Inside Deficit Reduction: What Now? December 5, 2011 Event The Budget Control Act of 2011 tasked members of a “Super Committee” to find at least $1.2 trillion in deficit reduction over the next decade. Members did not reach an agreement by the November 23 deadline and as a result automatic spending cuts to defense and entitlement programs are set…
Health Insurance Market Reforms: Pre-Existing Condition Exclusions October 8, 2012 Fact Sheet Insurers pursue multiple strategies to reduce the cost of covering enrollees with pre-existing conditions, or medical conditions and health problems that existed before the individual enrolled in a health plan. One strategy, the pre-existing condition exclusion, allows insurers to refuse to cover any costs associated with care for a pre-existing…
Explaining Health Care Reform: Questions About Health Insurance Exchanges April 1, 2010 Issue Brief 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 December 30, 2009 Issue Brief 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 July 22, 2010 Event 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)
Implementing New Private Health Insurance Market Rules January 7, 2013 Issue Brief 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…
Who Will be the H&R Block and TurboTax for Health Insurance? June 3, 2011 Perspective 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…
Understanding Mergers Between Hospitals and Health Systems in Different Markets August 23, 2023 Issue Brief This brief explains the role and implications of cross-market mergers between hospitals and health systems that operate in different regions and describes the approaches that government antitrust agencies have taken in reviewing these types of transactions.
Health Plan Liability — Policy Brief May 30, 1999 Issue Brief An 8-page policy brief to inform the policy debate in California about health plan liability issues, including barriers to lawsuits (ERISA), liability approaches used in other industries, and potential impact on premiums. The brief includes a variety of perspectives presented by speakers at a California Health Policy Roundtable held in…
External Review of Health Plan Decisions in the States and Medicare October 31, 1998 Report 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…