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U.S. House Education and Workforce Committee Moves Telehealth Billing Legislation

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…commercial sector. Senator Sanders floated a commercial site-neutral proposal in 2023, but ultimately introduced his bill with Senator Marshall that instead prohibited facility fee billing for the services identified without requiring that the amount insurers pay for the same services be the same in different settings. (Even if facility fees are prohibited, hospitals with market power could negotiate greater reimbursement…

Delays In Extending Enhanced Marketplace Subsidies Would Raise Premiums And Reduce Coverage

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…expanding insurance, and increasing access to health care. The Urban Institute estimates that the enhanced PTCs will lead to 7.2 million more people receiving subsidized Marketplace coverage and 4.0 million fewer people being uninsured in 2025, as compared to if the original PTCs were still in place. The Centers for Medicare and Medicaid Services estimates that the enhancements save the average Marketplace enrollee more…

Taking a Look at California’s Program to Assist People Losing Medi-Cal Enroll in Marketplace Coverage

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…for them a subsidized health plan through Covered California. The program launched in May 2023, with initial enrollments taking effect in July 2023.  In a report funded by the California Health Care Foundation, experts at Georgetown University’s Center on Health Insurance Reforms describe the critical policy and operational decisions state and Covered California officials made to implement SB260 and how…

Unpacking the Unwinding: Medicaid to Marketplace Coverage Transitions

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…with state Medicaid agencies resuming eligibility renewals and terminations, more than 25 million people across the country have been disenrolled from Medicaid coverage. For those that no longer qualify for Medicaid (for example, because they are over the income limit), the health insurance Marketplaces are a critical source of affordable coverage.  Apples to Oranges: Comparing Unwinding Data Accessible data on…

2023 Data From The Independent Dispute Resolution Process: Select Providers Win Big

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…being submitted to the IDR entities by providers and plans and on the reasons given by IDR entities for their decisions. Jack Hoadley, Kennah Watts, Zachary Baron, “2023 Data From The Independent Dispute Resolution Process: Select Providers Win Big,” Health Affairs Forefront, August 19th, 2024, https://www.healthaffairs.org/content/forefront/2023-data-independent-dispute-resolution-process-select-providers-win-big. Copyright © 2024 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc….

Biden Administration Proposes Rule To Ban Medical Debt From Credit Reporting

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…$49 billion worth of medical bills on their credit reports. In particular, CFPB found that medical debt disproportionately burdens older Americans as well as low-income and rural communities. In an effort to protect these patients, CFPB issued a proposed rule in June 2024 seeking to ban medical debt from certain credit reports. If finalized, the rule would also stop creditors from relying…

Enforcing Mental Health Parity: State Options to Improve Access to Care

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…behavioral health care for privately insured Americans. But enforcing the law’s protections can be challenging, and recent analyses have found that many health insurers are still not fully compliant with MHPAEA. In a new issue brief for the Commonwealth Fund, CHIR experts interviewed insurance regulators in ten states to identify the tools state regulators are using for MHPAEA oversight and…

July Research Roundup: What We’re Reading

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…Marketplace outreach, continuous Medicaid eligibility, and others. Unless action is taken, the CBO’s projection may come to fruition, and millions of people could lose critical coverage. National Health Expenditure Projections, 2023–32: Payer Trends Diverge As Pandemic- Related Policies Fade Fiore, Jacqueline A. et al. Health Affairs. July 2024. Available here. Researchers from the Centers for Medicare and Medicaid Services (CMS)…

New Georgetown CHIR Report Examines State Reforms of Prior Authorization

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…tool to curb costs and inappropriate service utilization. To learn more about how policymakers are responding to these concerns, we looked at four states’ prior authorization policies for the commercial market: Arkansas, Illinois, Texas, and Washington. Through qualitative interviews, surveys, and policy analysis, we examined a range of state-level prior authorization reforms, and provide an assessment of how they are affecting…

State And Federal Efforts To Improve Ownership Transparency

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…ownership and control have gaps, although recent CMS efforts will increase information on nursing homes. In addition, there is no complete, publicly available data source with ownership information for physician practices. The lack of good data on ownership and control limits the ability of policy makers to target policies aimed at lowering prices, encouraging competition, and improving quality. It also hinders researchers’ ability to study the…

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.