Trump Administration Archives

Proposed work requirements for Medicaid in Michigan: June 7, 2018

A white sheet of paper with writing. A green highlighter is highlighting the word "legislation", referring to new Michigan Medicaid work requirements.

At the start of 2018, the U.S. Centers for Medicare and Medicaid Services (CMS) announced a major shift in federal policy that would allow states to request permission to establish, and test the impact of, work and community engagement requirements for able-bodied adults receiving Medicaid health insurance coverage. In the last five months, work requirement proposals have been approved in four states; formal applications have been submitted by seven more, and a number of others are preparing proposals. Michigan is among the states proposing Medicaid work requirements.

In April, the Michigan State Senate took the first step toward establishing work requirements by passing Senate Bill 897. The Michigan House of Representatives passed an updated version of the bill on June 6. And on the morning of June 7, the Michigan Senate approved the revisions and sent the bill to the Governor’s office for signature.

In this fact sheet, we compare the characteristics and projected impact of Michigan’s most recent Medicaid work requirement proposal against the characteristics and projected impact of approved work requirement proposals in Kentucky, Indiana, Arkansas, and New Hampshire. We also describe new requirements for Healthy Michigan Plan enrollees who wish to maintain coverage after four years, and a series of triggers that would terminate the Healthy Michigan Plan if CMS fails to approve these requirements.

To learn more, read our Consumer’s Guide to the Medicaid work requirements.

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Setting the stage for the 2019 Health Insurance Marketplace

The Centers for Medicare and Medicaid Services is rolling back regulations around rate increases, essential health benefits, health insurance navigators, and more, for insurers offering Qualified Health Plan coverage on the Health Insurance Marketplace in 2019.

On April 9, 2018, the Centers for Medicare and Medicaid Services (CMS) issued new guidance for insurers offering Qualified Health Plan (QHP) coverage on the Health Insurance Marketplace created under the Affordable Care Act. In this guidance, CMS made several important changes intended to provide states with greater flexibility to regulate their individual and small group health insurance markets beginning in 2019.1

In a new fact sheet, CHRT compares the current rules and regulations to the changes that go into effect in 2019—with a special focus on Michigan. The face sheet reviews essential health benefits, health insurance navigators, maximum out-of-pocket limits, standardized plan options, rate increase reviews, medical loss ratio, risk adjustment, silver loading, individual mandate hardship exemptions, projected premium and federal spending changes, and the timeline for the 2019 filing process in Michigan.

Here are just a few highlights:

Rate increases under 15 percent will no longer require review;
Simple choice standardized plans will be eliminated; and
Consumer cost-sharing limits will increase by 7 percent.

These changes to the 2019 Health Insurance Marketplace will impact Michigan consumers as soon as November 1, 2018, when the next Marketplace Open Enrollment Period begins.

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Update: For more information about the 2019 Health Insurance Marketplace, read our rate analysis.

Bipartisan Budget Act adds $3B for substance abuse, mental health, more

A handshake between a red hand and a blue hand, indicating the bipartisanism of the Bipartisan Budget Act.

The Bipartisan Budget Act was signed into law on February 9, 2018. While the main purpose of the legislation is to temporarily fund the federal government through March 23, 2018, it also includes an agreement to raise the caps on domestic and military spending for the next two years.

The legislation includes many health care policies, as well. The health care policies in the Bipartisan Budget Act include:

New funding for the National Institutes of Health (NIH) and for substance abuse and mental health programs related to the opioid epidemic.
Extenders and reauthorizations for the Children’s Health Insurance Program (CHIP); Community Health Centers; the Maternal, Infant and Early Childhood Home Visiting Program; Medicare Extenders; a Medicare Therapy Caps Repeal; the National Health Service Corps; and the Teaching Health Center Graduate Medical Education Program.
Policy changes relating to the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act; the “Doughnut Hole” Closure; the Independent Payment Advisory Board (IPAB); Medicaid Disproportionate Share Hospital (DSH) Cuts; and Medicare Home Health Reforms.
Key offsets for Medicare Parts B & D Premiums, Physician Fee Schedules, and the Prevention and Public Health Fund (PPHF).

To learn the details of the health care policies included in the Bipartisan Budget Act, read the full brief.

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Health Care Provisions in the Tax Cuts and Jobs Act (H.R. 1)

Buttons decorated like the American flag, with "Tax Cuts and Jobs Act" written on them.

The Tax Cuts and Jobs Act passed the U.S. House of Representatives on November 16, 2017, and an amended version passed the U.S. Senate on December 2, 2017. Congress reconciled the differences between the two bills in a compromise conference report.

While the purpose of the legislation is to reduce tax rates for businesses and individuals, it includes several major health care policy changes.

For instance, the act repeals the tax penalty for those who choose not to enroll in health insurance. CBO estimates the impact of this will be that 13 million fewer individuals will have health insurance over 10 years and health insurance premiums for ACA Marketplace plans will increase an additional 10% per year.

The Tax Cuts and Jobs Act also lowers the threshold of health care tax deductions from 10% to 7.5% of income for 2017 and 2018. This means that more taxpayers and more expenses will be eligible for the deduction.

Finally, the act limits the tax credit amount for pharmaceutical companies that develop drugs to treat rare diseases from 50% to 25% of qualified clinical testing expenses.

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Editor’s Note: CHRT updated this fact sheet Jan. 12, 2018 to include more recent Medicare beneficiary numbers, updated information on PAYGO, and reflect that the conference report is now law.

ACA Repeal and Replacement: Proposals and Action

Beginning last month, both U.S. President Donald Trump and the U.S. Congress began taking steps to repeal and replace the Affordable Care Act (ACA). However, a single replacement strategy has not yet emerged.

In a new one-page fact sheet, CHRT summarizes the most developed ACA repeal and replacement proposals offered to date and outlines the tentative replacement process.

You can also review CHRT’s companion piece, Select Affordable Care Act Replacement Plans and Implications, for a detailed table summarizing the key features and implications of the most developed full ACA repeal and replacement plans offered to date.

The face sheet summarizes three full replacements for the ACA: the House Republicans’ “A Better Way” proposal, Rep. Tom Price’s “Empowering Patients First Act”, and the Burr-Hatch-Upton “Patient Choice, Affordability, Responsibility, and Empowerment Act”. It also summarizes one partial replacement, the Cassidy-Collins “Patient Freedom Act”.

The fact sheet also details the process to repeal and replace the ACA. We summarize President Trump’s January 20 Executive Order and the 2017 Congressional Action. On January 3, the Senate Budget Committee created a budget resolution to provide framework for a partial ACA repeal using budget reconciliation. On January 12 the resolution received full Senate approval and on January 13 it received full House approval.

The House and Senate committees intended to have draft actual reconciliation legislation by January 27, but this has been delayed. April 15 is the prescribed deadline under current rules for the House and Senate to adopt annual budget resolutions, but this is generally not enforced. June 15 is the prescribed deadline to enact any reconciliation legislation, but this is also generally not enforced.

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Rate Analysis: Michigan’s 2017 Health Insurance Marketplace

While the results of the 2016 presidential election have sparked recent debates about options to repeal and replace the Affordable Care Act, the health insurance marketplaces created under the law continue to operate as usual. So although the future of the law remains unknown, Michigan consumers who enroll in the 2017 Health Insurance Marketplace can likely expect their coverage to remain uninterrupted for the 2017 plan year.

The changing dynamics of the health insurance marketplace are important for 2017 enrollees to understand. Under current federal policy, enrollees who do not actively apply and enroll in 2017 coverage are auto-renewed into their 2016 plan, if it continues to be offered. Beginning with the 2017 open enrollment period, individuals who were enrolled in a plan offered by an issuer that is no longer participating in the marketplace will automatically be enrolled into a plan offered in their area by a different carrier if they do not actively choose another plan.

In addition, changes to benchmark plans directly affect premium tax credit amounts, so many enrollees will need to balance potentially higher costs for renewing their 2016 plan with other important considerations, such as the breadth of available provider networks.

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