…the ACA passed. Aside from the RFI, there has been no movement on Section 1333 compacts, while issues that would make cross-state health insurance sales vexing have only grown. The fact that none of the states that have pursued sales across state lines have made it work has not stopped the idea from coming back up every few years. In…
…coverage, a ban on preexisting condition exclusions, and rating rules that stop insurers from charging higher premiums to sick people. An estimated 27 percent of adults under age 65 have the kind of pre-existing condition that, before the ACA was passed, would have led an insurer to deny them coverage, such as diabetes, a cardiac condition, or a history of…
…pay rent, stopped payments to vendors, closed emergency departments, reduced staff, minimized medical equipment purchases, and more. In early 2024, Medical Properties Trust claimed Steward owed months of rent, and shortly thereafter, the health system filed for bankruptcy. At the time, Steward operated 33 hospitals across ten states, but Massachusetts, with eight Steward-owned hospitals, was particularly hard-hit by financial shortcomings…
…the manner in which the USPSTF members are selected violates the Appointments Clause of the U.S. Constitution. With the change in administration, there are concerns that the federal government may no longer defend the law or, through administrative actions, may stop enforcement of the ACA’s preventive services coverage provision, or otherwise weaken the preventive services requirements. Free access to life-saving…
…threshold option, a threshold of at least 95 percent of the net premium would be considered reasonable. The proposed rule included some tight constraints on the new options. Both would apply for purposes of triggering grace periods and coverage loss, but not for binder payments. And insurers could choose only one of the three threshold options. Furthermore, all of the…
Since the snow shows no sign of stopping, we might as well stay cozy inside and read up on the latest health policy research from January! This month we read about patient care after private equity acquisition of hospitals, and how to improve risk-adjustment accuracy in Medicare Advantage. Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals…
…hospital lobbyists convinced legislators to reject it. However, recent news that the SEHP is facing a loss of more than $106 million has prompted some advocates to revive calls for a reference pricing program. Third, the third-party administrators (TPAs) that many states use to design and administer their provider networks and process claims may oppose or obstruct a move to reference pricing, particularly…
…benefit requirements and premiums that do not vary based on gender or health status. These proposals would loosen rules for Association Health Plans (AHPs), eliminate state oversight of stop-loss plans, thus encouraging greater use of self-funded plans with this protection against high expenses (known as level funded products) among small employers instead of state-regulated insurance plans, and permit employers to…
An estimated 41 percent of adults in the US are in medical debt because of unpaid medical or dental bills. Medical debt can profoundly disrupt lives; it can lead to bankruptcies and loss of homes or wages and force difficult choices between basic needs and medical bills. As of 2023, 19 states and the District of Columbia have stepped in…
…to millions of low- and moderate-income enrollees, but the looming sunset of these more generous premium subsidies threatens family budgets and economic security, while foreshadowing dramatic coverage losses and higher premiums for enrollees who do not receive PTCs. Permanently authorizing enhanced PTCs is an immediate and impactful step on affordability that policymakers of all persuasions can make a shared priority….
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