Author Archive: CHIR Faculty

Questionable Quality Improvement Expenses Drive Proposed Changes to Medical Loss Ratio Reporting

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Under the Affordable Care Act, insurers must provide rebates to enrollees when their spending on clinical services and quality improvement, as a proportion of premium dollars, falls below a minimum threshold. Federal regulators have discovered some insurers are gaming the system by misallocating expenses or inflating their spending on providers. Karen Davenport takes a look at how this practice impacts consumers, and explains a new federal proposal to crack down on it.

New CHIR Report Assesses the Effectiveness of Policies in Improving Access to Primary Care for Underserved Populations

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It is hard to overstate the importance of primary care in ensuring robust health outcomes at the population level. In a new report supported by the National Institute for Health Care Reform, CHIR experts reviewed research to assess whether policy initiatives targeting primary care access have been effective in reducing health care disparities.

Tackling “Analysis Paralysis”: New Federal Proposal Would Bring Standardized Benefit Design Back to the Federally Facilitated Marketplace

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The Affordable Care Act’s health insurance marketplaces and consumer protections significantly improved the experience of purchasing individual health insurance, but consumers still face the difficult task of comparing a potentially overwhelming number of complicated benefit and network designs. A proposal in the Notice of Benefits and Payment Parameters for 2023 may improve this situation. Karen Davenport takes a look at the possible return of standardized plans to the federal marketplace, and what this change might mean for consumers.

Insurers are Now Covering At-Home COVID Tests but Implementation Varies

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Private health plans are now required to cover at-home over-the-counter COVID-19 tests. CHIR’s Megan Houston and Rachel Swindle reviewed the coverage policies of 51 insurers to see how consumers can access this benefit. They found a number of plans with restrictions that go beyond what federal guidelines allow.

Changes to Wellness Programs Suggest Employers are Rethinking Health Promotion

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January can feel like a time for new beginnings, and new year’s resolutions. In recent years, many employers have provided workplace wellness programs that may help employees stick with these resolutions, such as benefits, services, or financial incentives that encourage workers to improve their health. Recent data from KFF’s 2021 Employer Health Benefit Survey showing that employers are reconsidering key elements of their wellness initiatives prompted CHIR to take a look at some of the changes—and ongoing issues—with workplace wellness programs.

Encouraging Signs for the Public Option in Washington State: Improved Availability and Affordability of Plans in 2022

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This open enrollment, Washington State residents can once again purchase first-in-the-nation public option-style plans. Last year, Washington’s publicly procured plans—touted as a mechanism to improve affordability and competition in the marketplace—were less available and more expensive than proponents had hoped. In 2022, the second year of the program, these plans will offer average rate decreases and are available in a greater number of counties, an encouraging sign for the viability of Washington’s public option.

Filling a Gap in the No Surprises Act: What are States Doing to Protect Consumers from Out-of-Network Ground Ambulance Bills?

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In January, the No Surprises Act will provide landmark protections against surprise billing, but ground ambulance services are excluded from the new safeguards. In a post for the Commonwealth Fund’s To the Point blog, CHIR experts discuss challenges related to ground ambulance reimbursement and state strategies for protecting consumers from surprise bills.

The No Surprises Act Interim Final Rule on Dispute Resolution, Uninsured Protections, and External Review: Implications for States

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Last month, the Biden administration published a third rule implementing the No Surprises Act, the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. The interim final rule (IFR) provides details on the independent dispute resolution process, protections for uninsured patients, and more. In a new Expert Perspective for the Robert Wood Johnson Foundation’s State Health & Value Strategies program, CHIR experts provide a summary of the IFR, identifying implications and considerations for states.

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.