…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,…
Value-based payment models are promoted as a way to transform our health care system from one that rewards value rather than the volume of health care services delivered. These models require providers to accept the risk of financial losses should spending on patients in their care exceed targeted levels. While they may hold potential for lowering health care costs and…
…complications were more likely to have an interruption in coverage than those with complications, possibly due “job lock,” the phenomenon of people with health complications avoiding job changes to prevent the loss of their job-based coverage. Why it Matters Research often focuses on the effects of “churning” in and out of Medicaid coverage, but much less is known about the…
…reaching into his bag for his GasX and ibuprofen at the Clara Barton rest stop in New Jersey. We did not opt to have an autopsy done, so it is hard to say with 100 percent confidence that it was either the high cholesterol or the possible blood clot that caused this heart attack, and whether the first led to…
…selling STLDI can deny enrollment to people with pre-existing conditions and exclude from coverage essential health benefits like prescription drugs, maternity, and mental health treatment services. Also, unlike ACA-compliant policies, short-term plans are not subject to the medical loss ratio or risk adjustment, so they are not obligated to spend a certain amount of premium dollars on medical care, and…
…selling STLDI can deny enrollment to people with pre-existing conditions and exclude from coverage essential health benefits like prescription drugs, maternity, and mental health treatment services. Also, unlike ACA-compliant policies, short-term plans are not subject to the medical loss ratio or risk adjustment, so they are not obligated to spend a certain amount of premium dollars on medical care, and…
…Fund completes a national survey each year to track coverage gains and losses across the country. What it Finds 4 million working-age people (ages 19-64) lost coverage between 2016 and 2018, bringing the uninsured rate from 12.7 percent to 15.5 percent. Coverage losses are greatest among those below 250 percent of the federal poverty level (FPL), rising from 20.9 percent…
…those conditions, including essential health benefits like prescription drugs and maternity care. Unlike ACA-compliant policies, short-term plans are not subject to the medical loss ratio or risk adjustment, so insurers are not obligated to spend a certain amount of premium dollars on medical care, and they have no incentive to cover individuals with high-cost conditions. The Obama Administration limited the…
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