September 9 – September 14, 2015

Legal Challenge to Cost-Sharing Reductions Proceeds: On September 9, a federal district court judge ruled that the House of Representatives has standing to continue a lawsuit against the Department of Health and Human Services (HHS). The case challenges whether the administration has the authority to make payments to issuers in order to cover cost-sharing reductions, a type of financial assistance that helps cover out-of-pocket costs for eligible marketplace enrollees with incomes below 250 percent of the federal poverty level.

Round Up of Recent Federal Regulations and Guidance from HHS:

  • Fast-Track Enrollment for Medicaid Extended: States now have a permanent opportunity to streamline Medicaid and Children’s Health Insurance Program eligibility determinations by using data from the Supplemental Nutritional Assistance Program (SNAP).
  • Non-Discrimination Rule Proposed:The proposed rule outlines protections against sex discrimination (including gender identity) and for underserved populations, including people with limited English proficiency and those with disabilities, for people enrolled in coverage through the health insurance marketplaces and other HHS programs. Public comment is due November 6.
  • Insurer Data Reporting Guidelines Proposed: HHS has proposed requirements for insurers offering plans through the platform to share specific data about coverage offered through the marketplaces. This collection of information is required by Section 1311 of the Affordable Care Act and is meant to increase transparency about marketplace coverage (including, but not limited to, rating practices and claims payment policies). Per section 1311, insurers are required to submit data to HHS, insurance commissioners, and marketplaces, and make this information available to the public in plain language. Public comment is due October 13, and reporting would begin for the 2016 plan year.

GAO Study Finds More Marketplace Plan Options in 2015: On September 9, the Government Accountability Office published a report finding an overall increase in the number of health plans available on the marketplaces in 2015 as compared with 2014. They GEO also found that a higher proportion of counties had six or plans in each metal tier. The report includes downloadable spreadsheets with state-level data on the number of plans available and the range of premiums.

Updates on 2016 Premium Changes:

  • Maryland: On September 4, the Maryland Insurance Administration announced approved premiums for 2016, with premium changes for different insurers ranging from a decrease of 3.3 percent to an increase of 26 percent.
  • Kaiser Family Foundation (KFF) Analysis: In major cities in 12 states and the District of Columbia, premiums for benchmark plans (used to determine the amount of financial help available) are increasing by an average of 1 percent for 2016 after tax credits are taken into account, according to a KFF study released September 10. However, when KFF did not consider premium tax credits in the calculations, they found an average rate increase of 3 percent. The overall increase is slightly higher than last year’s, when a similar KFF analysis found that premiums for benchmark plans increased by 2 percent from 2014 to 2015), not factoring in tax credits.
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