Tag Archives: Covered California

What Could Happen If The Administration Stops Cost-Sharing Reduction Payments To Insurers?

The decision allowing 17 state attorneys general to join the House v. Price cost-sharing reduction litigation complicates the President’s ability to stop the CSR payments, but rumors that he will do so continue. This post focuses on issues that will arise if the administration defunds the CSRs.

August 2, 2017

Moving The Needle On Primary Care: Covered California’s Strategy To Lower Costs And Improve Quality

Covered California, a state health insurance exchange, has taken advantage of its role as a purchaser to work with health plans and clinicians to implement policies to emphasize and enhance the role of primary care.

June 14, 2017

California’s Coverage Expansion: Fiscal And Political Risks

Even if the US Senate substantially changes the American Health Care Act, California’s notoriously cyclical economy may ultimately render the state’s heroic health care coverage expansion untenable.

May 30, 2017

Amid ACA Uncertainty, Covered California’s Risk Profile Remains Stable

One of the constant concerns about the ACA and the status of the exchanges involves the average health status of enrollees in these state Marketplaces. Results reveal encouraging news, for amid talk of death spirals, it suggests Covered California continues to attract a healthy mix of enrollees.

May 15, 2017

How Californians Could Benefit From ACA ‘Repeal And Replace’

There are at least two major areas where California could cooperate with the Trump Administration and the Republican Congress: improving coverage and access for the working poor, and controlling health care costs.

February 9, 2017

Obamacare Premiums Are Lower Than You Think

Since the ACA's health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases. Missing from this narrative, however, is that average premiums in the individual market actually dropped significantly upon implementation of the ACA.

July 21, 2016

Lessons From California’s Public Reporting On Pathways To Health Insurance Coverage

California launched an ambitious effort to collect and report key data on the pathways to publicly subsidized health care coverage. The systematic understanding that the state is building about the flow of enrollment lays the groundwork for fully understanding the challenges of connecting...

May 4, 2016

What Risk Adjustment Does — The Perspective Of A Health Insurance Actuary Who Relies On It

Under the ACA, insurers offering new policies in the individual market must cover anyone who can pay. However, there are still ways for insurers to avoid the sickest people. What could Congress do to minimize avoidance of people more likely to use care? One good answer: risk adjustment.

March 29, 2016

How Do We Make Special Enrollment Periods Work?

Special Enrollment Periods are a critical part of the health insurance safety net created under the ACA. But the SEP safety net could be weakened if CMS or Marketplaces take steps that would make it more difficult for individuals to enroll using SEPs, a policy change that insurers are advocating.

February 16, 2016

Health Risk Continues To Improve In Covered California

The health risk scores of enrollees for individual plans in the California exchange have stabilized in the second year (regressed to the mean), with risk being more evenly distributed across all of the plans, and the overall risk score statewide for enrollees with chronic conditions has decreased.

October 26, 2015