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The State of State Protections: Maintaining Access to Services after Transitioning from Medicaid

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…become uninsured or face a gap in coverage. The federal Centers for Medicare and Medicaid Services has provided states with guidance on when and how to conduct redeterminations, and the federal health insurance marketplace has dramatically increased funding for consumer outreach and assistance. Several state-based marketplaces are also preparing innovative programs, such as auto-enrollment and premium assistance, to ease coverage…

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

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…stakeholder comment on this potential problem. Takeaway In the preamble to the proposed rules, the Departments stress the importance of expanding access to contraceptive services in the midst of state efforts to severely restrict abortion access after Dobbs. Access to contraception is a crucial, if insufficient component of reproductive autonomy. By eliminating cost sharing for contraceptive services, the ACA has…

February Research Roundup: What We’re Reading

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…Spending in the Affordable Care Act Markets, 2015–19, Health Affairs, February 2023. Researchers reviewed claims data from Affordable Care Act (ACA)-compliant individual and small group markets and medical loss ratio data to identify trends and potential drivers in health care spending. The authors assessed utilization, unit prices, and service mix between 2015 and 2019. What it Finds Total per member…

Can Employer-Sponsored Insurance Be Saved? A Review of Policy Options: Limiting Provider Consolidation and Anti-Competitive Behavior

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…Trade Commission (FTC) and U.S. Department of Justice share the responsibility for enforcing antitrust laws at the federal level. The FTC in particular has recently expressed increased interest in ramping up oversight over health care providers. In 2020, the FTC ordered six insurance companies to submit data that will help the FTC study the impact of hospital and physician group…

A Progress Report on Washington’s Public Option Plans

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…insurers in Washington already offer the public option plans, while another two were rejected in 2023 and the final insurer does not currently participate in the individual market. Additionally, complications related to network continuity and different procurement processes could create obstacles for insurers attempting to bid across programs. Improving Provider Participation Cascade Select networks, while complying with state network adequacy…

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

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…to a Marketplace plan. Will I still have access to the same doctors and medications? You can find even more FAQs on transitioning from Medicaid to private insurance here. And as always, the Navigator Resource Guide has over 300 searchable FAQs on topics such as financial assistance available through the Marketplace, how to enroll in coverage, and common post-enrollment issues….

COVID “Long Haulers” Still Struggle with Coverage and Care

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…see specialists at long COVID clinics; most of these centers are located in urban communities, putting care further out of reach for long COVID patients who live in rural areas. Moreover, patients currently have limited treatment options. The novelty of COVID-19 means that some post-COVID conditions may not yet be identified, and information on treatments’ effectiveness is still sparse, with…

January Research Roundup: What We’re Reading

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…enrollees. Using the MarketScan claims database, which includes expenditures on inpatient and outpatient services as well as outpatient drugs for roughly 350 payers, researchers compared total medical expenditures in 2018 among ESI beneficiaries with and without an SUD diagnosis to estimate potential savings generated by successful prevention and treatment of SUD (referred to as the “attributable cost”). What it Finds…

A Midterm Assessment Of President Biden’s Promise To Build On The ACA

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…to improve access to care in Medicaid managed care. This will be a complex but much needed regulatory undertaking to improve access to health and behavioral health care, advance racial equity, and tighten up oversight of private Medicaid managed care companies. Impressive Progress To Date Going forward, improving on the ACA will be challenging. Leaders in the US House may…

Implementing the Family Glitch Fix on the Affordable Care Act’s Marketplaces

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…effect for the 2023 plan year, marketplaces have had the crucial responsibility of implementing and broadcasting this new route to affordable health insurance. In a post for the Commonwealth Fund’s To the Point blog, CHIR experts highlight the variety of activities undertaken by the ACA’s marketplaces to implement the family glitch fix. In addition to updating eligibility and enrollment websites,…

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.