Category: Implementing the Affordable Care Act

Stakeholder Perspectives on CMS’s 2023 Notice of Benefit and Payment Parameters: Consumer Advocates

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In the recently released 2023 “Notice of Benefit & Payment Parameters,” the Biden administration is proposing significant changes to the Affordable Care Act marketplaces. In the first of a three-part series, CHIR’s Emma Walsh-Alker and JoAnn Volk reviewed public comments from multiple consumer advocacy organizations about the impact of the new policies on marketplace beneficiaries. Reviews of comments from insurers and state marketplaces and insurance departments will follow.

New Data Show Medical Debt Disproportionately Affects the Most Vulnerable Populations

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Unpaid medical bills are among the largest contributors to personal debt in the United States. Evidence indicates that medical debt disproportionately affects people of color and individuals with lower incomes. CHIR’s Maanasa Kona reviews new data from the Census Bureau and state court records that demonstrate the disparate impact of medical debt on vulnerable populations, and explores what policymakers can do to protect consumers from aggressive debt collection.

PrEP Coverage Obstacles Highlight Challenges Implementing the ACA Preventive Services Requirement

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The ACA requires coverage of recommended preventive services without cost-sharing for consumers enrolled in most private health plans. But even with these protections in place, some insurers improperly impose cost sharing for preventive services. Recently, this problem hit consumers who use pre-exposure prophylaxis (PrEP), a medication that can prevent contraction of HIV.

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.

January Research Roundup: What We’re Reading

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In our newest monthly roundup of health policy research, CHIR’s Emma Walsh-Alker reviews studies on the potential of personalized phone outreach to boost marketplace enrollment, trends in the small-group health insurance market, and the Congressional Budget Office’s latest report comparing how much commercial insurers and Medicare pay for health services.

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.

December Research Roundup: What We’re Reading

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This month, we’re ringing in the new year with new health policy research. In our final roundup of 2021 publications, CHIR’s Emma Walsh-Alker reviewed analyses about the impact of the ACA’s Medicaid expansion on coverage status and access to maternal care, how the Build Back Better Act would change health insurance for low-income individuals and families, and consumer choice in health care.

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.