Archive for Affordable Care Act


Health Insurance Markets Remain Highly Concentrated

The health insurance market was highly concentrated in 42 of the 50 states in 2019 and 2020 – the continuation of a trend identified in 2010 that has persisted ever since, according to a new report by the U.S. Government Accountability Office.

The GAO considers a market concentrated if three or fewer insurers in a state have 80 percent of that market.  Using Centers for Medicare & Medicaid Services health insurance enrollment data, the GAO looked at three distinct aspects of markets – individual policies, small group policies, and large group coverage – and found that

  • Each of the three markets in 2020 was concentrated in at least 42 states (including the District of Columbia).
  • The individual and small group markets generally became more concentrated in recent years. The median market share of the top three issuers in each market increased by 12 and 10 percentage points, respectively, from 2011 through 2020. With these increases, their median market share was at least 97 percent in both markets in 2020.

Learn more about the study’s origins in the Affordable Care Act and why its findings matter in the GAO report “Private Health Insurance:   Markets Remained Concentrated through 2020, with Increases

Federal Health Policy Update for Monday, August 8`

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, August 8.  Some of the language used below is taken directly from government documents.


On Sunday, the Senate passed the Democrats’ health care, climate, and tax bill, H.R. 5376, The Inflation Reduction Act, by a vote of 51-50, with Vice President Harris casting the tie-breaking vote.  Health care provisions in the reconciliation bill include:

  • allowing Medicare to negotiate prescription drug prices
  • limiting out-of-pocket prescription drug costs for Medicare enrollees to $2,000 a year
  • extending for three years enhanced Affordable Care Act subsidies for individuals to buy health insurance on the marketplace.

The bill now heads to the House, which expects to pass it Friday.  Find the Democrats’ summary of the bill’s health care provisions here.

White House

President Biden has issued an “Executive Order on Securing Access to Reproductive and Other Healthcare Services” to build on action the administration has taken to protect access to reproductive health care services.  The executive order coincides with the first meeting of the Task Force on Reproductive Healthcare Access and includes actions to support patients traveling out of state for medical care, even raising …

Federal Health Policy Update for Tuesday, August 2

The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, August 2.  Some of the language used below is taken directly from government documents.

White House

The White House has announced two new actions to address the youth mental health crisis:  it will award nearly $300 million from the FY 2022 bipartisan omnibus agreement to expand access to mental health services in schools and it will encourage governors to invest more in school-based mental health services.  Learn more about this effort, including the individual funding components of the $300 million in new spending, from this White House fact sheet.

Medicare Payment Regulations

  • CMS has issued its final Medicare inpatient prospective payment system and long-term care prospective payment system regulation for FY 2023.  Highlights of the final rule include a 4.3 percent increase in Medicare hospital inpatient rates and a 2.3 percent increase in LTCH rates; a reduction of $318 million in the Medicare DSH uncompensated care payment pool; introduction of a new “birthing-friendly hospital” designation for hospitals that meet certain criteria; the introduction of three new health equity measures; a permanent five percent cap on year-to-year wage index reductions; and more. 

Transparency Comes to Health Insurer Payments

When the calendar turned to July, health insurers came under a new federal requirement that they post on web sites the price they pay to every provider with which they contract for every service they cover.

The mandate, which traces its origins to the Affordable Care Act and was introduced in a 2019 executive order, was designed to enable consumers to compare what different insurers pay different providers for different services and possibly help them shop for more affordable services for themselves.  Doing so, however, will be a challenge for consumers at least at first because insurers will be posting millions of figures.  Eventually, though, businesses are expected to emerge offering to help consumers with their price comparisons.

Insurers that fail to post the required data will be subject to fines far greater than those suffered by hospitals that do not post their charges as required.  In addition, beginning next year insurers will be required to post 500 “shoppable” services – that is, bundles of service associated with some of the most common medical procedures.

Learn more about health insurer price transparency and the implications for insurers, providers, and consumers in the Fierce Healthcare article “How much health insurers

Federal Health Policy Update for Thursday, April 7

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, April 7.  Some of the language used below is taken directly from government documents.

White House

  • The administration is proposing to address a flaw in the Affordable Care Act often referred to as the “family glitch.”  Under the ACA, people who do not have access to “affordable” health insurance through their jobs may qualify for a premium tax credit to purchase coverage on the ACA’s health insurance marketplaces.

Current regulations define employer-based health insurance as “affordable” if the coverage for the employee alone is considered affordable; if the coverage for the employee is considered affordable but if it is not considered affordable for the employee’s family, those family members are not eligible for a premium tax credit.  This “family glitch” affects about five million people.

The Treasury Department and the Internal Revenue Service are proposing to eliminate the family glitch so that family members of workers who are offered affordable coverage only for themselves but not for their family may qualify for premium tax credits to buy ACA coverage.  Should this change be made, an estimated 200,000 uninsured people would gain coverage …