With the Patient Protection and Affordable Care Act’s (ACA’s) ninth open enrollment period (OEP) set to launch in less than a month, the ACA Marketplaces are seeing record enrollment numbers with more generous subsidies, new carrier competition, and a relatively stable rating environment. At the same time, there is uncertainty with the trajectory of the COVID-19 pandemic and medical costs trending upward as the economy recovers, albeit at an uneven pace. These trends have made for a challenging rate review process in the 47 states plus the District of Columbia (D.C.) that conduct their own ACA rate reviews of carrier-proposed rates using federal review standards. State announcements of 2022 rates have trickled out at a slower pace than in prior years, and it is likely that many states will not publish their approved rates until the beginning of open enrollment. As always, state rate results vary widely and, even within states, there often are substantial variations among carriers and across different regions in geographically diverse states. With these caveats, this expert perspective highlights some observations about the factors that are impacting rate changes this year and the kind of variations that exist among states.

State health updates as of October 8, 2021.

State health updates as of October 1, 2021.

As state-based marketplaces (SBMs) get ready for the next annual open enrollment period for health insurance, for many it represents a renewed opportunity to build on the hard work and lessons learned that took place over the year to enroll individuals in quality and affordable health coverage. The challenge for SBMs is getting all consumers to check out their options for the coming year and find the health coverage that best meets their needs now. In addition, for those new to the marketplace, SBMs will need to help these individuals navigate a process that may be unfamiliar. Many SBMs are making concerted efforts to connect residents with public and private health coverage options and are continuing to communicate the new financial help available through the American Rescue Plan. The ongoing COVID-19 pandemic continues to bring uncertainty for consumers and a need for marketplaces to continue to respond to that reality. This expert perspective highlights key messaging and outreach strategies state-based marketplaces are employing to conduct outreach, provide enrollment assistance, and clearly communicate with consumers what health coverage options are available for them in 2022.

State health updates as of September 24, 2021.

On September 17, 2021, the U.S. Departments of Health and Human Services and Treasury finalized the 2022 Notice of Benefit and Payment Parameters (NBPP) rule and announced a significant expansion of their oversight of health plans’ provider networks. This expert perspective reviews provisions of the rule of particular import to the state-based marketplaces (SBMs) and state insurance regulators.

State health updates as of September 17, 2021.

On September 10, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) released a second rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. This Notice of Proposed Rulemaking (NPRM) details the data on air ambulance services that must be reported to HHS and the Department of Transportation (DOT) and discusses the departments’ proposed approach to enforcement of the NSA. Beyond the NSA provisions, the NPRM also provides guidance on new federal requirements that individual market and short-term plan insurers disclose broker compensation to current and potential enrollees as well as to HHS. Comments on the NPRM are due October 18, 2021. This expert perspective summarizes the provisions of the NPRM and notes particular implications for state regulators and marketplace officials.

Medicaid enrollment has increased by over 10 million (or 15 percent) from February 2020 through February 2021 across all states since the outbreak of the COVID-19 pandemic. States have a clear imperative to center health equity as they plan for the end of the public health emergency (PHE) given that Black, Latino/a, and other people of color are most at risk of coverage loss. This expert perspective highlights strategies states can implement to ensure that the end of the PHE does not exacerbate already widespread racial and ethnic disparities in our health care system.

COVID-19 vaccines are now widely accessible in the United States and free to everyone over the age of 12. Given the spread of the Delta variant, there is an urgent need to increase vaccination rates, particularly among Medicaid enrollees. States across the country continue to report Medicaid enrollees are getting vaccinated at lower rates than the general population. This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.