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Surprise medical bills, which were already a concern for many consumers, are expected to increase because of the coronavirus crisis. While Congress should adopt a comprehensive solution for all patients, protecting those affected by coronavirus is critical and should be done quickly. In a post for the Health Affairs Blog, Jack Hoadley, Kevin Lucia, and Katie Keith propose an immediate, short-term solution that Congress could adopt now to protect patients from surprise bills due to coronavirus. .
In the midst of a global pandemic, consumers continue to be sold skimpy short-term plans that may not cover necessary testing and treatment. In their latest post for the Commonwealth Fund's To the Point blog, Dania Palanker and Christina Goe assess the ability of insurance regulators to understand the scope of the short-term plan market in their states and its impact on consumers' ability to access and afford care. .
The novel coronavirus, also known as COVID-19, has been the cause of confusion and anxiety for individuals and families across the country, especially when it comes to health care. We’ve pulled together some frequently asked questions, and added new COVID-19-specific inquiries, from our Navigator Resource Guide to help guide Navigators, brokers, assisters, and consumers through this complex and trying time. .
Small businesses have historically struggled to provide coverage to their workers. The ACA sought to address these issues through the Small Business Health Options Program (SHOP), creating marketplaces for small employers to offer coverage to their employees. In a new post for the Commonwealth Fund’s To the Point blog, CHIR experts take a look at ways that state-based marketplaces are investing in their SHOPs, and how some are seeing enrollment growth and savings for small businesses. .
The past few weeks have tested the U.S. health care system, exposing major gaps in access to testing and treatment of the novel coronavirus disease. In a world where we are all at risk of contracting and spreading COVID-19, it is abundantly clear that access to health care is a universal human need. However, under our current system, insurance coverage is not a guarantee. Still, facing this pandemic would have been even more difficult if it weren’t for the Affordable Care Act. .
High profile contract disputes between insurers and providers appear to be on the rise, raising the risks of disruptions for patients and unexpected out-of-network billing. In a new report for the Robert Wood Johnson Foundation, CHIR experts examine best practices among state regulators and insurers to protect consumers and provide recommended policies and procedures to mitigate risks when a provider leaves a health plan network. .
The cost of medical care associated with the novel coronavirus can be a barrier for many people who should get tested, raising a public health risk. Given our patchwork quilt system of health insurance coverage and the lack of a timely and comprehensive federal response, CHIR's Sabrina Corlette and Kevin Lucia consider actions states can take to encourage people to get the care they need. .
President Donald Trump has voiced an “ironclad pledge” to protect patients with pre-existing conditions, but his 2021 budget proposal, which repeats this promise, is silent on how he would do that. At the same time, the Trump administration has taken numerous actions that undermine the Affordable Care Act, including its support of a lawsuit to overturn the ACA and its key protections for people with pre-existing conditions. .
As Congress and a number of states craft legislation to protect consumers from surprise out-of-network billing, a critical issue is resolving how insurers will pay out-of-network providers for their services. In their latest post for the Commonwealth Fund's To the Point blog, CHIR's Jack Hoadley and Maanasa Kona assess the experience of states that use an independent dispute resolution process to determine these payments. .
The thorniest issue in pending legislation to protect consumers from surprise medical billing is how to resolve disputes between payers and providers over appropriate payment. In their latest post for the Commonwealth Fund's To the Point blog, CHIR experts Maanasa Kona, Jack Hoadley, and Katie Keith examine the seven states that have adopted a payment standard for out-of-network bills. .
In the last year, state regulators have stepped up their scrutiny of health care sharing ministries to warn consumers of their limits. In a new post for the Commonwealth Fund’s To the Point blog, CHIR's JoAnn Volk and Justin Giovannelli look at recent state action to protect consumers from the risks of health care sharing ministries and map out other options for states to step up their scrutiny of these arrangements. .
Congressional leaders are racing to meet a self-imposed May deadline for passing legislation to protect consumers from surprise medical billing. In their latest post for the Commonwealth Fund's To the Point blog, Jack Hoadley, Beth Fuchs, and Kevin Lucia identify key similarities and differences among competing proposals, and provide a comprehensive side-by-side guide to the key committee bills. .
The Trump administration's proposed rule governing the Affordable Care Act insurance markets for 2021 has been published, and comments are due from the public by March 2, 2020. In her latest article for the State Health & Value Strategies program, CHIR's Sabrina Corlette provides a detailed overview of changes proposed in the rule, with a focus on the implications for state departments of insurance and the health insurance marketplaces. .
For several years, we at CHIR have tracked health insurance industry trends by monitoring trade and mass media, Wall Street analyses, earnings, and other reports. In 2019, we observed an increase in reporting on contract disputes between health insurers and providers. These discussions are becoming more contentious as insurers face mounting pressure to rein in health care costs while ensuring consumers’ access to providers. Before consumers get caught in the crosshairs of these disagreements, insurers and providers need to establish best practices for reducing the risks to enrollees when negotiations fail or drag out for an extended period. .
In Congress and state legislatures across the country, policymakers are debating fixes to surprise medical bills. The federal government has yet to enact comprehensive reforms, but a number of states have taken steps to protect consumers. One such state is Texas, which last year enacted a new law holding consumers harmless in situations that commonly lead to surprise medical bills. However, Texas’ experience presents a cautionary tale for federal and state policymakers. CHIR’s Rachel Schwab takes a look at how previously proposed rules would have created a huge loophole in the law, and how new regulatory efforts better address consumer protection concerns. .

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