The No Surprises Act: A Bipartisan Achievement to Protect Consumers from Unexpected Medical Bills.

The No Surprises Act, passed by Congress at the end of 2020, offers significant protections to most Americans with private health insurance. Insured Americans are vulnerable to receiving surprise medical bills when they receive services from out-of-network providers. Protections for consumers against such bills initially emerged in several states that passed laws.

The ACA's Effect On The Individual Insurance Market.

The vision of the Affordable Care Act (ACA) for a reformed individual health insurance market included requirements and incentives for insurers to manage risk instead of avoiding it, minimum standards for coverage adequacy, income-related subsidies, managed competition through health insurance Marketplaces, and new programs to promote insurer competition. Against this vision, we assessed how insurance markets evolved between 2014 and 2019, using metrics such as premium changes, insurer participation, and enrollment. We also assessed how federal and state policy choices during the implementation of the ACA may have affected market performance.

Balance Billing by Health Care Providers: Assessing Consumer Protections Across States.

ISSUE: Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing. However, when obtaining care at emergency departments and in-network hospitals, patients treated by an out-of-network provider may receive an unexpected "balance bill" for an amount beyond what the insurer paid. With no explicit federal protections against balance billing, some states have stepped in to protect consumers from this costly and confusing practice.

Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplaces.

A main goal of the Affordable Care Act is to provide Americans with access to affordable coverage in the individual market, achieved in part by pro­moting competition among insurers on premium price and value. One primary mechanism for meeting that goal is the establishment of new individual health insurance marketplaces where consumers can shop for, compare, and purchase plans, with subsidies if they are eligible. In this issue brief, we explore how the Affordable Care Act is influencing competition in the individual marketplaces in four states--Kansas, Nevada, Rhode Island, and Washington.

The Experiences of State-Run Insurance Marketplaces That Use HealthCare.gov.

States have flexibility in implementing the Affordable Care Act's health insurance marketplaces and may choose to become more (or less) involved in marketplace operations over time. Interest in new implementation approaches has increased as states seek to ensure the long-term financial stability of their exchanges and exercise local control over marketplace oversight. This brief explores the experiences of four states--Idaho, Nevada, New Mexico, and Oregon--that established their own exchanges but have operated them with support from the federal HealthCare.

Implementing the Affordable Care Act: Revisiting the ACA's Essential Health Benefits Requirements.

The Affordable Care Act broadens and strengthens the health insurance benefits available to consumers by requiring insurers to provide coverage of a minimum set of medical services known as "essential health benefits." Federal officials implemented this reform using transitional policies that left many important decisions to the states, while pledging to reassess that approach in time for the 2016 coverage year. This issue brief examines how states have exercised their options under the initial federal essential health benefits framework.

Implementing the Affordable Care Act: state regulation of marketplace plan provider networks.

Health plans with relatively narrow provider networks have generated widespread debate, mainly concerning the level of regulatory oversight necessary to ensure plans provide consumers meaningful access to care. The Affordable Care Act creates the first federal standard for network adequacy in the commercial insurance market for plans offered through the law's insurance marketplaces. However, states continue to play a primary role in setting and enforcing network rules.

Implementing the Affordable Care Act: state approaches to premium rate reforms in the individual health insurance market.

The Affordable Care Act protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography. This brief examines how states have implemented these federal reforms in their individual health insurance markets. We identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law's requirements.

Implementing the Affordable Care Act: state action to reform the individual health insurance market.

The Affordable Care Act contains numerous consumer protections designed to remedy shortcomings in the availability, affordability, adequacy, and transparency of individual market insurance. However, because states remain the primary regulators of health insurance and have considerable flexibility over implementation of the law, consumers are likely to experience some of the new protections differently, depending on where they live. This brief explores how federal reforms are shaping standards for individual insurance and exam­ines specific areas in which states have flexibility when implementing the new protections.

What states are doing to simplify health plan choice in the insurance marketplaces.

The new health insurance marketplaces aim to improve consumers' purchasing experiences by setting uniform coverage levels for health plans and giving them tools to explore their options. Marketplace administrators may choose to limit the number and type of plans offered to further simplify consumer decision-making. This issue brief examines the policies set by some state-based marketplaces to simplify plan choices: adopting a meaningful difference standard, limiting the number of plans or benefit designs insurers may offer, or requiring standardized benefit designs.

Implementing the Affordable Care Act: State Action to Establish SHOP Marketplaces.

The Affordable Care Act seeks to help small employers offer coverage by reforming the small-group market and establishing Small Business Health Options Program (SHOP) marketplaces. Seventeen states and the District of Columbia chose to operate their own SHOP marketplaces in 2014, with the federal government operating the SHOP marketplace in 33 states. This brief examines state decisions to enhance the value of SHOP marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans.

Implementing the Affordable Care Act: choosing an essential health benefits benchmark plan.

To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan.

Implementing the Affordable Care Act: state action on the 2014 market reforms.

The Affordable Care Act includes numerous consumer protections designed to improve the accessibility, adequacy, and affordability of private health insurance. Because states are the primary regulators of health insurance, this issue brief examines new state action on a subset of protections--such as guaranteed access to coverage and a ban on pre­existing condition exclusions--that go into effect in 2014. The analysis finds that, to date, only one state passed new legislation on all of these protections, and an additional 10 states and the District of Columbia passed new legislation or issued a new regulation on at least one protection.

Child-only coverage and the Affordable Care Act: lessons for policymakers.

The Affordable Care Act prohibited insurers from denying or limiting cover­age for children under the age of 19 in 2010. In response, some insurers ceased to offer coverage to children in need of individual health insurance, known as a "child-only" pol­icy. This issue brief examines new state legislative and regulatory action to promote the availability of child-only policies in response to this market disruption.

Implementing the Affordable Care Act: state action on early market reforms.

The Affordable Care Act includes numerous consumer protections that took effect on September 23, 2010. This issue brief examines new state action on a subset of these "early market reforms." The analysis finds that 49 states and the District of Columbia have passed new legislation, issued a new regulation, issued new subregulatory guidance, or are actively reviewing insurer policy forms for compliance with these protections.

Genetic discrimination in health insurance: current legal protections and industry practices.

Most states have enacted genetic nondiscrimination laws in health insurance, and federal legislation is pending in Congress. Scientists worry fear of discrimination discourages some patients from participating in clinical trials and hampers important medical research. This paper describes a study of medical underwriting practices in the individual health insurance market related to genetic information.

Association health plans: what's all the fuss about?

Policymakers have tried to address the problem of the uninsured and to help small businesses with rising premiums by encouraging associations to offer coverage. Although supporters and opponents have made claims about the potential impact of this strategy, the association market has not been studied in depth. Examining current standards might explain why proponents seek changes.