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
Webinar: ACA Repeal and Replace: What’s Next?
Avalere experts examine proposed key reforms to the ACA and its potential impacts.
AHCA State Stability Fund Would Give More Money to States with Limited Insurance Competition
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.
House of Representatives ACA Repeal and Replace Legislation Could Increase Penalties for Failure to Buy Insurance
Low-income and older individuals would incur higher penalties for failing to purchase health insurance, compared to current individual mandate.
FINAL REPORT: The Impact of Medicare Advantage Data Submission System on Risk Scores
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).
FDA Priority Review Voucher Programs: Incentive for Industry to Develop Novel Treatments
Extension of the Sunset Clause provides additional opportunity for the FDA to award vouchers and for transference of vouchers from recipients to other sponsors.
Avalere’s Take on the ACA Market Stabilization Rule
Today, the Trump administration released a proposed rule for market stabilization of the Affordable Care Act (ACA).
Capped Funding in Medicaid Could Significantly Reduce Federal Spending
Analysis shows Medicaid block grants and per capita caps could result in state budget gaps.
Impact of Medicare Advantage Data Submission System on Risk Scores
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).
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.
Medicaid Expansion Map
While 31 states and DC expanded Medicaid under the ACA, the future of expansion is uncertain.
Podcast: E2 – Highlights of FDA and NIH in 21st Century Cures
The final signing of the 21st Century Cures Act is the culmination of 3 years of efforts by lawmakers in the House and Senate to expedite developing and making available new treatment options. In the final episode in our series, Jay Jackson discusses what changes are on the horizon for products under The Cures Act.
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.
1.2 Million People Could Gain Access to Medicaid Coverage Based on State Election Results
New analysis from Avalere finds that 1.2 million individuals from non-expansion states could gain Medicaid coverage in 2017 should a newly elected governor decide to expand the program.
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.