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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…

Retiree Health Benefits in 2003: Employer Survey

This survey, conducted by the Kaiser Family Foundation and Hewitt Associates between June and September 2003 provides detailed information on retiree health programs offered by large private-sector employers. The data in this survey reflect the responses of 408 large firms (private-sector employers with 1,000 or more workers) and provides information…

Impact of Potential Changes to ERISA: Litigation and Appeals Experience of CalPERS, Other Large Public Employers and a Large California Health Plan – Report

Impact of Potential Changes to ERISA:Litigation and Appeal Experience of CalPERS, Other Large Public Employers and a Large California Health PlanJune 1998By Coopers & Lybrand L.L.P.Sandra Hunt, M.P.A.John Saari, M.A.A.A.Kelly Traw, J.D.BackgroundThe Employee Retirement Income Security Act (ERISA) currently preempts state law related to the wrongful denial or delay of…

External Review of Health Plan Decisions in the States and Medicare

An analysis of the external review process, the formal dispute resolution process established by state or federal agencies, independent of disputing parties, that has the capacity to evaluate and resolve at least those disputes involving medical issues. This paper identifies critical features of external review systems in thirteen states and…

Health Care and the 2004 Elections: Medical Liability Reform

Medical Liability ReformDownload a printable .pdf of Health Care and the 2004 Elections: Medical Liability Reform.IssueBackgroundOptions for Assuring Access to Affordable Liability CoverageAssessing Candidate PositionsIssueSharp increases in medical liability insurance premiums in recent years, and the withdrawal of some insurers from this market have focused the attention of health care…

Explaining Health Care Reform: Questions About Health Insurance Exchanges

The Patient Protection and Affordable Care Act (PPACA), signed into law in March 2010, made broad changes to the way health insurance will be provided and paid for in the United States. PPACA created a new mechanism for purchasing coverage called Exchanges, which are entities that will be set up…

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…