…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 If the ACA is repealed, intervenor states[1] will lose about $702 billion in federal funds over ten years, including a loss of $518 billion from the elimination of the federal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…
…governors’ and legislatures’ control would be undermined; insurers would compete on an uneven playing field, risking insolvency and job loss for local carriers and brokers; and consumers would be “confused and [] angry” by the influx of low-quality coverage. States noted that this is not the right solution for reducing healthcare costs, since it would threaten the stability of local…
…the Medicaid expansion, which extended coverage to 465,000 Louisianans, as well as federal funding for premium subsides for private coverage (the ACA’s premium tax credits). Few, if any, states have the financial resources to offset the lost dollars on which these programs depend; for Louisiana alone, a win for the plaintiffs means a loss for the state of $3.6 billion…
…can exacerbate health conditions and inhibit the prevention of others. Groups have varied, but supportive, views on silver loading Five of the seven groups in this analysis responded to the agency’s request for comment on the practice of silver loading, in which insurers raise the price of premiums for silver-level plans on the marketplace to compensate for the loss of…
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