RISE summarizes the latest regulatory headlines.

HHS touts success of ACA but warns millions could lose coverage without ARP subsidies

A new report, released by the U.S. Department of Health and Human Services (HHS) on the 12th anniversary of the Affordable Care Act, promotes the success of the American Rescue Plan (ARP) investments, noting for millions of people coverage is up and prices are down with 2.8 million more consumers receiving tax credits to help with health coverage premium costs. Marketplace plans were more affordable due to the ARP, contributing to a record breaking 14.5 million consumers nationwide signing up for health care coverage–a 21 percent increase from last year. Without the ARP, the average monthly premium after Advanced Premium Tax Credit (APTC) for HealthCare.gov enrollees would have been $59 per month higher, or 53 percent higher, HHS said in an announcement. The department warns that an estimated 3.4 million Americans currently insured in the individual market would lose coverage and become uninsured if the ARP’s premium tax credit provisions are not extended beyond 2022. 

Politico report: Health care organizations in nearly every state had a health data breach in 2021

A new Politico analysis of HHS data reveals that nearly 50 million Americans had their sensitive health data breached last year. Hacking accounted for nearly 75 percent of all breach compared to 35 percent in 2016. Politico found that health care organizations (including providers and insurers) in every state except South Dakota reported a breach. Factors for the surge in incidents include the health care industry’s rapid move to digital among the pandemic, an increase in remote work, and greater reporting of attacks. The threat is only going to grow as the US prepares for potential Russian cyberattacks in retaliation for support of Ukraine. Click here to read the full report.

Dr. Lorna Breen Health Care Provider Protection Act becomes law

President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act, which authorizes the funding of programs to improve mental and behavioral health among health care providers. The bi-partisan sponsored legislation will help promote mental and behavioral health among those working on the frontlines of the pandemic. It also supports suicide and burnout prevention training in health professional training programs and increases awareness and education about suicide and mental health concerns among health care professionals. The legislation is named after Breen, an emergency room physician who committed suicide in April 2020 after weeks of treating COVID patients.

Federal appeals court throws out Texas payer’s challenge to ACA risk adjustment rules

The U.S. Court of Appeals for the 5th Circuit threw out a Texas health plan’s challenge to federal risk adjustment rules and how the HHS calculated its risk adjustment charges. The risk adjustment program under the Affordable Care Act redistributes actuarial risk among health insurance plans so those patients who are sicker-than-average can afford health care coverage. Vista Health Plan argued in the U.S. District Court for the Western District of Texas that it was assessed for risk-adjustment fees that exceeded its premium revenue, which eventually led to the company’s closure. The lower court ruled in favor of HHS and Vista appealed the decision. But the appeals court reaffirmed the district court’s decision on mainly procedural groups, noting that the issues were due to harmless error by HHS or lacked merit.

Study: CMS primary care initiative hasn’t reduced fragmentation of care

A March study published in the American Journal of Managed Care found no evidence that the Comprehensive Primary Care Plus (CPC+) Initiative has increased continuity or decreased fragmentation of care. The study aimed to determine the associations between the large-scale primary care redesign and the extent of continuity or fragmentation of ambulatory care for Medicare fee-for-service beneficiaries during the first three years of CPC+. Researchers focused on beneficiaries with highly fragmented care from January 2016 through December 2019. They measured the numbers of ambulatory visits and unique practitioners, reported by specialty category, the percentage of visits with the usual provider of care, and the reversed Bice-Boxerman Index. Study authors found no differences in continuity or fragmentation of care for CPC+ version comparison beneficiaries.

Key takeaways from AHIP’s state of Medicare supplement coverage report

A recent study from AHIP examined trends in Medicare supplement coverage enrollment and demographics. Among the main findings:

  • Among fee-for-service (FFS) Medicare enrollees without additional insurance coverage (such as Medicaid, employer-provided insurance, etc.), 53 percent had Medicare Supplement coverage in 2020.
  • Between December 2017 and December 2020, the share of Medicare FFS beneficiaries who purchase Medicare Supplement coverage increased from 35 percent to 39 percent.
  • Medicare enrollees with Medicare Supplement coverage were three times less likely to have problems paying medical bills compared to enrollees without Medicare Supplement policies. Only four percent of enrollees with Medicare Supplement coverage reported having difficulty paying medical bills in the last 12 months, compared to 12 percent of FFS Medicare enrollees without Medicare Supplement coverage.

COVID budget impasse could have devastating consequences for uninsured

The federal government is running out of money to cover medical bills for COVID tests and treatments for uninsured people and has stopped taking claims, the Associated Press reports. The uninsured program has been in operation since the Trump administration but is unable to continue operating due to the budget impasse between Congress and the White House over the Biden administration’s request for additional money for ongoing COVID response. The program reimburses health care providers for COVID care for uninsured people. “The lack of funding for COVID-19 needs is having real consequences," Martin Kramer, a spokesman for the Health Resources and Services Administration, told AP in a statement. “We have begun an orderly shutdown of the program."