States Don’t Know What’s Happening in their Short-term Health Plan Markets and That’s a Problem

In the midst of a global pandemic, consumers continue to be sold skimpy short-term plans that may not cover necessary testing and treatment. In their latest post for the Commonwealth Fund’s To the Point blog, Dania Palanker and Christina Goe assess the ability of insurance regulators to understand the scope of the short-term plan market in their states and its impact on consumers’ ability to access and afford care. Continue reading

State-Based Marketplaces Find Value, Potential Opportunity for Growth in Small-Business Offering

Small businesses have historically struggled to provide coverage to their workers. The ACA sought to address these issues through the Small Business Health Options Program (SHOP), creating marketplaces for small employers to offer coverage to their employees. In a new post for the Commonwealth Fund’s To the Point blog, CHIR experts take a look at ways that state-based marketplaces are investing in their SHOPs, and how some are seeing enrollment growth and savings for small businesses. Continue reading

On its 10th Anniversary, during a Public Health Crisis, the Affordable Care Act is More Important Than Ever

The past few weeks have tested the U.S. health care system. In a world where we are all at risk of contracting and spreading COVID-19, access to health care is a universal human need. On the 10th anniversary of the Affordable Care Act, CHIR takes some time to consider how battling this pandemic would have been even more difficult if it weren’t for this groundbreaking federal law. Continue reading

What Are State Officials Doing to Make Private Health Insurance Work Better for Consumers During the Coronavirus Public Health Crisis?

Many people may hesitate to seek coronavirus testing and treatment because they face significant deductibles or other cost-sharing under their insurance policy. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR experts Sabrina Corlette, Kevin Lucia, and Madeline O’Brien take a look at how states are stepping up to require insurance companies to expand their coverage in the face of an unprecedented public health crisis. Continue reading

When Things Fall Apart: A Roadmap for State Regulators Managing Fallout from Provider-Payer Contract Disputes

High profile contract disputes between insurers and providers appear to be on the rise, raising the risks of disruptions for patients and unexpected out-of-network billing. In a new report for the Robert Wood Johnson Foundation, CHIR experts examine best practices among state regulators and insurers to protect consumers and provide recommended policies and procedures to mitigate risks when a provider leaves a health plan network. Continue reading

Coronavirus Exposes Big Gaps in the U.S. System Of Coverage: What Can States Do to Help?

The cost of medical care associated with the novel coronavirus can be a barrier for many people who should get tested, raising a public health risk. Given our patchwork quilt system of health insurance coverage and the lack of a timely and comprehensive federal response, CHIR’s Sabrina Corlette and Kevin Lucia consider actions states can take to encourage people to get the care they need. Continue reading

How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing

As Congress and a number of states craft legislation to protect consumers from surprise out-of-network billing, a critical issue is resolving how insurers will pay out-of-network providers for their services. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR’s Jack Hoadley and Maanasa Kona assess the experience of states that use an independent dispute resolution process to determine these payments. Continue reading

Addressing Surprise Billing by Setting Payment Standards for Out-of-Network Providers

The thorniest issue in pending legislation to protect consumers from surprise medical billing is how to resolve disputes between payers and providers over appropriate payment. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR experts Maanasa Kona, Jack Hoadley, and Katie Keith examine the seven states that have adopted a payment standard for out-of-network bills. Continue reading

States Take Action on Health Care Sharing Ministries, But More Could Be Done to Protect Consumers

In the last year, state regulators have stepped up their scrutiny of health care sharing ministries to warn consumers of their limits. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s JoAnn Volk and Justin Giovannelli look at recent state action to protect consumers from the risks of health care sharing ministries and map out other options for states to step up their scrutiny of these arrangements. Continue reading

Update on Federal Surprise Billing Legislation: New Bills Contain Key Differences

Congressional leaders are racing to meet a self-imposed May deadline for passing legislation to protect consumers from surprise medical billing. In their latest post for the Commonwealth Fund’s To the Point blog, Jack Hoadley, Beth Fuchs, and Kevin Lucia identify key similarities and differences among competing proposals, and provide a comprehensive side-by-side guide to the key committee bills. Continue reading