Insurance Market Reform

The risk corridor program created by the Affordable Care Act (ACA) has proven to be one of the most controversial aspects of the health care law. Questions have been raised about the source of payments, whether the Department of Health and Human Services (HHS) has the authority to make payments under the program, and whether the program is required to be budget neutral. This brief has been updated to examine the impact of the Consolidated and Further Continuing Appropriations Act of 2015 on the risk corridor program and whether insurers will receive their full 2014 risk corridor payments.

In order to ensure that Consumer Services Divisions within state insurance regulatory agencies are equipped with the necessary resources to assist consumers experiencing insurance problems, the State Health Reform Assistance Network has developed a toolkit intended as a guide for consumer service representatives (CSRs). The resources in this updated toolkit include a reference manual with multiple entries across a number of categories, a glossary of acronyms, terms, and definitions, a benefits crosswalk template, and a reference table illustrating the applicability of ACA provisions to grandfathered and self-funded plans. 

The Affordable Care Act (ACA) requires health insurers to justify rate increases that are 10 percent or more for non-grandfathered plans in the individual and small-group markets. In analyzing these filings for renewals taking effect from mid-2013 through mid-2014, this brief finds that the average rate increase submitted for review was 13 percent. Insurers attributed the great bulk of these larger rate increases to routine factors, such as trends in medical costs. Most insurers did not attribute any portion of these medical cost trends to factors related to the ACA. The ACA-related factors mentioned most often were nonmedical: the new federal taxes on insurers, and the fee for the transitional reinsurance program.

The Affordable Care Act (ACA) protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography. This brief examines how states have implemented these federal reforms in their individual health insurance markets. The authors identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law’s requirements. Most states took the opportunity to customize at least some aspect of their rating standards.

One objective of the health insurance Marketplaces created through the Affordable Care Act (ACA) is to encourage competition among insurers with the goal of lower premiums for consumers and lower subsidy costs for the federal government. One strategy insurers have used to offer lower premiums and capture market share has been the creation of “narrow networks” of providers and facilities. The ACA includes network adequacy requirements, but there remains considerable variation in the breadth of acceptable hospital networks and the options available in each. This brief investigates which hospitals are included in Marketplace plans in major cities in six states, and examines how hospital networks vary across plans within a single insurer and across all insurers.