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Medicare, Medicaid, Health Reform

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Debate about whether consumers will pay more for insurance under health reform has become political, with conservative organizations saying Obamacare will increase premiums and liberals saying it won't, at least not when you take into account taxpayer-funded subsidies for health coverage. In a new study, RAND Corporation joins the latter group....
Health insurance in America has changed dramatically in the past few years, changes that will speed up once the Affordable Care Act (ACA) major provisions take effect in 2014. It’s easy to be sucked into the details of policy change, from payment reforms, to Accountable Care Organizations (ACO), to...
Risk adjustment is a key mechanism to ensuring appropriate payments for Medicare Advantage plans, Medicare Part D drug plans, and Medicaid health plans.  Since health plans vary in their mix of healthy and sick enrollees, risk adjustment modifies premium payments to better reflect the projected costs of members served and...
The individual health insurance market undergoes dramatic changes in 2014 under the Affordable Care Act, especially for health plans offering coverage through the new Health Insurance Exchanges.  The ACA’s regulatory and financial framework present challenges for health insurers in selling coverage, managing risk, ensuring compliance, and adapting to future...
The Affordable Care Act (ACA) coverage expansions to childless adults, through Medicaid and Health Insurance Exchanges, could have broad effects on public health. A recent study gives us one good example of that by showing that pregnant women in Medicaid with tobacco cessation coverage were less likely to smoke...
States and the federal government are doing all they can to make sure the Health Insurance Exchanges - also called Health Insurance Marketplaces - open on time, on October 1 this year. The rush to make sure everything is ready explains some of the recent news to delay certain...
Much about the Health Insurance Exchanges is uncertain, even as the October 1 deadline to make them operational approaches. Many states running their own or partnership exchanges have yet to decide on key elements of plan management, consumer outreach, and other important functions. Exchanges are a genuine game changer...
The federal Office of Personnel Management (OPM) had a tricky job in setting rules for multi-state health plans (MSP), which eventually will be offered in all states through Health Insurance Exchanges (HIX). The OPM had to take decide how to allow for disparate state and federal requirements for exchange-based plans,...
Fears abound that health insurance premium increases because of the Affordable Care Act (ACA) will discourage young, healthy people from participating in the Health Insurance Exchanges. But most young people are likely to be eligible for exchange subsidies, softening the sting of so-called premium shock and attracting healthier people to...
The Centers for Medicare and Medicaid Services (CMS) has answered some questions about how Arkansas’s creative plan to expand Medicaid under the Affordable Care Act (ACA). The plan, which Gov. Mike Beebe put forward, would use federal Medicaid expansion money to give premium subsidies for Medicaid beneficiaries to enroll...

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