Word from Washington: December 2023

Mid-December, for many people, marked the close of the open enrollment period for health insurance plans that will provide coverage beginning January 1, 2024. Preliminary data shows that enrollment in  Affordable Care Act (ACA) Marketplace coverage during the open enrollment period continued to grow at a record-breaking pace. The federal government projects that over 19 million Americans will end up enrolling in Marketplace plans for 2024. 

If you missed the December deadline, please note that you may still have time to sign up for or change your 2024 health insurance via healthcare.gov!  

You can still sign up for insurance that begins Jan. 1 in the following states: 

• Massachusetts (deadline is December 23) 
• California, Maryland, Nevada, New Jersey, New Mexico, Rhode Island (deadline is December 31) 

You can still sign up for ACA insurance that begins Feb. 1 via the extended open enrollment period that continues through at least Jan. 15, 2024, everywhere except for Idaho.  

If you need insurance but didn’t sign up before Dec. 15, use this extended opportunity to get coverage for 2024. And, if you find yourself re-enrolled in a plan that is more expensive than you expected, you may be able to use the extra time in this extended open enrollment period to change your coverage and avoid higher costs for at least the months of February-December 2024. (Remember, too, that enrollment in Medicaid, for those eligible, is open year-round. And special enrollment opportunities exist, separate and apart from the open enrollment period, for people who experience qualifying life events.) 

Quick Hits: 

• Litigation over the U.S. government’s copay accumulator rules continues. As previously reported, patient groups in late September won a district court ruling that vacated HHS (U.S. Department of Health & Human Services) rules from 2021 that allow health plans to implement copay accumulator adjusters. In November, HHS appealed that decision, asked the district court for clarification of its ruling, and informed the court that, pending new agency rulemaking, “HHS does not intend to take any enforcement action against issuers or plans based on their treatment of such manufacturer assistance.” In other words, HHS would not enforce previous (2020) rules curtailing the use of copay accumulators – even though the court’s reversal of the 2021 rule presumably reinstated the 2020 rule as governing law. Patient groups in December opposed the appeal and asked the district court to instruct HHS that the agency “may not lawfully erect an across-the-board policy of non-enforcement” of the 2020 rule. Meanwhile, 48 House lawmakers and 17 Senators (collectively, bipartisan sponsors of the HELP Copays Act) urged HHS to drop its appeal and enforce the 2020 rules. 
• Alarmed by ongoing problems in the Medicaid unwinding, the U.S. Centers for Medicare and Medicaid Services (CMS) published new rules to enforce state compliance with federal Medicaid reporting and renewal requirements. States that fail to file required monthly redetermination reports will have to submit corrective action plans. States that remain out of compliance may see their federal funding docked, and/or may be subjected to civil money penalties.  
• The House of Representatives passed a package of PBM (pharmacy benefits manager) reforms on Dec. 11. H.R. 5378, the “Lower Costs, More Transparency” Act, would subject PBMs to new transparency requirements and would ban the use of spread pricing in Medicaid (requiring PBMs to charge set fees, rather than percentage amounts, for their services in negotiating drug prices). No Senate legislation precisely matches H.R. 5378, but various Senate committees have advanced bills that contain similar provisions. 
• On Dec. 20, the U.S. Department of Labor published a proposal to rescind a 2018 rule that expanded the availability of association health plans, a form of coverage that sidesteps important ACA patient protection standards. The AHP rule has been in limbo since a federal court struck it down in 2019. HFA and allied patient groups applauded the Department of Labor’s latest proposal, noting that AHPs have historically proven risky for enrollees and have a history of financial mismanagement.