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As Expected, States Will Have More Control and Greater Flexibility in Regulating Obamacare Starting in 2019

In a CMS press release the Trump Administration announced yesterday, as expected, that beginning in 2019 individual states will have more control and greater flexibility in regulating the individual health insurance market and the Obamacare Marketplace (aka the Exchange). In a summary of the “final 2019 Payment Notice Rule” CMS highlighted provisions that were intended to increase flexibility, improve affordability, and decrease administrative burdens.

 

It’s likely that changes made at the individual state level will ultimately have some impact either directly or indirectly on employer sponsored health coverage, particularly the small group market. We will be monitoring this very closely for our clients and will report back, especially as we get closer to 2019 and more information becomes available.

In the meantime, here’s a sampling of the headlines and links to the respective articles following yesterday’s announcement by CMS:

Here’s a link to the CMS press release:

 

Could 2018 End Up Being a Year of Improved Health Insurance Market Stability? Here are Five Reasons It Could Be the Case.

With healthcare seemingly out of the political crosshairs for the moment and any tectonic shifts emanating from a new Amazon/Berkshire Hathaway/J.P. Morgan Chase superpower health entity a ways down the road, employers may get to experience some at least temporary market stability in the way of more choices, more consistent rates, less volatile renewals, and more opportunities to innovate (e.g. SharedFunding).

Employers have grounds for hope, at least for the next year or so.

Here are five (5) reasons that may lead to at least some temporary stability and have positive impact on cost and selection in the group market:

  1. The total number of people insured is holding steady or possibly even increasing despite the repeal of the individual mandate.
  2. Interest and energy in employer sponsored plans is up. More employers are offering health coverage. Many are also trying to improve their health coverage in order to compete for and retain talent in a more robust job market and a stronger economy.
  3. Much of the market activity for both insurance carriers and healthcare providers is geared toward gaining scale while building a better mousetrap (eg. Aetna/CVS, Unitedhealthcare and other carriers acquiring providers, etc). Strategic M&A activity is expected to continue.
  4. More states are experimenting by exercising the state waiver option (more info here and here). While tinkering with the individual market and Medicaid will get most of the headlines, more control on the state level should spawn more innovation and new options in the group market especially for small and mid-size employers.
  5. Health systems are now focused on vertical integration and improving their overall value proposition. They’re jockeying for market position and attempting to win over patients and payors alike.

 

 

Health Coverage By the Numbers (vol 2): The Cost of Coverage and Employer Contributions

Job-based health insurance is still far and away the largest single source of health care coverage in the U.S. As we continue to work on behalf of clients to drive new and better ways to stem the tide of health care costs, here are some key stats from 2017 to ponder:

1.)  Average annual premium nationally for single coverage — .$6,690 (or $557 per month)

2.)  Average annual premium nationally for family coverage — .$18,764 (or $1,564 per month)

3.)  Generally speaking, most employers cover at least 50% of the employee’s cost of premium. Nationally, employers cover on average 81% of the cost of single (employee only) premium.

4.)  Not all employers contribute to family coverage. Employers that do contribute to family coverage, cover on average 69% of the cost to cover dependents.

Source: Kaiser Family Foundation

Health Coverage By the Numbers

Job-based health insurance is the largest single source of health care coverage in the U.S.

1.) Employer-sponsored insurance covers more than 157  million workers and their dependents.

2.) The next largest source of coverage, Medicaid, insures less than half as many, 63 million.

3.) Medicare enrolls 45 million;

4.) Individual market (on/off Marketplace) provides coverage for about 21 million.

Source: Kaiser Family Foundation (KFF.org)

 

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