Search Results for: stop-loss

The Reconciliation Bill Eliminates Long-Standing State Flexibility to Operate Marketplaces and Regulate Private Health Insurance

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…per member user fees to generate the revenue to fund their operations. The reconciliation bill would reduce Marketplace enrollment by millions of people, thus reducing SBM revenue. To be financially sustainable, SBMs will need to increase their user fees. This will result in an increase in premiums, which could, in turn, lead to further enrollment losses. The Bill May Alter…

Federal Efforts Ostensibly Aimed at Marketplace “Fraud” Ignore Obvious Strategies to Counter Broker Misconduct

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…on the other hand, some of whom have fallen victim to broker misconduct, will be impacted by the rule. CMS anticipates that the proposal will cause 2 million people to lose Marketplace coverage (and that is without accounting for coverage losses that can be reasonably expected from changes that will make it harder for eligible individuals to enroll and renew)….

Death by Slow Strangulation: New Tactics in Longstanding Efforts to Repeal the Affordable Care Act 

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…rule) and a 90 percent reduction in funding for ACA Navigators, individuals who help consumers learn about and enroll in Marketplace coverage. Also, Congress has yet to extend the enhanced premium tax credits, due to expire at the end of 2025. The Congressional Budget Office (CBO) has preliminarily estimated the coverage losses between 2025 and 2034 as follows: 7.7 million…

Stakeholder Perspectives on CMS’ Proposed “Marketplace Integrity” Rule: Consumer and Patient Advocate Organizations

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…worsen access to care, increase financial hardship and negatively impact individual and community health. NILC cited research saying many DACA recipients forgo necessary care due to cost, contributing to worse public health outcomes and, along with Families USA, mentioned the potential for higher uncompensated care burdens on the health system due to coverage losses. Community Catalyst, CBPP, ACS-CAN and NHeLP…

Stakeholder Perspectives on CMS’ Proposed “Marketplace Integrity” Rule: State Insurance Departments and Marketplaces

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…that would grant conditional eligibility as opposed to imposing a $5 premium. States raised concerns that the provision would require costly system changes, lead to loss of coverage, increase adverse selection, and create consumer confusion, all to address a supposed problem that does not exist in SBM states. For example, New York noted that “there is no evidence that consumers…

Stakeholder Perspectives on CMS’ Proposed “Marketplace Integrity” Rule: Health Care Providers

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…broker misconduct and urged CMS to take further action to address fraud among agents and brokers. Finally, some provider organizations, such as the American Hospital Association, chose to forgo detailed comments on the proposed rule and instead expressed their deep concern about the anticipated coverage losses that would accrue from the overall regulation, with substantial consequences for individuals’ access to…

Old Diseases, New Threats: Are You Still Protected – and What Will Your Health Plan Cover?

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…such as short-term health plans, fixed indemnity insurance, and arrangements such as health care sharing ministries (HCSMs). Unless mandated by state law, these plans are not required to cover preventive services. Many may impose cost-sharing or do not cover vaccines at all.  Takeaways Infectious disease is on the rise, local public health programs providing preventive services face a loss of…

A blast from the past: Dusting off ACA Section 1333 compacts

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…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…

Here’s Something to Celebrate: The Affordable Care Act Just Turned 15!

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…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…

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