…decade contributing to rising prices for health care. The expansion of large health systems, with multiple hospitals, outpatient departments, and physician practices under the same ownership, has been significantly increasing what commercial insurers – and, ultimately consumers and employers – pay for care. One egregious example of this is the addition of outpatient facility fee charges to health care services…
…determined commercial insurer payments for hospital services in Indiana at nearly twice the rate of commercial insurer payments for the same services in the nearby state of Michigan. Price caps pose operational issues, such as whether the caps should be applied to each individual service or the weighted average of all services. They also raise compliance issues. Existing research suggests…
The U.S. House of Representatives Education & Workforce Committee is poised to advance a bill, H.R. 2813, that would encourage the expansion of self-funded employer-based insurance exempt from key Affordable Care Act (ACA) protections and preempt states’ efforts to stabilize premiums for small employers. Below is a lightly edited excerpt from Sabrina Corlette’s testimony before the committee, about the proposed…
CHIR is thrilled to welcome Hanan Rakine, M.P.H., as our newest faculty member. Hanan joins us as a Research Fellow. Her research will focus on emerging issues in health insurance and insurance markets along with facility fee charges and coverage in the commercial market. Prior to joining CHIR, Hanan worked at the Bipartisan Policy Center where she analyzed national health…
…and community engagement. States should be soliciting and incorporating public comment on their proposed Blueprint, and publicly posting their Blueprint applications. Greater transparency surrounding SBMs’ revenue source(s) and spending, such as more prominent public posting of audits, as well as data on key metrics such as plan selections, effectuated enrollments, call center wait times, and spending on Navigators and consumer…
…regulators about outliers in the market and potential indicators of anti-trust issues. Initiatives to constrain cost growth. Price data can inform the implementation and oversight of state-level initiatives such as total cost of care cost-growth benchmarks, public option plans, and reference pricing. Anti-trust enforcement. Price data can provide an independent source of information for state attorneys general and others monitoring compliance with anti-trust settlements and prohibitions on anti-competitive…
…access. Based on total cost of care data for commercial HMO enrollees in California’s Integrated Healthcare Association database, researchers estimated Golden Choice premiums for a 36-year-old enrollee, comparing this estimate to the corresponding premiums for gold and silver plans offered on California’s ACA Marketplace, Covered California, in 2019. Researchers also interviewed health plans and providers to better assess the feasibility…
…public option plans. In a post for the Commonwealth Fund’s To the Point blog, CHIR’s Christine Monahan and Madeline O’Brien compare Washington’s self-described “selective procurement” approach with Colorado’s requirement that all carriers offer public option plans, and observe how Nevada still has time to decide whether to take all-comers or be more selective. You can read the full post here….
…come into compliance with HIPAA’s standard telehealth rules. Similar privacy flexibilities for community-based testing sites and online applications for scheduling COVID vaccinations will also expire. The federal government issued guidance in 2020 allowing insurers to make mid-year changes to their coverage of telehealth services, such as eliminating cost-sharing requirements, without incurring penalties. Nongroup and fully insured group health plans were…
…health care prices. On average, commercial insurers are paying twice the amount that Medicare pays for the same service. There are a number of reasons for this. First, consolidation in the health care sector is granting providers with outsized market power to demand higher reimbursement rates. Second, a lack of price transparency has left many employers in the dark about…
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