…network composition as its own NQTL. To assess the outcomes associated with network composition, under the proposed rules, insurers would be required to collect data including, but not limited to, in- and out-of-network utilization rates, network adequacy metrics (time and distance data, number of providers accepting new patients), and provider reimbursement rates. If an analysis of the data reveals a…
By Jalisa Clark and Christine Monahan As another Marketplace Open Enrollment Period begins, millions of Americans will turn to insurance brokers to guide them to affordable and comprehensive insurance plans. However, a 2022 survey shows that the population brokers serve is overwhelmingly white; nearly half of health insurance brokers self-reported that their client base is comprised of 5 percent or fewer…
…policies and practices SBMs have implemented to facilitate access to health insurance information for LEP individuals and otherwise meet their needs. Using SBM survey responses and interviews with state officials, the authors describe SBM strategies to collect consumer language data, provide multilingual services at call centers, translate written materials, and plan outreach efforts. The authors also identify persistent gaps in language…
…an income attestation from the household when tax return data is not available. Enrollees will now have an additional 60 days to verify their household income (on top of the existing 90 days) should income data issues arise. These changes will lessen administrative burdens on individuals and families if the Marketplace is unable to verify their projected annual household income….
…must clear to obtain the care they need. Aditi P. Sen, Jessica Y. Chang, and John Hargraves, Health Care Service Price Comparison Suggests That Employers Lack Leverage To Negotiate Lower Prices, Health Affairs. Using Health Care Cost Institute claims data, researchers compared prices for common services paid by self-insured and fully insured employer plans. What it Finds In 2021, among…
…the increased revenues for hospitals generated by outpatient facility fees do not correspond to an increase in quality of care. The Senator highlighted bipartisan legislation that she has co-authored, in partnership with Senators Braun and Kennedy, to protect patients from unfair hospital facility fees. CHIR’s Christine Monahan then provided an overview of ESI and some of the key market trends…
…even lose their home or a portion of their paycheck. Though federal law has some safeguards against medical debt and its downstream consequences, the federal framework of medical debt protection has significant gaps. In a new report for the Commonwealth Fund, CHIR’s Maanasa Kona and Vrudhi Raimugia examine how states are filling gaps in federal law. Authors analyzed relevant federal…
…Abortion is a common medical procedure; according to the most recent analysis by the Guttmacher Institute, nearly one in four women will terminate a pregnancy prior to age 45. For comparison, one in four women will receive a coronary heart disease diagnosis while one in eight women will be diagnosed with breast cancer in their lifetime. Cost and Coverage Abortion…
…of proposals to reform abusive billing practices in the commercial market. Exhibit 1: Current congressional proposals to reform or increase transparency on facility fee billing under commercial health plans Source: Authors’ analysis. Price Caps And Site Neutrality In The Commercial Market By far, the most comprehensive bill floated to date is Senator Bernie Sanders’ (I-VT) Primary Care and Health Workforce Expansion…
…qualify for Medicaid to enroll in comprehensive, low cost health insurance. In a recent issue brief for the Robert Wood Johnson Foundation, CHIR and Urban Institute researchers examined New York and Minnesota’s experiences with the BHP and lessons for its design and implementation in other states. What’s a BHP? The ACA included an option for states to run a program,…
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.
