Private Insurance

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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.

The Latest

From Families USA:

Implementing the Patient Protection and Affordable Care Act: A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid gives state advocates an in-depth blueprint for action in 2012, outlining issues to start thinking about and tasks that deserve immediate attention. (February 2012)

2012 Federal Poverty Guidelines are now available.

Designing Consumer-Friendly Beneficiary Assignment and Notification Processes for Accountable Care Organizations discusses the challenges advocates will face when developing these processes, and it recommends certain notification requirements and beneficiary protections. (January 2012)

Putting the Accountability in Accountable Care Organizations: Payment and Quality Measurements examines some of the challenges that advocates will face when working with policy makers, insurers, and providers to develop mechanisms that ensure that beneficiaries receive high-quality care at a lower cost. | Determining Shared Savings or Losses (January 2012)

How Can We Establish an Essential Health Benefits Package that Meets Consumers’ Needs? provides background information and talking points on the critical issues that need to be addressed to ensure that consumers in the exchanges, individual and small group markets, and Medicaid benchmark plans have access to comprehensive coverage. (November 2011)

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 Blue Cross Blue Shield of Massachusetts Foundation: 

Massachusetts Health Reform: A Five-Year Progress Report examines major components of the law, such as expanding eligibility for Medicaid and CHIP, requiring all adults to obtain health insurance, and creating a health insurance exchange. It looks at how these provisions are working, the challenge of rising health care costs, and how health reform has affected coverage and access to care. (November 2011) 

From the Commonwealth Fund:

State Trends in Premiums and Deductibles, 2003-2010: The Need for Action to Address Rising Costs notes that total premiums for family coverage increased by 50 percent, and the employee share of premiums increased by 63 percent. It also explores the potential for the Affordable Care Act to reduce this growth while improving financial protections. (November 2011)

From Consumers Union: 

Addressing Barriers to Online Applications: Can Public Enrollment Stations Increase Access to Health Coverage? discusses the use of computers or kiosk stations in public places to make online applications more accessible. It identifies challenges and opportunities that policy makers need to understand as they design effective online application systems. (November 2011)

From Demos and Young Invincibles:

The State of Young America: Health Care and Coverage describes the difficulties young adults face in obtaining health insurance and paying for medical services. It notes that provisions of the Affordable Care Act have started to reverse the trend of rising uninsurance among young adults. (November 2011)

From the Employee Benefit Research Institute (EBRI):

Spending Adjustments Made by Older Americans to Save Money examines the percentage of older Americans that have made changes in prescription drugs or skipped doctor appointments to save money. It finds that one in five adults over age 50 has adopted these spending cuts involuntarily. (January 2012)

From the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute:  

Changes in Health Insurance Coverage in the Great Recession, 2007-2010 notes a severe decline in job-based coverage during this time period. Public coverage through Medicaid or the Children’s Health Insurance Program (CHIP) has offset some loss of coverage, but the overall uninsurance rate has risen. (December 2011)

From the Kaiser Family Foundation:

Women’s Health Insurance Coverage describes the different sources of health insurance for women and discusses how the Affordable Care Act will help the 20 percent of women ages 18 to 64 who are uninsured. (December 2011)

New CMS Estimates of State-by-State Health Expenditures examines trends in spending and their implications for several efforts to constrain health care costs, including provisions of the Affordable Care Act and various state initiatives. A video and podcast are available. (December 2011)

From the National Academy of Social Insurance and the Robert Wood Johnson Foundation: 

 Building a Relationship between Medicaid, the Exchange, and the Individual Insurance Market focuses on the following key areas where states can focus their efforts to promote continuity of coverage: establishing a joint strategy to align health plan policies across markets, aligning the eligibility determination and redetermination process, and coordinating benefit design across multiple markets. (January 2012)

Federally-Facilitated Exchanges and the Continuum of State Options reviews how the core functions of an exchange will work depending on where it falls on the continuum from entirely state-based to entirely federally operated. It also discusses the implications for states as they choose exchange formats as interim or permanent solutions. (December 2011)

From the National Institute for Health Care Reform:

Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-Offs examines decisions that state governments will face regarding standardization of premiums and benefits in their exchanges. States must find the right balance between simplicity and flexibility to promote competition among insurers, maximize the quality of health care, and minimize costs. (November 2011) 

From the Robert Wood Johnson Foundation and the Urban Institute:

Accountable Care Organizations in Medicare and the Private Sector: A Status Update provides an overview of ACOs, their origins, and the current status of Medicare and private health plans adopting this model. (November 2011)

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