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Full-Text Articles in Insurance

Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, Scott E. Harrington Sep 2017

Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, Scott E. Harrington

Issue Briefs

Subsidized reinsurance represents a potentially important tool to help stabilize individual health insurance markets. This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. It summarizes specific state initiatives and Congressional proposals that include subsidized reinsurance. It compares approaches to each other and to more direct subsidies of individual market enrollment. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the ...


Narrow Networks On The Individual Marketplace In 2017, Daniel Polsky, Janet Weiner, Yuehan Zhang Sep 2017

Narrow Networks On The Individual Marketplace In 2017, Daniel Polsky, Janet Weiner, Yuehan Zhang

Issue Briefs

This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at 27% and 30%. We also find large differences in narrow networks by state and by plan type.


Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse Nov 2016

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of ...


Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse Oct 2016

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse

Management Faculty Research

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of ...


Time To Lift The Veil Of Inequality In Health Care Coverage: Using Corporate Law To Defend The Affordable Care Act, Seema Mohapatra Apr 2015

Time To Lift The Veil Of Inequality In Health Care Coverage: Using Corporate Law To Defend The Affordable Care Act, Seema Mohapatra

Faculty Scholarship

No abstract provided.


Priority-Setting, Cost-Effectiveness, And The Affordable Care Act, Govind Persad Jan 2015

Priority-Setting, Cost-Effectiveness, And The Affordable Care Act, Govind Persad

Georgetown Law Faculty Publications and Other Works

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations,this Article attempts to defend three substantive propositions.

First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality.

Second ...


Examining Mainecare’S Coverage Options Under The Affordable Care Act, Erika C. Ziller Phd, Trish Riley Mar 2013

Examining Mainecare’S Coverage Options Under The Affordable Care Act, Erika C. Ziller Phd, Trish Riley

Population Health & Health Policy

The Affordable Care Act (ACA) was designed to achieve nearly universal access to health coverage in the United States—in part by standardizing Medicaid eligibility across the country so that each state’s program would cover individuals with incomes below 138% of the federal poverty level (FPL), or $15,856 for an individual and $32,499 for a family of four in 2013 (see Figure 1).i However, in June 2012, the U.S. Supreme Court determined that states could not be required to broaden Medicaid and retained the decision as a state option. States that choose to participate may ...


Federal Health Care Reform: An Overview, Andrew F. Coburn Phd Feb 2013

Federal Health Care Reform: An Overview, Andrew F. Coburn Phd

Population Health & Health Policy

This policy brief discusses three of the main components of the Patient Protection and Affordable Care Act (ACA), also known as "Obamacare". These components are helath insurance coverage, delivery system improvement, and cost containment. The policy brief highlights some of the provision of the law that have already been implemented and those where importnat implementation decisions will have to be made. The brief is authored by Dr. Andrew Coburn, PhD, Professor of Public Health and Director of the Population Health and Health Policy program at the USM Muskie School, and was presented at the Maine Policy Leaders Academy Health Care ...