone can get quality, affordable health coverage, and I've been in touch with state officials about how bold action at the federal level can strengthen Washington's efforts,” said Senator Murray. 'Establishing a strong, federal public option will force insurance companies to compete, bring drug companies and health care providers to the table, provide every Washingtonian a new quality, affordable coverage option, and ultimately drive down health care costs for all [FN28] families regardless of how they are covered.“ The public option is one of President Biden's campaign promises that has faced significant opposition. The RFI from Murray and Pallone asked for input on who should be eligible for the public option health insurance coverage, how the benefits would work, and what health care providers and pharmaceutical companies should expect as payments under a public option plan. 'We believe bold steps are necessary in order to achieve universal coverage and lower health care costs,” Murray and Pallone indicated in the letter. ‘As we work to craft legislation, our priority is to establish a federally administered public option that provides quality, affordable health coverage throughout the United States.” Democratic legislators attempted to include the public option in the Affordable Care Act, passed under President Obama. Biden brought back the idea during his presidential campaign in 2020. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -18- Insurers and health care providers are largely unsupportive of a public option. Others in the health care industry are unsure of the plan. The American Hospital Association asserted that the public option plan would have ‘inadequate reimbursement rates” and could reduce quality of care. According to a statement from the group's president, Rick Pollack, ‘'We continue to urge Congress and the administration to work to improve the programs that already exist in an effort to ensure that everyone is enrolled in some form of comprehensive coverage.” Larry Levitt of the nonpartisan Kaiser Family Foundation noted, ‘There are a host of difficult issues to address ... but the biggest by far is determining how much doctors, hospitals, and drug companies get paid. A public option has the potential to reduce prices and make [FN29] health care more affordable, but the further it goes in that direction, the bigger the blowback will be from the health care industry.“ Supreme Court Upholds Affordable Care Act The United States Supreme Court decided to uphold the Affordable Care Act against a challenge by several Republican states and the former Trump administration. The Supreme Court has upheld the ACA against challenges a total of three times. The justices ruled 7-2 that the challengers did not have legal standing to bring the case. The challengers argued that the ACA was not constitutional since the tax penalty under the law for failing to obtain health insurance coverage was eliminated. The justices indicated that the plaintiffs had not been injured by the provision of the law. 'Plaintiffs in this suit failed to show a concrete, particularized injury fairly traceable to the defendants' conduct in enforcing the specific statutory provision they attack as unconstitutional,' wrote Justice Stephen Breyer int the majority's decision. ‘They have failed to show that they have standing to attack as unconstitutional the Act's minimum essential coverage provision.’ Breyer continued that legal standing ‘requires identification of a remedy that will redress the individual plaintiffs' injuries ... No such remedy exists here.’ Ultimately, the justices dismissed the case. The Supreme Court upheld the constitutionality of the individual mandate in the 2012 case NFIB v. Sebelius in a 5-4 decision. The Supreme Court also upheld the law in 2015 over the question of the right of Americans purchasing health insurance coverage through the ACA exchanges to receive tax subsidies for those plans. That ruling was 6-3 in favor of the keeping the subsidies. In this latest case, Justices Brett Kavanaugh and Amy Coney Barrett joined the Chief Justice, as well as Justices Sonia Sotomayor, Elena Kagan, Thomas, and Breyer, in the majority opinion that kept the ACA intact. Justices Neil Gorsuch and Alito dissented. According to Katie Keith, JD, MPH, a research professor at Georgetown University's Center on Health Insurance Reforms, the court ‘resoundingly rejected” the challenge. 'They didn't think the lawsuit was strong enough to be in court in the first place because none of the plaintiffs -- neither the individuals nor the states -- are actually harmed by a penalty-less mandate,' Keith indicated. 'I think that it's becoming clearer and clearer that ... if anybody's going to change the Affordable Care Act, it's going to have to be Congress and not the Supreme Court,' Timothy Jost, JD, emeritus professor of law at Washington and Lee University in Lexington, Virginia, said. 'Eliminating the coverage, benefits and protections provided by this law would have thrown our health care system into chaos, and placed health care for millions of Americans in jeopardy. We are glad that the justices saw the need for the law to remain in place,' said George M. Abraham, MD, MPH, president of the American College of Physicians, in a press release. Abraham pointed to the over one million additional Americans who signed up for health coverage during the special enrollment period in the spring due to the COVID-19 pandemic. The American Rescue Plan included additional cost savings for enrollees in individual health plans. 'Our hope is that now that the ACA is firmly settled law, that we can continue to find ways to improve it and to improve our health care system.' Frederick Isasi, the executive director of the health advocacy non-profit Families USA, indicated, ‘Hundreds of millions of people with preexisting conditions can sleep soundly tonight, knowing their health care protections won't be ripped away.’ Considering the more conservative makeup of the current Supreme Court ruling against the challenge to the healthcare reform law, Isasi was hopeful that the court's ‘strong opinion will almost certainly foreclose other craven, ideological lawsuits.’ [FN30] 'The war on the ACA may finally be over,' he indicated. Funding Available to Increase Access to Insurance The Centers for Medicare & Medicaid Services (CMS) announced that $20 million in funding is available to help improve access to quality health insurance coverage for residents of states with State-based Marketplaces (SBMs). © 2022 Thomson Reuters. No claim to original U.S. Government Works. -19- The funding is available through the American Rescue Plan (ARP) to states to assist with modernizing and updating systems, programs, and technology for health insurance exchanges. States can use the funding to improve systems to comply with federal Marketplace requirements. States must make changes to marketplaces to accommodate the provisions of the American Rescue Plan (ARP) increasing financial assistance to some consumers. In the 2021 plan year so far, SBMs operating their own eligibility platforms enrolled over 3.8 million consumers in Marketplace coverage. Many of these consumers are eligible for increased savings that will reduce the cost of premiums. Consumers are also eligible for reduced deductibles and other out-of-pocket costs because of the ARP. States will need assistance with enrolling more consumers and recalculating current enrollees' eligibility for financial assistance. 'Our State-based Marketplaces are the gateway to quality, affordable health care for millions of consumers and these investments will make it even easier to sign up for coverage,” said CMS Administrator Chiquita Brooks-LaSure. ‘This funding available to states will help them to provide consumers with swift eligibility determinations and enrollment into comprehensive health care plans. We applaud State- based Marketplaces ? many of which have provided opportunities for special enrollment periods during the COVID-19 Public Health Emergency ? for their hard work.” The funding will provide up to 21 cooperative agreement grants to current SBMs meeting application requirements. SBMs using HealthCare.gov for eligibility and enrollment are also eligible for the funding. According to CMS, ‘States may also use the funds for program policies or procedures required for implementation of applicable federal requirements. This includes consumer notifications, consumer education or other assistance activities, stakeholder education or training, state and federal reporting, call center or appeal supports, staff training, and oversight and monitoring activities.” Applications for the funding are due on July 20, 2021. The agency expects to issue the grant awards in early September. The [FN31] performance period for the grant will run from the date of the award through September 9, 2022. ARP Allows Unemployed to Access Health Insurance Under the provisions of the American Rescue Plan (ARP), more people, including those receiving unemployment benefits, can qualify for health insurance coverage at a cost of as low as $1 a month in California. The state's health insurance exchange, Covered California, currently offers plans with low premiums, copays, and low or no deductibles. Approximately 207,000 California residents have coverage through Covered California. The ARP will allow more people to enroll. According to Covered California Executive Director Peter V. Lee, ‘Silver 94 plans' are the ‘best coverage’ available. Individuals receiving unemployment will not face eligibility requirements based on income. Lee stated that uninsured California residents and consumers enrolled in a different plan should explore the plans. He noted that hundreds of thousands of residents qualify for the plans and others will see reductions in their monthly premiums. Lee encouraged uninsured Californians and those currently enrolled in a different plan to ‘check your options,’ as hundreds of thousands of residents qualify while ‘others are seeing reductions of hundreds of dollars per month on the plan they've already chosen.“ [FN32] Oklahoma Expands Medicaid The Centers for Medicare & Medicaid Services (CMS) announced that Oklahoma expanded eligibility for Medicaid to individuals between the ages of 19-64. The expansion was possible under the Affordable Care Act (ACA). Approximately 190,000 people living in Oklahoma will become eligible for the program due to the eligibility expansion. The state started accepting applications on June 1, 2021. Over 120,000 people applied for coverage and were determined eligible. People who enrolled will receive coverage beginning on July 1. Full Medicaid benefits include access to primary and preventive care, emergency, substance abuse, and prescription drug benefits. The American Rescue Plan (ARP) made additional federal funding available for the Medicaid program for Oklahoma. The funding is estimated at almost $500 million over two years. Approximately 70,000 Oklahoma residents are now eligible for Medicaid coverage who have not yet applied. 'Today is a victory for the nearly 200,000 Oklahomans who have been waiting for health care,' said HHS Secretary Xavier Becerra. ‘I want to congratulate Oklahoma on joining the ranks of states that are bringing quality health coverage to our neighbors and families. I encourage the remaining 13 states to look at the opportunities included in the American Rescue Plan and join us, so that every person eligible can get covered.’ © 2022 Thomson Reuters. No claim to original U.S. Government Works. -20- ARP allocated additional funding to incentivize Medicaid expansion for states that had not yet chosen to expand eligibility for Medicaid. They will receive a five percent increase in their regular federal matching rate for many covered medical services for two years. States choosing expansion will also qualify for the 90% matching funds currently available under the ACA for states that already chose Medicaid expansion. Voters in Oklahoma chose to expand Medicaid in June of 2020. The state will join 37 states and the District of Columbia by expanding Medicaid eligibility. 'Medicaid is a lifeline for millions of people in this country and a step in the long road to achieving health equity by providing access to essential health care,' said CMS Administrator Chiquita Brooks-LaSure. ‘Oklahoma is now a model for other states looking to expand health coverage to those who need it most.’ Medicaid and the Children's Health Insurance Program (CHIP) are the largest source of health care coverage in the United States. The programs provide access to health insurance to over 80 million Americans. According to HHS, approximately 190,000 adults living in Oklahoma age 19-64 are eligible for Medicaid coverage. People at or below 133% of the federal poverty level in the state are now eligible for Medicaid. A family of four earning $35,245 or less is eligible for health [FN33] care coverage under Medicaid expansion. Report: Many Older Americans Lost Insurance Coverage During Pandemic According to a study from AARP, a significant number of older working Americans lost jobs, and consequently, lost health insurance coverage during the COVID-19 pandemic. The AARP Public Policy Institute commissioned the study based on research from Avalere Health. The report showed insurance coverage loss among 50 to 64-year-olds throughout 2020. Researchers also pointed to potential changes through December 2022. They found that a significant number of this age group lost health insurance coverage during the first months of the pandemic. These workers either remained without coverage or moved to individual plans through the Affordable Care Act (ACA) exchanges or public health insurance coverage through Medicaid. Older workers experienced a significant increase in unemployment, but not as significant as younger workers experienced during the first year of the pandemic. 'The unemployment rate among adults ages 50 to 64 jumped significantly in the initial phase of the pandemic, from 2.5% in February 2020 to a high of 12.5 percent in April 2020, according to the Bureau of Labor Statistics,” researchers noted. ‘During that two-month period, 4.2 million older adults lost their jobs.” Researchers found that the impact of loss of employment might be greater in the older age group because many workers decided to retire during the pandemic. Workers choosing to retire are not included in unemployment statistics. 'The unemployment rate among adults ages 50 to 64 has been gradually improving after its peak in April 2020. However, older-adult unemployment remained at 4.8% as of March 2021, a rate still nearly double pre-pandemic levels,” researchers stated. ‘The economic impact of the pandemic will likely be felt for some time, with Avalere estimating the unemployment rate among adults ages 50 to 64 could be as high as 4.9 percent by the end of 2022.” Most older workers receive health insurance coverage through employers. Loss of employment led to several options for these workers: going without coverage, purchasing a plan through the ACA exchanges, or applying for coverage through Medicaid. Most older workers in states that have not expanded Medicaid eligibility did not qualify for coverage under the program. Researchers noted that the individual insurance market, mostly through the ACA marketplace, was a significant source of access to coverage for older workers. Enrollment in these plans was declining for older workers prior to the pandemic. After the pandemic, more older workers began enrolling in these plans. 'Between March and August 2020, the number of adults ages 50 to 64 enrolled in the nongroup market grew by an estimated 210,000 people,” researchers indicated. 'Much of this group likely lost employer coverage and enrolled in ACA Marketplace coverage through a special enrollment period (SEP) that allows people to enroll outside of the usual open enrollment period.” A significant increase in Medicaid enrollment for older Americans also occurred during the pandemic. Between March and August 2020, about 460,000 older adults enrolled in Medicaid. That number is over twice the number of older adults purchasing new individual health insurance plans during that period. 'Avalere predicts that Medicaid enrollment, which has stayed fairly steady since August 2020, will continue to remain elevated, with between 230,000 and 320,000 more expected to be enrolled by December 2022 than would have been expected without the pandemic,” researchers stated. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -21- Researchers found that up to 140,000 more older Americans will be uninsured by December 2022 due to the COVID-19 pandemic. [FN34] HHS Announces Rule to Prevent Surprise Billing The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, announced an interim final rule aimed at preventing surprise billing for medical care. The rule, ‘Requirements Related to Surprise Billing; Part I,” will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing occurs when people unknowingly receive treatment from providers that are outside of their insurer's network for emergency and non-emergency care. The insurer covers a portion of the bill for out-of-network care, but the provider often balance bills the patient for the remaining charges. Currently, Medicare and Medicaid prohibit balance billing. The new rule will extend these protections to Americans with employer-sponsored and individual health plans. 'No patient should forgo care for fear of surprise billing,” said HHS Secretary Becerra. ‘Health insurance should offer patients peace of mind that they won't be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises.” The interim final rule bans surprise billing for emergency services, regardless of where they are provided. It also bans high out-of- network cost-sharing for both emergency and non-emergency services. Cost-sharing will be limited to the amount of cost-sharing for an in-network provider. The rule prohibits out-of-network charges for care provided at an in-network facility for ancillary care in all circumstances. It also bans [FN35] other out-of-network charges without advance notice. Proposed Actions Address Health Care Inequities The Centers for Medicare & Medicaid Services (CMS) is proposing actions to address health care inequities in the United States. The actions aim to give consumers information needed for fully informed decisions about health care, improve emergency care access in rural areas, and use lessons from the COVID-19 pandemic to improve care in the future. CMS is proposing these actions in response to President Biden's Competition Executive Order to move toward price transparency, hold hospitals accountable, and give consumers important information regarding health care. 'As President Biden made clear in his executive order promoting competition, a key to price fairness is price transparency,” said HHS Secretary Xavier Becerra. ‘No medical entity should be able to throttle competition at the expense of patients. I have fought anti- competitive practices before, and strongly believe health care must be in reach for everyone. With today's proposed rule, we are simply showing hospitals through stiffer penalties: concealing the costs of services and procedures will not be tolerated by this Administration.” 'CMS is committed to addressing significant and persistent inequities in health outcomes in the United States and today's proposed rule helps us achieve that by improving data collection to better measure and analyze disparities across programs and policies,” said CMS Administrator Chiquita Brooks-LaSure. ‘We are committed to finding opportunities to meet the health needs of patients and consumers where they are, whether it's by expanding access to onsite care in their communities, ensuring they have access to clear information about health care costs, or enhancing patient safety.” The proposed rule spans the following areas: Price Transparency According to CMS, ‘Hospital price transparency helps Americans know what a hospital charges for the items and services they provide. CMS takes seriously concerns it has heard from consumers that hospitals are not making clear, accessible pricing information available online, as they have been required to do since January 1, 2021.” The proposed rule would increase the penalty for hospitals that do not comply with Hospital Price Transparency final rule. A minimum civil monetary penalty of $300/day would apply to smaller hospitals with a bed count of 30 or fewer. Larger hospitals would face additional fines of $10/bed/day up to daily fines of $5,500. CMS indicated, ‘Based on information that hospitals have made public this year, there is wide variation in prices ? even within the same hospital or the same system, depending on what each insurance plan has negotiated with that hospital. CMS is committed to ensuring consumers have the information they need to make fully informed decisions regarding their health care, since health care prices can cause significant financial burdens for consumers.” Health Equity CMS asked for input on ways to make reporting of health disparities based on social risk factors, race, and ethnicity more comprehensive and actionable. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -22- The agency would like comments on potential collection of data, and analysis and reporting of quality measure results by a variety of demographic data points including, but not limited to, race, Medicare/Medicaid dual eligible status, disability status, LGBTQ+, and socioeconomic status. Access to Emergency Care in Rural Areas CMS noted that 138 rural hospitals have closed since 2010. The closures have especially affected communities with a higher population of people of color and communities with higher poverty rates. People living in these areas have shorter life expectancies, higher mortality, and have fewer local health care providers, resulting in poorer health outcomes in rural areas. CMS indicated, ‘Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care. To address these concerns, Congress enacted Section 125 of the Consolidated Appropriations Act of 2021 (CAA), which establishes a new provider type for Rural Emergency Hospitals (REHs). REHs will be required to furnish emergency department services and observation care and may provide other outpatient medical and health services as specified by the Secretary through rulemaking. In this proposed rule, CMS is requesting information to inform the development of requirements that would apply to Rural Emergency Hospitals (REHs). This new provider designation will apply to items and services furnished on or after January 1, 2023.” The agency solicited feedback on issues relating to access to healthcare in rural areas, including the potential services to be provided by REHs; health and safety standards and quality measures to be established for REHs; and payment provisions for this provider type. COVID-19 Lessons The agency also asked for comment on the extent to which hospitals are using flexibilities offered during the COVId-19 pandemic to provide mental health services remotely. The agency is considering making information about vaccination status of healthcare workers available to the public to consumers know how many workers in a health care setting are vaccinated against COVID-19. [FN36] CMS solicited comments on improving patient experiences and outcomes and improving patient safety. California to Expand Medi-Cal Eligibility for Medicare Recipients The California legislature recently approved a new state budget, including a measure that will help people enrolled in both Medi-Cal and Medicare stay covered based solely on income. The provision will eliminate that asset test for California residents enrolled in both Medi-Cal and Medicare. Financial eligibility for the program will be based only on income for people on Medicare, like it already is for other people covered through Medi-Cal. The change will allow aging or disabled California residents who need long-term care to receive nursing care through Medi-Cal without having to spend their savings on nursing care first. The budget agreement includes other provisions that facilitate enrollment in Medi-Cal in addition to the elimination of the asset test. Eligibility extends to people 50 and over regardless of immigration status. New mothers are eligible for Medi-Cal for one year after giving birth. In California, 95% of eligible people are enrolled in Medi-Cal. According to Laurel Lucia, director of the health care program at the Center for Labor Research and Education at the University of California-Berkeley, approximately 610,000 people in the state are eligible for the program but not enrolled. 'We are doing well, but so many people are eligible and not enrolled,” Lucia said. ‘The barriers to Medi-Cal enrollment and retention are really multifaceted, so the solutions have to be as well.” The program currently covers 13.6 million people in California. Enrollment is increasing, expected to reach 14.5 during this fiscal year. New eligibility extended to unauthorized immigrants over age 50 is expected to lead to 175,000 new enrollments in the first year. Additional 3,600 people are expected to enroll every year thereafter. The cost to the state is estimated at $1.3 billion annually. Additional coverage for new mothers is expected to cost the state approximately $200 million per year. The elimination of the asset test for eligibility of older California residents will take effect on July 1, 2022. It will significantly change the program, costing approximately $200 million per year once fully implemented. Under the federal Affordable Care Act, most Medicaid enrollees are not subject to the asset test—eligibility is based only on income. However, people who qualify for both Medicaid and Medicare were excluded. According to Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, nursing homes in California can cost $10,000 per month. Prior to the upcoming changes in California, older people had to spend through their savings and assets before becoming eligible for Medi-Cal. 'Thousands and thousands of people have become impoverished to afford nursing home care,” McGinnis said. ‘You want free medical [FN37] care? You're going to have to spend every penny you have to get it.“ Consumers Save on Premiums, Out-of-Pocket Costs, Under American Rescue Plan © 2022 Thomson Reuters. No claim to original U.S. Government Works. -23- The Centers for Medicare & Medicaid Services (CMS) released new data indicating that returning consumers purchasing health insurance through the state or federal health insurance exchanges can save an average of 40% off the cost of monthly premiums due to the enhanced tax credits under the American Rescue Plan (ARP). President Biden has proposed to extend these savings under part of his Build Back Better Agenda. The new tax credits began on April 1, 2021. Since then, 34% of new and returning health care consumers have purchased coverage for $10 or less per month through HealthCare.gov, the federal exchange. CMS also released a state-by-state breakdown of savings. The Biden-Harris Administration encouraged Americans to take advantage of the remaining Special Enrollment Period (SEP) to sign up for health insurance coverage. The SEP ended August 15. CMS also noted that consumers who received or are approved to receive unemployment compensation for any week beginning in 2021 might be eligible to even greater savings on premiums and out-of-pocket costs for health insurance plans through HealthCare.gov under the ARP. 'Health coverage is more affordable than ever for new and returning Americans at HealthCare.gov,” said HHS Secretary Xavier Becerra. ‘We encourage everyone to take advantage of this opportunity to get the peace of mind that health insurance offers. If you are in need of coverage or you have a friend or family member who is, please sign up today and encourage others to do the same.” The SEP began on February 15. Since that time, over 1.5 million people have enrolled in health insurance coverage through HealthCare.gov. Over 2.5 million current enrollees have returned to the exchange to enroll in plans with additional savings of an average of over $40 per month. 'Americans who need health coverage should act now. This is your opportunity to find quality, affordable health coverage that will protect you and the health of your family into the future. Please go to HealthCare.gov to enroll in a comprehensive plan that is affordable,” said CMS Administrator Chiquita Brooks-LaSure. ‘Visit HealthCare.gov to sign up today or call us 24/7 at 1-800-318-2596 if you need more help.” Applications for enrollment during the SEP were available online and over the phone. Local agents and brokers can also enroll [FN38] consumers in plans available through the federal and state exchanges. Public Option Health Insurance Legislation Reintroduced U.S. Senators Ben Ray Luj?n (D-N.M.) and Brian Schatz (D-Hawai“i) brought back bicameral legislation that would create a public option for health insurance that would work alongside the Affordable Care Act. The public option legislation would create a public health insurance option based on Medicaid. The option would be high-quality, low-cost public health insurance available for purchase through the health insurance exchanges alongside plans offered by private health insurance companies. 'Health care is a human right. For communities to thrive, Americans need quality, affordable health care,” said Senator Luj?n. ‘A state public option puts us one step closer to universal coverage for all Americans, and I'm honored to re-introduce this legislation alongside Senator Schatz to bolster our health care system.” 'Our bill will open up each state's Medicaid program to anyone who wants it, giving people a high-quality, low-cost public health insurance option,” said Senator Schatz. ‘Our ultimate goal here is to make sure that every single American has comprehensive health care coverage.” Under the State Public Option Act, states could create Medicaid buy-in programs for all state residents regardless of income. All residents would be able to purchase the state-driven Medicaid health insurance plan. Eighteen states are currently considering implementing a public option through their legislatures. Medicaid is cost-effective and includes a large provider network. It has positive ratings equal to the ratings of private health insurance and costs significantly less. States and the federal government work together through Medicaid to allow states flexibility to adapt services and models of care. Currently, over 30 million people lack health insurance in the United States. Public option legislation would make health insurance more affordable to people who cannot access health insurance coverage through employers and make too much to receive tax subsidies for coverage purchased under the ACA. The legislation would also widen options for people who live in counties with limited choice in insurance carriers. Co-sponsors of the bill in the Senate include U.S. Senators Jeanne Shaheen (D-N.H.), Elizabeth Warren (D-Mass.), Amy Klobuchar (D-Minn.), Jeff Merkley (D-Ore.), Martin Heinrich (D-N.M.), Jack Reed (D-R.I.), Tina Smith (D-Minn.), Jacky Rosen (D-Nev.), Mazie K. Hirono (D-Hawai“i), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Ed Markey (D-Mass.), Kirsten Gillibrand (D-N.Y.), Patrick Leahy (D-Vt.), Dick Durbin (D-Ill.), Chris Murphy (D-Conn.), and Sheldon Whitehouse (D-R.I.). © 2022 Thomson Reuters. No claim to original U.S. Government Works. -24- Companion legislation introduced in the House has received support from U.S. Representative Kim Schrier (D-Wash.), Evans (D- Penn.), Ruben Gallego (D-Ariz.), Betty McCollum (D-Minn.), Eric Swalwell (D-Calif.), Peter Welch (D-Vt.), Steve Cohen (D-Tenn.), Paul Tonko (D-N.Y.), Mike Doyle (D-Penn.), Eleanor Holmes Norton (D-D.C.), Doris Matsui (D-Calif.), Ilhan Omar (D-Minn.), Gwen Moore [FN39] (D-Wis.), Dean Phillips (D-Minn.), and Pete Aguilar (D-Calif.). New York Announces Rate Increases for Insurance Plans The New York State Department of Financial Services announced 2022 health insurance premium rates, indicating that it decreased many of the rate increases requested by insurers. The agency reduced the requested rate increases by nearly half for the small group market in the state. The small group market includes coverage for employers who have up to 100 employees. Insurance companies requested rate increases of an average of 14%. The state agency allowed a 7.6% increase. The larger increase would have cost New York small employers an additional $468 million. Insurance companies sought an 11.2% increase in premiums for the individual market. The agency held those increases back to 3.7%. The larger increase would have cost consumers over $138 million. Insurance companies with a significant market in the Rochester area asked for increases in the small group market. Excellus Blue Cross Blue Shield requested a 9.7% rate increase for 2022 plans. The agency limited the increased price to 8.7%. Excellus requested a 6.2% increase in the individual market. The state decreased the request to a 4.5 % increase in prices. MVP Health Plan requested a 7.9% increase in the small group market. The agency ultimately approved a 5.7% increase. MVP requested a 16.9% increase in the individual market. The agency cut that requested increase in half, allowing an 8.5% increase. According to the Dept. of Financial Services, in prior years, the increase in health care costs drove the increase in premium rates. Due to the COVID-19 pandemic, medical claims decreased in 2020 because of the postponement of elective and non-emergency services. In 2021, medical claims increased as more people caught up on medical appointments and elective surgeries. The breakdown of medical costs is as follows: drug costs, (38.7%) followed by inpatient hospital costs, (17.3%) primary care, (8.1%) [FN40] outpatient hospital costs (7.9%) and radiology (5.7%). Insurance Coverage Remained Steady in 2020 According to data released by the Census Bureau, the number of people who were uninsured and the uninsured rate remained steady in 2020. In the face of job and income losses during 2020 due to the COVID-19 pandemic, experts were concerned that loss of insurance coverage would be high. According to the data from the Census Bureau's Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC), the rate of uninsured people in the United States actually held steady during 2020. Researchers looked at the data and compared it to the trends in health coverage prior to and during the pandemic. They found that 27.4 million nonelderly peopled lacked health insurance coverage in 2020 in the United States. The uninsured rate was 10.2%. This rate was the same as the uninsured rate in 2018 but was higher than the rate of people without insurance in 2016, 9.1%. The number of people lacking health insurance in 2020 was over 2.5 million more than the number uninsured in 2016. Following the implementation of the Affordable Care Act in 2010, health insurance coverage rates began to increase. In recent years, that trend reversed. In 2014, the major coverage provisions in the ACA went into effect, causing the rate of uninsured people to decrease significantly. It continued to decrease through 2016. The data for uninsured people in 2020 was largely similar to the data in 2018: 58.7% of the nonelderly population was covered by employer-sponsored insurance, 6.4% purchased non-group coverage, 20.2% had Medicaid, and 4.5% had Medicare or military coverage in 2020. The uninsured rate among nonelderly non-Hispanic Black people increased from 10.5% in 2018 to 11.7% in 2020. The rate for Asian people decreased from 7.7% in 2018 to 6.4% in 2020. People with fulltime year-round jobs in 2020 were less likely to become uninsured. The rate of uninsured people among people working parttime was 14.6% in 2018 and 16.4% in 2020. Approximately 8.4% of fulltime workers lacked health insurance coverage in 2020, which was 1.1% less than fulltime workers in 2018. Most uninsured people in 2020 were adults. Among children, 5.6% lacked insurance in 2020 while 11.9% of adults lacked coverage. Researchers credited the broader availability of Medicaid and CHIP coverage for children. People earning less than 200% of the Federal Poverty Level (FPL) were most likely to be uninsured in 2020. Over eight in ten uninsured people were in families earning below 400% of FPL. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -25- People of color made up a disproportionate share of uninsured people in the United States in 2020. People of color are 43.6% of the nonelderly population but were 62.8% of the uninsured population. The largest share of the uninsured were Hispanic people at 40.1%. Non-Hispanic White people made up 37.2% of uninsured people. Hispanic, Black, and American Indian or Alaska Native people were all more likely to be uninsured than White people. Researchers noted, ‘Despite a public health crisis that caused significant economic turmoil, the CPS data indicate that health coverage during 2020 was relatively stable compared to before the pandemic. According to the data, the uninsured rate did not increase, and the share of people with private coverage through an employer and purchased directly in the individual market as well as those with Medicaid coverage did not change compared to 2018. While coverage overall was steady, certain groups experienced a greater risk of becoming uninsured in 2020, including nonelderly Black individuals and nonelderly adults who worked less than full-time.” Researchers found that the data was consistent with prior analyses of health coverage changes showing that job losses in 2020 were higher than declines in employer-sponsored health insurance coverage. Lower income workers were more likely to lose jobs during 2020. These jobs often do not include health insurance coverage. Many people losing jobs in 2020 were already insured or had coverage through a government sponsored program like Medicaid or the ACA Marketplace. Some people who lost jobs were put on temporary furlough with continued employer sponsored health insurance coverage during that time. Recent changes to the Marketplace coverage, including increased subsidies under the American Rescue Plan Act, occurred in 2021 and did not affect 2020 insurance rates. The data is less consistent with administrative data showing significant increases in Medicaid enrollment during the COVID-19 pandemic. Medicaid enrollment decreased in 2019 but increased by almost 15% since the beginning of the pandemic. Beginning in 2018, average monthly enrollment in Medicaid increased by 4%, as shown by the administrative data. CPS did not show this increase. Under the Families First Coronavirus Response Act (FFCRA), states must ensure continuous coverage for people enrolled in Medicaid beginning March 18, 2020 in order to qualify for enhanced federal funding during the pandemic. The data captured by the CPS does not account for people who were uninsured for part of the year. Analyses of monthly data on health coverage from the CPS ASEC indicated that a higher rate of adults lacked health insurance during part of 2020 than they did in 2018. A prior analysis also showed that the March 2021 coverage uninsured rate was higher than the rate for 2020. Researchers indicated that the loss of coverage was likely due to the pandemic. [FN41] According to researchers, continuing economic challenges due to the pandemic could lead to more coverage disruptions. New State Tax to Lower Premiums in New Mexico Insurance regulators in New Mexico announced that health insurance coverage will become significantly less expensive for consumers through the state's health insurance exchange due to federal pandemic relief, more people in the state signing up for coverage, and funding from a new state tax. Legislators approved a tax increase on a range of health insurance premiums. The tax will take effect on Jan 1, 2022. Funds will be used to assist in underwriting plans available through the health insurance exchange for low- and moderate-income individuals and employees of small businesses. The savings will be available in 2023. Due to federal pandemic relief, the cost of the average premium through the New Mexico exchange decreased from $195 to $139 in 2021. A large advertising campaign educated the public about the availability of these plans during a special enrollment period that closed on Aug. 15. State health exchange CEO Jeffrey Bustamante and state insurance Superintendent Russell Toal spoke with legislators about the changes in the financial realm of medical care. Legislators from both parties were concerned that the 2.75% tax increase on insurance policies would be passed on to businesses and consumers. However, insurance officials were confident that most of the cost of the new tax would go to managed care organizations providing Medicaid insurance. State House Majority Floor Leader Javier Mart?nez of Albuquerque supported the new tax, arguing that it will help prevent the treatment of the poor though expensive emergency rooms. 'This isn't to punish those of us with health insurance,” Martinez indicated. ‘This is to ensure that those that don't have access can access health care. — This is one of those rare moments when this Legislature has actually taken a leap of faith, a very well-informed and data-driven leap of faith.” © 2022 Thomson Reuters. No claim to original U.S. Government Works. -26- In New Mexico, approximately 214,000 out of 2.1 million residents lack health insurance coverage. Half of the uninsured people qualify for coverage under Medicaid or through subsidized insurance plans available on the state's health insurance exchange, according to Toal. Approximately 60,000 people in New Mexico are expected to leave Medicaid coverage next year when the federal pandemic provisions [FN42] end. Nearly 275,000 Eligible to Access Coverage Through Missouri Medicaid Expansion The Centers for Medicare & Medicaid Services (CMS) announced that about 275,000 Missouri residents had become eligible for health insurance coverage through the expansion of Medicaid in the state. The Affordable Care Act allowed states to choose to expand eligibility for the Medicaid program. Under the American Rescue Plan (ARP), Missouri will receive a projected $968 million in additional federal funding over the next two years for its Medicaid program. Some people in Missouri are eligible for the first time for free or low-cost health coverage. Single adults making up to $17,774 per year or a family of 4 with a yearly income up to $36,750 per year are now eligible for Medicaid coverage through MO HealthNet. Parents in those income levels who have not qualified prior to the expansion as well as adults without children are newly eligible. 'Hundreds of thousands of Missourians can now gain the peace of mind of having health coverage through Medicaid,” said Health and Human Services Secretary Xavier Becerra. ‘This is a win for all Missourians who have fought long and hard to gain their rightful access to quality health insurance made possible through the Affordable Care Act. As we celebrate Missouri's Medicaid expansion, the Biden-Harris Administration will double down on our outreach efforts to urge the remaining twelve states to join the rest of the nation in ensuring access to health care during this critical time.” The Missouri Medicaid program, MO HealthNet, began accepting applications for people newly eligible under Medicaid expansion in August 2021. They have received over 17,000 applications. The Biden-Harris Administration encouraged the 275,000 newly eligible Missouri residents to apply for coverage. Enrollment includes full Medicaid benefits covering primary and preventive care, emergency care, substance use disorder treatment, and prescription drug benefits. 'Medicaid in Missouri has expanded, and I encourage eligible Missourians to apply,” said CMS Administrator Chiquita Brooks-LaSure. ‘Thanks to the Affordable Care Act, eligible Missourians can now sign up for the health care they need. MO HealthNet's expansion will put comprehensive health coverage within reach for more than 275,000 additional Missourians. We will continue to encourage remaining states to extend the lifeline of Medicaid coverage to all who need it.” States that expand eligibility for Medicaid coverage are eligible for increased federal funding under the American Rescue Plan. The states receive a five percent increase in their regular federal matching rate for two years for many services. The increase is in addition to the 90 percent federal matching funding in place prior to the ARP. Currently 38 states and the District of Columbia have expanded health insurance coverage through Medicaid. Almost 4 million people in the remaining 12 states could gain access to Medicaid coverage if those states agreed to expand eligibility. Medicaid, along with the Children's Health Insurance Program (CHIP), are the largest source of health insurance coverage in the United [FN43] States. The programs provide access to health insurance to over 80 million people in the United States. Employers Charge Unvaccinated More for Health Insurance Among employers choosing to charge employees more for health insurance coverage if they or their close family members choose to remain unvaccinated for COVID-19 are Louisiana's largest nonprofit health care provider and Delta Airlines. Ochsner Health indicated in a letter to its employees that it will increase health insurance fees next year if their spouses or domestic partners are unvaccinated. The extra charge of around $200 per month will begin next year for employees whose covered spouses and domestic partners remain unvaccinated. According to the letter, the decision was made to ‘protect our entire Ochsner team, which includes employees, their families and the communities we serve.” Warner Thomas, the CEO and president of the company indicated that spouses and domestic partners would be permitted to file for exemptions to the policy for legitimate medical or religious reasons. Thomas insisted that the policy was not a vaccine mandate because spouses and domestic partners were free to seek health insurance coverage elsewhere. He also indicated, ‘The reality is the cost of treating COVID-19, particularly for patients requiring intensive inpatient care, is expensive.” © 2022 Thomson Reuters. No claim to original U.S. Government Works. -27- According to Thomas, approximately 90% of the COVID patients the company has treated since December were unvaccinated. Ochsner announced in August that it would impose a vaccine mandate on its employees, effect by the end of October. Approximately 70% of Ochsner employees had been vaccinated at the time of the announcement. Delta Air Lines also announced a similar policy in August, indicating that it would charge employees an extra $200 per month for health [FN44] insurance coverage. The Kaiser Family Foundation recently published as study showing that hospitalizations of unvaccinated COVID-19 patients cost the United States healthcare system billions of dollars. Researchers noted that COVID-19 vaccines have been free and widely available to adults throughout the United States since April 2021. They also noted that the vaccines are highly effective at preventing severe disease, hospitalization, and death from COVID-19. Vaccination rates have slowed, especially in some areas of the country and among some age groups (younger people). Due to the unvaccinated and the highly infectious delta variant, cases, hospitalizations, and deaths have risen. Researchers indicated, ‘The hospitalizations are also costing taxpayer-funded public insurance programs and the workers and businesses paying health insurance premiums. Our recent analysis found that insurers are beginning to reinstate cost-sharing for COVID-19 treatment, though patients still only pay a small share of the total costs.” Researchers could not gather real-time data on the cost of all COVID-19 hospitalizations but estimated through various sources an average cost of $20,000 per COVID-19 hospitalization. According to the Centers for Medicare and Medicaid Services (CMS), Medicare fee-for-service COVID-19 hospitalizations average $24,033. Another study of those fees showed an average cost of $21,752. An analysis of pre-pandemic private insurance claims for pneumonia hospitalizations with complications showed an average cost of $20,292. Costs for hospitalization requiring a ventilator are significantly higher. Researchers counted 32,000 preventable COVID-19 hospitalizations in June, 68,000 in July, and 187,000 in August. The total preventable COVID-19 hospitalizations for three months was approximately 287,000. At a cost of $20,000 each, those preventable COVID-19 hospitalizations of the unvaccinated have already cost the United States healthcare system billions of dollars since June. Estimated costs from June through August 2021 for preventable COVID-19 hospitalizations was $5.7 billion. Researchers focused on adult hospitalizations of people with confirmed COVID-19 in recent months reported to HHS, since many children are still ineligible for the COVID-19 vaccines. The costs are based on a conservative estimate of the total cost of preventable hospitalizations of unvaccinated people. Researchers estimated that 98.6% of people hospitalized with a COVID-19 diagnosis between June and August 2021 were unvaccinated. Even though the number of vaccinated people hospitalized with COVID-19 increased in August, the number of [FN45] hospitalized unvaccinated people with COVID-19 increased at roughly the same rate, so the percentages remained the same. New Bill: Enrollment in Health Insurance through Tax Returns New legislation aimed at simplifying health care enrollment for Americans would give people the opportunity to enroll in health insurance through their federal income tax returns. The Easy Enrollment in Health Care Act was introduced by U.S. Senator Chris Van Hollen (D-Md.) and Congressman Ami Bera, M.D. (D-Calif.). According to Van Hollen, the legislation ‘will streamline health care enrollment for uninsured families and help close the massive gap in eligible but uninsured Americans.” It is modeled from a successful program in Maryland. It would give Americans information about health insurance through their federal income tax returns and allow them to enroll in plans. 'The idea behind this bill is simple but powerful: millions of Americans who already qualify for free or very low-cost health coverage don't receive it because they are not enrolled in plans for which they are eligible. Closing this gap and getting more people enrolled in plans they already qualify for is key to providing better care to families and our communities. That's why I'm introducing this legislation to make it easier for Americans to sign up for existing health plans and to boost enrollment. This bill is based off of the success we've seen in Maryland and would help expand on and extend this success both in our state and nationwide. I'll be looking for every opportunity to pass this common-sense proposal to ensure more Americans are able to access the quality health care plans they are already eligible to participate in,” said Senator Van Hollen. 'As a doctor and former Chief Medical Officer for Sacramento County, I know that health care is extremely personal and oftentimes very stressful to navigate,” said Representative Ami Bera, M.D. ‘That why it's critical that we cut burdensome red-tape to make it easier for Americans to sign-up for health care coverage. I am proud to join Senator Van Hollen in introducing the Easy Enrollment in Health Care © 2022 Thomson Reuters. No claim to original U.S. Government Works. -28- Act, legislation that would help millions of uninsured Americans automatically enroll in affordable health insurance at the same time they file their federal tax returns.’ Almost two out of every three uninsured Americans are eligible for government-subsidized health insurance through Medicaid, CHIP, and Advanced Premium Tax Credits. The total is over 18 million people. Thirteen million of those people are eligible for health insurance coverage at no cost. The enrollment gap particularly affects people of color. Almost two of 3 uninsured children who qualify for Medicaid or Chip are Black, Latino, Indigenous, or other children of color. Four out of every five uninsured citizens and lawfully present immigrants filed federal income tax returns. Over half (64%) had incomes below 150% of FPL. The legislation would allow Americans to check a box on their federal income tax returns that would connect them with health care programs available where they live. The IRS would then be authorized to send data they have on file to the state health care marketplace exchange. The individual would receive a formal letter including a menu of options. The person could choose to opt into the health insurance program that they are eligible for, or they could remain uninsured. The program would include a 60-day special enrollment window to select coverage. People eligible for a plan that has a free premium who do not make a selection would be automatically enrolled in the plan that has the highest coverage with no premiums. The program created by this legislation could potentially reach millions of Americans without health insurance who do not know they are eligible to receive free health care. In 2017, 40% of uninsured Americans were unaware of the health insurance marketplaces despite public education campaigns and four open enrollment periods. According to Van Hollen, ‘By checking the box, these same families could see whether they qualify for free or low-cost health care and then enroll. This legislation brings health care information directly to people who need it most ? and makes it easier than ever to sign up for a plan with zero premiums.” The legislation has received support from: Families USA, Protect Our Care, Third Way, Blue Cross Blue Shield Association, First Focus, Alliance of Community Health Plans, American Academy of Pediatrics, American Cancer Society Action Network, American Heart Association, and Centene. 'Senator Van Hollen's game-changing legislation takes the best ideas from states like Maryland and health policy experts across the political spectrum to finally tackle America's enrollment gap in a significant manner. The enrollment gap is a huge, persistent problem that contributes to inequity in health care. Tens of millions of people ? disproportionately from working-class families and communities of color ? qualify for health coverage but still remain uninsured. Under his proposal, uninsured taxpayers who are unaware even that health insurance marketplaces exist would learn about their eligibility for assistance and be enrolled in coverage automatically ? simply by checking a consent box on their tax return. Families USA looks forward to working with the Senator and his colleagues in Congress to make this critical bill a reality so families can get the best health and health care they need and deserve,” said Frederick Isasi, Executive Director, Families USA. 'First Focus is pleased to support the introduction of the Easy Enrollment in Health Care Act because it will help uninsured, working parents quickly and easily determine if they and their children qualify for coverage under their state's health insurance exchange. This common sense approach which ties tax filing and health coverage determinations together has shown to be effective in the state of Maryland so we support expanding it to uninsured, working poor families across the country,” said Bruce Lesley, President of First Focus. 'Ensuring access to affordable, quality health care, regardless of race, gender, age or ethnicity, is essential to prevent and treat cardiovascular diseases. The American Heart Association is pleased to support the Easy Enrollment in Health Care Act and appreciates Sen. Van Hollen's efforts to ease the process of enrollment for the uninsured,” said Mark Schoeberl, Executive Vice President, Advocacy, American Heart Association. 'The Affordable Care Act is more popular than ever, but millions of people still don't know they are eligible for quality, affordable coverage under the law. Senator Van Hollen is bringing a commonsense approach to streamline health care enrollment for uninsured families that had overwhelming success in Maryland to the rest of the country. We must work to close the enrollment gap to build on the [FN46] ACA and ensure every American has access to health care,” said Anne Shoup, Communications Director, Protect our Care. California First State to Allow Parents to Join Children's Private Health Insurance Plans California became the first state to allow some parents to join their adult children's private health insurance plans as dependents. Advocates were in favor of the development, hoping that it will help to cover some of the people in the state whose immigration status prevents them from qualifying for other assistance programs. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -29- Since the implementation of the Affordable Care Act, children have been permitted to stay on their parents' health insurance plans until at least age 26. Some states, including Florida, Illinois, Pennsylvania and New Jersey, have allowed children to stay on their parents' plans until at least age 30. Gov. Gavin Newsom (Democrat) signed the law in California allowing dependent parents to join their children's plans. It will take effect in 2023. 'The signing of the Parent Healthcare Act will help more families care for their parents the way they cared for us,” Insurance Commissioner Ricardo Lara indicated. Adults must rely on their children for at least 50% of their total support to be eligible for the program. The law applies only to plans available through the individual market only. Employer-sponsored plans are not eligible. Most people in the state receive health insurance coverage through their employers. A prior version of the bill would have applied to more people and could have increased employer premiums between $200 million and $800 million per year, depending on enrollment. Business groups, including the California Chamber of Commerce, opposed the bill if it applied to employer-sponsored insurance. The California Department of Insurance estimates that 15,000 adults will utilize the new law. An annual increase of between $12 million and $48 million per year for individual premiums will result, reported the Senate Appropriations Committee. The Chamber of commerce removed its opposition to the bill once it was significantly reduced in scope. Democratic Assemblyman Miguel Santiago of Los Angeles wrote the bill. He indicated that it focuses on people who are not eligible for [FN47] subsidized health insurance due to living in the country illegally. Access to Medicaid and ACA Health Insurance Helped to Prevent Coverage Losses The U.S. Department of Health and Human Services (HHS) released a new report showing that access to Medicaid and health insurance plans available through the Affordable Care Act federal Marketplace helped to prevent major coverage losses in 2020 and 2021. The COVID-19 pandemic created downward economic pressures expected to affect access to health insurance. According to HHS, efforts taken by the Biden-Harris Administration, including expanding the 2021 Special Enrollment Period, helped to lessen the impact of the pandemic on health insurance coverage. 'The COVID-19 pandemic has disrupted our lives in many ways, yet today's report shows we made significant strides to protect Americans' health,” said HHS Secretary Xavier Becerra. ‘Thanks to the Biden-Harris Administration's efforts to secure access to critical health care, over 2.8 million Americans gained coverage during the Special Enrollment Period. We will double down on these gains by launching Open Enrollment season on Monday with the most affordable health coverage options to date.” 'Thanks to the American Rescue Plan, health care coverage is more affordable and accessible than ever. This Open Enrollment, consumers will have access to more affordable plan options, with more help, for an even longer period of time,” said Centers for Medicare & Medicaid (CMS) Administrator Chiquita Brooks-LaSure. ‘I urge individuals and families in need to sign up today at HealthCare.gov for comprehensive, affordable health care coverage for themselves and their loved ones.” Researchers at HHS' Office of the Assistant Secretary for Planning and Evaluation (ASPE) conducted the report. The ASPE report analyzed Medicaid and Marketplace enrollment data between 2020 and 2021. Researchers used this data to explore why the uninsured rate in the United States remained steady despite the pandemic. Researchers found that increases in enrollment in Medicaid and in insurance plans available through the ACA Marketplace assisted in offsetting the decreases in employer sponsored coverage due to the economic downturn. Medicaid enrolled about 10 million people during the pandemic. During the 2021 Special Enrollment Period, an additional 2.8 million people enrolled in coverage. These enrollments assisted in stabilizing health coverage overall. However, researchers also found that disparities in coverage continued for Black and Latino individuals, families with lower incomes, and people living in states that chose not to expand Medicaid. According to CMS, ‘Addressing such disparities is a top priority for the Biden-Harris Administration.” CMS also indicated, ‘This year, thanks to the American Rescue Plan and enhanced tax credits, people shopping for health insurance through the Marketplaces will find the widest variety of options at the lowest prices ever. They will also benefit from a longer period to shop for coverage with the Open Enrollment deadline being extended to January 15, 2022. Open Enrollment will launch with four times as many Navigators than last season, with around 1,500 Navigators available for consumers who use HealthCare.gov.” CMS highlighted the Biden Administration's efforts to reduce disparities in coverage. The administration has made record investments and has employed a local strategy to reach the remaining uninsured. Advertisements for open enrollment will be available in an expanded number of languages. CMS will increase the number of Navigators who help people enroll in coverage. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -30- CMS will also bring back the ‘Champions for Coverage” program, enlisting over 2,000 local organizations for outreach and education [FN48] efforts. Spending Plan Would Make Insurance Accessible to 2.2 Million The Democrats' $1.75 trillion social spending and climate change plan would make at least 2.2 million adults with low incomes eligible for government-funded health insurance coverage. Almost all people who would gain eligibility live in Texas and the Southeast. The number corresponds with the number of people who would be eligible for Medicaid under the Affordable Care Act if their states agree to expand the program. About a dozen states have chosen not to expand the program. People living in those states are in the coverage gap if they earn too much to qualify for Medicaid but below the $12,880 annual federal income minimum to qualify for a subsidized plan through the ACA insurance marketplaces. Most people in the coverage gap (60%) are Black or Hispanic, reported the Center on Budget and Policy Priorities. Almost two-thirds of the people live in three states controlled by Republicans, Texas (771,000), Florida (415,000) and Georgia (269,000). Under the Build Back Better plan announced by President Biden after negotiating with Democratic legislators in Congress, the people in the coverage gap would qualify for subsidized health insurance plans through the ACA marketplaces for four years. In 2023, they would receive additional cost-sharing protections that would make their out-of-pocket costs close to zero. The legislation would also increase the federal matching rate for states that have expanded Medicaid from 90% to 93% from 2023 through 2025 to encourage the states to maintain coverage levels. The legislation would also decrease spending by billions for special federal Medicaid funding to non-expansion states that goes to hospitals with disproportionately high rates of uninsured or Medicaid patients. The cuts would help fund the new coverage and would also encourage states to expand Medicaid. Hospital industry officials are against the proposed cuts. They are concerned that losing the funding to cover services. 'We always are in favor of coverage expansion,” indicated Beth Feldpush, senior vice president of America's Essential Hospitals, which represents hospitals that treat many poor and uninsured patients. ‘Our concern is it is paired with cuts to the safety net, and — that is a double-edged sword.” According to the American Hospital Association the funding cuts could reach $7.8 billion over ten years. Industry groups are in favor of extra Medicaid funding for hospitals to cover the cost of treating the over 25 million people who would still lack insurance coverage, even after an expansion. However, according to Matthew Fiedler for the USC-Brookings Schaeffer Initiative for Health Policy, the expanded coverage would increase profit margins of hospitals in non-expansion states by $11.9 billion in 2023. The factors affecting the increase are payments for care the hospitals already provide but is currently unpaid, and an increase in demand for care from newly insured people. While Marketplace health plans usually pay higher reimbursement rates than Medicaid, they have higher deductibles. It is often difficult for patients to pay the deductibles and for providers to collect. Consumer advocates are strongly in favor of the legislation. It would no longer require Republican-controlled states to agree to expand Medicaid to significantly expand access to health insurance. 'This is a big deal,” said Anne Swerlick, a public interest attorney in Tallahassee who has lobbied Florida's legislature to expand Medicaid. ‘It would make an extraordinary difference in the quality of life for tens of thousands of Floridians caught in the gap. In many instances, it will be a lifesaver.” Sen. Raphael Warnock (D-Ga.), a key lawmaker advocating for the provision, said Congress needs ‘to close the coverage gap in Georgia and the 11 other states where hardworking families wake up every day without health care coverage their neighbors in 38 other states enjoy.” However, he indicated that he and Georgia's other congressional Democrats oppose the cuts to special Medicaid funding for hospitals. Most state legislatures decided to expand Medicaid in 2014. The Virginia legislature agreed to the expansion in 2018. Six states have enacted Medicaid expansion through ballot initiatives. [FN49] The remaining non-expansion states are in the South, except for Wyoming, Kansas, South Dakota, and Wisconsin. © Copyright Thomson/West - NETSCAN's Health Policy Tracking Service [FN2] © 2022 Thomson Reuters. No claim to original U.S. Government Works. -31- . Bruce, Giles, “Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors,” KHN, January 7, 2021, available at https://khn.org/news/article/illinois-is-first-in-the-nation-to-extend-health-coverage-to-undocumented-seniors/. [FN3] . Press release, “CMS Releases August Medicaid and CHIP Enrollment Trends Snapshot Showing Continued Enrollment Growth,” CMS Newsroom, December 21, 2020, available at https://www.cms.gov/newsroom/press-releases/cms-releases-august-medicaid-and- chip-enrollment-trends-snapshot-showing-continued-enrollment-growth. [FN4] . Fields, Samantha, “Losing a job hasn't translated to losing health care — so far,” Marketplace, December 16, 2020, available at https://www.marketplace.org/2020/12/16/losing-a-job-hasnt-translated-to-losing-health-care-so-far/. [FN5] . Hurst, Andrew, “Almost 4 in 10 Americans Cut Back on Insurance Coverage in 2020, and Most Regretted Doing So,” ValuePenguin, January 11, 2021, available at https://www.valuepenguin.com/cutting-insurance-costs-to-save-money. [FN6] . Forestieri, Kevin, “New California law requires insurance companies to cover more mental health treatment,” Palo Alto Online, January 13, 2021, available at https://www.paloaltoonline.com/news/2021/01/13/new-california-law-requires-insurance-companies-to-cover- more-mental-health-treatment. [FN7] . Garvin, Jennifer, “Competitive Health Insurance Reform Act becomes law,” ADA News, January 14, 2021, available at https:// www.ada.org/en/publications/ada-news/2021-archive/january/competitive-health-insurance-reform-act-becomes-law. [FN8] . Press release, “Justice Department Welcomes Passage of The Competitive Health Insurance Reform Act of 2020,” Justice News, January 13, 2021, available at https://www.justice.gov/opa/pr/justice-department-welcomes-passage-competitive-health-insurance- reform-act-2020. [FN9] . Press release, “HHS Announces Marketplace Special Enrollment Period for COVID-19 Public Health Emergency,” WebWire, January 28, 2021, available at https://www.webwire.com/ViewPressRel.asp?aId=269604. [FN10] . Press release, “Warner Introduces Bipartisan Bill to Increase Access to Nutritious Foods, Help Eliminate Food Deserts,” Mark R. Warner, February 3, 2021, available at https://www.warner.senate.gov/public/index.cfm/pressreleases. [FN11] . Press release, “Michigan Department of Insurance and Financial Services to Allow Off-Marketplace Health Plan Enrollment During COVID-19 Special Enrollment Period,” Department of Insurance and Financial Services,” February 11, 2021, available at https:// www.michigan.gov/difs/0,5269,7-303-13222_13250-551974--,00.html. [FN12] . Press release, “PALLONE OPENING REMARKS AT FULL COMMITTEE MARKUP OF COVID-19 RELIEF BUDGET RECONCILIATION LEGISLATION,” February 11, 2021, available at https://energycommerce.house.gov/newsroom/press- releases/pallone-opening-remarks-at-full-committee-markup-of-covid-19-relief-budget; Committee on Energy and Commerce Staff, “Full Committee Markup of Legislative Recommendations for Budget Reconciliation,” February 9, 2021, available at https:// energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/FC_MarkupM#emo_2021.02.11.pdf; Cancryn, Adam, “Democrats plan big Medicaid expansion in Covid aid package,” Politico, February 10, 2021, available at https:// www.politico.com/newsletters/politico-pulse/2021/02/10/democrats-plan-big-medicaid-expansion-in-covid-aid-package-793297. [FN13] . Press release, “Bennet, Kaine Announce Introduction of Medicare-X Choice Act to Achieve Universal Health Care,” Michael Bennet U.S. Senator for Colorado, February 17, 2021, available at https://www.bennet.senate.gov/public/index.cfm/2021/2/bennet-kaine- announce-introduction-of-medicare-x-choice-act-to-achieve-universal-health-care. [FN14] © 2022 Thomson Reuters. No claim to original U.S. Government Works. -32- . Press release, “Shaheen Announces New Legislation to Lower Health Care Costs & Expand Access to Insurance for 4 Million More Americans,” Jeanne Shaheen U.S. Senator for New Hampshire, February 26, 2021, available at https://www.shaheen.senate.gov/news/ press/shaheen-announces-new-legislation-to-lower-health-care-costs-and-expand-access-to-insurance-for-4-million-more-americans. [FN15] . Ollove, Michael, “COVID-19 Relief Package Includes Expansion of Health Care Coverage,” PEW, February 18, 2021, available at https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/02/18/covid-19-relief-package-includes-expansion-of-health- care-coverage. [FN16] . “Standardized Health Benefit Plan Colorado Option: Concerning the establishment of a standardized health benefit plan to be offered in Colorado,” Colorado General Assembly, 2021 Regular Session, available at https://leg.colorado.gov/bills/hb21-1232; Associated Press, “Colorado lawmakers unveil public-run health insurance bill,” Modern Healthcare, March 19, 2021, available at https://www.modernhealthcare.com/politics-policy/colorado-lawmakers-unveil-public-run-health-insurance-bill. [FN17] . Press release, “MEDIA RELEASE: AS NATION MARKS 11TH ANNIVERSARY OF THE AFFORDABLE CARE ACT, THE GENERAL ASSEMBLY IS ON TRACK TO PASS THREE MAJOR HEALTH CARE BILLS,” Health Care for All, March 23, 2021, available at https:// healthcareforall.com/2021/03/media-release-as-nation-marks-11th-anniversary-of-the-affordable-care-act-the-general-assembly-is-on- track-to-pass-three-major-health-care-bills/. [FN18] . Press release, “HHS Secretary Becerra Announces More Than 500,000 Americans Have Enrolled in Marketplace Coverage During Special Enrollment Period,” CMS Newsroom, April 7, 2021, available at https://www.cms.gov/newsroom/press-releases/hhs-secretary- becerra-announces-more-500000-americans-have-enrolled-marketplace-coverage-during. [FN19] . Associated Press, “More than a half million Americans gain health insurance coverage under Biden,” Tampa Bay Times, April 7, 2021, available at https://www.tampabay.com/news/health/2021/04/07/more-than-a-half-million-americans-gain-health-insurance-coverage- under-biden/. [FN20] . Cox, Cynthia, Krutika Amin, Gary Claxton, and Daniel McDermott, “The ACA Family Glitch and Affordability of Employer Coverage,” KFF, April 7, 2021, available at https://www.kff.org/health-reform/issue-brief/the-aca-family-glitch-and-affordability-of-employer- coverage/. [FN21] . Press release, “Fact Sheet: The American Families Plan,” The White House Briefing Room, April 28, 2021, available at https:// www.whitehouse.gov/briefing-room/statements-releases/2021/04/28/fact-sheet-the-american-families-plan/. [FN22] . Beam, Adam, “California could be the 1st state to allow adults to add parents to health care plans,” ABC 7, April 28, 2021, available at https://abc7.com/covered-california-health-insurance-first-state-parents-on-care-plans/10557130/. [FN23] . Press release, “CMS to Adopt Rules to Lower Health Care Costs in 2022 Federal Health Insurance Marketplace Plans,” CMS Newsroom, April 30, 2021, available at https://www.cms.gov/newsroom/press-releases/cms-adopt-rules-lower-health-care-costs-2022- federal-health-insurance-marketplace-plans. [FN24] . Press release, “Statement by President Joseph R. Biden, Jr. on One Million Americans Signing Up for Health Coverage During 2021 Special Enrollment,” The White House Briefing Room, May 11, 2021, available at https://www.whitehouse.gov/briefing-room/ statements-releases/2021/05/11/statement-by-president-joseph-r-biden-jr-on-one-million-americans-signing-up-for-health-coverage- during-2021-special-enrollment/. [FN25] . Sullivan, Becky, and Selena Simmons-Duffin, “U.S. Will Protect Gay And Transgender People Against Discrimination In Health Care,” NPR, May 10, 2021, available at https://www.npr.org/2021/05/10/995418963/u-s-will-protect-gay-and-transgender-people-against- discrimination-in-health-car. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -33- [FN26] . Smith, Kate, “REPORT: 40% of Alabama residents who died from the virus did not have health insurance,” WAFF48, April 30, 2021, available at https://www.waff.com/2021/04/30/report-alabama-residents-who-died-virus-did-not-have-health-insurance/. [FN27] . Press release, “CMS Encourages Companies to Promote Quality, Affordable Health Coverage for Gig Workers,” CMS Newsroom, May 26, 2021, available at https://www.cms.gov/newsroom/press-releases/cms-encourages-companies-promote-quality-affordable- health-coverage-gig-workers. [FN28] . Press release, “Senator Murray Announces Plans to Develop a Public Option Proposal to Lower Health Care Costs,” United States Senator Patty Murray Working for Washington State Newsroom, May 26, 2021, available at https://www.murray.senate.gov/public/ index.cfm/newsreleases?ID=8FF12431-5247-4677-95D3-68AFFA4E5491. [FN29] . Alonso-Zaldivar, Ricardo, “Leading Dems seek input on ?public option' health care plan,” AP, May 26, 2021, available at https:// apnews.com/article/donald-trump-health-care-reform-business-health-government-and-politics-bbc45a9528f5852f0726ddf3cbe45ee5. [FN30] . Firth, Shannon, “SCOTUS Dismisses Threat to Obamacare Once More,” MedPage Today, June 17, 2021, available at https:// www.medpagetoday.com/washington-watch/repeal-and-replace/93160. [FN31] . Press release, “CMS Announces $20 Million in American Rescue Plan Funding Available to Improve Access to State-based Marketplace Coverage,” CMS Newsroom, June 21, 2021, available at https://www.cms.gov/newsroom/press-releases/cms- announces-20-million-american-rescue-plan-funding-available-improve-access-state-based https://www.cms.gov/newsroom/press- releases/cms-announces-20-million-american-rescue-plan-funding-available-improve-access-state-based. [FN32] . Sasic, Ema, “Health insurance for $1? Unemployed Californians now eligible for coverage,” Desert Sun, June 21, 2021, available at https://www.desertsun.com/story/news/health/2021/06/21/health-insurance-1-unemployed-californians-now-eligible/5297505001/. [FN33] . Press release, “Oklahoma's Medicaid Expansion will Provide Access to Coverage for 190,000 Oklahomans,” CMSNewsroom, July 1, 2021, available at https://www.cms.gov/newsroom/press-releases/oklahomas-medicaid-expansion-will-provide-access- coverage-190000-oklahomans. [FN34] . Woolridge, Scott, “Many Older Americans Lost Health Insurance During Pandemic,” Think Advisor, July 9, 2021, available at https://www.thinkadvisor.com/2021/07/09/older-american-workers-saw-significant-job-losses-during-the-pandemic-and-health- insurance-415-417212/. [FN35] . Press release, “HHS Announces Rule to Protect Consumers from Surprise Medical Bills,” CMS Newsroom, July 1, 2021, available at https://www.cms.gov/newsroom/press-releases/hhs-announces-rule-protect-consumers-surprise-medical-bills. [FN36] . Press release, “CMS Proposes Rule to Increase Price Transparency, Access to Care, Safety & Health Equity,” CMS.gov, July 19, 2021, available at https://www.cms.gov/newsroom/press-releases/cms-proposes-rule-increase-price-transparency-access-care-safety- health-equity. [FN37] . Kaiser Health News, “California Makes it Easier for Low-Income Residents to Get and Keep Free Health Coverage,” US News and World Report, July 20, 2021, available at https://www.usnews.com/news/best-states/articles/2021-07-20/california-eases-access-for- low-income-residents-to-get-free-health-coverage. [FN38] © 2022 Thomson Reuters. No claim to original U.S. Government Works. -34- . Press release, “American Rescue Plan Lowered Health Costs for Millions of Americans Ahead of August 15 Deadline to Get Covered on HealthCare.gov,” CMS Newsroom, August 4, 2021, available at https://www.cms.gov/newsroom/press-releases/american-rescue- plan-lowered-health-costs-millions-americans-ahead-august-15-deadline-get-covered. [FN39] . OFFICE OF SENATOR BEN RAY LUJ?N (D-N.M.) , “Senators Reintroduce Public Health Insurance Option,” KRWG, August 12, 2-21, available at https://www.krwg.org/post/senators-reintroduce-public-health-insurance-option. [FN40] . Gorbman, Randy, “New York Announces Health Insurance Rates Approved For 2022,” WSKG, August 16, 2021, available at https:// wskg.org/news/new-york-announces-health-insurance-rates-approved-for-2022/. [FN41] . Jennifer Tolbert, Kendal Orgera and Anthony Damico, “What Does the CPS Tell Us About Health Insurance Coverage in 2020?,” KFF, September 23, 2021, available at https://www.kff.org/uninsured/issue-brief/what-does-the-cps-tell-us-about-health-insurance-coverage- in-2020/. [FN42] . Lee, Morgan, “Health Insurance Is About To Get A Lot Cheaper In NM,” The Paper, September 23, 2021, available at https:// abq.news/2021/09/health-insurance-is-about-to-get-a-lot-cheaper-in-nm/. [FN43] . Press release, “Missouri Medicaid Expansion Brings Quality Essential Health Coverage to More than 275,000 Missourians,” HHS.gov, October 4, 2021, available at https://www.hhs.gov/about/news/2021/10/04/missouri-medicaid-expansion-brings-quality-essential-health- coverage.html. [FN44] . Lukpat, Alyssa, “A Louisiana health system will increase insurance fees of employees with unvaccinated spouses,” The Baltimore Sun, October 5, 2021, available at https://www.baltimoresun.com/coronavirus/ct-aud-nw-nyt-louisiana-unvaccinated- spouses-20211005-zs7si3d6ifhavbi7bs4oyr66pq-story.html. [FN45] . Amin, Krutika, “Unvaccinated COVID-19 hospitalizations cost billions of dollars,” Peterson-KFF Health System Tracker, September 14, 2021, available at https://www.healthsystemtracker.org/brief/unvaccinated-covid-patients-cost-the-u-s-health-system-billions-of-dollars/. [FN46] . Press release, “VAN HOLLEN, BERA INTRODUCE NEW BICAMERAL BILL TO MAKE IT EASIER FOR AMERICANS TO SIGN UP FOR HEALTH CARE, CLOSE MASSIVE ENROLLMENT GAP,” Chris Van Hollen U.S. Senator for Maryland, October 19, 2021, available at https://www.vanhollen.senate.gov/news/press-releases/van-hollen-bera-introduce-new-bicameral-bill-to-make-it-easier-for- americans-to-sign-up-for-health-care-close-massive-enrollment-gap. [FN47] . Associated Press, “California becomes 1st state to let adult children add parents to their health care plan,” KTLA5, October 8, 2021, available at https://ktla.com/news/california/california-becomes-1st-state-to-let-adult-children-add-parents-to-their-health-care-plan/. [FN48] . Press release, “New Report: Federal Health Insurance Options Helped Prevent Major Coverage Losses,” CMS Newsroom, October 29, 2021, available at https://www.cms.gov/newsroom/press-releases/new-report-federal-health-insurance-options-helped-prevent- major-coverage-losses. [FN49] . Galewitz, Phil, and Andy Miller, “Uninsured in South Would Win Big in Democrats' Plan, but Hospitals Fear Funding Loss,” Kaiser Health News, November 4, 2021, available at https://khn.org/news/article/uninsured-in-south-would-win-big-in-democrats-plan-but- hospitals-fear-funding-loss/. Produced by Thomson Reuters Accelus Regulatory Intelligence 22-Jan-2022 © 2022 Thomson Reuters. No claim to original U.S. Government Works. -35-