Healthcare Report: November 2019

Healthcare Report: November 2019

Healthcare Report

By Margaret O’Hara

Affordable Care Act: Premium Prices Fall, Health Insurance Providers Rise

2020 Enrollment in the ACA Marketplace is available from November 1 to December 15. According to Modern Healthcare, health insurance premiums for benchmark ACA exchange plans will decrease for the second year in a row. Also in 2020 the number of health insurers selling plans will increase to 175, up from 155 in 2019. The lower premiums and added insurance companies are signs that the ACA federal insurance market has stabilized after a rough few years of regulatory uncertainty, premium hikes, and dwindling choice of health plans.

The benchmark plan is the second lowest cost silver plan. Premiums for this plan will decline by more than 10% in six states, according to Modern Healthcare. Premium prices vary, depending on the way states implement health insurance programs. 

High Cost of Prescription Medications: Legislation to Reduce Medication Costs Advances

On October 18, the U.S. House Education and Labor Committee voted along party lines to approve a sweeping prescription drug bill aimed at lowering costs of medicine across the country. The thrust of the proposed legislation would allow Medicare to negotiate lower prices on as many as 250 of the most expensive drugs per year and apply those discounts to private health plans across the U.S. The bill also includes a penalty on drug makers that refuse to negotiate or fail to reach an agreement with the U.S. government, starting at 65% of the gross sales of the drug in question.

Meanwhile, Illinois Congresswoman Lauren Underwood (IL-14) introduced a five-point plan to reduce the high cost of prescriptions. It lists steps Congress must take to reduce out-of-pocket costs, negotiate lower drug prices, eliminate price hikes, ensure generics remain affordable options, and invest in research for tomorrow's cures. 

In the U.S. Senate, the bipartisan Prescription Drug Pricing Reduction Act (S. 2543) was sent to the Congressional Budget Office in September after advancing out of the Senate Finance Committee in July by a 19-9 vote, with only Republicans voting against. The bill would cap what people on Medicare pay for drugs at $3,100 a year beginning in 2022 and would cap drug costs by forcing drug companies to give rebates to Medicare if they increase their prices above inflation, among more than two dozen other provisions. The bill reportedly would save taxpayers more than $100 billion and save beneficiaries more than $30 billion in out-of-pocket costs. 

States, including Illinois, also are tackling the high cost of prescription drugs. See last month’s healthcare report for more.

Public Charge Rule: Fewer Immigrants Enroll in Medicaid

According to the Kaiser Family Foundation, nearly half (47%) of community health centers report that many or some immigrant patients declined to enroll in Medicaid in the past year, and nearly a third (32%) of centers say that some patients dropped or decided not to renew such coverage.

Interviews with health center staff report similar findings and indicate that fear and confusion surrounding recent immigration policy contribute to these changes. The findings come at a time when the Trump Administration is tightening “public charge” rules under which immigrants can be denied entry to the U.S. or legal permanent resident status if federal officials determine they are likely to rely on public programs such as Medicaid and certain housing and nutrition programs. The final rule change to “public charge” inadmissibility policies was scheduled to take effect October 15, but a federal judge in New York issued a temporary injunction blocking it.


Margaret O’Hara serves on LWVIL’s Healthcare Issues Committee.

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