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
Avalere Analysis Shows That Health Needs and Cost of Medicaid Expansion Populations Grow over Time
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.
What Are Association Health Plans?
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.
Final 2018 Exchange Enrollment Numbers
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).
FDA Prepares for the Next Generation of Regenerative Medicines
In its new regulatory framework for regenerative medicines released in November 2017, FDA takes a flexible approach, creating opportunity for manufacturers.
California, North Carolina, and New York Will See the Largest Provider Payment Cuts and Beneficiary Savings Due to 340B Program Changes
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%.
Funding Reinsurance and Cost-Sharing Reductions Would Lower Individual Market Premiums and Increase Enrollment
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.
Plans with More Restrictive Networks Comprise 73% of Exchange Market
Deductibles remain high, nearing $4,000 on average for silver plans.
Broader Federal Flexibility for Medicaid Expansion Rules Could Increase Coverage in Both Medicaid and Exchanges
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.
Most Counties Will Have Free 2018 Exchange Plans for Low-Income Enrollees
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).
Our Take on the NBPP Proposed Rule
This past Friday, the Centers for Medicare & Medicaid Services released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.
Impact Evaluation: Medicare Advantage Transition from RAPS to EDS
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).
Silver Exchange Premiums Rise 34% on Average in 2018
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.
Uncertainty Reigns as Consumers Begin to Make Health Insurance Decisions for 2018
Avalere experts preview the 2018 ACA open enrollment season
Administration’s Decision to End Cost-Sharing Reduction Payments Will Lead to Substantial 2017 Losses for Health Plans
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).
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.