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Would States Eliminate Key Benefits if AHCA Waivers are Enacted?

The data we used in our analysis were obtained from the Centers for Medicare and Medicaid Services (CMS) through a Freedom of Information Act Request, submitted January 10, 2017, with data supplied April 11, 2017.  The data are now available here: https://www.cms.gov/cciio/resources/data-resources/health_plan_finder_data.html. Insurers submitted the data to CMS to be displayed on the Health Plan Finder on HealthCare.gov.  Data were submitted periodically and updated periodically by CMS. We received data for three quarters in 2011, and for four quarters in 2012 and 2013.  The data fields changed over the period; we used data from the fourth quarter of 2013, the last available, for our analysis. The 2013 data have more benefit categories than the 2011 data and more information about limits on benefits than the 2012 data.  Our discussion with CMS staff suggested that the data became more complete as they were updated through the year, so we chose to use the fourth quarter.

The analysis is limited to plans for which the insurer reported that there were enrollees in the underlying product upon which the plan was based. Results are not enrollment weighted. Enrollment was reported only by product, so we do not know if there were actually enrollees in each of the plans associated with that product.  A plan was assumed not to offer coverage for a benefit category if the dataset left the coverage description blank for that category.  The analysis of benefit limits was conducted among plans that offered coverage for the benefit category analyzed, for example outpatient mental/behavioral health services.

Issue Brief

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