…threshold option, a threshold of at least 95 percent of the net premium would be considered reasonable. The proposed rule included some tight constraints on the new options. Both would apply for purposes of triggering grace periods and coverage loss, but not for binder payments. And insurers could choose only one of the three threshold options. Furthermore, all of the…
Since the snow shows no sign of stopping, we might as well stay cozy inside and read up on the latest health policy research from January! This month we read about patient care after private equity acquisition of hospitals, and how to improve risk-adjustment accuracy in Medicare Advantage. Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals…
…hospital lobbyists convinced legislators to reject it. However, recent news that the SEHP is facing a loss of more than $106 million has prompted some advocates to revive calls for a reference pricing program. Third, the third-party administrators (TPAs) that many states use to design and administer their provider networks and process claims may oppose or obstruct a move to reference pricing, particularly…
…benefit requirements and premiums that do not vary based on gender or health status. These proposals would loosen rules for Association Health Plans (AHPs), eliminate state oversight of stop-loss plans, thus encouraging greater use of self-funded plans with this protection against high expenses (known as level funded products) among small employers instead of state-regulated insurance plans, and permit employers to…
An estimated 41 percent of adults in the US are in medical debt because of unpaid medical or dental bills. Medical debt can profoundly disrupt lives; it can lead to bankruptcies and loss of homes or wages and force difficult choices between basic needs and medical bills. As of 2023, 19 states and the District of Columbia have stepped in…
…to millions of low- and moderate-income enrollees, but the looming sunset of these more generous premium subsidies threatens family budgets and economic security, while foreshadowing dramatic coverage losses and higher premiums for enrollees who do not receive PTCs. Permanently authorizing enhanced PTCs is an immediate and impactful step on affordability that policymakers of all persuasions can make a shared priority….
…as the elimination of critical protections for LGBTQ+ people, pregnant individuals, and those who have had abortions or miscarriages. These proposals, if implemented, would result in a significant loss of health care access and an increase in health care costs for millions of Americans. Over the coming weeks and months we will learn more about the new administration’s health care…
…as an investigation of Cigna revealed – use their own or contractor created AI-based systems. Research indicates that these AI-based programs are often missing important information, and they are highly likely to reflect societal biases and perpetuate existing inequities as they incorporate the particular values and incentives of the systems’ designers. In turn, many providers hire firms to limit their financial losses from such high…
…Marketplace may provide a notice to the taxpayer warning of immediate eligibility loss and explaining the reason, or a more general notice warning of potential eligibility loss for one of several reasons and explaining FTR rules, without specifying the reason. The proposed rule also notes that Marketplaces on the federal platform will, and state-based Marketplaces are encouraged to, provide additional…
…of the looming expiration of expanded federal PTCs. The issue brief describes how none of these programs are a substitute for the expanded PTCs and no state will be insulated from coverage losses should the expanded federal credits expire, nor would states be shielded from premium increases as their risk pools worsen. You can read the full issue brief here….
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.
