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Peering Into the Black Box of Insurance Rating

Recently, the New York Times reported that private health insurers continue to seek large premium increases despite seeing lower than expected use of medical care and booking record profits. The story highlights a significant problem for health policy: the lack of good, public information about how health insurers manage health…

Who Will be the H&R Block and TurboTax for Health Insurance?

There’s been quite a bit of focus lately insofar as these issues go, anyway on health insurance agents and brokers (sometimes known in the industry as “producers”). They are pushing legislation that has been introduced in Congress and is now being studied by the National Association of Insurance Commissioners that…

Transparency and Complexity

This fall a new rule takes effect requiring all private health plans to offer a uniform, simple to read, summary of benefits and coverage (SBC).  The SBC will provide consumers with standardized information about how plans cover essential health benefits and what coverage limits and cost sharing applies. The SBC…

Explaining Douglas v. Independent Living Center: Questions About the Upcoming United States Supreme Court Case Regarding Medicaid Beneficiaries’ and Providers’ Ability to Enforce the Medicaid Act

On October 3, 2011, the U.S. Supreme Court is scheduled to hear oral argument in a group of three cases, Douglas v. Independent Living Center of Southern California, Douglas v. California Pharmacists Association, and Douglas v. Santa Rosa Memorial Hospital. All three cases raise the same issue: whether Medicaid beneficiaries…

Managed Care Plan Liability: An Analysis of Texas and Missouri Legislation – Report

Managed Care Plan Liability: An Analysis Of Texas And Missouri Legislation Patricia A. Butler, JD, DrPH November 1997 Background As increasing numbers of Americans receive health care coverage through managed care plans, public attention has been focused on some of the problems consumers have with such plans. Although most consumers…

External Review of Health Plan Decisions in the States and Medicare – Report

External Review of Health Plan Decisions:An Overview of Key Program Features in the States and MedicareExternal Review of Health Plan Decisions:An Overview of Key Program Features in the States and MedicarePrepared for the Kaiser Family Foundation by:Karen Pollitz, M.P.P., Geraldine Dallek, M.P.H., and Nicole Tapay, J.D.Institute for Health Care Research…

How Private Health Coverage Works: A Primer – 2008 Update

How Private Health Coverage Works: A Primer— 2008 UpdateThis primer explains the role and operations of private health coverage in the United States. Private health coverage is provided under a variety of different arrangements, including health insuring organizations regulated under state law and health plans sponsored by employers and employee organizations…

Primers on Key Health Care Topics and Programs

The Kaiser Family Foundation maintains a number of primers providing overviews of key health care programs and issues. Written by Foundation staff, each primer provides key data and information that helps illustrate the topic and its relevance for the nation's health care system.Medicaid: A PrimerMedicare: A PrimerThe Uninsured: A PrimerHealth…