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2016 Insurer Participation Remains Stable in State-Based Marketplaces

…the 17 state-based marketplaces also found stable participation. Despite the struggles of many consumer operated and oriented plans (CO-OPs) and persistent market challenges, most state-based marketplaces have an equal or greater number of insurers competing for business this year. State-based marketplaces have fostered competition by establishing rules that encourage plans to participate. These efforts have included creating waiting periods for…

A Look at Proposals for Improving Health Coverage Affordability

…this post, we examine various proposals to improve affordability of coverage under the ACA. While the ACA has increased access to health insurance, improving perceived affordability remains a concern. According to the July-August 2015 Commonwealth Fund Health Care Affordability Index, 13 percent of privately insured adults were found to have unaffordable premiums, 10 percent unaffordable deductibles, and 11 percent unaffordable…

Enroll Before Jan. 15 for Feb. 1 Coverage and Other Open Enrollment Reminders

…and coverage start dates. If this is your first time enrolling, the Navigator Guide answers questions like the following on marketplace coverage: What health plans are offered through the marketplace (FAQ 1.6.1) Will covered benefits under all marketplace plans be the same? How can I compare? (1.6.4) How can I find out if my doctor’s in a health plan’s network?…

The Failure of the ACA’s Health CO-OPs: Lessons for Policymakers

…to manage a company failure and ensure the smoothest possible transition for consumers. Barriers to market competition As the Department of Justice and many state regulators examine the proposed mergers between major national insurers Aetna/Humana and Anthem/CIGNA, the CO-OP lesson is particularly pertinent. One factor regulators must consider is how easy it is for a new company to enter the…

Depressed Doctors and What Healthcare Payers and Providers Can Do

…contribute to physician stress because of how these doctors are compensated. According to the 2014 Medical Group Management Association’s compensation survey, non-specialized physicians, such as primary care doctors, averaged $220,000 in annual salary compared to $400,000 for specialists and over half a million dollars for cardiologists and orthopedic surgeons. While specialists’ pay is driven by the procedures performed, compensation for…

Proposed Mergers among Major Health Insurers: Context and Perspectives

…mergers can generate, including: Coordinated pricing – when sellers agree to buy/sell a product at a fixed rate; Unilateral efforts – when competition is eliminated and the merged entity exercises total market power; Monopsony – when one large buyer has the ability to drive down prices among many sellers, for instance, reducing prices paid to physicians below a competitive level;…

Federal and State Policymakers Work to Ensure Continuity of Health Care for Consumers

…although the scope and strength of the state continuity of care protections vary widely. In their latest blog post for the Commonwealth Fund, CHIR researchers Sabrina Corlette, Ashley Williams and Kevin Lucia provide a 50-state overview of state continuity of care protections, and assess how they compare to the federal proposal. To read more, visit the Commonwealth Fund blog, here….

What About “Don’t Discriminate Against Sick People” Do You Not Understand?

There’s no question that the Affordable Care Act (ACA) is a complicated law. But there is at least one part of it that’s not complicated. And that’s the requirement that insurance companies stop discriminating against people with pre-existing conditions. It’s very simple. You. Can’t. Discriminate. Against. Sick. People. Yet some insurance companies appear confused by this rule. Or they’re just…

Deadline for January 1, 2016 Coverage Approaching: What to Do

…open enrollment runs until January 31, 2016. Wondering when coverage starts when you buy a plan during open enrollment? Check out Frequently Asked Question (FAQ) 1.3.5 on our Navigator Resource Guide to get the effective coverage dates. Other FAQs related to enrollment that we answer include: I don’t have a checking account. Can the insurance company require that I get…

NAIC Fall Meeting: As One Issue Winds Down, Another Rears Its Head

…billing”). These provisions could help protect consumers who use emergency services or unknowingly get care from an out-of-network provider at an in-network facility and are hit with a large bill. Now the action moves to the states. When the NAIC adopts a model law, the state insurance commissioners commit to submitting the model to their state legislatures. When it comes…

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.