Federal and State Policy
As the largest US healthcare payer, the federal government plays a dominant role in shaping the healthcare marketplace, while states take center stage when it comes to developing novel policy approaches. Our experts track, interpret, and model policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Elizabeth Carpenter to Present at NGA Summer Meeting
Elizabeth Carpenter, Senior Vice President, will present on July 15 at the National Governors Association Summer Meeting in Providence, RI, in a governors-only session entitled “The Future of Health Care.”
Update on The Medicare Trustee’s Report: IPAB Is Not Triggered
Today, the Medicare Trustees delivered to Congress their annual report on the financial operations and status of the program.
Medicaid Funding Reform: Impact on Dual-Eligible Beneficiaries
The Better Care Reconciliation Act (BCRA) would cap Medicaid funding to states. In this analysis, Avalere worked with The SCAN Foundation to examine how BCRA Medicaid changes would impact dual-eligible beneficiaries. We compare these outcomes to the impact of the House-approved American Health Care Act.
Senate Health Bill to Reduce Federal Medicaid Funding to States
New analysis from Avalere finds that states could see federal funding for their Medicaid programs decline by between 6% and 26% under the Better Care Reconciliation Act (BCRA) by 2026.
21st Century Cures: What to Expect This Summer
The 21st Century Cures Act presents medical product manufacturers, patient groups, and advocacy organizations with a unique opportunity to plan for upcoming policy changes that are aimed at accelerating the pace of development and approval of new therapies.
Premium Increases and Fewer Insurers Participating Expected in Exchange Market in 2018
More than 40% of counties could see only one exchange plan in 2018, with risk that some counties may have no commercial options.
Our Take on The President’s Budget for Fiscal Year 2018
Today, the Trump Administration released its budget for fiscal year 2018 (FY 2018). The budget provides the President's recommendations for how the Congress should fund the government and marks the beginning of the FY 2018 budget season.
VA Formulary Coverage Much More Limited than Ohio Medicaid
Across 8 therapeutic areas, the Veteran's Administration (VA) National Formulary covers 49 percent fewer drugs than Ohio's largest Medicaid managed care plan and 68 percent fewer drugs than the Ohio Medicaid preferred drug list (PDL).
Per Capita Caps Could Reduce Funding for Children Covered by Medicaid
All 50 states and DC would receive fewer Medicaid dollars for non-disabled children.
AHCA Will Remove Low Cost-Sharing Guarantees for Low-Income Individuals
The elimination of cost-sharing reductions could lead to low-income individuals facing higher deductibles and maximum out-of-pockets.
Medicare Advantage Patients Less Likely to Use Post-Acute Care
New analysis from Avalere finds that Medicare Advantage (MA) patients use fewer post-acute care services after being discharged from the hospital compared to traditional Medicare fee-for-service (FFS) patients.
Proposed High-Risk Pool Funding Likely Insufficient to Cover Insurance Needs for Individuals with Pre-Existing Conditions
Funding earmarked for high risk pools in the American Health Care Act will cover five percent of the total number of enrollees with pre-existing chronic conditions in the individual market today.
Avalere Deepens Expertise in Medicare Advantage Payment Systems with Hire of Sean Creighton
Sean Creighton has joined the Avalere team as a vice president in the policy practice, and will be responsible for leading advisory services work tied to Medicare Advantage, risk adjustment, and related issues.
Medicaid Per Capita Caps Could Cut Funding for Dual-Eligible Beneficiaries
Capping Medicaid funding could also shift costs to Medicare
Avalere’s Take on the Market Stabilization Final Rule
Today, the Centers for Medicare & Medicaid Services (CMS) released its final rule for market stabilization of the health insurance exchanges, following the departure of some health plans from the marketplace for the upcoming plan year.
Webinar: ACA Repeal and Replace: What’s Next?
Avalere experts examine proposed key reforms to the ACA and its potential impacts.
AHCA State Stability Fund Would Give More Money to States with Limited Insurance Competition
New research from Avalere finds that under the American Health Care Act (AHCA), large states as well as those states with fewer insurers offering plans in the individual and small group markets could receive the most money from the federal government to help stabilize their markets.
House of Representatives ACA Repeal and Replace Legislation Could Increase Penalties for Failure to Buy Insurance
Low-income and older individuals would incur higher penalties for failing to purchase health insurance, compared to current individual mandate.
Final Report: The Impact of Medicare Advantage Data Submission System on Risk Scores
Avalere analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
Avalere’s Take on the ACA Market Stabilization Rule
Today, the Trump administration released a proposed rule for market stabilization of the Affordable Care Act (ACA).