Category: State of the States

Ensuring the Adequacy of ACA Marketplace Plan Networks

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Following the Trump administration’s decision to roll back federal network adequacy standards for Affordable Care Act marketplace plans, the Biden administration signaled it will soon resume oversight, proposing new, quantitative standards as well as proactive compliance procedures. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Justin Giovannelli examines current state and federal approaches to network adequacy, and what would change under the new standards proposed by the Biden administration.

Fixing the Family Glitch and Other Priorities: The Next Wave of Federal Administrative Action to Enhance the Affordable Care Act

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The federal government has taken a series of actions to strengthen the Affordable Care Act (ACA) and Medicaid, and the Biden administration has announced its intent to do more in this arena. Stakeholders have aided federal policy efforts by suggesting administrative options for increasing access to affordable, comprehensive health insurance and promoting health equity. In her latest post for the Commonwealth Fund’s To the Point blog, Georgetown’s Katie Keith identifies thirteen high-priority administrative policies to strengthen the ACA and Medicaid and evaluates their current status.

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.

Limited Plans with Minimal Coverage Are Being Sold as Primary Coverage, Leaving Consumers at Risk

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People shopping for health insurance online are often directed to websites using misleading or deceptive practices to steer them to products that are not compliant with the Affordable Care Act, such as fixed indemnity policies. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Dania Palanker and Kevin Lucia discuss the marketing of limited plans as a primary form of coverage and the risks these products pose to consumers. 

State “Easy Enrollment” Programs Gain Momentum, Lay Groundwork for Additional Efforts to Expand Coverage

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The American Rescue Plan made health insurance more affordable, but covering the 30 million remaining uninsured will require innovative efforts to broadcast and facilitate enrollment in subsidized insurance. To that end, several states, following an inaugural effort in Maryland, have proposed or are implementing a new avenue to enrollment through the tax-filing process. In a new post for the Commonwealth Fund’s To the Point blog, CHIR experts take a look at states that are operating or implementing “Easy Enrollment” programs, and how they may offer a bridge to more ambitious initiatives like automatic enrollment.

State Efforts to Standardize Marketplace Health Plans Show How the Biden Administration Could Improve Value and Reduce Disparities

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The federal government is moving forward with standardized benefit designs via HealthCare.gov, following in the footsteps of several states. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR experts Justin Giovannelli, Rachel Schwab, and Kevin Lucia assess the experience of these states with standardized plans and draw lessons for federal officials.

New Georgetown Report: States’ Actions to Expand Telemedicine Access During COVID-19 and Future Policy Considerations

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During the COVID-19 pandemic, many states temporarily lowered barriers to using telemedicine for health care services. Subsequently, a number of states have taken action to make those changes permanent. In their latest report for the Commonwealth Fund, CHIR experts examine this emerging body of state law and its potential impact on the use of health care services, costs, and outcomes.

Are Surprise Billing Payments Likely to Lead to Inflation in Health Spending?

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Under the No Surprises Act, enacted in December of 2020, federal regulators face a balancing act as they develop a mechanism for determining payments to out-of-network providers for covered services. The law also provides for deference to state mechanisms, where they exist. In their latest post for the Commonwealth Fund, CHIR’s Jack Hoadley and Kevin Lucia assess the implications for provider payment as well as long term impacts on health care spending.

State-Based Marketplaces Gear Up to Implement the American Rescue Plan

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The state-based health insurance marketplaces are taking varied approaches to implementing the enhanced premium tax credits provided under the American Rescue Plan. CHIR’s Sabrina Corlette and Rachel Schwab review these states’ decisions and their impact on when and how consumers will access health plans with more affordable premiums.

Hybrid Approach to Resolving Payment Disputes Breaks Legislative Stalemates Over Balance Billing, How Will the No Surprises Act Affect These New State Laws?

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Seven states in 2020 were able to break a longstanding stalemate and enact protections against surprise out-of-network billing. CHIR’s Jack Hoadley and Kevin Lucia delve into the factors that got these states across the finish line and how the federal No Surprises Act will impact these states’ new laws.

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.