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How Private Insurance Works: A Primer

This primer, prepared by Gary Claxton of the Institute for Health Care Research and Policy at Georgetown University, examines the structure and operation of private health insurance including the types of organizations that provide it, how managed care is delivered, and how risk pools work and describes how private health…

Protection For Consumers In Managed Care Plans: A Comparison Of Medicare, Medicaid and the Private Insurance Market

This policy paper describes key requirements of consumer protection regulation under Medicare, Medicaid and federal and state laws as they apply to private health insurance. These include choice and availability of plans, disclosure of information, marketing, access, quality, and the grievance and appeals process. The discussion highlights differences and similarities…

New Survey on Consumer Experiences with Health Plans

Survey on Consumer Experiences with Health PlansA Kaiser Family Foundation/Harvard School of Public Health survey found that more than six in ten privately insured American adults under age 65 give their health plans a grade of A or B, but nearly half report having some type of problem with their…

Peering Into the Black Box of Insurance Rating

Recently, the New York Times reported that private health insurers continue to seek large premium increases despite seeing lower than expected use of medical care and booking record profits. The story highlights a significant problem for health policy: the lack of good, public information about how health insurers manage health…

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…

Remember the People Outside of the Exchanges

There has been a substantial amount of focus on the recently released draft regulations governing state-based health insurance exchanges under the Affordable Care Act (ACA). And that’s appropriate, since the exchanges have the important roles under reform of providing consumers with easier access to insurance and facilitating tax credits and cost-sharing subsidies…

The Individual Mandate: How Sweeping?

The so-called “individual mandate”  – the provision under the Affordable Care Act (ACA) that requires most individuals to carry a minimum level of insurance coverage and is now being considered by the Supreme Court – has emerged as the least popular element of the reform law and the prime target for…

Is a Death Spiral Inevitable If There is No Mandate?

If the Supreme Court acts within the next couple of weeks to overturn the individual mandate in the Affordable Care Act (ACA) while leaving the rest of the law intact, expect to hear a lot about how the individual insurance market will be destined for a “death spiral.” When compared…