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
Beneficiaries in Specialized Diabetes-Focused Medicare Plans Have Fewer Hospitalizations
Compared to beneficiaries with diabetes who are enrolled in other Medicare Advantage plans, enrollees in special needs plans experience better outcomes, after adjusting for demographic and clinical factors.
Avalere’s Take on the MA/PD Landscape Files Release
The Centers for Medicare & Medicaid Services (CMS) just released the annual Landscape Files containing data on plan participation, beneficiary premiums, and benefit designs for the 2018 Part D — Medicare's prescription drug benefit — and Medicare Advantage (MA) markets.
Updated Analysis: Revised Graham-Cassidy Bill Would Reduce Federal Funding to States by $205B
Avalere has updated its previous analysis to reflect the September 25 version of the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA).
Graham-Cassidy-Heller-Johnson Bill Would Reduce Medicaid Funds to States by $713B Over the Next 10 Years
New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a substantial reduction in federal Medicaid funding to states of $713B through 2026 and more than $3.5T over a 20-year period if block grant funding is not reauthorized (Figure 1).
Graham-Cassidy-Heller-Johnson Bill Would Reduce Federal Funding to States by $215B
New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a reduction in federal funding to states by $215B through 2026 and more than $4T over a 20-year period (Table 1).
Exchange Reinsurance Stabilization Package Could Reduce 2018 Premiums by 17%
Market stabilization efforts could also lead to higher enrollment in exchanges.
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.