Rep. Kevin Brady, chair of the House Ways and Means Committee, said during a budget hearing on Thursday that immediate action is necessary to stabilize the individual insurance market if the GOP wants to avoid being blamed for rising premiums and the lack of marketplace plan options in 2018. Brady, a Republican, called for temporary funding of the subsidy payments to allay uncertainty among insurers while Congress works on repealing and replacing the Affordable Care Act (ACA). 

Donald Trump has threatened more than once to halt the payments in an attempt to force Democrats to negotiate on a replacement bill. Dr. Tom Price, secretary of Health and Human Services, said the proposed budget provides for two more years of the subsidies but would not guarantee that they would continue. Some insurers have said their premiums will increase by more than 20 percent if the ACA’s individual mandate and cost-sharing subsidies are eliminated, but increases would be less than 10 percent in many cases if the subsidies stay in place. Insurers must file their ACA exchange plans with the federal government by June 21. 

State insurance commissioners are trying to calm wary insurers by offering more flexibility in their own timelines and pricing strategies. Some commissioners are considering options such as state-administered reinsurance programs, tax relief incentives and allowing insurers to file more than one round of premium requests.

Meanwhile, New York Governor Andrew Cuomo issued emergency regulations to offset the deleterious effects of a possible ACA repeal. The regulations will require insurers that participate on the state’s insurance exchange to offer the same 10 essential health benefits required by the ACA and prevent insurers from discriminating against consumers based on pre-existing conditions, age or sex. They will also ban insurers that withdraw from New York’s ACA marketplace from participating in Medicaid and other state insurance programs. The regulations protect access to reproductive health services and cost-free contraception, as well. 

Likewise, Colorado Governor John Hickenlooper is considering barring Anthem from state Medicaid contracts if Anthem chooses to leave the state’s ACA marketplace. If Anthem does exit, 14 counties in Colorado would have no ACA plan options next year.

In Texas, state Medicaid officials are requesting that the CMS extend the state’s Medicaid waiver program, even though survey results regarding the program were mixed, at best, and often negative. Texas opted not to expand its Medicaid program under the ACA but received approval for a waiver in 2011 that provides $4 billion year in federal funding to cover uncompensated care. 

In Nevada, the state legislature passed a bill that would give all residents the opportunity to participate in a proposed Medicaid-for-all program. The Nevada Care Plan would operate within the state’s Medicaid program but wouldn’t technically be Medicaid; it would be offered through the state’s marketplace exchange, and residents theoretically could use their ACA tax credit to help pay for costs. If Governor Brian Sandoval takes no action on the bill by this Friday, it will automatically become law—but it wouldn’t go into effect until Jan. 1, 2019. 

Separately, Nevada Governor Sandoval vetoed a bill passed by the state Senate and Assembly that targeted diabetes drug pricing. He said the proposed legislation could lead to unintended consequences for consumers, and it ignored the role pharmacy benefit managers (PBMs) play in pricing, FiercePharma reported. In response, lawmakers quickly passed a broader version of the bill that not only would require drugmakers to disclose their profits on essential diabetes drugs, but also would require PBMs to disclose rebate information. The new bill reportedly has garnered greater support from the governor. 

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