Access to Health Care: States Respond to Growing Crisis : Report to Congressional RequestersThe Office, 1992 - 84 pages |
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access to coverage Access to Health Achieve Universal Access adults all-payer system average Barriers to Private beneficiaries budget Children's Health Plan constraints copayments cover eligible for Medicaid employer-provided insurance employers to provide enacted enrollment estimated exemption Expand Access Incrementally extend coverage federal poverty level fee-for-service plan financing fiscal Hawaii HCFA health benefits Health Care Act health care costs Health Care Coverage health care system health maintenance organization Helping Low-Income Groups high-risk pool implementation Incrementally by Helping initiatives legislation legislature limited Maine Health Program Massachusetts Medicaid eligibility Medicaid expansion Medicaid program medically uninsurable Medicare Minnesota Oregon Health Plan participation payers percent of poverty play-or-pay mandate preemption clause pregnant women premiums Prepaid Health Private Health Insurance private insurers problems provide coverage provide health insurance Reduce Barriers regulations reimbursement remain uninsured risk pool single-payer small businesses standard benefits package Strive to Achieve uncompensated uninsured children uninsured population Vermont waiver
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Page 50 - Medicaid benefits to all pregnant women and children up to age 6 with family incomes up to 133 percent of the Federal poverty level. (See box 16-B for a summary of OBRA-89 and OBRA-90...
Page 74 - Privately sponsored and state-facilitated small -employer pools have improved af fordability and access for some small firms. Their success has been somewhat tarnished, however, by a number of small-employer pools that have gone out of business or failed to pay claims, leaving groups and individuals with millions of dollars of unpaid bills. An additional problem has been a concentration of high-risk small-employer groups in pools, while low-risk groups obtain less costly Insurance elsewhere. CONCLUSIONS...
Page 74 - Some states, however, prohibit this enrollee selection practice, known as carving out; they want to avoid shifting costs from employers to the high-risk individuals and to avoid the pass-through costs small groups can incur when insurers are assessed to cover part of pool costs. Reinsurance pools help insurers accept entire small-employer groups regardless of the health status of individual members, by spreading pool costs across several insurers.
Page 72 - More time will be needed for these state initiatives to develop fully before a conclusive assessment can be made of these issues. The Incentive Effect of Waiving Mandated Benefits Appears to be Modest To encourage Insurance companies to design less costly insurance packages for small businesses, nearly half of the states have passed legislation reducing or eliminating health insurance coverage requirements — "mandated benefits" — and now permit Insurance companies to offer lower-cost "bare bones"...
Page 1 - The Honorable John D. Dingell Chairman, Committee on Energy and Commerce House of Representatives The Honorable Dan Rostenkowski Chairman, Committee on Ways and Means House of Representatives The Honorable Barbara B.
Page 72 - Regulatory Reforms May Improve Availability of Insurance but Raise Average Premiums States have been particularly active in the past 2 years in limiting the extent to which insurance companies can deny coverage or price high-risk firms or individuals out of the insurance market. Forty-three states have initiated one or more insurance regulatory reforms that affect the small group market. Reforms include measures to help ensure that (1) employees who want health insurance will be accepted and renewed...
Page 72 - Reforms include measures to help ensure that (1) employees who want health insurance will be accepted and renewed by insurers; (2) waiting periods for coverage of preexisting conditions will be short, will occur only once, and will be based only on recent medical history; (3) coverage will be continuous; and (4) extremes In premium costs will be narrowed to fall within ranges specified by the states. These reforms are aimed at correcting a growing sense of unfairness in the insurance market in which...
Page 73 - ... small firms. In response, insurers in most of those states have offered plans to the small group market with premiums up to 40 percent lower than existing small group policies. In addition to excluding previously mandated benefits, these plans also often incorporate higher deductibles, preexisting condition clauses, and limit the choice of doctors that policyholders may use.
Page 22 - The Honorable Ron Wyden Chairman, Subcommittee on Regulation, Business Opportunities, and Energy Committee on Small Business House of Representatives Dear Mr.
Page 20 - ERISA, which has constrained states' ability to regulate employersponsored health plans that choose to self-insure. Although ERISA was designed to correct serious problems with the solvency of employer- funded pension funds, the act also covers all employee welfare benefit plans, which include health and other employee benefits. While ERISA confirmed the states' authority to regulate Insurance companies, it preempted states from regulating self -Insured health plans.