…than anticipated. Fortunately, for consumers, the Affordable Care Act prevents insurers from pocketing all of this windfall. First, the law limits the portion of premium dollars that insurers can translate into profits, administration, and marketing (called the “medical loss ratio” or MLR). For individuals and small employers, this means insurers must spend at least 80 percent of their premium revenue…
…and the White House for a solution to surprise billing. In an era when consensus on so many issues is blocked by partisan rancor, action to address surprise medical bills should transcend, and congressional leaders should resolve the modest disputes that remain. Failure to do so will be a true loss for consumers in the midst of a global pandemic….
…an estimated 48 million nonelderly people will live in families with a member experiencing job loss related to COVID-19, with 10.1 million losing health insurance tied to loss of employment. Of those 10.1 million people, researchers estimate: 32 percent (3.3 million) will gain insurance coverage through a family member; 28 percent (2.8 million) will enroll in Medicaid and CHIP; 6…
…different industries, as do rates of uninsurance (exhibit 1). In addition, sizable percentages of essential workers with ESI obtain that coverage not through their own employer but through a family member’s employer (exhibit 2). Thus, those workers are just a recession-related job loss away from losing the coverage they have. Exhibit 1: Nonelderly workers in essential industries with employer-sponsored insurance…
…authors point out that as the recession continues and layoffs spread to other sectors such as state and local governments, the loss of employer-sponsored insurance is likely to grow. Another set of transitions, of course, is between public sources of coverage. Children whose families are losing income may move from CHIP to Medicaid – many states have been seeing this…
…loss of MEC SEP enrollments increasing by 139 percent compared to April 2019. Compared to 2019, overall SEP enrollments in 2020 from the end of Open Enrollment through May are up by 27 percent. Loss of MEC SEP enrollments account for 82 percent of the increase. Why It Matters The ACA’s marketplaces are a critical source of coverage for people…
…to offer on the marketplaces, regulators in most states permitted insurers to make last minute changes to premiums to make up for the expected losses. Given the uncertainties associated with the coronavirus pandemic, state and federal regulators could give insurers similar flexibility this year. What are Insurers Saying about COVID-19 Costs? In these early filings, most insurers are not –…
…Enrollment Barriers The COVID-19 pandemic and related economic shutdown have caused a surge in unemployment, income reductions, and insurance losses. The pandemic struck at a time when marketplace enrollment is usually restricted to a small set of circumstances that trigger “special enrollment periods” (SEP), including the loss of employer-based coverage. In response to the public health emergency, the Centers for…
…refuse the terms and conditions and thus not receive funds. Participation is hard to predict and could vary according to their payer mix, loss of elective patients, or number of COVID-19 patients. It is also unclear how patients will be able to know if a provider treating them has agreed not to send balance bills. Indications from HHS are that…
…of insured Americans under 65 have job-based health coverage, researchers at the Commonwealth Fund and SSRS conducted a survey to study how recent job loss has impacted access to health insurance. What It Finds Forty-one percent of respondents dealing with job insecurity, including job loss, pay cuts, and lost hours, reported either losing insurance, being worried about losing insurance, or…
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