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.
New analysis from Avalere finds that the proposed rule on association health plans (AHPs) is projected to lead to 3.2M enrollees shifting out of the Affordable Care Act's (ACA) individual and small group markets into AHPs by 2022.
On February 9, the Senate voted to pass the Bipartisan Budget Act of 2018, which funds the government through March 23, lifts spending caps for 2 years, and suspends the debt ceiling until March 2019.
Today, the Trump Administration released its budget for fiscal year 2019 (FY 2019).
Avalere experts provide their insights on what the impact of coverage gap discount changes in budget agreement.
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released Part II of the Advance Notice and Call Letter (ANCL), describing the Agency's proposed 2019 payment policies and other policy updates for the upcoming plan year for Medicare Advantage (MA) and Part D plans.
Rural hospitals will see an average 2.7% net increase of Part B payments.
Beneficiaries show signs of pent-up demand with acute healthcare needs early in their enrollment, but over time costs increase substantially and shift toward chronic care.
On January 4, the Department of Labor (DOL) issued a proposed rule to allow certain self-employed individuals, small businesses, and large businesses, including as part of a professional/trade organization or chamber of commerce, to band together to provide health insurance for their employees and their dependents.
At 100% of the OEP, we are at 96% of total Healthcare.gov enrollment compared to 2017 (8.8M n 2018 compared to 9.2M in 2017).
In its new regulatory framework for regenerative medicines released in November 2017, FDA takes a flexible approach, creating opportunity for manufacturers.
Analysis also finds that 62% of impacted facilities will experience less than a 5% reduction in Medicare Part B revenue due to the drug cuts, but 6% of applicable hospitals will experience cuts greater than 10%.
New analysis by Avalere examines the impact of two market stabilization proposals-funding the cost-sharing reductions (CSRs) and implementing a federal reinsurance program-on individual market premiums and enrollment.
Deductibles remain high, nearing $4,000 on average for silver plans.
If federal government permits states to expand Medicaid to only 100% of poverty, nearly 4M people could shift from Medicaid to exchanges, and 7M could be newly eligible for coverage.
New analysis from Avalere finds that nearly 98% of counties with exchanges operated by HealthCare.gov will have free bronze plan options for low-income consumers aged 50 earning 150% of poverty or less ($18,090 for an individual or $36,900 for a family of four).
This past Friday, the Centers for Medicare & Medicaid Services released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.
In February 2017, Avalere, an Inovalon company, analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
New analysis from Avalere finds that the 2018 exchange market will see silver premiums rise by an average of 34%. According to Avalere's analysis of filings from Healthcare.gov states, exchange premiums for the most popular type of exchange plan (silver) will be 34% higher, on average, compared to last year.
Avalere experts preview the 2018 ACA open enrollment season
New analysis from Avalere finds that the administration's decision last week to end federal funding for the cost-sharing reduction (CSR) payments could lead to substantial losses for health plans-ranging from -$1.2M in North Dakota to -$200M in Florida through the end of 2017 (Figure 1).