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  • 4 Apr 2023 2:22 PM | Addie Thompson (Administrator)
    As women continue to die due to pregnancy or childbirth each year in the United States, new federal data shows that the nation’s maternal death rate rose significantly yet again in 2021, with the rates among Black women more than twice as high as those of White women.

    Experts said the United States’ ongoing maternal mortality crisis was compounded by Covid-19, which led to a “dramatic” increase in deaths.

    The number of women who died of maternal causes in the United States rose to 1,205 in 2021, according to a report from the National Center for Health Statistics, released Thursday by the US Centers for Disease Control and Prevention. That’s a sharp increase from years earlier: 658 in 2018, 754 in 2019 and 861 in 2020.

    That means the US maternal death rate for 2021 – the year for which the most recent data is available – was 32.9 deaths per 100,000 live births, compared with rates of 20.1 in 2019 and 23.8 in 2020.

    The new report also notes significant racial disparities in the nation’s maternal death rate. In 2021, the rate for Black women was 69.9 deaths per 100,000 live births, which is 2.6 times the rate for White women, at 26.6 per 100,000.

    The data showed that rates increased with the mother’s age. In 2021, the maternal death rate was 20.4 deaths per 100,000 live births for women under 25 and 31.3 for those 25 to 39, but it was 138.5 for those 40 and older. That means the rate for women 40 and older was 6.8 times higher than the rate for women under age 25, according to the report.

    The maternal death rate in the United States has been steadily climbing over the past three decades, and these increases continued through the Covid-19 pandemic.

    Questions remain about how the pandemic may have affected maternal mortality in the United States, according to Dr. Elizabeth Cherot, chief medical and health officer for the infant and maternal health nonprofit March of Dimes, who was not involved in the new report.

    “What happened in 2020 and 2021 compared with 2019 is Covid,” Cherot said. “This is sort of my reflection on this time period, Covid-19 and pregnancy. Women were at increased risk for morbidity and mortality from Covid. And that actually has been well-proven in some studies, showing increased risks of death, but also being ventilated in the intensive care unit, preeclampsia and blood clots, all of those things increasing a risk of morbidity and mortality.”

    The American College of Obstetricians and Gynecologists previously expressed “great concern” that the pandemic would worsen the US maternal mortality crisis, ACOG President Dr. Iffath Abbasi Hoskins said in a statement Thursday.

    “Provisional data released in late 2022 in a U.S. Government Accountability Office report indicated that maternal death rates in 2021 had spiked—in large part due to COVID-19. Still, confirmation of a roughly 40% increase in preventable deaths compared to a year prior is stunning new,” Hoskins said.

    “The new data from the NCHS also show a nearly 60% percent increase in maternal mortality rates in 2021 from 2019, just before the start of the pandemic. The COVID-19 pandemic had a dramatic and tragic effect on maternal death rates, but we cannot let that fact obscure that there was—and still is—already a maternal mortality crisis to compound.”

    During the early days of the pandemic, in 2020, there was limited information about the vaccine’s risks and benefits during pregnancy, prompting some women to hold off on getting vaccinated. But now, there is mounting evidence of the importance of getting vaccinated for protection against serious illness and the risks of Covid-19 during pregnancy.

    The Covid-19 pandemic also may have exacerbated existing racial disparities in the maternal death rate among Black women compared with White women, said Dr. Chasity Jennings-Nuñez, a California-based site director with Ob Hospitalist Group and chair of the perinatal/gynecology department at Adventist Health-Glendale, who was not involved in the new report.

    “In terms of maternal mortality, it continues to highlight those structural and systemic problems that we saw so clearly during the Covid-19 pandemic,” Jennings-Nuñez said.

    “So in terms of issues of racial health inequities, of structural racism and bias, of access to health care, all of those factors that we know have played a role in terms of maternal mortality in the past continue to play a role in maternal mortality,” she said. “Until we begin to address those issues, even without a pandemic, we’re going to continue to see numbers go in the wrong direction.”

    ‘This is a problem in our country’

    Some policies have been introduced to tackle the United States’ maternal health crisis, including the Black Maternal “Momnibus” Act of 2021, a sweeping bipartisan package of bills that aim to provide pre- and post-natal support for Black mothers, including extending eligibility for certain benefits postpartum.

    As part of the Momnibus, President Biden signed the bipartisan Protecting Moms Who Served Act in 2021, and other provisions have passed in the House.

    In the United States, about 6.9 million women have little or no access to maternal health care, according to March of Dimes, which has been advocating in support of the Momnibus.

    The US has the highest maternal death rate of any developed nation, according to the Commonwealth Fund and the latest data from the World Health Organization. While maternal death rates have been either stable or rising across the United States, they are declining in most countries.

    “A high rate of cesarean sections, inadequate prenatal care, and elevated rates of chronic illnesses like obesity, diabetes, and heart disease may be factors contributing to the high U.S. maternal mortality rate. Many maternal deaths result from missed or delayed opportunities for treatment,” researchers from the Commonwealth Fund wrote in a report last year.

    The ongoing rise in maternal deaths in the United States is “disappointing,” said Dr. Elizabeth Langen, a high-risk maternal-fetal medicine physician at the University of Michigan Health Von Voigtlander Women’s Hospital. She was not involved in the latest report but cares for people who have had serious complications during pregnancy or childbirth.

    “Those of us who work in the maternity care space have known that this is a problem in our country for quite a long time. And each time the new statistics come out, we’re hopeful that some of the efforts that have been going on are going to shift the direction of this trend. It’s really disappointing to see that the trend is not going in the right direction but, at some level, is going in the worst direction and at a little bit of a faster rate,” Langen said.

    “In the health care system, we need to accept ultimate responsibility for the women who die in our care,” she added. “But as a nation, we also need to accept some responsibility. We need to think about: How do we provide appropriate maternity care for people? How do we let people have time off of work to see their midwife or physician so that they get the care that they need? How do all of us make it possible to live a healthy life while you’re pregnant so that you have the opportunity to have the best possible outcome?”

  • 4 Apr 2023 2:22 PM | Addie Thompson (Administrator)

    In most states, beneficiaries who lose Medicaid coverage when the public health emergency ends are likely to transition into employer-sponsored health plans, according to a study funded by AHIP from NORC at the University of Chicago (NORC).

    NORC used the Urban Institute’s public health emergency Medicaid coverage loss estimates and historic data from the Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC).

    The researchers recategorized the data, taking into account respondents’ coverage type in year one and year two of the transition, supplementing data for smaller states, and applying a hierarchy of coverage types to distribute respondents with multiple coverage sources. When respondents had multiple coverage types, the researchers prioritized first employer-sponsored coverage, then uninsurance, CHIP, nongroup coverage, and other public coverage, respectively.

    Dig Deeper

    When the researchers blended these two data sources, the study found that individuals who lose their Medicaid coverage after the end of the public health emergency will transition into employer-sponsored health plans in most states.

    More than half of the beneficiaries who lose Medicaid coverage will transition to employer-sponsored health plan coverage in every state except for Georgia (48.9 percent), according to the dashboard associated with the report. The state with the highest share of beneficiaries going into employer-sponsored health plans after the public health emergency was Delaware (57.1 percent).

    Overall, more than one in five beneficiaries who lose Medicaid coverage will become uninsured. Seven states had a 23.1 percent expected uninsurance rate or higher: Arizona (23.5 percent), Florida (23.1 percent), Maine (23.3 percent), New Mexico (23.1 percent), North Carolina (23.2 percent), South Carolina (26.2 percent), and Texas (24.5).

    Delaware had the lowest uninsurance rate projection, but it was still above 15 percent. The First State may see 17.7 percent of its beneficiaries become uninsured after the public health emergency.

    Altogether, 54 percent of beneficiaries will end up in employer-sponsored health plans, 21 percent will become uninsured, 15 percent will gain CHIP coverage, seven percent will join nongroup coverage, and three percent will get other public payer coverage.

    These estimates were close to the Urban Institute estimates except for the CHIP and other public payer coverage projections. Urban Institute expected that 18 percent of beneficiaries would turn to CHIP coverage and only one percent would fall under other public coverage.

    Around 18 million Medicaid beneficiaries will lose their coverage in the first 14 months after the public health emergency ends, according to the Urban Institute.

    In response to the threat of coverage loss after the public health emergency ends, AHIP has partnered with numerous organizations to introduce a new coalition. The coalition’s website consolidates CMS guidance around the redetermination process. The coalition itself encourages information-sharing between stakeholders.

    A separate, state-based analysis from the Kaiser Family Foundation found that states that saw significant Medicaid enrollment gains during the coronavirus pandemic could experience the biggest drop in enrollment after the public health emergency ends.

  • 4 Apr 2023 2:21 PM | Addie Thompson (Administrator)

    In case you haven't heard, COVID-19’s public health emergency (PHE) and national emergency (NE) are coming to a close. The Biden administration announced that both emergencies will terminate on May 11, 2023. In addition to the cessation of various group health plan obligations to provide certain COVID-19-related items/services without cost-sharing under the PHE and the end to the extended deadlines under the NE’s “outbreak period,” the PHE’s expiration will also lead to the unwinding of Medicaid continuous coverage protection.

    Starting as early as February 2023, state agencies in charge of Medicaid may begin the process of redetermining which Medicaid participants may no longer be eligible and, consequently, dropped from Medicaid starting April 1, 2023. The exact timing will vary by state. More information regarding when a particular state will begin this re-evaluation process may be found here(opens a new window).

    Key Takeaways

    • The Medicaid redetermination process will result in numerous individuals losing their current Medicaid coverage.

    • Loss of Medicaid coverage is a HIPAA special enrollment right, allowing individuals to return to employer-sponsored coverage mid-year if they provide notice within 60 days.

    • Bottom line: Employers may see a significant uptick in covered employees and family members in the coming months.


    The Families First Coronavirus Response Act, passed in early 2020, increased federal Medicaid funding for states that agreed to allow anyone already enrolled or who became enrolled in Medicaid during the PHE to remain enrolled throughout the PHE, even if their eligibility status changed. This continuous coverage rule increased Medicaid enrollment by roughly 30% to approximately an additional 18 million participants. Legislation passed late last year allows states to redetermine eligibility and begin involuntary terminations. It is estimated that roughly 6 million individuals who lose Medicaid coverage will be eligible for coverage under an employer-sponsored health plan.

    Effect on Employer-Sponsored Medical Plans

    Losing Medicaid triggers a HIPAA special enrollment right in employer-sponsored medical plans. And, for many employers who allow employees to pay medical premiums on a pre-tax basis through a cafeteria plan, it is also a qualifying election change event. Generally, the window for notifying the plan of losing Medicaid eligibility is 60 days. However, keep in mind that we are still in the Outbreak Period (think NE) through July 10, 2023, so the 60-day window is temporarily extended for anyone losing Medicaid before that date.

    Lockton Comment: For example, if an employee were to lose Medicaid eligibility effective April 1, they would (under pre-covid rules) have until May 30th to enroll in their employer-provided medical plan, assuming they are otherwise eligible. This year, however, with the extra padding of time under the NE, their 60-day clock to exercise the HIPAA special enrollment right will not start ticking until the end of the Outbreak Period on July 10, 2023, bringing their deadline to Sept. 8, 2023 (July 10 plus 60 days).

    Bring In the Actuaries

    From an actuarial perspective, Lockton’s Actuarial Practice anticipates the impact will likely vary greatly from employer to employer, depending on the employer’s situation. The Medicaid redetermination process would be a non-event for some employers, while others could see a significant impact. Here are points that Lockton’s actuaries recommend employers consider:

    • New members joining a plan due to no longer being eligible for Medicaid could be spread over the next 12 to 18 months.

    • Federal regulators estimate that 5-6 million people who lose Medicaid coverage will seek enrollment in employer-sponsored health plans. This concurs with other CMS data stating that 15-18 million will lose coverage, and 30-40% will seek coverage through employer-sponsored plans. This represents a potential increase of approximately 3% to the total amount of people currently participating in private insurance (~160M).

      • Using this as a starting point, we could expect nationwide employer-sponsored plan membership to increase by 3%.

      • The members coming on to the plan would be expected to have similar costs as those currently on the plan unless other information is available from the client about these members. Thus, the additional members would be expected to result in an increase of 3% cost for employer-sponsored plans.

    • Based on an employer’s specific situation, the impact could be very close to zero (not noticeable among other changes in membership throughout the year); the impact could also be much higher than 3% for employers that were more affected by the pandemic.

    • It is believed that those people impacted by the end of the PHE and NE are more likely those whose employment was also impacted during the pandemic (food service, hospitality, service industries).

    • Employers that were able to move employees to remote working situations during the pandemic and/or didn’t experience a significant loss of workers are not likely to be impacted by this redetermination. These will typically be white-collar industries and those with higher compensated employees.

    Lockton Comment: We recommend that employers review historical waiver percentages pre-pandemic and currently. If the percentage of employees that waived coverage pre- to post-pandemic increased, it is an indicator that an influx of new enrollees could impact the plan. Consideration should also be given to additional dependents being added to the plan for employees currently enrolled.

    There is no information available to help determine how many of an employer’s employees are currently on Medicaid. If somehow an employer had that information, it is expected that about 13% of Medicaid enrollees will be disenrolled, and only about 26% of those will enroll in private insurance (with the rest either re-enrolling in Medicaid based on qualifications or going uninsured).

    Again, for most employers, we do not expect this to be an event to cause any noticeable increase in cost or enrollment; however, for specific employers in certain industries, there could be a cost increase due to the number of new enrollees that should be considered in financials on top of the standard trend.

  • 21 Mar 2023 12:22 PM | Addie Thompson (Administrator)

    Aetna is leveraging its parent company's retail stores to let Medicaid members know they may need to renew their coverage. 

    Kelly Munson, president of Aetna Medicaid, a CVS Health company, told Becker's CVS retail stores have a chance to reach all Medicaid members when they walk into a store, regardless of if they are members of Aetna or another managed care plan. 

    "Regardless of payer, CVS can be supportive of all the Medicaid members that are walking in the door," Ms. Munson said. "We have messaging in the stores that plays over the sound system, videos that remind members they need to be looking for redeterminations, and we have QR codes they can scan so they can know and understand what their next move is." 

    Up to 18 million people nationwide could lose their Medicaid coverage beginning April 1, according to estimates from the Robert Wood Johnson Foundation. Some Medicaid members will lose coverage because they make too much income to qualify for the program, while others may be dropped for administrative reasons. 

    Read more about how Aetna is reaching members ahead of redeterminations here.

  • 17 Mar 2023 10:51 AM | Addie Thompson (Administrator)

    About 15 million Americans could lose Medicaid health insurance coverage as states unwind the “continuous coverage requirement” implemented at the beginning of the COVID-19 pandemic to ensure people retained health benefits, a new analysis from the Kaiser Family Foundation shows.

    The federal government has called the expiration of the coverage requirement, first authorized by the Families First Coronavirus Response Act, the “the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act.” The move paused disenrollment from Medicaid in February 2020 at the pandemic’s beginning and has contributed to a boom in growth of health insurance for low income Americans to nearly 95 million by the end of this month when the continuous enrollment provision ends.

    “Millions of beneficiaries are expected to be disenrolled over the next year, including some who are no longer eligible for Medicaid and others who still qualify but lose coverage due to administrative paperwork problems,” the Kaiser Family Foundation, which worked with the Georgetown University Center for Children and Families, to survey states on how they would disenroll people from Medicaid, as part of the 21st annual KFF survey of state Medicaid and Children’s Health Insurance Program (CHIP) report, which was issued Thursday.

    “One-third of states that were able to report projected coverage losses estimate that about 18% of Medicaid enrollees will be disenrolled after the continuous enrollment provision ends,” Kaiser said. “The estimates range from 7% to 33% of total enrollees and are consistent with other estimates that about 15 million people may lose Medicaid coverage over the coming year.”

    Aside from Americans including children and families who could lose coverage, the coming loss of Medicaid recipients is on the minds of health insurance companies across the country that could lose business. Executives from UnitedHealth Group, Centene, Elevance Health, CVS Health’s Aetna health insurance unit and a host of other companies are regularly peppered with questions from Wall Street analysts about the coming end to the continuous coverage provision.

    But it’s difficult to know exactly how many Americans will lose Medicaid coverage and when because states, which administer such health benefits, have different plans and strategies, the Kaiser analysis shows. Meanwhile, some states are making it easier for people remain eligible to keep their coverage while others are making it more difficult, the Kaiser analysis showed.

    The process will be slow with 43 states “taking 12-14 months to complete renewals following the end of the continuous enrollment provision,” the Kaiser analysis said.

    Here’s a link to the entire Kaiser 50-state Medicaid survey.

  • 17 Mar 2023 10:43 AM | Addie Thompson (Administrator)

    I am continually proud of South Carolina’s senators for the leadership they show in Washington on issues that are important to their constituents. Through my work as a national committeeman, I have had the opportunity to get to know these gentlemen and see their work firsthand.

    That is why I am thankful to Sens. Tim Scott and Lindsay Graham for leading on issues surrounding senior health care and pushing policies that offer affordable, accessible options to our aging community. Last month, Scott emerged as a lead signer on a bipartisan senate letter calling on the Biden Administration to continue supporting Medicare Advantage. Graham also supported and signed this same letter. This is exactly the kind of leadership that our senators should be focused on.

    Medicare Advantage is an increasingly popular program for seniors, offering them health care coverage that is tailored to their needs at a low cost. Nationwide, over 30 million Americans choose to be enrolled in a Medicare Advantage plan, including over 450,000 South Carolinians. The program gives seniors access to a variety of great benefits, including capping out-of-pocket costs and expanded in-home care coverage, all under one plan.

    Read more at: https://www.thestate.com/opinion/article272951480.html#storylink=cpy

  • 21 Dec 2021 4:29 PM | Addie Thompson (Administrator)

    During the National Association of Insurance Commissioners’ (NAIC) opening session to its 233rd National Meeting, NAIC President and Commissioner of Florida’s Department of Insurance, David Altmaier, recognized South Carolina Department of Insurance Director, and NAIC Immediate Past President, Ray Farmer, with the NAIC President’s Award for Distinguished NAIC Leadership (President’s Award).

    The President’s Award is given at the discretion of the current NAIC President and honors an NAIC member who has shown exemplary leadership; has a sustained length of industry service; and who has contributed to advancing the mission of the NAIC.

    “Director Farmer has displayed exceptional leadership at the NAIC as he navigated the organization through a global pandemic, spearheaded the Special Committee on Race and Insurance, and served on the leadership teams for climate and resiliency, technology, data, privacy and cybersecurity task forces, as well as several other priority initiatives,” said NAIC President and Florida Insurance Commissioner, David Altmaier.

    Following the presentation of the President’s Award, NAIC President Altmaier, announced that the NAIC President’s Award would be renamed in Director Farmer’s honor.

    “It was the unanimous opinion of the NAIC officers that leadership examples such as the ones Director Farmer set for all of us and has displayed during his 53 years of industry service, are truly profiles in courage that should be memorialized well beyond handing out this award. Today, I proclaimed that the President’s Award be renamed the Raymond G. Farmer Award for Exceptional Leadership, and it is the award to be presented for exceptional NAIC Leadership from this day forward,” said Altmaier.

    The NAIC President’s Award was first awarded at the 2008 Fall National Meeting to Commissioner, Jim Long. Other recipients include Commissioner Alfred Gross (2010); Commissioner, Sandy Praeger (2014); Superintendent, Joseph Torti III (2015); and Commissioner, Roger Sevigny (2017).

    About the National Association of Insurance Commissioners

    As part of our state-based system of insurance regulation in the United States, the National Association of Insurance Commissioners (NAIC) provides expertise, data, and analysis for insurance commissioners to effectively regulate the industry and protect consumers. The U.S. standard-setting organization is governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer reviews, and coordinate regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally.

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