Expert Perspectives

Sep 11, 2020 

Updating the Essential Health Benefit Benchmark Plan: An Unexpected Path to Fill Coverage Gaps?

On August 28, 2020, the U.S. Department of Health & Human Services (HHS) approved new essential health benefit (EHB) benchmark plans for Michigan, New Mexico, and Oregon, bringing to five (with Illinois and South Dakota) the number of states that have revised their benchmarks in recent years. Although many stakeholders were concerned that new rules for EHB benchmark selection adopted in the 2019 Notice of Benefit and Payment Parameters (NBPP) would result in less generous benefits, these five states have modestly enhanced their benefit packages to address perceived gaps in coverage. This expert perspective highlights the efforts in these five states and provide an overview of how other states can consider changing their EHB benchmark plans to enhance coverage.

Sep 1, 2020 

Adjusting Open Enrollment Outreach to Meet a New Moment

A new open enrollment landscape created by the continued health and economic impacts of the COVID-19 pandemic, a national movement calling for racial justice, and the concurrent timing of a presidential election year is raising new challenges for states as they plan outreach and enrollment campaigns. Marketplaces are reimagining their campaign strategies to meet this moment, with plans to operationalize virtual activities, communicate with new and existing audiences, and reflect changing consumer behaviors in their outreach tactics. This expert perspective highlights strategies from SHVS’ 2-part webinar series on preparing for OEP 2021 and features several strategies states can pursue to help ensure a successful open enrollment period this year.

Aug 21, 2020 

Essential Workers in Challenging Environments: How States Are Working to Protect Farmworkers

While efforts to reduce the spread of COVID-19 have been difficult in all environments, the conditions for those working in agricultural production raise additional challenges. Migrant and seasonal farmworkers, many of whom travel as crops ripen throughout the spring and summer, live and work under conditions that even before COVID-19 posed risks to their safety and wellbeing. This expert perspective  examines approaches to addressing the particular risks of COVID-19 faced by farmworkers, provides a survey of state and local policies and outlines some key themes and recommendations for policymakers as they work to support agricultural workers and stem the spread of COVID-19.

Aug 21, 2020 

Partial Win for Insurers in Cost-sharing Reduction Litigation: Implications for State Insurance Regulation

On August 14, 2020, the Court of Appeals for the Federal Circuit affirmed a lower court ruling that the federal government is liable to insurers selling marketplace health plans for the loss of cost-sharing reduction (CSR) reimbursements mandated under the Affordable Care Act (ACA). However, the court determined that the federal government could reduce the damages it owes to insurers because most successfully mitigated their losses through a practice called silver loading. This expert perspective highlights implications for state insurance regulators of the recent federal Court of Appeals’ ruling on CSR reimbursement mandated under the ACA.