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Questions About Essential Health Benefits

The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits,…

An Employer Health Benefits Balance Sheet

There seems to be growing interest in the question of how many employers will keep offering coverage to their full-time employees once the Affordable Care Act (ACA) is fully implemented in 2014, or instead will choose to stop offering coverage and pay a penalty. While there is some good analysis…

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…

Pop Quiz: Assessing Americans’ Familiarity with the Health Care Law

Based on the December Kaiser Health Tracking Poll, the latest KFF data note explores Americans’ awareness of what the Affordable Care Act (ACA) will do. As the 112th Congress prepared to take office and the discussion of repeal was on the rise, we ‘quizzed’ Americans on whether they thought a…

Insurance Brokers and the Medical Loss Ratio

In a close vote, the National Association of Insurance Commissioners (NAIC) recently adopted a resolution urging Congress and the Department of Health and Human Services (HHS) to exempt insurance broker and agent compensation from medical loss ratio (MLR) requirements or otherwise adjust the requirements to ease their effect. HHS last…

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 Economy and Medical Care

Various market watchers have reported that the use of health care services has not been growing recently as it had in the past, resulting in lower than expected health care claims for people with private insurance and higher than expected earnings for insurers. A look at physician office visits by…

What Do They Mean When They Talk About Pre-Existing Health Conditions?

One health care issue about which the presidential candidates acknowledge they have differences is how the health care system should treat people with pre-existing health conditions. People who have a health condition (such as an illness or pregnancy) or who are at higher than average risk of needing health care…