…insurers’ data files to confirm compliance, issue rules or guidance to insurers to improve data accessibility and usability, provide user-friendly data-reporting templates, and hold plans accountable if and when they are not in compliance. Looking Forward Price transparency is a means to an end. Health care payers, policy makers, and researchers must be able to access and analyze data to…
…Benefytt made it hard for consumers to cancel their coverage once they discovered that what they bought didn’t measure up to what they were told. The FTC’s investigation found that consumers searching online for comprehensive coverage compliant with the Affordable Care Act (ACA) would instead be directed to deceptive websites with names like “Obamacareplans.com.” From there, agents would push plans…
…year. But as ASPE’s data show, as many as 15 million individuals are at risk of becoming uninsured once the PHE expires. This group is disproportionately comprised of children, young adults, and people of color, underscoring the health equity implications of mitigating coverage losses. Gaps in insurance coverage also threaten continuity of care for patients currently receiving treatment. ASPE’s latest…
…at a data-driven healthcare solutions company, conducting research on telehealth and health care providers. She has also worked in corporate law, intellectual property law, privacy and data transfer law, and family law. Vrudhi received her LL.M. from The George Washington University School of Law and her LL.B. from the University of Mumbai, India. She is also a member of the…
…laws that prohibit discriminatory practices. Federal rulemaking has dictated the breadth and depth of these protections. Will this third set of Section 1557 regulations establish long-lasting expectations for insurers and durable protections for their enrollees? Perhaps this time a combination of timing, political will, and policy insight will result in regulations with staying power. OCR is accepting comments on the…
By Christine Monahan and Jalisa Clark The affordability of diabetes care is a national issue. Even with insurance, diabetic patients can spend thousands of dollars on medication, supplies, and health services. These costs can present a particular burden on Black families. Black and Hispanic patients face disproportionally high hospitalizations and emergency department visits due to diabetes complications, emphasizing that affordable…
…require insurers—including marketplace insurers, group health plans, and third-party administrators—to annually submit data on non-quantitative treatment limits (NQTLs), such as prior authorization and mental health and SUD service claims denials to aid in parity enforcement. This builds on the Consolidated Appropriations Act of 2021, which (among other things) requires insurers to prepare comparative analyses of NQTLs imposed on mental health…
…data transparency requirements, QHP issuers have so far only reported data for in-network claims. What it Finds Among the 213 issuers offering QHPs on HealthCare.gov that reported in-network claims data for plan year 2020, only 144 members of this group provided complete data. Issuers reported receiving 230.9 million in-network claims, and denied 42.3 million of them—an average denial rate of…
…doctor, OB/GYN, or pediatrician, or rely on continued access to a particular prescription. Yet people who transition from Medicaid to the Marketplace will enroll in plans with different benefit designs, drug formularies, provider networks, and cost-sharing policies than their Medicaid coverage. Services they previously received for free could come with deductibles or other cost-sharing. Hospitals and doctors may suddenly become…
…operational differences; and (3) elimination of a profit margin. These differences are expected to translate into reduced premiums for employers and employees without sacrificing comprehensive coverage. Indirectly, competition from a public option also could drive down premiums among private plans. A public option also would increase federal tax revenues as employers shift spending from health insurance to wages because the…
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.
