Insurance Market Reform

The purpose of this bulletin is to provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define actuarial value (AV) for qualified health plans (QHPs) and other non-grandfathered coverage in the individual and small group markets under the ACA.

The Colorado Division of Insurance's annual report to the legislature on the cost of insurance for Coloradans reports that eighty-one percent of the health insurance premiums collected in 2010 by Colorado carriers went directly to the cost of providing health care services, up from just under 77 percent in 2009.

This Milliman analysis was conducted for Washington and identified essential health benefits not generally covered by the benchmark plan options outlined in the December 16, 2011 bulletin.

The National Conference of State Legislatures (NCSL) Health Program compiled a report that presents state-level data on state and employee share of premiums for two common types of health insurance coverage (one low-cost plan and one comprehensive plan), to reflect the current diverse insurance market.

The United States Department of Treasury, Labor, and Health and Human Services have released final rules on the simplified coverage summaries health plans are required to provide under the health reform law.

This fact sheet summarizes key provisions in the Affordable Care Act that may affect small businesses and their employees, and explains the law’s small business tax credits and the Small Business Health Options Program exchanges to be established in each state by 2014.

This report presents data on 2010 administrative costs for all health plans that reported  health premiums for Minnesota residents.

This table is a one-stop resource that shows states' request for an adjustment to the MLR standard, a consumer protection provision under the ACA. The HHS Secretary may determine that a state meeting the 80% Medical Loss Ratio standard may destabilize the individual market. In order to qualify for this adjustment, a state must demonstrate that requiring insurers in its individual market to meet the 80% MLR has a likelihood of destabilizing the individual market and result in fewer choices for consumers.

This report examines the critical need for risk adjustment in programs serving persons dually eligible for both Medicare and Medicaid and describes federal and state experience implementing risk adjustment models.

This ConsumersUnion brief discusses how actuarial value will be employed under the health reform law, the definitional and measurement issues associated with its use, and how to craft a measure that is usable by consumers.