Governors pen bipartisan letter to Congress urging five-year extension of funding for the Children's Health Insurance Program (CHIP); new analyses find Medicaid funding cuts under the AHCA would disproportionately affect women; and a Heritage Foundation fellow is tapped to lead HHS's Center for Consumer Information and Insurance Oversight.

AHCA ACTIVITY AND ANALYSIS:

Senate Health Reform Discussions Pick Up

A group of moderate Republican and Democratic senators, organized by Senators Susan Collins (R-ME) and Bill Cassidy (R-LA), met on Monday to discuss potential bipartisan healthcare legislation. Separately, Senate Republicans last week formed a 13-member working group on health reform, which includes Senate Majority Leader Mitch McConnell (R-KY), Senate Finance Committee Chair Orrin Hatch (R-UT), Senate HELP Committee Chair Lamar Alexander (R-TN), and a number of other influential Senate Republicans (the full list can be found here).

AHCA's Per Capita Caps Would Substantially Reduce Federal Medicaid Funding to States

A Brookings Institute report finds that the AHCA's per capita caps would have lowered federal Medicaid spending by $17.8 billion in 2011 and required significant increases in state funding to maintain benefit levels, had the caps been implemented in 2004. The authors highlighted that the per capita cap, by design, would only have created losers among the states. States face cuts if their spending exceeds the cap, but they do not receive any benefit if they keep their spending below the caps. The analysis uses state-level spending data from 2000-2011.

Medicaid Cuts Would Disproportionately Impact Women

Medicaid cuts proposed in the AHCA and public funding cuts for family planning services proposed by Republicans and the Trump Administration would disproportionately impact the 39% of low-income women enrolled in Medicaid, according to two briefs from the Kaiser Family Foundation and the Center on Budget and Policy Priorities (CBPP). The publications note that Medicaid provides coverage to nearly 50% of pregnant women, accounts for 75% of public funding for family planning services, and covers long-term care and other services for nearly 40% of Latina and African American women over age 65. The CBPP report also provides the number of women enrolled in Medicaid and a state-by-state demographic breakdown of the 40 million women enrolled in Medicaid.

Mississippi: Governor May Waive ACA Provisions if AHCA Becomes Law

Governor Phil Bryant (R) said he would waive some ACA consumer protections under the AHCA, if doing so would "improve the state's insurance market." Governor Bryant is the third governor to publicly consider waiving the federal essential health benefits under what has become known as the MacArthur Amendment to the AHCA.

FEDERAL AND STATE MEDICAID/CHIP NEWS:

Governors Call for CHIP Funding Extension After Senate Postpones Committee Hearing

The National Governors Association, in a bipartisan letter, urged Congress to pass a five-year extension of the Children's Health Insurance Program (CHIP). The letter arrived on the heels of a decision by the Senate Finance Committee to postpone a hearing on CHIP scheduled for May 9. CHIP traditionally has enjoyed broad bipartisan support, but federal funding for the program is set to expire on September 30, 2017. Some observers are concerned that the program will be swept up in the larger debate over the future of repeal and replace.

CMS Extends Compliance Deadline for Home and Community-Based Settings Criteria Until 2022

CMS has extended the deadline from 2019 to 2022 for states to demonstrate compliance with home and community-based settings (HCBS) criteria established under a 2014 HCBS final rule. The rule established additional outcomes-based requirements for Medicaid HCBS programs, however states were permitted to develop transition plans of up to five years for programs that were approved at the time the rule was issued.

Florida: Medicaid Work Requirement Legislation Fails

A bill requiring some Medicaid enrollees to prove they are employed, actively seeking work, or enrolled in a job-training program failed in the Senate after passing the House earlier this month. The bill called for a one-year coverage lock-out for those who fail to meet the work requirement.

FEDERAL AND STATE MARKETPLACE UPDATES:

CMS Announces Plans to End HealthCare.gov SHOP Marketplace

HealthCare.gov will no longer handle SHOP enrollment functions beginning in 2018, according to an HHS announcement on Monday. HealthCare.gov will continue to determine eligibility for the small employer tax credit, however CMS plans to issue a proposed rule under which employers and employees could enroll in SHOP plans directly through agents or brokers, or through a State-based SHOP Marketplace.

Premiums and Rate Increases Higher in Markets With One Insurer

An Urban Institute brief found that individuals living in Marketplace rating regions with only one insurer face higher median monthly premiums ($451) and premium rate increases (29.8%), compared to markets with three to five insurers ($311-$317 and 12.1%, respectively). Regions with one insurer tend to be less populated, located in the South, and use HealthCare.gov for Marketplace eligibility and enrollment. A Blue Cross Blue Shield affiliate is the only remaining insurer in 98% of these regions.

Aetna Withdraws From the Marketplaces for 2018

Aetna will not offer Marketplace plans in Delaware and Nebraska in 2018, completing the insurer's full withdrawal from the ACA Marketplaces. Aetna currently offers Marketplace plans in four states for plan year 2017, and earlier this year announced its plans to withdraw from Iowa and Virginia.

New York: Open Enrollment Period Demonstrates Strong Coverage Gains

Approximately one in five New Yorkers enrolled in health coverage through NY State of Health, New York's State-based Marketplace, during the 2017 open enrollment period. Enrollment in qualified health plans (QHPs) and New York's basic health plan, rose by 39% compared to the previous open enrollment period, and more than half of individuals enrolling in a QHP received tax credits. The report notes that coverage gains from this year contributed to a significant reduction in the State's uninsurance rate, now 5% compared to 10% in 2013.

FEDERAL AND STATE STAFFING NEWS:

New CCIIO Director Appointed

Randy Pate, formerly of the Health Care Service Corporation and the Heritage Foundation, has been named director of HHS's Center for Consumer Information and Insurance Oversight (CCIIO). Pate replaces acting director and acting Marketplace CEO Jeff Wu. CCIIO is responsible for overseeing the implementation of ACA private insurance provisions, including the Marketplaces.

Maryland: New Chair of Maryland Health Care Commission Appointed

Robert Moffit was appointed chair of the Maryland Health Care Commission, an independent regulatory agency. Moffit is a senior fellow at the Heritage Foundation and was previously deputy assistant secretary at the U.S. Department of Health and Human Services. The commission was previously chaired by Craig Tanio, whose term expired last month.