…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…
…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…
…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…
…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…
…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…
…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…
…(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…
…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…
…young adults (ages 19-34) would experience the largest coverage losses should the PTCs expire, estimating a 1.5 million or 14.1 percent increase in the number of uninsured young adults relative to extending the PTCs. Researchers find that non-Hispanic Black populations will also be disproportionately harmed by the PTCs expiring, potentially facing a 17.7 percent increase in the uninsured population. While…
…like issuing cease and desist orders for Salvasen/Triada to stop the sale of their plans. Takeaway Salvasen Health will not be the first or last company to target vulnerable consumers with false claims that they are selling comprehensive health insurance. The multi-state effort to uncover Salvasen as an unlicensed actor and exert pressure to get these products removed from the…
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