CMS finalizes rule, making major changes to ACA exchanges

CMS on Friday finalized the final Notice of Benefit and Payment Parameters for 2027, a rule that will institute significant new policies for ACA exchanges.

Specifically, the rule will allow health insurance companies to offer catastrophic plans to more people for up to 10 years. These plans were originally intended for people younger than 30 or experiencing hardships defined by the ACA.

According to the new rule, people with incomes below the federal poverty level — which is $15,960 for an individual in the 48 contiguous states and Washington, D.C., and higher in Alaska and Hawaii — or above 250% of the poverty level would qualify for a catastrophic plan if their incomes decrease or increase and make them ineligible for premium subsidies.

In addition, the rule permits health plans with no provider networks to operate on the ACA exchanges, rescinds a requirement that states setting up new exchanges must operate as a hybrid federal-state marketplace for one year before fully taking over, and reduces the health insurance company user fee from 2.5% to 1.9% for federal exchanges and from 2% to 1.5% for state exchanges using the federal enrollment system.

The rule also tightens marketing standards, requiring agents and brokerages to use standardized eligibility forms and enrollees to personally affirm the information in any applications prepared by third-party marketers is correct.

(Early, Modern Healthcare, 5/15)

Senate health committee chair loses primary

Sen. Bill Cassidy (R-La.), chair of the Senate Health, Education, Labor, and Pensions committee and a doctor, lost his primary on Saturday, finishing third behind Rep. Julia Letlow (R-La.) and state Treasurer John Fleming, both of whom will face off in a Jun. 27 runoff.

President Donald Trump endorsed Letlow and has lashed out at Cassidy over a variety of issues, including Trump's claim that Cassidy "stood in the way" of the nomination of Casey Means for surgeon general, and Cassidy's vote to convict Trump on impeachment charges in 2021.

After the loss, Cassidy defended his impeachment vote. "That may have cost me my seat, but who cares? I had the privilege of voting to uphold the Constitution. Isn't that a great thing?" Cassidy said. "When I die, if that's put in my obituary, 'he voted to uphold the Constitution' — I'll figure that that's going to be a better obituary."

While his voting record has generally been in line with the Trump administration's agenda, Cassidy has been publicly critical of Trump and his administration. For example, in June last year, Cassidy criticized HHS Secretary Robert F. Kennedy Jr.'s decision to fire all 17 members of CDC's Advisory Committee on Immunization Practices.

Cassidy was also a key vote in confirming Kennedy as HHS secretary, a nomination he initially said he was "struggling" with but ultimately decided to vote in favor of following "intense conversations" with both the White House and Vice President JD Vance.

(Bettelheim, Axios, 5/18; Kapur, et al., NBC News, 5/18)

The court ruled 7-2 to grant the emergency appeal and set aside the order from the appeals court. Justices Samuel Alito and Clarence Thomas dissented in the decision, with Thomas writing that the two companies are not entitled to the court's action to spare them "lost profits from their criminal enterprise."

Alito said in his dissent that the decision is "unreasoned" and "remarkable."

"What is at stake is the perpetration of a scheme to undermine our decision in Dobbs v. Jackson Women's Health Organization, which restored the right of each State to decide how to regulate abortions within its borders," Alito wrote.

(Sherman, et al., Associated Press, 5/14; Savage, Los Angeles Times, 5/14; Simmons-Duffin, NPR, 5/14)

Chief spokesman for RFK Jr. resigns in protest over move to allow flavored vapes

Rich Danker, the chief spokesperson for HHS Secretary Robert F. Kennedy Jr., resigned on Wednesday in protest over the department's push to allow tobacco companies to sell flavored vapes.

In a letter to President Donald Trump obtained by the New York Times, Danker said that Trump had "twice restored our prosperity and national security against all odds" and warned that authorizing flavored vapes will draw more children into vaping and increase their risk for many health issues.

The letter also cited "senior HHS officials" other than Kennedy who were behind the push, including a new policy posted by FDA on Friday in which the agency said it would take steps to remove illicit vapes from the market and allow sales of those that have crossed certain benchmarks toward agency approval.

"Senior HHS officials in the immediate office of the secretary have in recent months sought U.S. Food and Drug Administration marketing approval of e-cigarette flavors that would appeal to children and expose them to nicotine addiction, lung damage, and higher risk of cancer," Danker wrote.

(Stolberg, New York Times, 5/13)