This analysis for the Peterson-Kaiser Health System Tracker uses information from the Current Population Survey to look at the average amounts and the shares of family income people in working families with employer-based coverage pay out-of-pocket toward their premiums and direct payments for medical care. It finds that lower income families spend a greater share of their income on health costs than those with higher incomes, and that health status of family members is associated with higher out-of-pocket expenses.
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In this Axios column, Drew Altman shows that employer coverage for lower wage workers is much worse than ACA marketplace coverage for similar populations. It’s a bigger problem we need to talk about more, he says.
On December 14, 2018, a federal trial court judge ruled that the entire Affordable Care Act (ACA) is unconstitutional in Texas v. U.S. While the trial court’s ruling is likely not the last word on the ACA’s constitutionality, this brief considers the complex and far-reaching impact were the entire law ultimately held to be invalid.
Karen Pollitz, senior fellow for health reform and private insurance at KFF, answers three questions about denied claims and how the federal government may change the data insurers are required to report on this issue.
Analysis: Marketplace Plans Denied an Average of Nearly One in Five Claims in 2017 with Wide Variations across Insurers
Healthcare.gov marketplace insurers denied nearly one out of every five claims (19%) submitted for in-network services in 2017, and enrollees only appeal a tiny share (0.5%) of those denied claims, a KFF analysis of recently released claims data finds. The analysis finds a huge variation across insurers, with average denial…
Based on an analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS), this brief assess claims denials and appeals among issuers offering individual market coverage on healthcare.gov and finds that 19% of in-network claims were denied by issuers in 2017, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%. Consumers appealed less than 1% of denied claims.
A new issue brief looks at long-term trends in employer-based health insurance coverage, and finds that although the share of nonelderly Americans with employer-based health insurance has risen modestly in recent years, the long-term trend still shows a decline. If coverage rates had stayed at the 1999 level (67.3%), almost 24…
This Drew Altman column in Axios reveals an uptick in the number of Americans with employer coverage, and discusses the implications for policy and politics.
KFF’s Karen Pollitz testimony before the U.S. House Committee on Ways and Means on Jan. 29, 2019 examines the prevalence of pre-existing conditions, the impact of the Affordable Care Act’s prohibition against medical underwriting and other provisions aimed at stabilizing the insurance risk pool, and the trade-offs involved in relaxing those provisions.