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  • Insurance Coverage of Contraceptives

    Perspective

    In this post, we answer some of the key questions about the new contraceptive coverage policy generally, and more specifically, how it will be applied to religious organizations.

  • Betting on Private Insurers

    Perspective

    Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the economic downturn, as private insurance has declined and Medicaid has grown. It has also increased due to our demographic destiny: the growing cohort of baby…

  • Explaining Health Care Reform: Medical Loss Ratio (MLR)

    Fact Sheet

    This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and…

  • Pharmaceutical Policy and Pricing: Are Other Countries Getting Greater Value?

    Event Date:
    Event

    Spending on prescription drugs in the U.S. rose at a faster clip in 2009 than spending for hospital and physician care, a trend that is expected to continue through 2020. The desire to get a handle on drug spending is a focus not only in the U.S. but in other countries as well. What are some strategies used in our country and in the UK, Germany and France to control pharmaceutical spending? How well are…

  • States Focus on Cost Containment as a Loss of Federal Stimulus Funds Means State Costs for Medicaid Will Jump in FY 2012

    News Release

    NEWS RELEASEThursday, October 27, 2011 New 50-State Survey Finds Cuts In Provider Payments And Changes In Delivery Of Services WASHINGTON, D.C. - Faced with the end of stimulus money and a continuing weak economy, Medicaid officials in virtually every state are enacting a variety of cost cutting measures as states’ spending for Medicaid is projected to increase 28.7 percent this fiscal year to make up for the loss of federal funds, according to a new survey…

  • Medicare Part D 2011 Data Spotlights

    Report

    The Kaiser Family Foundation has issued a collection of analyses related to the Medicare Part D stand-alone drug plan options available to seniors for calendar year 2011. These spotlights focuses on key aspects of the drug plan choices available and relevant trends since the Medicare drug benefit took effect in 2006. They were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation. 2012 Part D Data Spotlights Now Available…

  • Medicare Part D Data Spotlight: A First Look at Part D Plan Offerings in 2012

    Report

    This data spotlight examines the stand-alone Part D drug plan options available to Medicare beneficiaries in 2012. Medicare beneficiaries will, on average, be able to choose from 31 stand-alone Medicare Part D prescription drug plans to choose from, a new Kaiser analysis finds. Average premiums would increase by 4 percent from 2011 to 2012 if beneficiaries remain with their current plans during the open enrollment period, which begins October 15 and December 31. That represents…

  • The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States

    Issue Brief

    This policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits. The brief was prepared by researchers at the Foundation's Kaiser Commission on Medicaid and the Uninsured and Avalere Health. Policy Brief (.pdf)

  • Questions About Essential Health Benefits

    Perspective

    The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA). As expected, the committee preparing the IOM report did not recommend which specific services should be covered, but rather discussed what the process should be for defining the essential benefits, which all insurers selling coverage to individuals and small businesses will have to provide beginning in 2014. Somewhat unexpected was their recommendation to set a…

  • Darius Antonides

    Other Post

    Darius, age 9, was born with periventricular leukomalacia, a brain injury that causes frequent seizures, as well as central apnea, a condition that often causes him to stop breathing. He also has mild cerebral palsy, which impairs his mobility, balance, and reflexes. Since Darius was born, Medicaid has covered his specialist care, hospital care, prescription drugs, oxygen regulator and other medical equipment, and other services that have saved his life and significantly mitigated the neurological…