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
Landscape for Diagnostics Will Continue to Change in 2019
While precision medicine is expected to revolutionize patient therapy, the increasing complexity of diagnostics is leading policymakers to revamp the way these tests are regulated and paid for.
Podcast: Key Takeaways on the Ruling Declaring the Affordable Care Act Unconstitutional
Listen to Avalere experts discuss the implications for a recent decision ruling the Affordable Care Act is Unconstitutional.
New HRA Rule Could Reshape Enrollment and Access in Individual and Employer Markets
A proposed rule released by the Treasury Department, Department of Labor, and Department of Health and Human Services would expand the allowed uses of employer-sponsored Health Reimbursement Arrangements (HRA). Comments on the rule can be submitted until December 28, 2018.
Free Exchange Plan Options Are Available in Most Counties for 2019
New analysis from Avalere finds that over 95% of counties with exchanges operated by HealthCare.gov have free plan options for low-income consumers.
Health Plans with More Restrictive Provider Networks Continue to Dominate the Exchange Market
Narrow network plans comprise nearly three-quarters of the exchange market.
Out-of-Pocket Costs for Oncology Drugs Vary Substantially Between Employer and Non-Employer Based Part D Plans
New Avalere analysis finds that beneficiaries enrolled in Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for select drugs than beneficiaries enrolled in other types of Part D plans.
Podcast: E3 – Trends in Health Policy and the Mid-Term Elections Results
Tune in to the last episode of our mid-term elections series to hear Avalere experts Chris Sloan and Elizabeth Carpenter discuss potential implications on health policy.
New Opioid Law Takes Broad Aim at Opioid Crisis
The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, signed into law on October 24, 2018, takes aim at the opioid crisis from multiple angles.
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.
Access to Abuse-Deterrent Opioid Formulations Tied to Reduced Risk of Opioid Abuse and Overdose
New Avalere research finds that health plan members enrolled in plans that cover abuse-deterrent formulations (ADFs) of opioids have a lower risk of opioid abuse (OA) and overdose (OD) and lower opioid abuse-related hospitalizations than people in plans that do not offer coverage of ADF opioids.
Trends in Opioid Use: History, Background, and Origins of the Epidemic
Shift in clinical practice as far back as 30 years ago planted the seeds for the current opioid epidemic. New research by Avalere Health finds that between the mid-1980s and 1990s, individual pharmaceutical manufacturers, national scientific bodies, and professional societies began a push to treat pain more aggressively.
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.
CMS HCC Risk Adjustment Model 2019: Winners & Losers
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.
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.