Publications: Private Insurance
Failing Grades: Illinois Fails to Protect Consumers in the Individual Health Insurance Market focuses the broader discussion of inadequate consumer protections for the individual market on Illinois, examining how the state falls short in protecting consumers, leaving them vulnerable to insurance company abuse. The report also includes recommendations for reforms needed in the private market. 28 pp. Free (September 2008)
An Unequal Burden: The True Cost of High-Deductible Health Plans for Communities of Color discusses the full costs associated with high-deductible health plans and why these expenses are disproportionately unaffordable for racial and ethnic minorities. It also examines several myths about health savings accounts (HSAs), which are often coupled with such health plans. 12 pp. Free (September 2008)
Empty Promise: Searching for Health Insurance in an Unfair Market discusses how the individual health insurance market differs from the employer market and examines what happens to consumers who seek coverage in the individual market. Problems in the individual market include policies that don't provide quality coverage; policies that are very expensive or that cost more than advertised; and the fact that many applicants cannot obtain a policy at any price. 8 pp. Free (August 2008)
Fighting Revocations and Limitations of Health Insurance Policies addresses the insurance company practice of revoking an individual's health insurance or suddenly eliminating coverage for health services long after the person has enrolled (known as "post-claims underwriting"). It also discusses what consumers and advocates can do about the practice. 8 pp. Free (July 2008)
Failing Grades: State Consumer Protections in the Individual Health Insurance Market. Laws protecting consumers purchasing health coverage in the individual market vary across the country. In many states, insurance companies can deny coverage, raise premiums significantly, refuse to cover treatment for certain conditions, and even revoke the coverage of policyholders who have been paying premiums for years. 36 pp. $10.00 (June 2008) More in-depth resources that supplement the report:
- The Facts about Prior Approval of Health Insurance Premium Rates discusses several insurance industry myths about the consequences of prior approval. The prior approval process is used by most states to make sure that insurance companies' proposed premium increases are not excessive. 4 pp. Free (June 2008)
- Medical Loss Ratios: Evidence from the States presents the results of a 50-state survey we conducted in March and April 2008 that determined which states have laws or regulations that establish a minimum "medical loss ratio" (a percentage of premium dollars that must be spent on medical care). 8 pp. Free (June 2008)
- Post-Claims Underwriting Survey presents the findings of a survey we conducted in April and May 2008 of all state insurance departments regarding laws in their states that prohibit insurers from limiting or rescinding health insurance policies after they have been issued. 8 pp. Free (June 2008)
Reinsurance: A Primer aims to help policymakers and advocates better understand what reinsurance is and how it can make coverage easier to obtain and more affordable. It also identifies some of the benefits of reinsurance to aid lawmakers as they design reinsurance programs to meet the needs of their states. 20 pp. Free (April 2008)
Reward/Penalty Plans for Wellness: Coming Soon to an Office Near You? Encouraging healthy lifestyles is important, but might some wellness plans place your access to health care at risk? This piece explores some of the hidden effects that reward/penalty plans for wellness may have on consumers, as well as the problems that these plans might present in both employer-sponsored coverage and Medicaid. 8 pp. Free (January 2008)
- The National Committee for Quality Assurance (NCQA) has released a draft of standards that will be used to accredit or certify reward/penalty plans and other types of wellness programs. Click here to read Families USA's comments on these standards. (June 2008)
Too Great a Burden: America's Families at Risk finds that more and more American families are spending a substantial share of their incomes on health care costs, and most of these families have insurance. Faced with high health care costs and tight budgets, families are turning to credit cards to finance their care, and many are falling into medical debt. 28 pp. $15.00 (December 2007) l state reports
Maine's Dirigo Health Reform of 2003 is a thorough examination of the state's health care expansion. It discusses program eligibility, how much people pay for the different types of coverage, what benefits they receive, how the expansion is financed, how it reforms the state's insurance regulations, lessons learned so far, and the future of health reform in Maine. 16 pp. Free (November 2007)
Massachusetts Health Reform of 2006 is a thorough examination of the state's far-reaching expansion in health coverage. The report discusses who is eligible, how much enrollees pay for the different types of coverage available, what benefits they receive, who is providing coverage, the individual mandate, and how the reform is being financed. It also discusses what lessons state advocates have learned from the process of getting the legislation passed. 14 pp. Free (August 2007)
Retail Medical Clinics: Okay in a Pinch, but No Substitute for Real Health Coverage provides an overview of the growing trend of clinics popping up in stores such as Wal-Mart, Target, and CVS. While their convenience is appealing, the tradeoff may be piecemeal services that lack appropriate oversight. Consumers should use such clinics only to supplement care from their regular primary care physician. 6 pp. Free (August 2007)
Pennsylvania's 2007 Health Care Proposal: Prescription for Pennsylvania examines the governor's plan for comprehensive health reform. This report looks at who is eligible for new coverage, how much they'll pay, what benefits they'll get, and how the state will finance the expansion. It also discusses strengths of the plan, as well as areas of concern. 10 pp. Free (July 2007)
State Guides to Finding Health Insurance (updated March 2007)
If you are looking for health coverage, Families USA has created a guide for each state that can help point the way. Whether you have recently lost your job, are an early retiree, or have a serious medical condition, these guides include numerous resources that may help you find the coverage you need.
A Pound of Flesh: Hospital Billing, Debt Collection, and Patients' Rights provides an overview of some of the progressive reform measures that state policymakers have implemented to help families struggling with medical debt. 8 pp. Free (March 2007)
Premiums versus Paychecks: A Growing Burden for State Workers. A series of state-specific reports detailing the increased cost of health care premiums versus stagnant pay. (December 2006). Go to State Information, click on the state from drop-down menu in the right-hand column, and scroll down to Other Resources.
Six Reasons to Be Wary of High-Deductible HSA Plans 2 pp. Free (December 2006)
Stop Bad Ideas—How HSAs Can Drain Your Wallet and Harm Your Health presents three examples that illustrate what can happen to employees working for a hypothetical company that purchases a high-deductible health plan. 8 pp. Free (December 2006)
Vermont's Health Reform Laws discusses the basics of the state's two new laws, known as "Catamount Health." The piece also examines how Catamount Health will be financed, how the laws build on existing health coverage programs, and pros and cons of the laws. 6 pp. Free (December 2006)
Stop Bad Ideas—HSAs: Missing the Target examines the effects that HSAs will have on those without health insurance and on the health care system overall. 8 pp. Free (November 2006)
Understanding How Health Insurance Premiums Are Regulated discusses the state and federal regulation of health insurance premiums. (September 2006)
Employers Should Pay Their Fair Share for Health Care explains what employer responsibility legislation is and discusses its benefits and potential drawbacks using examples of states that have implemented such legislation. 7 pp. Free (September 2006)
H.R. 2355, The Health Care Choice Act: The Wrong Prescription for America's Health Care Needs discusses how this legislation, sponsored by Rep. Shadegg and favored by the Administration, would undermine state laws designed to protect health care consumers. 2 pp. Free (August 2006)
Making History: Maryland's Fair Share Health Care Law discusses how the law works, who it affects, and the key strategies advocates used to get the law passed. It also includes a timeline of critical events. 8 pp. Free (May 2006)
High-Risk Health Insurance Pools provides answers to key questions about high-risk pools, including who they help and how they are financed. The report also includes a list of questions consumers should ask if they are considering joining a high-risk pool, as well as a checklist for advocates. 12 pp. Free (May 2006)
The Enzi Bill: Bad Medicine for America summarizes the flaws in this legislation and provides state-by-state listings of consumer protections that will be lost and the numbers of people affected if the Enzi bill is enacted. 9 pp. Free (May 2006)
Summary of S. 1955: The Health Insurance Marketplace Modernization Act outlines the legislation that introduces Small Business Health Plans (SBHPs) and exempts private insurers from many state laws and regulations governing health insurance. 5 pp. (March 23, 2006)
President Bush's Fiscal Year 2007 Budget: Analysis of Key Health Care Provisions Includes discussion and commentary on Health Savings Accounts (HSAs), Medicaid, and Medicare. 13pp. (February 22, 2006)
Proposed Health Reform in Massachusetts: Net Gain for the Business Community examines the health reform bill passed by the Massachusetts House of Representatives, which is designed to expand coverage to the state's uninsured. It finds that, overall, the bill would result in a net benefit for the state's business community. 15 pp. Free (January 2006)
Stop Bad Ideas—AHPs: Bad Medicine for Small Employers Association Health Plans (AHPs) are a major part of the President's package of health care proposals aimed at reducing the growing number of uninsured Americans. This fact sheet finds that AHPs are not a solution for the number of uninsured, are not an effective way to control costs, and provide fertile ground for fraud and abuse. 5 pp. Free (December 2005)
Stop Bad Ideas—HSAs: Missing the Target This fact sheet examines the effects that health savings accounts (HSAs) will have on the uninsured and on the health care system overall. It finds that HSAs won't reduce the number of uninsured, are not an effective way to control costs, are inequitable, and are a radical threat to our current health insurance system. 7 pp. Free (December 2005)
Stop Bad Ideas—Too Little, Too Late: Why a $1,000 Tax Credit Won’t Help the Uninsured Every year since 2001, President Bush has proposed a $1,000 tax credit to help uninsured people purchase health insurance in the individual market. This fact sheet finds that his tax credit is justified by questionable studies, is tied to the flawed individual market, and wouldn't make insurance affordable. 4 pp. Free (December 2005)
What Consumers Need to Know about Buying Health Coverage from Associations 2 pp. Free (July 2005)
What Consumers Need to Know about Health Savings Accounts 2 pp. Free (July 2005)
What Consumers Need to Know about Purchasing Health Insurance as an Individual 2 pp. Free (July 2005)
Paying a Premium: The Added Cost of Care for the Uninsured
This report quantifies, for the first time, the dollar impact on private health insurance premiums of care provided to the uninsured. 35 pp. $15.00 (June 2005)
Have health insurance? Think you're well protected? Think Again! This one-page fact sheet provides quick stats on how health care expenses overwhelm even insured working families, forcing many into bankruptcy. 1 p. (February 2005)
HSAs: Why High-Deductible Plans Are Not the Solution
This fact sheet examines the effects that health savings accounts (HSAs) will have on those without health insurance and on the health care system overall. 7 pp. Free (January 2005)
Ideas that Work: Expanding Health Coverage for Workers
A Tool Kit for those who want to build a state-based health coverage initiative based on employer-provided insurance. Includes case studies of California and Hawaii, a "decision guide," and tables with state-by-state data about employment and insurance coverage. $20.00 (October 2004)
Health Care: Are you better off today than you were four years ago?
Health care has emerged as one of the top concerns of Americans in recent years. To understand what forces are driving this change, Families USA posed a variation of a question raised by Ronald Reagan more than two decades ago: When it comes to health care, are we better off today than we were four years ago? The results of our analysis show that the answer is a clear no. | en espanol 52 pp. $15.00 (September 2004)
The Illusion of Group Health Insurance: Discretionary Associations
Discretionary associations enable insurance carriers to market individual health insurance policies under the guise of group insurance to consumers seeking low-cost insurance that appears to offer group protections. This Issue Brief identifies problems in the discretionary association marketplace and suggests a number of regulatory and legislative solutions. 18 pp. $3.00 (March 2004)
The Trade Act Health Insurance Subsidy: An Update from the States: This Issue Brief analyzes the implementation of the new subsidy offered by the Trade Adjustment Assistance Reform Act of 2002 (TAARA) and suggests changes that might strengthen the existing program. 28 pp. $5.00 (December 2003)
What's Wrong with Tax-Free Savings Accounts for Health Care?
Tax-free personal savings accounts for health care have become the latest cure-all for the problems facing our health care system. This Issue Brief uses a hypothetical company to examine how such accounts undermine the pooling of risk--the basis for insurance. 6 pp. Free (November 2003)
A Shelter in the Storm: How a Subsidy Could Help Unemployed Workers Get Health Insurance The rise in unemployment over the past three years has contributed to a substantial increase in the the number of uninsured Americans. This Issue Brief discusses the Trade Adjustment Assistance Reform Act of 2002 (TAARA) health insurance subsidy as one possible model for providing financial assistance to unemployed workers for the purchase of health coverage. 12 pp. Free (October 2003)
Private Plans: A Bad Choice for Medicare The role of private plans in Medicare up to this point. The evidence so far indicates that, for seniors and people with disabilities, particularly those living in rural areas, the traditional Medicare program works better than private plans. 2 pp. Free (September 26, 2003)
The Health Insurance Tax Credit in the Trade Adjustment Assistance Reform Act of 2002
This issue brief defines the TAARA tax credit and discusses who is eligible for it. It also provides answers to many other questions about how the tax credit will be administered, what kinds of insurance quality insurance will be provided, and the role states have in implementing the credit. Includes advocate suggestions for shaping the credit. 16 pp. Free. (April 2003)
Protecting Consumers from Unfair Rate Hikes: The Need for Regulation of Health Insurance Renewal Premium Increases This Issue Brief examines the insurance industry practice of re-underwriting at renewal and discusses current efforts to regulate the practice at the federal and state levels. 7 pp. Free. (February 2003)
Medicaid Managed Care Final Regulations Issued A Field Report. In June, the Bush Administration released final regulations implementing patient protections for Medicaid beneficiaries enrolled in managed care. This report summarizes the main provisions of these regulations, including state plan requirements, enrollee rights, and grievance systems. 11 pp. $3.00 (September 2002)
More than 725,000 Laid-off Workers Have Lost Health Coverage Since the Recession Began in March A Special Report. 4 pp. Free. (December 2001)
The Bush Administration's Health Proposals in the Economic Stimulus Package
A Health Policy Memo. 2 pp. Free. (October 8, 2001)
Consumer Health Assistance Programs: Report on a National Survey
Consumer health assistance programs come in many shapes and sizes. Some serve Medicare beneficiaries, for example; some serve people in long-term care facilities or those who are privately insured. Families USA conducted a nationwide survey of these programs, and the findings are summarized in this report. 48 pp. $15.00 (July 2001)
Designing a Consumer Health Assistance Program
As health care becomes more complex, many states and localities are developing consumer health assistance programs to meet the needs of consumers within their jurisdictions. This guide reviews some key considerations to keep in mind when designing such programs. 24 pp. $15.00. (June 2001)
Healthy Pay for Health Plan Executives
The managed care industry claims that the cost of patients' rights legislation will make families lose health insurance coverage--a charge that is both misleading and self-serving. This report examines the compensation for the highest-paid executives of 10 for-profit, publicly traded companies that own health plans serving multiple states. A Special Report. 27 pp. $8.00. (June 2001)
Medicaid Managed Care Consumer Protection Regulations: No Patients' Rights for the Poor A Special Report. 12 pp. $2.00. (May 2001)
A Guide to Monitoring Medicaid Managed Care
This guide will help community organizations determine how well managed care plans are serving Medicaid beneficiaries. Provides the how-to's of monitoring projects, from simple "do-it-yourself" efforts to the gathering and analysis of data from many sources. 84 pp. $20.00. (September 2000)
Rural Neglect: Medicare HMOs Ignore Rural Communities
A look at the availability of Medicare HMOs in non-metropolitan counties in the U.S., which finds that 73 percent of rural Medicare beneficiaries have no access to any Medicare HMO. Concludes that Medicare reform should not be predicated on HMOs. 19 pp. $15.00. (September 1999)
The Quality of Maryland and District of Columbia Medicaid Managed Care Plans: External Reviews A 36-page report looks at the external quality review process for Medicaid HMOs and finds problems in how external reviews are administered. December 1998
The Best from the States II: The Text of Key State HMO Consumer Protection Provisions
This 49-page publication offers the relevant text of state laws and regulations addressing important managed care consumer protections, including emergency room services, access to providers, liability, and more. $10.00 (October 1998)
Premium Pay II: Corporate Compensation in America's HMOs
This updated report examines 1997 executive compensation for the 15 for·profit, publicly traded companies that owned HMOs with enrollments over 100,000. These 15 companies owned 75 of the nation's largest HMOs in 1997. 33 pp. $15.00. (September 1998)
Hit and Miss: State Managed Care Laws
This 45-page report surveys state legislation addressing common problems with managed care. It analyzes state-by-state activity on 13 illustrative consumer protections and finds that many Americans are left unprotected. The spottiness of state consumer protections is compounded by ERISA, which preempts state laws for those in "self-insured" plans--one out of three people with employer-provided coverage. $15.00. (July 1998)
Monitoring Medicare HMOs: A Guide to Collecting and Interpreting Available Data
Aimed at groups working with Medicare beneficiaries, this 86-page guide provides step-by-step instructions for gathering and making sense of Medicare HMO data from federal agencies, state governments, and other sources. Parts of the guide will be useful to those interested in Medicaid and/or commercial HMOs. 86 pp. $15.00. (May 1998)
Premium Pay: Corporate Compensation in America's HMOs
This report examines the 1996 costs of compensation for top level executives of some of the nation's most profitable HMOs (April 1998)
A Guide to Access to Providers in Medicaid Managed Care
This 62-page guide examines how managed care has affected Medicaid beneficiaries' access to primary care physicians and specialists, including "traditional Medicaid providers." Explores problems in access to care, explains access requirements in federal law, and gives suggestions for steps advocates can take to help assure provider availability. Features tables of provider access requirements in state Medicaid managed care contracts. $20.00. Print only. (April 1998)
A Guide to Meeting the Needs of People with Chronic and Disabling Conditions in Medicaid Managed Care
This 44-page guide, written by National Health Law Program and Families USA, examines issues confronting states as they move toward mandating managed care for people with chronic and disabling conditions. The guide discusses problems experienced when either populations or services are "carved out," looks at steps states have taken to ensure quality care, and provides advocates with information about where to make their voices heard. $20.00. Fact sheet also available. Free. Print only. (January 1998)
A Guide to Complaints, Grievances, and Hearings Under Medicaid Managed Care
This 43-page guide, written by National Health Law Program and Families USA, provides an overview of Medicaid managed care enrollees' legal rights, common problems that prevent beneficiaries from receiving an impartial review, examples of what states have done to protect the rights of beneficiaries, and suggestions for ways advocates can help ensure an adequate complaint process is in place. $20.00. Fact sheet also available. Free. Print only. (January 1998)
Comparing Medicare HMOs: Do They Keep Their Members?
This 44-page report looks at Medicare HMOs to see how many beneficiaries quit, or disenroll. Includes state-by-state and plan-by-plan data on the overall disenrollment rates as well as "rapid" disenrollment rates. The report finds that the lowest disenrollment rates, indicating that beneficiaries are generally satisfied, are in nonprofit plans with a long history of serving Medicare beneficiaries. $15.00. (December 1997)
A Guide to Cost-Sharing and Low-Income People
This 40-page guide addresses the imposition of cost-sharing (co-payments, deductibles, premiums) in both the Medicaid program and the new State Children's Health Insurance Program. Current legal requirements are presented and research on the effects of cost-sharing is summarized. $20.00. Fact sheet also available. Free. Print only. (October 1997)
A Guide to Marketing and Enrollment In Medicaid Managed Care
This guide reviews common problems experienced when states move their Medicaid populations into managed care and discusses solutions to those problems. Includes a chart comparing provisions of various state RFPs used to solicit enrollment brokers. 34 pp. $20.00. Fact sheet also available. Free. (June 1997)
Medicare Managed Care: Securing Beneficiary Protections
This 66-page report outlines the policy changes needed to ensure that Medicare Beneficiaries who join HMOs are adequately protected. $15.00. Print only. (April 1997)
HMO Consumers at Risk: States to the Rescue
An overview of 14 key HMO consumer protection issues addressed by a number of states through legislation or regulation during 1995 and the first half of 1996. 48 pp. $15.00. Print only. (July 1996)
Doing Without: The Sacrifices Families Make to Provide Home Care
This report examines the amount of unpaid care that family and friends provide to the elderly; the income, age and health status of unpaid caregivers; and consumers' high out-of-pocket costs for paid home care. 24 pp. $10.00 Print only. (July 1994)
Skyrocketing Health Inflation 1980-1993-2000: The Burden on Families and Businesses
A analysis of health care spending of American families and businesses, nationally and state-by-state. Also includes data on sources of payment by families and businesses. 40 pp. $10.00. Print only. (November 1993)
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