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Where the Bread is Really Buttered: Insurers’ Q4 Earnings Reports Show Heavy Reliance on Government Business

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…its fourth quarter, after reducing their expectations for Medicare Advantage membership in 2022. Humana executives largely attributed the loss to unexpected COVID-19 costs. They remain undaunted, however, and announced plans to invest $1 billion into expanding its Medicare Advantage business. Competition has increased significantly in this business between large payers and small “insuretechs” that market consumer-friendly technology and user experience,…

New Data Show Medical Debt Disproportionately Affects the Most Vulnerable Populations

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…pandemic. New evidence indicates that these practices have continued unabated, according to an analysis of complaint data from the Consumer Financial Protection Bureau. In March 2021, the number of complaints filed with the Bureau reached the highest monthly level since 2018. An investigation into medical debt practices of New York’s non-profit hospitals between March and November of 2020 by the…

PrEP Coverage Obstacles Highlight Challenges Implementing the ACA Preventive Services Requirement

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…among the same communities that could most benefit from it. Black/African American and Hispanic/Latino patients report higher levels of distrust in the medical system compared to non-Hispanic whites, which may discourage further engagement with providers or insurers following an incorrect bill. Gaps in health insurance literacy also complicate the process of filing an appeal: according to a 2013 study from…

Questionable Quality Improvement Expenses Drive Proposed Changes to Medical Loss Ratio Reporting

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…the Centers for Medicare and Medicaid Services (CMS) has proposed some key changes that will, they say, place new limits on health plans’ ability to manipulate this process at consumers’ expense. Background Rebates are designed to discourage insurers from inflating premiums To determine their premiums for the coming year, insurers project their enrollees’ likely health status and use of services….

Ensuring the Adequacy of ACA Marketplace Plan Networks

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…as well as proactive compliance procedures. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Justin Giovannelli examines state and federal approaches to network adequacy. He finds that, even though the ACA established a federal network adequacy protection for marketplace enrollees in all states, regulation of marketplace plan networks remains a patchwork affair. This may begin…

New CHIR Report Assesses the Effectiveness of Policies in Improving Access to Primary Care for Underserved Populations

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…improve access. The primary care access problem can be divided into five composite and interconnected dimensions: (1) availability of primary care clinicians, (2) accessibility of primary care services geographically, (3) accommodation in terms of appointment availability and hours, (4) affordability, and (5) acceptability in terms of comfort and communication between patient and clinician. In a new report, CHIR’s Maanasa Kona…

January Research Roundup: What We’re Reading

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…been relatively stable, particularly in comparison to the decade before ACA implementation when offer rates were declining steeply. However, compared to the large-group market, the relatively limited availability of employer-sponsored coverage at smaller businesses—particularly for low-wage workers—suggests the need for policies that help these workers obtain affordable and comprehensive health insurance. Although the data show only modest increases in self-funding…

Oregon’s Public Option Implementation Report Emphasizes Cost Containment, Health Equity

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…affordable coverage and to assist with enrollment. What’s Next? The Oregon legislature is only in session for just over a month in 2022, from February 1 to March 7. According to an interview with Rep. Andrea Salinas, the vice-chair of the Oregon House Interim Committee on Health Care, we shouldn’t expect the legislature to pass comprehensive public option legislation during…

Tackling “Analysis Paralysis”: New Federal Proposal Would Bring Standardized Benefit Design Back to the Federally Facilitated Marketplace

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…bag and picking your seat. Even using a fare aggregator site, it can be hard to make an apples-to-apples comparison. Similarly, while the Affordable Care Act’s health insurance marketplaces and consumer protections have significantly improved the experience of purchasing individual health insurance, consumers must still undertake the difficult task of comparing a potentially overwhelming number of complicated benefit and network…

Insurers are Now Covering At-Home COVID Tests but Implementation Varies

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…then seek reimbursement, many will find that their insurance company has imposed more restrictions on testing coverage than the new federal rules would allow. Others are complying with the federal standards but have made the process onerous for the consumer. Below we summarize the very wide range of insurance company approaches to the reimbursement of over-the-counter COVID-19 tests. Challenging Reimbursement…

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