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Firearms are the Leading Cause of Death for Children in the United States But Rank No Higher Than Fifth in Other Industrialized Nations

Firearms are now the number one cause of death for children in the United States, but rank no higher than fifth in 11 other large and wealthy countries, a new KFF analysis finds. Guns – including accidental deaths, suicides, and homicides – killed 4,357 children (ages 1-19 years old) in…

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Marketplace Insurers Denied Nearly 1 in 5 In-Network Claims in 2020, though It’s Often Not Clear Why

Healthcare.gov marketplace insurers denied nearly one out of every five claims (18%) submitted for in-network services in 2020, though why the denial rates are so high and the ultimate consequences for consumers are difficult to access from the publicly available data, a new KFF analysis finds. The Affordable Care Act…

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Claims Denials and Appeals in ACA Marketplace Plans in 2020

This analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS) finds that 18% of in-network claims were denied by healthcare.gov marketplace insurers in 2020, with denial rates varying widely from less than 1% to more than 80%. Consumers appealed just over one-tenth of 1% of those denied claims.

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Falling off the Subsidy Cliff: How ACA Premiums Would Change for People Losing Rescue Plan Subsidies

This post examines what would happen to ACA marketplace premiums for enrollees with incomes more than four times the federal policy level if the enhanced American Rescue Plan Act subsidies expire, including variations by state .

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Demographics and Health Insurance Coverage of Nonelderly Adults With Mental Illness and Substance Use Disorders in 2020

In this issue brief, we use 2020 data from the National Survey on Drug Use and Health (NSDUH) to examine key characteristics, coverage and health status of nonelderly adults with mental illness or substance use disorders to help inform ongoing federal and state efforts to improve quality and expand access.

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Data Note: 2022 Medical Loss Ratio Rebates

We find that insurers estimate they will issue a total of about $1 billion in Medical Loss Ratio (MLR) rebates this year across all commercial markets under a provision of the Affordable Care Act (ACA) that limits the share of premiums that insurers can keep for administration, marketing, and profits.

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Private Insurers Expect to Pay $1 Billion in Rebates to Consumers This Year for Setting Premiums Too High Relative to Medical Costs

Private insurance companies are expecting to pay out $1 billion in rebates to consumers this fall under an Affordable Care Act provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three…

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Examining Prior Authorization in Health Insurance

This post explains what’s known about how insurers use prior authorization as a tool to control costs and encourage cost-effective care, the state and federal laws that govern it, and ongoing policy debates over efforts to impose standards to limit or regulate its use.

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The Uncertain Future of Policies to Promote Access and Affordability Put in Place During the COVID-19 Pandemic

In this column for the JAMA Health Forum, Larry Levitt highlights four changes implemented during the COVID-19 pandemic that helped to make health care more accessible and affordable and the prospects for those changes to telehealth, COVID-19 coverage, Medicaid and marketplace premiums continuing beyond the pandemic’s end.

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For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

Most customers with coverage through Affordable Care Act’s marketplaces will face big premium increases next year if Congress doesn’t extend the temporary enhanced tax credits included in the American Rescue Plan Act (ARPA) of 2021. If the outcome isn’t clear by summer, fall open enrollment could be a mess.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.