A Three-Part Strategy for Better Health Insurance
This brief discusses the dilemma of rising healthcare spending and a three-part federal policy strategy to constrain drivers of cost growth.
This brief discusses the dilemma of rising healthcare spending and a three-part federal policy strategy to constrain drivers of cost growth.
This blog discusses the Senate Finance Committee's request for information to reform U.S. health coverage, and considerations for people with diabetes to help inform policymaking.
This publication breaks down the Senate Finance Committee's request for information on health coverage and highlights topic and section considerations for commentors.
This blog discusses healthcare ownership transparency, why it matters, and federal bills and policy considerations to improve oversight.
This blog discusses a proposal for a "Fair Pay, Fair Play" TPA to compete with dominant insurer TPAs.
This blog discusses hospital outpatient billing and state and federal action for reform, such as facility fee bans and billing transparency.
This blog discusses CMS' 2022-2025 report on NSA compliance and enforcement, highlighting the NSA effectively shields from surprise bills and potentially decreases out-of-pocket costs.
This blog discusses what essential health benefits are, their protections, and future rulemaking.
This blog discusses Data Marketing Partnership v. Department of Labor and the impact a settlement could have on consumer coverage, individual market premiums, and state insurance oversight.
This blog discusses healthcare transaction oversight and specific state strategies for oversight authority.
This blog analyzes the request for information and outlines EHB considerations.
This blog provides initial 2027 proposed Marketplace rate increases and discusses insurance carrier exits and federal policies that have impacted these rates.
This blog discusses the proposed and final Notice of Benefit & Payment Parameters for 2027 and its impact on insurance regulators and Marketplaces.
This blog explains vertical integration; its impact on consumers, employers, and clinicians; and federal bills designed to reduce market concentration.
This blog examines public comments from healthcare providers, hospital associations, physician organizations, and safety-net providers submitted to the Centers for Medicare & Medicaid Services in response to the proposed Notice of Benefit and Payment Parameters.
This blog examines public comments from consumer and patient advocate organizations submitted to the Centers for Medicare & Medicaid Services (CMS) in response to the proposed Notice of Benefit and Payment Parameters.
This blog examines public comments state departments of insurance, state-based Marketplaces, and other representative associations submitted to CMS in regard to the proposed 2027 rule.
This blog discusses the Consolidated Appropriations Act, its effect, and the new national provider identifier requirement.
This blog explains the drivers for site-neutrality payment reform and offers four domains to develop site-neutral policy.
This blog examines public comments health insurers, brokers, and other stakeholders submitted to CMS in regard to the proposed 2027 rule.
In this blog post, Georgetown Center on Health Insurance Reforms researchers provide context about recent federal price transparency efforts and summarize the major changes being proposed in the new Transparency in Coverage amendment.
his blog shares a fact sheet explaining how 2027 NBPP proposals intersect with existing statutory requirements and recent judicial decisions.
This blog posts tracks Medicaid-related bills that are under consideration in ten state legislative sessions.
This blog post highlights the decrease in prenatal care during the first trimester from 2021-2024 and takes a look at the state of prenatal care in Florida, Virginia, and New Hampshire.
This blog post discusses how non-network plans would violate ACA requirements and destabilize marketplaces, leaving consumers with fewer and more expensive coverage options.
This blog discusses surprise bills for ambulatory services and recommends reforms to address it.
This blog explains Medicare reimbursement for hospitals with varying classifications and current policy debates at the state and federal level.
This blog discusses how states are approaching medical debt and protecting patients from financial harm.
This blog offers a variety of reforms and strategies for state policymakers to use in healthcare affordability efforts such as billing regulation and price transparency.
This brief discusses the policy changes in CMS' proposed rule for Marketplaces, including impacts on state insurance departments.
This blog shares the impact and limitations of cost-growth benchmarks and recommendations for states to contain healthcare prices and improve affordability.
This blog discusses the effectiveness of mobile health and how states plan on implementing mobile health initiatives in their Rural Health Transformation Program applications.
This blog highlights why aligning coverage with evidence-based standards matters for better health outcomes.
This blog discusses Marketplace enrollment declines and the impact on healthcare affordability.
This blog discusses federal vaccine recommendations and how states are ensuring access to preventive care.
The Patients Deserve Price Transparency Act aims to improve billing-related information, increase employer access to sponsored health plan information, and build on existing federal transparency regulations.
This blog explains the impact of prior authorization on healthcare spending and discusses federal and state policy actions for reform.
This blog discusses existing protections and other policy reforms state policymakers can consider to protect consumers from costly and unpredictable facility fees.
This blog discusses Congressional proposals to extend or replace the enhanced premium tax credits and implications for consumers.
This blog shares state approaches for successful hospital price regulation to curtail spending growth and improve healthcare affordability.
This blog shares state approaches for hospital oversight, including price regulation and ownership transparency, to examine opportunities for healthcare affordability.
This blog guides policymakers on how to craft effective reforms to reduce hospital prices.
This blog discusses the impact of health insurance versus paying for care.
This blog discusses recent federal health policies and their effect on enrollment, health costs, and Individual Coverage Health Reimbursement Arrangements.
This blog discusses the Patients Deserve Price Tags Act and the strategies it uses to address certain healthcare challenges.
This blog shares insights on monitoring outpatient facility fees with state examples.
This blog discusses new changes to Marketplace enrollment and coverage due to federal policies, including reduced eligibility, affordability, and enrollment assistance.
This blog discusses the effects of not extending the enhanced premium tax credits, such as increased premiums and coverage losses.
This blog discuss the administrative hurdles to accessing marketplace coverage imposed by H.R.1 and the Marketplace Integrity and Affordability rule, which are expected to increase the number of uninsured people living in the United States.
This blog discusses the implications of the 2025 SCOTUS ruling on coverage of preventive services.
This blog discusses establishing legislation for hospital consolidation oversight with a state example.
This blog discusses how enrollees will face higher premiums and cost-sharing responsibilities should enhanced premium tax credits expire following the budget reconciliation bill's passage.
This brief provides findings about perceptions of FIM programs, including the program aspects respondents value the most.
This blog discusses the major Marketplace changes included in the reconciliation law and their impact.
This blog explains the role of ownership transparency in healthcare with state examples.
This blog explains Kentucky's removal of dental care from its proposed benchmark update, likely due to increased costs.
This blog shares the budget reconciliation's effect on diabetes coverage and treatment.
This blog provides background on price transparency implementation and updates for health systems.
This blog discusses the rise in use of independent resolution and its outcomes.
This blog discusses changes to CMS' Marketplace eligibility and enrollment systems.
This blog includes an interactive map for variations in dental coverage in health marketplaces across states.
This blog provides an analysis of independent dispute resolution trends and potential implications for future use.
This blog discusses how federal policy changes and the expiration of enhanced premium tax credits are affecting 2026 insurance rates.
This blog compares the House and Senate budget reconciliation proposals for Marketplace enrollment.
This blog discusses the single policy clarification related to broker accountability in CMS’ Marketplace integrity proposal and identified straight-forward, yet thus-far overlooked, ways to curtail broker misconduct.
This blog profiles Marketplace enrollees who would face obstacles in maintaining Marketplace coverage if the reconciliation bill becomes law.
This blog shares the rationale behind the new administration's funding cuts and highlights the gravity of reducing the Navigator program and outreach and enrollment assistance.
This blog discusses potential policies slated for the budget reconciliation package, which limit enrollment and increase administrative barriers.
This blog addresses rising concerns of TPA practices and how policymakers can intervene.
This blog pinpoints stakeholder challenges with price data and offers strategies to improve them.
This blog discusses how potential Medicaid policy changes will impact young adults with diabetes as they transition from their parents' coverage.
This blog analyses enrollment and participation in stand-alone dental plans through health Marketplaces and how state-specific policy decisions impacts them.
This blog discusses preventive services for infectious diseases covered by health insurance plans.
This blog documents comments from insurance brokers, healthcare providers, consumers, state Marketplaces, and departments of insurance on CMS' proposed "Marketplace Integrity" rule.
This blog discusses marketplace policy changes for Deferred Action for Childhood Arrivals recipients and considerations for a proposed rule that could reverse this coverage.
This blog summarizes recent action on EHB updates and adult dental coverage and discusses operational considerations for states.
This blog highlights the MHPAEA rule requirements for behavioral healthcare and use of “non-quantitative treatment limits."
This blog discusses the background and status of price transparency for healthcare services and the new executive order requirements.
This blog examines potential changes if CMS implements proposed changes to ACA marketplace and insurance rules.
This blog shares a report that provides a roadmap for states to design and maintain a successful rate review program.
This blog covers the implications of private-equity financial and operational decisions and policy reform to counteract decreased access to quality care as a result.
This blog outlines the regulations within the NBPP regarding fraudulent enrollment reductions and improvements to consumer plan choices.
This blog post analyzes Oklahoma and South Carolina's approach to provider-based reference pricing and its benefits, such as significant savings for members and state taxpayers.
This blog highlights how the updated complaints data report, qualifying payment amounts audit, and federal market reviews have shown that compliance with the NSA is effective.
This blog post outlines the recent proposals to cut ACA funding and implications for ACA marketplaces.
This guide provides a national overview of health insurance data and an interactive map of information about state agencies and coverage sources.
This blog examines the benefits of pro-competition reform in healthcare, such as innovation and better-value services.
This article reviews how states can shift the responsibility of accessing financial assistance away from patients and onto hospitals.
This presentation explores how increased transparency in healthcare can be leveraged by consumers, employers, researchers, and states in support of cost-containment efforts.
This blog reviews options for state policymakers seeking to advance healthcare transparency of prices, ownership, and billing to rein in commercial healthcare prices.
This article focuses on policies related to Marketplaces, insurance reforms, and Advance Premium Tax Credits (APTC).
This blog reviews Oregon’s response to the state's increase in healthcare spending and provider consolidation through state oversight of health system transactions.
This blog reviews the benefits of extending premium tax credits (PTCs) and the drawbacks of delaying their extension.
This blog highlights the aftermath of the Medicaid unwinding and state efforts to smooth coverage transitions.
This report reviews four states’ prior authorization policies for the commercial market, examines a range of state-level prior authorization reforms, and assesses how they affect patients, providers, and insurers.
This blog examines the assumptions and justifications behind the 2025 premium increases for individual and small-group market health plans in the District of Columbia (DC), Maine, Maryland, Oregon, and Vermont.
This blog discusses how states are promoting primary care in commercial investment and through other state agencies, and steps other states consider as they focus on setting primary care investment targets.
This blog reviews state legislation to regulate outpatient facility fees.
One of the proposed changes to the federal regulations that govern the ACA would permit states to require the coverage of adult dental services. This blog reviews comments submitted in response to the proposed 2025 Notice of Benefits and Payers Parameters by select stakeholder groups.
This blog shares a brief from the Commonwealth Fund, which reviews policy decisions by state-run Marketplaces and the federally facilitated Marketplace.
In this blog, CHIR shares findings from a 50-state assessment of insurance department authority to conduct rate review.
This blog discusses market reforms, Marketplace standards, and Advance Premium Tax Credit Policies in relation to HHS' 2025 Payment Rule.
This blog explores a few frequently asked questions about Marketplace coverage issues that LGBTQI+ individuals may face.
This blog highlights a new Commonwealth Fund post, which assesses the status of state efforts to smooth coverage transitions during the unwinding and discusses the need for more timely and accurate data.
This blog examines eligibility requirements for individuals interested in Marketplace coverage.
This blog highlights a new Commonwealth Fund brief, which documents the policies and practices State Based Marketplaces have implemented to facilitate access to health insurance information for Limited English Proficiency individuals and otherwise meet their needs.
This blog summarizes a number of new and ongoing policy changes that will impact the Marketplace as the annual open enrollment period for Affordable Care Act Marketplace coverage kicks off November 1 in most states.
This blog examines actions states are taking to fill in the gaps when it comes to protecting residents from medical debt.
This blog examines the current slate of proposals to reform abusive billing practices in the commercial market.
This blog examines New York and Minnesota’s experiences with the BHP and lessons for its design and implementation in other states.
This blog shares findings from a report that sheds light on HCMs.
This blog shares the findings of CHIR's research into the rate requests from select states with early rate filing deadlines to see what’s behind the premiums consumers could be facing in 2024, both on- and off-Marketplace.
This publication explores how Medicaid enrollees searching for new health plans on the private market are facing aggressive and misleading marketing of limited benefit products that often fail to protect consumers from the steep cost of healthcare.
This report analyzes current laws and regulations in 11 study states.
This report, and accompanying brief, explores outpatient facility fee billing in the commercial sector, including the impact of these fees on consumers and how states are responding.
This blog reviews the promise of price transparency as a tool to understand what is driving healthcare cost growth and target strategies to constrain it.
This blog examines systemic barriers to health care coverage that the LGBTQ+ community faces, and highlights a few key coverage and access issues that continue to impact LGBTQ+ individuals with private health insurance.
This blog discusses actions insurance regulators can take to hold providers accountable and meet affordability goals.
This blog compares Washington’s “selective procurement” approach with Colorado’s requirement that all carriers offer public option plans.
This blog reviews selected policies tied to the PHE and evaluates how their expiration will impact consumers’ access to services.
This blog focuses on market reforms and consumer assistance within the 2024 Notice of Benefit & Payment Parameters.
This blog discusses key themes underlying many of the 2024 rules including the administration's commitments to advancing health equity, improving the costumer experience, and expanding marketplace enrollment.
A key component of the No Surprises Act is the federal process for determining how much a patient’s insurer or health plan will pay an out-of-network facility or provider. This blog reviews how the independent dispute resolution (IDR) process is working to date.
This blog examines issues including network adequacy, door-to-door enrollment assistance, re-enrollment decision hierarchies, and standardized plans.
This blog examines comments about the NBPP from state departments of insurance and state-based marketplaces.
This blog discusses actions government officials have been taking to promote continuity of coverage to minimize the number of people who become uninsured or face a gap in coverage.
This blog reviews the primary drivers of the erosion occurring in ESI and identifies three recognized policy options to improve affordability: regulating prices, reducing anti-competitive behavior, and improving price transparency.
This blog highlights updates to the Center On Health Insurance Reforms' Navigator Resource Guide to help consumers and enrollment assisters during the unwinding.
This blog highlights the variety of activities undertaken to implement the family glitch fix.
This blog assesses proposed policy options designed to improve the affordability of ESI, the state of the evidence supporting or refuting the proposed policy change, and opportunities for adoptions.
On December 12, 2022, the Centers for Medicare & Medicaid Services released its proposed Notice of Benefit & Payment Parameters for plan year 2024. This blog assess provisions of the proposed rule that are of interest to state-based marketplaces regulators.
This blog delves into specific actions states can take to minimize gaps in coverage for consumers who become ineligible for Medicaid.
This blog looks into how the adequacy of these plans has been eroding over time, and it presents policy options that may control and reduce healthcare prices and alleviate the burden on many low-income working Americans.
This blog reviews a report published by the task force on recommendations for creating a “Bridge Program” by using Section 1331 of the Affordable Care Act (ACA), which authorizes state-based Basic Health Programs (BHP).
This blog discusses the delicate balance that must be achieved between different policy goals in the case that value assessment methodologies discriminate on the basis of race, color, national origin, age, disability, or sex.
This brief focuses on enforcement of parity requirements for “non-quantitative” treatment limits that insurers impose on enrollees, such as prior authorization requirements and medical necessity determinations.
This blog examines how states are working with the federal government to implement the No Surprises Act.
This brief includes recommendations researchers have made to policymakers to ensure the promise of MHPAEA is realized for patients across the country.
This blog includes a summary of these and other recent policy changes that consumers may encounter this year.
This blog discusses how these reforms could bring in up to $344 million to the state and decrease the uninsured rate among people eligible for but not enrolled in subsidized marketplace coverage by up to 12% over five years.
In this blog, CHIR’s Sabrina Corlette and Justin Giovannelli recap the legal issues in the case and outline options for states seeking to preserve consumers’ access to preventive services.
This blog discusses how federal regulators can put greater restrictions on short-term plans, including limiting their coverage duration and banning sales during open enrollment to prevent junk plan sales.
In this blog, Jack Hoadley, Kevin Lucia, and JoAnn Volk review the final rule and discuss its implications for state balance billing protections and oversight.
For the third time, the Department of Health and Human Services’ Office of Civil Rights (OCR) has issued a Notice of Proposed Rulemaking to effectuate the application of civil rights protections to the health care industry under Section 1557 of the Affordable Care Act (ACA). This blog discusses whether the rule, through a combination of timing, political will, and policy insight, will result in regulations with staying power.
This blog highlights the different approaches states are taking to expand affordable access to diabetes management and reduce disparities in care for diabetic patients.
This blog discusses how policy decisions can help chart a course to a proven method for reducing opioid mortality rates, and why lowering insurance-related barriers to MAT is key to ensuring access to this lifesaving care.
Amid rising healthcare costs, this blog explores how a public coverage option in the individual and small group Marketplace could help reduce costs and expand access to coverage for people with job-based insurance.
This blog examines insurers use of utilization management tactics, including prior authorization and claims review.
This blog details the Colorado public option, the significance of the 1332 waiver approval, projected impact on premiums and enrollment, and what this means for future state action.
With the premium tax credit expansion’s (PTC) sunset approaching, Congress has been considering passing an extension—first in the Build Back Better Act and more recently for potential inclusion in narrower reconciliation legislation. This blog explores cost and enrollment rates without an extension of the ARPA’s expanded PTC.
This blog explores why some are sounding the alarm and calling for better regulation to control costs and protect patients as private equity involvement in the healthcare industry increases.
This blog examines the landscape of marketplace race and ethnicity data and detail strategies state-based marketplaces can implement for the upcoming open enrollment period to improve data collection.
This blog analyzes the Centers for Medicare & Medicaid Services' final rules for provider network adequacy standards in the federal healthcare marketplaces and Medicaid.
This blog compares the standards for network adequacy in Medicaid with those in the marketplaces.
This blog examines how policymakers can increase access to abortion services.
This blog post reviews policy approaches to providing greater access to services that treat and manage mental health and substance use disorders (MH/SUD).
This blog provides updates focused on health insurance coverage, insurance markets, and how people are affected by insurance reform.
This blog answers questions about the ACA's "family glitch," a flawed regulatory interpretation that has created barriers to coverage. The current administration is currently working to correct this interpretation that prevents 4.8 to 5 million individuals from accessing more affordable health insurance.
This blog discuss the important role that ACA marketplaces will play in mitigating coverage losses as they prepare for the end of the Public Health Emergency and identifies basic as well as more innovative strategies marketplaces can adopt to help consumers make a smooth transition to affordable, comprehensive coverage.
This brief reviews the regulatory framework for network adequacy for Medicaid Managed Care Organizations and Marketplace qualified health plans and identifies policies and practices to ensure their networks include the number and mix of providers that enrollees need.
This blog summarizes feedback from representatives of consumer advocates, insurers, and state agencies on CMS' proposed annual Notice of Benefits and Payment Parameters, which updates regulations governing the Affordable Care Act’s marketplaces.
This blog explores data on Health Care Sharing Ministries (HCSM) operating in Massachusetts, due to a state requirement to regularly report on enrollment, membership fees, and other information about HCSM operations and finances.
This blog analyzes comments submitted by state departments of insurance and state-based marketplaces to better understand the impact of The Centers for Medicare & Medicaid Services recently proposed set of rules governing the marketplaces and health insurance standards for next year.
This blog explores the obstacles consumers have faced obtaining free preventive services since the Affordable Care Act (ACA) was enacted in 2010.
This blog explores how CMS's proposal to resurrect and revise its previous initiative that encouraged health insurance companies selling plans in the federally facilitated marketplace (FFM) would impact consumers.
This report builds on The Oregon Health Authority (OHA) ’ draft “Recommendation Memo,” to make a public health insurance option available in the individual market and, potentially, the small group market as well.
This blog explores value-based, alternative payment models as employer-sponsored health insurance costs have increased by 6.3 percent in the United States since 2010, with additional increases projected.
This brief explores whether insurance shoppers are still being directed towards alternative coverage at a time when the Affordable Care Act coverage was broadly available and more affordable than ever because of the enhanced premium subsidies under the American Rescue Plan Act.
This expert perspective summarizes the provisions of the No Surprises Act relating to air ambulances and notes particular implications for state regulators and marketplace officials.
This blog describes how the American Rescue Plan Act expanded access to affordable health insurance coverage in a variety of ways.
This report analyzes states’ experiences trying to resolve surprise medical payment disputes between health care providers and insurers.
This commentary discusses the importance of waiving costs for COVID-19 testing.
This commentary explores the high levels of profitability insurers have seen in 2020.
This guide provides answers to frequently asked questions about selecting and using health insurance coverage and applying for financial help for 2021's open enrollment period.
This commentary examines how proposals to protect patients from aggressive medical debt collection during the COVID-19 pandemic could serve as a model for the future.
This commentary discusses how potential requirements for workplace coronavirus testing may force essential workers to bear a disproportionate share of the cost.
This commentary outlines recent data that examines how difficult it will be to predict the effect of the COVID-19 pandemic on the uninsured rate.
This commentary outlines how state legislative sessions took a hit this year from the novel coronavirus pandemic.
This commentary assesses how insurers are developing their 2021 premium rates by reviewing preliminary actuarial findings in the District of Columbia, New York, Oregon, Vermont, and Washington.
This commentary compiles thoughts from navigators across five states using the federally-facilitated marketplace about how they are faring during the COVID-19 pandemic.
This blog posts pulls together frequently asked questions about the novel coronavirus to help guide Navigators, brokers, assisters, and consumers through this complex and trying time.
In this report, researchers reviewed laws and interviewed state officials and insurers in six states—California, Georgia, Massachusetts, North Carolina, Pennsylvania, and Texas—to determine current policies and best practices to protect patients from disruptions in services and financial burdens as a result of disputes between providers and payers.
This guide is a practical, hands-on resource to help assisters and consumers navigate this enrollment season.
This report investigates what is motivating states to transition to full state-based marketplace status, assesses the benefits and risks of such a switch, and identifies considerations for other states considering a similar move.
This commentary outlines ways in which Congress can look to actions by state-level policymakers for guidance on how to achieve legislative compromise on balance billing.
In this report, insurance experts share findings from a case assessing New York’s experience with its Surprise Billing law, five years in.
This commentary provides a brief background on the recent litigation surrounding cost sharing reductions, including executive actions, and state and insurer responses, as well as what could happen next.
Alaska, Minnesota and Oregon were the first to gain approval and federal funding to implement their own reinsurance programs under a 1332 waiver. This issue brief assesses their progress and lessons learned to date.
In response to President Trump’s October 12 executive order (EO), the U.S. Department of Labor (DOL) published proposed rules to expand the availability of health coverage sold through associations to small businesses and self-employed individuals. The full brief provides state health officials with a detailed review of the content of the proposed rule and examines the implications for states.
This report examines six states that faced the prospect of bare counties for 2018: Iowa, Nevada, Ohio, Oklahoma, Tennessee, and Washington.
This report discusses the scope of state authority and tools available to ensure that consumers living within their borders benefit from the insurance protections promised under federal law. It also discusses specific statutory and administrative options for states in the event of selected possible federal administrative actions, including a: Rollback of the essential health benefits; relaxation of marketplace health plan oversight; re-definition of what constitutes minimum essential coverage; loosening of medical loss ratio standards; and an expansion of off-marketplace enrollment opportunities.