The Centers for Medicare & Medicaid Services (CMS) has introduced a new option for states to update their essential health benefits (EHB) benchmark plan to include routine adult dental coverage, aiming to address disparities in oral health outcomes, particularly for low-income and minority adults. In their latest Expert Perspective for the State Health & Value Strategies program, CHIR’s JoAnn Volk and Manatt’s Tara Straw discuss considerations for states weighing this addition.

Many Americans struggle with high healthcare costs, leading state policymakers to explore transparency measures to lower prices. While transparency alone has limited impact on cost reduction, states are innovating by increasing transparency in areas like provider ownership, billing practices, and price data, which can inform broader policy solutions and have bipartisan support, paving the way for more effective cost-containment strategies. In their latest article for CHIRblog, CHIR experts Stacey Pogue and Nadia Stovicek explore transparency options for state policymakers.

In recent years, federal price transparency rules have required hospitals and health plans to publicly post their prices. However, challenges persist with data access and use, limiting the data’s effectiveness for consumers and policymakers. Two bipartisan bills in Congress seek to strengthen these rules. CHIR experts Stacey Pogue and Nadia Stovicek discuss the federal price transparency landscape in their latest article for CHIRblog.

The U.S. health care system’s lack of regulation over provider pricing and insurer claims has led to a rise in profit-driven middlemen, such as revenue cycle management firms. While these intermediaries aim to maximize reimbursements for providers, they often increase costs for consumers and complicate access to care. This complex environment underscores the urgent need for regulatory oversight to address the inefficiencies and rising expenses in the system. In their latest piece for Health Affairs Forefront, Linda J. Blumberg and Kennah Watts break down the effect of middlemen on US health care.

CMS recently released their draft Notice of Benefit & Payment Parameters (NBPP) for plan year 2026. In their latest piece for Health Affairs Forefront, Sabrina Corlette and Jason Levitis discuss what this means for Marketplaces, insurance reforms and Advance Premium Tax Credits (APTCs.)

The Affordable Care Act (ACA) marketplaces have become vital lifelines for millions, especially for communities of color, significantly reducing the uninsured rate and expanding access to affordable coverage. However, the future of these marketplaces hangs in the balance, with political priorities influencing their stability and funding, particularly regarding federal subsidies. As the 2024 election cycle approaches, the choices voters make could reinforce the progress achieved or risk undoing critical health care coverage advancements.