Category: CHIR

Providers Challenge Payments In ‘No Surprises’ Act Dispute Resolution Process

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Under the No Surprises Act, consumers are held harmless beyond in-network cost sharing when they receive certain kinds of out-of-network care. In these scenarios, to determine the provider’s payment, payers and providers may enter independent dispute resolution (IDR). Recently, federal agencies released an initial report on the No Surprises Act’s IDR process. In a post for Health Affairs Forefront, CHIR experts Jack Hoadley and Kevin Lucia analyze the new report and discuss what it suggests about the No Surprises Act.

Biden’s Budget Sets Up a Spending Showdown, With ACA Subsidies in the Crosshairs

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President Biden released his Fiscal Year 2024 budget earlier this month, outlining the administration’s spending and policy priorities for a number of key programs, including the Affordable Care Act (ACA) Marketplaces. However, with a sharply divided Congress, consumers who rely on Medicaid and the ACA’s Marketplaces are likely in the crosshairs of an upcoming spending showdown. CHIR’s Emma Walsh-Alker examines the potential impact of cutbacks to the ACA’s Marketplace subsidies on low- and moderate-income families.

Questionable Conduct: Allegations Against Insurers Acting as Third-Party Administrators

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Nearly half of U.S. residents are enrolled in employer-sponsored health insurance. Many of these plans use third-party administrators (TPAs), intermediaries—frequently insurance companies themselves—that help build provider networks, design benefit packages, and adjudicate claims, among other responsibilities. But a TPA’s interests may not align with those of their employer clients. CHIR’s Christine Monahan highlights several examples of questionable insurer-TPA practices uncovered in recent years.

Proposed Rules on the ACA’s Frequently Litigated “Birth Control Mandate” Aim to Close Gaps in Coverage

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Last month, the Biden administration proposed new rules to restore access to free contraceptive services under the Affordable Care Act. In the wake of severely restricted access to reproductive health care, the stakes of the Biden administration’s proposals are high. With comments due on April 3, CHIR’s Rachel Schwab provides an overview of the Biden administration’s proposals and key considerations for consumers’ access to contraceptive services.

February Research Roundup: What We’re Reading

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Along with “Health Policy Valentines,” February brought a host of new health policy research. This month, we read about trends in medical and pharmacy spending, the relationship between health systems’ financial performance and amounts paid by commercial plans, and mental health provider network adequacy.

A Progress Report on Washington’s Public Option Plans

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Washington State’s “public option” program is now in its third year. After initial cost and access challenges hindered the program’s reach, growing insurer participation and recent enrollment data suggest meaningful progress is being made. CHIR’s Christine Monahan and Madeline O’Brien provide an update on how Washington’s public option plans performed in the recently concluded open enrollment period, outlining key issues to watch as Washington moves forward with its first-in-the-nation program.

Updates to the Navigator Resource Guide Provide Information for People Transitioning from Medicaid to Private Health Insurance

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After a three-year pause on Medicaid redeterminations, states can begin the process of removing residents from their rolls beginning on April 1. Many people who are terminated from Medicaid will be eligible for free or low-cost plans through the Affordable Care Act’s Marketplaces. To help consumers and enrollment assisters during this nationwide coverage event, we’ve updated our Navigator Resource Guide with new content about transitioning between Medicaid and private health insurance.

COVID “Long Haulers” Still Struggle with Coverage and Care

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The COVID-19 public health emergency expires this spring, bringing an end to pandemic-related funding, infrastructure, and flexibilities. Meanwhile, millions of people continue struggling to find and pay for effective treatment for post-acute, COVID-related conditions. Karen Davenport provides an update on the progress—or lack thereof—towards covering the ongoing and unique care needs of these COVID “long haulers.”

January Research Roundup: What We’re Reading

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Welcome to another year of health policy research. In the first month of 2023, CHIR reviewed studies on how policies expanding health coverage would impact household spending, surprise medical bills generated by ground ambulance rides, and health care costs associated with substance use disorders.

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.