Supreme Court Decision Limiting the Authority of Federal Agencies Could Have Far-Reaching Impacts for Health Policy July 1, 2024 Issue Brief On June 28, 2024, the U.S. Supreme Court overturned a longstanding legal precedent that required federal courts to defer to reasonable agency interpretation when statutes are ambiguous. The decision will shift many policy decisions from federal agencies to federal judges, with implications for health policy that will reverberate for years to come. This issue brief examines the decision and assesses what’s ahead.
Final Prior Authorization Rules Look to Streamline the Process, but Issues Remain May 2, 2024 Issue Brief This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.
SCOTUS Case Could Weaken the Impact of Regulation on Key Patient and Consumer Protections April 9, 2024 Issue Brief This brief discusses the longstanding legal doctrine, Chevron deference, being challenged in two cases before the U.S. Supreme Court and includes examples of what could be at stake for health care consumers should federal courts no longer use this doctrine to address litigation related to federal health regulations. The focus here is on patient and consumer protection regulation, but overturning the Chevron deference would have implications in all areas of health care.
What resources are available for privately insured patients who get surprise balance bills? March 19, 2024 Issue Brief Most patients do not know about the new surprise billing protections and likely also do not know of resources available to seek recourse for incorrect medical bills. This brief provides resources to privately insured patients who receive surprise balance bills and also summarizes relevant policies and how they apply to balance billing.
Access to Adult Dental Care Gets Renewed Focus in ACA Marketplace Proposal March 8, 2024 Blog Adult dental care can lead to high out of pocket costs for consumers, especially for those with private insurance coverage. This post analyzes a proposed provision in the HHS Notice of Benefit and Payment Parameters for 2025, and possible implications for consumers who have Marketplace coverage.
Lower Income Adults with Employer Sponsored Insurance Face Unique Challenges with Coverage Compared to Higher Income Adults December 19, 2023 Issue Brief This analysis examines the experiences of lower income adults with their employer sponsored insurance and finds they were more likely to self-report problems with affordability, enrollment, and network adequacy, and to experience negative health consequences as a result of insurance problems, compared to their higher income peers.
Signing Up for Marketplace Coverage Remains a Challenge for Many Consumers October 30, 2023 Blog As open enrollment begins for Marketplace plans, this Policy Watch provides information about consumer experiences with Marketplace sign up from the 2023 KFF Consumer Survey. Data from the survey show that Marketplace sign up has been a challenge to many consumers—often more complicated than enrollment in other kinds of health insurance. The Policy Watch also spotlights efforts to address common enrollment problems such as option overload and transitioning to Marketplace coverage from other forms of coverage.
Overall Satisfaction with Medicare is High, But Beneficiaries Under Age 65 With Disabilities Experience More Insurance Problems Than Older Beneficiaries October 26, 2023 Issue Brief This brief analyzes data from the 2023 KFF Survey of Consumer Experiences with Health Insurance to get a current understanding of how Medicare is working for older adults and younger people with disabilities. The analysis shows that people with Medicare who are under 65 with disabilities experience more problems using their Medicare coverage, including access and cost-related problems, than beneficiaries who are 65 and older.
Proposed Mental Health Parity Rule Signals New Focus on Outcome Data as Tool to Assess Compliance September 29, 2023 Issue Brief Proposed updates to federal mental health parity rules would make wide ranging changes to current standards that apply to private insurance and coverage provided by most employers. This issue brief focuses on one aspect of the new proposal—a requirement that plans perform an “outcome analysis” before they can place certain restrictions on behavioral health coverage. This would require that plans evaluate specific data to determine the impact of certain restrictions on behavioral health access, such as prior authorization rules or limited provider network access. The use of data analysis as an oversight tool would be new for federal insurance regulators. The brief discusses this new proposed tool and the key policy questions that it triggers.
Consumer Survey Highlights Problems with Denied Health Insurance Claims September 29, 2023 Issue Brief This Data Note includes major findings from the KFF Consumer Survey on consumer experiences with claim denials. Among those who used the most health care over the past year, 27% experienced a denied claim. More consumers with private insurance experienced denied claims compared to Medicaid or Medicare.