Lindley and Matthew R.
Legislative battles in Congress, fluctuating support from healthcare stakeholders, and threats of repeal have left many payers facing an uncertain future. Lawmakers have already removed several key pillars of the legislation, including the individual mandate and the cost-sharing reductions, while adding uncertainty through alternative coverage pathways like association health plans AHPs.
The open enrollment period saw 8. But in the coming year, payers should expect the changes in the ACA to impact premium rates, add challenges to the individual health plan market, and adjust how states leverage customized solutions for their Medicaid programs.
Here are some of the most significant changes to the health insurance market from and how they are likely to impact payers in the year ahead.
The Academy believes that healthy individuals will less likely to enroll in a health plan because they will not be penalized for not having coverage. Without a higher number of healthy members to stabilize risk pools, premiums will go up as the balance shifts towards less healthy, higher-cost beneficiaries.
Payers are expected to lose millions of potential beneficiaries in the individual market over a ten-year period due to the removal of the mandate. Previously, the funds had offset increases in consumer premiums needed to keep health plans financially profitable while compensating for the pre-existing conditions protections of the ACA.
A USC Brookings report found that payers in individual markets experienced only moderate premium growth of around 6. However, without the CSRs, premiums are expected to grow by 20 percent for individual health plans.
Additionally, the USC Brookings team found that claims spending in would have accounted for 86 percent of earned premium revenues. Individual health plan premiums would have only required an increase by 4 percent to maintain profitability and account for increases in claims costs.
Many payers sponsoring individual health plans recently hiked their premium rates as a way to compensate for the loss of the CSRs. Pennsylvania cited premium rate increases of 30 percent, California had payers that increased premiums by 12 percent, and Washington state approved multiple rate increases that ranged from 9 to 27 percent.
State governments can use the waivers to expand Medicaid eligibility or constrict member eligibility requirements. Missouri, Vermont, and New Jersey have waivers that expand federal poverty level FPL guidelines for populations with economic healthcare barriers.
Conversely, other waivers would allow state governments to add accountability requirements for individuals seeking Medicaid benefits. For example, the state of Maine submitted a waiver that adds work requirementscharges individuals for missed healthcare appointments, and offers lower copays when beneficiaries utilize an urgent care center or primary care provider instead of the ED.
States also use the waivers to address wide-reaching population health concerns.
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Many states have supported or pursued waiver approvals that increase the number of beds in drug treatment facilities and allow their Medicaid programs to facilitate substance use disorder SUD treatments. Expansion of association health plan availability In October, President Trump issued an executive order that increases the length of time association health plans AHPs can cover individuals.
The order also allows individuals to pay for AHP coverage with health reimbursement agreements like HSAs and related savings accounts. Association health plans have low-cost consumer premiums but are not required to provide EHBs.
The appeal of AHPs could also justify employers and individual health plans in raising premiums to offset expected costs of unbalanced risk pools, the organizations added. The individual health plan market could still present a great opportunity for payers, but may require a new set of solutions that limit profitability concerns as well as premium increases.Full Text of the Affordable Care Act and Reconciliation Act; Certified Full-panel-body Version: Affordable Care Act Certified Full-panel-body Version: Reconciliation Act The first link listed above contains the full panel-body of the Affordable Care Act and the Health Care and Education Reconciliation Act of in one document.
Health care prices in the United States describes market and non-market factors that determine pricing, along with possible causes as to why prices are higher than other countries.
Compared to other OECD countries, U.S.
healthcare costs are one-third higher or more relative to the size of the economy (GDP). According to the CDC, during health expenditures per-person were nearly $10, on. Hospital Assistance. Hospitals face the fiscal burden of managing uncompensated care unless they leverage the Advocacy based program provided by DECO.
The Center for Medicare Advocacy, is a national nonprofit, nonpartisan law organization that provides education, advocacy and legal assistance to help older people and people with disabilities obtain fair access to Medicare and quality health care.
Nov 05, · The Affordable Care Act contains comprehensive health insurance reforms and includes tax provisions that affect individuals, families, businesses, insurers, tax-exempt organizations and government entities. As the Affordable Care Act (ACA) moves toward its key implementation phase next year, this massive law is starting to affect physicians’ incomes in a variety of ways.
In January , the ACA will carry out the largest insurance coverage expansion since and make historic changes in the way that insurers operate.