In an earlier Insider Update article, we considered three possible outcomes of the 2020 United States elections and some possible implications of each.
Since then, the Democratic Party has gained control of the Senate, while winning the White House and keeping control (just barely) of the House of Representatives.
From the Delta Dental perspective, this “clean sweep” impacts all our stakeholders, including dentists, enrollees and our group customers. What follows are some potential opportunities and challenges that may affect you.
The Affordable Care Act (ACA) and the health insurance marketplace (exchange) system will be preserved and expanded
President Joe Biden’s administration has made restoring the ACA an immediate priority, and many of the cuts and restrictions imposed by the administration of former President Donald Trump are being reversed.
This is a positive development for the dental industry, said Jeff Album, Vice President of Public & Government Affairs for Delta Dental.
“News that’s good for the ACA and good for the exchanges is good news for the industry,” Album said. “This market and the increased subsidies attract people who wouldn’t otherwise get insurance.”
Among the ACA-related actions that are either underway or soon to happen under this administration:
A special enrollment period to increase exchange enrollment is officially underway
Biden signed an executive order to create a special enrollment period from February 15, 2021 through May 15, 2021, during which eligible people can enroll in coverage from the federal health insurance marketplace. Uninsured residents in the 36 states that use the federal exchange system, including those who lost coverage because of the pandemic, can look for plans.
States with their own marketplaces are also creating special enrollment periods, although the time frames and eligibility requirements may differ.
The Centers for Medicare & Medicaid Services (CMS) has earmarked $50 million for outreach and education during the enrollment period.
The ACA’s Navigator Program will return
Reversing the prior administration’s move to defund this program, CMS will now provide about $2.3 million to help people find coverage on the federal exchanges, a process that can be confusing. The money will fund 30 Navigator Programs in 28 states. This, Album said, should help bolster dental enrollment.
“Several studies suggests that consumers are completely unaware of marketplace open enrollment dates, including the special enrollment periods,” Album said. “We believe this type of outreach will definitely help promote adult dental voluntary enrollment.”
Subsidies for exchanges will increase
The $1.9 trillion American Rescue Plan Act of 2021 (ARP), which Biden signed into law on March 11, includes increases to ACA subsidies. Consumers with household income more than 400% the federal poverty threshold (about $51,000 per year) will receive federal assistance to ensure that no more than 8.5% of their income goes toward a plan.
“The subsidies are getting better and the Biden administration is trying to bring more people into the exchanges,” Album said. “A great many small business and individuals impacted by the economy and COVID will now have an opportunity to get exchange-based dental coverage.”
Waivers that allow states to circumvent exchanges may be eliminated
Section 1332 of the ACA permits states to apply for a waiver to pursue “innovative strategies” to provide their residents with access to affordable health insurance, so long as they retain the basic protections of the ACA.
However, in 2020, the state of Georgia used the 1332 waiver to effectively eliminate its exchange program and force Georgia residents to purchase plans from private insurers without any kind of centralized platform. As a result, Biden directed federal agencies to reexamine all waiver policies, including 1332.
“I think this administration is going to be tougher than the former one when it comes to deviating from the ACA’s framework,” Album said. “We’re not likely to see any other states attempt a direct enrollment alternative to centralized state-based exchanges or the federally facilitated exchange.”
Medicaid eligibility under the ACA will expand
The ARP also includes incentives to encourage states to expand Medicaid eligibility under the ACA. States that choose to expand would receive a 5‑percentage-point increase in Federal Medical Assistance Percentage (FMAP) payments to current Medicaid enrollees.
“The FMAP increases are important because that’s what allows states to do optional benefits like adult dental,” Album said. “Here in California, the adult dental Medicaid program was going to be in trouble if the state didn’t receive more financial assistance.”
A “public option” with a dental benefit could be created — but probably won’t
A public option would be a federal health insurance program offered on states’ exchanges as an alternative to private plans. It would probably be subsidized for lower income Americans and at least partially paid for by enrollees who don’t qualify for subsidies.
While dental coverage wouldn’t be a guaranteed benefit for anyone other than children, it could be made available on a voluntary basis.
Initially, it seemed as though a clean sweep by the Democrats would almost guarantee a public option. Candidate Biden repeatedly said he supported it during his 2020 campaign. And California Attorney General Xavier Becerra, Biden’s pick for Secretary of the U.S. Department of Health and Human Services and a long-time proponent single payer health care, said during a recent Senate hearing that he would support Biden’s efforts to do so.
However, the Democratic sweep in the 2020 election might not be enough to push this through. Despite their control of the Senate, the Democrats depend on the tie-breaking vote of Vice President Kamala Harris. Furthermore, the Democratic majority in the House narrowed significantly, which increases the leverage of moderate Democrats who aren’t enamored with the public option.
“Given the Democrats’ razor-thin majority in both the Senate and the House, and Republican opposition to the concept, a public option currently seems unlikely,” Album said. “I don’t see it happening.”
Leaving the ACA, here are a few other possible issues likely to come up for Congress and the new administration to consider that may potentially impact dental insurance.
A dental benefit could be added to Medicare
Democrats in the House and Senate have introduced bills to add dental under Medicare Part B. As introduced, these bills do not specify which benefits should be added, which makes it difficult to assess whether the proposals help or hurt existing Medicare Advantage dental plans.
“Neither the House nor the Senate is likely to take these bills up in earnest until the latter half of the year,” Album said, “but our goal will be to participate in discussions yet to come on how the industry can help facilitate bringing dental care to seniors without disrupting existing, successful programs.”
As with any new administration, there are more questions than answers at this point, and how — or if — some of these proposed changes will be implemented is uncertain. What is certain, however, is that we can expect more proposals and policy updates that will affect the dental insurance industry in the upcoming months. Be sure to refer back to Insider Update for news and updates as they become available.