Shoring up Health Exchanges
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Stateline Vol. 26, No. 5 • May 2017 MidwestTHE MIDWESTERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS INSIDE CSG Midwest Issue Briefs 2-3 Shoring up health exchanges • Criminal Justice & Public Safety: Illinois opens up professional licensing for ex-offenders • Agriculture & Natural Resources: Minnesota Premium hikes in 2017 led Minnesota to intervene with tax credit provides relief to farmers, help to schools • Passenger Rail: State, federal officials crafting funding for subsidies, reinsurance; all states face uncertainty plan for better intercity service in Midwest • Education: Indiana reduces class time spent on by Jon Davis ([email protected]) assessments, expands graduation pathways Around the Region 4 ast summer, as insurers filed their % change in Midwest health What happened? individual health insurance plan rate South Dakota at forefront of national effort to ‘kill insurance premiums for 2017 premiums for 2017, it became clear In 2014, as a central part of providing Quill,’ collect taxes from remote sales L that something was wrong: Rates in 31 coverage through the U.S. Affordable 7% MLC Chair’s Initiative 5 states shot up by double digits (triple Care Act of 2010, health insurance 59% exchanges opened up across the country Uptick in maternal death rates leads to new digits for Arizona); overall, the average 39% 16% — either run by states themselves, the Michigan law, proposal in U.S. Congress increase in premiums was 25 percent. 7% federal government or a combination In the Midwest, Minnesota was socked 51% 25% 2% of the two. Question of the Month 5 with a 59 percent increase that fur- 43% -3% Which Midwestern states impose additional or ther roiled an already shaky individual Because these exchanges created a special registration fees on electric vehicles? 42% health insurance market (or exchange). new way of providing and purchasing Legislators there responded earlier this health insurance, no one knew what to Profile 8 State’s increase was at or lower than expect, says Sara Collins, vice president Kansas House Speaker Ron Ryckman year by first providing help to those not the overall U.S. average increase of of The Commonwealth Fund’s health covered by federal subsidies and then cre- 25 percent care coverage and access program. Hence FirstPerson 9 ating a state-funded reinsurance program. State’s increase was higher than the South Dakota Sen. Deb Soholt on a new law in An analysis released in October by the overall U.S. average increase of 25 the federal reinsurance program, which her state to deal with the shortage of physicians Kaiser Family Foundation attributed the percent essentially provided insurance for the premium rate hikes across the country * Changes from 2016 to 2017 are based on premiums for insurance companies by having the CSG News & Events 10 to a combination of factors, including second-lowest-cost “silver” plan for a 27-year-old. government pay some portion of claims State legislators selected to lead bipartisan substantial losses experienced by many Source: The Fiscal Times (based on U.S. Department of Health & for the first two years of implementation committees of Midwestern Legislative Conference insurers in the individual market and the Human Services data) (from 2014 through 2016). Capitol Clips 12 phasing out of the federal reinsurance According to Collins, insurance car- program. Kaiser researchers also found would withdraw from the Iowa exchange riers now have a better understanding • Indiana raises gas tax to invest more in roads that due to losses in the individual mar- for 2018, possibly making that state the of how the markets work and, therefore, • Wisconsin seeks drug screening in Medicaid ket, the average number of participating first to have no insurers in most counties. have a more accurate sense of pricing, so • Nebraska looks to help mammography patients insurers dropped to 3.9 per state in 2017, So with some states’ individual ex- the 2017 premium spikes were basically • Iowa cracks down on texting while driving down from 5.4 in 2016 and 5.9 in 2015. changes in flux — and uncertainty over a pricing correction reflecting both that That trend looks to continue. Wellmark whether the U.S. Congress will repeal and and the phasing out of federal reinsur- Blue Cross/Blue Shield and Aetna both replace the Affordable Care Act — what ance payments. announced in April that they will pull out happened? And what lessons for Iowa Gary Claxton, vice president at the (and other states) might there be in how Kaiser Family Foundation and director Stateline Midwest is published 12 times a year of Iowa’s exchange in 2018, leaving Medica by the Midwestern Office of Insurance Co. as the only available insurer Minnesota dealt earlier this year with the of its Healthcare Marketplace Project, The Council of State Governments. in all but five of the state’s 99 counties. problems in its state exchange? agrees. “There’s reason to believe that Annual subscription rate: $60. Wellmark’s president, John Forsyth, PLEASE TURN TO PAGE 6 To order, call 630.925.1922. told The Des Moines Register that his company has lost $90 million over the last Premiums for individual three years, and that the “overall problem health insurance policies is too few healthy, young consumers are sold in state and federal buying health insurance,” and that the exchanges skyrocketed U.S. Affordable Care Act’s penalty for from 2016 to 2017. CSG Midwestern Office Staff individuals refusing to buy insurance Experts say that was Michael H. McCabe, Director “hasn’t been enough to goad many young fueled by the planned Tim Anderson, Publications Manager consumers into the pool.” phasing out of a federal Jon Davis, Assistant Editor/Policy Analyst Iowa Insurance Commissioner Doug reinsurance program and Cindy Calo Andrews, Assistant Director a better understanding Ilene K. Grossman, Assistant Director Ommen concurred in an April 6 state- Lisa R. Janairo, Program Director ment: “This is a problem created by the of the makeup of Laura Kliewer, Senior Policy Analyst Affordable Care Act and needs to be fixed exchange markets. But, Gail Meyer, Office Manager what comes next? Laura A. Tomaka, Senior Program Manager in Congress.” Kathy Treland, Administrative Coordinator and Meeting Planner In early May, Medica said it, too, Katelyn Tye, Policy Analyst CSG MIDWEST ISSUE BRIEFS Issue Briefs cover topics of interest to the interstate groups and policy committees of CSG Midwest, including the Midwestern Legislative Conference, Great Lakes Legislative Caucus, Midwest Interstate Passenger Rail Commission and Midwestern Radioactive Materials Transportation Committee. Criminal Justice & Public Safety Nationwide, many state laws on occupa- Illinois legislation looks to # of adults released from correc tional reduce employment barriers for tional and business licensing exclude applicants with facilities in Midwest, 2015 felony convictions. The American Bar Association people with criminal histories documents an estimated 32,000 licensing laws that ach year in Illinois, around 30,000 adults return 1,525 include consideration of an individual’s criminal home from state correctional facilities, many in 7,669 record; of these, more than one-third automatically Esearch of jobs. To reduce employment barriers 2,764 5,553 exclude felons, The Council of State Governments for people with criminal records, lawmakers have 13,728 Justice Center notes in a 2015 study. changed the way Illinois’ professional licensing 5,522 “It’s like people are serving an additional 2,358 body reviews applications for certain occupations. 21,759 sentence outside of jail or probation,” Evans says. 16,225 Under a law enacted last year, the state Department 29,732 This year, Evans has introduced two bills (HB 2752 of Financial and Professional Regulation must now 5,950 and 3822) that would create a similar licensing process consider “mitigating factors” surrounding a criminal for more than a dozen additional occupations, includ- conviction before denying an application for eight Source: U.S. Bureau of Justice Statistics ing dance hall managers, landfill operators, livestock occupations: funeral directing and embalming; dealers and insurance agents. These measures would barbering; cosmetology; esthetics; hair braiding; Evans, who sponsored the legislation (HB 5973) in require the state to provide written notice to license ap- nail technology; and roofing. 2016. He hopes the new review process will attract plicants who are denied based on their criminal history. The mitigating factors include whether the people who may have been deterred from applying Also under consideration are HB 3342, which individual’s criminal offense would have any for a license in the past. would reduce licensing barriers for health care work- impact on his or her fitness for the occupation, “A lot of folks didn’t even have the courage to ers, and HB 3395, which would do so for emergency how much time has elapsed since the conviction, apply because they assumed they would be denied medical technicians, acupuncturists, athletic trainers, and the person’s age at the time of the conviction. based on their background,” Evans says. social workers, dietitians and nurse practitioners. Prior to the law’s passage, license applications To track the law’s impact, the department must At least four other states in the Midwest from people with criminal histories would either report annually (starting next year) on the number (Michigan, Minnesota, North Dakota and Ohio) have be denied outright or be left pending for an of applicants with criminal convictions who were adopted laws in recent years to improve licensing indeterminate amount of time, says Rep. Marcus granted and denied licenses in the eight occupations. opportunities for people with criminal records. Brief written by Katelyn Tye, CSG Midwest staff liaison to the Midwestern Legislative Conference Criminal Justice and Public Safety Committee. She can be reached at [email protected]. The committee’s co-chairs are Illinois Sen. Mattie Hunter and Ohio Rep.