Federal 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 policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Featured Content
Consumer Costs Continue to Increase in 2017 Exchanges
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.
Podcast: E1 – How 21st Century Cures May Impact Health Plans in 2017
The final signing of the 21st Century Cures Act is the culmination of three years of efforts by lawmakers in the House and Senate to expedite developing and making available new treatment options. Listen to Cara Kelly break down the impacts in episode 1 of our series on 21st Cures.
What You Need to Know About Today’s Cures Vote
Today, the House will vote on the updated version of the 21st Century Cures Act, H.R. 34.
Plan Participation and Premium Growth in 2017 Exchanges
As 2017 exchange open enrollment begins, Avalere examined marketplace changes in plan choice and premiums at the county level.
Webinar: The 2016 Elections Impact on Healthcare Policy
With expanded administrative authority and flexibility to advance policy priorities through entities such as CMMI and IPAB, the new administration will shape the future of the Affordable Care Act, potential drug pricing reforms, and potential action on tax and/or entitlements.
2017 Open Enrollment Preview
2017 exchanges struggle to address challenges with enrollment, risk management, and consumer choice.
CORRECTION: Premium Increases for Most Popular Medicare Drug Benefit Plans, Market for Medicare Advantage Plans Appears Stable in 2017
According to a new Avalere analysis of data from the Centers for Medicare & Medicaid Services (CMS), premiums for stand-alone prescription drug plans (PDPs) will increase and the number of PDPs available in 2017 will decrease. Conversely, the Medicare Advantage market appears strong as 8 in 10 beneficiaries have access to MA plans that offer prescription drug benefits with a zero premium.
Health Insurance Is a Good Buy to Protect Against Significant Financial Risk for a Range of Common Health Conditions
A new analysis from Avalere finds that consumers with a range of common health conditions could reduce their spending between $8,800 and $90,020 by purchasing insurance through the Affordable Care Act (ACA).
Consumers Enrolling in Exchanges through Special Enrollment Periods Have Higher Costs, Lower Risk Scores, than Open Enrollment Consumers
A new analysis from Avalere finds that individuals who enroll in exchange coverage during special enrollment periods (SEP) have higher costs and lower risk scores than open enrollment period (OEP) consumers.
Avalere Analysis on Recently Released 2017 Medicare Advantage Landscape Files
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 2017 Part D and Medicare Advantage (MA) markets. Avalere offers the following observations on key trends in the MA and Part D programs that are likely to influence the 2017 market.
Webinar: Navigating the Exchange Market: Policy Updates and Strategies for Mitigating Risk
Earler this month, the Obama Administration released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year. Meanwhile, the exchange market faces instability. Recent Avalere analysis finds that more than one-third of rating regions may have only one insurance carrier participating on the exchange in 2017.
Avalere Analysis on MedPAC’s Proposed Part D Reforms to Modify Beneficiary Cost Sharing
Avalere recently analyzed two different Part D policy proposals outlined in The Medicare Payment Advisory Commission (MedPAC) June 2016 report to Congress.
CMS Takes on Risk Adjustment in Latest NBPP Proposal
In late August, CMS released its proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year.
What are the ACA Enrollment Figures for 2016?
Recently, Avalere worked with the Council for Affordable Health Coverage to examine enrollment trends for the Affordable Care Act (ACA).
Experts Predict Sharp Decline in Competition across the ACA Exchanges
Avalere experts predict that one-third of the country will have no exchange plan competition in 2017, leaving consumers with few options for coverage.
The Inpatient Prospective Payment Systems (IPPS) FY 2017 Overview
Last Tuesday, August 2, the Centers for Medicare & Medicaid Services (CMS) released the FY 2017 IPPS final rule
Outpatient Services Are the Largest Driver of 2017 Premium Increases
Prescription drugs are not outsized contributors to rate increases.
Podcast: E2 – What the Elections Might Mean for the Drug Pricing Debate
Between now and November, Avalere will to bring election content, including podcasts to the public dialogue. Our experts provide a quick glimpse into the role healthcare will play in the 2016 elections and hot topics you can expect to hear about on the campaign trail
UPDATE: Early Analysis Finds 2017 Proposed Exchange Premiums for Low Cost Silver Plans Increasing 8 Percent on Average
Rates vary widely by state; popular low cost options see smaller increases.
Snapshot of Gubernatorial Elections and Outlooks
Recently, Avalere took a look at the gubernatorial elections happening this year, their outlooks, and where they stand on the Exchanges and the Medicaid expansion.