GPAHU Pulse – February 2023

GPAHU - Monthly State and Legislative Updates

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year.

Research from Voya Financial conducted in November of 2022 found that 63 percent of employees are likely to participate in voluntary benefits offered by their employers, such as critical illness coverage, hospital indemnity, disability income and accident insurance. That is up from the previous year when 45 percent said they were interested. This trend of increased interest in voluntary benefits is also significantly higher among working Americans with children at home (76%) — which is up from 52% in 2021. From a generational standpoint, 71% of millennials indicated that they are likely or extremely likely to participate in more voluntary benefits offered by their employer, which is up from 52% in 2021.

Source: Voya Financial Survey, November 23-24, 2022, https://www.voya.com/voya-insights/voluntary-benefits-101-what-are-they-and-how-do-they-work

The Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients.  Here are this month’s big three!

PA House of Representatives Flips to Full Democratic Control

After a month of chaos and disputes over which party controlled the Pennsylvania House of Representatives, Democrats regained a clear one-vote majority on February 7th following three wins in special elections. Now that Democrats will have definitive control of the House for the first time in 12 years, it is anticipated that the chamber will soon be able to start the business of legislating. During January, when control was disputed, the House did not consider any policy matters. An initial attempt at bipartisan government fizzled and House Republicans and Democrats were unable to come to consensus on chamber rules or the slating of House committees.    

The reason for all the turmoil involved open House seats. Even though Democrats won one more seat than the Republicans on Election Day 2022, at the end of the evening two Democratic House members were also elected on to higher offices. This created two open seats, in addition to one more created by the October 2022 death of Representative Anthony DeLuca (D-32). On January 3, 2023, Representative Mark Rossi (D-Berks) was elected and sworn in as an “independent” Speaker by all House Democrats and 16 House Republicans. However, cooperation between the two parties collapsed within days. 

All three of the open seats were in the Pittsburgh area, and in each special election, the Democratic candidate won handily. Once the election results are fully certified, the House is expected to seat its new members quickly. Then, House Democrats should have enough votes to pass a rules package, name members to all committees and appoint Committee chairs, and begin the process of enacting legislation. During the months ahead, GPAHU will be watching for action on measures related to telehealth, cybersecurity requirements specific to the insurance industry, and the release of deidentified health insurance claims data to mid-sized groups, among other things.

Acting Insurance Commissioner Humphreys Nominated for Permanent Post

Governor Josh Shapiro recently nominated Acting Insurance Commissioner Michael Humphreys to be a permanent member of his cabinet as Insurance Commissioner. While this position requires Senate confirmation, Humphrey’s approval process is expected to be non-controversial and he is already participating in formal cabinet meetings.

Humphreys previously served for three years as Chief of Staff to Pennsylvania’s last Insurance Commissioner, Jessica Altman. Then Governor Wolf named Humphreys Acting Commissioner in February of 2022, when Altman left her position to go lead the California health insurance exchange. Before coming to Pennsylvania, Humphreys worked as Tennessee’s Assistant Commissioner of Insurance and for the National Conference of Insurance Legislators.

End To National Emergency Period Will Have Health Insurance Implications

President Biden recently announced his intention to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. We recommend that agents, brokers and consultants gain an understanding of how the end to the emergency periods will impact clients and health insurance coverage.

No More “Outbreak Period”

When the COVID-19 national emergency ends, it will start the wind-down process for the COVID-19 emergency “outbreak” rules. These rules temporarily stopped group health plan deadlines during the “outbreak period” for: (1) COBRA notices, elections, and payments; (2) HIPAA special enrollment periods (i.e., the ability to enroll in a health plan after a marriage or birth of a baby), (3) claims and appeals procedures, and (4) external review. Federal guidance currently allows each individual beneficiary’s outbreak period to expire on a case-by-case basis as of the earlier of: (1) one year from the date an individual was first eligible for deadline relief, or (2) sixty days after the end of the national emergency, which as of now is slated to be July 10, 2023 (May 11, 2023, plus 60 days).

Telehealth Changes

The PHE made it much easier for people across the country to access telehealth services. Certain prescribing and HIPAA/HITECH privacy and data security requirements were relaxed, as were group coverage requirements so employers could offer telehealth access to typically ineligible employees. In addition, many states, including Pennsylvania, lifted provider licensing requirements and other state-level restrictions to make it easier to perform telehealth services in each state. Without additional federal and state action, telehealth services offered by some group health plans may be more constrained if the PHE ends on May 11, 2023.

Update to COVID-19 Testing and Vaccination Coverage Mandate

Health insurers and self-funded group health plans are currently required to pay for COVID-19 tests and related care, home tests, and COVID-19 vaccinations performed by out-of-network providers on a first-dollar basis. If the PHE ends on May 11, 2023, then guaranteed access to COVID-19 vaccines from any provider and COVID-19 tests without cost-sharing will cease unless there is additional public policy action to change these rules.

Medicaid Eligibility Change

Federal COVID-19 policy action required states to keep people on Medicaid and not reexamine eligibility in many cases during the emergency periods. Otherwise, they would not get a temporary increase in federal Medicaid funding. When the PHE period ends, the extra federal funding will cease and Pennsylvania will likely end Medicaid benefits for those people who do not currently meet eligibility criteria. When that happens, individuals who lose their Medicaid eligibility will qualify for an individual market special enrollment period (SEP), as well as a group coverage SEP if they are eligible for coverage through an employer-sponsored plan.

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out! 

Kaiser Family Foundation recently released a slide deck showing how American’s spending on healthcare has changed over time.


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