A Placeholder Won’t Protect People with Pre-Existing Conditions

President Donald Trump has voiced an “ironclad pledge” to protect patients with pre-existing conditions, but his 2021 budget proposal, which repeats this promise, is silent on how he would do that. At the same time, the Trump administration has taken numerous actions that undermine the Affordable Care Act, including its support of a lawsuit to overturn the ACA and its key protections for people with pre-existing conditions. 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

There Are New Federal “Public Charge” Rules Going Into Effect Next Week: Here’s What You Need to Know

Beginning February 24, 2020, new rules that expand the criteria for determining whether certain immigrants would be considered a “public charge” are going into effect. While appeals of these new expanded rules make their way through the courts, the U.S. Supreme Court ruled that the policy may take effect in all states except Illinois, where a separate injunction remains statewide. As the changing rules can be confusing for consumers and assisters, we’ve updated our Navigator Resource Guide to help break it down. Continue reading

A Mixed Bag for States: The Proposed 2021 Notice of Benefit and Payment Parameters

The Trump administration’s proposed rule governing the Affordable Care Act insurance markets for 2021 has been published, and comments are due from the public by March 2, 2020. In her latest article for the State Health & Value Strategies program, CHIR’s Sabrina Corlette provides a detailed overview of changes proposed in the rule, with a focus on the implications for state departments of insurance and the health insurance marketplaces. Continue reading

Payer-Provider Contract Disputes Dominate Headlines in 2019, With No Signs of Slowing Down

For several years, we at CHIR have tracked health insurance industry trends by monitoring trade and mass media, Wall Street analyses, earnings, and other reports. In 2019, we observed an increase in reporting on contract disputes between health insurers and providers. These discussions are becoming more contentious as insurers face mounting pressure to rein in health care costs while ensuring consumers’ access to providers. CHIR’s Emily Curran digs into what’s behind the trend and what it means for patients. Continue reading

The Texas Two-Step: Implementation of State Balance Billing Law Reveals Gaps in Consumer Protections

In Congress and state legislatures across the country, policymakers are debating fixes to surprise medical bills. The federal government has yet to enact comprehensive reforms, but a number of states have taken steps to protect consumers. One such state is Texas, which last year enacted a new law holding consumers harmless in situations that commonly lead to surprise medical bills. However, the state’s new protections were almost gutted due to an implementation loophole, a cautionary tale for federal and state policymakers. CHIR’s Rachel Schwab takes a look at what happened in Texas. Continue reading