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State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting the Risk to the Individual Market

March 29, 2018

ABSTRACTIssue: Certain forms of individual health coverage are not required to comply with the consumer protections of the Affordable Care Act (ACA). These "alternative coverage arrangements" — including transitional policies, short-term plans, health care sharing ministries, and association health plans — tend to have lower upfront costs and offer far fewer benefits than ACA-compliant insurance. While appealing to some healthy individuals, they are often unattractive, or unavailable, to people in less-than-perfect health. By leveraging their regulatory advantages to enroll healthy individuals, these alternatives to marketplace coverage may contribute to a smaller, sicker, and less stable ACA-compliant market. The Trump administration recently has acted to reduce federal barriers to these arrangements.Goal: To understand how states regulate coverage arrangements that do not comply with the ACA's individual health insurance market reforms.Methods: Analysis of the applicable laws, regulations, and guidance of the 50 states and the District of Columbia.Findings and Conclusions: No state's regulatory framework fully protects the individual market from adverse selection by the alternative coverage arrangements studied. However, states have the authority to ensure a level playing field among coverage options to promote market stability.

Premium Incentives to Drive Wellness in the Workplace: A Review of the Issues and Recommendations for Policymakers

February 27, 2012

Outlines trends in workplace wellness programs; healthcare reform law provisions allowing greater financial incentives for employees; policy considerations for vulnerable populations, privacy issues, and affordability of coverage; and recommendations.

The Role of Exchanges in Quality Improvement

September 28, 2011

Explores state options and considerations for driving healthcare quality improvement and delivery system reform at the plan and provider levels through insurance exchanges, including the need to involve all stakeholders in developing and executing policy.

Active Purchasing for Health Insurance Exchanges

June 3, 2011

Examines the extent to which exchanges could be active purchasers that contract selectively with carriers, set stricter criteria, or negotiate discounts to leverage high-quality, affordable coverage, and not simply provide the broadest array of plans.

The Massachusetts and Utah Health Insurance Exchanges: Lessons Learned

March 30, 2011

Examines the quality and choice of plans, affordability, and ease of enrollment in existing state-run exchanges. Outlines lessons learned, including the need for ongoing refinement, consideration of broader market interactions, and public outreach.