The Affordable Care Act’s health insurance marketplaces rely on robust competition to control costs and to provide consumer choice. But the decisions of several large insurers to scale back their 2017 marketplace participation, and the failure of many health insurance co-ops will leave marketplace shoppers in many states with fewer choices than they had in 2016. Furthermore, those insurers remaining in the exchanges have often found their marketplace customers to be less healthy than they projected, and they are raising premiums in response. Our briefing focuses on these trends, what they mean for the long-term viability of the marketplaces, and what public policy steps can be taken to bring more healthy people into the risk pool and to encourage insurer participation in the individual market.
In advance of the fourth open enrollment period for health coverage under the Affordable Care Act (ACA), which begins Nov. 1, this briefing examined who has gained coverage, who remains uninsured, and why uninsured individuals have not obtained coverage. Speakers also discussed marketplace stability, factors driving premium trends, and the outlook for 2017 premiums. In addition to insights from our panelists, this briefing included a discussion of survey results from The Commonwealth Fund ACA Tracking Survey and what it tells us about consumers’ experiences with the marketplaces.
A top Federal Trade Commission official, along with key experts, met with reporters Dec. 15 to discuss the recent surge in health care consolidation; the driving forces behind this trend; and the implications for policymakers and enforcers.
In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This briefing will discussed the driving forces behind this recent increase in consolidation; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.
In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This toolkit explores the driving forces behind this trend; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.
With the third open enrollment period for health insurance marketplaces launching November 1st, this briefing took a detailed look at what consumers can expect regarding premiums, health plan availability and affordability.
With the third open enrollment period for health insurance marketplaces launching November 1st, two marketplace executives and an analyst will help reporters understand what to expect.
This briefing, the second in a three-part series on the role of consumers and patients in our health care system, discussed the role of consumers in today’s health care coverage market, exploring questions such as: How is the evolving insurance marketplace affecting the choices consumers have when selecting a health plan, whether through a health insurance exchange, employer, or other mechanism? What information do consumers need to select a plan that is right for them? Are consumers well informed regarding health insurance matters, and do they know how to make use of their coverage once they have it?
In advance of the third open enrollment period for health coverage under the Affordable Care Act, this briefing examined coverage trends, who has gained coverage and who remains uninsured, and why those uninsured individuals have not obtained coverage.
A new Alliance for Health Reform toolkit will help you prepare for and understand the Supreme Court’s King v. Burwell decision, which could come as early as Friday. A major challenge to the Affordable Care Act (ACA) is before the Supreme Court, which is expected to make a decision in the King v. Burwell case by the end of its term in June 2015. The case concerns the legality of health insurance tax credits offered through a federally run health insurance marketplace, as opposed to a marketplace established by an individual state.
The Affordable Care Act (ACA) created new health insurance marketplaces for small businesses, known as Small Business Health Options Program (SHOP) marketplaces, and made substantial changes to the regulation of health insurance for small businesses. For purposes of health insurance regulation, small businesses have traditionally been defined by states as businesses with up to 50 employees. The ACA defined the small group market as employers with 1-100 employees, while allowing states to limit small group participation to employers with 50 or fewer workers from 2014 through 2016. Every state chose to do so, but, for plan years beginning in 2016, the definition of small business is set to expand to include those with 100 or fewer employees—with potentially significant consequences for the small group health insurance market and the SHOP marketplaces.
Join us for a special breakfast for reporters to address major changes set to take place for small businesses and health coverage in 2016, and proposals to delay or reconsider those changes. The Affordable Care Act (ACA) created new health insurance marketplaces for small businesses, known as Small Business Health Options Program (SHOP) marketplaces, and made substantial changes to the regulation of health insurance for small businesses. For plan years beginning in 2016, the definition of a small business is set to expand from up to 50 employees to up to 100 employees—with potentially significant consequences for the small group health insurance market and the SHOP marketplaces.
Efforts are underway throughout the Medicare program to better manage beneficiaries’ chronic conditions, with the goal of improving quality and lowering the costs of care. With an estimated 31 million Medicare beneficiaries suffering from a chronic condition such as cardiovascular disorders, diabetes and cancer, many still do not receive the coordinated services they need to manage their chronic conditions, and beneficiaries with multiple chronic conditions incur higher-than-average spending. However, traditional fee-for-service Medicare, Medicare Advantage, and newer models such as Accountable Care Organizations (ACOs) differ in the tools and methods available to manage chronic care.
Despite new private insurance coverage over the past year, many people do not understand the very terms and concepts necessary to make informed choices, according to recent studies. A new Alliance for Health Reform Toolkit, “Health Literacy and Health Insurance Literacy: Do Consumers Know What they are Buying?” addresses the extent and significance of both health literacy and health insurance literacy for Americans buying and using health insurance.
Almost three in ten Medicare beneficiaries are enrolled in the Medicare Advantage (MA) program, which offers a choice of competing private health plans – typically managed care plans such as HMOs and PPOs. The Affordable Care Act (ACA) made significant changes to the way Medicare Advantage plans are paid, including tying a portion of payments to a quality star rating system. Despite predictions that MA enrollment would drop in the wake of scheduled payment reductions to the program, the percentage of seniors who are choosing to enroll in MA plans is still growing. However, the impact of upcoming reductions remains the subject of much debate.
With the launch of the Affordable Care Act’s second open enrollment period this week, millions of people are again expected to flood marketplace websites to enroll or reenroll in health plans. At the same time, insurance commissioners are announcing draft regulations to help their states respond to an issue that was the subject of major controversy during the first round of enrollment: Some of the new health plans are offering consumers networks that exclude certain doctors, hospitals and other medical providers. Some claim that these networks hamper provider access and choice; others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs, without compromising the quality of care. The November 19 webinar will explain new draft regulations from the National Association of Insurance Commissioners. What are states already doing and must they adopt these regulations? How would this regulatory approach affect consumer costs and access to medical providers? How does it handle tiered networks? What is the effect on consumers, providers and health plans? Will there also be federal standards for health plan networks?
One day after this briefing, on November 15, the second open enrollment period begins for health plans sold in federal and state marketplaces. More than 7 million people who bought insurance for 2014 can shop around for new plans or stay where they are. Those who received federal subsidies will face a redetermination process to assess their current income and other eligibility factors. Experts estimate there may be millions of new enrollees.
Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.