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…
…health insurance literacy, who will flock to the cheaper plans despite their lack of financial protections. In addition to these risks, ACS-CAN cautioned that short-term plans are exempt from medical loss ratio (MLR) requirements, allowing insurers to spend fewer premium dollars on medical claims. They argue that expanding these products would lead to higher profit margins for insurers at the…
…services) and increased utilization; The increase in the overall sickness of the risk pool due to ACA-related policy changes that lead to the loss of young and healthy enrollees; Whether the insurer expects to be a payor or a payee under the ACA’s risk adjustment program; Changes in benefit plan designs; Changes in service areas; Changes in the impact of…
…capped at 8.5% of household income. Other components of the Urban Institute’s proposal include: Eliminating the employer mandate penalty along with the “firewall” that stops individuals with employer offers of insurance from buying on the new Healthy America market. Cost-sharing reductions would be increased, extending deductible and cost-sharing assistance to those earning up to 300 percent of the FPL (up…
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