While Congress was on recess, state legislators from around the country, along with policymakers from around the world, gathered in Boston for the National Conference of State Legislators’ annual legislative summit. Although the agenda featured a range of issues, health insurance sessions were among the most popular of the week, which isn’t surprising since the state legislators were coming together in the shadows of the Senate’s failure to pass a reconciliation bill and following President Trump’s tweets and statements that he is willing to stand aside and let the ACA flounder without intervention from the White House.

On Sunday evening, Seema Verma, administrator of CMS, received a rock-star welcome to a standing room only session to deliver a healthcare overview from CMS. In her opening remarks, Verma noted that the situation in the individual market is dire, with the prediction that 40% of counties could be facing a market with only one carrier in 2018. The Administration recognizes the value of choice in the insurance market, and right now having one carrier in any market is not seen as a choice. When providers have only one carrier to negotiate with, it creates a virtual monopoly, and the Administration recognizes that a monopoly in the market only yields higher costs to consumers.

Verma emphasized that the Administration is seeing individuals dropping their enrollment on the exchanges because of cost while enrollment in Medicaid is higher than expected. So far this year, the Administration has released the Market Stability rule and guidance on applying for 1332 waivers, and has solicited suggestions from insurance industry stakeholders in order to determine regulations that can be put in place to stabilize the health insurance market and attempt to prevent further increases in premiums. NAHU will be meeting with senior HHS officials next week to discuss each of the items, which NAHU previously commented on (Market Stability rule comment letter, CMS RFI comment letter).

Other items that Verma is interested in focusing on include drug pricing, ways to partner with states for innovation within the health insurance markets, further use of telemedicine and ways to tackle the opioid crisis. In return, CMS is very interested in hearing from state policymakers on what they see as the most pressing issues in the industry. Verma closed her remarks by stating that CMS is trying to be as flexible as possible in regards to regulations, is trying to streamline the waiver-application process and to respond faster with approvals, and is trying to increase transparency and communication with the states as changes are made on the federal level. 

Later in the week, the “Fixing Health Care: What’s Next?” panel read like a who’s who of previous NAHU Capitol Conference speakers, including: Chiquita Brooks-LaSure, former director of coverage policy, HHS and CCIIO deputy center and policy director, and current managing director of Manatt Health; Joe Antos, resident healthcare scholar at the American Enterprise Institute; and Sara Rosenbaum, professor of Health Law and Policy at George Washington University, amongst others. The state legislators in attendance were eager to hear ideas they could implement within their borders. Unfortunately, much of the conversation hinged on action needed on the federal level to allow for state action.

Much of this panel focused on the uncertainty of the employer and individual mandates as well as the cost-sharing reduction (CSR) payments. As we have mentioned several times in the Washington Update, the uncertainty in the market, especially the CSRs, has caused carriers to be extremely cautious in pricing plans for 2018, resulting in reports of sharp increases in premiums in the coming year. In addition, Brooks-LaSure pointed out the importance of marketing and outreach in efforts to increase enrollment. As much as we have focused on the issues of market uncertainty, over the past several months many industry stakeholders have reinforced the continued need of marketing and outreach efforts, including the importance of the role of agents and brokers play in these vital efforts.

During this session, NAHU member and Florida State Representative Richard Stark voiced a concern of NAHU regarding the dissolution of risk-adjustment payments, and the need to implement some type of reinsurance risk pool. Stark’s comments were well received among the panel, with interest in development of federal and state stabilization funds for the creation of some type of reinsurance mechanism; however, this will need federal action to be put in place.

Although there was not a dedicated session on 1332 waivers, the topic did come up repeatedly in the health insurance sessions. There was shared frustration between state legislators and federal policymakers regarding the hurdles in place for applying for 1332 waivers and the need for federal action to ease the requirements for states to submit an application. NAHU featured our new 1332 landing site in the state action center on 1332 waivers, and will continue to provide updates as any federal action is taken to create a streamlined process to apply for these waivers.

Overall, there was some frustration among attendees as though the states’ hands were tied by federal inaction preventing them from truly being able to move forward with any type of state innovation. However, with that frustration has come renewed invigoration on behalf of state legislators to do as much as they can as soon as they can to take control within their borders to stabilize the market.

Meanwhile the federal government was busy with one agenda item on health insurance: Yesterday, the deadline for filing final rates for 2018 ACA plans in many states was delayed to September 6, giving carriers three more weeks to attempt to find any certainty in the market that could affect their decisions for the pricing of healthcare.gov plans. The next important deadline is September 27, which is the date by which carriers are to sign final contracts to participate on healthcare.gov in 2018 with open enrollment still scheduled to begin on November 1.