…among the companies. See Table 2. Table 2. Average Proposed Small-Group Market Rate Changes in Selected States (Plan Year 2025) State Highest Average Rate Request (%) Lowest Average Rate Request (%) DC 8.0 (Kaiser Foundation Health Plan) 1.4 (CareFirst BlueCross BlueShield – PPO) Maine 19.6 (Maine Community Health Options) 3.9 (Taro Health Plan) Maryland 21.7 (Aetna – PPO) 3.2 (CareFirst…
…Mergers Brot-Goldberg, Zarek et al. National Bureau of Economic Research. June 2024. Available here. Researchers from the University of Chicago, Yale, Harvard, the University of Wisconsin–Madison, and the US Department of Treasury combined data on privately insured healthcare prices and utilization to investigate how price increases following hospital mergers negatively impact premiums, payrolls, employment, federal tax revenue, and mortality. What it…
…continued ICHRA growth. Oscar Health CEO Mark Bertolini stated: “We believe ICHRA’s time has come,” noting that many employers will see ICHRAs as a “hedge” against rising health care inflation. Centene CEO Sarah London touted her company’s strategy of marketing ICHRAs to small employers, using the health benefits platform Take Command. Both of these companies have a significant presence in…
This spring, as millions of people prepared their taxes, an increasing number of states were using the tax-filing process to connect those who are eligible but uninsured with comprehensive, affordable health insurance. These “easy-enrollment programs” allow filers to check a box on forms they file with the state (e.g., income tax returns) to indicate that they do not have health…
…Consumer notification requirements. While their choice of tool varies, the broad array of states taking action is consistent with survey data showing widespread, bipartisan support for outpatient facility fee regulation. Connecticut, Colorado, Maine, and Indiana Remain at the Forefront of Reforms CHIR and West Health previously dug into how 11 study states have been approaching outpatient facility fee reforms. That…
Over the past 30 years, hospitals and physician practices have been merging at an accelerated pace, and as a result, they have been able to command higher prices for their services. The top ten largest health systems in the country control almost a quarter of the national hospital market, and over 70 percent of hospital markets around the country have…
…non-claims payment data to the state all-payer claims database. Under the state’s law, failure to comply with its minimum primary care spending requirement can result in civil penalties, issuance of cease-and-desist orders, or revocation of licenses. In all three states, the agencies responsible for enforcing these targets periodically produce reports assessing insurers’ compliance. In Rhode Island and Delaware, insurers have…
…programs, further state take up of multi-year continuous eligibility in Medicaid and CHIP for young children, and adding 12 months of continuous eligibility for adults. In the last few years, the US has made tremendous progress providing more people with access to affordable, comprehensive health insurance coverage. Coverage not only improves families’ financial security, it is proven to improve access to primary and preventive care,…
…states taken to reform facility fees? Facility fees are billed charges that cover the operation expenses of health care services in a facility. Facilities submit these fees separately from professional service fees for providers. Evidence indicates that facility fees vary by geography and increase spending, premiums, and out-of-pocket (OOP) costs for consumers, without commensurate gains in quality. Furthermore, separate hospital…
…controls spending. Prices Paid to Hospitals by Private Health Plans: Findings from Round 5 of an Employer-Led Transparency Initiative Christopher M. Whaley, et al. RAND Corporation. May 13, 2024. Available here. RAND researchers analyzed 2020-2022 medical claims data to examine geographic variation in negotiated prices for commercial insurance enrollees, as compared to Medicare rates. What it Finds In the past…
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