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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…

Issues for Structuring Interim High-Risk Pools

One of the first provisions that would be implemented under federal health reform bills in the House and the Senate would establish a national high-risk pool program to offer coverage to otherwise uninsurable individuals during the interim period between enactment and implementation of broader health care reforms. High-risk pools provide…

Statement of Gary Claxton to NAIC Exchanges (B) Subgroup

Kaiser Family Foundation Vice President Gary Claxton, who directs the Foundation’s Marketplace Policy Project, testified July 22, 2010, at a public hearing before the National Association of Insurance Commissioners’ Exchanges (B) Subgroup established by the health reform law.  Testimony (.pdf)

Insurer Rebates under the Medical Loss Ratio: 2012 Estimates

Beginning in 2011, the Affordable Care Act (ACA) requires insurance plans to pay out a minimum percentage of premium dollars towards health care expenses and quality improvement activities, limiting the amount spent on administrative and marketing costs and profit. Under the law, large group plans are required to spend at…

Implementing New Private Health Insurance Market Rules

With the Jan. 1, 2014 effective date for implementing major changes in the private insurance market under the Affordable Care Act (ACA) approaching, this brief looks at three proposed federal regulations released in late November 2012 that detail how the ACA’s rules will operate in the following areas: private insurance…

Inside Deficit Reduction: What Now?

The Budget Control Act of 2011 tasked members of a “Super Committee” to find at least $1.2 trillion in deficit reduction over the next decade. Members did not reach an agreement by the November 23 deadline and as a result automatic spending cuts to defense and entitlement programs are set…

Health Insurance Market Reforms: Pre-Existing Condition Exclusions

Insurers pursue multiple strategies to reduce the cost of covering enrollees with pre-existing conditions, or medical conditions and health problems that existed before the individual enrolled in a health plan. One strategy, the pre-existing condition exclusion, allows insurers to refuse to cover any costs associated with care for a pre-existing…

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.