RISE summarizes recent regulatory-related headlines.
Study: 4M people will lose health insurance if premium tax credit enhancements expire
A new Urban Institute report finds that that subsidized Affordable Care Act marketplace enrollment would decrease by more than seven million people and four million people would become uninsured if the enhanced premium tax credits expire. The tax credits allowed people during the COVID-19 pandemic to help purchase health coverage but are set to expire after 2025. The Urban Institute has created an interactive tool that shows the impact on health insurance coverage in each state by age, income, race, and ethnicity.
The report, which is based on the Urban Institute’s Health Insurance Policy Simulation Model, finds that if enhanced premium tax credits expire:
- States without expanded Medicaid would see the largest effects. Although the 10 nonexpansion states account for just 28 percent of the nation’s under-65 population, researchers found that they would account for 63 percent of the enrollment decline in subsidized marketplace plans (4.5 million people).
- The remaining 41 states (including Washington, D.C.) that expanded Medicaid account for 72 percent of the country’s under-65 population but just 37 percent of the enrollment decline in subsidized marketplace plans (2.7 million people).
- One million Black people would lose subsidized Marketplace coverage, about 75 percent of whom live in nonexpansion states. In addition, 1.3 million Hispanic people would lose subsidized marketplace coverage, about 75 percent of whom live in nonexpansion states. More than half of the 4.3 million white people who would lose subsidized Marketplace plans live in nonexpansion states.
Commonwealth Fund: Nearly 1 in 4 US adults are underinsured
The Commonwealth Fund’s 2024 Biennial Health Insurance Survey finds that nearly one in four U.S. adults have health coverage all year, but are underinsured. They face high out-of-pocket costs and deductibles that force many to skip needed care or take on medical debt. The study also found up to one-third of people with chronic conditions like heart failure and diabetes report that they skip medication doses or don’t fill their prescriptions because of the cost.
The survey included interviews with a nationally representative sample of 8,201 adults age 19 and older between March 18 and June 24 but focuses on the 6,480 respondents ages 19–64. The survey found:
- Twenty-three percent were underinsured, which means they had coverage for a full year that didn’t provide them with affordable access to health care.
- Among adults who were insured all year but underinsured, 66 percent had coverage through an employer, 16 percent were enrolled in Medicaid or Medicare, and 14 percent had a plan purchased in the marketplaces or the individual market.
- Nearly three of five (57 percent) underinsured adults said they avoided getting needed health care because of its cost; 44 percent said they had medical or dental debt they were paying off over time.
- Two of five (41 percent) working-age adults who reported a cost-related delay in their care said a health problem worsened because of it.
- Nearly half of adults (48 percent) with medical debt are paying off $2,000 or more; half of those with debt said it stemmed from a hospital stay.
DOJ: Texas lab owner charged with role in $79M fraud scheme
The owner and operator of a Texas laboratory was charged this week in connection with his role in a $79 million respiratory pathogen panel testing fraud scheme. The Department of Justice reports that Osman Syed, 34, also known as Syed Osman, caused BioDX Labs LLC (BioDX) to submit more than $79 million in fraudulent claims to Medicare and Texas Medicaid for tests that were not provided and were medically unnecessary.
Court documents said Osman used the personal identifying information of a physician, without the physician’s knowledge or consent, to cause the submission of millions of dollars in claims to Medicare and Medicaid for respiratory pathogen panel tests for beneficiaries and recipients, even though the physician had no prior relationship with the beneficiaries and recipients, was not treating the beneficiaries and recipients for respiratory symptoms, and did not use the tests to treat the beneficiaries and recipients.
To conceal the scheme, Osman allegedly falsely represented that BioDX used reference laboratories to perform its testing. Osman laundered the proceeds by transferring substantial amounts of money to bank accounts abroad, including accounts in China, Hong Kong, Turkey, Greece, and Switzerland. In connection with the charges, the government seized over $15 million in cash.
He is charged with three counts of health care fraud, conspiracy to engage in money laundering, and three counts of money laundering. If convicted, he faces a maximum penalty of 10 years in prison on each count.