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From Cancer Screenings to Prenatal Care, the Latest Challenge to the Affordable Care Act Threatens Availability of Free Preventive Services

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…the way the ACA defines the list of preventive services that must be covered without cost sharing—incorporating recommendations by the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP) as well as guidelines from the Health Resources and Services Administration (HRSA)—is unconstitutional. While some legal experts have pointed out flaws in the plaintiffs’ arguments, others…

Prior Authorization – Boon or Bane? Federal and State Policymakers Seek Reforms to Insurers’ Utilization Management Practices

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…still admitted to a facility. Retrospective Review: Claims review that occurs after a treatment has already been given or completed. Utilization management began in the 1950s as third-party payment for health care was expanding after World War II. Some utilization management was instituted by providers as a way to ensure quality and assess physician performance. Beginning in the 1960s, Blue…

In a Post-Roe World, Employers Looking to Cover Out-of-State Travel for Abortion Services Have Multiple Options and Plenty of Uncertainty

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…high-deductible health plan combined with an HRA or in an HSA-qualified high-deductible health plan in 2020. (KFF’s data does not indicate how many workers who enrolled in HSA-qualified plans also held a funded HSA.) Employers alone fund HRAs, which need not be combined with a high-deductible plan, while workers and employers can both contribute to HSAs. Employees may use funds…

HHS Approves Nation’s First Section 1332 Waiver for a Public Option–Style Health Care Plan in Colorado

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…the federal government has taken action to approve state legislation introducing new, more heavily regulated plans into Affordable Care Act marketplaces to compete against traditional plans. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Christine Monahan, Justin Giovannelli, and Kevin Lucia dive into Colorado’s new law. The authors detail the state public option, the significance…

CHIR Interactive Map Highlights New Details on No Surprises Act Enforcement

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…so. Some states have opted to share this responsibility with the federal government, often through a collaborative enforcement agreement. Additionally, almost half of states have laws governing the process for determining payment from insurers (generally, state-regulated insurers) to out-of-network providers, in lieu of the federal dispute resolution system. The Centers for Medicare and Medicaid Services (CMS) released letters outlining state…

Party’s Over: Health Plan Premiums Poised to Spike in 2023, After Period of Modest Growth

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…because enrollees who are disenrolled from Medicaid after the end of the PHE are expected to have poorer health, on average, than typical commercial market enrollees. For example, Neighborhood Health Plan of Rhode Island writes in its rate filing: “[We] made assumptions around increases in enrollment and higher claims expenses from [members transitioning from Medicaid]. [We are] anticipating a morbidity…

Delays Extending The American Rescue Plan’s Health Insurance Subsidies Will Raise Premiums And Reduce Coverage

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…a fixed IT capacity, so adding new work diverts resources from other key priorities. Last-minute changes also create more demand for call centers, which are both a large expense and subject to staffing shortages that money cannot readily solve. All of this comes at what is already a challenging time for Marketplaces with the coming unwinding of the Medicaid continuous…

June Research Roundup: What We’re Reading

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…low of 26.3 percent in 2019 and a high of 38.7 percent in 2022. Researchers were able to fill in data gaps using data self-reported by enrollees in a prior year, reducing the share of enrollees with missing data to 23.5 percent. Using census data, researchers calculated the probability that an individual belonged to a certain racial and ethnic group…

Improving Race and Ethnicity Data Collection: A First Step to Furthering Health Equity Through the State-Based Marketplaces

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…demographic data to target policies and determine whether equity-focused interventions are achieving their objectives, but significant gaps in the data pose obstacles. After the 2022 open enrollment period, more than half of SBMs were missing race or ethnicity data for over 20 percent of enrollees. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Dania Palanker,…

Understanding the Role of Private Equity in the Health Care Sector

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…acquires a target company that has the potential to make more money, makes operational or management changes to realize these gains, and then sells the company for a profit. PE funds are not registered with the Securities and Exchange Commission (SEC), and are not required to disclose any information about their investments. PE involvement in commercial sectors like tech, retail,…

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.