Posted on October 23, 2014
A new report from University of Pennsylvania researchers, funded by the Robert Wood Johnson Foundation, finds that significant state variation exists in the Affordable Care Act (ACA) essential health benefits (EHB), which insurers must cover to offer plans on the exchanges. 45 states consider chiropractic care an EHB, 26 states include autism spectrum disorder services in their EHB package, and only five states considered weight loss programs and acupuncture as EHBs. The report states that the variation in EHB requirements is mostly a result of allowing states to determine their own essential health benefit package by using a “benchmark plan” already offered in the state as a model.
Posted on October 21, 2014
Insurers must sign Affordable Care Act (ACA) qualified health plan (QHP) agreements in order to offer their plans on HealthCare.gov for 2015. The 2015 agreements include a provision that takes into account the fact that the Supreme Court could issue a ruling on the Halbig v. Burwell case sometime next year that would make ACA subsidies illegal in federal exchange states. In the agreements, CMS reassures plans that if ACA premium tax credits and cost-sharing subsidies are no longer available to qualifying enrollees in the federal exchanges, the health plan could have cause to terminate the agreement subject to applicable state and federal law.
Posted on October 14, 2014
A new poll conducted by the The Associated Press and the NORC Center for Public Affairs Research suggests that high deductibles remain a significant barrier to health care for many privately insured Americans. The survey finds that of privately insured adults under age 64, about one in five said they don’t go to a doctor when they are sick despite having health coverage. A similar number of survey respondents reported going without preventive care and cutting back on retirement savings, or having to use all their savings for care. These issues were particularly acute among the 26 percent of respondents with high deductible plans. Consequently, about half of those surveyed said they preferred higher premiums over higher out-of-pocket costs.
Posted on September 30, 2014
A federal judge in Oklahoma ruled that tax subsidies granted under the Affordable Care Act (ACA) cannot go to residents of states with a federally-facilitated health insurance exchange rather than a state-run exchange. The ruling is similar to the D.C. Circuit’s decision in Halbig v. Burwell earlier this month. The government has requested an en banc review of the US Court of Appeals for the DC Circuit in order to ensure an opportunity to resolve circuit split before the Supreme Court grants cert.
Posted on September 23, 2014
Researchers at Georgetown University’s Center on Health Insurance Reforms (CHIR) conducted a six-state case study to assess changes in the network design of plans offered through the health insurance marketplaces, as well as the response of state officials in the face of consumer and provider concerns. The report finds that insurers have narrowed their networks, relative to what they offered in the past, however states and insurers reported few consumer complaints about the ability to obtain medically necessary care in-network. Most of the study states are unlikely to take action to change their standards for network adequacy, however, half of the states studied will require insurers to provide better, up-to-date provider directories, so that consumers can better understand which providers are in which plan networks before they buy.
Posted on September 10, 2014
The Kaiser Family Foundation (KFF) released its annual Employer Health Benefits Survey, which provides a snapshot of health coverage in the workplace. The 2014 survey results show that annual premiums for employer-sponsored family health coverage are up 3 percent from last year, continuing a recent trend of moderate premium growth. Premiums increased more slowly over the past five years than the preceding five years (26 percent vs. 34 percent) and well below the annual double-digit increases recorded in the late 1990s and early 2000s. This year’s increase also is similar to the year-to-year rise in worker’s wages and general inflation.
Posted on September 10, 2014
Two studies by the Urban Institute show that the provisions of the Affordable Care Act (ACA) have in many cases helped to insure more parents, but have not been as successful at increasing coverage for their children. The studies found that nationally, between September 2013 and June 2014, the estimated uninsured rate for parents fell 2.4 percentage points from 16.7 percent to 14.3 percent. However, for the same time period, no statistically significant change was found in the estimated uninsured rate for children under age 17. Additionally, findings suggest that the majority of uninsured children are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) but are not yet enrolled. The implications of these studies could be important as Congress considers whether to reauthorize funding for CHIP beyond 2016.
Posted on September 8, 2014
The Center for American Progress released a report proposing an approach known as the “Accountable Care States” in order to control health care costs. The model will keep costs down by giving states flexibility and incentives to control costs. A state that designates itself an Accountable Care State will be accountable for health care costs, quality of care, and access to care with sizable financial rewards for keeping overall costs low. Using Congressional Budget Office (CBO) data, the report estimates that if half of the states participate, the Accountable Care States model would yield $1.7 trillion in savings on total health care spending over 10 years.
Posted on August 22, 2014
The Center on Budget and Policy Priorities (CBPP) released a report to help state policymakers design waiver proposals for alternative approaches to expanding Medicaid. Arkansas, Iowa, and Michigan have all been granted waivers by the federal government to expand their Medicaid programs through alternative methods. The report outlines what federal officials have previously permitted and refused to help newly interested states successfully obtain a waiver.
Posted on August 13, 2014
A study by the Urban Institute analyzed marketplaces in 10 states finding that in states largely dominated by one insurer, such as Alabama, Arkansas, Rhode Island and West Virginia, premiums are generally higher. In the more competitive markets- Colorado, Maryland, Massachusetts, New York, Oregon, and Virginia, the authors often found limited provider networks, which allows insurers to keep premiums low. However, these limited networks may hinder access to certain providers