…while states that rely on reduced federal government support for such activities suffered a loss in enrollment. Since new consumers are typically healthier than renewing consumers in the marketplace, ensuring that these populations continue to enroll in individual market plans is key to keeping premiums low and preventing carrier exits. Insurers are already making decisions about 2019 participation and premiums,…
…a stop-gap measure for 2019, the bill would enable residents who live in bare counties to purchase state-subsidized coverage through Washington’s high-risk pool. However, Premera Blue Cross has pledged to participate in the marketplace in any county that lacks another insurer, so the high-risk pool option is unlikely to be needed. Protecting Markets from Plans That Don’t Comply with the…
In Germany, when the “Ampel Mann,” or traffic man, is red, the culture is to stop and wait. When I studied in Berlin in 2014, I did not realize this until I crossed the street and an older woman chastised me, “Den Kindern ein Vorbild!” (Be a role model for the children!). So, what happens if someone ignores the Ampel…
…analysis looks at past, present, and future challenges for employer-sponsored health insurance (ESI), and considers the point at which employers may cease offering subsidized health coverage to their employees. What it Finds The “tipping point” for ESI will be when employers face significant financial losses that cannot be passed on to employees through higher premiums, and that are not outweighed…
…subsequent loss of 2.6 million jobs across the country. The majority of jobs lost would be in non-health care industries and, without an ACA replacement, there would be a “$1.5 trillion loss in gross state products and a $2.6 trillion reduction in business output” between 2019 and 2023. In their own analyses, states corroborated these economic findings. UC Berkley’s Center…
…a collapse of the market and are considering further retrenchment; others felt confident that a market for highly subsidized, low-income consumers would continue. The midyear loss of the ACA’s cost-sharing reduction plan reimbursements drove 2018 premium increases ranging from 10 percent to 20 percent. However, several insurers noted that proposed federal legislation to restore cost-sharing reduction funding could result in…
…because of the amount of health care the enrollee had used the previous year. HIPAA stopped that practice, requiring insurers to renew individual policies except in certain limited conditions (i.e., the entire product line is discontinued, or the enrollee doesn’t pay premiums or moves outside the plan’s service area). The HIPAA guaranteed renewability protection applies to health insurance issuers, and…
…mental health parity to the Medical Loss Ratio (MLR). This new round of grants, the State Flexibility to Stabilize the Market Grant Program, will fund more state-based initiatives in three key areas of market reforms and consumer protections: guaranteed issue, guaranteed renewability, and the ACA’s Essential Health Benefits (EHB). Guaranteed Issue and Guaranteed Renewability Under the ACA, insurers are required…
…enrollees receive payments from those insurers with a relatively low share of high-risk enrollees. Yes Not clear**** Medical loss-ratio standard Limits how much premium revenue an insurer can devote to profits and administrative costs (20 percent in the individual market) compared to what they spend on patient care and quality improvement. Yes Not clear**** *State-based plans may impose a pre-existing…
…that would waive the prior coverage requirement for certain SEPs if the individual lived in a services area without any QHPs. While no states had “bare counties” in 2018, organizations such as AARP and NHeLP endorsed this proposal as a necessary consumer protection. Many of the organizations also favored HHS’ proposal to create a loss of coverage SEP for women…
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