The U.S. Department of Health and Human Services has proposed a new rule to severely weaken the Affordable Care Act’s prohibitions against discrimination in health care, and to erase references to protections against discrimination by health care programs on the basis of gender identity or sex stereotype in regulations. These protections are provided under Section 1557 of the Affordable Care Act and its regulations.
The Utah Department of Medicaid released its much-anticipated proposal for a Section 1115 Medicaid waiver seeking a “per capita cap” – or a limit on federal spending – on major portions of its Medicaid program. If approved by the Trump administration, it would set a new precedent that could have catastrophic effects for state budgets and Medicaid programs in the future.
On May 16th, the Centers for Medicare and Medicaid Services announced a final regulation for Medicare’s Part D drug benefit for 2020. The regulation backed off of a proposal that would have created significant exceptions to requirements that Part D plans cover all drugs in six “protected classes”.
High and rising drug prices jeopardize consumers’ health and well-being.1 To address the harms of high drug prices, families across America want and deserve meaningful reforms that target and reduce the underlying “list” prices of drugs. Polling shows that nine out of 10 voters support allowing the government to negotiate lower drug prices in Medicare.2
On April 18, 2019, the Trump Administration finalized the Notice of Benefit and Payment Parameters for 2020 (NBPP). This rule will govern health insurance marketplaces and set the framework for insurance companies to propose plans and premium rates for 2020. Consumer advocates achieved several important victories in the final 2020 NBPP. Contrarily, the final rule also establishes harmful changes that will decrease access to high-quality, affordable coverage and care for families across the country.
The Return of Churn: State Paperwork Barriers Caused More Than 1.5 Million Low-Income People to Lose Their Medicaid Coverage in 2018
In 2018, enrollment in Medicaid and the Children's Health Insurance Program decreased by about 1.6 million enrollees, 744,000 of which were children. There is strong evidence that a driving factor of the decline in enrollment is state policy decisions to engage in punitive annual (or even monthly) eligibility redetermination processes in which large percentages of Medicaid enrollees lose coverage.
Surprise billing, also called surprise out-of-network balance billing, is a common problem when, through no fault of their own, families receive medical treatment from an out-of-network provider. The surprise comes in the form of doctor bills for the difference between what a provider charges and what the insurer pays that provider. Congress is currently considering legislation to address this problem for families all over the country. This piece describes the legislation under consideration in Congress and Families USA’s recommendations for a Congressional fix to this problem.
On March 26, 2019, the chairs of three House committees with jurisdiction over core health care issues jointly introduced legislation that would lower health care costs for millions of people. The "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019," would: increase financial assistance for families who buy their own insurance, without help from Medicaid, Medicare, or an employer; protect people with preexisting conditions by repealing Trump administration policies that sabotage the safe operation of insurance markets; and take other steps to help consumers understand and sign up for coverage.
The Administration’s proposed budget is in part a return to policies that Americans have overwhelmingly rejected. It proposes to gut core insurance protections, end the expansion of Medicaid to low income adults, and block grant the Medicaid program, cuts amounting to over a trillion dollars over ten years. But the budget also signals new and deeply concerning policy changes including mandatory new work documentation requirements in Medicaid, and increasing the cost of health insurance premiums for low income people in the non-group market.