Comparison of Estimated No Surprises Act Qualifying Payment Amounts and Payments to In-Network and Out-of-Network Emergency Medicine Professionals.

Importance: The No Surprises Act (NSA), which took effect on January 1, 2022, applies a qualifying payment amount (QPA) as an out-of-network payment reference point. An understanding of how QPA measures compare with the in-network and out-of-network payments physicians received before the NSA implementation may be useful to policy makers and stakeholders.

Objective: To estimate the QPA for geographic and funding markets and compare QPA estimates with in-network and out-of-network payments for 2019 emergency medicine claims.

Medicare Part D: Time for Re-Modernization?

Objective: To understand the mechanisms that have held Part D beneficiary premiums stable despite increasing reinsurance subsidies.

Data Sources: Secondary data on Part D plan bids, federal subsidies, and claims from 2007 through 2015.

Study Design: Comparisons of standardized, enrollment-weighted average Part D plan bids and reinsurance bids with plan and reinsurance liability calculated from Part D claims data.

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums.