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Hybrid Approach to Resolving Payment Disputes Breaks Legislative Stalemates Over Balance Billing, How Will the No Surprises Act Affect These New State Laws?

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…for example, failed to reach a compromise over several sessions, as insurer and provider stakeholders pushed competing bills. In 2020, the logjam broke after key leaders met repeatedly to find agreement. The story was similar in Virginia, where a previous legislature created a task force to identify a particular combination of elements on which Virginia stakeholders could agree. In Michigan,…

March Research Roundup: What We’re Reading

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…differ from those reflected in the data used to calculate the amounts. Document their reasoning for other arbitrators and regulatory agencies to refer to. Researchers also recommend that federal agencies use a competitive process to select arbitrators in cases where parties fail to agree on an arbitrator. They argue that this process should favor arbitrators who commit to charging low…

Rookie Report: How did New Jersey and Pennsylvania State Marketplaces Fare in Their Inaugural Enrollment Period?

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…immigration status affected consumer applications. While some assisters reported state call center wait times to be shorter compared to the federal call center, assisters in both states did report long wait times—up to an hour in some cases. Regarding the website interfaces, while many assisters preferred the new state platform, assisters in both states found room for improvement. According to…

The American Rescue Plan: What You Need to Know about Enhanced Premium Tax Credits

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President Biden signed the American Rescue Plan Act into law on March 11, 2021. The $1.9 trillion package provides relief to millions of families, businesses, schools, and state and local governments struggling because of the COVID-19 pandemic and its economic fallout. The law also includes provisions to expand access to affordable, comprehensive insurance coverage. The following frequently asked questions (FAQs)…

New Georgetown CHIR Report: Taking the Disputes out of Dispute Resolution

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…One factor could be that arbitrators in both states consider the provider’s full billed charge, which is not competitively determined. Federal regulators must consider a range of IDR approaches and outcomes, as well as various market and competitive forces at play in states across the U.S., to build a fair and effective federal IDR structure. Read the full brief here….

American Rescue Plan Act Will Strengthen Public and Private Health Insurance

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…COBRA coverage, substantially increases subsidies for the purchase of health plans offered through the Affordable Care Act’s marketplaces, and targets additional marketplace subsidies to those receiving unemployment benefits. We have put together an issue brief to explain these provisions in greater detail. Read the brief here. *Edwin Park is a Research Professor with Georgetown University’s Center for Children & Families…

Removing Roadblocks: Special Enrollment Period Data Show Increase in Marketplace Signups

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…or CHIP. This SEP activity comes after a busy Open Enrollment Period (OEP), where 8.3 million new and returning enrollees selected marketplace plans through HealthCare.gov. While the numbers appear to lag behind the rate of signups during the OEP, SEP signups are best understood in comparison to enrollees coming to the marketplace outside of the annual enrollment window, as OEP…

February Research Roundup: What We’re Reading

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…February 2021 In this working paper, researchers from the National Bureau of Economic Research examine data taken from Medicare’s prescription drug benefit program to assess the impact cost-sharing has on patient behavior and mortality. What it Finds An increase of 33.6 percent in patient out-of-pocket costs (valued at $10.40 per drug) causes a 22.6 percent drop in total drug consumption…

Are the Good Times Over for Health Insurers?

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It’s no secret that health insurers experienced increased profits in the early months of the COVID-19 pandemic. As elective and routine health services were postponed or canceled, insurers had unprecedented excess revenue. However, in the closing months of 2020, the financial good times appeared to be coming to an end. Although overall insurers performed better financially in 2020 than they…

Navigator Guide FAQs Of The Week: Who is Eligible for Financial Assistance?

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…through modified versions of silver plans that are offered on the marketplace. These plans will have lower deductibles, co-pays, coinsurance and out-of-pocket limits compared to regular silver plans. Once the marketplace determines you are eligible for cost-sharing reductions, you will be able to select one of these modified silver plans, based on your income level. Look out for more weekly…

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.