In this update:
- Legislative Update
- CBO Answers Congressional Questions on Changes in Spending Projections
- Federal Agencies
- HHS Awards $558 Million to Improve Maternal Health
- HHS Awards $100 Million to ACA Marketplace Navigators
- Other Updates
- KFF Publishes Report on ACA Marketplace Physician Networks
Legislative Update
CBO Answers Congressional Questions on Changes in Spending Projections
On August 22nd, the Congressional Budget Office (CBO) published a document continuing answers to Congressional questions on changes in its spending projections. Among the issues CBO addressed were changes in projections of health care spending. In particular, CBO was asked about the causes of the very large reduction ($6.3 trillion) in estimated spending during the period from 2010-2033 from CBO’s original 2010 estimate. CBO noted the most significant source of the overestimate from the 2010-2020 period was lower-than-anticipated spending on prescription drugs in Medicare Part D. Its estimate for the 2021-2023 period has been changed to reflect the overall slower rate of growth in federal spending on health care programs in recent decades.
CBO was also asked about the causes of the increase in estimated spending on Affordable Care Act (ACA) premium tax credits and related spending. CBO’s most recent baseline projects that ACA subsidies will cost $1.3 trillion in the next decade ($1.7 trillion if enhanced credits are extended), up from $600 billion in its September 2020 projection. CBO indicated that while some of the increase in estimated cost is due to different projection periods, the primary driver is larger projections of enrollment in Marketplace plans. This increase is driven by more generous subsidy availability from the American Rescue Plan (ARP) and Inflation Reduction Act (IRA) during the period up to 2025. After 2025, the projected higher enrollment is partly due to other factors, including changes to CBO’s economic and demographic forecast and immigration. Another contributor is administrative actions to ease access, including changes to affordability standards for dependents (in determining premium tax credit eligibility), the continuous special enrollment period for individuals with income less than 150% FPL, and the elimination of some income verification steps in the eligibility determination process.
The CBO document is available here.
Federal Agencies
HHS Awards $558 Million to Improve Maternal Health
On August 27th, the Department of Health and Human Services (HHS) announced over $558 million in maternal health grants. The grants were administered through the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC). HRSA is awarding more than $440 million through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program Awards, which expand maternal, infant, and early childhood home visiting services for eligible families. The New York State Department of Health will receive over $12 million in MIECHV funding. The CDC will distribute $118.5 million over five years to 46 states and six territories to expand support to Maternal Mortality Review Committees (MMRCs), which will better identify and prevent pregnancy-related deaths.
The announcement is available here.
HHS Awards $100 Million to ACA Marketplace Navigators
On August 26th, HHS announced $100 million in awards to ACA marketplace navigators. Navigators offer free assistance to individuals enrolling in plans on HealthCare.gov, the federal health insurance marketplace which covers 31 states, including reviewing available plans, assisting with eligibility and enrollment forms, and helping with enrollment/renewal of Medicaid and Children’s Health Insurance Program (CHIP) coverage. The grants are part of a larger HHS commitment of $500 million to support these services as marketplace enrollment hits record highs. In this installment, HHS is funding 44 grantees in states using HealthCare.gov. (New York does not use HealthCare.gov.)
The announcement is available here.
Other Updates
KFF Publishes Report on ACA Marketplace Physician Networks
On August 26th, the Kaiser Family Foundation (KFF) released an analysis of physician networks serving ACA Marketplace plans. KFF compared 2021 physician workforce data to 2021 provider networks of federal and state-based Marketplace plans. On average, researchers found that Marketplace enrollees had in-network access to 40% of physicians near their home (using CMS’ network adequacy standards). Access varied widely, with 23% of enrollees in a plan that included 25% or fewer local physicians (a metric some researchers use to define “narrow network plans”), while just 4% of enrollees in a plan with more than 75% of area doctors. Some of the narrowest networks were in large metro counties, where, on average, enrollees had access to 34% of physicians. On average, plans with higher shares of physicians in-network had higher premiums.
The report is available here.