HHS Broadens Catastrophic Coverage Eligibility On ACA Exchange
Starting Nov. 1, Affordable Care Act participants who don't qualify for the advanced subsidies or cost-sharing reductions may apply for a hardship exemption. In other news: ACA insurers might need to revise 2026 prices; companies and their employees are looking at higher health care costs; and more.
Fierce Healthcare:
Trump Administration Expands Access To ACA Catastrophic Plans
The Trump administration unveiled plans to expand access to catastrophic plans on the Affordable Care Act's (ACA's) exchanges as the expiry of enhanced premium tax credits looms. The Department of Health and Human Services (HHS) said Thursday that consumers who do not qualify for the advanced subsidies or cost-sharing reductions can apply for a hardship exemption beginning Nov. 1, the first day of open enrollment for the marketplaces. (Minemyer, 9/4)
Modern Healthcare:
ACA Enrollment Appeal Forces Insurers To Retool Prices For 2026
A federal court ruling could drive many exchange insurers to scrap their plans for 2026 — again. Perhaps ironically, the latest complication facing health insurance exchange carriers is connected to a legal victory against a Centers for Medicare and Medicaid Services regulation that likely would suppress exchange membership. (Tepper, 9/4)
The New York Times:
Health Care Costs For Workers Begin To Climb
Employees of large and small companies are likely to face higher health care costs, with increases in premiums, bigger deductibles or co-pays, and will possibly lose some benefits next year, according to a large survey of companies nationwide that was released on Thursday. The survey of 1,700 companies, conducted by Mercer, a benefits consultant, indicated that employers are anticipating the sharpest increases in medical costs in about 15 years. Higher drug costs, rising hospital prices and greater demand for care are all contributing factors, experts said. (Abelson, 9/4)
On Medicaid cuts and the uninsured —
Politico:
Plans For Second GOP Megabill Face Growing Skepticism
Republican hopes of pursuing a second major domestic policy package this year are running into major roadblocks as they confront a lack of consensus and a grand, unifying goal — like the extension of sweeping tax cuts that held the last megabill together. The bearish view — already prevalent inside the Senate GOP — is now taking hold among some members of Speaker Mike Johnson’s leadership circle, after he was touting the possibility of a fresh party-line bill as he worked to push the first package across the line in July. (Hill and Carney, 9/5)
AP:
New Mexico Governor Urges Lawmakers To Protect Safety Net Programs
New Mexico’s governor is calling on state lawmakers to shore up safety net programs in response to federal spending cuts enacted by President Donald Trump, in an announcement Thursday that highlighted reduced federal support for Medicaid and food assistance programs. More than 40% of New Mexico residents are enrolled in Medicaid health care for people living in poverty or on the cusp — among the highest rates in the nation. (Lee, 9/5)
North Carolina Health News:
Medicaid Cuts Threaten Care For NC Residents With Severe Disabilities
Jennifer Shigley can’t speak or walk without assistance. The 49-year-old also cannot feed or bathe herself. Her father, a retired child psychologist, described her as having the mental capacity of a toddler. “She requires total care,” Hal Shigley said. “Thank goodness she is in a facility where she’s taken good care of.” (Baxley, 9/5)
KFF Health News:
Trump Administration Investigates Medicaid Spending On Immigrants In Blue States
The Trump administration is taking its immigration crackdown to the health care safety net, launching Medicaid spending probes in at least six Democratic-led states that provide comprehensive health coverage to poor and disabled immigrants living in the U.S. without permanent legal status. (Hart and Shastri, 9/5)
KFF Health News:
He Built Michigan's Medicaid Work Requirement System. Now He's Warning Other States
It was March 2020, and Robert Gordon was about to kick some 80,000 people off health insurance. As the Michigan state health director, he had spent the past year, and some $30 million in state tax dollars, trying to avoid that very thing. Gordon was a Democrat, a veteran of the Obama administration, and he did not want people to lose the Medicaid coverage they had recently gained through the Affordable Care Act. (Wells, 9/5)
The (Cleveland) Plain Dealer:
MetroHealth Considers Cutting Charity Care For Some Uninsured Patients
In an effort to rein in spiraling spending on charity care, MetroHealth System is considering reducing free or discounted bills for some uninsured patients. The proposed reductions would hit, as an example, individuals making $39,000 to $63,000 annually, or a four-person family making $80,000 to $128,000 annually. (Washington, 9/5)
On Medicare Advantage —
Modern Healthcare:
UCare To Exit Medicare Advantage In 2026
UCare will exit the Medicare Advantage market in 2026, the company announced Thursday, citing financial challenges in the business. As of Aug. 1, the nonprofit carrier had 186,700 Medicare Advantage members across Minnesota and Wisconsin, up 31.3% from the same period last year, according to data from the Centers for Medicare and Medicaid Services. Overall, the company is one of Minnesota’s largest health insurers, with 600,000 total enrollees. It is the state’s second-largest Medicare Advantage carrier, trailing Blue Cross and Blue Shield of Minnesota, which has 242,500 members. (Tepper, 9/4)
Modern Healthcare:
Elevance Health Cuts Some Medicare Advantage Plans For 2026
Elevance Health will cut some Medicare Advantage plans and fully exit the Medicare Part D standalone prescription drug market next year. The for-profit Blue Cross and Blue Shield licensee will eliminate unprofitable Medicare Advantage plans covering approximately 150,000 individual and group members in total, Chief Financial Officer Mark Kaye said Thursday during the 2025 Wells Fargo Healthcare Conference. The company has prioritized HMO and Dual Special Needs Plan coverage for 2026, he said. (Tepper, 9/4)