Broker blog from Delta Dental

Category: Industry and policy (Page 1 of 2)

Find in-depth pol­i­cy analy­sis and the lat­est on indus­try news.

The Supreme Court nomination and the ACA: What’s at stake

In the case of Cal­i­for­nia v. Texas, sched­uled to be heard before the Unit­ed States Supreme Court on Novem­ber 10, par­ties chal­leng­ing the Afford­able Care Act (ACA) seek to over­turn the law as uncon­sti­tu­tion­al. What might this case mean for the future of the ACA and insur­ance more wide­ly?

The usu­al ques­tions sur­round­ing the out­come of this case have been great­ly com­pli­cat­ed by the impend­ing appoint­ment of a new jus­tice to the Supreme Court. Depend­ing on which jus­tice is appoint­ed and when, the ACA might be upheld, weak­ened or elim­i­nat­ed entire­ly. 

What’s at stake for the ACA?

The elim­i­na­tion of the ACA could have sig­nif­i­cant con­se­quences, includ­ing:

  • Decreas­es or com­plete loss of state and fed­er­al Exchange enroll­ment, adult Med­ic­aid enroll­ment and com­mer­cial enroll­ment of depen­dents up to age 26
  • A reduc­tion or elim­i­na­tion of indi­vid­ual health insur­ance sub­si­dies, which could erode Exchange enroll­ment
  •  A reduc­tion or elim­i­na­tion den­tal ben­e­fits for adults in Med­ic­aid

So what’s California v. Texas about, anyway?

The state of Texas, along with a group of oth­er states and indi­vid­ual plain­tiffs, is argu­ing that the ACA is uncon­sti­tu­tion­al. Specif­i­cal­ly, they say that the 2017 changes to tax law, elim­i­nat­ing the penal­ty for fail­ure to pur­chase health cov­er­age, essen­tial­ly elim­i­nat­ed the indi­vid­ual man­date, upon which the entire law depend­ed.

Orig­i­nal­ly, the indi­vid­ual man­date required most peo­ple to have health insur­ance cov­er­age. It penal­ized those who failed to com­ply by requir­ing them to pay a finan­cial penal­ty to the IRS. The 2017 Tax Cuts and Jobs Act elim­i­nat­ed the finan­cial penal­ty, but left the man­date in place.

The Texas-led plain­tiffs argue that because the man­date no longer pro­duces rev­enue for the fed­er­al gov­ern­ment, it’s uncon­sti­tu­tion­al. Fur­ther, they say that the man­date can’t be sev­ered from the rest of the ACA, so if the man­date is uncon­sti­tu­tion­al, the entire ACA is uncon­sti­tu­tion­al.

In Decem­ber of 2018, a U.S. Dis­trict Court judge in Texas agreed. In 2019, the case went to the U.S. Court of Appeals for the Fifth Cir­cuit. That court agreed with the Dis­trict Court’s deci­sion that the man­date was uncon­sti­tu­tion­al, but didn’t rule on whether the man­date was insev­er­able. The Supreme Court could rule on the man­date, decide the issue of sev­er­abil­i­ty, or send the case back to the low­er court to deter­mine which ACA pro­vi­sions should be retained if the man­date is elim­i­nat­ed.

On the oth­er side, Cal­i­for­nia, togeth­er with a group of 18 oth­er states, is defend­ing the ACA.

In an unusu­al move, the fed­er­al gov­ern­ment is sid­ing with Texas, though offer­ing argu­ments to allow some ele­ments of the ACA to con­tin­ue.

The Supreme Court has agreed to hear the case, sched­uled for Novem­ber 10. It will decide whether the Texas case has mer­it, whether the man­date is uncon­sti­tu­tion­al and, if so, whether this inval­i­dates the entire ACA, or whether to let low­er courts rule on sev­er­abil­i­ty.

Depend­ing on the out­come of the Supreme Court appoint­ment, sev­er­al sce­nar­ios are pos­si­ble.

Why a new Supreme Court justice matters

Pres­i­dent Don­ald Trump has nom­i­nat­ed Judge Amy Coney Bar­rett to fill a vacant seat on the Supreme Court.  

Bar­rett is cur­rent­ly a cir­cuit judge on the U.S. Court of Appeals for the Sev­enth Cir­cuit. She is report­ed­ly a polit­i­cal con­ser­v­a­tive and con­sti­tu­tion­al orig­i­nal­ist, which means she believes the U.S. Con­sti­tu­tion should be inter­pret­ed as it was under­stood at the time it was writ­ten. As a judge, she has also ruled against the ACA in the past. If appoint­ed, she would replace Jus­tice Ruth Bad­er Gins­burg, known for being one of the Supreme Court’s most lib­er­al jus­tices.

Her con­fir­ma­tion is still ongo­ing. The con­fir­ma­tion has three pos­si­ble out­comes, and each could poten­tial­ly affect the Cal­i­for­nia v. Texas rul­ing:

  • A pre-elec­tion appoint­ment. Bar­rett is appoint­ed before the pres­i­den­tial elec­tion. Repub­li­cans appointees will have a 6–3 advan­tage dur­ing the hear­ing. A rul­ing by a court with a clear con­ser­v­a­tive major­i­ty could make the elim­i­na­tion of the ACA more like­ly than a rul­ing from a more even­ly bal­anced court. As of this post­ing, Bar­rett is expect­ed to be con­firmed by the full Sen­ate on Mon­day, 10/26.
  • A “lame duck” appoint­ment. Bar­rett is appoint­ed, but not in time for the hear­ing. This leaves Repub­li­can appointees with their cur­rent 5–3 advan­tage. This out­come gives the con­ser­v­a­tive jus­tices less of an advan­tage than a pre-elec­tion appoint­ment. How­ev­er, a 5–3 deci­sion, or even a 4–4 tie, would leave the Texas deci­sion in place, which could weak­en the ACA or elim­i­nate it entire­ly.
  • A post-Jan­u­ary 1 appoint­ment. If the Repub­li­cans fail to appoint Bar­rett, and Trump los­es the pres­i­den­tial elec­tion, a Biden appointee could nar­row the court split to 5–4. This appoint­ment wouldn’t come in time to affect the Cal­i­for­nia v. Texas deci­sion, but it could affect future chal­lenges to the ACA.

While one can make assump­tions about pos­si­ble rul­ings based on these out­comes, what specif­i­cal­ly each out­come means in terms of a rul­ing is unclear, said Jeff Album, Vice Pres­i­dent of Pub­lic & Gov­ern­ment Affairs for Delta Den­tal.

“We’re not sure how the con­ser­v­a­tive judges are going to hear this par­tic­u­lar case,” Album said. “Con­ser­v­a­tives are thought to be orig­i­nal­ists or strict inter­pre­ta­tion­ists, and if they were tru­ly to fol­low an orig­i­nal­ist phi­los­o­phy, strik­ing the entire­ty of the ACA is not con­sis­tent with that.”

That’s because, Album said, if Con­gress had intend­ed to over­turn the ACA, the 2017 tax cut bill would have explic­it­ly called for such an over­turn, and the mer­its of that debat­ed open­ly in hear­ings. That this didn’t hap­pen speaks to the intent of Con­gress, which is an impor­tant con­sid­er­a­tion for a Supreme Court reach­ing a deci­sion based on orig­i­nal­ist think­ing.

“Strict inter­pre­ta­tion­ists are loath to reverse an act of Con­gress,” Album said. “They don’t want to counter Con­gres­sion­al intent, and they cer­tain­ly don’t want to leg­is­late from the bench. And if you lis­ten to remarks that Amy Bar­rett has been mak­ing in the hear­ings, she’s gone out of her way to say she doesn’t believe that it’s a judges’ job to do any­thing oth­er than enforce the Con­sti­tu­tion and enforce the law.”

Still, that’s not a guar­an­tee that Bar­rett will rule to pre­serve the ACA, Album said.

“We know that Amy Bar­rett is not fond of the ACA,” Album said. “She’s ruled against it many times, so she already has that track record.”

So what if the ACA is struck down? Then what?

If the Supreme Court rules to strike the entire bill, the impacts are “going to be pro­found,” Album said.

In that sce­nario, blue states such as Cal­i­for­nia, New York, Mass­a­chu­setts and Mary­land would pass state laws to attempt to pre­serve some ele­ments of the ACA, Album said, but they might lack fed­er­al sup­port for the sub­si­dies peo­ple depend on to afford those pro­grams. Few red states, mean­while, would be pre­pared to run their own Exchanges with­out the fed­er­al­ly facil­i­tat­ed mar­ket­place. This could lead to enroll­ment in Exchanges drop­ping sub­stan­tial­ly, Album said.

And this could lead to sub­stan­tial enroll­ment declines for insur­ance com­pa­nies with size­able man­aged Med­ic­aid and Exchange busi­ness.

About 1.9 mil­lion adults who have pur­chased option­al, non-sub­si­dized den­tal ben­e­fits in the Exchanges could lose their cov­er­age. Young adults between the ages of 19 and 26 who were added to com­mer­cial employ­er cov­er­age as a result of the ACA will lose that cov­er­age if the ACA is com­plete­ly struck.

Con­gress could decide to pro­vide relief, but its abil­i­ty to do so is depen­dent on the results of the Novem­ber elec­tion. We’ll take a clos­er look at what the elec­tion results could mean for these issues in an upcom­ing arti­cle.

However…

Regard­less of what hap­pens, Album said, don’t expect any­thing to hap­pen any time soon. Fol­low­ing the Cal­i­for­nia v. Texas hear­ing in Novem­ber, the deci­sion won’t be announced until April or May, and pos­si­bly as late as June.

And if the Court agrees that the man­date is sev­er­able and sends that ques­tion back down to the low­er courts, it could take years before that out­come and the addi­tion­al legal chal­lenges it will face.

A final twist is that while the cur­rent admin­is­tra­tion is argu­ing that the man­date should be struck down, it’s also urg­ing that low­er courts rule which pro­vi­sions should and shouldn’t be inval­i­dat­ed.

“Even the Trump admin­is­tra­tion has sug­gest­ed, and per­haps will argue in the Supreme Court, that some things should be left alone,” Album said. “We just don’t know which things they would cher­ry-pick in terms of what should be insev­er­able and what shouldn’t.”

How has COVID-19 affected the dental industry?

The new coro­n­avirus (COVID-19) pan­dem­ic has sig­nif­i­cant­ly altered how the den­tal indus­try oper­ates. Here are three ways the pan­dem­ic has changed the den­tal insur­ance land­scape.

Timid patients

There’s an almost dai­ly debate of what con­sti­tutes a good rea­son for leav­ing your house right now. Indi­vid­ual states are at dif­fer­ent stages of re-open­ing or shut­ting back down. With so much uncer­tain­ty, it makes sense that 42% of patients respon­dents may skip or post­pone care out of fear or dis­com­fort, par­tic­u­lar­ly for non-emer­gency pro­ce­dures.

This on top of the 61% of peo­ple who already suf­fer den­tal fears means that show­ing patients the exten­sive infec­tion con­trol mea­sures in place may be an impor­tant aspect of get­ting them back in the chair.

A boom in teledentistry

Tele­den­tistry is a way for den­tists to pro­vide a vir­tu­al con­sul­ta­tion through a phone call, text, or video chat. Den­tists can use tele­den­tistry to address prob­lems that don’t need an office vis­it, which allows them to save time and mon­ey on infec­tion con­trol mea­sures like per­son­al pro­tec­tive equip­ment and san­i­tiz­ing office spaces. This gives prac­tices an ide­al way to assess and triage patients with­out a risk of expo­sure, while also poten­tial­ly allow­ing a den­tist to see more patients in a day.

Even before the pan­dem­ic, tele­den­tistry was show­ing itself as an inter­est­ing and promis­ing addi­tion to tra­di­tion­al den­tal care. It allows den­tists to see patients who are at-risk, live in rur­al areas, or those who just desire the con­ve­nience as well as poten­tial­ly decreas­ing costs of den­tal care over­all.

The key ingre­di­ent to the suc­cess of tele­den­tistry is wide­spread patient accep­tance. One pos­si­ble issue, accord­ing to a review of survey’s about tele­den­tistry, is that patients may feel like the qual­i­ty of care received remote­ly is not as high as care received in per­son. How­ev­er, users in one study were gen­er­al­ly sat­is­fied with the expe­ri­ence and respon­dents in anoth­er sur­vey indi­cat­ed that they would use tele­den­tistry if it was avail­able.

Americans losing health insurance

The biggest shift has been in the num­ber of peo­ple with access to health insur­ance. With mil­lions of jobs lost, many indi­vid­u­als and their fam­i­lies have lost both their cov­er­age from their employ­ers as well as a steady income. Accord­ing to researchers from the Urban Insti­tute, some indi­vid­u­als will be able to become insured under a fam­i­ly member’s pol­i­cy, through the Afford­able Care Act mar­ket­place, Med­ic­aid or by choos­ing indi­vid­ual cov­er­age through a bro­ker. Still, that leaves almost 3.5 mil­lion peo­ple who may become unin­sured. With the end of fed­er­al pro­grams to sup­port those who have lost their jobs, one big ques­tion for the den­tal indus­try is whether or not peo­ple will make the choice to go to the den­tist.

Dentists seen as an economic indicator

The den­tal indus­try may be a good indi­ca­tor of whether Amer­i­cans have ful­ly recov­ered from the pan­dem­ic, accord­ing to a June New York Times arti­cle. This is because den­tists offer a unique ser­vice that has no clear alter­na­tive.

Since the coro­n­avirus (COVID-19) pan­dem­ic hit the U.S. in ear­ly March, the nation­al econ­o­my has seen a down­turn and a sub­se­quent uptick. The den­tal indus­try expe­ri­enced an ampli­fied ver­sion of these nation­al employ­ment trends, with half of all den­tal work­ers los­ing their jobs in March and April, and 94% of den­tist offices rehir­ing their full staff by mid-August.

Getting dentists back into the office

Stim­u­lus pro­grams may be a key fac­tor in help­ing den­tists to weath­er this storm. Prac­tices that took part in the fed­er­al Pay­check Pro­tec­tion Pro­gram were more like­ly to remain open than those that didn’t.

Even after job gains since June, the den­tal indus­try still has 289,000 few­er work­ers than it did before the pan­dem­ic. That sug­gests to Bet­sey Steven­son, a Uni­ver­si­ty of Michi­gan eco­nom­ics pro­fes­sor quot­ed in the Times arti­cle, that the indus­try — and the rest of the Amer­i­can econ­o­my — is far from recov­ered.

What does the future look like?

Though den­tist offices have been open for sev­er­al months, it’s unclear whether their patient bases will return. In mid-June, most states gave den­tist offices the go-ahead to reopen ful­ly, but in August patient vol­umes were still low­er than what they were before the pan­dem­ic. The rate at which patients were return­ing has even tapered off as of mid-August and some econ­o­mists don’t pre­dict patient vol­umes to return ful­ly before the end of 2020.

This hes­i­ta­tion is a sign of mul­ti­ple prob­lems fac­ing patients dur­ing the pan­dem­ic. Some patients may feel cau­tious about remov­ing their masks for a close-up pro­ce­dure. Oth­ers may think that since they haven’t noticed any den­tal issues since the pan­dem­ic start­ed, they can go a lit­tle longer with­out get­ting a den­tal clean­ing. Some peo­ple can sim­ply no longer afford den­tal pro­ce­dures after los­ing their jobs and their insur­ance ben­e­fits through their employ­ers. Econ­o­mists who spoke to the Times pre­dict that employ­ment rates for den­tists will even­tu­al­ly return to where they were before the virus hit, even though it may be slow going.

Policy pops: How does dental fit into the gig economy?

3‑minute read

Join our guest blog­ger, Devin McBray­er, as she explores the role of den­tal ben­e­fits in the fast-grow­ing gig econ­o­my. Devin is a Leg­isla­tive and Pol­i­cy Ana­lyst based in Sacra­men­to, Cal­i­for­nia.

The large major­i­ty of Amer­i­cans have den­tal ben­e­fits — 77% in fact, accord­ing to the Nation­al Asso­ci­a­tion of Den­tal Plans. Most Amer­i­cans receive this cov­er­age through their employ­er or groups like AARP. How­ev­er, the job mar­ket is chang­ing. Each year, more Amer­i­cans are leav­ing tra­di­tion­al work­places to join the gig econ­o­my and be their own boss. This shift could change the land­scape of the ben­e­fits indus­try in the very near future.

Who’s in the gig economy?

Near­ly one quar­ter of Amer­i­cans earn some or all of their income in the gig econ­o­my, Edi­son Research esti­mates. Not sur­pris­ing­ly, a 2019 sur­vey by Bankrate shows that almost half of Mil­len­ni­al work­ers work in the gig econ­o­my in some capac­i­ty. While that’s more than any oth­er gen­er­a­tion, a 2018 Pru­den­tial study notes that Gen X‑ers work the most hours per week in their gig jobs of any gen­er­a­tion and are also more like­ly to rely exclu­sive­ly on gig work for income. Baby boomers tend to use gig work to make extra mon­ey in retire­ment.

Do gig jobs offer dental benefits?

The increas­ing num­ber of Amer­i­cans work­ing odd jobs for TaskRab­bit or dri­ving for Uber may not receive tra­di­tion­al employ­ee ben­e­fits, includ­ing den­tal cov­er­age. That can cause anx­i­ety, when an esti­mat­ed 44% of Amer­i­can gig work­ers rely on the gig econ­o­my as the sole source of their income. Gig work­ers might be able to afford to pur­chase indi­vid­ual den­tal cov­er­age direct­ly from a car­ri­er or through their state’s exchange, but for some, that cov­er­age might be more than they can afford. A 2017 study by Free­lancers Union & Upwork found that over half of free­lancers dipped into their sav­ings each month to make ends meet.

On the oth­er end of the spec­trum, the gig econ­o­my work­ers using their gig to sup­ple­ment their income from a more tra­di­tion­al employ­er may already have den­tal ben­e­fits from their pri­ma­ry job. If not, they may actu­al­ly use the extra cash to pur­chase indi­vid­ual cov­er­age.

What does the trend mean for benefits brokers?

Gig work­ers, espe­cial­ly those who have nev­er had access to employ­er-spon­sored ben­e­fits, may need edu­ca­tion about the val­ue of den­tal cov­er­age. Adults with den­tal ben­e­fits are more like­ly to vis­it the den­tist and seek pre­ven­tive care, accord­ing to the 2017 Delta Den­tal Plans Asso­ci­a­tion, Adult Oral Health and Well-being Sur­vey. Rou­tine den­tal exams can detect health prob­lems ear­ly and low­er the risk for cost­ly con­di­tions down the road like crowns, implants or even oral can­cers.

The rise of the gig econ­o­my could also change the way that den­tal ben­e­fits are sold to this pop­u­la­tion. For work­ers in the gig econ­o­my exclu­sive­ly, indi­vid­ual den­tal plans with com­pet­i­tive cov­er­age and pric­ing will become increas­ing­ly impor­tant. Many gig work­ers use apps like Lyft and Post­mates to earn mon­ey, which may sig­nal that they’re more like­ly to pur­chase insur­ance online and look for plans geared toward tech-savvy con­sumers.

For more thought lead­er­ship from Delta Den­tal, sub­scribe to Insid­er Update, our newslet­ter for bro­kers, agents and con­sul­tants.

If you’re a ben­e­fits deci­sion mak­er, admin­is­tra­tor or HR pro­fes­sion­al, sub­scribe to our group newslet­ter, Word of Mouth.

Policy pops: Health care exchanges — 2019 enrollment results

3‑minute read

Join our guest blog­ger, Devin McBray­er, as she reviews the out­comes of the 2019 open enroll­ment peri­od for health care exchanges. Devin is a Leg­isla­tive and Pol­i­cy Ana­lyst based in Sacra­men­to, Cal­i­for­nia.

The open enroll­ment peri­od to pur­chase Afford­able Care Act (ACA)-compliant indi­vid­ual health insur­ance cov­er­age off the health insur­ance exchanges for 2019 has come to an end. Sign-ups were off to a slow start at the begin­ning of the enroll­ment peri­od, leav­ing many experts fear­ful that ACA plans would expe­ri­ence a sig­nif­i­cant decrease in enroll­ment. How­ev­er, total enroll­ment only decreased by about 3.8% nation­wide on Healthcare.gov, much of this due to a 15% reduc­tion in new sign-ups.

While the total enroll­ment drop in indi­vid­ual health insur­ance plans on the exchange may have been less dras­tic than expect­ed, it is still worth explor­ing why new enroll­ment decreased con­sid­er­ably and why year-to-year enroll­ment con­tin­ues to decline. Sev­er­al 2018 pol­i­cy changes, com­bined with a grow­ing econ­o­my, could help explain the decrease in enroll­ment in ACA plans for the 2019 plan year.

Are policy changes to blame?

In 2018, Con­gress reduced the tax penal­ty for not hav­ing an ACA-com­pli­ant health insur­ance plan to zero, effec­tive­ly elim­i­nat­ing it. The fed­er­al gov­ern­ment also short­ened the open enroll­ment peri­od and reduced mar­ket­ing for open enroll­ment. Simul­ta­ne­ous­ly, the fed­er­al gov­ern­ment passed sev­er­al rules that expand­ed the avail­abil­i­ty of cheap­er and less com­pre­hen­sive insur­ance plans such as short-term lim­it­ed dura­tion plans. No tax penal­ty for lack of cov­er­age, com­bined with a short­er sign-up peri­od and more plan options out­side the exchanges, may help explain the enroll­ment decrease.

The impact of the economy

Anoth­er pos­si­ble expla­na­tion for the drop in enroll­ment could be attrib­uted to an improv­ing econ­o­my. When open enroll­ment start­ed on Novem­ber 1, 2018, 2 mil­lion more jobs were added to the econ­o­my than were added at the same time in 2017. As more peo­ple head back to work, it’s pos­si­ble that they’re gain­ing access to employ­er-spon­sored health insur­ance, elim­i­nat­ing the need to renew their ACA plan.

What does this mean for dental?

Any loss in enroll­ment for med­ical cov­er­age also means less peo­ple enrolled in den­tal cov­er­age on the exchange. (As a reminder, den­tal cov­er­age is an essen­tial health ben­e­fit for chil­dren but not for adults.)

In the exchanges, den­tal cov­er­age is includ­ed in some health plans or con­sumers can get a stand-alone den­tal plan and pay a sep­a­rate pre­mi­um. How­ev­er, there is no way for con­sumers to pur­chase a stand-alone den­tal plan with­out also pur­chas­ing a med­ical plan on the health care exchange. Push­ing for states and the fed­er­al gov­ern­ment to allow for the inde­pen­dent pur­chase of stand-alone den­tal plans on state and fed­er­al health insur­ance exchanges is a top pri­or­i­ty for the Pub­lic & Gov­ern­ment Affairs team at Delta Den­tal.

For more thought lead­er­ship from Delta Den­tal, sub­scribe to Insid­er Update, our newslet­ter for bro­kers, agents and con­sul­tants.

If you’re a ben­e­fits deci­sion mak­er, admin­is­tra­tor or HR pro­fes­sion­al, sub­scribe to our group newslet­ter, Word of Mouth.

Policy pops: Medicaid expansion won many voters. Now what?

2‑minute read

Join our guest blog­ger, Devin McBray­er, as she explains how the results of the midterm elec­tion affect Med­ic­aid expan­sion across the coun­try. Devin is a Leg­isla­tive and Pol­i­cy Ana­lyst based in Sacra­men­to, Cal­i­for­nia.

The 2018 midterm elec­tion revealed that many Amer­i­cans sup­port Med­ic­aid expan­sion: Three of four states with expan­sion on the bal­lot vot­ed to approve it, and two of four guber­na­to­r­i­al can­di­dates sup­port­ing Med­ic­aid expan­sion won elec­tion. If these states are suc­cess­ful in grow­ing their pro­grams, access to den­tal care for low-income Amer­i­cans will like­ly increase. How­ev­er, the futures of these states’ Med­ic­aid pro­grams face polit­i­cal and finan­cial obsta­cles.

Utah, Nebras­ka and Ida­ho vot­ers approved expand­ing cov­er­age to 300,000 low-income Amer­i­cans, yet these states are already expe­ri­enc­ing push­back or chal­lenges:

  • In Ida­ho, while the bal­lot ini­tia­tive to expand Med­ic­aid passed with more than 60% of vot­ers, Repub­li­cans in the state have filed a law­suit against the bal­lot ini­tia­tive say­ing that it vio­lates parts of the state’s con­sti­tu­tion.
  • Imple­men­ta­tion efforts in Utah are like­ly to be blocked by con­ser­v­a­tives in the state House of Rep­re­sen­ta­tives.
  • The Nebras­ka state leg­is­la­ture faces the dif­fi­cult task of fig­ur­ing out how to pay for the pro­gram.

Mean­while, Mon­tana vot­ed to allow their exist­ing Med­ic­aid expan­sion to sun­set in 2019, which means Mon­tanans who pre­vi­ous­ly gained health care cov­er­age will lose it on Jan­u­ary 1, 2019.

Com­pli­cat­ing mat­ters, in all states the 100% fed­er­al fund­ing match for new­ly eli­gi­ble Med­ic­aid enrollees has begun to phase down. By 2020 the match will drop down to 90%, which will force states to finance a greater share of expan­sion costs.

Aside from bal­lot ini­tia­tives, four guber­na­to­r­i­al can­di­dates ran with Med­ic­aid expan­sion as a core part of their polit­i­cal plat­form. Two Demo­c­ra­t­ic can­di­dates sup­port­ing expan­sion won their races and flipped their state exec­u­tive office, but the path to expan­sion isn’t clear.

  • In Wis­con­sin, Repub­li­cans in the state Assem­bly and Sen­ate have already passed bills that could lim­it the pow­ers of Gov­er­nor-elect Tony Evers, includ­ing his Med­ic­aid expan­sion efforts.
  • In the Kansas elec­tion that put Demo­c­rat Lau­ra Kel­ly in the governor’s office, vot­ers also elect­ed a more con­ser­v­a­tive Leg­is­la­ture. Any bill seek­ing to expand Med­ic­aid in Kansas will now have a tougher time get­ting to the governor’s desk.

The guber­na­to­r­i­al can­di­dates sup­port­ing Med­ic­aid expan­sion in Flori­da and Geor­gia lost their races, fur­ther low­er­ing the pos­si­bil­i­ty for expan­sion in these states.

Delta Den­tal will con­tin­ue to mon­i­tor the impact of these elec­tions and oth­er trends that could have major impacts on low-income adults’ access to den­tal ben­e­fits and care across the coun­try.

For more thought lead­er­ship from Delta Den­tal, sub­scribe to Insid­er Update, our newslet­ter for bro­kers, agents and con­sul­tants.

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