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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.

The Cost of Cancer

This Kaiser Family Foundation documentary explores the financial consequences faced by three people, all privately insured, after being diagnosed with cancer. It was released in conjunction with a joint Kaiser/American Cancer Society report, “Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System.” To download the video, right-click…

Nursing Home Reform: Then and Now

To mark the 20th anniversary of the passage of landmark federal legislation to improve the quality of nursing home care, the Omnibus Budget Reconciliation Act of 1987 (known as OBRA 87), this video examines the history surrounding the law. The video includes a look at the state of nursing home…

Medicaid Expansion Through Marketplace Premium Assistance

This fact sheet compares the two Medicaid premium assistance authorities (state plan option and demonstration waiver) and identifies key beneficiary protections in Medicaid expansion premium assistance programs.

Explaining Health Care Reform: What is Health Insurance?

A key element in any comprehensive health reform plan is defining what health insurance is and the amount of insurance coverage people will have. There are two components to that coverage: the types of services covered (e.g., physician care, hospitalization, prescription drugs, etc.), and the cost sharing required of enrollees…

Health Reform: Lessons From Massachusetts

As Congress debates comprehensive national health reform, the Kaiser Family Foundation has two reports and an updated fact sheet that examine state-level health reform in Massachusetts and the lessons it offers for policymakers in Washington. Consumers’ Experience in Massachusetts: Lessons For National Health Reform and In Pursuit of Affordable Health…

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…