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

New brief discusses premium rate review

Posted on June 20, 2014 | Comments Off

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.

Continue Reading »

KFF survey discusses ACA “plan switchers”

Posted on June 19, 2014 | Comments Off

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.

Continue Reading »

ASPE report indicates premium variation among states

Posted on June 18, 2014 | Comments Off

A new report by the US Department of Health and Human Services (HHS) describes how premiums vary among the 36 states operating federally-facilitated Marketplaces under the Affordable Care Act (ACA). The report, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS, found the average premium payment by an individual receiving subsidies to be $82, with the subsidized average for the silver plan metal tier being $69. Average subsidized premiums ranged from $23/month in Mississippi to $148/month in New Jersey. The report does not capture the corresponding data for the state-based Marketplaces.

Continue Reading »

CMS rule sets payment adjustments for low-volume hospitals

Posted on June 13, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued a rule to change the payment adjustment for low-volume hospitals and Medicare-dependent hospitals. The changes would be issued under the hospital inpatient prospective payment systems (IPPS) for the second half of fiscal-year 2014. According to the rule, a hospital is considered low-volume if it is more than 15 miles from another hospital and has less than 1600 discharges of individuals entitled to or enrolled in Medicare Part A.

Continue Reading »

CCIIO issues FAQ on ECPs

Posted on June 12, 2014 | Comments Off

A new FAQ released by the Center for Consumer Information and Insurance Oversight (CCIIO) addresses questions insurance issuers may have concerning Essential Community Providers (ECPs). The Affordable Care Act (ACA) requires issuers to contract with a sufficient number of ECPs, or providers that generally treat low-income and medically underserved patients. The FAQ describes specifics of the ECP requirements, how issuers can access the non-exhaustive ECP list, and how ECPs can actively pursue inclusion in insurance planes. A similar FAQ addressing the same ECP issues was released in May of 2013.

Continue Reading »

CBO and JCT revise mandate penalty estimation

Posted on June 5, 2014 | Comments Off

An updated analysis released by the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimates that 2 million fewer individuals are anticipated to pay the shared responsibility payment in 2016. Under the Affordable Care Act (ACA), most individuals not receiving minimum essential coverage through their insurance plans are expected to pay a fine for not complying with the individual mandate. The last estimate released by the analysts in 2012 postulated that 6 million individuals way pay the fine in 2016. CBO and JCT cite the expected increase in the number of individuals receiving exemptions from the individual mandate as the main reason for the estimated drop.

Continue Reading »

Article discusses likelihood of funding gaps for safety-net hospitals

Posted on June 2, 2014 | Comments Off

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.

Continue Reading »

Report discusses use of narrow networks

Posted on May 30, 2014 | Comments Off

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.

Continue Reading »

IRS Q&A clarifies employer payment plans

Posted on May 27, 2014 | Comments Off

According to a Q&A document recently released by the Internal Revenue Service (IRS), employers that do not offer health insurance but reimburse premiums for employees that purchase private insurance may be hit with a financial penalty. The Q&A states that employers utilizing this approach are effectively creating employer payment plans, which are beholden to the same rules and requirements as other group health plans under the Affordable Care Act (ACA). The IRS states that this arrangement does not comply with the ACA market reforms, and offering this option to employees may result in a $100/day excise tax per applicable employee for the employer.

Continue Reading »

CMS issues Medicare Advantage and Part D final rule for 2015

Posted on May 21, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued the final rule for Medicare Advantage (Part C) and the Medicare prescription drug benefit program (Part D) for contract year 2015. The rule aims to clarify program provisions, enact statute requirements, and improve payment accuracy. One specific provision provided in the rule said CMS will not open up preferred networks to permit any willing pharmacy to offer preferred cost-sharing. CMS indicated they would continue to study preferred cost-sharing practices to address stakeholder reactions and concerns to the proposed policy.

Continue Reading »