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We are delighted to welcome Rebecca Herzberg as a Research Assistant.

On June 15, 2026, The Centers for Medicare and Medicaid Services (CMS) released an RFI, asking for input into potential changes to how the federal government implements the ACA’s Essential Health Benefits EHB requirements. In a considerations document, CHIR Faculty Amy Killelea analyzes the RFI and outlines EHB considerations for people with insulin-requiring diabetes. Comments to the RFI are due July 15th.

New Trump administration regulations give unprecedented flexibilities to insurance companies to increase patient cost sharing and sell “non-network” plans where all providers are out-of-network. In a new blog post for the Commonwealth Fund’s To The Point blog, CHIR’s Justin Giovannelli describes what the rulemaking reveals about the administration’s priorities during this period of uncertainty.

As Congressional inaction on premium tax credit enhancements caused net marketplace premiums to spike in 2026, initial sign-ups declined. In a new blog post for the Commonwealth Fund’s To The Point blog, CHIR faculty examine emerging state marketplace data showing that enrollment has continued to decline, with more dramatic drop-offs in coverage.

On May 19, Georgetown University’s Center on Health Insurance Reforms (CHIR) hosted an event discussing how large corporations are reshaping health care markets and patient care. In this blog, CHIR experts discuss the implications of vertical integration in the health care industry.

As insurers develop their rates for 2027, they contend with federal policy changes that are causing upheaval in the individual market. In a new blog, CHIR experts investigate proposed 2027 Marketplace rate filings made publicly available to date, which provide some clues behind 2027 Marketplace rate increases.

While nearly one in three U.S. adults reported a mental illness or substance use issue in 2024, access can still fail even when providers and insurance coverage exist. Drawing on a literature review and interviews with patient advocates, safety net providers, and researchers, this new CHIR report examines sociocultural barriers to make care truly usable, safe, and sustainable.

In a break with past practice, the Advisory Committee on Immunization Practices has begun removing universal recommendations from some vaccines and downgrading them to a shared clinical-decision making (SCDM) designation. In a recent article for The Commonwealth Fund’s To The Point blog, CHIR faculty discuss new federal vaccine recommendations.

On May 15, 2026, CMS released the final Notice of Benefit and Payment Parameters (NBPP). In their latest analysis for the State Health and Value Strategies program, CHIR expert Sabrina Corlette, along with experts from the Urban Institute and Manatt Health, breaks down the final rule and discusses its implications for state policymakers.

The Employee Retirement Income Security Act of 1974 (ERISA) is the primary law governing most private employer-sponsored health insurance plans. In their new publication, CHIR Faculty examine ERISA and discuss how it can support a more transparent and affordable health care system.

While federal subsidies decreased for enhanced PTCs, states took action to lessen the financial burden by launching new or modifying existing subsidy programs. In a new piece for the Commonwealth Fund’s “To The Point” blog, CHIR experts discuss the practice and sustainability of these programs.

Due to recent actions by Congress and the Trump administration, insurance products that do not comply with the ACA are likely to become more prevalent. In a new explainer for the Commonwealth Fund’s “To the Point” blog, CHIR experts break down how these products differ from ACA-compliant coverage, and the financial risks they raise for consumers.

Vertical integration has resulted in increased health care spending. In this blog, CHIR’s Julia Burleson examine its effects on key stakeholders and highlight federal bills strengthening and expanding antitrust enforcement.

There is wide variability in coverage for continuous glucose monitors (CGMs). In their latest analysis for Health Affairs Forefront, CHIR experts explore coverage policies for CGMs and prior authorization reform.

Facility fees in hospital outpatient settings are a driver in the growing healthcare affordability crisis. In their latest analysis for Health Affairs Forefront, CHIR and West Health experts explore how various states are implementing facility fee reforms and the impact on hospital systems.

Risk pooling and risk segmentation represent different approaches to financing healthcare, leading to different outcomes for consumers. In a new piece for the Commonwealth Fund, CHIR experts discuss how these processes impact healthcare affordability.

The Trump administration has proposed a sweeping set of policy and operational changes for the Affordable Care Act Marketplaces in the annual Notice of Benefit & Payment Parameters. In the fourth and final in our 4-part series of posts summarizing stakeholder views on these proposals, CHIR’s Karen Davenport focuses on comments submitted by health care providers.

To combat rising costs without burdening employees, state health plans are leveraging their unique market power to address the underlying drivers of health care prices directly. In a new report, CHIR’s Stacey Pogue and Abigail Knapp examine how SEHPs in five states utilize transparency data to improve affordability.

Oregon is curbing corporate health care influence by strengthening medical practice laws and transaction oversight to protect physician autonomy and patient care. CHIR’s Julia Burleson discusses how these reforms provide a roadmap for other states to dismantle corporate workarounds and prioritize patients over profits.

The Trump administration has proposed a sweeping set of policy and operational changes for the Affordable Care Act Marketplaces in the annual Notice of Benefit & Payment Parameters. In the third in our 4-part series of posts summarizing stakeholder views on these proposals, CHIR’s Leila Sullivan focuses on comments submitted by consumer and patient advocate organizations.

The recently signed Consolidated Appropriations Act of 2026 includes a provision on unique national provider identifier (NPI) requirements. In her latest analysis for Health Affairs Forefront, CHIR expert Christine Monahan explore the effects of this law and methods to optimize its impact.

The Trump administration has proposed a sweeping set of policy and operational changes for the Affordable Care Act Marketplaces in the annual Notice of Benefit & Payment Parameters. In this second in a 4-part series of posts summarizing stakeholder views on these proposals, CHIR’s Stacey Pogue focuses on comments submitted by state insurance departments and marketplaces.

Policymakers are beginning to look into site-neutral payment reform options for the commercial health insurance market, where site-of-service cost differences can be particularly severe. In this new resource, CHIR experts explore drivers behind the need for reform and outline the rationale for adopting a site-neutral approach.

The Trump administration has proposed a sweeping set policy and operational changes for the Affordable Care Act Marketplaces in the annual Notice of Benefit & Payment Parameters. In this first in a 4-part series of posts summarizing stakeholder views on these proposals, CHIR’s Sabrina Corlette focuses on comments submitted by health insurers and brokers.

Federal price transparency rules were designed to empower consumers, but the reality has been a mountain of complex data. In their latest analysis for Health Affairs Forefront, CHIR experts and Morgan A. Henderson dive into newly proposed updates to the Transparency in Coverage (TiC) rules and explore how these changes aim to streamline massive data files.

While the No Surprises Act continues to protect patients from unexpected out-of-network costs, the federal system for resolving payment disputes is experiencing significant growth. In their latest analysis for Health Affairs Forefront, CHIR experts and Ellie DeGarmo review newly released data from the first half of 2025, exploring the latest trends in dispute volume and the evolving legal and administrative factors currently shaping the law’s implementation.

In February 2026, CMS published the proposed 2027 Notice of Benefit and Payment Parameters, which serves as the primary annual regulation governing coverage under the Affordable Care Act. Experts from CHIR, Urban Institute, and Brown University discuss how these proposals intersect with existing statutory requirements and recent judicial decisions.

The Trump administration is promoting a new type of health plan that may have lower premiums, but includes no provider network. CHIR expert Sabrina Corlette and colleagues Jason Levitis and Lindsey Murtagh dig into how such plans would work for patients, for providers, and for the stability of the market.

Despite protections under the No Surprises Act, consumers can still face large, unexpected bills following medical emergencies. In a new piece for the Commonwealth Fund, CHIR experts explore how states are stepping in to address this remaining gap.

This February, between the season’s final frost and the first signs of spring, we explored new research on healthcare affordability. This month we read about the pricing impacts of vertical consolidation, the primary drivers behind the recent surge in national health spending, and the persistent threat of medical debt for patients following acute injuries.

Hospitals operate under different legal requirements and funding streams that shape their financial status and operations. In their latest piece for Health Affairs Forefront, CHIR’s Christine Monahan and Kennah Watts, along with Ariel Winter, explain how Medicare reimburses different types of hospitals.

Federal policy changes are expected to exacerbate medical debt among insured patients. In a new piece for the Commonwealth Fund, CHIR experts examine how state policymakers are responding to protect patients from long-term financial harm.

In a recent article for the Commonwealth Fund, CHIR experts explore how the federal retreat on mental health parity affects state oversight and enforcement, noting the varying responses from states working to maintain or strengthen behavioral health coverage protections.

As 2026 premium hikes make ACA Marketplace plans less affordable, misleadingly marketed non-ACA “junk plans” are gaining traction, risking consumer financial harm and market instability. In their latest piece for Health Affairs Forefront, CHIR’s Amy Killelea and JoAnn Volk discuss how state regulators can strengthen oversight and protect consumers.

As health care costs continue to strain families and employers, states are stepping up with proven strategies. CHIR’s Leila Sullivan discusses tools that offer a practical roadmap for making care more affordable now.

The Trump administration has proposed a sweeping set of policy and operational changes for the Affordable Care Act. In a new issue brief for the State Health & Value Strategies program, Sabrina Corlette, Jason Levitis, and Tara Straw assess the implications for state Marketplaces and insurance rules.

Cost-growth benchmarks are intended to curb health care spending, but they are often insufficient on their own. In this blog, CHIR experts Abigail Knapp and Sabrina Corlette discuss the the limits of benchmarks and state strategies to more effectively constrain health care cost growth and improve affordability.

The Rural Health Transformation Program (RHTP) aims to help states modernize rural health care infrastructure. In this blog, CHIR experts Julia Burleson and Leila Sullivan review state RHTP applications to explore how mobile health could be used to strengthen rural health systems.

Coverage on paper does not always translate into meaningful access to care. In this blog, CHIR experts Leila Sullivan and Amy Killelea explore how private insurance coverage rules and utilization management policies align with clinical standards of care for diabetes.

Early open enrollment data provide a glimpse into how consumers are responding to increased premiums for Marketplace coverage. In this blog, CHIR experts Stacey Pogue and Karen Davenport explore initial trends in early Marketplace enrollment data that indicate potential coverage declines.

We are delighted to welcome two faculty members who are now full-time on the CHIR team: Amy Killelea and Zeynep Çelik.

Texans are struggling to manage high and rising health care costs. In their latest State Spotlight, CHIR authors assess recent efforts by Texas lawmakers to improve affordability by banning anti-competitive provider-payer contracts.

Recent events have cast doubt on whether federal expert bodies can be relied on to provide science-backed recommendations. In a new post for the Commonwealth Fund, CHIR faculty outline different state approaches to preserve access to preventive services.

Hospital financial data are often fragmented across multiple sources and require specialized expertise to interpret, making it difficult for states to identify which systems are at greatest financial risk. In their newest Health Affairs Forefront article, CHIR faculty explore different measures states can take to better understand the financial standing of hospitals and health systems.

The Patients Deserve Price Tags Act, a bipartisan bill introduced in July 2025, strives to make health care prices more transparent. In their newest Health Affairs Forefront article, CHIR faculty explore the bill’s price transparency provisions, which codify federal rules and strengthen them to improve and expand price information.

Increasing concerns about prior authorization abuses have resulted in new federal and state reforms targeting the processes insurers use. In their newest Health Affairs Forefront article, CHIR faculty explore key trends in state level prior authorization reform and implications for consumers.

High and unexpected charges like facility fees continue to drive patients away from care. In this blog, CHIR experts Karen Davenport and Kennah Watts explore the impact of facility fees on health delivery and health insurance, and policy reforms states have implemented to protect consumers.

Recent federal policy changes will result in millions of people losing health insurance coverage. CHIR experts Sabrina Corlette and Karen Davenport partnered with the NAIC Consumer Representatives to outline strategies for states to mitigate the expected coverage loss.

Congress has returned to Washington, D.C. from its Thanksgiving break, but has yet to resolve the debate on whether or how to extend enhanced premium tax credits (ePTCs) scheduled to expire on December 31. CHIR’s Stacey Pogue talks about what proposals to extend or replace ePTCs will mean for consumers.

Rising health care spending has led states to employ different approaches to price regulation. In this blog, CHIR experts describe state approaches illustrated in our newly released 50 state maps, and highlight the strategies used in Oregon and Rhode Island.

The health care market has seen significant vertical and horizontal integration of health care providers and insurers. CHIR faculty recently published an expert perspective describing the complex web of intertwined financial interests that has developed across the health care system. This blog breaks down the main ideas from the paper, highlighting how these consolidation trends shape prices, competition, and patient access.

Many of the regulatory and oversight activities influencing the American health care system occur at the state level. CHIR faculty examined state oversight of hospitals in health care markets and developed a set of 50 state interactive maps demonstrating these varied approaches.

This fall, as leaves changed, election season heated up, and open enrollment approached, we dove into the latest health policy research. This combined September and October Research Roundup looks at the impact of expiring Marketplace premium tax credits on uncompensated care and health insurance coverage rates, Affordable Care Act (ACA) tax credit cliffs, and how hospital and private equity affiliation affects specialty care prices.

Hospitals provide essential health care, so it is crucial they maintain financial viability and can readily serve their communities. CHIR Faculty break down how to use their latest resource: A new guide to better understand organizational and financial differences across US hospitals.

As Congress ends the government shutdown, the debate over extending enhanced premium tax credits remains unresolved, with President Trump proposing to replace them with direct payments to individuals to purchase their own health care. CHIR’s Karen Davenport and Sabrina Corlette share what the research says on this, and why cash is no substitute for coverage.

On October 29, Georgetown University’s Center on Health Insurance Reforms (CHIR) hosted an event discussing the rise of health care corporatization and how it has directly contributed to higher health care costs. CHIR Faculty discuss the speakers’ perspectives and potential solutions to increase affordability.

As provisions of H.R. 1 impact the individual market for coverage, workers with employer-funded ICHRAs will face harsh enrollment barriers and higher costs. In a new post for the Commonwealth Fund’s “To the Point” blog, CHIR faculty look at how newly adopted changes to the market will affect the usability of ICHRAs.

As states move to regulate prior authorization and other utilization management practices, growing scrutiny has focused on how effectively insurers translate evidence-based clinical guidelines into coverage policies. CHIR Faculty Amy Killelea, Christine Monahan and Zeynep Celik talk about what this means for diabetes access.

The Patients Deserve Price Tags Act, a bipartisan bill introduced in July 2025, seeks to bring greater transparency to health care costs. In their newest Health Affairs Forefront article, CHIR faculty explore the problems the bill targets and discuss additional measures to enhance its impact.

For many lawfully residing immigrants, recent federal policy changes have effectively eliminated affordable pathways to comprehensive Marketplace health coverage. In this blog, CHIR’s Stacey Pogue and Jalisa Clark examine how immigration status shapes access to Marketplace coverage and discuss how recent federal actions have dismantled long-standing opportunities for lawfully present immigrants to obtain affordable Marketplace plans.

Several states—including Colorado, Maine, Connecticut, and Washington—have undertaken efforts to collect and analyze data on outpatient facility fee billing. In their latest piece for Health Affairs Forefront, CHIR faculty examine these state initiatives and share key insights from their reports on the commercial market.

Debates over premium tax credits have dominated headlines, but other federal changes will also shape this year’s open enrollment. In this blog, CHIR experts Sabrina Corlette and Karen Davenport discuss what consumers can expect in an unusually turbulent year for the ACA.

2026 ACA premium rates have shown sharp cost increases and coverage losses. In their latest piece for Health Affairs Forefront, Jason Levitis, Sabrina Corlette, and Claire O’Brien discuss the additional harms that PTC recipients are expected to experience in upcoming weeks unless PTC enhancements are enacted.

As Americans struggle with health care affordability, federal policy changes have enabled many to access $0 premiums in both Marketplaces and Medicare. But some in Congress want to eliminate $0 premiums for Marketplace plans. CHIR faculty discuss how critical such plans have been to improve access to coverage and reduce premiums, market-wide.

Since taking office, the Trump administration has pursued multiple tactics to limit access to affordable health care coverage. In a new post for the Commonwealth Fund’s “To the Point” blog, CHIR’s Jalisa Clark, Justin Giovannelli, and Christine H. Monahan discuss the impact of administrative hurdles and the new enrollment barriers consumers can face.

The budget reconciliation bill, combined with expiring enhanced premium tax credits and other recent federal policy changes, will exacerbate the United States’ medical debt crisis. In a new piece for the Commonwealth Fund, CHIR’s Maanasa Kona, Sabrina Corlette, and Billy Dering discuss the impact of recent federal policy changes as well as state-level strategies to curb rising medical debt.

The No Surprises Act’s arbitration process has generated an estimated $5 billion in total costs from 2022 to 2024, stemming from required fees, administrative costs, and additional payments for services. In their latest piece for Health Affairs Forefront, Jack Hoadley and Kennah Watts examine recent IDR trends and their financial impacts.

Although the Supreme Court recently upheld the constitutionality of the Affordable Care Act’s mandate to cover recommended preventive services, recent actions by HHS Secretary Kennedy have placed access to vaccine services at risk. CHIR experts assess the state of preventive services coverage – and how some states are stepping up to maintain access for consumers.

This August, between summer weekends and back-to-school prep, CHIR dug into fresh health policy research. This month’s Research Roundup covers health insurance tax credits, financial health in private equity owned hospitals, and recent trends in patient repayment of hospital bills.

New federal guidance expands eligibility for “catastrophic” health plans that offer lower premiums but come with very high deductibles. In their latest post for the State Health & Value Strategies program, CHIR experts assess the new federal policy and what it means for consumers, insurance markets, and state regulators.

Historically, New Mexico had limited formal oversight of hospital transactions. In the latest State Spotlight, CHIR experts Julia Burleson and Stacey Pogue examine new legislation aimed at strengthening the state’s ability to address hospital consolidation and safeguard access to affordable health care.

In August, 16 U.S. Senators asked CHIR to review health insurers’ filings to state regulators supporting their 2026 rate requests. Drawing on an analysis of 178 Marketplace plan filings, CHIR examines the double-digit premium increases many insurers are proposing for 2026.

Marketplace enrollees are facing threats to their health coverage and healthcare affordability as a result of the recently enacted budget reconciliation bill. CHIR expert Karen Davenport discusses the impending expiration of enhanced premium tax credits, which would drastically compound the coverage losses of H.R. 1 for American consumers.

On August 22, a federal court blocked major provisions of a regulation affecting the Affordable Care Act’s health insurance Marketplaces. In a new post for the State Health & Value Strategies program, CHIR’s Sabrina Corlette and the Urban Institute’s Jason Levitis review the court’s ruling and its implications for states.

We are delighted to welcome Sloane Daly as a Research Assistant.

The first of numerous federal policies that reverse recent coverage gains under the the Affordable Care Act are scheduled to go into effect on August 25, but two lawsuits have been filed to block them. CHIR’s Sabrina Corlette reviews the imminent policy changes, their impact, and the legal challenges to watch.

As state policymakers grapple with rising commercial health care prices, they showed a growing interest during 2025 legislative sessions in leveraging ownership transparency as a tool to understand health care markets, strengthen oversight efforts, and inform consumers. Stacey Pogue discusses what states are doing to increase ownership transparency, and how other states may follow.

New federal rules attempt to curtail insurance coverage of treatment for gender dysphoria. In her latest expert perspective for the State Health & Value Strategies project, Sabrina Corlette shares key considerations for the state officials charged with implementing the new restrictions.

The recently enacted federal budget law is set to significantly roll back health insurance coverage for millions. CHIR experts Billy Dering, Amy Killelea and Christine Monahan discuss what this means for people with insulin-requiring diabetes.

The 2025 Notice of Benefit and Payment Parameters gave states the flexibility to require adult dental coverage beginning in plan year 2027. CHIR experts discuss Kentucky’s decision to not add adult dental services as an essential health benefit and what recent federal law changes may mean for states considering coverage changes.

President Trump recently signed into law some of the most dramatic changes to our healthcare system since the Affordable Care Act (ACA) was enacted in 2010. CHIR’s Leila Sullivan provides a roundup of recent research projecting what the new law means for coverage, affordability, and uncompensated care.

With the recent signing of H.R. 1, many may be wondering what this means for their Medicaid and Marketplace plans. CHIR’s Sabrina Corlette and CCF’s Edwin Park break it down in this reader-friendly Explainer.

In May, the Departments of Health and Human Services, Labor, and the Treasury announced several actions to enhance health care price transparency. In her latest piece for Health Affairs Forefront, Stacey Pogue discusses how these actions mark the start of a process to make hospital and health plan price transparency data more accessible and useful.

We are delighted to welcome two new faculty members: Madison Harden and Abigail Knapp.

IDR entities have come to play an instrumental role in OON payments, but entities’ determinations and decision-making practices lack transparency. In their latest piece for Health Affairs Forefront, Kennah Watts and Jack Hoadley analyze variation IDR entities’ decision-making patterns and discuss the implications for the IDR process.

Recent federal rules are projected to cause up to two million people to lose health insurance and raise premiums for many more. In a new article for the State Health & Value Strategies project, Sabrina Corlette and Tara Straw dissect the rule and its implications for states.

President Trump’s signature on H.R. 1, the budget reconciliation bill, will lead to upwards of 17 million people losing their health insurance and millions more with higher barriers to accessing care. At CHIR, we’ll be working to minimize the law’s harms, document its effects, and partner with those seeking to reverse its worst abuses.

Dental coverage offered through the ACA Marketplaces is constantly changing. Building on CHIR’s 2024 analysis of enrollment, premiums, and insurer participation in stand-alone dental plans (SADPs), this new interactive map allows users to dive deeper into state-level data.

While the independent dispute resolution (IDR) process is intended to lead to fair outcomes for out-of-network payment, new analysis demonstrates unexpectedly high use of the IDR process, mostly by private-equity-backed providers that win often and win large. In their latest piece for Health Affairs Forefront, Jack Hoadley, Kennah Watts, and Zachary Baron illustrate trends in the IDR process and explore implications for costs.

The U.S. House of Representatives’ Ways & Means Health Subcommittee recently held a hearing about ways to advance digital health technologies. CHIR expert Sabrina Corlette was one of the invited panelists, warning the committee that, while these new technologies hold promise, consumers can only benefit from them if they have access to affordable, high quality health insurance.

This year, insurers are setting their rates for 2026 while Congress and the administration weigh several policies that are projected to cause premiums to spike and the number of people with Marketplace coverage to plummet. In a new blog, CHIR experts investigate early 2026 rate filings and related analysis to explore how insurers are responding to an array of anticipated federal ACA policy changes and uncertainty around them.

With the passage of H.R.1, the House of Representatives’ version of the budget reconciliation bill that will advance President Trump’s domestic policy agenda, all eyes are turned towards the Senate. In a new CHIRblog, ACA experts Karen Davenport, Stacey Pogue, and Sabrina Corlette discuss how draft legislation emerging from the Senate would create enrollment barriers to Marketplace coverage that largely mirror the House’s reconciliation bill.

While Indiana lawmakers have been working to reduce health care costs for commercial health insurance for more than a decade, Indiana’s 125th Legislative Session was particularly productive. CHIR experts explore Indiana’s efforts to improve health care affordability, and discuss how this could serve as an example for other states.

In May, we welcomed spring blooms and warm weather, while staying engaged with the latest health policy research. This month we read about potential effects of the reconciliation bill on provider revenue and uncompensated care, Rhode Island’s affordability standards and their effects on hospital prices, and coverage retention and plan switching following changes in premiums.

The budget reconciliation bill passed by the U.S. House of Representatives would eliminate much of the flexibility granted to states over the operations of State-Based Marketplaces (SBMs), impose burdensome new requirements, and reduce their revenue base. In a new CHIRblog post, ACA experts Jason Levitis, Christen Linke-Young, Sabrina Corlette, Ellen Montz, and Claire O’Brien dive into the bill’s costly new mandates for states.

The proposed Marketplace Integrity rule and House-passed budget bill purportedly aim to curb ACA fraud but overlook basic steps to address broker misconduct. CHIR experts explain how these policies increase barriers for eligible enrollees without improving oversight of unethical brokers or implementing common-sense reforms.

The Senate will soon consider the “One Big, Beautiful Bill” that would make changes to Marketplace eligibility and enrollment processes, potentially leaving millions, including new families, laid-off workers, and small business owners in a tangle of red tape and at risk of losing critical health coverage. CHIR’s Karen Davenport looks at who might be hurt by these policies.

By Rachel Swindle, Jalisa Clark, and Justin Giovannelli One of the first actions by the Centers for Medicare and Medicaid Services under the Trump administration was to announce extreme cuts in funding for Navigators, the Affordable Care Act (ACA) grant program for organizations that provide outreach, education, and enrollment assistance activities. The 90 percent reduction …

As U.S. health care spending continues to spiral higher, states are using a variety of tools to push back. In a new book of essays, CHIR experts examine the impacts and limitations of three mechanisms through which states are leveraging their role as a contractor to lower health care prices in the private health insurance market and to advance broader policy goals.

Recent proposals from the Trump administration and Congress would shorten or eliminate the windows of opportunity for people to enroll in the Affordable Care Act Marketplaces. In a recent article for the Commonwealth Fund, CHIR’s Sabrina Corlette and Rachel Swindle discuss how such policies would result in reduced access to coverage and higher costs for Marketplace enrollees.

Pharmacy benefit managers have received significant public attention for their exploitative, cost increasing practices, but similar practices of third-party administrators (TPAs) have received relatively little public attention. In their latest piece for Health Affairs Forefront, Karen Handorf, Christine Monahan, and Kennah Watts argue that understanding TPA business models and how they generate profits requires looking under the hood at their agreements with health care providers and other third-party intermediaries.

While the health plan price transparency data available under current guidance and enforcement have proven challenging to access and use, a renewed focus under the Trump administration aims to improve Transparency in Coverage (TiC) data. In this blog, CHIR experts Stacey Pogue and Nadia Stovicek present insights into known issues with TiC machine-readable files, a recent executive order’s implications, and the issues that limit access to publicly available TiC data.

As Congress debates policies that would disenroll millions of people from both Medicaid and marketplace coverage, young adults living with diabetes could face coverage losses and challenges finding private insurance that is both comprehensive and affordable. In their latest piece for Health Affairs, Amy Killelea and Christine Monahan explore how variations in health insurance coverage can make health coverage transitions difficult for these young adults.

An obscure provision in the U.S. House reconciliation bill could have major consequences for the Affordable Care Act Marketplaces. In a guest post for CHIRblog, the Urban Institute’s Jason Levitis and Brookings’ Visiting Fellow Christen Linke-Young dig into how this provision could radically change people’s ability to access and maintain affordable health insurance.

The U.S. House of Representatives is poised to take up legislation that, if enacted, would be tantamount to a repeal of the Affordable Care Act (ACA) for millions of Americans who will lose their health insurance, and for millions more who will be required to submit to red tape and higher costs to retain their coverage. CHIR experts Sabrina Corlette, Karen Davenport, and Stacey Pogue dive into what the bill includes and what it means for the 24 million Americans who are covered through the ACA Marketplaces.

The Trump administration’s proposed “Marketplace Integrity” rule has generated almost 26,000 public comments. In this fourth in a 4-part blog series summarizing comments from a range of key stakeholders, CHIR’s Leila Sullivan digs into the responses and recommendations from consumer and patient advocate organizations.

The Trump administration’s proposed “Marketplace Integrity” rule has generated almost 26,000 public comments. In this third in a 4-part blog series summarizing comments from a range of key stakeholders, CHIR’s Stacey Pogue digs into the responses and recommendations from state-based Marketplaces and insurance departments.

The Trump administration’s proposed “Marketplace Integrity” rule has generated almost 26,000 public comments. In this second in a 4-part blog series summarizing comments from a range of key stakeholders, CHIR’s Karen Davenport digs into the responses and recommendations from provider representatives.

The Trump administration’s proposed “Marketplace Integrity” rule has generated almost 26,000 public comments. In this first in a 4-part blog series summarizing comments from a range of key stakeholders, CHIR’s Sabrina Corlette digs into the responses and recommendations from health insurers and health insurance agents and brokers.

A new CHIR report offers a snapshot of the dental coverage landscape on the ACA Marketplaces in 2025. In this analysis, CHIR experts present insights into why stand alone dental plan uptake remains limited and what state-specific policy decisions could mean for future dental coverage options.

With infectious diseases such as measles on the rise, many Americans are wondering what they can do to protect themselves and loved ones against illness. CHIR’s Leila Sullivan breaks down what vaccines, boosters and titers tests your insurance is and is not required to cover under current federal law.

In March, we anticipated sunshine and warmer days while keeping up with the latest health policy research. We read about marketplace plan deductibles, physician turnover in private-equity acquired practices, and estimated savings from prescription drug rebates.

By Karen Davenport In recently-proposed regulatory changes to Affordable Care Act (ACA) marketplace coverage, the Trump Administration intends to strip Deferred Action for Childhood Arrivals (DACA) recipients of eligibility for marketplace coverage, premium subsidies, and cost-sharing assistance. This proposal represents the latest twist in the roller coaster of policy changes and litigation DACA recipients have …

In recently proposed regulatory changes to marketplace coverage, the Trump Administration intends to strip Deferred Action for Childhood Arrivals (DACA) recipients of eligibility for marketplace coverage. This proposal represents the latest twist in the roller coaster of policy changes and litigation DACA recipients have endured.

By Madeline McBride, Elizabeth Bielic, Zeynep Celik, JoAnn Volk, and Kevin Lucia The Affordable Care Act (ACA) recognized the importance of oral health for child development by including pediatric dental services as an essential health benefit (EHB). However, the law did not mention adult dental coverage. In the 2025 Notice of Benefit and Payment Parameters, …

CMS recently finalized a change in the 2025 Notice of Benefit and Payment Parameters, granting states the flexibility to update essential health benefit (EHB) benchmark plans. In this post, CHIR experts reflect on recent state updates to EHB and adult dental coverage.

Last fall, the Biden Administration finalized a rule updating standards for the Mental Health Parity and Addiction Equity Act (MHPAEA). In their latest piece for the Commonwealth Fund, CHIR’s JoAnn Volk and Billy Dering discuss the new requirements for use of “non-quantitative treatment limits” that impose significant barriers to behavioral health treatment.

We are delighted to welcome three new members to the CHIR team: Karen Handorf, Julia Burleson, and Amanda Concepcion.

In February, the Trump administration issued an executive order outlining steps for federal agencies to promote healthcare price transparency for patients, employers, and policymakers. In her latest piece for Health Affairs, Stacey Pogue explores how this executive order could improve areas where healthcare price transparency has historically faced challenges.

Peter Nelson, the new director of the Center for Consumer Information and Insurance Oversight (CCIIO) has brought a long forgotten ACA provision back into the spotlight. CHIR’s Stacey Pogue breaks down Section 1333 compacts, what it would mean for consumers, and concerns for implementation.

On March 23, 2025, we celebrated the 15th anniversary of the Affordable Care Act (ACA). In this post, CHIR experts reflect on how the law’s reforms affected people’s access to affordable, high quality health insurance, and what the next 15 years might bring.

Over the last two months, CHIR hosted a three-part webinar series about the corporate transformation of health care. Kennah Watts discusses some unanswered questions from the series relating to price caps, transparency, and rural hospitals, and highlights further CHIR resources on the subject.

On March 10, 2025, the Trump administration released draft rules with policy changes for the Affordable Care Act Marketplaces and insurance rules. In their latest Expert Perspective for the State Health & Value Strategies program, Sabrina Corlette and Jason Levitis review the implications of the proposal for State-Based Marketplaces and state insurance regulators.

In February we stayed out of the cold and bundled up with the latest in health policy research. We read about salary and utilization changes in hospitals acquired by private equity, challenges with price transparency requirements, and changes to hospital community benefit rules in Oregon.

Last year, reports emerged of unscrupulous health insurance brokers enrolling people in marketplace coverage or switching enrollees to different plans without permission. In their latest piece for the Commonwealth Fund, CHIR’s Justin Giovannelli and Stacey Pogue explore how policymakers can crack down on broker misconduct.

Massachusetts recently enacted a law to increase transparency and oversight of private equity in healthcare following the collapse of Steward Health Care. CHIR experts Stacey Pogue and Kennah Watts break down the law and how it serves as a potential model for other states facing similar challenges with healthcare corporatization.

As the federal budget reconciliation process heats up, Congressional committees will soon be drafting legislation that spells out the program cuts Congress will need to offset the cost of extending existing tax cuts. CHIR’s Karen Davenport discusses the growing body of research around the important role health insurance plays in the health and financial status of American families.

High and rising healthcare costs in the U.S. are driven largely by escalating hospital prices, fueled by increasing consolidation among health systems. In a recent Issue Brief for the Milbank Memorial Fund, Sabrina Corlette and Karen Davenport discuss what states can do to enhance premium rate review programs, to ultimately curb provider price increases.

A case before the Supreme Court and a new Secretary of the U.S. Department of Health & Human Services could substantially weaken the ACA’s guarantee of no-cost preventive services in private insurance. Experts Sabrina Corlette and Tara Straw provide a roadmap for state policymakers to protect their residents, in a recent article for State Health and Value Strategies.

Private equity is not new to the health care sector, but recent growth in private equity investment has sparked a plethora of research studies, media attention, and political attention. A recent Congressional investigation and agency report, on top of continuing research indicate the time for policymakers to take action against private equity in health care is now.

The Notice of Benefit & Payment Parameters prescribes standards and rules that govern insurers and Marketplaces under the ACA. This annual regulation, that went into effect January 15, represents a final set of health insurance policies from the Biden administration focusing on quality and affordability. In their latest piece for Health Affairs Forefront, Sabrina Corlette and Jason Levitis discuss this final rule and what it means.

Since the snow shows no sign of stopping, we might as well stay cozy inside and read up on the latest health policy research from January! This month we read about patient care after private equity acquisition of hospitals, and how to improve risk-adjustment accuracy in Medicare Advantage. 

Like other employer health plans across the commercial insurance market, state employee health plans (SEHPs) regularly face significant increases in health care costs. A new piece by CHIR faculty for Health Affairs explores how SEHPs’ use of provider-based reference pricing to constrain cost growth has been gaining traction.

The No Surprises Act (NSA) has largely succeeded in protecting consumers from surprise medical bills by reducing out-of-network billing and establishing a dispute resolution process. However, while compliance has improved, challenges with the IDR process, legal actions, and incomplete data hinder a full assessment of its cost containment goals and effectiveness. CHIR experts Nadia Stovicek and Jack Hoadley discuss recent complaint data in their newest piece for CHIRblog.

President Trump’s price relief memorandum calls for reducing unnecessary administrative costs and rent-seeking behavior in health care. With federal agencies empowered to gather information and potentially drive reforms to eliminate wasteful spending, CHIR’s Christine Monahan discusses how they can effectively implement this directive by investigating intermediaries like pharmacy benefit managers (PBMs) and third-party administrators (TPAs) that increase consumer and employers costs through profit-driven practices.

Right before an early executive order signaling the Trump Administration’s interest in reducing access to health coverage, House Budget Committee leadership shared a wish-list of spending cuts that will severely damage health insurance affordability for marketplace enrollees. CHIR’s Karen Davenport considers the full picture for coverage policy.

A snowy first week of January gave us plenty of time to read some of the last research from 2024. This month we read about prescription drug pricing and the impacts of rebates on consumers, as well as market shares of Medicare Advantage carriers.

The Association of Health Care Journalists has released an updated, interactive 50-state Media Guide to help journalists navigate the complexities of the U.S. health care system, offering detailed data on health insurance coverage, state policies, and regulatory agencies. Developed in partnership with Georgetown University’s Center on Health Insurance Reforms, the guide includes a national overview, state-level resources, and essential tools for reporting on health coverage and consumer experiences.

The Biden administration has advanced several pro-competition reforms aimed at lowering health care costs and increasing consumer choice, an area of potential alignment with the incoming Trump administration. CHIR’s Kennah Watts discusses competition as a bipartisan policy and what the incoming Trump administration can do to support competitive markets and improve health care affordability.

In November, CHIR was thankful for the latest health policy research. We read about charity care provided by non-profit hospitals, Marketplace coverage for small business and self-employed workers, and out-of-pocket costs of traditional fee-for-service Medicare versus Medicare Advantage.

A new proposal in New York State seeks to reduce rising outpatient care costs by implementing site-neutral payment. The bill aims to cap payments, eliminate facility fees, and protect consumers from higher costs. In her latest article for CHIRblog, Karen Davenport breaks down this new proposal.

The Biden Administration has proposed a rule to expand coverage of preventive services, including over-the-counter (OTC) contraceptives, without cost sharing. However, the proposal’s future is uncertain due to potential legal challenges and the political factors surrounding reproductive health. CHIR faculty Leila Sullivan and Amy Killelea discuss the proposal.

The Affordable Care Act mandates that health plans in the individual and small-group markets cover essential health benefits (EHB), with states setting the scope through a benchmark plan. A new brief for the Commonwealth Fund by CHIR faculty explores how states have used recent flexibility to expand EHB, address consumer needs, and advance health policy, while highlighting ongoing challenges

In 2023, for the first time, more than half of Medicare beneficiaries were enrolled in Medicare Advantage (MA) plans, which offer private insurance alternatives to traditional Medicare, with 34 million enrollees in MA and 23 million in standalone Part D drug plans. A compendium of 70 policy proposals, created by Georgetown’s Center on Health Insurance Reforms, Medicare Policy Initiative offers a comprehensive resource for improving these programs, addressing issues like cost efficiency, provider networks, and many more.

In a recently published JAMA article, CHIR’s Maanasa Kona discusses the steps states can take to improve the financial assistance programs offered by hospitals, as well as the need for better state oversight of hospitals’ eligibility criteria and decision-making.

On November 20, CHIR hosted an all-star lineup of speakers to discuss how increased transparency can help support efforts to improve affordability in our health care system. In this post we provide some top takeaways from the event and a link to the recording.

The Centers for Medicare & Medicaid Services (CMS) has introduced a new option for states to update their essential health benefits (EHB) benchmark plan to include routine adult dental coverage, aiming to address disparities in oral health outcomes, particularly for low-income and minority adults. In their latest Expert Perspective for the State Health & Value Strategies program, CHIR’s JoAnn Volk and Manatt’s Tara Straw discuss considerations for states weighing this addition.

Enhanced premium tax credits (PTCs) have significantly reduced health insurance premiums and expanded coverage for millions of Americans, particularly low- and middle-income individuals, but these subsidies are set to expire in 2025. If Congress doesn’t act to make them permanent, premiums will rise, leading to coverage losses and greater financial hardship for millions. CHIR’s Karen Davenport discusses what the incoming Congress can do to address healthcare affordability issues.

The leaves are falling but the latest health policy research is evergreen! Last month we read about health system competition in metropolitan areas, health care affordability prior to the American Rescue Plan (ARPA,) how high deductible health insurance can exacerbate racial and ethnic wealth disparities, and about unmet dental vision and hearing needs among low-income Medicare Advantage beneficiaries.

Many Americans struggle with high healthcare costs, leading state policymakers to explore transparency measures to lower prices. While transparency alone has limited impact on cost reduction, states are innovating by increasing transparency in areas like provider ownership, billing practices, and price data, which can inform broader policy solutions and have bipartisan support, paving the way for more effective cost-containment strategies. In their latest article for CHIRblog, CHIR experts Stacey Pogue and Nadia Stovicek explore transparency options for state policymakers.

In recent years, federal price transparency rules have required hospitals and health plans to publicly post their prices. However, challenges persist with data access and use, limiting the data’s effectiveness for consumers and policymakers. Two bipartisan bills in Congress seek to strengthen these rules. CHIR experts Stacey Pogue and Nadia Stovicek discuss the federal price transparency landscape in their latest article for CHIRblog.

The 2024 election results will require concerted and aggressive efforts to preserve gains in insurance coverage, improvements in health equity, and greater health care affordability. CHIR’s faculty share thoughts on the work ahead.

The U.S. health care system’s lack of regulation over provider pricing and insurer claims has led to a rise in profit-driven middlemen, such as revenue cycle management firms. While these intermediaries aim to maximize reimbursements for providers, they often increase costs for consumers and complicate access to care. This complex environment underscores the urgent need for regulatory oversight to address the inefficiencies and rising expenses in the system. In their latest piece for Health Affairs Forefront, Linda J. Blumberg and Kennah Watts break down the effect of middlemen on US health care.

CMS recently released their draft Notice of Benefit & Payment Parameters (NBPP) for plan year 2026. In their latest piece for Health Affairs Forefront, Sabrina Corlette and Jason Levitis discuss what this means for Marketplaces, insurance reforms and Advance Premium Tax Credits (APTCs.)

The 2021 expansion of federal premium tax credits (PTCs) drove uninsured rates to a record low in 2023, but this critical financial assistance will expire after 2025 unless Congress acts. CHIR faculty Rachel Swindle and Justin Giovannelli talk more about this in their latest issue brief for the Commonwealth Fund.

Open enrollment for the Affordable Care Act Marketplaces begins on November 1. We review several important policies and programmatic changes that could affect Marketplace consumers in 2025.

The Affordable Care Act (ACA) marketplaces have become vital lifelines for millions, especially for communities of color, significantly reducing the uninsured rate and expanding access to affordable coverage. However, the future of these marketplaces hangs in the balance, with political priorities influencing their stability and funding, particularly regarding federal subsidies. As the 2024 election cycle approaches, the choices voters make could reinforce the progress achieved or risk undoing critical health care coverage advancements.

While the weather may be cooling down, the research is not! This month we read about Medicare Advantage quality bonus payments, out-of-pocket drug costs for consumers, effects of enhanced premium tax credits on older adults, and strategies to increase eligibility verification and receipt of Marketplace subsidies.

CHIR expert Christine Monahan recently testified before the Texas House Insurance Committee regarding outpatient facility fee billing. Her research highlights how facility fees contribute to significantly higher healthcare costs. In her testimony, she discussed measures to curtail hospital billing tactics that inflate costs and ways to mitigate financial burdens on patients.

Reinsurance has been a popular mechanism to stabilize insurance markets and reduce premiums. However, some argue that it could negatively affect affordability and enrollment for low-income individuals. In a new article for the State Health & Value Strategies program, Jason Levitis, Sabrina Corlette, and Claire O’Brien review the evidence and discuss considerations for state reinsurance programs.

Since the early 1990s, health care provider consolidation in states like Oregon has led to higher prices, reduced access, and worsened health inequities. In response, Oregon established the Health Care Market Oversight Program in 2022 to review major health care transactions, aiming to ensure they reduce costs and improve care access, especially for underserved populations. While the program has approved most transactions so far, concerns about transparency, resource adequacy, and high profit thresholds for review persist. CHIR’s Nadia Stovicek discusses the need for ongoing evaluation and improvement, and how other states can learn from Oregon.

More hot days mean more hot research! This month we read about the growing divergence between Medicare Advantage bids and payments, the impact of enhanced premium tax credits by race and ethnicity, and about how narrow or broad ACA marketplace physician networks really are.

Earlier this summer, the Biden administration announced updated guidance on medical debt. In a new blog post for the Commonwealth Fund, CHIR faculty, Maanasa Kona, reviews recent state action on medical debt and what this landscape looks like moving forward.

J.D. Vance, candidate for Vice President of the United States, has called for replacing the ACA’s insurance reforms with “high risk pools” for people with pre-existing conditions. CHIR’s Sabrina Corlette revisits how high risk pools worked (or more often, didn’t work) for people, prior to the ACA.

Recently, the U.S. House Education and Workforce Committee approved the Transparency Telehealth Bills Act, which standardizes billing for telehealth services and eliminates extra facility fees, ensuring consumers receive only one bill for their telehealth care. CHIR’s Christine Monahan discusses what this bill means for simplifying costs and protecting consumers from unexpected out-of-pocket expenses.

A debate is looming for the U.S. Congress – whether or not to extend enhanced premium tax credits for Affordable Care Act insurance coverage. In their latest article for Health Affairs, Jason Levitis, Sabrina Corlette, and Claire O’Brien identify several reasons Congress needs to act as soon as possible to preserve coverage and prevent a spike in premiums.

A recently enacted law creates a streamlined pathway to health insurance for individuals who are found ineligible for Medi-Cal but are likely eligible for Marketplace subsidies. In a recent report, CHIR experts assess the critical policy and operational decisions to implement the program and how these choices have affected consumers’ coverage transitions.

As Medicaid unwinding draws to a close, millions of people have had to find new health coverage options, many of them through the Affordable Care Act (ACA) Marketplaces. Emma Walsh-Alker discusses what we know about how they have fared, and whether state efforts to smooth coverage transitions have been successful.

The No Surprises Act (NSA) protects consumers from unexpected medical bills, with disputes between payers and providers settled through independent dispute resolution (IDR). CHIR’s Jack Hoadley and Kennah Watts review the latest results from the IDR process and discuss the ongoing legal and regulatory challenges affecting the NSA.

In response to widespread concerns about the impact of medical debt, the Consumer Financial Protection Bureau (CFPB) proposed a rule in June 2024 aimed at limiting the influence of medical debt on credit reports and preventing certain debt collection practices. Despite recent changes by credit agencies to exclude small medical debts from reports, many Americans still face significant medical debt, particularly affecting vulnerable populations. In a recent piece for Health Affairs Forefront, Georgetown experts examine this proposed rule and the effect it could have on consumers.

The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) is the primary federal law protecting access to behavioral health care for privately insured Americans. In a new issue brief for the Commonwealth Fund, CHIR experts interviewed insurance regulators in ten states to identify the tools state regulators are using for MHPAEA oversight and enforcement, as well as the barriers they are facing.

Last month CHIR stayed cool indoors to catch up on the latest in health policy research. In July, we read studies that assessed policies to increase insurance coverage rates and forecasted insurance coverage and health expenditures for the next decade.

Health insurers use of prior authorization appears to be on the rise. A recent report by CHIR researchers examines four states’ prior authorization policies for the commercial market to identify potential reform strategies to ease provider burden and improve patient access without also increasing insurers’ costs.

While there is some movement toward improved health care provider ownership transparency at the federal level and in some states, more attention is warranted given increasingly complex and obscured provider ownership structures and the impact they can have on health care prices, access, and quality. In a recent piece for Health Affairs Forefront, CHIR experts Stacey Pogue and Nadia Stovicek analyze efforts to improve ownership transparency at the state and federal levels.

July is rate review season for state insurance departments. Proposed premiums for 2025 can help reveal how health insurers are responding to market trends, policy changes, and underlying drivers of health care cost growth. In her latest article for CHIRblog, Sabrina Corlette digs into the projected premium changes for 2025 and what’s driving them.

Last month CHIR soaked up the sun and the latest in health policy research. This month we read studies that examined hospital mergers’ impact on the economy, reviewed insurance coverage rates during various policy periods, and analyzed the benefits of enhanced premium tax credits.

Two national health insurers recently discussed their plans to invest in “ICHRAs,” tax advantaged accounts that workers use to purchase individual market health insurance. CHIR’s Hanan Rakine explores what a greater use of ICHRAs could mean for workers, and for the stability of insurance markets.

Easy-enrollment programs offer states an efficient, low-cost mechanism for connecting residents with comprehensive, affordable health care coverage. In a recent post for the Commonwealth Fund, CHIR experts Rachel Swindle, Rachel Schwab, and Justin Giovannelli review state efforts and effective strategies for improving easy enrollment programs and boosting healthcare enrollment. 

As hospitals and health systems expand their ownership and control of ambulatory care practices, they are frequently charging new facility fees for routine medical services delivered in outpatient settings. These bills are driving up premiums and health expenditures for consumers, employers, and, ultimately, tax payers. With support from and working in partnership with West Health, CHIR experts are studying outpatient facility fee billing reforms and share their findings in a new online repository.

Over the past 30 years, hospitals and physician practices have been merging at an accelerated pace, and as a result, they have been able to command higher prices for their services. A recent report by CHIR Faculty discusses federal and state mechanisms to address provider consolidation, and what can be done to strengthen them.

The U.S. significantly under-invests in primary care, even though the benefits of primary care access are well known. Several states are now using their health insurance rate review authority to push insurers to increase their investment. CHIR’s Maanasa Kona and Sabrina Corlette review these states’ strategies and their impact to date.

The Congressional Budget Office has released its 10-year projections for the country’s health insurance coverage rates. In her latest article for Health Affairs Forefront, CHIR’s Sabrina Corlette reviews the agency’s predictions and provides a roadmap for maintaining – and even improving – our nation’s historically high coverage rates.

Over the last several months, CHIR hosted the webinar series “Understanding Hospital Financing.” CHIR’s Kennah Watts reviews this series and answers timely questions relating to hospital financial health, facility fees, and the Maryland All-Payer Model.

The days are heating up and so is the summer research! This month we read about the effects of health risk assessments on Medicare Advantage payments, how the Affordable Care Act transformed the healthcare landscape in this country, and finally, about hospital pricing and the values of transparency.

The U.S. Department of Health & Human Services has released a final regulation allowing people who receive Deferred Action for Childhood Arrivals (DACA) to access new health insurance options. CHIR’s Sabrina Corlette and Julian Polaris of Manatt Health review the rule and its implications for state policy.

With more outpatient care being delivered in hospital outpatient departments (HOPDs) than in previous years, consumers increasingly face high hospital facility fee charges on top of their provider’s bill for routine medical care. CHIR’s Hanan Rakine discusses the 2024 legislative session and how different states have been successful in regulating outpatient facility fees.

In a new post for the Commonwealth Fund’s To The Point blog, CHIR’s Jalisa Clark and Christine H. Monahan describe how Washington and California’s quality programs are focusing on equity and highlight opportunities for other state-based marketplaces to similarly strengthen their own quality programs.

On Tuesday, May 21st, Georgetown University’s Center on Health Insurance Reforms held the final of three events in its series on the Futures of Employer-Sponsored Health Insurance. Event speakers Stacy Sanders, Erin Fuse Brown, David Seltz and Charles Miller discussed competition in health care from the federal and state perspectives.

The US Department of Labor recently finalized regulations governing the formation of Association Health Plans, reversing a 2018 Trump-era policy. In a recent Health Affairs Forefront article, CHIR’s Sabrina Corlette reviews the final rule and its impact on small business health insurance.

The Centers for Medicare & Medicaid Services have recently finalized rules and standards governing health plans and Marketplaces under the Affordable Care Act. In a recent Expert Perspective for the State Health & Value Strategies project, CHIR’s Sabrina Corlette and the Urban Institute’s Jason Levitis summarize provisions that have implications for states.

Recent federal rules will limit the marketing and use of short-term limited duration health insurance. In a recent Expert Perspective for the State Health & Value Strategies project, CHIR’s Sabrina Corlette discusses the implications for state regulators.

A growing number of states are taking action to reform facility fee billing practices, but opposition from hospital associations can stall these efforts. Several states have enacted legislation mandating facility fee studies instead of reforms. CHIR’s Rachel Swindle explores some lessons learned from these states and how studies can be leveraged to lead to meaningful consumer protections.

April showers bring…cozy rainy days to catch up on the latest health policy research. This month we read about public option plans, provider price regulation, and self-reported insurance coverage during the Medicaid unwinding.

CHIR is delighted to welcome two new faculty members: Amy Killelea and Leila Sullivan.

Lack of access to care for behavioral health conditions is a longstanding issue. In a recent post for the Commonwealth Fund, CHIR experts JoAnn Volk and Justin Giovannelli reviewed state and federal access standards for behavioral health providers and services.

A growing body of evidence suggests private equity investments in health care have raised provider prices and reduced care quality in certain settings. In a new Health Affairs Forefront article, Linda Blumberg and Kennah Watts look at the track record of private equity acquisitions and how cost-containment efforts could help mitigate private equity’s influence and improve patient outcomes.

Federal regulations require hospitals and insurers to publish negotiated prices. States are also playing a role in this effort by monitoring compliance with the federal rules and implementing other policies to educate consumers and improve this cost-containment tool. In their recent Health Affairs Forefront article, Maanasa Kona and Nadia Stovicek look at state actions to promote price transparency.

The U.S. Department of Health & Human Services recently released a final rule setting standards for the Affordable Care Act Marketplaces and health insurers for plan year 2025. In their latest Health Affairs Forefront article, Sabrina Corlette and Jason Levitis discuss the new Marketplace standards, insurance reforms, and policies concerning Advance Premium Tax Credits.

Last month the Biden administration finalized rules establishing new standards and disclosure requirements for certain limited benefit products. In one of her recent Health Affairs Forefront articles, Sabrina Corlette takes a look at what’s in the final regulations.

As another tax filing season comes to a close, millions of Americans have reduced their taxable income through accounts that help pay for medical costs using a “health savings account” (HSA). Members of Congress have put forth bipartisan proposals to expand HSAs, but with the benefits of these accounts primarily accruing to healthier and wealthier Americans, expanding this option could exacerbate an already regressive tax break without improving access to coverage or care.

Thanks to daylight savings in March, CHIR had more time to keep up with the latest health policy research. Last month, we read studies about Affordable Care Act Marketplace plans and enrollee characteristics, Georgia’s reinsurance waiver, and Oregon’s hospital price cap.

Last month, CHIR experts Rachel Swindle and Karen Davenport shared findings from CHIR’s research on state-level facility fee reforms before House and Senate committees of the Maryland General Assembly.

The final Notice of Benefits and Payment Parameters for plan year 2025 is expected soon. The proposed rule included a provision that would permit states to require coverage of adult dental services as part of the Essential Health Benefits. As part of a CHIRblog series on Marketplace dental benefits, CHIR reviewed comments submitted in response to this proposal by select stakeholder groups.

In the United States, immigrants are disproportionately likely to be uninsured. This disparity stems from systemic inequalities such as legal barriers to affordable coverage for noncitizens—especially undocumented immigrants. While state efforts to provide Medicaid-equivalent benefits to some populations of undocumented residents have helped expand access to coverage, many low- and moderate-income undocumented residents remain without affordable health insurance options. In a recent post for the Commonwealth Fund’s To the Point blog, CHIR’s Justin Giovannelli and Rachel Schwab explore recent state actions to fill this gap.

According to recent estimates, almost 100 million people have debt because of medical or dental bills. To mitigate this problem, nineteen states and the District of Columbia require hospitals to provide financial assistance to low-income populations, but the process of applying for financial assistance is often cumbersome and inaccessible. In a recent post for the Commonwealth Fund’s To the Point blog, CHIR’s Maanasa Kona discusses how some states have made the financial assistance application process easier for their residents.

In February, CHIR used Leap Day to catch up on the latest health policy research. This month we read studies on the uninsurance rate, dynamics between the small-group market and individual Marketplace, and the availability of mental telehealth services.

On March 7, CHIR hosted the second event in a series of policy briefings on the future of employer-sponsored health insurance, sponsored by Arnold Ventures. This event, featuring remarks from Congressman “Bobby” Scott and a panel discussion moderated by Julie Appleby of KFF Health News, focused on the No Surprises Act’s impact on consumers and implementation challenges associated with the independent dispute resolution process.

Last month, the Biden administration reported on independent dispute resolution (IDR) cases resolved under the No Surprises Act in the first half of 2023. In a new post for the Commonwealth Fund, CHIR’s Jack Hoadley and Kevin Lucia analyze the IDR data and what it means for patients, providers, payers, and health care costs.

Last year, Colorado became the first state to require comprehensive data from all health care sharing ministries (HCSMs) selling memberships in the state. In a post for the Commonwealth Fund, CHIR’s JoAnn Volk and Justin Giovannelli, along with attorney and health policy consultant Christina L. Goe, take a look at data from Colorado’s first HCSM report.

In November, the Biden administration released the proposed Notice of Benefits and Payment Parameters for plan year 2025, an annual rule setting standards for the Affordable Care Act (ACA) Marketplaces and health insurers. For CHIR’s third and final blog summarizing stakeholder comments on the proposed rule, Maanasa Kona and Rachel Schwab reviewed letters submitted by state insurance departments and state-based Marketplaces.

The Biden administration will soon finalize its annual rulemaking for the Affordable Care Act Marketplaces. To better understand the impact of the proposed changes, CHIR reviewed the public comments submitted by key stakeholder groups. In the second post in a 3-part blog series, CHIR’s Karen Davenport and Emma Walsh-Alker review the feedback provided by consumer advocates.

This winter, CHIR curled up with some good reads: the latest in health policy research. In December and January, we read studies on trends in employer-sponsored insurance, expanding insurance options for non-citizens, and state efforts to improve provider directory accuracy.

CHIR is delighted to welcome two new faculty members: Stacey Pogue and Kennah Watts.

Dental care is an important element of comprehensive health care. The Affordable Care Act (ACA) requires coverage of pediatric dental services in many commercial plans, but the law has had less of an impact on adult dental coverage. This first blog in a new series on dental coverage in the ACA Marketplaces summarizes the legal framework of dental coverage and potentially forthcoming changes under the proposed Notice of Benefit and Payment Parameters for 2025.

States remain motivated to adopt reforms that improve affordability and expand access to coverage for populations that still lack access to care. State public option–style plans are a key candidate for consideration. In a post for the Commonwealth Fund, CHIR experts provide an update on states that have established or are laying groundwork for public option–style plans.

The Biden administration will soon finalize its annual rulemaking for the Affordable Care Act Marketplaces. To better understand the impact of the proposed changes, CHIR reviewed the public comments submitted by key stakeholder groups. In this first in a 3-part blog series, CHIR expert Sabrina Corlette reviews the feedback provided by health insurance companies and web-brokers.

The Affordable Care Act’s Marketplaces have seen record signups for 2024. Marketplaces can pursue innovative and consumer-friendly policies that bolster this crucial source of coverage. In a recent issue brief for the Commonwealth Fund, CHIR experts reviewed policy decisions across state-run Marketplaces and the federally facilitated Marketplace.

A handful of states are working to improve health insurance affordability by boosting their insurance department’s rate review authority and empowering regulators to look “under the hood” at the prices commercial insurance companies negotiate for health care goods and services. In a recently released report, CHIR experts share findings from a 50-state assessment of rate review programs.

Open enrollment for the Affordable Care Act’s Marketplaces has ended in most states, with a record number of people selecting a Marketplace plan for 2024. This week, we’re highlighting answers to common post-enrollment questions from our Navigator Resource Guide.

Last month, the U.S. Department of Labor proposed a rule rescinding a Trump-era regulation that expanded the use of Association Health Plans (AHPs). In a post for Health Affairs Forefront, CHIR’s Sabrina Corlette takes a look at the history of AHPs and what’s at stake in the Biden administration’s proposal to roll back the 2018 rule.

Congress is considering legislation that would make telehealth coverage an “excepted benefit.” CHIR experts discussed how the bill would impact consumers when it advanced in the House of Representatives in early 2023. In light of recent efforts to add the proposal to the government funding package, CHIRblog is republishing their post.

In recent years, outpatient care has contributed considerably to growth in U.S. health care spending. Efforts to curb outpatient spending have been stymied by fundamental problems connecting data on sites of care, providers, and specific charges, but a bill that recently passed the U.S. House of Representatives could provide new information necessary to craft reforms and slow spending growth.

Open enrollment for the Affordable Care Act’s Marketplaces is coming to a close. In most states, January 16 is the last day to sign up for a 2024 plan. This week, we’re highlighting frequently asked questions from CHIR’s Navigator Resource Guide concerning the end of open enrollment.

The No Surprises Act (NSA) provides comprehensive protections from many of the most prevalent forms of surprise medical billing, and a new process for determining out-of-network provider reimbursement aims to control health care costs by limiting insurer payments for surprise bills. It remains to be seen if the new federal law—implemented only last year—will achieve these goals. Two recently released reports provide some of the first indicators of the NSA’s impact.

Last month, the Biden administration proposed changes to Affordable Care Act (ACA) Marketplace policies and procedures. In a post for Health Affairs Forefront, Sabrina Corlette and Jason Levitis take a look at the proposals related to market reforms, Marketplace standards, and premium tax credits.

As 2023 comes to a close, it’s time to think about health insurance for 2024. Consumers searching for a 2024 plan online may come across products that do not have to comply with the Affordable Care Act’s (ACA) consumer protections. This week, we’re highlighting frequently asked questions from our Navigator Resource Guide concerning the risks of buying coverage outside the ACA’s Marketplace.

Several state-based Marketplaces have deployed innovative programs to keep people covered during the Medicaid unwinding. In their latest post for the Commonwealth Fund, CHIR’s Rachel Swindle and Sabrina Corlette assess the status of these programs and discuss the urgent need for more timely and accurate data on people transitioning from Medicaid to other forms of coverage.

It’s time to sign up for 2024 coverage on the Affordable Care Act’s Marketplaces. This week, the Centers for Medicare & Medicaid Services (CMS) is spotlighting how the Marketplaces can serve LGBTQI+ individuals, a community that has historically faced discriminatory barriers to health insurance and health care. Here are a few frequently asked questions (FAQs) from CHIR’s Navigator Resource Guide about some Marketplace coverage issues that LGBTQI+ individuals may face.

The deadline to sign up for Marketplace coverage that begins January 1 is fast approaching. This week, we’re spotlighting frequently asked questions (FAQs) from our Navigator Resource Guide about how to compare benefits and out-of-pocket costs across Marketplace plans.

It’s open enrollment season for many employer health plans, and the rising cost of care may increase workers’ premiums and out-of-pocket expenditures. Recently, CHIR surveyed state employee health plans (SEHP) to identify challenges and opportunities for controlling health care costs. In a new post for Health Affairs Forefront, Sabrina Corlette and Karen Davenport discuss the survey findings and how SEHP strategies can inform broader cost containment efforts.

The Affordable Care Act’s Marketplaces are a critical source of health insurance for small business owners and their employees. In our weekly installment of FAQs from the Navigator Resource Guide, we’re spotlighting questions on coverage for people who own or work for a small business.

In just the first eight months of 2023, over 323,000 workers engaged in a labor action against their employers. Unions have been demanding better wages, protections, and benefits—including better health plans. CHIR’s Maanasa Kona takes a look at the role of unions in securing affordable health coverage for workers, including the innovative strategies they’ve used to reduce the unsustainable growth in health system costs.

Open Enrollment for 2024 is in full swing, and thanks to a temporary expansion of federal premium subsidies, most Marketplace enrollees qualify for coverage at a very low monthly cost. This week, we’re highlighting frequently asked questions from our Navigator Resource Guide regarding the financial assistance available through the Marketplace.

In preparation for Health Policy Halloween, CHIR read up on the latest health policy research. In October, we read studies on consumer experiences enrolling in the Affordable Care Act (ACA) Marketplace, health care affordability issues among the insured and uninsured, and the impact of Medicaid expansion on coverage in heavily redlined areas.

November 1 marked the first day of the Marketplace Open Enrollment Period in most states. CHIR recently updated its Navigator Resource Guide, and we’ll be highlighting frequently asked questions (FAQs) from the Navigator Guide throughout the annual enrollment window. This week, we’re taking a look at who is eligible for Marketplace plans.

Consumers are facing higher out-of-pocket costs when they receive outpatient care due to hospital “facility fees.” In a post for Health Affairs Forefront, Linda Blumberg and Christine Monahan provide a primer on facility fees, including the trend of hospital consolidation driving these fees and federal policy options to protect consumers from rising costs in outpatient settings.

The comment period recently ended for the Biden administration’s proposed a rule to bolster enforcement of federal mental health parity requirements and improve access to crucial services. In a post for Health Affairs Forefront, Maanasa Kona explains what’s in the proposed rule.

As another Marketplace Open Enrollment Period begins, millions of Americans will turn to insurance brokers to guide them to affordable and comprehensive health insurance. In a new post for the Commonwealth Fund, CHIR’s Jalisa Clark and Christine Monahan look into the underrepresentation of people of color in the broker profession and the clients they serve, including the historical origins of these racial disparities and how the Affordable Care Act Marketplaces are intervening.

The annual Marketplace Open Enrollment Period is just around the corner. Enrolling in health insurance can be a challenge, especially for the millions of Americans with limited English proficiency (LEP). In a new issue brief for the Commonwealth Fund, CHIR experts document how the Affordable Care Act’s Marketplaces are facilitating access to health insurance information for LEP individuals, identify persistent gaps in language services, and recommend federal policies to improve language access in the Marketplaces.

The annual open enrollment period for Affordable Care Act (ACA) Marketplace coverage kicks off November 1 in most states. A number of new and ongoing policy changes will impact the Marketplace in 2024, including special enrollment opportunities tied to the Medicaid “unwinding,” continuing enhanced financial assistance, and administrative flexibilities designed to reduce barriers to enrollment. CHIR’s Emma Walsh-Alker summarizes these and other recent policies that consumers may encounter this year.

As we fall into autumn weather, CHIR continues to keep up with the latest health policy research. In September, we read about trends in individual market enrollment, mental health care networks available through the Affordable Care Act’s (ACA) Marketplace, and employers’ ability to negotiate lower prices for health care services.

On October 3, CHIR held the first in a series of in-person policy briefings on the future of employer-sponsored insurance (ESI), sponsored by Arnold Ventures and West Health. The event, featuring remarks from U.S. Senator Maggie Hassan and a panel discussion moderated by Sarah Kliff of The New York Times, spotlighted state cost containment policies and employer strategies to inform the federal policy process concerning ESI, which covers almost half of all Americans.

Medical debt is one of the leading causes of bankruptcy in the United States. Though federal law provides some protection against medical debt and its downstream consequences, the federal framework has significant gaps. In a new report for the Commonwealth Fund, CHIR’s Maanasa Kona and Vrudhi Raimugia examine how states are filling gaps in federal law.

CHIR is excited to welcome Billy Dering, M.P.H., as our newest faculty member.

In the wake of the Supreme Court’s decision overturning Roe v. Wade, states have taken action to protect and promote access to abortion. CHIR’s Rachel Swindle and Karen Davenport outline some of these state efforts as they relate to private insurance.

As hospitals expand and take over outpatient care settings, consumers are facing additional charges in the form of facility fees when they see physicians and other providers. In a new post for Health Affairs Forefront, Christine Monahan and Linda Blumberg detail congressional proposals to reform billing practices that expose consumers to facility fees.

A September 12 vote in Oregon would make it the third state to establish a Basic Health Program, after New York and Minnesota. CHIR and Urban Institute researchers recently examined New York and Minnesota’s experiences with the BHP and the lessons learned for other states considering the program.

As summer was winding down, CHIR was reading up on the latest health policy research. In August, we read about differences between Medicare Advantage and commercial plans’ negotiated hospital prices, the affordability of employer-sponsored insurance for older adults, and the expected growth of 2024 Affordable Care Act Marketplace premiums.

CHIR is delighted to welcome Nadia Stovicek (she/her), M.P.P., as our newest faculty member.

The “Colorado Option” – a unique state effort improve health insurance affordability – is underway. With the first year of enhanced premium scrutiny now completed, CHIR experts Christine Monahan, Nadia Stovicek, and Sabrina Corlette examine how the process unfolded and what it means for consumers.

A recently proposed federal rule aims to mitigate the harm of short-term insurance plans, products exempt from the Affordable Care Act’s consumer protections. In a post for the Commonwealth Fund, Justin Giovannelli, Kevin Lucia, and Christina L. Goe explain the proposed federal rule and describe what else states can do to further protect their residents.

A massive coverage transition is underway for millions of people who have relied on Medicaid throughout the COVID-19 pandemic. After a three-year pause, states have begun disenrolling residents from Medicaid, leaving millions of people in need of new coverage. A secret shopper study conducted in June 2023 suggests that people losing Medicaid are facing aggressive marketing of limited benefit products.

Millions of Americans rely on Health Care Sharing Ministries (HCSM) in lieu of insurance to provide a financial cushion if they get sick or injured. But data from HCSM public filings suggest that reliance may be built on a shaky foundation. CHIR’s Nadia Stovicek and JoAnn Volk share their findings.

The No Surprises Act is largely working as intended to protect patients from unexpected medical bills. However, the rising number of Independent Dispute Resolution (IDR) cases is creating challenges for the health care system. In a post for Health Affairs Forefront, Jack Hoadley and Kevin Lucia evaluate the causes and implications of the increasing number of IDR cases.

CHIR’s summer reading list includes the latest health policy literature. In July, we read about the disparities in medical debt burdens, policy interventions to reduce choice errors in the Affordable Care Act (ACA) Marketplace, and the affordability of Marketplace health insurance under subsidy expansion.

The Centers for Medicare & Medicaid Services has published proposed rate changes for 2024 Marketplace plans. In some states, insurers submitted rate requests earlier in the summer, alongside justifications for the proposed changes to next year’s premiums. CHIR dug into the rate requests from select states with early rate filing deadlines to see what’s behind the premiums consumers could be facing in 2024, both on- and off-Marketplace.

While the federal COVID-19 Public Health Emergency (PHE) ended in May, the PHE declaration for the opioid crisis continues. Opioid overdose deaths remain alarmingly high, and the Biden administration recently bolstered the federal government’s response to the opioid crisis with new proposed rules to strengthen access to treatment. CHIR’s Rachel Swindle and Kristen Ukeomah explore this proposal as well as other recent state and federal policy changes that aim to reduce barriers to evidence-based treatment for opioid use disorder.

In a new case study, published in collaboration with the Milbank Memorial Fund, CHIR researchers examined stakeholder efforts to improve primary care access in Kanawha County, West Virginia—an area designated as a primary care health professional shortage area for low-income residents.

This month, the Biden administration issued a Request for Information (RFI) on “the scope, prevalence, terms, and impacts” of medical credit cards and other high-cost medical financing products. In a post for Health Affair’s Forefront, CHIR’s Maanasa Kona explains the RFI and outlines some of the risks these products pose for patients.

Last month, the Centers for Medicare & Medicaid Services (CMS) held the first ever CMS Health Equity Conference. CHIR members who attended the inaugural conference provide an overview of the meeting—including a presentation by CHIR’s Christine Monahan—and its implications for current and future health equity initiatives.

One year ago, the U.S. transitioned to a new, three-digit nationwide number for suicide prevention and mental health crisis response services. In their latest expert perspective for the Robert Wood Johnson Foundation’s State Health & Value Strategies project, JoAnn Volk and Sabrina Corlette provide a roadmap for states seeking to expand access to behavioral health crisis services, spotlighting Washington State’s comprehensive approach.

Consumers are increasingly being exposed to a new expense when they seek outpatient medical care: hospital facility fees. In a new report and issue brief supported by West Health, CHIR’s Christine Monahan, Karen Davenport, and Rachel Swindle explore outpatient facility fee billing in the commercial sector, including the impact of these fees on consumers and how states are responding.

The Biden administration has proposed a new rule limiting insurance products that are largely exempt from federal and many state-level consumer protections. In a post for Health Affairs Forefront, Sabrina Corlette takes a look at the risks these products pose to consumers and insurance markets, and what’s in the proposed rule.

As we splashed into summer, CHIR soaked up the latest health policy research along with some rays. In June, we read about trends in coverage and access for LGBT adults, the rise of facility fees, and the out-of-pocket cost burden of mental health care.

State employee health plans are uniquely situated to tackle the health care cost growth that is reducing health care affordability. CHIR’s 50-state survey of state employee health plans has key findings about their cost containment strategies, and the implications for other employer purchasers.

The rising costs of employer-sponsored insurance are placing financial pressure on employers and workers alike. In a four-part series, CHIR experts have reviewed the evidence supporting a range of policy options to improve the affordability this critical coverage option. This, their fourth and final post in the series, focuses on health care price transparency.

Happy Pride Month from CHIR! Each June, Pride is an opportunity to celebrate the LGBTQ+ community and honor the ongoing struggle for LGBTQ+ rights—including in health care access. CHIR’s Emma Walsh-Alker examines the systemic barriers to health care coverage that the LGBTQ+ community faces, and highlights a few key coverage and access issues that continue to impact LGBTQ+ individuals with private health insurance.

The U.S. House of Representatives Education and Workforce Health Subcommittee held a hearing on health care costs, competition, and transparency. CHIR’s Christine Monahan testified before the committee regarding consolidation in health care markets.

April showers bring May flowers, and May was abloom with health policy research. Last month, we read about the impact of ending pandemic-related coverage policies, consumer awareness of the resumption of Medicaid renewals, and approaches to tackling rising health care costs in commercial health insurance markets.

The U.S. House of Representatives’ Education & Workforce Committee is poised to advance H.R. 2813, legislation that would expand self-funded employer plans in the small group market and preempt state insurance regulation. CHIR’s Sabrina Corlette testified about the bill at an April 26, 2023 committee hearing.

CHIR is thrilled to welcome Hanan Rakine, M.P.H., as our newest faculty member.

On May 15, 2023, the 5th Circuit Court of Appeals temporarily paused the Braidwood v. Becerra ruling by a federal district court. That court’s decision would have blocked federal enforcement of the ACA’s requirements that insurers cover and waive cost-sharing for preventive services. In their latest post for the State Health & Value Strategies project, Sabrina Corlette and Tara Straw discuss who is impacted, and how states can help protect their residents.

The Affordable Care Act established health insurance Marketplaces to facilitate enrollment in comprehensive and affordable health insurance. Most states rely on the federal government to run their Marketplace, but recently, several states have expressed interest in taking over Marketplace operations. With Marketplace enrollment at an all-time high, and millions more people poised to transition from Medicaid to commercial insurance, the role of the Marketplaces as a coverage safety net has never been more pivotal. But federal rules impose few standards for states launching and maintaining a Marketplace. It may be time for the federal government to establish a stronger federal floor.

The transparency of health care prices can help policymakers, employers, and researchers identify the drivers of cost growth and target solutions. In her latest post for Health Affairs’ Forefront, Sabrina Corlette identifies how states can play a role making health plan price data more accessible and usable.

For our monthly research roundup, we reviewed studies on a public option proposal for California, how personalized outreach can increase enrollment in affordable Marketplace plans, and recent trends in Marketplace premiums and insurer participation.

Washington, Colorado, and Nevada are partnering with private health insurance carriers to offer new “public option” plans. In a post for the Commonwealth Fund’s To the Point blog, CHIR’s Christine Monahan and Madeline O’Brien compare state approaches to selecting insurance carriers to offer the new state plans.

After more than three years, the federal COVID-19 public health emergency (PHE) is set to expire on May 11, 2023. Once the PHE designation is lifted, a number of federal policies intended to help the U.S. health care system adapt to the pandemic will also expire. CHIR’s Emma Walsh-Alker reviews selected policies tied to the PHE and evaluates how the impending expiration will impact consumers’ access to services.

The U.S. House of Representatives’ Education & Workforce Committee is considering several bills affecting the affordability and accessibility of employer-sponsored insurance. CHIR’s Sabrina Corlette was invited to testify on these proposals and the state of private insurance generally.

The Biden administration has published its rules for the ACA’s insurers and Marketplaces for plan year 2024. In a post for Health Affairs’ Forefront, Sabrina Corlette reviews what is changing, and what is not.

Winter is finally over, and health policy research is in full bloom. In March, we read about disparities in health insurance coverage for people of color, medical debt, and preventive service usage among private health plan enrollees.

Under the No Surprises Act, consumers are held harmless beyond in-network cost sharing when they receive certain kinds of out-of-network care. In these scenarios, to determine the provider’s payment, payers and providers may enter independent dispute resolution (IDR). Recently, federal agencies released an initial report on the No Surprises Act’s IDR process. In a post for Health Affairs Forefront, CHIR experts Jack Hoadley and Kevin Lucia analyze the new report and discuss what it suggests about the No Surprises Act.

The U.S. Department of Justice has requested that a Texas district court suspend its decision to strike down the ACA’s preventive services benefits while it pursues an appeal. In her latest Health Affairs Forefront article, CHIR’s Sabrina Corlette explores what could happen if a stay is not granted in the case.

At the end of March, a federal judge in Texas partially invalidated one of the ACA’s most popular provisions—the requirement to cover a set of preventive services without cost sharing. In a recent post for the Commonwealth Fund’s To the Point blog, CHIR experts break down the recent decision and how it will impact access to care.

The Biden administration has proposed new rules for the Affordable Care Act’s (ACA) marketplaces in 2024, which are expected to be finalized any day. In the final installment of our annual NBPP stakeholder comment series, CHIR’s Rachel Schwab reviews state responses to the proposed rule.

The Biden administration is poised to finalize new rules governing the Affordable Care Act Marketplaces and insurance reforms for plan year 2024. In the second installment of our annual review of key stakeholder responses to the proposed policy changes, CHIR’s Kristen Ukeomah and Karen Davenport focus on consumer advocate comments on the proposed rule.

President Biden released his Fiscal Year 2024 budget earlier this month, outlining the administration’s spending and policy priorities for a number of key programs, including the Affordable Care Act (ACA) Marketplaces. However, with a sharply divided Congress, consumers who rely on Medicaid and the ACA’s Marketplaces are likely in the crosshairs of an upcoming spending showdown. CHIR’s Emma Walsh-Alker examines the potential impact of cutbacks to the ACA’s Marketplace subsidies on low- and moderate-income families.

The Biden administration is poised to finalize new rules governing the Affordable Care Act Marketplaces and insurance reforms for plan year 2024. In its annual review of how key stakeholders are responding to the proposed policy changes, CHIR will be publishing a three-part series focused on insurance company, consumer advocate, and state comments on the proposed rule.

Nearly half of U.S. residents are enrolled in employer-sponsored health insurance. Many of these plans use third-party administrators (TPAs), intermediaries—frequently insurance companies themselves—that help build provider networks, design benefit packages, and adjudicate claims, among other responsibilities. But a TPA’s interests may not align with those of their employer clients. CHIR’s Christine Monahan highlights several examples of questionable insurer-TPA practices uncovered in recent years.

The Affordable Care Act is now 13 years old. To celebrate this milestone, CHIR takes a look at the law’s big accomplishments and its impact on American families.

As states resume conducting Medicaid and CHIP re-determinations of eligibility, the U.S. faces the most dramatic shift in coverage since implementation of the Affordable Care Act. As millions of people transition from Medicaid to private insurance coverage, they could experience disruptions in critical health care services. In their latest post for the Commonwealth Fund, Sabrina Corlette and Maanasa Kona review state-level continuity of care protections and actions states can take to preserve access to life-saving services for our most medically vulnerable.

Last month, the Biden administration proposed new rules to restore access to free contraceptive services under the Affordable Care Act. In the wake of severely restricted access to reproductive health care, the stakes of the Biden administration’s proposals are high. With comments due on April 3, CHIR’s Rachel Schwab provides an overview of the Biden administration’s proposals and key considerations for consumers’ access to contraceptive services.

Along with “Health Policy Valentines,” February brought a host of new health policy research. This month, we read about trends in medical and pharmacy spending, the relationship between health systems’ financial performance and amounts paid by commercial plans, and mental health provider network adequacy.

High and rising health care prices are a key driver of increased cost sharing in employer plans. A significant contributor to rising prices is the consolidation in health care provider markets. In the third post of a series on policy options to improve the affordability of employer-sponsored insurance, CHIR’s Maanasa Kona and Sabrina Corlette explore strategies to limit provider consolidation and anti-competitive behavior.

Washington State’s “public option” program is now in its third year. After initial cost and access challenges hindered the program’s reach, growing insurer participation and recent enrollment data suggest meaningful progress is being made. CHIR’s Christine Monahan and Madeline O’Brien provide an update on how Washington’s public option plans performed in the recently concluded open enrollment period, outlining key issues to watch as Washington moves forward with its first-in-the-nation program.

States have begun conducting Medicaid redeterminations and renewals after an almost 3-year pause, a process that is being called the “Unwinding.” In their latest article for the State Health & Value Strategies program, Sabrina Corlette, Jason Levitis, and Tara Straw outline strategies state Marketplaces and insurance departments can implement to reduce coverage disruptions and ensure continuity of care.

After a three-year pause on Medicaid redeterminations, states can begin the process of removing residents from their rolls beginning on April 1. Many people who are terminated from Medicaid will be eligible for free or low-cost plans through the Affordable Care Act’s Marketplaces. To help consumers and enrollment assisters during this nationwide coverage event, we’ve updated our Navigator Resource Guide with new content about transitioning between Medicaid and private health insurance.

The COVID-19 public health emergency expires this spring, bringing an end to pandemic-related funding, infrastructure, and flexibilities. Meanwhile, millions of people continue struggling to find and pay for effective treatment for post-acute, COVID-related conditions. Karen Davenport provides an update on the progress—or lack thereof—towards covering the ongoing and unique care needs of these COVID “long haulers.”

Welcome to another year of health policy research. In the first month of 2023, CHIR reviewed studies on how policies expanding health coverage would impact household spending, surprise medical bills generated by ground ambulance rides, and health care costs associated with substance use disorders.

As a candidate, President Biden promised to protect and build on the Affordable Care Act. At the halfway mark of his first term, CHIR’s Sabrina Corlette and CCF’s Joan Alker write on Health Affairs’ Forefront about the progress he has made to fulfil that promise, and what work there remains to do.

A record number of people have signed up for health insurance through the Affordable Care Act’s marketplaces. This historic enrollment coincides with a new rule that fixes the “family glitch,” a former policy that blocked over 5 million people from accessing marketplace subsidies. In a post for the Commonwealth Fund’s To the Point blog, CHIR experts highlight the variety of activities undertaken by the ACA’s marketplaces to implement the family glitch fix.

In a new Perspectives piece for the New England Journal of Medicine, CHIR’s Sabrina Corlette and Christine Monahan help readers navigate the United States’ patchwork system of health insurance coverage, where people’s access to services and level of financial protection — not to mention whether they have coverage at all — vary depending on their birthplace, age, job, income, location, and health status.

A federal judge is poised to gut one of the most popular provisions of the Affordable Care Act’s (ACA) preventive services requirement, potentially cutting off millions of peoples’ access to crucial care such as flu shots and cancer screenings. In a post for the Commonwealth Fund, CHIR researchers look at states that have codified the ACA’s preventive service requirement, identifying gaps and opportunities to bolster state-level protections.

Amidst growing health care costs, adequate health insurance coverage is increasingly unaffordable for employers and employees. There is a growing focus on the role employer-sponsored plans can play in health care cost containment, but under the Employee Retirement Income Security Act of 1974 (ERISA), the access, affordability, and adequacy of employer coverage is dictated less by law and regulation and more by individual employers.

The open enrollment period has officially ended in most states. After signing up for 2023 coverage, enrollees may have questions about the ins and outs of health insurance and access to care. We’re spotlighting some of the post-enrollment questions and answers on our Navigator Resource Guide.

Health insurance is becoming increasingly unaffordable for employers and workers alike. In the second in their blog series assessing policy options to shore up employer-sponsored insurance as a source of coverage, CHIR experts Linda Blumberg, Sabrina Corlette and Jack Hoadley tackle a policy that economists and budget forecasters predict would have the biggest impact: hospital price regulation.

Happy New Year! The holiday season may be over, but health policy researchers continue to bestow gifts onto our field. In December, we read about disruptions in health insurance coverage, the uninsured population, and gaps in provider network oversight. This roundup will highlight key findings of these articles, as well as their significance for our work.

In most states, January 15 marks the end of the open enrollment period for 2023 coverage. While taking the final steps to enroll in a marketplace plan, there are a few important policies and procedures to keep in mind. We’ve highlighted some of the FAQs from our Navigator Resource Guide to help consumers through the process of finalizing their enrollment.

Primary care is a critical tool to prevent illness and death and improve equitable distribution of health care. In a new case study, published in collaboration with the Milbank Memorial Fund, CHIR researchers detail stakeholder efforts to expand primary care access in Columbia County, Arkansas—a county classified as a primary care health professional shortage area.

Open Enrollment is drawing to a close; in most states, consumers only have until January 15 to sign up for a 2023 marketplace plan. To help with last-minute shopping for health insurance, this week’s set of FAQs from our Navigator Resource Guide focuses on comparing plan options.

The Biden administration released a draft of the annual rule governing the Affordable Care Act marketplaces and insurance reforms. In this Expert Perspective for the State Health & Value Strategies program, Sabrina Corlette and Tara Straw review provisions of particular importance to states.

Although the deadline to enroll in a marketplace plan beginning January 1 has passed in most states, Open Enrollment is still ongoing. As consumers look for an affordable health plan, it can be tempting to search for plans online, which may lead people to products sold outside of the Affordable Care Act’s (ACA) marketplace. This week, as a part of CHIR’s weekly Navigator Resource Guide series, we’ve highlighted FAQs discussing some of the pitfalls of buying a plan off-marketplace.

On December 9, the Centers for Medicare and Medicaid Services announced the membership of the Advisory Committee on Ground Ambulance and Patient Billing, as required by the No Surprises Act (NSA). As the committee prepares to begin its work, there is new evidence out of Texas that the NSA’s exclusion of ground ambulance bills puts consumers at a significant financial risk when they need emergency medical transport.

In its 2024 Notice of Benefit & Payment Parameters, the Biden administration has proposed a number of policy changes and operational updates for the Affordable Care Act’s marketplaces and consumer protections. CHIR’s Sabrina Corlette provides a deep dive on the proposals in Health Affairs’ Forefront.

In most states, it’s the last week to sign up for marketplace plan that begins January 1. The Affordable Care Act expanded access to reproductive health services. As part of CHIR’s weekly installment of FAQs from our updated Navigator Resource Guide, we highlight questions about the marketplace and reproductive health care.

CHIR had a lot to be thankful for this November, including new health policy research. For the latest installment of our monthly research roundup, we reviewed studies on consumer awareness of Medicaid renewals resuming when the COVID-19 public health emergency (PHE) expires, integrating health equity into value-based payment models, and trends in hospital consolidation across health care markets.

States are expected to resume redeterminations of Medicaid eligibility in early 2023, resulting in a projected 15 million people losing access to Medicaid. Ensuring these individuals transfer to another source of coverage smoothly and seamlessly is a particular challenge for states. In their latest Expert Perspective for the State Health & Value Strategies program, Jason Levitis and Sabrina Corlette delve into specific options for states to promote continuity of coverage.

The marketplaces are critical source of health insurance for small businesses, including small business owners, sole proprietors, and workers. In our weekly installment of FAQs from the Navigator Resource Guide, we highlight questions about marketplace coverage for small business owners and their employees.

Employer-sponsored insurance (ESI) covers 160 million Americans, but the adequacy of these plans is in decline. In a new series for CHIRblog, Maanasa Kona and Sabrina Corlette assess some proposed policy options designed to improve the affordability of ESI. The first blog of the series looks at the primary drivers of the erosion occurring in ESI and identifies three recognized policy options to improve affordability for employers and workers alike.

Democrats in Congress have put forward several proposals to create a public health insurance option over the past decade. In a new post for the Commonwealth Fund, CHIR’s Christine Monahan and Kevin Lucia break down the main features of four bills from the 117th Congress that would establish new public option plans.

Open Enrollment for 2023 is in full swing, and our recently updated Navigator Guide has hundreds of FAQs that are likely top of mind for consumers and those assisting them. This week, CHIR’s Kristen Ukeomah highlights FAQs regarding the recent fix to the “family glitch.”

The leaves may be changing, but the importance of health policy research is evergreen. Last month, we read up on the results of a survey on the state of U.S. health insurance coverage, enrollment patterns on- and off-marketplace, and the impact of marketplace enrollment strategies.

With support from the Robert Wood Johnson Foundation, CHIR recently updated its Navigator Resource Guide. During Open Enrollment, we will highlight FAQs that are likely top of mind for consumers and those assisting them. This week, CHIR’s Kristen Ukeomah shares FAQs on who is eligible for marketplace coverage.

At the end of the COVID-19 public health emergency, millions of people will lose Medicaid as states resume eligibility determinations. To help connect these consumers to a new source of affordable coverage, Oregon is considering an option under the ACA to leverage federal funding for health plans that cover lower-income consumers: a Basic Health Program (BHP). CHIR took a look at a recent state task force report recommending a BHP in Oregon to serve as a “bridge program.”

As health care costs continue to rise, stakeholders are looking to innovations in provider payments and benefit designs grounded in the known “value” of different health services. But these strategies might fail to reflect the needs, values, and preferences of certain patients. This tension is evident as the Department of Health and Human Services’ Office of Civil Rights considers whether value assessment methodologies discriminate against protected groups, such as people with disabilities and older adults.

The tenth open enrollment season for the Affordable Care Act’s marketplace is in full swing. With support from the Robert Wood Johnson Foundation, CHIR has updated and improved our Navigator Resource Guide. Navigators and other enrollment assisters can access over 300 frequently asked questions and answers, state fact sheets, a summary of new federal policies for 2023, and more.

The tenth annual open enrollment period for the Affordable Care Act’s marketplaces is upon us. In a new issue brief for the Commonwealth Fund, CHIR experts Rachel Schwab, Rachel Swindle, and Justin Giovannelli detail innovative outreach strategies employed by state-based marketplaces during the open enrollment period for plan year 2022—tactics that can be applied during the forthcoming enrollment season for plan year 2023.

CHIR is delighted to welcome a new staff member to our team: Research Associate Kristen Ukeomah.

The midterm elections are upon us, and most voters view health care as a “very important” issue. Republican House members have put out a health policy agenda through their Healthy Future Task Force. CHIR’s Rachel Schwab looks at several of the task force’s affordability recommendations.

The No Surprises Act (NSA) aims to protect consumers facing surprise medical bills after receiving care from out-of-network providers under circumstances beyond their control. In a new report for the Commonwealth Fund, CHIR experts look at how states are working with the federal government to implement this landmark law.

The Mental Health Parity and Addiction Equity Act (MHPAEA) aims to remove insurance-related obstacles to mental health and substance use disorder treatment, but inadequate compliance has raised questions about health plan enrollees’ ability to access critical behavioral health services. In a new issue brief, CHIR experts look at current barriers to effective state enforcement and identify opportunities to improve MHPAEA compliance.

It’s officially fall, and along with the new season came an autumnal bounty of new health policy research. This month, we reviewed studies on the connection between medical debt and social determinants of health, private equity acquisition of physician practices, and controlling health care costs through state surprise billing laws.

The annual open enrollment period for Marketplace coverage is right around the corner, running from November 1 through January 15 in most states. There are many new policies impacting the Marketplace in 2023, including an extension of enhanced financial assistance through the Inflation Reduction Act; a federal fix to the “family glitch” that will create more affordable coverage opportunities for families; and tools to make shopping for a Marketplace plan more consumer-friendly. CHIR’s Emma Walsh-Alker summarizes these and other recent policy changes that consumers may encounter this year.

Last week, the Nevada Department of Health and Human Services released the results of an actuarial study projecting hundreds of millions of dollars in savings from the state’s Public Option plans within the program’s first few years. CHIR’s Christine Monahan takes a look at the estimated impact of the state’s public option-style law.

Hospitals and health insurers are now required to publicly post their prices for health care services. However, as Maanasa Kona and Sabrina Corlette observe in their latest Health Affairs Forefront blog, the new disclosure requirements have not – yet – translated into data that can be used to identify the drivers of health care cost growth. Their piece identifies options for federal and state regulators to improve compliance and ultimately help support informed health care purchasing and policy decisions.

Last month, the Federal Trade Commission (FTC) took action against Benefytt Technologies, finding the company relied on deceptive websites, high-pressure sales tactics, and misleading information to push consumers into enrolling in junk plans, and then made it difficult for consumers to cancel their coverage. CHIR’s prior research on the marketing of junk plans shows that these tactics are neither new nor unique.

A federal judge in Texas has ruled that Affordable Care Act requirements that insurers cover and waive cost-sharing for preventive services is unconstitutional. While the case is likely to be appealed, states can act now to preserve residents’ access to affordable and often life-saving preventive care. In a new Expert Perspective for the State Health & Value Strategies project, Sabrina Corlette and Justin Giovannelli outline how.

For the August edition of our monthly research roundup, CHIR said farewell to summer by reviewing the latest health policy research. This month, we summarize studies on how the end of the COVID-19 public health emergency (PHE) will impact health coverage, global efforts to achieve universal health coverage, and the effects of eliminating nominal marketplace premiums.

CHIR is delighted to welcome three new faculty members to our team: Research Professor Linda Blumberg, Senior Research Fellow Karen Davenport, and Assistant Research Professor Vrudhi Raimugia.

For the third time, the Department of Health and Human Services’ Office of Civil Rights has proposed rules to effectuate the application of civil rights protections to the health care industry under Section 1557 of the Affordable Care Act. If finalized, the regulation will have significant implications for health insurers and provide important nondiscrimination protections for insurance enrollees.

The Biden administration has published its final rules governing the independent dispute resolution process outlined in the No Surprises Act. In a new Expert Perspective for the State Health & Value Strategies project, CHIR’s Jack Hoadley, Kevin Lucia, and JoAnn Volk review the rule and its implications for state regulators.

The affordability of diabetes care is a national issue. Even with insurance, diabetic patients can spend thousands of dollars on medication, supplies, and health services. These costs can present a particular burden on Black families. Black and Hispanic patients face disproportionally high hospitalizations and emergency department visits due to diabetes complications, emphasizing that affordable access to diabetes care is an issue of health equity. In a new post for the Commonwealth Fund, CHIR experts highlight different approaches states are taking to reduce health care disparities for diabetic patients.

As the number of opioid-related overdose fatalities remains alarmingly high, access to medication-assisted treatment (MAT) is inconsistent. Private insurance does not always cover the full range of MAT options, and when it does provide coverage cost sharing can be prohibitive. CHIR’s Rachel Swindle takes a look at state and federal reforms that can help lessen private insurance related barriers to treatment.

Congress is poised to enact the Inflation Reduction Act, a $740 billion reconciliation package that includes sweeping climate change, deficit reduction, and health policy provisions. In her latest Expert Perspective for the State Health & Value Strategies project, Sabrina Corlette reviews the health care changes and their implications for states.

New health policy research topped CHIR’s list of beach reads this July. For the latest monthly research roundup, we reviewed studies on marketplace enrollees’ denied claims, how marketplace coverage has benefitted small business and self-employed workers, and out-of-pocket spending on insulin.

Many of those losing their Medicaid eligibility after the COVID-19 public health emergency will have illnesses or conditions requiring uninterrupted access to health care services. In their latest Expert Perspective for the State Health & Value Strategies project, Sabrina Corlette and Jason Levitis outline several policy and operational changes states can make to ensure that people transitioning from Medicaid to the Marketplace can maintain continuity of care.

Employer-sponsored insurance is the largest source of health coverage in the U.S., but the employer market’s historic status as the “backbone” of the U.S. health care system is imperiled by rising health care costs. A public health insurance option could help reduce health care costs and expand access to coverage for people with job-based insurance, and has received increasing support among employers.

The ACA requires that most insurers and employers cover a set of preventive health services at no cost to enrollees. Estimates suggest that more than 150 million people have access to over 100 services such as cancer screenings, contraception, and vaccines without any out-of-pocket costs. A case pending in federal court threatens to cut off consumers’ access by allowing insurers to impose cost-sharing on these services or, in some cases, cease covering them altogether. CHIR’s Rachel Schwab takes a look at some of the currently free services in jeopardy.

Utilization management is one tool that insurers can use to help keep premiums in check, but it comes with significant tradeoffs for patients. CHIR’s Megan Houston considers the history and current landscape of utilization management tools, what they are used for and what policymakers are doing to keep them in check.

Following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, analyses project up to half of women and girls in the U.S. between the ages of 15 and 44 will live in states that significantly restrict or ban abortion services. The scale and geographic reach of these bans intensifies questions about travel costs and access to these services. Employers are looking at ways to cover abortion-related travel costs for workers.

The U.S. Department of Health and Human Services recently approved a new Section 1332 waiver authorizing Colorado’s public option-style law. The waiver approval marks the first time the federal government has taken action to approve state legislation introducing new, more heavily regulated plans into Affordable Care Act marketplaces to compete against traditional plans. In a new post for the Commonwealth Fund, CHIR experts dive into the details of Colorado’s law and waiver, and what they mean for future state action. 

The No Surprises Act (NSA) went into effect this year, providing new protections against surprise medical bills for patients who receive unanticipated out-of-network care. CHIR has analyzed state NSA implementation and enforcement schemes and published an interactive map for the Commonwealth Fund, providing details about policies such as state enforcement strategies and patient-provider dispute resolution. In the newest iteration of the map, CHIR added updates on state payment determination mechanisms and protections against surprise ground ambulance bills.

Health insurers have begun to submit their proposed premium rates for 2023, and they’re not looking pretty. CHIR’s Sabrina Corlette dives into what is driving hefty premium increases in her annual review of the rate justifications insurers submit to state insurance departments.

Congress has spent months debating an extension of enhanced premium tax credits enacted under the American Rescue Plan Act of 2021. However, as CHIR’s Sabrina Corlette and the Urban Institute’s Jason Levitis discuss in this recent Health Affairs Forefront article, the clock is ticking. Continued delays would likely cause coverage losses and additional costs that wouldn’t be restored even if a subsidy extension is later enacted.

It’s finally summer, and during the latest heat wave, the CHIR team cooled off with new health policy research. In June, we reviewed studies on improving race and ethnicity data collection in health insurance marketplaces, the value of health savings accounts, and variation in medical debt accumulation across the U.S.

The ACA’s marketplaces are working to advance health equity. State-based marketplaces are uniquely situated to improve health equity if they can close current gaps in race and ethnicity data. In a new post for the Commonwealth Fund, CHIR’s Dania Palanker, Jalisa Clark, and Christine Monahan examine the landscape of marketplace race and ethnicity data, and detail strategies for the upcoming open enrollment period to improve data collection.