Health insurers use of prior authorization appears to be on the rise. A recent report by CHIR researchers examines four states’ prior authorization policies for the commercial market to identify potential reform strategies to ease provider burden and improve patient access without also increasing insurers’ costs.
On October 3, CHIR held the first in a series of in-person policy briefings on the future of employer-sponsored insurance (ESI), sponsored by Arnold Ventures and West Health. The event, featuring remarks from U.S. Senator Maggie Hassan and a panel discussion moderated by Sarah Kliff of The New York Times, spotlighted state cost containment policies and employer strategies to inform the federal policy process concerning ESI, which covers almost half of all Americans.
The U.S. House of Representatives Education and Workforce Health Subcommittee held a hearing on health care costs, competition, and transparency. CHIR’s Christine Monahan testified before the committee regarding consolidation in health care markets.
Federal law now requires hospitals to publish the prices they negotiate with private insurers, yet many of them are not complying. In this post for the Health Affairs Blog, CHIR’s Sabrina Corlette and Maanasa Kona and Marilyn Bartlett of the National Academy for State Health Policy discuss ways that state health benefit purchasers, such as state employee plans, can help increase hospital compliance.
As we’ve been blogging about, the Trump administration finalized a Market Stabilization rule that makes numerous changes in how marketplaces and insurers are operating. One of the biggest changes affecting consumers is the Trump administration’s new interpretation of guaranteed issue or availability; but states have a range of options regarding this policy under the rule. CHIR’s Sandy Ahn and JoAnn Volk break it down for us.
Medical underwriting, outlawed by the Affordable Care Act (ACA), is a practice used by insurance companies to assess a consumer’s health status. In the event of an ACA repeal, millions of people could lose coverage, pay higher premiums, or receive inadequate benefits that exclude essential health services, all based on a pre-existing condition. While many of us don’t see ourselves as falling under that category, the list of health conditions that qualify you for the chopping block may surprise you.
The administration recently announced that it will require verifying documents from consumers with a qualifying life change for special enrollment periods. For consumers, this means more work and likely a bumpy road to accessing health insurance through healthcare.gov. Sandy Ahn takes a look at this change and what it may mean for consumers.
The administration recently published the results of its compliance review of health plans participating in federally facilitated marketplaces. The review, however, focused more on process, such as whether plans have the appropriate policies and procedures in place. While this information is somewhat helpful, CHIR’s Sabrina Corlette and Sandy Ahn discuss why these types of compliance reviews fall short of helping regulators assess whether plans are meeting the ACA’s patient protection standards.
We’re counting down again to Open Enrollment 3 and this year, all health plans must make accessing provider directories and formularies, or the list of covered prescription drugs, easy for consumers. This means consumers should be able to find this information on insurer website sites without creating an account or entering a policy number. CHIR’s Sandy Ahn flexes her investigative skills and looks to see how accessible this information really is.
Most Americans see the need for more data about health insurance and how it’s working for consumers, and the insurance industry itself seems to recognize the importance of collecting and analyzing data. But it’s not clear that our government regulators do. JoAnn Volk looks at the mismatch between what insurers are undertaking and what federal rules will require for data collection.
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.
