…compete in underserved markets, such as by relaxing network adequacy standards, supporting the use of telemedicine for some services, or offering temporary relief from the medical loss ratio requirement if an insurer had an unexpectedly bad year. Other thoughtful analyses of the ACA’s individual markets, and prescriptions for improvement, are discussed in briefs by the Commonwealth Fund, the Urban Institute,…
…stop-loss insurance, which many employers that self-fund their health plans purchase to protect themselves against claims above a specified threshold (called an “attachment point”). The goal here is to make it easier for employers to self-fund their plans and limit the ability of federal regulators to claim that stop-loss insurance with a low attachment point is de facto health insurance…
…costs incurred, or the net loss, was more than $1.2 billion for all 35 state high-risk pools combined in 2011. As a result, many states had to limit enrollment, impose waiting periods, cut benefits, and charge premiums as much as twice the price of traditional individual market plans. On the eve of the ACA, these pools covered just a fraction…
…aided by unnamed investors from the Maryland healthcare community. The company then had to exit the individual market exchange in December, pending approval from CMS. This resulted in a loss of 10,000 members to competing insurers. Their current 26,000 member population is drawn from the employer group market, with most coming from small businesses. Evergreen executives say that the transition…
…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…
…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…
…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…
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.
