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Implementing the Affordable Care Act: state regulation of marketplace plan provider networks. 实施《平价医疗法案》:各州对市场计划提供者网络的监管。
LDI issue brief Pub Date : 2015-05-05 DOI: 10.15868/socialsector.25030
Justin Giovannelli, Kevin W Lucia, S. Corlette
{"title":"Implementing the Affordable Care Act: state regulation of marketplace plan provider networks.","authors":"Justin Giovannelli, Kevin W Lucia, S. Corlette","doi":"10.15868/socialsector.25030","DOIUrl":"https://doi.org/10.15868/socialsector.25030","url":null,"abstract":"Health plans with relatively narrow provider networks have generated widespread debate, mainly concerning the level of regulatory oversight necessary to ensure plans provide consumers meaningful access to care. The Affordable Care Act creates the first federal standard for network adequacy in the commercial insurance market for plans offered through the law's insurance marketplaces. However, states continue to play a primary role in setting and enforcing network rules. This brief examines state network adequacy standards for marketplace plans in the 50 states and District of Columbia. We identify state requirements in effect at the outset of marketplace coverage, focusing on quantitative measures of network sufficiency and rules designed to ensure the delivery of accurate and timely provider directories. We then explore the extent to which those standards evolved for 2015. Though regulatory changes were limited in year one, states were most likely to act to promote network transparency and enhance oversight.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"3 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2015-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81944960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 19
The problem of underinsurance and how rising deductibles will make it worse. Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014. 保险不足的问题以及不断上升的免赔额将使情况变得更糟。联邦基金两年期健康保险调查结果，2014年。
LDI issue brief Pub Date : 2015-05-01 DOI: 10.15868/socialsector.21911
S. Collins, P. Rasmussen, S. Beutel, M. Doty
{"title":"The problem of underinsurance and how rising deductibles will make it worse. Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014.","authors":"S. Collins, P. Rasmussen, S. Beutel, M. Doty","doi":"10.15868/socialsector.21911","DOIUrl":"https://doi.org/10.15868/socialsector.21911","url":null,"abstract":"New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year--or 31 million people--had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"7 1","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87979509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 79
Innovation waivers: an opportunity for states to pursue their own brand of health reform. 创新豁免:各州追求自己的医疗改革品牌的机会。
LDI issue brief Pub Date : 2015-04-15 DOI: 10.15868/socialsector.25029
D. Bachrach, Joel Ario, Hailey E Davis
{"title":"Innovation waivers: an opportunity for states to pursue their own brand of health reform.","authors":"D. Bachrach, Joel Ario, Hailey E Davis","doi":"10.15868/socialsector.25029","DOIUrl":"https://doi.org/10.15868/socialsector.25029","url":null,"abstract":"States have long been the testing ground for new models of health care and coverage. Section 1332 of the Affordable Care Act, which takes effect in less than two years, throws open the door to innovation by authorizing states to rethink the law's coverage designs. Under State Innovation Waivers, states can modify the rules regarding covered benefits, subsidies, insurance marketplaces, and individual and employer mandates. States may propose broad alternatives or targeted fixes, but all waivers must demonstrate that coverage will remain as accessible, comprehensive, and affordable as before the waiver and that the changes will not add to the federal deficit. This issue brief describes how states may use State Innovation Waivers to reallocate subsidies, expand or streamline their marketplaces, replace or modify the mandates, and otherwise pursue their own brand of reform tailored to local market conditions and political preferences.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"281 5 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2015-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86575981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Health care coverage and access in the nation's four largest states. Results from the Commonwealth Fund Biennial Health Insurance Survey, 2014. 全国四个最大的州的医疗保险覆盖面和准入。2014年联邦基金两年期健康保险调查结果。
LDI issue brief Pub Date : 2015-04-01 DOI: 10.15868/socialsector.21379
P. Rasmussen, S. Collins, M. Doty, S. Beutel
{"title":"Health care coverage and access in the nation's four largest states. Results from the Commonwealth Fund Biennial Health Insurance Survey, 2014.","authors":"P. Rasmussen, S. Collins, M. Doty, S. Beutel","doi":"10.15868/socialsector.21379","DOIUrl":"https://doi.org/10.15868/socialsector.21379","url":null,"abstract":"Across the country's four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. Similarly, lower percentages of New Yorkers and Californians reported having a medical bill problem in the past 12 months or having accrued medical debt compared with Floridians and Texans. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state's uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"108 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90074985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
The federal medical loss ratio rule: implications for consumers in year 3. 联邦医疗损失率规则:第三年对消费者的影响。
LDI issue brief Pub Date : 2015-03-26 DOI: 10.15868/socialsector.24996
M. Mccue, M. Hall
{"title":"The federal medical loss ratio rule: implications for consumers in year 3.","authors":"M. Mccue, M. Hall","doi":"10.15868/socialsector.24996","DOIUrl":"https://doi.org/10.15868/socialsector.24996","url":null,"abstract":"For the past three years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses--known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. Insurers' spending on quality improvement remained low, at less than 1 percent of premiums. Insurers' administrative and sales costs, such as brokers' fees, and profit margins have reduced slightly but remain fairly steady. In the first three years under this regulation, total consumer benefits related to the medical loss ratio--both rebates and reduced overhead--amounted to over $5 billion. This was achieved without a great exodus of insurers from the market.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"1 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2015-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82986303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access to Care Could Be an Indication of Future Results. 缩小差距:过去医疗保险在减少获得医疗服务方面的种族和民族差异方面的表现可能是未来结果的一个指标。
LDI issue brief Pub Date : 2015-03-05 DOI: 10.15868/socialsector.25026
S. Hayes, P. Riley, D. Radley, D. McCarthy
{"title":"Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access to Care Could Be an Indication of Future Results.","authors":"S. Hayes, P. Riley, D. Radley, D. McCarthy","doi":"10.15868/socialsector.25026","DOIUrl":"https://doi.org/10.15868/socialsector.25026","url":null,"abstract":"This historical analysis shows that in the years just prior to the Affordable Care Act's expansion of health insurance coverage, black and Hispanic working-age adults were far more likely than whites to be uninsured, to lack a usual care provider, and to go without needed care because of cost. Among insured adults across all racial and ethnic groups, however, rates of access to a usual provider were much higher, and the proportion of adults going without needed care because of cost was much lower. Disparities between groups were narrower among the insured than the uninsured, even after adjusting for income, age, sex, and health status. With surveys pointing to a decline in uninsured rates among black and Hispanic adults in the past year, particularly in states extending Medicaid eligibility, the ACA's coverage expansions have the potential to reduce, though not eliminate, racial and ethnic disparities in access to care.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"126 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2015-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72468558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 35
How will the Affordable Care Act affect the use of health care services? 《平价医疗法案》将如何影响医疗服务的使用?
LDI issue brief Pub Date : 2015-02-01 DOI: 10.15868/socialsector.25025
S. Glied, Stephanie Ma
{"title":"How will the Affordable Care Act affect the use of health care services?","authors":"S. Glied, Stephanie Ma","doi":"10.15868/socialsector.25025","DOIUrl":"https://doi.org/10.15868/socialsector.25025","url":null,"abstract":"In January 2014, the Affordable Care Act extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. We project that primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"19 1","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72963095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 22
What's behind health insurance rate increases? an examination of what insurers reported to the federal government in 2013-2014. 医疗保险费率上涨的背后是什么?对保险公司在2013-2014年向联邦政府报告的内容的审查。
LDI issue brief Pub Date : 2015-01-20 DOI: 10.15868/socialsector.25024
M. Mccue, M. Hall
{"title":"What's behind health insurance rate increases? an examination of what insurers reported to the federal government in 2013-2014.","authors":"M. Mccue, M. Hall","doi":"10.15868/socialsector.25024","DOIUrl":"https://doi.org/10.15868/socialsector.25024","url":null,"abstract":"The Affordable Care Act requires health insurers to justify rate increases that are 10 percent or more for nongrandfathered plans in the individual and small-group markets. Analyzing these filings for renewals taking effect from mid-2013 through mid-2014, this brief finds that the average rate increase submitted for review was 13 percent. Insurers attributed the great bulk of these larger rate increases to routine factors such as trends in medical costs. Most insurers did not attribute any portion of these medical cost trends to factors related to the Affordable Care Act. The ACA-related factors mentioned most often were nonmedical: the new federal taxes on insurers, and the fee for the transitional reinsurance program. On average, insurers that quantified any ACA impact attributed about a third of their larger rate increases to these new ACA assessments.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"43 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2015-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84627336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Primary Care Providers' Views of Recent Trends in Health Care Delivery and Payment. Findings from the Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers. 初级保健提供者对卫生保健提供和支付的最新趋势的看法。联邦基金/凯撒家庭基金会2015年全国初级保健提供者调查的结果。
LDI issue brief Pub Date : 2015-01-01 DOI: 10.15868/socialsector.25044
M. A. Abrams, Mollyann Brodie, Jamie Ryan, Michelle Doty Doty, Liz Hamel, Mira Norton
{"title":"Primary Care Providers' Views of Recent Trends in Health Care Delivery and Payment. Findings from the Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers.","authors":"M. A. Abrams, Mollyann Brodie, Jamie Ryan, Michelle Doty Doty, Liz Hamel, Mira Norton","doi":"10.15868/socialsector.25044","DOIUrl":"https://doi.org/10.15868/socialsector.25044","url":null,"abstract":"A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers--physicians, nurse practitioners, and physician assistants--about their experiences with and reactions to recent changes in health care delivery and payment. Providers' views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers' experiences under the ACA's coverage expansions and their opinions about the law.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"15 1","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84501286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Managed Care. 管理式医疗。
LDI issue brief Pub Date : 2015-01-01 DOI: 10.1007/978-3-030-39903-0_301118
J. Karberg
{"title":"Managed Care.","authors":"J. Karberg","doi":"10.1007/978-3-030-39903-0_301118","DOIUrl":"https://doi.org/10.1007/978-3-030-39903-0_301118","url":null,"abstract":"","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"40 1","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78052516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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