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  • Brief Examines Efforts to Create Health Plan Options that Don’t Comply with the Affordable Care Act’s Rules

    News Release

    Though Congress last year failed to repeal key Affordable Care Act requirements for non-group health insurance that people buy themselves, the Trump Administration and some states are promoting other types of plans through regulatory changes that would allow the sale of products that skirt many of the ACA’s requirements. A new Kaiser Family Foundation brief examines four of those options and the tradeoffs involved if such loosely regulated markets take root as an alternative to…

  • Individual Insurance Market Performance in 2017

    Issue Brief

    This brief examines recently-released annual financial data from 2017 and finds insurers selling individual market plans had their best financially since 2014, when new ACA insurance market rules took effect that guaranteed access to coverage for people with pre-existing conditions. At the same time, recent political and policy changes, including the repeal of the individual mandate penalty as part of tax reform legislation and proposed regulations to expand loosely-regulated short-term insurance plans, cloud plans’ outlook…

  • Health Affairs Blog: The Myth Of The Abortion Insurance Rider

    Perspective

    In a Health Affairs blog post, Laurie Sobel, Caroline Rosenzweig and Alina Salganicoff of the Kaiser Family Foundation discuss the feasibility of abortion riders to private group and individual health plans as a means of providing access to abortion coverage when states ban the coverage as part of an insurance plan. They summarize their 2018 analysis that these amendments are virtually non-existent.

  • New Analysis Maps Prevalence of Pre-Existing Conditions by Metro Area

    News Release

    A new Kaiser Family Foundation analysis maps rates of pre-existing conditions across 129 metropolitan and micropolitan areas in the U.S., finding that even within the same state, the prevalence of such conditions can vary substantially. For example, 34 percent of residents of Florence, South Carolina have a pre-existing condition, but further south in Charleston and Hilton Head, the rate is 24 percent. The share of non-elderly adults with a pre-existing condition ranges from 41 percent…

  • How Much and Why ACA Marketplace Premiums Are Going Up in 2025

    Issue Brief

    This analysis of insurers' preliminary rate filings shows that ACA Marketplace insurers are requesting a median premium increase of 7% for 2025, similar to the 6% premium increase filed for 2024. Insurers cite growing health care prices – particularly for hospital care – as a key driver of premium growth in 2025.

  • Insurance Coverage of OTC Oral Contraceptives: Lessons from the Field

    Report

    This report is based on 35 structured interviews conducted from January to August 2023, with nearly 80 experts and key players such as pharmacists, health plans, and state Medicaid officials involved in the coverage and provision of OTC contraception in seven states with one or more of these coverage approaches (IL, NJ, NM, NY, OR, UT, and WA). It discusses the challenges and successes in coverage under private health insurance and Medicaid and reviews policy…

  • As ACA Marketplace Enrollment Reaches Record High, Fewer Are Buying Individual Market Coverage Elsewhere

    Issue Brief

    This analysis looks at how many people are signed up for each type of individual ACA Marketplace coverage—both on- and off-Marketplace and with or without subsidies—as of early 2023 based on federal enrollment data and administrative data insurers report to state regulators, as compiled by Mark Farrah Associates. The number of people enrolled in compliant and non-compliant plans was also evaluated.

  • Already at Record High, ACA Marketplace Enrollment Could Increase Further

    News Release

    Enhanced Marketplace subsidies have continued to drive up enrollment in the individual market, and the loss of Medicaid coverage by millions of people could contribute to this trend, according to a new KFF analysis. Meanwhile, enrollment in non-ACA-compliant plans is at a record low. As of early 2023, an estimated 18.2 million people have individual market coverage, the highest since 2016. Individual market enrollment grew by about 29% between early 2020 and early 2023 —…

  • KFF Examines Challenges in Navigating Coverage for Opill, the First Over-the-Counter Daily Oral Contraceptive Pill, Coming to Market Next Year 

    News Release

    As Opill—the first over-the-counter daily oral contraceptive pill in the United States—is expected to be available for purchase in early 2024, new research conducted by KFF examines barriers to its accessibility for consumers and challenges in providing insurance coverage for it. Based on interviews with nearly 80 representatives from private insurance plans, state Medicaid programs, chain pharmacies, and other key groups, the report provides a deeper view into the operational challenges in expanding access to…