…enforcement cases involving MEWAs since 1985, it admits that its “enforcement efforts often were too late to prevent or fully recover major financial losses,” and that it fails to consistently collect information about the “associated unpaid claims or their financial impacts on patients and healthcare providers.” DOL’s final rule has since been blocked by a federal district court, an order…
…in states that fully embraced the Act by expanding Medicaid. If this Administration truly cared about increasing coverage and decreasing uncompensated care, it would stop sabotaging the ACA, stop approving waivers requiring Medicaid beneficiaries to report work hours to stay covered, and start paying attention the troubling decline in Medicaid and CHIP enrollment. Instead, this Administration has overseen two years…
…than an enrollee who meets the weight loss threshold. Or, a diabetic who has trouble controlling his or her blood sugar level could face a higher deductible than one who controls it well. States would be required to design these programs so they do not result in a decrease in coverage or increase the cost to the federal government. However,…
…about who might enroll in the new marketplace plans and what their health status might be, the risk corridors program sought to protect insurers against inaccurate rate setting. The program set certain thresholds, wherein insurers that experienced higher than expected profits would pay into the program, while those with heavy losses would collect reimbursements from the fund. However, this scheme…
…the coverage gap. Under DOJ’s remedy, will beneficiaries in the eighteen plaintiff states still be subject to higher spending? What happens if a beneficiary moves to a plaintiff state mid-year? These and other national reforms, including changes to provider payments, industry taxes, quality initiatives, and more, were never designed to stop at a state’s border. Implementing them in some states…
…and benefits of using them compared to HealthCare.gov or official state marketplace sites. These new federal policy changes are in addition to numerous changes that were implemented last year, including the elimination of the individual mandate penalty, the availability of short-term health plans, and the potential loss of ACA subsidies for enrollees who fail to file and reconcile their federal…
…to successful payment reform. Hall, M and McCue, M. How the ACA’s Medical Loss Ratio Rule Protects Consumers and Insurers Against Ongoing Uncertainty. Commonwealth Fund; July 2, 2019. The medical loss ratio (MLR) is an ACA reform that requires insurers to spend no more than 20 percent of their premium revenue on administrative overhead and profit margin; if they spend…
…joined as additional intervenors. The 21 States Have a Huge Financial Interest in Upholding the ACA The 21 intervenor states have a clear financial interest in defending the ACA. If the ACA is repealed, intervenor states[1] will lose about $702 billion in federal funds over ten years, including a loss of $518 billion from the elimination of the federal insurance…
…a number of policy changes in 2017, shaking the foundation of the individual market and prompting the threat of bare counties, skyrocketing premiums, and coverage losses. Although states have been hard at work to shore up their markets through reinsurance programs and other state-based innovations, premiums and out-of-pocket costs remain a top concern for consumers. Individuals and families with incomes…
…that the loss ratios (the percentage of premium revenues spent on medical claims) of individual market insurers dropped to an average of 70 percent. Their average per member/per month (PMPM) margins increased to $166.82 (compared to an average PMPM loss of $9.21 in 2015). As a result, insurers expect to owe consumers $800 million in medical loss ratio rebates for…
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