Most Americans receive their health coverage through the private insurance market, usually through their jobs. However, many people buy insurance on their own in the individual market. Since coverage from private companies is the largest source of insurance for Americans, it is likely to be a central part of federal and state health reform efforts.
This section of our Web site keeps you up-to-date on what's happening in the private health insurance arena.
Key Differences between Wellness Reward/Penalty Programs and Value-Based Insurance Design compares how each method of designing health insurance affects access to care for consumers. (October 2013)
Job-Based Coverage and the Affordable Care Act: Why the Law Won't Cause Employers to Drop Coverage explains why employers will continue to offer coverage under the Affordable Care Act and how the law makes it easier for small employers to offer coverage to their workers. (May 2013)
2013 Federal Poverty Guidelines are now available from HHS, and Families USA has calculated the figures for various household sizes by percentage of the federal poverty level.
From Families USA:
How the Affordable Care Act Makes Health Coverage More Affordable explains the many ways that the Affordable Care Act makes health insurance coverage more affordable for consumers through fairer premiums for people with pre-existing conditions, women, and older people, income-based subsidies, and new, affordable coverage options for young adults. (June 2013)
Tobacco Rating: Issues for Consumers explains why charging tobacco users higher premiums for health insurance is a concern, and it outlines what states can do to protect consumers. (May 2013)
The Promise of Care Coordination: Transforming Health Care Delivery discusses care coordination as an opportunity for health system reform that is based on the needs of patients. It explains what advocates need to know to ensure that their state's care coordination programs stay focused on improving care quality and patient health. (April 2013)
Keeping Coverage Affordable: Addressing CHIP “Premium Stacking” explains how states can help families whose payments for CHIP premiums will not be included when calculating how much premium assistance they will receive to pay for marketplace coverage. (April 2013)
Tobacco Rating: State Solutions explains what states can do to keep the practice of tobacco rating from pricing people out of the health coverage they need. (March 2013)
Language Access Checklist for Marketplace Implementation provides recommendations that advocates can use to encourage their states to address the needs of consumers with limited English proficiency in health insurance marketplaces. (March 2013)
Five Key Elements of a Consumer-Friendly Exchange lists aspects of design and implementation that those working on exchanges should consider to best meet the needs of consumers. (February 2013)
State Advocate To-Do List for 2013 outlines issues that advocates may want to address in 2013 in anticipation of the changing health care environment. (January 2013)
Help Wanted: Preparing Navigators and Other Assisters to Meet New Consumer Needs explains the requirements for navigator programs and answers seven key questions that states will face as they seek to establish effective navigator programs. It is available as an online tool kit and as a PDF. (Updated January 2013)
Filling in Gaps in Consumer Assistance: How Exchanges Can Use Assisters explains the key differences between navigator and assister programs and how in-person assistance can function in the different types of exchanges. It also recommends actions advocates can take. (Updated January 2013)
Consumer-Friendly Standards for Qualified Health Plans in Exchanges: Examples from the States outlines the minimum standards for qualified health plans as set out in the Affordable Care Act. It then provides examples from eight state-based exchanges and one partnership exchange state on how to implement those standards in consumer-friendly ways. (January 2013)
Regulations and Guidance for the Affordable Care Act: The Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Internal Revenue Service (IRS) have issued interim final rules and requests for information on several provisions of the health reform law pertaining to private insurance. Families USA has submitted commments on many of these provisions. Click here for our Regulations and Guidance page.
From the Commonwealth Fund:
Implementing the Affordable Care Act: State Action on the 2014 Market Reforms finds that only 11 states and the District of Columbia have taken legislative action to allow state regulators to enforce the law’s consumer protections. Since states continue to be the primary regulators of health insurance, the remaining states should take steps to ensure that consumers see the full benefits of the protections in the Affordable Care Act. (February 2013)
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