Health Coverage & Costs: Recent News and Reports


Disclaimer: Reprinted material and links to third-party websites are for information only and are not intended to reflect NCSL policy or editorial decisions.

Connecticut law bars Trump administration's short-term health insurance plansCT Mirror, August 2018. 
The Connecticut Insurance Department has determined state law prohibits the sale of skimpy "short term" plans that are being promoted by President Donald Trump as a cheaper alternative to Affordable Care Act coverage. “Connecticut already has the necessary statutory consumer protections in place to prohibit ‘junk plans’ ” Insurance Commissioner Katharine Wade said in a statement released Thursday. The department also said a review of the new Trump administration rules for short-term, limited duration plans require any of these policies sold in the state to cover the Affordable Care Act’s comprehensive “essential health benefits.”

      Other states, including New Jersey and Massachusetts, also regulate short-term plans to make them follow nearly all the same insurance rules that the Affordable Care Act plans have. In some of those states, carriers have decided against offering any short-term plans at all.

ACA Exchanges See Market Expansions and Few Exits - Health Plan Weekly -7/11/2018
Against heavy odds, the Affordable Care Act (ACA) health insurance exchanges are stabilizing, and plans’ preliminary premium rates for 2019 are falling below last year’s rates, industry consultants and Wall Street analysts say. In Florida, for example, state regulators said nine companies submitted rate filings for individual ACA-compliant products for 2019, seven of them to participate on exchanges. Plans’ average requested rate hike of 8.8% for 2019 in Florida is down from this year’s 18% increase. (Read full article)

The Washington Post: States Act On Their Own To Fill Holes Washington Is Knocking In Affordable Care Act
The first Sunday after his inauguration, New Jersey Gov. Phil Murphy signed an executive order directing state agencies to report everything they could do to ramp up the visibility of the Affordable Care Act and persuade more people to buy health coverage under the law. Four months later, the Democratic governor signed into law a requirement that makes New Jersey the first state in a dozen years to compel most residents to carry insurance. As bureaucrats in Trenton scramble to set the mandate in motion, New Jersey’s decisions are at the forefront of a nascent movement with states stepping out on their own to counteract Washington’s efforts to erode the ACA. (Goldstein, 7/1/2018)

Majority of people who signed up in ACA exchanges came from Trump states. 

Majority of people who signed up in ACA exchanges came from Trump states

(Joe Raedle/Getty Images)

A year-end 2017 analysis found that more than 4 in 5 people, or 7.3 million of the 8.8 million Americans who signed up for Affordable Care Act plans through the federal exchange this year, came from states that voted for President Donald Trump in 2016. Figures also showed that Florida, Texas, North Carolina and Georgia, which had the highest sign-up rates and accounted for almost 3.9 million enrollees, were all Trump states. CBS News/The Associated Press, 12/26/2017.

  •  Make health care a right-Oregon state lawmakers vote. Oregon's Legislature took a step Feb 13 toward enshrining the right to health care in the state Constitution, a move that would be unprecedented in the United States but raises serious funding questions.The House of Representatives' 35-25 endorsement of the bill sends it to the state Senate, whose approval would put the proposed constitutional amendment on the ballot for Oregon voters in the November election. The move comes as the Trump administration has tried to dismantle former President Barack Obama's health care law. 
    Amending the constitution to establish health care as a right would be unprecedented in the United States, according to Richard Cauchi of the National Conference of State Legislatures. "Some states have an extensive history of considering universal health coverage, going back 15 to 20 or more years," Cauchi said. "However, no such binding ballot question language has been passed and added to a state constitution." ABC News/AP, Feb. 13, 2018.

G.O.P. Attacks on Obamacare Expand Role of Government. Efforts by Republicans to chip away at the Affordable Care Act have left behind a health program ever more reliant on subsidies.While President Trump has insisted that the health law was “essentially” being repealed, what remains of it appears relatively stable. Read article from the NYTimes, 12/27/2017

How states can save the individual mandate.
As Congress moves toward repealing Obamacare's individual mandate, a growing number of states are exploring creating their own.
      In California, Maryland, and the District of Columbia, there are already discussions swirling about how a state could set up its own requirement to purchase health coverage. These are states (and one district) that have their own insurance marketplaces and are generally supportive of the Affordable Care Act. > Published full text by  Dec 8, 2017

Comparing state-run and federally-run health exchanges:
A) Fewer issuers apply to participate in Federally-run Health Insurance Exchanges for 2018 (
Posted by CMS, 7/10/2017)
"The Centers for Medicare & Medicaid Services (CMS) announced (July 10, 2017) that 141 individual market qualified health plan (QHP) issuers submitted initial applications to offer coverage using the Federally-facilitated Exchange eligibility and enrollment platform in 2018. At the initial filing deadline last year, 227 issuers submitted an application compared to 141 this year, a 38 percent drop in filings. At the beginning of the open enrollment period for 2017 coverage, issuer participation had fallen from 227 initial applicants to only 167 issuers actually participating, a drop of 26 percent. Each participating issuer is required to sign a final QHP contract by the end of September in order participate in the Exchange in 2018. “This is further proof that the Affordable Care Act is failing,” said CMS Administrator Seema Verma. “Insurers continue to flee the Exchanges, causing Americans to lose their choice for health insurance or lose their coverage all together. These numbers are clear: the status quo is not working. The American people deserve healthcare choices and access to quality, affordable healthcare coverage.” Submissions were made by issuers in the 39 states that use the Federal Exchange eligibility and enrollment platform. CMS expects this number to fluctuate over the next several months as it has in past years. Rates will be finalized by mid-August."

Date /

Plan Year

39 Federally-run states

Initial QHP Submission

Open Enrollment QHOs: November
PY 2016 281 237
PY 2017 227 167
PY 2018 141 TBD

B) State Health Exchange Leaders Support Bipartisan Bill Efforts. - Oct. 23, 2017
The State Health Exchange Leadership Network has written a letter commending the Alexander-Murray bipartisan Senate bill that seeks to stabilize health insurance markets. Addressing Senate and House leaders, the nine executive directors of state-based health insurance marketplaces, wrote, “We applaud the bipartisan effort of the Senate to advance a bill that seeks to address the desperate need for short-term stability to our health insurance markets… Many of our states have already begun negotiations for our 2019 insurance products and swift action on this bill would provide timely information to help ensure lower rates and broaden choice for our consumers.”

C) Issuers Hold Steady in State-based Exchange States. (compiled by NASHP, 7/12/2017)
On Monday, July 10th, the Centers for Medicare and Medicaid Services (CMS) released a tally of issuer submissions to offer individual market coverage through the Federally-facilitated Exchange. The National Academy for State Health Policy (NASHP) conducted an analysis of preliminary rate filings for states that have opted to run a State-based Exchange (SBE), finding that issuer participation is anticipated to remain steady in the SBE states. NASHP will track and updates submission as they become finalized early in the fall. “SBE officials remain hard at work in partnership with their state insurance departments and issuers to maintain consumer choice for exchange enrollees, said NASHP Executive Director, Trish Riley. “These states are working to preserve affordable options amid uncertainty over national policies of consequence to insurance markets including funding for cost-sharing reduction (CSR) payments and further regulatory and legislative reforms made to the Affordable Care Act.”

Total number of issuers offering individual market coverage through the State-based exchanges[1]
  2016 2017 2018
  Proposed Final Proposed Final Proposed
California 12 12 11 11 N/A[2]
Colorado 10 8 7 7 7
Connecticut 4 4 3 2 2
District of Columbia 2 2 2 2 2
Idaho 5 5 5 5 4
Maryland 5 5 3 3 5
Massachusetts 9 10 9 9 N/A2
Minnesota 4 4 4 4 N/A2
New York 15 15 14 14 13
Rhode Island 3 3 2 2 2
Vermont 2 2 2 2 2
Washington 8 8 6 6 6

[1] States that operate as SBEs using the federal platform, Kentucky, Nevada, New Mexico and Oregon, were not included in NASHP’s analysis as they were included in the CMS tally released on July 10, 2017.[2]  not yet been publicly posted.

C) The Same Agency That Runs Obamacare Is Using Taxpayer Money to Undermine It
Three ways the Department of Health and Human Services has campaigned against the current health law. The Trump administration said on Aug. 31 that it would slash spending on advertising and promotion for the Affordable Care Act, but it has already been waging a multipronged campaign against it.  Anti-Obamacare infographics tweeted by Mr. Price:

HHS Anti-Obamacare infographics tweeted by Mr. Price- NYTimes 9/4/17Graphics by HHS; NY Times Posted 9/4/2017; print edition 9/10/2017.

Using Cost Estimators to Help Consumers Understand Health Plan Costs - February 2017 report
The Affordable Care Act’s health insurance marketplaces were designed to help consumers buy insurance on their own. In the marketplaces, people can and compare plans in one place. However, shopping for insurance can still be challenging. Consumers are very interested in—but often confused by—a health plan’s cost.
      A new issue brief explores the marketplace’s use of total cost estimators—tools that help consumers estimate a plan’s total costs, including premiums, subsidies, and expected cost-sharing. Through interviews with marketplace officials and other stakeholders, the authors for The Commonwealth Fund examine the benefits and challenges of these tools. Read full report ...Understand Health Plan Costs. Published 2/9/2017.

 ACA Round-Up: House Replacement Principles, New Bills, And Coverage Rate Updates [Read full analysis by Prof Tim Jost] Health Affairs, 2/17/2017  *NEW*

Health Insurance: What If You Could Take It With You? - [Read More] - Kaiser Health News, 3/1/2017.
Republican leaders "have promoted the idea that consumers should have a “health care backpack,” which would make it possible to take insurance from job to job or when moving, starting a business or retiring. T"he concept — often referred to as “portability” — is appealing. Why should a health plan be tied to where you work or live?" 

12.2 Million Sign Up for 'Obamacare' Despite Its Problems.  "More than 12.2 million people have signed up for coverage nationwide this year under the Obama-era health care law even with the uncertainty created by President Donald Trump's vow to repeal and replace it.... A count by The Associated Press shows that many consumers returned to the program despite its problems. Aside from the political turmoil, those difficulties include a spike in premiums, rising deductibles and dwindling choice of insurers." [Read full article] AP/NY Times Feb. 10, 2017

Legal Analysis: CBO Releases Report On Effects of ACA Repeal.  Health Affairs, Prof. Timothy Jost, Jan. 17, 2017

NCSL in the News- Federal Actions Affecting States.

On March 13 the Senate confirmed Seema Verma to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). After her swearing in on March 14, she and Health and Human Services Secretary (HHS) Tom Price, M.D., took their first joint action by cosigning a letter to the nation’s governors that commits their support for state initiatives aimed at improving health outcomes, and pledges to ensure long-term sustainability of the program. The letter outlines key areas where efforts will be made to improve collaboration with the states including:

  1. facilitating expedited approval of waiver and demonstration project extensions.
  2. declaring their intent to use existing Section 1115 demonstration authority to review and approve innovations with training, employment and independence.
  3. creating greater alignment between Medicaid’s design and benefit structure with common features of commercial health insurance.
  4. providing additional time for states to comply with the Jan. 16, 2014, Home and Community-Based Services (HCBS) rule. These rules have been of some concern to many states in that the requirements may jeopardize the availability of care for beneficiaries in rural areas, or alter arrangements for beneficiaries that have produced successful outcomes. The regulations were meant to be fully implemented by March 17, 2019. Additional Resources on the Program
  5. expressing a commitment to ensure that states have the tools they need to combat the growing opioid epidemic. CMS will continue to work with states to improve care under the Medicaid state plan and through the Medicaid Innovation Accelerator Program. In addition, CMS will strive to develop a more streamlined approach for the Section 1115 substance abuse treatment demonstration opportunities.

NCSL has posted additional details regarding this action on the NCSL website

Hawaii measures aim to save 'best parts' of Obamacare | Because of the rapidly shifting discussion in Washington, many state lawmakers around the country are grappling with what kind of bills to introduce to preserve parts of the Affordable Care Act, said Richard Cauchi, health program director at the NCSL. Fox News | NY Times - Feb. 1, 2017.

The State of Health Insurance, 2017 Webinar. NCSL hosted this webinar on Jan. 6, 2017, to provide a federal and state-oriented look at the private health insurance market. 2017 will bring significant changes, choices and challenges to health insurance in the United States. View three national experts’ slides on developments and policy scenarios. View PowerPoint slides and the NCSL overview with more links. |

Archive of Health News and Reports, 2016

The costs of health services and delivery in the United States continues to be a major concern.  The $3.2 trillion total calculated for 2016 is predicted to continue to climb.  The federal Affordable Care Act (ACA) and a variety of state and commercial market initiatives seek to address this trend to "bend the health cost curve."  NCSL's Health Cost Containment Project tracks two dozen or more promising practices in a series of publications, reports and articles.

News Table of Contents

Hand-Wringing Over the Affordable Care Act Forgets How Very Far We Have Come

The latest round of news about insurance company exits and price increases in the Affordable Care Act marketplaces has sparked more hand-wringing about the future of the law. But to truly assess how the law is working, we need to remember where we were, before the ACA, and how far we have come. Sabrina Corlette author,  Georgetown Univ. Center for Healt Reforms. Posted 9/26/2016

Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces.
Aug 28, 2016 - (Read the full report online) by Kaiser Family Foundation
This report provides a preliminary picture of the potential effect insurer exits and entrants may have on competition and consumer choice in the Affordable Care Act (ACA) marketplaces. This analysis was done at the request of the Wall Street Journal.

  • The August analysis found that UnitedHealth’s absence from these markets would leave many parts of the country with fewer marketplace insurers, and that the number of counties with a single insurer would likely increase substantially if there were no new entrants.
  • Similarly, the July analysis of insurer participation in 17 states with detailed, publicly available premium and participation data found that on average there would be fewer insurers participating in 2017 in these states than there had been in 2016 or 2015.

Can’t Find A Plan On HealthCare.Gov? One May Be Picked For You.  The federal government will choose health plans for hundreds of thousands of consumers whose insurers have left the Affordable Care Act marketplace unless those people opt out of the law’s exchanges or select plans on their own, under a new policy to make sure consumers maintain coverage in 2017. “Urgent: Your health coverage is at risk,” declares a sample “discontinuation notice,” drafted by the government for use by insurers. It tells consumers that “if you don’t enroll in a plan on your own, you may be automatically enrolled in the plan picked for you.” The New York Times: (Full Article by R. Pear), published 10/8/2016

NY Regulators Announce Measure To Protect Some Insurers
New York's Department of Financial Services has issued an emergency regulation intended to help the state's health insurers deal with a federal requirement that puts some under sharp financial stress. The federally mandated program for adjusting financial risk under the Affordable Care Act transfers pooled funds to plans showing higher-risk clients. (Associated Press, 9/11/2016)

Drivers of 2016 Health Insurance Premium Changes.
The Affordable Care Act (ACA) established three premium stabilization programs: the permanent risk adjustment program and the transitional risk corridor and reinsurance programs. These programs were modeled after similar risk sharing programs in the Medicare Part D prescription drug program that have contributed much toward that program’s success. They have provided some stability for the first three years of the implementation of the Affordable Care Act’s individual and small group market reforms; the reinsurance program is credited with reducing marketplace premiums for 2014 by 10 to 14 percent and for 2015 by 6 to 11 percent. Posted by Health Affairs, Prof. Tim Jost, Sept. 12, 2016.


Colorado: Analysis of Universal Coverage Ballot Amendment -  2016 not passed by voters
A financial analysis from the Colorado Health Institute (CHI) examined the viability of a proposed constitutional amendment to create a system of universal state health care coverage called ColoradoCare. The analysis projects that ColoradoCare would break even in its first year (2019) while extending coverage to all Coloradans (6.7 percent of whom remain uninsured). The program could slide into deficits in future years due to insufficient tax revenue and federal funds.


Disclaimer:  Reprinted material and links to third-party websites are for information only and may not reflect NCSL policy or editorial decisions.

Updated by Richard Cauchi, NCSL Health Program, Denver