Federal & State Policy
As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal and state policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Featured Content
Podcast: E2 – Key Mid-Term Elections Driving Medicaid Expansion to Watch
Tune in for episode 2 of our mid-term elections podcast. Avalere experts, Chris Sloan and Tiernan Meyer, discuss potential state and federal-level scenarios for Medicaid expansion.
Podcast: E1 – Impacts the Mid-Term Elections Could Have on Pre-Existing Conditions
Tune in to hear the first episode in our 3-part series covering the mid-term elections and potential implications on health policy. Avalere expert, Chris Sloan, discusses potential implications of the mid-term elections on health policy. To kick off the series Avalere Founder, Dan Mendelson, covers pre-existing conditions.
2.7 Million People Could Gain Access to Medicaid Coverage Based on Outlook for State Elections
New analysis from Avalere finds that 2.7 million individuals from states that have not expanded Medicaid could gain Medicaid coverage should their newly elected governors decide to expand the program or states pass expansion referenda on their ballots.
Repeal of ACA’s Pre-Existing Condition Protections Could Affect Health Security of Over 100 Million People
New analysis from Avalere finds that 102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs if the ACA’s pre-existing condition protections were repealed.
Podcast: E1 – New Supplemental Benefits Offered Through Medicare Advantage Plans
In episode 1 of our series Fred Bentley, Sean Creighton, and Kenny Kan discuss the new supplemental benefits offered through Medicare Advantage plans for 2019.
Impact of CMS Changes to the Medicare Advantage Risk-Adjustment Models
Our analysis finds there will be winners and losers at the plan level under the new models.
Avalere Observations: 2018 Election Cycle and the Outlook for Health Policy
With the 2018 mid-term elections weeks away, polls show healthcare is a top issue on the minds of voters.
CMS 2019 Star Ratings Remain Stable for MA-PD Plans, Shift for PDPs
Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.
Medicare Advantage Beneficiaries Will See a Jump in New Supplemental Benefit Offerings in 2019
MA plans expand coverage of supplemental benefits following administration’s policy change.
Rheumatoid Arthritis Patients Could Face Access Barriers Under Proposal to Address Drug Prices
New research from Avalere finds that Medicare patients with rheumatoid arthritis (RA) may face higher out-of-pocket costs under a proposal to move Medicare Part B drugs into Part D, absent additional policy change to lower cost sharing in the Part D program.
California Becomes the 6th State to Restrict Short-Term Plans in 2018
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.
2019 Premium Increases Lowest on Average Since 2015
Average premiums projected to grow 3.1% heading into next year.
CMS Proposal Would Alter Office Visit Payments
In its proposed changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year 2019 (CY2019), the Centers for Medicare & Medicaid Services (CMS) proposes a potentially sweeping change to the way it values physician office and outpatient visits, also known as Evaluation & Management (E/M) codes.
Medicare Advantage Achieves Better Health Outcomes and Lower Utilization of High-Cost Services Compared to Fee-for-Service Medicare
New research from Avalere finds that Medicare Advantage (MA) beneficiaries with hypertension, hyperlipidemia, and diabetes experienced significantly fewer inpatient stays and emergency room visits relative to those in traditional fee-for-service (FFS) Medicare.
CMS Rejects Massachusetts’ Medicaid Closed Formulary Proposal
On June 27, CMS notified Massachusetts of a partial approval of the MassHealth program’s proposed 1115 waiver request.
Final Rule Lowers Barriers to Forming and Joining Association Health Plans
On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).
Double-Digit Premium Increases Expected in the Exchange Market in 2019
2019 rate filings suggest increased competition and plan choice
CMS Expands Benefit Flexibilities in Medicare Advantage
Earlier this year, the administration granted Medicare Advantage plans greater flexibility to target benefit designs for individuals with certain high-risk health conditions. These changes are expected to position the program for continued growth.
Medicare Trustees Report Triggers Program Funding Warning
In its 2018 Report, the Medicare Trustees issued a Medicare funding warning, citing concerns over the program's near-term financial health and spending impact on the federal budget.
Seniors Pay More for Medicare Part D Generics Despite Stable Prices
Avalere analysis finds that price of generic drugs has remained flat but the cost to seniors is increasing.
