Morning Briefing
Summaries of health policy coverage from major news organizations
Advocates Cheer New Rx Rules To Prevent Discrimination
Politico Pro: Groups Seek More Drug Benefit Enforcement
In a proposed rule issued late Friday, CMS wrote that if an insurer places “most or all” drugs for a specific condition on tiers with the greatest out-of-pocket spending requirements, “we believe that such plan designs effectively discriminate against, or discourage enrollment by, individuals who have those chronic conditions.” ... Carl Schmid, deputy executive director of the AIDS Institute, was pleased to see such language but said it will mean little if not enforced. (Pradhan, 11/25)
Modern Healthcare: Medicaid, CHIP Coverage At Risk For Thousands Of Pre-ACA Enrollees
Many states are struggling to re-enroll adults and children in Medicaid and the Children's Health Insurance Program, with hundreds of thousands of current beneficiaries at risk of losing coverage, advocates say. The enrollees who are at greatest risk are pregnant women, children and blind and disabled individuals who were enrolled in Medicaid prior to the effective date of two Patient Protection and Affordable Care Act provisions—the 2014 expansion of coverage to all adults with incomes up to 138% of the federal poverty level, and the establishment of a new formula to define household income under the Modified Adjusted Gross Income (MAGI) standard. (Dickson, 11/25)
Meanwhile, the administration warns employers against dumping high-cost workers into government insurance exchanges -
Kaiser Health News: Administration Warns Employers: Don’t Dump Sick Workers From Plans
As employers try to minimize expenses under the health law, the Obama administration has warned them against paying high-cost workers to leave the company medical plan and buy coverage elsewhere. Such a move would unlawfully discriminate against employees based on their health status, three federal agencies said in a bulletin issued this month. (Hancock, 11/25)
Kaiser Health News: Turning 21? Here’s How To Avoid A Big Hike In Health Insurance Premiums
For young people, turning 21 is generally a reason to celebrate reaching adulthood. If they’re insured through the federal health insurance marketplace that operates in about three dozen states, however, their birthday could mean a whopping 58 percent jump in their health insurance premium in 2015, according to an analysis by researchers at the Center on Budget and Policy Priorities. The reason: They’re no longer considered children under the age-rating rules insurers use to set premiums. (Andrews, 11/25)
