Insurance Market Reform

State action to prevent discriminatory benefit designs has been prompted, in part, by vital input from consumer advocacy organizations. This resource, which resulted from invitations sent to health-related consumer groups that signed the 2014 "We are (Still) Essential" letter to U.S. Department of Health and Human Services Secretary Burwell, provides a compilation of organizations that are willing to assist state insurance regulators with identifying discriminatory benefit designs or for other regulatory tasks that require expertise related to a certain disease group or consumer concern.

Employees of small businesses have much lower rates of insurance coverage and less generous benefits than their peers at bigger companies, owing largely to challenges unique to the small group market. The ACA introduced significant reforms aimed squarely at these problems, but implementation has moved slowly and the ultimate impact of these changes is unclear. This essay takes a look at developments in the small group market since the passage of the ACA and highlights several issues that could threaten the long-term viability of this market as implementation moves forward.

Introduced by the Affordable Care Act (ACA), the Essential Health Benefits (EHBs) are a set of ten health care service categories that non-grandfathered health plans in the individual and small group markets must cover. States are in the process of making important decisions about the EHBs, therefore this is a key time to influence and shape the next phase of EHBs across states. This brief highlights steps that California has taken to update the EHBs, and continued advocacy efforts.

In March of 2012, the U.S. Department of Health and Human Services issued a regulation defining student health plans as individual health insurance under federal law. As a result, they are now subject to the same consumer protections afforded to all those covered by individual health insurance set forth in the Public Health Service Act, as amended by the Affordable Care Act (ACA). This issue brief examines student health plans, which cover over 1 million students, and investigates the interplay between federal and state regulation with regard to these plans.

Health plans with relatively narrow provider networks have generated widespread debate, mainly concerning the level of regulatory oversight necessary to ensure plans provide consumers meaningful access to care. The Affordable Care Act (ACA) created the first federal standard for network adequacy in the commercial insurance market for plans offered through the law’s insurance marketplaces. However, states continue to play a primary role in setting and enforcing network rules. This brief examines state network adequacy standards for marketplace plans in the 50 states and District of Columbia.