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
Exchange Plans in Counties with the Least Insurer Competition Have the Highest Premiums
Benefit designs do not vary widely based on insurer competition, except for deductibles that are lower in areas with three or more insurers.
FDARA Builds on Progress in Expanded Access
The FDA Reauthorization Act of 2017 (FDARA), which was signed into law on August 18, 2017, calls on FDA to examine underlying barriers to access to investigational drugs.
Our Take on the Senate Passage of the FDA User Fee Reauthorization Bill
Today, the Senate voted to pass H.R.2430, the FDA Reauthorization Act of 2017.
Part D Premiums Update: What You Need to Know
On July 31, the Centers for Medicare & Medicaid Services (CMS) announced that the base Part D premium will be $35 for 2018.
Cruz Amendment to BCRA Would Lead to Coverage Losses and Increased Premiums for Individuals with Higher Medical Expense
Affordable Care Act-compliant plan market would see 39% higher premiums, while non–ACA-compliant plans would have much lower premiums
Elizabeth Carpenter to Present at NGA Summer Meeting
Elizabeth Carpenter, Senior Vice President, will present on July 15 at the National Governors Association Summer Meeting in Providence, RI, in a governors-only session entitled “The Future of Health Care.”
Update on The Medicare Trustee’s Report: IPAB Is Not Triggered
Today, the Medicare Trustees delivered to Congress their annual report on the financial operations and status of the program.
Medicaid Funding Reform: Impact on Dual-Eligible Beneficiaries
The Better Care Reconciliation Act (BCRA) would cap Medicaid funding to states. In this analysis, Avalere worked with The SCAN Foundation to examine how BCRA Medicaid changes would impact dual-eligible beneficiaries. We compare these outcomes to the impact of the House-approved American Health Care Act.
Senate Health Bill to Reduce Federal Medicaid Funding to States
New analysis from Avalere finds that states could see federal funding for their Medicaid programs decline by between 6% and 26% under the Better Care Reconciliation Act (BCRA) by 2026.
21st Century Cures: What to Expect This Summer
The 21st Century Cures Act presents medical product manufacturers, patient groups, and advocacy organizations with a unique opportunity to plan for upcoming policy changes that are aimed at accelerating the pace of development and approval of new therapies.
Premium Increases and Fewer Insurers Participating Expected in Exchange Market in 2018
More than 40% of counties could see only one exchange plan in 2018, with risk that some counties may have no commercial options.
Our Take on The President’s Budget for Fiscal Year 2018
Today, the Trump Administration released its budget for fiscal year 2018 (FY 2018). The budget provides the President's recommendations for how the Congress should fund the government and marks the beginning of the FY 2018 budget season.
VA Formulary Coverage Much More Limited than Ohio Medicaid
Across 8 therapeutic areas, the Veteran's Administration (VA) National Formulary covers 49 percent fewer drugs than Ohio's largest Medicaid managed care plan and 68 percent fewer drugs than the Ohio Medicaid preferred drug list (PDL).
Per Capita Caps Could Reduce Funding for Children Covered by Medicaid
All 50 states and DC would receive fewer Medicaid dollars for non-disabled children.
AHCA Will Remove Low Cost-Sharing Guarantees for Low-Income Individuals
The elimination of cost-sharing reductions could lead to low-income individuals facing higher deductibles and maximum out-of-pockets.
Medicare Advantage Patients Less Likely to Use Post-Acute Care
New analysis from Avalere finds that Medicare Advantage (MA) patients use fewer post-acute care services after being discharged from the hospital compared to traditional Medicare fee-for-service (FFS) patients.
Proposed High-Risk Pool Funding Likely Insufficient to Cover Insurance Needs for Individuals with Pre-Existing Conditions
Funding earmarked for high risk pools in the American Health Care Act will cover five percent of the total number of enrollees with pre-existing chronic conditions in the individual market today.
Avalere Deepens Expertise in Medicare Advantage Payment Systems with Hire of Sean Creighton
Sean Creighton has joined the Avalere team as a vice president in the policy practice, and will be responsible for leading advisory services work tied to Medicare Advantage, risk adjustment, and related issues.
Medicaid Per Capita Caps Could Cut Funding for Dual-Eligible Beneficiaries
Capping Medicaid funding could also shift costs to Medicare
Avalere’s Take on the Market Stabilization Final Rule
Today, the Centers for Medicare & Medicaid Services (CMS) released its final rule for market stabilization of the health insurance exchanges, following the departure of some health plans from the marketplace for the upcoming plan year.