Mary Agnes Carey's slides from the Center for Health Journalism webinar, "After the mandate, states plot their own futures for health coverage," 2.5.18 More info: https://www.centerforhealthjournalism.org/content/mandate-gone-what-happens-health-exchanges-now

1. After the Mandate: States Plan
Their Own Futures for Health
Coverage
Mary Agnes Carey
Partnerships Editor and Senior Correspondent
Kaiser Health News
USC Annenberg Center for Health Journalism Webinar
February 5, 2018

2. The ACA and Congress
• Tax bill includes ACA individual mandate penalty repeal beginning in
2019
• Another attempt at full ACA repeal unlikely
• ACA Stabilization Bills: House and Senate GOP leaders may be
warming to “reinsurance” legislation to help insurers cover the
highest-cost cases. Other measures would fund ACA “cost-sharing”
subsidies

3. Trump Administration Flexibility
• New rules proposed for Association Health Plans (AHPs)
• Allowing insurers to offer “short term” plans that do not comply with
the ACA requirements for a full year (up from 90 days)
• Supporters say these offer lower cost options for individuals and small
businesses. Critics say they lack important consumer protections and
draw young, healthy consumers out of market, adding to instability
• Medicaid flexibility, including work requirements
• New flexibility for ACA plans in 2019

4. How States Are Responding
• Maryland, California and the District of Columbia may create their
own versions of the individual mandate
• Idaho – State insurance officials will allow insurers to ignore some
ACA rules for plans not sold on the ACA marketplaces
• Kentucky and Indiana – HHS approved state requests to add Medicaid
work requirements. More state requests pending
• Oregon – Voters approved tax to fund Medicaid programs
• States that opposed Medicaid expansion might change their minds,
but seek work requirements and other flexibility

5. How Do I Cover This?
• How is your state insurance commissioner and/or legislature
responding to new ACA flexibility? Profile your state’s insurance
commissioner or a state lawmaker that heads a committee with
jurisdiction over health insurance.
• Interview a local broker or insurance agent and consumers about
what types of health insurance they’re buying. Are they interested in
ACA plans? Less generous policies?
• Find people who don’t qualify for ACA subsidies to help offset the
cost of premiums. Will they still buy coverage if they don’t have to
pay a penalty for not having it?

6. How Do I Cover This ? (continued)
• If your state didn’t participate in the ACA’s Medicaid expansion, are
lawmakers considering it now? Why or why not? Talk to your local
hospitals and community health centers.
• Find an individual (likely a single, childless adult) who could gain
health insurance coverage if his/her state expanded Medicaid. How
would having health coverage affect their lives? Have they postponed
medical treatment because they didn’t have coverage?
• If your state has expanded Medicaid, what would it mean for
beneficiaries if work requirements were added? Six in 10 Medicaid
beneficiaries already work and 8 in 10 come from working families.

7. Great Stories
Rising Health Insurance Costs Frighten Some
Early Retirees
• https://khn.org/news/rising-health-
insurance-costs-frighten-some-early-
retirees/
• Smart story about how ACA premiums can
be unaffordable for people who don’t
qualify for subsidies.

8. The Adults a Medicaid Work
Requirement Would Leave Behind
• https://www.nytimes.com/2017/02/
25/health/medicaid-work-
requirement.html
• This piece explained how some
Medicaid beneficiaries have struggled
to find and keep jobs due to health
reasons.
Great Stories (cont.)

9. Desperate For Coverage: Are Short-Term
Plans Better Than None At All?
• https://khn.org/news/desperate-for-
coverage-are-short-term-plans-better-
than-none-at-all/
• Nice explainer on what these plans are and
why people would want to buy them
rather than more comprehensive ACA
coverage.
Great Stories (cont.)

10. Great Stories (cont.)
Drug firms poured 780M painkillers into WV
amid rise of overdoses
• https://www.wvgazettemail.com/news/cops_a
nd_courts/drug-firms-poured-m-painkillers-
into-wv-amid-rise-of/article_99026dad-8ed5-
5075-90fa-adb906a36214.html
• The Gazette-Mail in Charleston, W.Va.,
obtained previously confidential drug
sales records to discover the number of
pills sold to every pharmacy in the state.

11. An ER visit, a $12,000 bill — and a
health insurer that wouldn’t pay
• https://www.vox.com/policy-and-
politics/2018/1/29/16906558/anthe
m-emergency-room-coverage-
denials-inappropriate
• A fantastic look at the real world
complications of an insurer’s
decision to deny coverage for ER
visits they deemed to not be
emergencies.
Great Stories (cont.)

12. Kaiser Health News (KHN) Is Here To Help!
• Sign up at KHN.org for our “Morning Briefing” daily news aggregation.
We highlight the best health care coverage and send it directly to your
inbox.
• Your can use KHN content to help create your own stories. All we ask
is that you credit KHN.
• Email me at macarey@kff.org to be added to our “New from KHN”
email highlighting our most recent stories, photos and graphics that
you can republish for free.