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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.

Private Insurance Benefits and Cost-Sharing Under the ACA

The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients…

Insurance Coverage of Contraceptives

In this post, we answer some of the key questions about the new contraceptive coverage policy generally, and more specifically, how it will be applied to religious organizations.

Quality Care for Less Money: Can Regional Successes Go National?

On February 15, the Kaiser Family Foundation hosted an event featuring a PBS documentary with former Washington Post correspondent T.R. Reid – U.S. Health Care: The Good News – which explores efforts to provide low-cost, quality health care in the U.S. The film looks at variations in health spending across…

Essential Health Benefits: Balancing Affordability and Adequacy

Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges as well as non-grandfathered plans offered in the individual and small group markets – will be required to cover a set of health benefits and services called the “essential health benefits” package. Guidance issued…

Key Issues to Consider for Outreach and Enrollment Efforts under Health Reform

The Affordable Care Act will significantly expand health coverage opportunities through an expansion in Medicaid and the creation of new health insurance exchanges in 2014. Effective outreach and enrollment efforts will be vital for assuring the expansions translate into increased coverage. Based on a discussion with federal and state officials…

A Guide to the Supreme Court’s Review of the 2010 Health Care Reform Law

With the Supreme Court preparing to hear oral arguments about challenges to the 2010 Affordable Care Act in March 2012, this Kaiser Family Foundation brief serves as a primer on the pending case, which challenges the constitutionality both of the law’s individual mandate that requires most Americans to obtain health…