Global Health

Beginning in 2011, the Affordable Care Act (ACA) requires insurance plans to pay out a minimum percentage of premium dollars towards health care expenses and quality improvement activities, limiting the amount spent on administrative and marketing costs and profit. Under the law, large group plans are required to spend at least 85 percent of premium dollars on health care and quality improvement, while small group plans must spend at least 80 percent. These ratios are known as the Medical Loss Ratio (MLR). This analysis looks at the latest estimates provided by insurers to state insurance commissioners.

Rebates Expected to Vary Significantly by State

This data note provides estimates of the potential cost-sharing levels for plans that will be available in the non-group market (including in new health insurance exchanges) when the ACA is fully implemented in 2014. It builds on previous work from Kaiser and reflects recent guidance from the federal government on benefits and cost-sharing for plans offered in those markets.

The March 2012 briefing featured experts analyzing the policy and political implications of the pending U.S. Supreme Court case on the Affordable Care Act.

This fact sheet explains how the Medical Loss Ratio provision under the Affordable Care Act (ACA) will affect health insurers and consumers. The provision requires most insurance companies that cover individuals and small businesses to spend at least 80% of their premium dollars on health care (i.e. medical claims) and quality improvement, leaving no more than 20% for administration, marketing, and profit. Large group plans must spend at least 85 percent of premium dollars on health care. Insurers failing to meet these standards will have to pay rebates to consumers beginning late in 2012.

This analysis estimates the share of the non-elderly population in over 2,000 geographic areas across the U.S. who had family income up to four times the poverty level in 2010 and were either uninsured or buying coverage on their own. The analysis includes an interactive tool that allows users to enter in their zip codes and see the percentage of people in their communities who could be helped by subsidies to help pay for private insurance or eligible for Medicaid starting in 2014 under the Affordable Care Act.

This fact sheet summarizes key provisions in the Affordable Care Act that may affect small businesses and their employees.  The fact sheet explains the law’s small business tax credits and the Small Business Health Options Program exchanges to be established in each state by 2014, both of which are designed to make it easier for small businesses to purchase insurance for their workers.

On Wednesday Dec. 7, 2011 the Kaiser Family Foundation held a live interactive webcast to discuss trends in state health care expenditures and the implications for national and state efforts to constrain health care costs.  The webcast examined new state-by-state estimates of public and private health spending from the Centers for Medicare and Medicaid Services (CMS).

This analysis assesses the competitiveness of state insurance markets for individuals and small businesses to establish a baseline as implementation of the health reform law proceeds.

This brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees.