New Report Examines State Options for Oversight of Risk-Bearing Provider Organizations

Value-based payment models are promoted as a way to transform our health care system from one that rewards value rather than the volume of health care services delivered. These models require providers to accept the risk of financial losses should spending on patients in their care exceed targeted levels. A new brief from State Health and Value Strategies, authored by researchers at Bailit Health and CHIR, explores potential state approaches to oversight of provider organizations that accept financial risk. Continue reading

The District of Columbia’s Coverage Requirement Is Caught in Congressional Crosshairs, and Consumers Could Pay the Price

When Congress repealed the individual mandate’s financial penalty, some states acted quickly to protect their markets from deterioration. A handful of state legislatures and the Council of the District of Columbia considered or enacted legislation creating a state-based coverage requirement. While many states faced political hurdles and unforgiving timelines in enacting their own mandates, D.C. now has an additional obstacle: the U.S. Congress. Continue reading

July Research Round Up: What We’re Reading

Health policy researchers are keeping busy, assessing the impact of recent and potential state and federal actions. CHIR’s Olivia Hoppe digs into new research on how interruptions in insurance coverage impact chronic disease management, the debate over the Affordable Care Act’s (ACA) employer mandate, the innovative ways that California is keeping its risk pool healthy, characteristics of the uninsured in the U.S., and the coverage and premium effects of state-based individual mandates. Continue reading

Understanding the Market for Short-Term Health Plans: States Prepare to Identify, Oversee Sellers and Products

Last week, the Trump administration issued a final rule reversing federal limits on short-term health coverage, allowing such plans to become a long-term alternative to individual market coverage. On the eve of this policy shift, we surveyed Departments of Insurance in the seventeen state-based marketplace states to better understand their short-term markets. We found that most states do not have a complete picture of which insurers are marketing short-term policies in their state. Continue reading

Coverage That (Doesn’t) Count: How the Short-Term, Limited Duration Rule Could Lead to Underinsurance

Any day now, the Trump administration is expected to publish new rules that will expand access to short-term, limited duration insurance (STLDI). These plans are allowed to discriminate against sick people, exclude coverage of essential health services, and impose lifetime and annual benefit limits. The Congressional Budget Office (CBO) says that the majority of plans expanded under this rule will be considered health insurance. CHIR’s Rachel Schwab takes a closer look at how CBO defines health insurance, and explains how the expansion of STLDI could lead to widespread underinsurance. Continue reading

Look Past the Jargon and the Trump Administration’s Risk Adjustment Decision Ultimately Hurts People with Pre-existing Conditions

The Trump administration recently decided to suspend payments under an obscure Affordable Care Act program called risk adjustment. The issue is technical and full of jargon, but at bottom it’s about undermining protections for people with pre-existing conditions. CHIR’s Sabrina Corlette explains why. Continue reading

The Road Not Traveled: How Policy, Business Decisions in Iowa Led to Higher Premiums

Iowa’s legislature recently made the extraordinary decision to abdicate that state’s authority over health insurance products. And in doing so they’ve made a bad insurance market worse. In their latest piece for the Commonwealth Fund’s To the Point blog, CHIR’s Sabrina Corlette and Kevin Lucia team up with actuaries at Wakely Consulting Group to assess what premiums and marketplace enrollment in Iowa would look like if the state had taken a slightly different path. Continue reading