VISIT STATE HEALTH COMPARE
Publication
Leveraging 1332 State Innovation Waivers to Stabilize Individual Health Insurance Markets: Experiences of Alaska, Minnesota, & Oregon
Presentation by SHADAC Senior Research Fellow Emily Zylla at the 2018 Association for Public Policy Analysis & Management (APPAM) Fall Research Meeting in Washington, DC.
Publication
Modeling State-based Reinsurance: One Option for Stabilization of the Individual Market
Presentation by SHADAC Director Lynn Blewett at the 2018 Association for Public Policy Analysis and Management (APPAM) Fall Research Conference in Washington, DC.
Download a PDF of the presentation slides.
Blog & News
Lynn Blewett in Health Affairs Blog: Examining the New Basic Health Plan Financing Rule
October 2018:
On August 24th, the Centers for Medicare and Medicaid (CMS) released a Final Administrative Order that would revise and recalculate their payments toward Basic Health Programs (BHPs). Only two states have established BHPs—Minnesota and New York—under Section 1331 of the Affordable Care Act (ACA).
SHADAC Director Lynn Blewett and David Anderson, a researcher at the Duke University Margolis Center, co-authored a Health Affairs blog that takes a look at the background of BHPs in Minnesota and New York, how this new order affects them, and what may happen with federal BHP financing going forward.
BHP Background and Financing
BHPs are optional state coverage programs designed to improve continuity of care and affordable coverage for low-income individuals who would otherwise be eligible for coverage on the health insurance Marketplace. Minnesota and New York both implemented BHPs in 2015, and their BHPs currently cover 89,000 and 700,000 people, respectively. BHPs must cover the ACA’s essential health benefits, and both New York and Minnesota offer low to no cost-sharing.
Federal funding for BHPs is based on 95 percent of the total advance premium tax credits (APTCs) and cost-sharing reductions that would have been provided if a state’s BHP population would have enrolled in the second-lowest-cost silver qualified health plan (QHP) on the state’s health insurance Marketplace. The methodology for determining payment is published annually and is based on BHP enrollment characteristics for each state, including age, geographic area, household size, and income. Minnesota estimated that approximately 25 percent of the federal funding for its BHP came from cost-sharing reductions.
Major Changes to BHP Federal Financing
In October 2017, the Centers for Medicare and Medicaid Services (CMS) announced it would stop paying cost-sharing reductions to insurers, who remain legally obligated to pay for these same reductions to cover costs of deductibles, coinsurance, and co-payments for individuals at 100 to 250 percent FPL in states that did not expand Medicaid, and 138 to 250 percent FPL in Medicaid expansion states. Many insurers chose to offset the elimination of cost-sharing reduction by increasing premiums in order to secure higher premium tax credits for consumers.
State and Federal Responses
Minnesota and New York were notified that the CMS would stop funding the cost-sharing reductions of their BHPs in December 2017, and payments were subsequently halted in the first quarter of 2018. Both Minnesota and New York initially requested that CMS revise its calculations to account for a higher premium tax credit component of BHP payments to make up for the cost-sharing elimination. CMS did not initially respond, and the states moved to sue CMS.
CMS responded to the litigation by providing an interim settlement of $169 million to the states and establishing a new BHP payment methodology that provides an 18.8 percent adjustment to the BHP payment for both Minnesota and New York based on a survey of health insurers on the extent of their 2018 premium increase attributed to the discontinuation of cost-sharing reduction funding. Both Minnesota and New York questioned the revised BHP payment methodology. However, the new methodology currently only holds for 2018, and it is yet unknown if it will be used to calculate payments for 2019 and 2020.
Learn More
Read the full Health Affairs blog to learn more about the future of BHPs for Minnesota and New York.
Publication
Exploring the New State-Level Opioid Data on SHADAC's State Health Compare: Webinar
Date: September 5, 2018
Time: 12:00 p.m. - 1:00 p.m. Central
Watch a recording of the event below, or download a PDF of the presentation slides and the event transcript.
Between 2000 and 2016, the annual number of drug overdose deaths in the United States more than tripled, from 17,500 to 63,500, and most of these deaths involved opioids. Despite widespread increases in overdose death rates from natural and semi-synthetic opioids, synthetic opioids, and heroin, individual states’ death rates varied widely. For example, in 2016, Nebraska’s rate of 1.2 deaths per 100,000 people was the lowest in the U.S. for natural and semi-synthetic opioids, while West Virginia’s rate (the highest) was more than 15 times larger, at 18.5 deaths. These deaths are the most glaring indication of the growing crisis of opioid abuse and addiction that has been spreading unevenly throughout the country over the past two decades.
On this SHADAC webinar, Research Fellow Colin Planalp examined the United States opioid epidemic at the state level, analyzing trends in overdose deaths from heroin and other opioids, such as prescription painkillers. Using data available through SHADAC’s State Health Compare, he also looked at which states have the highest rates of opioid-related deaths and which have experienced the largest increases in death rates.
Mr. Planalp was joined by SHADAC Research Fellow Robert Hest, who discussed the data on opioid-related overdose deaths from the U.S. Centers from Disease Control and Prevention (CDC) that are available on SHADAC’s State Health Compare. He also spoke about State Health Compare data from the U.S. Drug Enforcement Administration (DEA) on sales of common prescription opioid painkillers, and demonstrated how to access and use the data for state-level analyses.
Event Resources
The Opioid Epidemic: National Trends in Opioid-Related Overdose Deaths from 2000 to 2016 (SHADAC Brief)
The Opioid Epidemic: State Trends in Opioid-Related Overdose Deaths from 2000 to 2016 (SHADAC Brief)
Significance Testing Using State Health Compare (SHADAC Brief)
Blog & News
Now Available: SHADAC Presentations from the 2018 AcademyHealth Annual Research Meeting
July 19, 2018:SHADAC presentation materials from the 2018 AcademyHealth Annual Research Meeting (ARM) are now available. Click on the presentation titles below to view and download the materials.
- “The Intersection of Structural Risk Factors and Insurance-Based Discrimination on Healthcare Access Inequities”
Presenter: Kathleen Call
Co-Authors: Rhonda Jones-Webb, Brooke Cunningham, Giovann Alarcón, Sarah Hagge, Alisha Simon - “Who Gets It Right? Characteristics Associated with Accurate Reports of Health Insurance Coverage”
Presenter: Kathleen Call
Co-Authors: Angela Fertig, Joanne Pascale, Don Oellerich - “Minnesota LTSS Projection Model: MN-LPM”
Presenter: Giovann Alarcón
Co-Authors: Robert Hest, Lynn A. Blewett - “Modeling Financial Eligibility for Medicaid Payment of LTSS”
Presenter: Robert Hest
Co-Authors: Giovann Alarcón, Lynn A. Blewett - “Modeling State-based Reinsurance: One Option for Stabilization of the Individual Market"
Presenter: Brett Fried
Co-Authors: Lynn A. Blewett, Coleman Drake - “Advancements in Care Coordination: Findings from an Evaluation of Minnesota’s State Innovation Model Initiative”
Presenter: Carrie Au-Yeung
Co-Authors: Christina Worrall, Donna Spencer, Emily Zylla, Kelli Johnson, Lacey Hartman - “Section 1115 Medicaid Expansion Waivers: Implementation Experiences of Arkansas, Indiana, Iowa, & Michigan”
Presenter: Carrie Au-Yeung
Co-Authors: Emily Zylla, Elizabeth Lukanen, Colin Planalp
