Good morning. I’m Julie Appleby, a KFF Health News senior correspondent who writes about all things insurance. Have you been switched out of an Affordable Care Act plan without your permission? Contact me at [email protected]. Not a subscriber? Sign up here.Today’s edition: A Philadelphia nonprofit lost its latest bid to open a supervised drug-use center. A Chicago-based company got the first green light from federal regulators for an artificial intelligence-powered tool to detect sepsis. But first …As some game federal ACA exchanges, CMS plays catch-upThe Biden administration faces what looks like a growing problem for the federal Affordable Care Act’s insurance exchange: disreputable insurance brokers enrolling people who don’t need coverage or switching them to new plans without their authorization.It happened to Michael Debriae, a restaurant server who lives in Charlotte. Unbeknownst to him, an agent in Florida with whom he’d never spoken enrolled him in an ACA plan in March 2023. Debriae had insurance through his job and discovered the Obamacare coverage only when his longtime pharmacy rejected a 90-day refill because the ACA plan didn’t allow it.He filed a complaint with the federal marketplace and canceled the plan. But because the pharmacy had billed the ACA plan for other prescriptions, federal investigators told him they couldn’t retroactively cancel his coverage. He got stuck with a $700 tax bill — his entire tax refund, he said — for some of the tax credits the IRS paid his Obamacare insurer from March until July.The ACA saw record enrollment for this year of more than 21 million people, but growing complaints from consumers like Debriae and agents who say they’ve lost clients to unauthorized switches cast a shadow on that achievement, a KFF Health News investigation found.On Feb. 26, the Centers for Medicare and Medicaid Services sent an “unauthorized plan switch” update to insurance industry representatives acknowledging “a large number” of 2024 cases and outlining technical efforts to resolve problems.“CMS is committed to protecting consumers in the marketplace,” Jeff Wu, deputy director for policy for the Center for Consumer Information & Insurance Oversight at CMS, said in a March statement.Wu’s office didn’t disclose the number of complaints that have been filed or how many brokers it has sanctioned. CMS reports enforcement actions to state insurance departments, whose authority includes revoking licenses, Wu’s statement said.Brokers say the ease with which unscrupulous agents can get into policyholder accounts in the 32 states served by the federal marketplace plays a major role in the problem. With only a person’s name, date of birth and state, a licensed agent can access a policyholder’s coverage through the federal exchange or its direct enrollment platforms. It’s harder to do in ACA marketplaces run by states, which often require additional information.Federal regulators imposed new rules in June that require brokers to get policyholders’ written or recorded verbal consent before making changes to their coverage. But brokers say they’re rarely asked to provide that documentation to regulators.CMS is “actively considering further regulatory and technological solutions,” Wu said.Many state-run exchanges do more than the federal marketplace to secure accounts. In Colorado, for example, customers specify which brokers can have access. California sends a one-time passcode to enrollees to provide to their agents.Jonathan Kanfer, an insurance broker in West Palm Beach, Fla., says his agency lost 700 clients to unauthorized plan switches. He said he’s had telemarketers offer him lists of potential clients, telling him, “You don’t even have to speak with the people.”He turns them down, but he said rival agents might be enticed by the opportunity to collect the monthly commissions that insurers pay.KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.Philadelphia nonprofit loses latest try to open supervised drug-use centerA federal judge ruled against a Philadelphia health organization’s request to operate a facility where people can consume illicit drugs under the supervision of staffers trained to prevent overdoses, our colleague David Ovalle reports. U.S. District Judge Gerald Austin McHugh dismissed a lawsuit filed by the nonprofit Safehouse, which claimed its work is inspired by Judeo-Christian beliefs about saving lives and caring for the sick. The group argued that banning the centers violates its board members’ rights to religious freedom.The bigger picture: The decision marks a victory for the Justice Department, which argued that such facilities violate federal law, and for critics who believe the centers enable users and increase crime. It deals a blow to advocates of supervised consumption sites, who view them as crucial spaces that save lives as the country grapples with an increasingly deadly illicit drug supply. Currently, the only two government-sanctioned overdose prevention centers in the United States are in New York. The facilities, which do not provide illicit drugs, have prevented more than 1,000 overdoses, according to operators.In a first, FDA authorizes AI-driven test to predict sepsisThe Food and Drug Administration authorized the nation’s first artificial intelligence-powered test to predict a patient’s risk for sepsis, our colleagues Daniel Gilbert and Rachel Roubein report. Sepsis occurs when the body’s immune system mistakenly attacks its own organs while fighting an infection, contributing to at least 350,000 deaths annually in the United States. Managing the complex condition is a key priority for federal health agencies. A closer look: Chicago-based Prenosis developed its diagnostic tool by acquiring more than 100,000 blood samples along with clinical data from hospital patients, and training the algorithm to identify the health measures most associated with developing sepsis. While Prenosis is the first test of its kind to receive the FDA’s go-ahead, other companies, including Epic Systems, have already introduced AI-driven diagnostic tools for sepsis to the market. Abortion vs. immigration fuels heated Biden-Trump rematchDemocrats and Republicans are pushing what they view as their strongest issues to the forefront in the run-up to the November elections – for Democrats, abortion, and for Republicans, immigration – with each side betting their rhetoric will galvanize their supporters, The Post’s Hannah Knowles reports. On the campaign trail, Donald Trump is capitalizing on dismal approval ratings for President Biden’s handling of the southern border. The presumptive Republican nominee fills his rallies with apocalyptic warnings of an “invasion” and promises to carry out the largest deportation operation in U.S. history. Democrats, meanwhile, are hammering on the issue Trump hardly talks about — hoping to re-create their success in many elections since a trio of Supreme Court justices appointed by the former president helped overturn Roe v. Wade. When Trump sidestepped a Tuesday question about an abortion ban recently upheld in Florida — “We will be making a statement next week on abortion,” he said — Biden responded on social media, noting Trump’s past boasts that “without me, there would be no 6 weeks.”“You already made your statement, Donald,” Biden wrote.New this a.m.: Just 3.7 percent of U.S. women reported smoking cigarettes at any time while pregnant in 2022, down by nearly half since 2016, according to final births data from the National Center for Health Statistics. Overall, there were 3,667,758 births registered in the United States in 2022, which is essentially unchanged from the previous year. A federal watchdog is recommending that the Biden administration require nursing homes to “systematically document” facility-initiated discharges of residents, citing concerns about the industry’s compliance with federal requirements for these processes. Millions of Americans are struggling to access mental health care because of a shortage of providers willing to serve Medicare and Medicaid patients, according to a review by the federal health department’s inspector general. The White House is warning that a budget proposal from the Republican Study Committee would cut funding for state programs addressing the opioid crisis, the Hill’s Alex Gangitano reports. Alabama hospital to end IVF treatments at the end of the year, citing litigation concerns (By Brammhi Balarajan | CNN)Rural hospitals seek help as private Medicare patients increase (By Tony Pugh | Bloomberg Law)Robert F. Kennedy Jr.’s running mate and the vaccine wars (By Glenn Kessler | The Washington Post)Thanks for reading! We’ll see you tomorrow.
https://www.washingtonpost.com/politics/2024/04/04/unauthorized-sign-ups-cast-shadow-obamacares-record-enrollment/
Unauthorized sign-ups cast shadow on Obamacare’s record enrollment
