How the States are Handling Health Insurance

There are many proposed and approved changes to our health care system at both the state update health insurancefederal and state levels, which may impact the cancer community. If you don’t live in one of these states, it’s important to know that these changes could come to your state next.

Health Insurance Marketplace Data:

We have heard a lot in the news about how the plans in the Health Insurance Marketplace are more expensive this year. The final enrollment report just came out and it showed that 7.5 million people qualified for financial assistance to purchase their plan. The average monthly premium for those plans was $89. This is actually less than the average from 2017, which was $107. Also, more people were able to get better coverage for less money, choosing more gold plans than last year. For example, in Wyoming, in 2018, 46% of plans chosen were gold, compared to 3% in 2017.

Other National News:

  1. The IRS has made some changes to Health Savings Accounts (HSAs). If you have an HSA, read more hereabout the changes to avoid any penalties and other IRS news.
  2. A new survey finds that 44% of people surveyed said they didn’t go to a doctor when they were sick or injured last year because of cost. 30% of people said that they had to choose between medical care and paying for basic necessities (food, heating, housing, etc.). And, 39% of people didn’t go to a dentist last year when they needed treatment. Read more here.
  3. Nearly 1 in 5 Americans has crippling medical debt. Medical debt is still the leading cause of personal bankruptcy in the United States. RIP Medical Debt is an organization that uses donations to purchase debt portfolios from collection agencies, to help people who need it the most. While you cannot apply to have your debt forgiven through RIP Medical Debt, there is an opportunity to add your name to their Debt Forgiveness Registry. If RIP Medical Debt is able to have your debt forgiven, they will notify you. Read more here.


The Governor of Hawaii signed a bill that would allow physicians to prescribe life-ending medication to terminally ill patients. Adult patients who are terminally ill have to meet strict guidelines to get the medication, including:

  • Meeting with a counselor who must determine that the patient isn’t suffering from conditions that may interfere with decision-making, such as a lack of treatment for depression;
  • Making two oral requests for the medication, with a 20-day waiting period in between, and sign a written request witnessed by two people, one of whom can’t be a relative; and
  • Two doctors have to confirm the patient’s diagnosis, prognosis, ability to make decisions, and that the request is voluntary. They must also agree that the patent has less than six months to live.

Hawaii joins California, Colorado, Oregon, Vermont, Washington, and the District of Columbia, which have death with dignity laws. Click herefor more information about state laws. Hawaii’s bill takes effect January 1, 2019.


In November, voters in Maine passed a proposition to expand Medicaid coverage in Maine, under the ACA.  The state legislature has actually passed Medicaid expansion laws 5 times since the ACA was signed into law on March 23, 2010. Each time, the Governor of Maine, Paul LePage, vetoed the expansion. When the voters approved Medicaid expansion, the Governor immediately said he would not implement it, unless lawmakers in Maine came up with the money to pay for Medicaid expansion without raising any taxes. The Governor had a deadline of April 3, 2018. to submit an expansion proposal to the federal government for approval.  But April 3rdhas come and gone and there has been no action. It is now up to legislature to figure out how to handle the funding. Expansion is supposed to begin July 2, 2018. Read more about Medicaid in Maine here.


Read this articleabout the paid family and medical leave proposal currently being discussed by the state legislature.  If the legislature doesn’t approve a plan, then advocacy groups are working to get a voter proposition on the November ballot.

Paid Family leave programs are also being discussed in Connecticut and New Hampshire.


Governor Kim Reynolds has signed a bill to let the Iowa Farm Bureau Federation and Wellmark Blue Cross & Blue Shield sell health insurance plans. These “health benefit plans” would not be deemed “insurance,” so they are able to deny coverage or charge more for people with pre-existing conditions and would not be subject to regulation by the Iowa Insurance Division. With the change of a word, consumers lose access to many protections, especially those with serious medical conditions.

Many states are looking at this as an option. Tennesseewas actually the first state to allow farm bureau plans to be carved out of insurance protections.  These plans can ask people about their pre-existing conditions on the application, and reject people it expects to have high medical costs.


Governor Gary Herbert signed a bill to give more than 70,000 Utahans access to Medicaid. Now the state waits for the Trump administration to sign off on their partial Medicaid expansion plan. If approved, it will likely be at least a year, before people will be able to sign up. This partial expansion covers adults making up to 100% of the federal poverty level (FPL), or $12,140 a year for an individual. The ACA’s Medicaid expansion covered adults up to 138% of the FPL, or $16,753 for an individual. It also includes a work requirement.

There are also advocacy efforts to collect signatures to put an initiative on the November ballot, which would expand coverage to adults with a household income up to 138% of the FPL. The deadline for collecting signatures was April 15.  We will see if this proposal gets on to the November ballot.

Stay tuned for the latest news  . . .

An Update From the States

An Update from the States

In an ongoing effort to keep you up to date on the many proposed and approved 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. 

Medicaid News:

Do you have Medicaid coverage? You can now access the services included in Amazon Prime for a discounted fee of $5.99 a month, less than half the regular cost of $12.99 a month. Access to Prime services, including free expedited shipping, can be particularly useful for someone who is treatment. Instead of having to go grocery shopping or running other errands for household items, Amazon Prime can deliver those items to your doorstep for free. Amazon also now offers electronic benefit transfer (EBT) cards, which are used for food stamp benefits.

Other National News:

In the recent Bipartisan Budget Act of 2018, passed by Congress on February 9th, there were several changes made to our health care system that may be helpful and challenging for the cancer community:

  1. It provided two additional years of funding to State Health Insurance Assistance Programs (SHIP) and Area Agencies on Aging, which are two valuable resources that help seniors manage their Medicare coverage and get access to other programs and services.
  2. It eliminated the Medicare cap on access to outpatient physical, occupational, and speech therapy services as of January 1, 2018.
  3. It closed the Medicare Part D donut hole one year earlier in 2019, lowering the cost of prescription drugs for people with Medicare.
  4. It also changed the way that Medicare pays for home health services beginning in 2020. The home health coverage will be reduced from 60 days to 30 days and therapy thresholds will be eliminated. Beginning in 2019, Medicare will be allowed to base eligibility for home health services on a review of a patient’s medical record, including a home health agency’s record.


The Hawaii House has approved a bill that would allow physicians to prescribe life-ending medication to terminally ill patients. The bill now moves to the Senate, which approved a similar bill laws year. If approved, Hawaii would join California, Colorado, Oregon, Vermont, Washington, and the District of Columbia, which have death with dignity laws. Click here for more information about state laws.


A few weeks ago we shared that the Idaho Governor announced that he 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.

This past week, the Trump Administration did reject Idaho’s plan to sell plans in violation of the ACA.  Many other states had been closely watching this decision, as they also were looking at allowing plans without the ACA consumer protections. The cancer advocacy community was pleased to see that these consumer protections wouldn’t be ignored. However, the Administration did suggest to Idaho that they instead promote the sale of short-term insurance plans. Click here for more information on these plans.


The Iowa Senate voted last week to let the Iowa Farm Bureau Federation and Wellmark Blue Cross & Blue Shield sell health insurance plans that don’t comply with the ACA, allowing people with pre-existing conditions to be denied or charged more for coverage.  Given the Administration’s rejection of Idaho’s plans, it is likely that Iowa will not be able to move forward with the sale of these plans.


There was a question as to whether or not Arkansas’ legislature was going to keep their expanded Medicaid program. However, lawmakers did vote to keep the program that covers 285,000 people in Arkansas another year.

In addition, the Trump Administration has approved Arkansas’ request to add a work requirement to their Medicaid program, joining Indiana and Kentucky as states that have added this new requirement. There are seven other states that have submitted applications for a Medicaid work requirement and 14 other states that are considering it.

Stay tuned for the latest news  . . .