Insurance Market Reform

This analysis of rate review activities in calendar year 2012 shows that the rate review process saved consumers approximately $1.2 billion on their premiums when compared to the amount initially requested by insurers. In the individual market, the average rate request increase dropped by 12 percent after rate review, saving consumers an estimated $311 million. In addition to the $1.2 billion saved due to rate review, consumers received an additional $500 million in medical loss ratio rebates for 2012, for a total $1.7 billion in savings in 2012. Moreover, insurers were much less likely to submit requests for rate increases of 10 percent or more in 2012 than in previous years, and it is likely that this change in issuer behavior is a result of the Affordable Care Act policy that requires requests for increases of 10 percent or more to be justified and reviewed.

This proposed rule provides guidance on the tax credit available to certain small employers that offer health insurance coverage to their employee, detailing eligibility for and calculating the tax credit. Comments on the rule are due by November 25, 2013.

These final regulations provide guidance to individual taxpayers on the liability for the shared responsibility payment for not maintaining minimum essential coverage.

A number of states have recently released information on what premiums will be in the individual insurance market in 2014, when significant changes in that market take effect due to the Affordable Care Act (ACA). However, these premiums are in effect “sticker prices” that many people will not pay because they will be eligible for federal tax credits under the ACA to offset the cost of insurance. In this data note, we explain how the tax credits will work and estimate how much premium assistance people now buying their own insurance will be eligible for in 2014.

Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. States have taken different approaches in regulating the adequacy of health plan networks based on their state-specific market, and states have a variety of options available to maintain robust health insurance markets by balancing access needs with the goals of controlling costs and attracting a healthy number of insurers. This brief, prepared by the Georgetown University Health Policy Institute, explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues.

A goal of the ACA is to increase competition and transparency in the markets for individual and small group insurance, leading to higher quality, more affordable products. To date, this proposition has largely been based on theory. However, information on proposed premiums in the individual and small group markets has recently been made available by selected states, and it is now possible to move from theoretical arguments to data-driven analysis. This research brief analyzes proposed rates in the individual market for 2014 in the eleven states that have made information available, and compares these rates to those estimated by the Congressional Budget Office (CBO). 

On July 1, 2013, HHS issued final implementing regulations that specify which individuals may be eligible for exemptions from the Shared Responsibility penalty payment, a special tax established under the Affordable Care Act (ACA) that applies to non-exempt individuals who have access to affordable insurance but fail to purchase it. The final rule also explains the role of Exchanges in granting “certificates of exemption” from the penalty payments, and identifies the range of health benefits that the government will consider as satisfying the Act’s “minimum essential coverage” rule. The final rule shows some, but not a lot, of changes from its original proposed form. This update summarizes the highlights of the final rule.

New York's Department of Financial Services (DFS) released its approved premium rates for the insurers planning to offer coverage in the state’s state-based marketplace.

On June 28, the Departments of the Treasury, Labor, and Health and Human Services issued the final rules on the ACA requirements that health plans cover contraceptives for women with no cost-sharing. For employees of religious non-profits, insurers and third-party administrators will be required to provide contraceptives to employees. The final rule also provides further clarification on exemption of houses of worship from this requirement.