Marketplace
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States Can Prevent Surprise Bills for Patients Seeking Coronavirus Care
The ongoing COVID-19 pandemic raises the stakes in the debate over surprise medical bills. Consumers’ fear of incurring medical bills could lead some to avoid testing or treatment. While new federal laws require insurers to waive cost-sharing for COVID-19 testing and the associated medical visit, that protection does not extend to treatment. Nor does it prevent balance…
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The Provider Relief Fund: How Well Does it Protect Patients from Surprise Medical Bills for COVID-19 Related Services?
The cost of health care is a critical concern during the current pandemic. People who worry about out-of-pocket costs are more reluctant to seek care. For those with private health insurance, out-of-pocket costs may take the form of deductibles, copayments, or coinsurance. When receiving services from an out-of-network provider, patients may also face balance bills (amounts billed…
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March Research Round Up: What We’re Reading
This blog was originally posted on the Georgetown Center on Health Insurance Reforms’ CHIRBlog. This March, we had to reconcile the anniversary of a landmark health law with the anxiety and grief caused by the growing novel coronavirus (COVID-19) pandemic. As we celebrate the 10th year of the Affordable Care Act (ACA), we also look to researchers to help…
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COVID-19 Response: States That Run Their Own ACA Marketplace Are Better Positioned to Help Consumers Get Covered
This blog was originally posted on the Georgetown Center on Health Insurance Reforms’ CHIRBlog. As COVID-19 cases climb, social distancing – the best tool we have to bring the virus to heel – has wrought an unprecedented loss of jobs, income, and health coverage. Over the coming months, the uninsured rate is expected to skyrocket. In the…
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Expanded Coverage for COVID-19 Testing is an Important Step, But Loopholes Expose All of Us to Greater Risk
[This blog was originally posted on the Georgetown Center on Health Insurance Reforms’ CHIRBlog.] After a delayed response to the COVID-19 pandemic, the federal government has significantly picked up the pace. In the space of three weeks, Congress enacted three stimulus bills: An $8.3 billion emergency appropriations bill (March 6), the Families First Coronavirus Response Act (March…
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Navigating Coverage During the COVID-19 Pandemic: Frequently Asked Questions
[This post by our partners at the Georgetown University Center on Health Insurance Reforms focuses mainly on questions about Marketplace coverage. Medicaid and CHIP provide even more affordable health coverage options to those who qualify. You can can learn more about Medicaid and CHIP coverage here.) The novel coronavirus (COVID-19) has been the cause of…
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What Are State Officials Doing to Make Private Health Insurance Work Better for Consumers During the Coronavirus Public Health Crisis?
Slowing the spread of the novel coronavirus, or COVID-19, and ensuring affected patients receive treatment requires an urgent, coordinated, and comprehensive response from the federal government and states. Efforts must include improving testing capacity, supporting providers, addressing the lack of paid sick leave, and expanding access to Medicaid for the uninsured. At the same time, policymakers…
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New Georgetown CHIR Report Finds Ability of Insurers, Employers to Respond to Provider Consolidation is Limited
Most employers are implementing few, if any, changes to their health plans for the 2020 plan year. That’s not surprising – employers are generally reluctant to make big or abrupt adjustments to provider networks or cost-sharing that could cause pushback from employees. But many health care experts believe that if we’re ever to truly tackle out-of-control health care…
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What’s New for 2020 Marketplace Enrollment?
On November 1, the seventh open enrollment period begins for marketplace coverage under the Affordable Care Act (ACA). We at CHIR are tracking several policy changes that could affect marketplace enrollment and plan affordability in 2020. These include: Public Charge Rule: In August 2019, the Department of Homeland Security issued a final rule that broadens the types…
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New Initiative Could Undermine ACA Consumer Protections Under Guise of ‘Wellness Program’
Before the Affordable Care Act (ACA) was enacted, one of the primary ways insurance companies deterred less healthy people from enrolling was to charge them into a higher premium based on their expected health risk. The ACA prohibited this practice beginning in 2014. Health insurers in the individual market can now adjust premium rates solely based…
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How the Lawsuit to Overturn the Affordable Care Act Would Further Harm Medicaid and CHIP Coverage of Children
Introduction Texas vs. United States, the lawsuit to overturn the Affordable Care Act (ACA) in its entirety, continues to proceed apace through the federal courts, despite its extraordinarily weak legal reasoning. Most of the attention is rightfully focused on how the case could increase the number of uninsured in the nation by 20 million people,…
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MACPAC Releases FactSheet on CHIP Health Services Initiatives
Not everyone knows that states are allowed to use a limited amount of CHIP funding to implement health services initiatives (HSIs) – activities that protect the public health, promote a state’s capacity to deliver public health services, or accomplish public health goals relating to improving the health of children, including children in Medicaid and CHIP.…
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How a Small Provision of ACA Made a Big Difference for One Pennsylvania Family
Years after its passage, I am still finding new ways that the ACA helps my family. For over two and a half years, my family has been involved in the fight to save the Affordable Care Act and prevent cuts to Medicaid. We travel around Pennsylvania and Capitol Hill educating others about the importance of…
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Is There Really A Question? Intervenor States Have Clear Interest in Defending the Affordable Care Act
The Fifth Circuit Court of Appeals has asked the parties in Texas v. United States to file supplemental briefings on the issue of whether the defendant states attorneys generals and the U.S. House of Representatives have standing to appeal. Standing is a legal term that means a party has a right to bring a lawsuit,…
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States Leaning In: Washington Doubles Down on Efforts to Shore up Market, Protect Consumers
Recently, the Commonwealth Fund published scorecards on state health system performance. These tallies, informed in part by CHIR research, evaluate each state on a range of health care metrics, including access to care and income-based health disparities. One of the top-performing states is Washington State, ranked fourth in the country; the state has risen ten spots since the last…
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More Sabotage: Trump Administration Cuts Marketplace Premium Subsidies
The Centers for Medicare and Medicaid Services recently issued the Notice of Benefit and Payment Parameters for 2020, which finalized a harmful provision first proposed in January that would effectively reduce the amount of premium tax credits available to purchase marketplace plans over time. Like prior Administration actions that have sabotaged the marketplaces, this would…
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Affordable Care Act Back in the Spotlight: Build on its Progress or Scrap it Entirely
It is hard to find a starker example of the different approaches our two political parties take to health care than the events of March 26, 2019. The day started with headlines about the Trump administration’s push to have the Affordable Care Act (ACA) declared unconstitutional, and ended with Democratic legislators in the U.S. House introducing a bill that…
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What does the Partial Government Shutdown Mean for the Affordable Care Act Marketplaces?
As the clock ticks, the likelihood increases that we are in the midst of the longest-ever shutdown of U.S. government agencies. Hundreds of thousands of federal workers are either furloughed or working without pay and critical government services are going unperformed. For the millions of Americans who rely on the federal government for their health care, many likely have…
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New Guidance Reinterprets Section 1332 Waivers
On October 22, the Trump Administration issued new guidance related to section 1332 state waivers of certain provisions of the Affordable Care Act. The guidance eviscerates the existing statutory requirements for affordability, comprehensiveness and coverage that section 1332 waivers must satisfy to receive federal approval. As a result, as other analysts have pointed out (here…
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Trump Administration Hands States Another Tool for Dismantling Preexisting Condition Protections
Last week, the Trump administration issued long-anticipated guidance regarding the Affordable Care Act’s Section 1332 “innovation waiver” program. The release rebrands and creatively reimagines the ACA program (they’re now “State Relief and Empowerment” waivers), breaking dramatically with past policy and, arguably, with the statute it purports to interpret. In the administration’s view, the ACA permits states to…
