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The Scoop: October 30, 2019 Edition

In this edition

Welcome to this week’s round-up of state-level health reform news, including:

Open enrollment starts on Friday. Here’s what you need to know.

If you buy your own health insurance, open enrollment begins on Friday. For the next month and a half (a little longer in some states), you’ll have an opportunity to compare the plans that are available in your area, see if you qualify for financial assistance, and get signed up for 2020 coverage.

Here’s a quick overview of some important points for this year’s enrollment:

  • Enrollment is already underway in California, and the state has new premium subsidies that have higher income limits. Residents who didn’t get subsidies in previous years might qualify for financial assistance in 2020.
  • Plans are available for window shopping now in nearly every state (Rhode Island and Massachusetts will have 2020 plan comparisons available when open enrollment begins, on November 1).
  • Federal premium subsidies are available for a family of four in 2020 with a household income up to $103,000. Here’s what you need to know about how household income is calculated, and some tips for getting your income into the subsidy-eligible range.
  • Residents in Nevada need to enroll through Nevada Health Link for 2020, instead of HealthCare.gov.
  • Residents in Massachusetts, DC, New Jersey, Rhode Island, and California are required to have health insurance in 2020. Non-compliance will result in tax penalties for residents who don’t qualify for an exemption.
  • Insurers are joining the exchanges in Alaska, Colorado, Florida, Georgia, Kansas, Louisiana, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, Utah, Virginia, Washington, and Wisconsin. In many other states, insurers are expanding their coverage areas.
  • Average benchmark plan premiums across the country will be lower than they were in 2019, but that means premium subsidies will also be smaller – in some areas, much smaller. If you want more insight into what might be happening with your 2020 health insurance premiums, read Andrew Sprung, David Anderson, and Charles Gaba. But no matter what, it’s essential that you shop around during open enrollment to make sure you’re getting the plan that best fits your needs.
  • Although Medicaid enrollment is not limited to an open enrollment window, enrollment in Idaho’s expanded Medicaid program also begins on Friday, with coverage effective January 1.

Oklahoma submits record number of signatures for Medicaid expansion ballot initiative

Medicaid expansion advocates in Oklahoma have been gathering signatures in Oklahoma to get a Medicaid expansion initiative on the 2020 ballot. They needed 178,000 signatures, and submitted 313,000 – the most signatures that have ever been collected for a ballot initiative in Oklahoma.

Georgia expected to propose partial Medicaid expansion

Georgia enacted legislation this year that allows the state to submit waiver proposals to the federal government in order to transform some aspects of the state’s health care system. One proposal, slated to be unveiled next week, is expected to propose partial Medicaid expansion. The other is likely to propose a reinsurance program.

November elections could affect Medicaid expansion rules in Virginia, Kentucky, Mississippi, and Louisiana

Although many Americans are already looking ahead to the 2020 elections, there’s still a lot at stake in some states next month. At Vox, Matthew Yglesias explains how the legislative and gubernatorial elections in Virginia, Kentucky, Mississippi, and Louisiana could affect Medicaid expansion – or the lack thereof – in those states over the coming months and years.

Nebraska publishes draft proposal for 2020 Medicaid expansion

Voters in Nebraska approved Medicaid expansion last fall, and the state is very slowly making progress on a fairly complicated version of Medicaid expansion that will take effect in October 2020. Nebraska plans to have two tiers of coverage, with enrollees required to comply with various requirements in order to get Prime Coverage instead of Basic Coverage (roughly a third of enrollees are expected to have Basic Coverage). The details were published in late October, and a public comment period runs through late November.

Tennessee commenters overwhelmingly oppose Medicaid block grant proposal

The public comment period for Tennessee’s proposed Medicaid block grant program closed earlier this month, and commenters overwhelmingly opposed the proposal. Governor Bill Lee believes many people who commented on the block grant proposal are “misinformed,” but has said that he plans to read the 2,200 pages of comments and make modifications to the proposal based on concerns that his administration considers valid. The state will then submit the proposal to the federal government by November 20.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.


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