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

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Under the Affordable Care Act, insurers must provide rebates to enrollees when their spending on clinical services and quality improvement, as a proportion of premium dollars, falls below a minimum threshold. Federal regulators have discovered some insurers are gaming the system by misallocating expenses or inflating their spending on providers. Karen Davenport takes a look at how this practice impacts consumers, and explains a new federal proposal to crack down on it.

Ensuring the Adequacy of ACA Marketplace Plan Networks

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Following the Trump administration’s decision to roll back federal network adequacy standards for Affordable Care Act marketplace plans, the Biden administration signaled it will soon resume oversight, proposing new, quantitative standards as well as proactive compliance procedures. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Justin Giovannelli examines current state and federal approaches to network adequacy, and what would change under the new standards proposed by the Biden administration.

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

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It is hard to overstate the importance of primary care in ensuring robust health outcomes at the population level. In a new report supported by the National Institute for Health Care Reform, CHIR experts reviewed research to assess whether policy initiatives targeting primary care access have been effective in reducing health care disparities.

January Research Roundup: What We’re Reading

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In our newest monthly roundup of health policy research, CHIR’s Emma Walsh-Alker reviews studies on the potential of personalized phone outreach to boost marketplace enrollment, trends in the small-group health insurance market, and the Congressional Budget Office’s latest report comparing how much commercial insurers and Medicare pay for health services.

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

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The Oregon Health Authority recently released its Public Option Implementation Report, stemming from a legislative directive to develop a plan to make a public health insurance option available in the individual (and potentially small group) market. CHIR’s Christine Monahan takes a look at what’s in the new report and what’s next for the Oregon public option initiative.

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

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The Affordable Care Act’s health insurance marketplaces and consumer protections significantly improved the experience of purchasing individual health insurance, but consumers still face the difficult task of comparing a potentially overwhelming number of complicated benefit and network designs. A proposal in the Notice of Benefits and Payment Parameters for 2023 may improve this situation. Karen Davenport takes a look at the possible return of standardized plans to the federal marketplace, and what this change might mean for consumers.

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

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Private health plans are now required to cover at-home over-the-counter COVID-19 tests. CHIR’s Megan Houston and Rachel Swindle reviewed the coverage policies of 51 insurers to see how consumers can access this benefit. They found a number of plans with restrictions that go beyond what federal guidelines allow.

Adoption of Value-Based, Alternative Payment Models: Where Are We Today and Where Do We Go from Here?

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Employer-sponsored health insurance costs had their highest annual increase since 2010 last year, and some experts are projecting additional health spending increases in 2022. Research has found that provider prices are the leading cause of high and rising health care spending in the US, and many policy experts have advocated for moving towards value-based, alternative payment models (APMs). CHIR’s Maanasa Kona takes a look how APMs have performed thus far and what the future may hold.

Fixing the Family Glitch and Other Priorities: The Next Wave of Federal Administrative Action to Enhance the Affordable Care Act

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The federal government has taken a series of actions to strengthen the Affordable Care Act (ACA) and Medicaid, and the Biden administration has announced its intent to do more in this arena. Stakeholders have aided federal policy efforts by suggesting administrative options for increasing access to affordable, comprehensive health insurance and promoting health equity. In her latest post for the Commonwealth Fund’s To the Point blog, Georgetown’s Katie Keith identifies thirteen high-priority administrative policies to strengthen the ACA and Medicaid and evaluates their current status.

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.