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The Henry J. Kaiser Family Foundation

Protection in Managed Care Plans: A Side-by-Side Comparison of Proposal Federal Legislation

Protection in Managed Care Plans: A Side-by-Side Comparison of Proposed Federal Legislation. A side-by-side comparison of the provisions for consumer protection in managed care plans contained in the House and Senate budget reconciliation bills and in eight other consumer protection bills currently under consideration by Congress. These bills, which would…

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The Henry J. Kaiser Family Foundation

The Impact of Managed Care Legislation: An Analysis of Five Legislative Proposals from California

This study analyzed five 1997 managed care consumer protection proposals currently or recently under consideration by the California state legislature: allowing consumers to sue their HMO (health maintenance organization) or managed care plan; expanding access to prescription drugs not approved by the health plan; expanded coverage of mental health services;…

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The Henry J. Kaiser Family Foundation

External Review of Health Plan Decisions — Policy Brief

An 8-page policy brief on the external review of health plan decisions to inform the policy debate in California and nationally. The policy brief covers external review systems in other states and the Medicare program, the current status of external review in California, and issues regarding the design and implementation…

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The Henry J. Kaiser Family Foundation

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…

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The Henry J. Kaiser Family Foundation

Health Insurance Market Reforms: Portability

Most Americans have access to health insurance through an employer-sponsored health plan, a fact that has made changing or losing a job a complex issue for the purposes of maintaining health insurance. Moving to a new job can be hard if the employer does not offer health insurance, or if…

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The Henry J. Kaiser Family Foundation

A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan

Most people get their health care through some form of managed care plan – a health maintenance organization, preferred provider organization, or point-of-service option. Most of the time, people receive the care they need, but the potential exists for disagreements over the services that will be provided or paid for…

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The Henry J. Kaiser Family Foundation

Navigator and In-Person Assistance Programs: A Snapshot of State Programs

With the open enrollment period for health insurance exchanges less than six months away, consumers are already asking questions about their new health care options under the Affordable Care Act (ACA). Even in the age of digital information, hands-on consumer assistance could play a key role in helping people understand…

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The Henry J. Kaiser Family Foundation

Health Affairs Article: Impact of State Tort Reforms on Physician Malpractice Payments

A study in the March/April 2007 issue of Health Affairs analyzes the impact of state tort reforms on physician malpractice claims. The study finds that the tort law changes have had a measurable but limited impact on physician malpractice claims, depending on the type and strength of the tort reform. Commissioned by…

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The Henry J. Kaiser Family Foundation

In Pursuit of Affordable Health Care: On the Ground Lessons From Families in Massachusetts

This report, based on focus groups with adults in a variety of circumstances, highlights the experiences of Massachusetts residents in obtaining health coverage, accessing health care services and managing out-of-pocket costs in the wake of the state’s 2006 health reform law. Report (.pdf)

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The Henry J. Kaiser Family Foundation

Explaining Health Care Reform: Medical Loss Ratio (MLR)

This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and businesses.

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