Network Adequacy: Balancing Cost, Access and Quality

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.

Health Insurance Marketplaces in 2014: Behind the Numbers

With the first open enrollment period for health insurance marketplaces now completed, an estimated 8 million people have enrolled in new private health insurance plans, with millions more newly enrolled in Medicaid. This briefing will look behind the enrollment numbers to take a detailed look at the demographics of marketplace enrollees, initial consumer experiences with health plans and lessons for next year’s open enrollment period.

Rates of Change: Putting 2015 Insurance Premiums into Context

Health insurance premiums have been one of the most closely-watched features of the new health insurance marketplaces. In 2014, insurers set rates based on limited data about who would sign up for coverage. Round II of open enrollment is fast approaching, allowing little time to process the first year’s data and to prepare for tomorrow. For 2015, some analysts anticipate increases of 10 percent or less, while others forecast growth of 20 percent or more.

Health Insurance Marketplaces: The First 8 Weeks

Health insurance marketplaces, or exchanges, opened October 1, and while states have released some enrollment data, and much of the attention has been on the initial technical challenges, there has been less information about overall consumer experience.

The Employer Mandate of the Patient Protection Affordable Care Act

The Toolkit, available here, details the ACA’s employer requirements and penalty. It also includes information about the delay in the mandate to 2015, and analysis about its impact on employer-based coverage. The Toolkit includes: key facts about the employer mandate; data about trends in employment-based health coverage; links to news articles and reports explaining and analyzing the issue; health care experts who understand the issue and its implications, along with contact info.

ABCs of the ACA – What You Need to Know

The Alliance for Health Reform answers key questions about the insurance marketplaces that opened for enrollment October 1 in this new FAQ, available here. The document also provides links to websites that go into detailed explanations of how the law and the exchanges work. Some links point directly to state marketplaces and other government resources.

“Rate Shock” — Or Not?

This Alliance for Health Reform webinar gave you the latest on what insurance rates will look like when state insurance exchanges open for enrollment on October 1.

Health Insurance Marketplaces: Different Strokes for Different States

The Patient Protection and Affordable Care Act (ACA) sets October 1, 2013 as opening day for enrollment in health insurance plans through marketplaces, or exchanges. The law allowed states to choose between running their own exchanges or having the Department of Health and Human Services (HHS) run a federally facilitated exchange.

Rural Reality: More Coverage, Enough Care?

Sixty-two million Americans live in rural areas and they have higher rates of mortality, disability and chronic disease than their urban counterparts. With high poverty and unemployment rates, low rates of health insurance coverage and an undersupply of health care providers, the ills of the health care system are especially notable in rural communities. The Patient Protection and Affordable Care Act (ACA) contains provisions relating to access to care, coverage and delivery system reform. But the impact of these provisions is uncertain in rural America, with its unique challenges.

Webinar: Making Sense of the Census Uninsured Numbers

The Census Bureau announced today that the number of people without health insurance dropped from 50 million to 48.6 million in 2011, marking the first decrease since 2007. That information came from the Current Population Survey, but it isn’t the only data that Census is releasing on the uninsured.

Oral Health: Putting Teeth into the Health Care System

We don’t often associate crowded emergency departments with dental complaints. But according to The Pew Center on the States, preventable dental conditions were the primary diagnosis in over 800,000 visits to ERs in the U.S. This makes sense, as more than 100 million Americans lack oral health coverage, and therefore have impaired access to dental care. What’s more, poor oral health is an integral factor in physical health, associated with conditions such as diabetes, heart and lung disease, stroke and preterm birth. So regular detection and treatment of oral health problems – which are received more regularly by those with coverage – can improve physical health and quality of life.

Health Insurance Exchanges: Can States and the Federal Government Meet the Deadline?

According to the health reform law, health insurance exchanges are to begin covering people in every state by January 2014. While some states have made progress toward establishing their own exchanges by this deadline, others have displayed little activity in this arena. Now that the Supreme Court has ruled on the constitutionality of the law, many states are just now beginning to think about their options for state-run exchanges and federal-state partnerships to run them. With implementation and evaluation deadlines rapidly approaching, state governments face the challenge to decide and act quickly.

Essential Health Benefits: Balancing Affordability and Adequacy

Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges – as well as non-grandfathered plans offered in the individual and small group markets – will be required to cover a set of health benefits and services called the “essential health benefits” package. Guidance issued last month by the Department of Health and Human Services will give each state some discretion to specify benefits within the 10 categories specified in the law.