…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…
“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…
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…
…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…
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…
…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…
…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…
…forced to cap or close enrollment in their high risk pools in order to limit losses. And all of them experienced losses, even though they received billions in government subsidies. In 2011, net losses for the 35 state high-risk pools were over $1.2 billion. There is no question that high-risk pools provided a source of coverage to a set of…
By Sabrina Corlette and Jack Hoadley We’re experiencing another round of bad headlines for the Affordable Care Act (ACA) marketplaces. A government report found that, on average, premiums will rise 25 percent and consumers will have fewer insurance company choices in 2017. Eighty-three insurers will stop offering plans through the marketplaces next year while only 16 insurers will enter; 21…
…medical management programs (e.g., asthma, heart disease, low back pain, weight loss or pain management), and insurance companies. Perhaps the most important tool for consumers available again this year will be navigators, assisters, and brokers, who assist consumers looking to enroll or re-enroll into marketplace coverage. As we’ve noted before, these assisters play a key role for consumers wanting to…
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