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What We’re Reading: US Uninsured Rate to Rise; Contraception Cost Investigation; Medicare Advantage Star Ratings Changes

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The rate of uninsured Americans will rise to 8.9% over the next decade; Senator Bernie Sanders (I, Vermont) wants a government watchdog to investigate why women are still being charged for contraception considered free under federal law, and proposed Medicare Advantage Star Ratings target top performers.

US Uninsured Rate to Rise Nearly 9% in the Next Decade

Although uninsured rates dropped significantly from 2019 to 2023 due to COVID-19 pandemic response efforts, a Congressional Budget Office report released Tuesday showed that the rate of uninsured Americans will rise to 8.9% over the next decade from 7.7% in 2024, according to Reuters. The report explained that this rise in uninsured Americans will be driven by rising immigration and reduced insurance eligibility for those between the ages of 19 and 24 due to federal policy changes. It noted that most of the decline will happen in the next 2 years, but the uninsured rate should stabilize at around 9% between 2027 and 2034. More specifically, 17 million people aged 19 to 24 are expected to be uninsured by 2034 as this age group is less likely to be offered employer-sponsored plans and represents a higher group of undocumented immigrants possibly ineligible for government-funded plans.

Lawmaker Calls for Contraception Cost Investigation

Senator Bernie Sanders (I, Vermont), the chair of the Senate Health Committee, wants a government watchdog to investigate why women are still being charged for contraception considered free under federal law, according to the Washington Post. Under the Affordable Care Act, health plans are required to provide birth control to patients as a preventative service. Therefore, they are required to cover at least one form of contraception in each birth control category. However, patients are repeatedly asked to pay for birth control due to little enforcement of the law. Sanders cited a recent investigation by Vermont, which found that 3 insurers wrongly charged residents more than $1.5 million for contraception. Also, a 2022 House Oversight Committee investigation found that health insurers persistently denied no-cost contraceptive requests, some denying coverage for certain brand-name contraceptives.

Proposed Medicare Advantage Star Ratings Changes Target Top Performers

Medicare Advantage insurers with past high quality scores may lose up to $19.5 billion in bonus payments over 10 years under a new CMS policy proposal, according to Modern Healthcare. More specifically, the “hold harmless” policy is at stake, where health plans that earn at least 4 out of 5 stars can choose to ignore 2 highly weighted quality improvement score elements that track annual quality metric changes. In a 2022 pitch, CMS said it may raise the threshold so that only 5-star plans can take advantage of this policy starting in 2026; at the time, CMS estimated this would reduce quality bonus payments by $19.5 billion over 10 years. Although this was not initially instituted, experts think it may be a good time for CMS to reevaluate its plans after the recent court ruling against the Medicare Advantage Star Ratings program. This modification would balance scores across the sector, benefiting insurers with lower ratings, like Molina Healthcare, and disadvantaging top performers, like Kaiser Health Plan.

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