Tag: ERISA

Questionable Conduct: Allegations Against Insurers Acting as Third-Party Administrators

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Nearly half of U.S. residents are enrolled in employer-sponsored health insurance. Many of these plans use third-party administrators (TPAs), intermediaries—frequently insurance companies themselves—that help build provider networks, design benefit packages, and adjudicate claims, among other responsibilities. But a TPA’s interests may not align with those of their employer clients. CHIR’s Christine Monahan highlights several examples of questionable insurer-TPA practices uncovered in recent years.

ERISA 101: The United States’ Hands-Off Approach to Regulating Employer Health Plans

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Amidst growing health care costs, adequate health insurance coverage is increasingly unaffordable for employers and employees. There is a growing focus on the role employer-sponsored plans can play in health care cost containment, but under the Employee Retirement Income Security Act of 1974 (ERISA), the access, affordability, and adequacy of employer coverage is dictated less by law and regulation and more by individual employers.

In a Post-Roe World, Employers Looking to Cover Out-of-State Travel for Abortion Services Have Multiple Options and Plenty of Uncertainty

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Following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, analyses project up to half of women and girls in the U.S. between the ages of 15 and 44 will live in states that significantly restrict or ban abortion services. The scale and geographic reach of these bans intensifies questions about travel costs and access to these services. Employers are looking at ways to cover abortion-related travel costs for workers.

May Research Roundup: What We’re Reading

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This month, the CHIR team celebrated the end of the school year with new health policy research. For the latest installment of our monthly research roundup, we reviewed studies on access to providers in Medicaid managed care networks, how the Employee Retirement Income Security Act (ERISA) affects state cost containment reforms, and the health coverage implications of the Biden administration’s recent changes to the public charge rule for immigrant communities.

State and Federal Policies to Increase Access to Medication Abortion

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A leaked draft of an impending Supreme Court decision has previewed the potential for states to prohibit and even criminalize abortion. Access to abortion has long been a story of the haves and have-nots. Medication abortion can improve access to this basic health care service, but the delivery and coverage of medication abortion are subject to numerous restrictions and requirements, creating multi-faceted obstacles for patients seeking care. CHIR’s Rachel Schwab looks at several policy actions that can reduce barriers to medication abortion.

DOJ’s Proposed Remedy in Texas v. United States Is an Unrealistic Solution

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In supplemental briefings to the Fifth Circuit Court of Appeals, the Department of Justice recently proposed that the Affordable Care Act be struck down in the eighteen plaintiff states bringing suit in Texas v. United States, but upheld in all other states. CHIR’s Emily Curran, Dania Palanker, and Sabrina Corlette explain why this “solution” would upend our system of employer-based coverage and is illogical given the ACA’s national reforms.

The Future of the Affordable Care Act under President Trump: Stakeholders Respond to the Proposed Association Health Plan Rule. Part V: Departments of Insurance

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In this final blog in our series reviewing stakeholder comments on the Department of Labor’s proposed rule to expand Association Health Plans, CHIR’s Emily Curran summarizes responses from the National Association of Insurance Commissioners and nine state departments of insurance (DOI). While the DOIs expressed some areas of support for the proposed rule, their comments were largely negative, with most expressing deep concerns about the rule’s ambiguity.

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.