A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

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Report finds state differences in EHBs

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.

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Survey assesses impact of high deductibles

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.

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Georgetown releases report on post-ACA network design

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.

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10.3 million adults estimated to have gained coverage under the ACA

Posted on July 24, 2014

A new study published in the New England Journal of Medicine found that an estimated 10.3 million adults gained insurance coverage under the Affordable Care Act (ACA).  The study, performed by Harvard researchers, reported a 5.2% decline in the uninsured rate during the first open enrollment period.  Data analyzed for this project included Gallup polls and ACA enrollment statistics from the US Department of Health and Human Services (HHS).

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Two new ACA studies released

Posted on June 26, 2014

A new study published in Health Affairs found that open enrollment for the Affordable Care Act (ACA) should coincide with the tax filing season. The researchers argued that consumers are more likely to make better decisions with their health coverage when taxes are on their minds, not the stresses associated with holiday spending. Currently, ACA open enrollment for 2015 is scheduled for November 15, 2014 to February 15, 2015.

Another study from the Urban Institute indicates that Medicaid expansion was associated with a reduction in the number of uninsured individuals as of March 2014. The study, which relied upon data from Urban’s Health Reform Monitoring Survey, found that states expanding Medicaid saw a drop in the uninsurance rate by 4%, whereas states that did not expand Medicaid saw a 1.4% reduction. Unlike the ACA open enrollment period, individuals eligible for Medicaid can enroll in the program at any point in a year.

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New brief discusses premium rate review

Posted on June 20, 2014

The Robert Wood Johnson Foundation and the Leonard Davis Institute of Health Economics at Penn released a brief on premium proposals and rate review under the Affordable Care Act (ACA). The brief, Deciphering the Data: Health Insurance Rates and Rate Review, discusses the economic, political, and regulatory factors that contribute to rate determinations. Additionaly, the brief discusses how states with prior approval for rate review authority increased their capacity and scope to coincide with requirements under the ACA.

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KFF survey discusses ACA “plan switchers”

Posted on June 19, 2014

A new survey conducted by the Kaiser Family Foundation (KFF) discusses the experience of individuals that were enrolled in the individual health insurance market prior to the Affordable Care Act (ACA), and then switched into the ACA health insurance Marketplace. The survey found that 46% of these individuals have lower premiums after switching to the ACA Marketplace, while 39% have higher premiums. Additionally, about 50% of these “plan switchers” received cancellation notices from their insurance issuers because their plans were deemed non-compliant with the ACA prior to the issuance of the transitional policy.

The survey also indicated that affordability is still an issue for individuals enrolled in ACA plans, as 6 in 10 of those surveyed fear their plans may become unaffordable in the future.

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Article discusses likelihood of funding gaps for safety-net hospitals

Posted on June 2, 2014

A new article published in Health Affairs finds that some safety-net hospitals will still face funding issues, even after implementation of the Affordable Care Act (ACA). The article cites rising healthcare costs, the number of Americans still without insurance, and the disproportionate share hospital payment reductions within the ACA as reasons contributing to the continuation of funding gaps for many safety-net hospitals. States that did not expand Medicaid may be particularly impacted by these funding gaps, as they will not be receiving federal expansion money to offset the cuts in the safety-net funds.

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Report discusses use of narrow networks

Posted on May 30, 2014

Under the Affordable Care Act (ACA), many insurers have been creating plans with narrower provider networks. A new report discusses how to use narrow networks as a means to contain costs, but not compromise patient access to care. The report, published by the Urban Institute and The Center on Health Insurance Reforms at Georgetown University, suggests that the appropriate balance between consumer choice and containing costs can be achieved through regulations, transparency, and oversight.

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Exemptions and Special Enrollment Periods under the ACA

Posted on May 14, 2014

Below are three tables that describe the exemptions and SEPs in the ACA. The first table enumerates the exemptions and the method by which an individual may claim them. The second table focuses specifically on one type of exemption pathway- hardships. This table lists several specific events that will qualify as a hardship exemption and how to claim them. The third table describes the SEPs, including the rationale behind them and who is affected.

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