Search Results for: stop-loss

Lawmakers had a Chance to Provide Relief from Surprise Medical Bills – and Whiffed It

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…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…

House Farm Bill Supports AHPs with Federal Grants—Following in the Footsteps of the ACA’s CO-OP Program

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…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…

Massive Navigator Funding Cuts Pose Risks for Consumers, Marketplaces

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…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…

When Policy and Politics Conflict: Challenges to State-level Market Stabilization Efforts

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…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…

August Research Round Up: What We’re Reading

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…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…

Cities File Suit Against the Administration for Deliberately Failing to Enforce the ACA

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…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,…

New Report Examines State Options for Oversight of Risk-Bearing Provider Organizations

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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…

July Research Round Up: What We’re Reading

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…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…

When Being Uninsured Cuts Life Short: In Memory of My Dad

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…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…

Stakeholders Respond to the Proposed Short-term, Limited Duration Insurance Rule. Part IV: Short-Term Insurers and Brokers

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…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…

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