By Henry J. Aaron*, Kevin Lucia and Justin Giovannelli Health reform (aka Obamacare) is entering a new stage. The recent announcement by United Health Care that it will stop selling insurance to individuals and families through most health insurance exchanges marks the transition. In the next stage, federal and state policy makers must decide how to use broad regulatory powers…
…back to the United States from abroad; and moving to a state that expanded Medicaid and having a change in income making that consumer eligible for financial assistance. The rule also eliminates the requirement that people be allowed to use the moving SEP 60 days in advance of a move and eliminates the SEP for the loss of a dependent…
…we are pleased to see that the final rule better incorporates pediatric providers. For example, the final rule requires states to develop pediatric network adequacy standards for the following classes of providers: primary care, behavioral health (including mental health and substance use disorder), specialists, and dental. Accountability and Transparency: The final rule maintains the minimum medical loss ratio of 85%…
…the different SEPs that are available (for example, due to a permanent move rather than loss of other coverage). However, that data is not available in the report, nor is there data to show reasons enrollees allow coverage to lapse (for example, because an enrollee obtained other coverage). My fellow consumer representative, Sarah Lueck, offered a consumer perspective on SEPs,…
…sell ACA-compliant plans through 23 marketplaces, citing financial losses. What is short-term health insurance and why do insurers like selling these policies? We’ve written about short-term health insurance on CHIRblog before, noting that these policies are not regulated by the ACA, and thus don’t need to comply with federal prohibitions on pre-existing condition discrimination, out-of-pocket cost protections, or requirements to…
…cost increases in check. In her testimony, Ms. Corlette emphasized: In spite of early fears that the Affordable Care Act (ACA) would result in job losses and a decline in employer sponsored insurance (ESI), the opposite is in fact true. The foundation of ESI as a source of health coverage in this country remains as strong as ever, and employers…
…give states time to incorporate the National Association of Insurance Commissioners (NAIC) model act on network adequacy. But while CMS stopped short of establishing quantitative measures of network adequacy via regulation, the federal government will incorporate maximum time and distance standards in its certification process for QHPs, as outlined in its 2017 letter to QHP issuers in the FFM. However,…
…Association of Insurance Commissioners (NAIC) released a white paper draft, titled “Stop Loss Insurance, Self-Funding and the ACA,” which explores the various regulatory issues that state insurance departments must be aware of when regulating stop-loss insurance policies. Specifically, the NAIC sought to provide state officials with options for regulating stop-loss coverage in situations in which mere disclosure of the policy’s…
A recent review by PoliticoPro of insurers’ financial filings has found that the remaining 11 companies in the Affordable Care Act’s CO-OP program sustained substantial losses in 2015 – collectively close to $400 million, with the bulk of the losses coming in the fourth quarter. Perhaps even more distressing, CO-OPs that appeared to do reasonably well in 2014 were hit…
…process is forthcoming, the administration will require consumers to upload or to mail documents verifying the following life events: Loss of minimum essential coverage or loss of another type of health insurance, Permanently moving to an area where an individual will have access to new health plans, Birth, Adoption or child support or court order, Marriage. The administration is making…
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