Uninsurance Rate at All-Time Low
The national uninsurance rate for all populations hit an historic low in 2015 (9.1%), with the largest coverage gains being among adults earning below 200% of FPL, according to the Centers for Disease Control and Prevention's National Health Interview Survey. Between 2014 and 2015, 7.4 million individuals gained coverage. Uninsurance for adults (ages 18-64) remains higher (13%) than for children (5%). States that expanded Medicaid under the ACA had larger decreases in adult uninsurance rates (18.4% to 9.8%) compared to non-expansion states (22.7% to 17.5%). The uninsured rate for adults had been increasing since 1997 and hit a high of 22.3% in 2010.
RWJF Seeks a Marketplace Plan Selection App Based on Prescription Drug Costs
The Robert Wood Johnson Foundation (RWJF) is offering up to $100,000 in prize money for the development of a mobile or web application that utilizes multiple datasets with formulary, pharmacy network and pricing data to help consumers select a Marketplace plan based on prescription drug costs and coverage. This two-phase "Developers' Challenge" first focuses on strategy and blueprint development, and then requires developers to create a fully functional application. Submissions will be evaluated based on potential market impact (30% of score), sustainable business model (30%), utilization of available data (20%), user interface/user experience design (10%), and conceptual creativity and ingenuity (10%). Challenge registration opened May 22 with Phase 1 strategies due August 14. Winners will be identified by the end of the year.
Massachusetts: 1332 Waiver Not Necessary to Maintain Small Group Market Features
CMS concluded in its letter to the State, as shared by POLITICO Pro, that Massachusetts does not require a 1332 waiver in order to maintain its "shared non-group and small group risk pool," which retains enrollment and rating practices typical of a non-merged market. Massachusetts will therefore be permitted to continue current practices, such as permitting small group enrollees to enroll and renew in health plans on a rolling basis throughout the year. The waiver was determined unnecessary because CMS does not consider Massachusetts to have a merged market for purposes of the single risk pool provision of the ACA.
Vermont: Prescription Drug Bill Aims to Increase Price Transparency On and Off Marketplace
A bill targeting the rising cost of prescription drugs on and off Vermont Health Connect (the State-based Marketplace) passed the Senate and House and awaits Governor Peter Shumlin's (D) signature. S.216 would require Vermont Health Connect carriers to provide formulary information online for enrollees, potential enrollees and providers, including covered prescription drugs, applicable out-of-pocket costs, drug tiers, prior authorization, step therapy and utilization management requirements. The bill also directs the Department of Vermont Health Access to convene an advisory committee to develop options for standard bronze-level qualified health plan benefit designs that include at least one plan with a higher out-of-pocket (OOP) limit on prescription drug coverage than currently established in State law and two or more plans with OOP limits at or below current law. Finally, among other provisions, the bill would also require pharmaceutical manufacturers who sell prescription drugs on which the State spends "significant health care dollars" and for which the acquisition cost has increased by a certain percentage to justify the increases. The State would fine any manufacturer that does not provide documentation $10,000 per violation and would post all written justifications online.