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.
More than 40% of counties could see only one exchange plan in 2018, with risk that some counties may have no commercial options.
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.
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).
All 50 states and DC would receive fewer Medicaid dollars for non-disabled children.
The elimination of cost-sharing reductions could lead to low-income individuals facing higher deductibles and maximum out-of-pockets.
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.
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.
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.
Capping Medicaid funding could also shift costs to Medicare
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.
The 21st Century Cures Act requirement to post compassionate use policies may explain increase.
Avalere experts examine proposed key reforms to the ACA and its potential impacts.
New research from Avalere finds that under the American Health Care Act (AHCA), large states as well as those states with fewer insurers offering plans in the individual and small group markets could receive the most money from the federal government to help stabilize their markets.
Low-income and older individuals would incur higher penalties for failing to purchase health insurance, compared to current individual mandate.
Avalere 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).
Extension of the Sunset Clause provides additional opportunity for the FDA to award vouchers and for transference of vouchers from recipients to other sponsors.
Today, the Trump administration released a proposed rule for market stabilization of the Affordable Care Act (ACA).
Analysis shows Medicaid block grants and per capita caps could result in state budget gaps.
Avalere 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 Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
Plans sold in exchange markets in 2017 feature higher premiums, growing consumer out-of-pocket costs, and more restricted access to providers and hospitals than in previous years, according to a new analysis from Avalere.