Broker blog from Delta Dental

Tag: election

The 2020 elections and the Democrats’ clean sweep: What’s at stake for dental insurance

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.”

Questions remain

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.

The 2020 elections and the ACA: What’s at stake for dental insurance

For the dental insurance industry, the upcoming November elections are among the most important in recent history. Depending on the outcome, the Affordable Care Act (ACA) could be affected significantly, which in turn could reduce access to oral health care for millions of Americans.

What’s going on with the ACA?

The future of the ACA is in question. In the case of California v. Texas, scheduled to be heard before the United States Supreme Court on November 10, the court will decide whether the law should be struck down, and which elements may or may not be saved.

A previous Insider Update article looked at how the upcoming Supreme Court nomination might affect the fate of the ACA. We’ll now consider the potential impact of the upcoming elections.

The upcoming election: What could happen?

On November 3, U.S. voters will decide whether to reelect President Donald Trump, a Republican, or replace him with former Vice President Joe Biden, a Democrat. They’ll also decide who will fill many United States Senate and House of Representative seats. Three outcomes are possible: 

  • A clean sweep by the Democrats. Democrats gain control of the White House and Senate, and retain control of the House.
  • A partial sweep by the Democrats. Democrats gain control of the White House and retain control of the House, but Republicans keep control of the Senate.
  • A return to status quo. Republicans keep the White House and Senate, and Democrats retain control of the House.

Current polling data strongly suggests that Democrats will retain the House, so a Republican sweep is unlikely.

How could a Democratic sweep affect the dental insurance industry?

A clean sweep for the Democrats, not surprisingly, would likely preserve and strengthen the ACA, regardless of the Supreme Court’s decision on California v. Texas, said Jeff Album, Vice President of Public & Government Affairs for Delta Dental.

“With Democrats controlling all three branches, Congress can quickly restore almost anything the Supreme Court might strike down, and do so long before the court’s decision becomes effective,” Album said.

Beyond the ACA, industry experts predict a clean sweep could lead to many other outcomes relevant to the dental industry:

  • Medicare could become available to people younger than 65, which could open new Medicare Advantage (MA) markets in which dental is often offered.
  • A dental benefit could be added to Medicare Part B, or as separate Part “T” (for teeth). Depending on the extent of the benefit provided, a Part B dental benefit could create or eliminate opportunities for dental insurers. A comprehensive Part B benefit could replace the private dental coverage purchased by millions of Medicare beneficiaries today, give growth to dental as a part of Medi-Gap policies, and eliminate employer-sponsored retiree dental plans. However, a Part B dental benefit limited to only preventive care could create opportunities for insurers to offer supplemental benefits plans. A Part B dental benefit would also require that all Medicare Advantage plans provide at least the same set of dental benefits, which would result in these plans receiving larger payments from the U.S. Centers for Medicare & Medicaid Services (CMS). About a third of MA plans today don’t offer dental.
  • A “public option” could be created. While the Biden campaign hasn’t offered many details, a public option is conceptually a federal health insurance program to be offered on state Health Insurance Exchanges as an alternative to private plans. It would likely be subsidized for lower income Americans, and partially or fully paid by enrollees who currently don’t qualify for subsidies. While dental coverage isn’t guaranteed to be a benefit for anyone other than children, an intriguing possibility is that it could be made available on a voluntary basis.
  • The public option might even entail automatic enrollment for low-income people into an existing Medicaid managed care or Medicaid fee-for-service plan.
  • Balance billing, or “surprise billing,” by out-of-network providers could become regulated by federal law, but it’s unclear how this might affect dental benefits, if at all.

How about a partial Democratic sweep?

A partial sweep, with a Republican-controlled Senate able to prevent legislation beginning in the House from reaching the president, would likely thwart a public option, strengthening the ACA or adding dental coverage to Medicare. However, a Biden White House could preserve the ACA as it currently exists, and eliminate through executive order moves by the prior administration to weaken it.

“Dramatic change is unlikely,” Album said.

Paired with an unfavorable Supreme Court ruling, however, a partial sweep could spell trouble for the ACA, Album said.

“It makes recovering from an adverse Texas decision in the Supreme Court much harder because the Senate Republicans may support many of the cutbacks an adverse SCOTUS decision could cause,” Album said. “And should the Supreme Court strike the ACA entirely, it’s hard to imagine Democrats and Republican agreeing on replacement.”

And what if we maintain status quo?

Should the country continue with a Republican president and divided Congress, the outcome of California v. Texas is uncertain.

A ruling that either leaves the ACA in place, or finds that the law’s individual mandate can be eliminated while leaving the ACA otherwise intact, means little change. But a ruling that the ACA is inseverable from the mandate means millions will lose coverage they have today, with Congress likely unable to respond.

Album predicts that a Republican White House would probably continue to work through executive orders to weaken the ACA and make ACA-non-compliant alternatives more widely available.

The worst-case scenario for the ACA occurs if federal funding for the program is eliminated. As many as 2 million people with Exchange-based dental benefits in the Exchanges could lose that coverage. For insurers, the risk is most acute for those with sizeable managed Medicaid and Exchange business.

“Marketplace changes could be profound,” Album said.

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.

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

Policy pops: Midterm elections’ impact on Medicaid (and dental) expansion

3‑minute read

Join our guest blogger, Devin McBrayer, as she explores the role of Medicaid expansion in the midterm elections and the potential impact on low-income adults’ access to dental benefits. Devin is a legislative and policy analyst based in Sacramento, California.

Midterm elections are just around the corner on November 6, and the results of the election could change the future of Medicaid in several states. Medicaid expansion is an important platform issue for some contested governors’ races as well as the subject of several ballot initiatives across the country. If more states expand Medicaid coverage for adults through the Affordable Care Act (ACA), dental coverage for low-income adults could also grow.

Currently, 33 states, plus Washington D.C., have opted to expand Medicaid, and 14 states have chosen not to do so. Three states, Idaho, Nebraska and Utah, will vote on Medicaid expansion for the first time this Election Day. If these states vote to expand their Medicaid programs, an additional 300,000 low-income Americans would be eligible for coverage. Montana also has a ballot initiative to extend their temporary expansion that covers 100,000 people in the state. Unless Montana voters approve the ballot initiative, the temporary expansion of Medicaid will end in 2019.

Several hotly-contested races for governor also feature Medicaid expansion as a central issue for candidates. Florida, Georgia, Kansas and Wisconsin all have Democratic gubernatorial candidates interested in expanding Medicaid if elected. Medicaid expansion could open the doors to providing more extensive dental benefits for those states’ adult populations in the future. Florida and Georgia’s current state Medicaid programs, in particular, offer emergency-only adult dental benefits, which are most often limited to pain relief under very specific situations.

Most states offer a limited dental benefit to their adult Medicaid population, but since adult dental is not a required benefit and the state must pay the entire cost of providing the benefit, fewer than half of states offer an extensive adult dental benefit. In FY 2018, 19 Medicaid expansion states chose to enhance the covered benefits in their Medicaid program, and three of those states, Arizona, California and Utah, chose specifically to enhance the dental benefit or access to dental services.

Along with the impact of elections on Medicaid expansion, it’s important to have an eye on the economic conditions. States that expanded their Medicaid programs in 2014–2016 received a 100% funding match from the federal government for newly eligible Medicaid enrollees. However, this federal match has begun to phase down and by 2020 the match will drop to 90%, which will force states to finance a greater share of the costs of Medicaid expansion. Delta Dental will continue to monitor these important elections and other trends that could have big impacts on low-income adults’ access to dental benefits across the country.

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.

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