…the 2017 policy changes. What It Finds Medical Loss Ratios (MLR), or the percentage of premiums insurers spend on medical claims, saw continued improvement mid- 2018, down to an average of?? 69 percent as compared to a peak of 93 percent in 2015, indicating an increase in insurer profitability. When measuring performance of an insurer by gross margins, or by…
By Sabrina Corlette and Rachel Schwab On November 1, the Affordable Care Act’s (ACA) insurance marketplaces will launch their sixth enrollment season. This year, the challenges they face may be greater than laster year, with the loss of the individual mandate penalty as an enrollment incentive and the emergence of a parallel, unregulated market that could siphon away healthy enrollees….
…eligible for a SEP in the 60 days prior to loss of CHIP coverage until 60 days after the loss of CHIP coverage. Proposed Public Charge Rule: The Department of Homeland Security released a proposed rule that would broaden the types of public benefits that would count against an immigrant’s application for admission to the U.S. or permanent residency to…
…these hard working families access to health coverage is good public policy. Even DHS itself admits that the proposed rule could increase poverty, and that immigrants who don’t enroll in benefits for which they’re eligible could experience a loss in productivity, adverse health effects, higher medical expenses, and reduced educational attainment. Comments on the rule are due December 10, 2018….
…ambulance providers clearly disclose charges for transportation and non-transportation services and “provide other consumer protections for customers of air ambulance operators.” While this provision would not have given states the clear authority to step in and stop egregious balance billing, it would have required a clear separation of medical and transport charges, with the potential that states could regulate the…
…In its first year, the CO-OPs attracted 500,000 enrollees and almost immediately began to lose money. By the end of their first year, the CO-OPs had aggregate losses of $376 million, and by the end of 2015, half of the plans had shut down. Today, only four of the CO-OPs remain. Among other funding and political considerations, the CO-OPs struggled…
…is all but setting up these organizations for failure because they will not be able to enroll a “meaningful amount” of consumers with fewer resources, and won’t have the capacity to take on added consumers as brokers stop serving the individual market. For example, I volunteer as a certified application counselor in Northern Virginia. Up to this point, there have…
…risk of paying claims, with a stop-loss policy that protects the employer from unexpectedly high claims costs. However, although these arrangements can be affordable and attractive to small employers with young and healthy employees, they carry significant risk. If someone in the group gets sick, the employer can face significant rate hikes, unexpected claims liability, and even lose eligibility for…
…There is currently a lawsuit, Texas v. United States, challenging the constitutionality of the ACA due to the loss of the individual mandate penalty that could gut most, if not all, of the law. If that were to happen, those who gained the most under the ACA, which includes some of the most vulnerable populations in the country, have the…
…individuals and families by reducing the time available for them to find the right plan. For 2018, the Administration cut the open enrollment period in half – from 90 to 45 days, despite warnings that the cut would dampen enrollment. At the same time, the Administration stopped sending officials to promote local enrollment events, and reduced its social media support,…
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