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Legislative developments for State Single Payer and Medicaid Buy-In models

There is a growing discontent and an unease that surrounds the health care reform creating a pressure to act with the rise insurance premiums, no access, and the uncertainty for repeal of the Affordable Care Act.

 

Companies like United Healthcare, Humana, and Aetna rolling back participation in the ACA marketplaces, then Anthem announcing it’s exiting the Ohio health insurance marketplace which could leave 18 counties with no exchange plan for next year. Other states like Missouri and Washington State face Marketplace participation issues that are similar. Some states have seen increases for premiums of more than 45% since 2016. Among these are states like Illinois, Arizona, Alabama, Kansas, Oklahoma, Minnesota, Pennsylvania, and Tennessee. On top of this; steep rate increase is being asked for next year for participating exchange plans that average around 11.1%. to 44.7%.

 

States are now exploring different options to help leverage the federal 1332 & 1115 waivers to help provide some flexibility in developing market stabilization programs plus regulatory changes to individual and Medicaid markets.

 

There are a few states legislatures who recently leap frogged some one-off programs as high-risk pools or reinsurance to try and create some really different market structure.

 

There are several states legislatures who’ve developed state driven solutions to address the consumer access and concerns over prices. These states include California, New York, and Nevada. The models proposed could fundamentally reshape framework for the state health insurance markets.

There is a growing discontent and an unease that surrounds the health care reform creating a pressure to act with the rise insurance premiums, no access, and the uncertainty for repeal of the Affordable Care Act.

 

Companies like United Healthcare, Humana, and Aetna rolling back participation in the ACA marketplaces, then Anthem announcing it’s exiting the Ohio health insurance marketplace which could leave 18 counties with no exchange plan for next year. Other states like Missouri and Washington State face Marketplace participation issues that are similar. Some states have seen increases for premiums of more than 45% since 2016. Among these are states like Illinois, Arizona, Alabama, Kansas, Oklahoma, Minnesota, Pennsylvania, and Tennessee. On top of this; steep rate increase is being asked for next year for participating exchange plans that average around 11.1%. to 44.7%.

 

States are now exploring different options to help leverage the federal 1332 & 1115 waivers to help provide some flexibility in developing market stabilization programs plus regulatory changes to individual and Medicaid markets.

 

There are a few states legislatures who recently leap frogged some one-off programs as high-risk pools or reinsurance to try and create some really different market structure.

 

There are several states legislatures who’ve developed state driven solutions to address the consumer access and concerns over prices. These states include California, New York, and Nevada. The models proposed could fundamentally reshape framework for the state health insurance markets.

The State Models

 

Essentially the developments for state legislative fall into 2 groups that are called “State Single Payer” and then the “Medicaid Buy-In.”

 

  • State Single Payer – most systems creating single coverage mechanisms for any health care administered through a central authority. Both California and New York fall into this category.
  • Medical Buy-In – this is a proposal the Nevada legislature approved attempting to leverage structure and negotiate rates for the Medicaid program enabling commercial insurance carries in order to replace these features in the private market and did not expand this Medicaid program to everyone.

 

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