…also suggest that the high commercial-to-MA price ratios among system-affiliated hospitals indicate that hospital market concentration increases negotiated prices primarily in the commercial market, rather than in MA plans. Finally, this study demonstrates a use of the hospital price data published in accordance with the price transparency rules, underscoring the importance of improving compliance with these regulations and making the…
…first woman governor, who expanded Medicaid in the state during her first day in office. Nadia holds a master’s degree in public policy from the Georgetown University McCourt School of Public Policy. While earning her graduate degree, she interned at the Georgetown University Center for Children and Families, the Center for American Progress Women’s Initiative team, and CHIR. She also…
…to comply. The DOI Commissioner may then hold a public hearing with both the insurers and providers at which the insurers can testify about why specific hospitals prevented them from lowering reimbursement rates, thus limiting their ability to lower premiums. At the conclusion of the hearing, the Commissioner may set new reimbursement rates that the providers must accept and the…
…differences between comprehensive coverage subject to the ACA’s consumer protections and other coverage arrangements, including short-term plans. In a post for the Commonwealth Fund’s To the Point blog, CHIR’s Justin Giovannelli and Kevin Lucia and attorney and health policy consultant Christina L. Goe discuss the risks short-term plans pose for consumers and markets. The authors explain the proposed federal rule…
…the restrictions of limited benefit products or misrepresented the availability or affordability of marketplace plans. Most representatives selling limited benefit products also refused to provide written plan information. Many representatives, particularly those selling limited benefit products, used aggressive sales tactics, such as pressuring consumers to commit to a plan over the phone or suggesting that plans would become unavailable or…
…marketing, to buy memberships—need more complete data reported on a regular basis. Ensuring HCSMs comply with the requirement to make available an annual audit is a place to start in states where that applies, but even that data is limited and all states should have an interest in obtaining more complete data to better understand this growing segment of coverage….
By Jack Hoadley and Kevin Lucia For consumers, the goal of the No Surprises Act (NSA) is to ensure that they are not financially penalized when they are treated by an out-of-network facility or provider in many circumstances where they have no real opportunity to receive care from a facility or provider in their insurance network. For the most part, the law…
…percent to 37.6 percent. Across New York, the burden of medical debt fell greater on communities of color and lower-income households and communities. However, medical debt is not limited to low-income households—in communities in the highest quartile of median household income reported 3 percent of consumers had medical debt, but in some regions this proportion rose to 7 percent. Though…
…example, both PacificSource and Kaiser Foundation Health Plan of the Northwest predicted that premiums would be lower under the Waiver compared to premiums without the Waiver. Coordinated Care indicated the Waiver would increase membership and decrease overall morbidity, resulting in lower rates than a non-Waiver scenario. On the other hand, Community Health Plan of Washington noted that, while enrollment is…
…MOUD providers, particularly in-network providers, continues to complicate or preclude OUD patients’ treatment access. The Centers for Medicare & Medicaid Services (CMS) is hoping to improve treatment access for enrollees on the Affordable Care Act’s Marketplace by adding Substance Use Disorder Treatment Centers as new category of “Essential Community Provider” (ECP) for plan year 2024. Insurers participating in the Marketplace…
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.
