Search Results for: stop-loss

Reading the Fine Print: Do ACA Replacement Proposals Give States More Flexibility and Authority?

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…have maintained or enacted standards that exceed the federal minimum. Most states elected to retain their role as the primary regulators of insurance and enforce both federal and state protections.[1] At a minimum, most states continue to ensure that companies have sufficient financial reserves, review proposed premium rate increases, confirm that plans deliver on promised benefits, identify and stop fraudulent…

Risky Business: Health Actuaries Assess the Individual Market and Rates

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…of stabilizing the market while covering people with pre-existing conditions, noting that historically, “enrollment has generally been low, coverage has been limited and expensive, they required external funding, and they have typically operated at a loss.” Examining a proposal on the more progressive end of the spectrum, AAA concludes that a public option could hurt market competition and provider participation…

Congress Asked States for Health Reform Ideas. They May Be Surprised by What They Hear

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…urged caution, and asked Congress to avoid causing market disruption and the loss of coverage for people in their state. Utah’s governor urged Congress to act “carefully” and “methodically.” Arizona’s Douglas Ducey wrote: “I don’t want to see any Arizonans have the rug pulled out from under them.” Alabama’s governor warned that “repealing the ACA without a clear replacement could…

Promising Steps to Strengthen Marketplace Risk Pools Could be in Vain, if Affordable Care Act is Repealed

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“A death spiral.” “Collapsing under its own weight.” Since its inception, critics of the Affordable Care Act (ACA) have argued that the demise of the law’s marketplaces is imminent. Their arguments gained some currency this past summer when insurers hiked premiums for 2017 and some announced they would not offer 2017 coverage because of continued financial losses. But if the…

Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too

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Much of the recent attention on the future of the Affordable Care Act (ACA) has focused on the fate of the 22.5 million people likely to lose insurance through a repeal of Medicaid expansion and the loss of protections and subsidies in the individual insurance market. Overlooked in the declarations of who stands to lose under plans to “repeal and…

Busting the “Falling under its Own Weight” Myth: New Analysis Shows Better Outlook for the Affordable Care Act Marketplaces

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…Donald Trump tweeted that the ACA will “fall under its own weight;” Senate Majority Leader McConnell has said the same. And to be sure, the ACA’s marketplaces have been through some rocky times. This year, a number of insurers, including large national carriers such as United and Aetna, pulled out of marketplaces across the country, citing major losses. Along with…

Loss of Cost-Sharing Reductions in the ACA Marketplace: Impact on Consumers and Insurer Participation

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By JoAnn Volk, Dania Palanker, Justin Giovannelli and Kevin Lucia While there has been considerable discussion of the new Congress’s plans to repeal and replace the Affordable Care Act (ACA), there is another, potentially more immediate, threat to millions of Americans that could materialize without legislative action. Under the ACA, insurers must reduce the cost-sharing obligations of low-income enrollees, such…

From Acne to EcZema: The Return of Medical Underwriting Puts Millions at Risk for Losing Coverage or Higher Premiums

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…Rectal bleeding Gallstones Irritable bowel syndrome Chronic diarrhea Hepatitis Elevated liver function test Jaundice Cirrhosis Gallbladder infection or inflammation Pancreatitis Crohn’s disease Kidney infection Kidney stones Bladder infection Cystitis Urinary influx Urinary tract infection Diabetes Thyroid disorder High/low blood sugar Adrenal, pituitary, or other glandular disorder Chronic fatigue syndrome Obesity/weight loss surgery Seizures Migraine headaches/chronic severe headaches Head injury Paralysis…

In the Midst of Federal ACA Woes, States Play an Important Consumer Protection Role

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…substance use disorder benefits, appeals processes, and lowering the cost of coverage (Medical Loss Ratio (MLR)). CMS funding for these proposals comes from a $250 million pot, initially allocated by the ACA to improve state rate review. From 2010-2014, four cycles of grants funded state actions to regulate carrier pricing. After 2014, unobligated funds from the initial allocation remained available…

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.