Taking a Look at ACA Non-Discrimination Rules: When Does Medical Management Cross the Line?

The ACA prohibits benefit limits and cost sharing that discriminate against individuals based on health status and other factors, but federal rules also stress that insurers can continue to use reasonable medical management, which would allow benefit limits based on certain circumstances. JoAnn Volk looks at what this may mean for regulators and consumers trying to tell the difference.
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First Compliance Review Focused on Policies and Procedures, but a Better Approach Exists to Assess Health Plan Compliance

The administration recently published the results of its compliance review of health plans participating in federally facilitated marketplaces. The review, however, focused more on process, such as whether plans have the appropriate policies and procedures in place. While this information is somewhat helpful, CHIR’s Sabrina Corlette and Sandy Ahn discuss why these types of compliance reviews fall short of helping regulators assess whether plans are meeting the ACA’s patient protection standards. Continue reading

Big Data and Baby Steps: Two Very Different Approaches to Data Collection

Most Americans see the need for more data about health insurance and how it’s working for consumers, and the insurance industry itself seems to recognize the importance of collecting and analyzing data. But it’s not clear that our government regulators do. JoAnn Volk looks at the mismatch between what insurers are undertaking and what federal rules will require for data collection. Continue reading

Back in the Day – Lessons from Pre-reform Days: Death to the Death Spirals

While we’re struggling with Affordable Care Act (ACA) issues, there’s value in taking the time to look back and appreciate the impact of the ACA and other healthcare reforms implemented over the past few decades. To that end, CHIR faculty member and former Indiana Insurance Commissioner Sally McCarty is posting a series called “Back in the Day – Lessons from Pre-reform Days.” This installment looks at policies in a “death spiral.” Continue reading

Narrow Networks: Who’s Looking Out for Consumers?

Media outlets are reporting on a trend towards narrow network health plans offered through the Affordable Care Act’s health insurance marketplaces. Max Farris and Sally McCarty provide context for this emerging issue and discuss the state role in ensuring consumers have access to a sufficient number of primary care and specialty care physicians, facilities, and other providers. Continue reading