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This Health Policy 101 chapter explores the complex landscape of private health insurance regulation in the United States, detailing the interplay between state and federal regulations that shape access, affordability, and the adequacy of private health coverage. It focuses on key laws such as the Affordable Care Act (ACA) and the Employer Retirement Income Security Act (ERISA), and discusses how regulations impact the private insurance market, illustrating the challenges consumers face in navigating this system.

A new KFF poll finds that many older voters are unaware of the provision in the Inflation Reduction Act that for the first time requires the federal government to negotiate the price of some prescription drugs in the Medicare program, a key campaign issue for President Joe Biden. The 48%…

This Health Policy 101 chapter explores employer-sponsored health insurance (ESI), the primary health coverage source for non-elderly residents in the U.S. In addition to detailing ESI requirements and incentives, structure, availability, and costs, the chapter examines ongoing challenges related to affordability and access to care for those with ESI coverage.

In his new column, KFF President and CEO Drew Altman discusses the pros and cons of labeling socio-economic problems as health issues.

This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.

This brief describes Medicare coverage of sexual and reproductive health services, including contraception, and compares that coverage with private insurance plans and Medicaid. These benefits are particularly relevant to nearly 1 million women of reproductive age (20-49) who are eligible for Medicare due to having a long-term disability.

In light of worsening mental health among youth, strategies have been implemented to improve access to behavioral health services in recent years, including expanding school-based care for students. Leveraging Medicaid to improve and address gaps in school-based behavioral health services has been a key strategy in recent years as youth mental health concerns have grown. Provisions from the Safer Communities Act of 2022 utilize Medicaid to expand both school-based health care and other mechanisms of youth behavioral health care. This issue brief explores the implementation of these provisions from the Safer Communities Act thus far, with a focus on the guidance issued from CMS.

In this column, KFF President and CEO Drew Altman examines the conservative Republican Study Committee’s sweeping proposals to remake Medicare, Medicaid and the Affordable Care Act and their potential to make waves in this year’s elections. Whether former President Trump ignores, embraces, or repudiates their ideas will be key.

The Centers for Medicare and Medicaid Services has recently taken actions to increase transparency in Medicare Advantage, however substantial data gaps remain that limit the ability of policymakers and researchers to conduct oversight and assess the program’s performance, and for Medicare beneficiaries to compare Medicare Advantage plans offered in their area.

The FDA recently approved a new use for Wegovy, the blockbuster anti-obesity drug, to reduce the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese – a decision that opens the door to Medicare coverage of Wegovy, which is prohibited by law from covering drugs used for obesity. This brief analyses how many Medicare beneficiaries could be eligible for the new use of Wegovy and the potential impact on Medicare spending.