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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…

Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

This issue brief explains provisions in current law that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners—namely, the participating provider program, limitation on balance billing, and conditions on private contracting for doctors who opt out of Medicare or join “concierge” practices. It also analyzes the implications of modifying these provisions for beneficiaries, providers, and the Medicare program.

Connecting Consumers to Coverage: Lessons Learned from Assisters for Successful Outreach and Enrollment

This brief highlights the experiences of Navigators and other Marketplace consumer assistance programs under the Affordable Care Act (Obamacare) in conducting outreach and providing enrollment assistance during the ACA’s first open enrollment period. It provides insight into the outreach and enrollment strategies the assisters developed and identifies the keys to successfully overcoming the challenges of the first year. These insights are based on findings from focus groups with assisters in four cities: Miami, Florida; Houston, Texas; Raleigh, North Carolina; and Cleveland, Ohio.