Search Results for: stop-loss

Supporting Continuity of Coverage from Medicaid into the Marketplace: Post-PHE Considerations for States

Posted by

By Jason Levitis* and Sabrina Corlette The unwinding of the Medicaid continuous coverage requirement will trigger the largest coverage transition since the Affordable Care Act (ACA) took effect. More people are projected to leave Medicaid than currently have marketplace coverage, creating a great risk of coverage loss but also a huge enrollment opportunity for marketplaces. States have already made tremendous…

October Research Roundup: What We’re Reading

Posted by

…decline in non-ACA-compliant coverage, which can leave consumers at financial risk when they need care. This KFF study suggests that more generous premium subsidies have been key to increasing access to and take up of comprehensive health insurance on the individual market. Adrianna McIntyre, Evidence-Based Outreach Strategies for Minimizing Coverage Loss During Unwinding, JAMA Health Forum, October 2022. The author…

The GOP’s Plans for Health Care if they Take Control of Congress: A Mixed Bag for Consumers

Posted by

…EHB categories, such as maternity care. While federal regulators put a stop to Idaho’s “innovative” plans, the Healthy Future Task Force proposal would embrace this type of state action. While states can “innovate,” without a federal floor for coverage, this flexibility comes at a high price for consumers who may face medical underwriting, benefit exclusions, and other discriminatory industry practices…

Nevada Actuarial Study Projects Significant Savings from Public Option Plans

Posted by

…of the Affordable Care Act’s medical loss ratio standard. Plans participating in the public option program will need to agree to these standards and requirements as part of their contract arrangement with the state. Nevada’s actuarial study anticipates that these lower premiums could generate up to $341 million or $464 million in savings to the federal government (via lower federal…

Federal Court Decision Threatens the ACA’s Preventive Services Benefit: State Options to Mitigate Harm to Consumers

Posted by

…the U.S. Department of Justice is likely to appeal the ruling, some legal experts believe the Braidwood Management plaintiffs may prevail in the higher courts, too. The preventive services benefit is one of the more popular provisions of the ACA. The loss of this protection means that over 167 million people will need to pay out-of-pocket for dozens of critical…

August Research Roundup: What We’re Reading

Posted by

…strategies to prevent coverage losses. What it Finds A projected 82.7 percent of Medicaid beneficiaries (71.7 million people, based on December 2021 enrollment data) will stay in Medicaid once the PHE ends, while 17.4 percent or 15 million current Medicaid enrollees will leave the program: 8.2 million people, or 9.5 percent of the individuals leaving Medicaid, are estimated to become…

Party’s Over: Health Plan Premiums Poised to Spike in 2023, After Period of Modest Growth

Posted by

…years, although there are a few insurers proposing only modest hikes, or even small reductions. See Figure 2. Paying it Forward (Not in a Good Way) After a banner year in 2020, many insurers had higher-than-expected utilization in 2021 and in early 2022, resulting in a market-wide $1.7 billion underwriting loss that many are seeking to recoup with higher premiums…

Delays Extending The American Rescue Plan’s Health Insurance Subsidies Will Raise Premiums And Reduce Coverage

Posted by

…But that is not the case. Congress’s real deadline to avert premium increases and coverage losses is August. That’s because most consumers will make 2023 coverage decisions in 2022, and there are substantial operational runways to set insurance rates, update eligibility systems and consumer-facing language to reflect PTC parameters, and calculate enrollees’ new eligibility and notify them—all before the open…

Understanding the Role of Private Equity in the Health Care Sector

Posted by

…(in addition to $4 million obtained from the company itself for submitting Medicaid claims for mental health services by unlicensed and unqualified staff). Preventing consolidation Finally, both federal and state regulators have the potential to better monitor, and when necessary stop PE-driven mergers and acquisitions activity in the health care space. Indeed, the Federal Trade Commission (FTC) was able to…

Broker Commissions for Mid-Year Enrollment in the Marketplaces: Options for State Marketplaces and Insurance Regulators to Prevent Discrimination

Posted by

…Perspective for the State Health & Value Strategies project, CHIR’s Justin Giovannelli looks at the consequences of cutting commissions for special enrollment periods (SEP). Reducing or eliminating broker commissions for SEPs puts consumers at risk of coverage loss after the PHE, and may weaken the individual market risk pool. Additionally, this marketing practice likely violates federal nondiscrimination rules. States should…

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.