This Month in State Policy

Health Insurance Open Enrollment and State Impact

As Congress continues to debate ways to finance health insurance assistance, the enhanced premium tax credits (ePTCs) expired on January 1. Without legislative action, the subsidies first made available by the American Rescue Plan Act cannot be restored. As a result, premiums are expected to increase by 114% on average.

In fact, recent data suggest the increased premiums are already affecting enrollment numbers. More than 1.4 million fewer people enrolled in exchange-based health insurance compared with the same time last year, including a 14% decline in new customers. While overall enrollment has fallen, trends vary by state, revealing a more complex landscape.

In some states, policymakers acted in advance to offset the loss of ePTCs by creating state-funded subsidies. For example, during a special session convened last year by New Mexico Governor Michelle Lujan Grisham (D), lawmakers approved more than $17 million to help families earning up to 400% of the federal poverty level with premium costs. This year, New Mexico saw enrollment growth, with more than 80,000 residents selecting coverage, including over 9,000 new enrollees.

By contrast, four states that accounted for 55% of national enrollment growth since the introduction of the enhanced subsidies—Florida, Georgia, North Carolina, and Texas—saw mixed results, with Florida, Georgia, and North Carolina experiencing overall decreases with regards to enrollment this year. In fact, North Carolina’s 22% drop in enrollment was among the highest in the entire country.

However, in Texas, more than 4.1 million individuals selected plans, exceeding this time last year. Importantly, these data do not distinguish how many enrollees were automatically reenrolled, meaning some families may not realize their premiums have increased. In addition, Texas lawmakers enacted a bipartisan law in 2021 that subsidizes bronze and gold plans, potentially contributing to the state’s figures.

Other states experienced more drastic drops, such as Pennsylvania’s state-run exchange Pennie, which has seen at least 70,000 individuals not reenroll.

STI Remote Testing

California remains the only state in the U.S. that mandates coverage of remote STI testing, but Wisconsin could soon join them. Representative Mike Bare (D – Verona) introduced AB754, which would require coverage for at-home STI testing kits that meet certain criteria. The kits must be recommended by either the Center for Disease Control (CDC) or the U.S. Preventive Services Taskforce (USPSTF), receive FDA approval, and receive a CLIA-waiver or be developed in a lab in accordance with state and federal regulations.  Health care advocates have argued that offering remote STI testing through mandated insurance coverage can increase usage and accessibility, offering individuals who may not feel comfortable going into a clinic with the option to test in privacy.

The FDA has approved several over-the-counter STI testing mechanisms in recent years, including a single-use kit  that uses vaginal swabs to test for chlamydia, gonorrhea, and trichomoniasis, as well as the first-ever at-home syphilis test kit.

HIV Prevention

Policymakers across a few jurisdictions are eyeing ways to increase access to HIV prevention medications, known as pre-exposure prophylaxis (PrEP), which are taken as a daily oral pill or administered as a long-acting injectable.

In New Jersey, Assemblymember Luanne Peterpaul (D – Long Branch), introduced AB6293, which would expand pharmacists’ authority to prescribe PrEP for up to 90 days. If the bill became law, New Jersey would join nearly two dozen states across the U.S. that allow pharmacists to prescribe and dispense HIV prevention medications.

Meanwhile in Massachusetts, SB2883, sponsored by the Joint Committee on Financial Services, would expand zero-cost sharing for HIV prevention drugs across several areas, including state retirement plans. The bill would also make it easier for individuals leaving correctional facilities to be provided with a supply of HIV prevention medication if they are deemed clinically eligible and interested; individuals would have the option to receive a 90-day oral PrEP supply or the longest duration of an injectable medication available.