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
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.
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.
FDA Has Received $7.67 Billion from Manufactures to Fund Drug Review
Since 1992, the Food and Drug Administration (FDA) has collected $7.67 billion in user fees from pharmaceutical manufacturers to fund drug reviews based on an Avalere analysis of FDA data.
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.
What Is a Complete Response Letter?
The US Food and Drug Administration (FDA) makes its medical product marketing approval decisions based on a risk–benefit determination of safety and effectiveness.
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.