Search Results for: stop-loss

Stakeholder Perspectives on CMS’ Proposed “Marketplace Integrity” Rule: Consumer and Patient Advocate Organizations

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…worsen access to care, increase financial hardship and negatively impact individual and community health. NILC cited research saying many DACA recipients forgo necessary care due to cost, contributing to worse public health outcomes and, along with Families USA, mentioned the potential for higher uncompensated care burdens on the health system due to coverage losses. Community Catalyst, CBPP, ACS-CAN and NHeLP…

Stakeholder Perspectives on CMS’ Proposed “Marketplace Integrity” Rule: State Insurance Departments and Marketplaces

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…that would grant conditional eligibility as opposed to imposing a $5 premium. States raised concerns that the provision would require costly system changes, lead to loss of coverage, increase adverse selection, and create consumer confusion, all to address a supposed problem that does not exist in SBM states. For example, New York noted that “there is no evidence that consumers…

Stakeholder Perspectives on CMS’ Proposed “Marketplace Integrity” Rule: Health Care Providers

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…broker misconduct and urged CMS to take further action to address fraud among agents and brokers. Finally, some provider organizations, such as the American Hospital Association, chose to forgo detailed comments on the proposed rule and instead expressed their deep concern about the anticipated coverage losses that would accrue from the overall regulation, with substantial consequences for individuals’ access to…

Old Diseases, New Threats: Are You Still Protected – and What Will Your Health Plan Cover?

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…such as short-term health plans, fixed indemnity insurance, and arrangements such as health care sharing ministries (HCSMs). Unless mandated by state law, these plans are not required to cover preventive services. Many may impose cost-sharing or do not cover vaccines at all.  Takeaways Infectious disease is on the rise, local public health programs providing preventive services face a loss of…

A blast from the past: Dusting off ACA Section 1333 compacts

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…the ACA passed. Aside from the RFI, there has been no movement on Section 1333 compacts, while issues that would make cross-state health insurance sales vexing have only grown. The fact that none of the states that have pursued sales across state lines have made it work has not stopped the idea from coming back up every few years.  In…

Here’s Something to Celebrate: The Affordable Care Act Just Turned 15!

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…coverage, a ban on preexisting condition exclusions, and rating rules that stop insurers from charging higher premiums to sick people. An estimated 27 percent of adults under age 65 have the kind of pre-existing condition that, before the ACA was passed, would have led an insurer to deny them coverage, such as diabetes, a cardiac condition, or a history of…

State Spotlight: New Massachusetts Law Enhances Oversight of Private Equity in Health Care

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…pay rent, stopped payments to vendors, closed emergency departments, reduced staff, minimized medical equipment purchases, and more. In early 2024, Medical Properties Trust claimed Steward owed months of rent, and shortly thereafter, the health system filed for bankruptcy. At the time, Steward operated 33 hospitals across ten states, but Massachusetts, with eight Steward-owned hospitals, was particularly hard-hit by financial shortcomings…

Protecting Access to Preventive Services: A State Roadmap

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…the manner in which the USPSTF members are selected violates the Appointments Clause of the U.S. Constitution. With the change in administration, there are concerns that the federal government may no longer defend the law or, through administrative actions, may stop enforcement of the ACA’s preventive services coverage provision, or otherwise weaken the preventive services requirements.  Free access to life-saving…

Final 2026 Notice of Benefit & Payment Parameters: Marketplace Standards And Insurance Reforms

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…threshold option, a threshold of at least 95 percent of the net premium would be considered reasonable. The proposed rule included some tight constraints on the new options. Both would apply for purposes of triggering grace periods and coverage loss, but not for binder payments. And insurers could choose only one of the three threshold options. Furthermore, all of the…

January Research Roundup: What We’re Reading

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Since the snow shows no sign of stopping, we might as well stay cozy inside and read up on the latest health policy research from January! This month we read about patient care after private equity acquisition of hospitals, and how to improve risk-adjustment accuracy in Medicare Advantage. Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals…

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