More Trouble than it’s Worth? The Affordable Care Act’s Redefinition of the Small Group Market

The Affordable Care Act includes a reform of the health insurance market that has received relatively little attention, but that’s likely to change. The provision requires a change in the definition of small group health plan, and it could have a significant impact on premiums and offers of coverage by employers. Sabrina Corlette takes a look. Continue reading

HHS Proposes EHB Rule Changes

The federal Department of Health and Human Services recently published a proposed regulation that signals some potentially helpful changes to the requirement that health insurers cover a set of essential health benefits. Our colleague at Georgetown University’s Center for Children and Families, Joe Touschner, offers this overview. Continue reading

Implementing the Affordable Care Act: Revisiting the ACA’s Essential Health Benefits Requirements

Within the next several months, federal officials must decide whether to maintain or modify their “transitional” approach to implementation of the Affordable Care Act’s essential health benefits (EHB) requirements. In a new issue brief for the Commonwealth Fund, CHIR researchers examine how states have exercised their flexibility under the current EHB rules. Continue reading

New Issue Brief Examines Specialty Drugs in Tiered Pharmacy Benefit Structures

Health plans have been increasingly using tiered pharmacy benefit designs. These new designs raise challenges for consumers and the state insurance regulators responsible for reviewing and approving plans for sale. CHIR faculty members Sally McCarty and David Cusano explore these issues in a new brief for the Robert Wood Johnson Foundation’s State Health Reform Assistance Network. Continue reading

New Federal Guidance Helps Protect People from Discrimination in Benefit Design

In response to actions by some health plans to impose benefit-specific waiting periods for coverage of serious health conditions, such as organ transplants, the Obama Administration recently issued guidance to prohibit the practice and protect consumers from discriminatory benefit design. Georgetown Law Center’s Sandy Ahn reviews the new guidance and the impact for consumers in this guest post. Continue reading

More New Resources Available to State Regulators

A set of new tools for state insurance regulators, as well as updated versions of some older resources, have recently been posted on the Robert Wood Johnson State Health Reform Assistance Network (State Network) web site. CHIR faculty Sally McCarty, David Cusano, and Max Farris, who serve as technical assistance professionals (TAPS) in the State Network Program, developed the new resources. Sally McCarty describes them here and provides information about an upcoming Webinar to introduce them and demonstrate their use. Continue reading

Time for a Dental Check Up

One challenging question for families as they enroll in health insurance coverage on the new Marketplaces is what to do about kids’ dental coverage. Our colleague at Georgetown’s Center for Children and Families, Joe Touschner, has the skinny and links to some helpful resources to better understand this complex policy area – and how things might change for 2015. Continue reading

Narrow Networks Under the ACA: Financial Drivers and Implementation Strategies

The ACA’s essential health benefits and metal tier coverage standards, guaranteed issue, and community rating requirements help level the playing field among insurers. To compete on price, many are turning to limited network products. CHIR experts David Cusano and Amy Thomas discuss insurers’ approaches to the development of plan networks in the post-ACA era in a new blog post originally published by Health Affairs. Continue reading