Instead of Encouraging Enrollment in Comprehensive Health Coverage, New Federal Guidance Requires Taxpayers to Subsidize Health Care Sharing Ministries

In the midst of the COVID-19 pandemic, the IRS has published a proposed rule that would grant tax advantages reserved for insurance to individuals’ spending on health care sharing ministries, raising real questions about using federal funds to promote a coverage option that fails to provide consumers with financial protection for health care expenses. JoAnn Volk walks through the proposed rule and its potential implications for consumers.
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Proposed Federal Changes to Short-Term Health Coverage Leave Regulation to States

The Trump administration is expected to reverse federal limitations on short-term insurance, which does not have to comply with Affordable Care Act rules like preexisting condition protections. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR’s Dania Palanker, Kevin Lucia, Sabrina Corlette, and Maanasa Kona examine how ten states currently regulate the short-term insurance market. Continue reading

States Take the Lead with Policies to Protect Residents with Chronic Conditions from High Out-of-Pocket Drug Costs

Lowering the cost of prescription medication has broad support over the political spectrum and there were many campaign promises to reduce prices. But to date, there’s been little federal action. States, however, are taking the lead with policies designed to protect consumers with chronic conditions from high out-of-pocket costs associated with expensive specialty drugs. A new CHIR brief details the findings from a 50-state survey of such policies and observations from supplementary interviews with state regulators, insurance company representatives and consumer advocates. Continue reading

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