How States are Changing Health Insurance Rules

In an ongoing effort to keep you up to date on the many proposed and approvedhealth insurance
changes to our health care system and how they might impact the cancer community, this week, we bring you updates from around the country. If you don’t live in one of these states, be aware, these changes could come to your state next.

National News:

Two weeks ago, we reported that 11 states have applied for waivers to make some individuals work, in order to get access to health care through Medicaid. Since then, Kentucky and Indiana’s waivers have already been approved by the Center for Medicare and Medicaid Services and those states are moving forward with implementing plans for a Medicaid work requirement. Click here to learn more about the impact of the Medicaid waivers and to see what the states are asking for in their waivers.

In addition to work requirements, five states have also asked the U.S. Department of Health & Human Services if they can place a lifetime cap on how long an individual can receive Medicaid coverage. For example, Arizona, would like to place a 5-year lifetime cap on coverage. Kansas, Utah, Maine and Wisconsin are also seeking to impose lifetime caps.

This would be a substantial change to the Medicaid program, since signed into law under President Truman in 1965.  More than 68 million people receive Medicaid coverage, including children, seniors, and people with disabilities.  HHS has not released any guidance on this issue, to date.


Ohio has now joined Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi (still in process), New Hampshire, North Carolina, Utah, and Wisconsin, in asking for permission to add a work requirement to their Medicaid program. The work requirement would begin July 1, 2018, if approved in time.

Ohio has also asked the federal government for permission to not comply with the individual mandate. This will likely have no actual impact, as Congress reduced the penalty for not purchasing health insurance to $0, in the latest tax bill. The $0 penalty will begin in 2019, which means that those who don’t have health insurance in 2018 will still be responsible for the penalty!

Rhode Island:

Rhode Island is also making cuts to its Medicaid program, which covers more than 300,000 people. Individuals will be required to pay co-pays when receiving health care services or prescription drugs.  However, there will be an annual cap on co-pays equal to 6% of an individual’s income.


Idaho announced last week that they will allow insurance companies to sell plans in violation of the Patient Protection and Affordable Care Act (ACA). The ACA required health insurance plans to meet certain minimum requirements in order to protect consumers from pre-existing condition exclusions and annual and lifetime limits, while ensuring coverage of essential health benefits. Insurers argue that providing this quality coverage is more expensive and that is why plans sold in the Health Insurance Marketplace can be more expensive.

Idaho’s approach to bring down the cost of insurance is to allow plans to offer less coverage and to exclude people with pre-existing conditions. This directly violate the law. It will be up to HHS to enforce the law or allow Idaho to continue offering these illegal plans. There are many other states waiting to see how HHS will react.

Blue Cross of Idaho has already unveiled five new plans that don’t comply with the ACA, including having annual caps on coverage and pre-existing condition exclusions for up to 12 months.

Advocates have three concerns about this approach:

  1. People who are healthier will leave the Marketplace to buy these cheaper plans, which will drive up the costs of plans in the Marketplace
  2. If these healthier individuals are diagnosed with serious medical conditions, they will find they have inadequate coverage
  3. People with pre-existing conditions won’t be able to purchase these cheaper plans, which means they will be stuck in the marketplace with more expensive plans

This turn of events is very concerning for the cancer community, as it allows insurance companies to do an end run around the ACAs protections for people with pre-existing conditions.

Congress Takes Steps to Undermine the ADA

Many have heard of the Americans with Disabilities Act (ADA), but may not know all of the details. The ADA is the federal law that protects people with disabilities from discrimination in a variety of ways.

The ADA was passed by Congress in 1990, more than 28 years ago.  Congress improved protections in the ADA in 2008 by passing the ADA Amendments Act.  Most people are familiar with its physical access requirements, such as having accessible parking spots, ramps into buildings, and accessible restrooms. However, despite its age, many who are protected by the ADA, don’t know it.

In addition to physical access requirements, the ADA also provides protections for people with disabilities in the workplace.  Title I of the ADA requires that covered employers provide eligible employees with protection against discrimination and rights to privacy, as well as access to reasonable accommodations. For more information about these protections and how they apply to individuals diagnosed with cancer AND their caregivers, visit:

The ADA also provides protections for children, adolescents, and young adults with disabilities in school, including those diagnosed with cancer.

Approximately 36% of adults ages 65 and over have some type of disability. Learn 7 facts about Americans with disabilities.

This month, Congress took a step to erode the protections in the ADA.  The U.S. House of Representatives passed (252-192) the ADA Education and Reform Act, which forbids individuals with disabilities from suing a business for violating their rights under the ADA, unless they first:

  1. Provide written notice to the business that they are in violation of the ADA
  2. Wait 6 months to see if the business fixed the violation

Opponents of the bill argue that this allows businesses to refuse to comply with the ADA, until an individual with a disability sends them a written complaint and then they get another 6 months to comply. Meanwhile, the individual with a disability is unable to access that hospital, doctor’s office, restaurant, store, movie theater, hotel, or other public place.

Advocates for people with disabilities are skeptical that businesses need more time to comply with a law that was enacted almost thirty years ago.

In what other area of society do we allow a business to ignore a law until someone sends them a written complaint?

Oh, wait.  That sounds a lot like health insurance appeals.

The bill now awaits a vote in the U.S. Senate. For more information about how to be an effective advocate, visit Stay tuned.