Relaxing the Affordable Care Act’s Guaranteed Issue Protection: Issues for Consumers and State Options

As we’ve been blogging about, the Trump administration finalized a Market Stabilization rule that makes numerous changes in how marketplaces and insurers are operating. One of the biggest changes affecting consumers is the Trump administration’s new interpretation of guaranteed issue or availability; but states have a range of options regarding this policy under the rule. CHIR’s Sandy Ahn and JoAnn Volk break it down for us. Continue reading

From Acne to EcZema: The Return of Medical Underwriting Puts Millions at Risk for Losing Coverage or Higher Premiums

Medical underwriting, outlawed by the Affordable Care Act (ACA), is a practice used by insurance companies to assess a consumer’s health status. In the event of an ACA repeal, millions of people could lose coverage, pay higher premiums, or receive inadequate benefits that exclude essential health services, all based on a pre-existing condition. While many of us don’t see ourselves as falling under that category, the list of health conditions that qualify you for the chopping block may surprise you. Continue reading

Healthcare.gov Changing Approach to Special Enrollment Periods, May be Bumpy Road for Consumers

The administration recently announced that it will require verifying documents from consumers with a qualifying life change for special enrollment periods. For consumers, this means more work and likely a bumpy road to accessing health insurance through healthcare.gov. Sandy Ahn takes a look at this change and what it may mean for consumers. Continue reading

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

Accessing Provider Directories and Formularies: CHIR Goes Sleuthing

We’re counting down again to Open Enrollment 3 and this year, all health plans must make accessing provider directories and formularies, or the list of covered prescription drugs, easy for consumers. This means consumers should be able to find this information on insurer website sites without creating an account or entering a policy number. CHIR’s Sandy Ahn flexes her investigative skills and looks to see how accessible this information really is. 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

Balance Billing for Air Ambulance Remains a Problem in Maryland

Although Maryland is among the handful of states that regulate balance billing for out-of-network situations, as we discuss in a previous report, the state’s law does not address air ambulance charges. Balance billing for air ambulances remain a problem in Maryland and its insurance department held a public meeting last Friday to discuss the issue. CHIR’s Sandy Ahn provides highlights of the meeting and other state efforts to address this consumer problem. Continue reading

Why ACA Marketplaces Should Report Comprehensive Enrollment Data

The Affordable Care Act’s new health insurance marketplaces could be critical sources of data about how people access and use coverage. Yet, to date, the marketplaces have released varying degrees of information, with little uniformity or consensus over what data should be collected and how. In our latest post for The Commonwealth Fund, CHIR researchers Sean Miskell, Justin Giovannelli and Kevin Lucia examine data collection and reporting by the health insurance marketplaces. Continue reading

New Georgetown Report Calls for Harnessing of ‘Big Data’ for Better Health Plan Oversight and Consumer Protection

Last week the Obama Administration took a small step forward to implement Affordable Care Act transparency rules. This week, CHIR researchers Sabrina Corlette, JoAnn Volk and Sandy Ahn released a new report outlining a new and powerful data collection and transparency framework that can help state and federal policymakers better understand how insurers are complying with new market rules and consumer protections. Continue reading

Feds Take a Baby Step Forward on ACA’s Sunshine Rules

The Obama Administration has taken a step forward to implement long-delayed transparency provisions of the ACA, which require insurers and employer-based health plans to report a range of data to help policymakers and consumers better understand how insurance is working for people. CHIR expert Sabrina Corlette finds the latest action to be just a baby step, as well as a missed opportunity. Continue reading