…level-funded products in significant numbers, it will leave employers with older, sicker workers behind. This causes adverse selection, where premium rates rise for employers whose groups cannot pass the stop-loss issuers’ underwriting. Just as with AHPs, this legislation does nothing to address the underlying reason why there is an affordability crisis for ESI: the prices that commercial insurers pay for…
…(DOJ) can and should ask the court to “stay” the decision—in lay terms, to stop it from going into effect—while they pursue an appeal. But such a stay is by no means a sure result, meaning that millions could, in very short order, lose access to no-cost early cancer screenings, mental health assessments, statins for heart disease, PreP to prevent…
…subsidies entirely—corresponding to an annual average loss of $3,277 in subsidies per person. Residents of populous states with high Marketplace enrollment numbers—including California, Florida, Georgia, North Carolina, Pennsylvania, and Texas—would likely face the largest coverage losses and affordability reductions if the enhanced subsidies expire. Governors from these and other states have urged the federal government to make the enhanced subsidies…
…transitions. However, even those who successfully shift to another coverage option face the risk of disrupted care and loss of access to providers they were seeing under their Medicaid plans. Many of these people will be in the midst of treatment, pregnant, or have serious chronic conditions. It is, therefore, critically important for states to develop strategies to promote continuity…
…pregnancies and a federal backstop to replace state-funded contraceptive services. Access to contraceptive services would occur without any cost sharing on the eligible individual’s part, and “independent of any action by the objecting entity.” Although providers must confirm the consumer’s eligibility for the arrangement, this can be done through an attestation or documents that a plan must already furnish, such…
…Spending in the Affordable Care Act Markets, 2015–19, Health Affairs, February 2023. Researchers reviewed claims data from Affordable Care Act (ACA)-compliant individual and small group markets and medical loss ratio data to identify trends and potential drivers in health care spending. The authors assessed utilization, unit prices, and service mix between 2015 and 2019. What it Finds Total per member…
…percent of the time. The availability of appeals beyond this stage varies depending on the type of coverage the patient holds. Public Health Insurance Eligibility Depending on their family’s overall income, patients who experience job loss or loss of income due to long COVID may become eligible for subsidized health plans on the Affordable Care Act Marketplace or qualify for…
…documentation of income. Providing an extra year for subsidized Marketplace enrollees to file a tax return with the Internal Revenue Service and reconcile any advance premium tax credits, before risking the loss of subsidy. Requiring plans on the federally run Marketplace (gov) to offer plans with standardized benefit designs so that consumers can more easily compare. Improving coverage adequacy. Plans…
…persist for years—a phenomenon that—as the authors suggest—shows how loss of insurance can create more permanent barriers to accessing the health care system, such as lacking a usual source of care. These findings underscore the need for policies that mitigate the risk of coverage gaps during the transition between Medicaid and other coverage programs. Jennifer Tolbert, Patrick Drake, and…
…percent). Why it Matters With the PHE recently extended into 2023, stakeholders continue to prepare for the massive wave of coverage transitions expected to occur once Medicaid renewals resume. Low levels of consumer awareness about the upcoming resumption of Medicaid renewals are a cause for concern as stakeholders seek to minimize coverage losses. While sources such as social media and…
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