Private Insurance

Most Americans receive their health coverage through the private insurance market, usually through their jobs. However, many people buy insurance on their own in the individual market. Since coverage from private companies is the largest source of insurance for Americans, it is likely to be a central part of federal and state health reform efforts. 
 
This section of our Web site keeps you up-to-date on what's happening in the private health insurance arena.

• "Private Insurance General" provides links to several good overview and introductory resources on private insurance.
• "Affordability of Coverage" includes studies and other materials that document the rising costs of coverage and ways to address this problem for Americans.
• "Adequacy of Coverage" features materials about benefits and cost-sharing, which make or break the quality of an insurance policy.
• "Availability of Coverage" looks at the special problems that people with pre-existing conditions or who are otherwise at high risk face in getting and keeping insurance, along with the protections that are necessary to help such people obtain coverage that meets their needs.
• "COBRA & TAARA Coverage" has information about how COBRA continuation coverage works, including details about the 65 percent subsidy included in the economic stimulus act, and about the TAARA tax credit to help workers displaced by trade.
• "Bad Ideas" discusses Health Savings Accounts (HSAs), Association Health Plans, and other “solutions” to the health crisis that would actually make matters worse, not better.
• "Legal Rights" offers resources to help consumers facing an array of complex issues, laws, and regulations in the private health insurance market.
• "Improving the Market" provides more technical information for advocates and policymakers about tools used to regulate and improve the private market for consumers.

The Latest 

From Families USA and Small Business Majority

A Helping Hand for Small Businesses: Health Insurance Tax Credits analyzes the health reform provision that provides tax credits to small employers to help them buy health coverage for their workers. This report, which was commissioned along with Small Business Majority, provides national and state-level data on the number of small businesses eligible for the credit in 2010, as well as the number eligible for the maximum tax credit. (July 2010)

From Families USA:

Grandfathered Plans under the Patient Protection and Affordable Care Act discusses health plans that existed on the date that health reform was enacted and are therefore exempt from some provisions of the law. It explains the requirements health plans must meet to maintain grandfathered status and outlines which protections in the health reform law apply to such plans and which do not. (August 2010)

Designing a Consumer Health Assistance Program discusses these programs and how health reform will dramatically expand the assistance they provide. It reviews key considerations to keep in mind when designing such programs, including grants and other funding, function, scope, location, staffing, training, and outreach. (August 2010)

COBRA Assistance: A Lifeline for America’s Unemployed briefly explains the urgency of extending the COBRA subsidy until the end of the year. Enacted as part of the economic stimulus legislation, this subsidy pays 65 percent of the cost of COBRA continuation coverage for unemployed families and individuals. Read two stories about Americans who have depended on the COBRA subsidy. (May 2010)

Health Coverage for Young Adults: Health Reform Will Soon Allow You to Stay on Your Parent's Health Plan is a fact sheet aimed at young adults (and their parents) that is designed to answer important questions about this new opportunity to keep or obtain health coverage for young adults up to age 26. (May 2010)

Families USA's Comments on Rate Review in response to an HHS request for information to help guide the development of regulations implementing rate review provisions of the new health reform law. (May 13, 2010)

Families USA's Comments on the Mental Health Parity and Addiction Equity Act (MHPAEA) Interim Final Rules: Our comments to the Departments of Health and Human Services, Labor, and Treasury on MHPAEA support the rules, which make mental health and substance use disorder services more accessible and affordable for consumers in large employer plans. (May 3, 2010)

Health Reform: Help for Americans with Pre-Existing Conditions discusses how, under health reform, no one will be denied coverage, charged a higher premium, or sold a policy that excludes coverage of essential benefits because of pre-existing conditions. The report presents the number of Americans with diagnosed pre-existing conditions who, absent reform, would be at risk of being denied coverage in the individual insurance market. It breaks down this number by age, income, and race. | State Reports (May 2010)

From the Center on Budget and Policy Priorities:

Medicaid Expansion in Health Reform Not Likely to “Crowd Out” Private Insurance finds that the expansion will overwhelmingly provide coverage to people who would otherwise be uninsured, rather than shift people with private coverage into Medicaid. The analysis shows that fears about “crowding out” private insurance are exaggerated and inconsistent with past experiences with similar expansions. (June 2010) 

From the Commonwealth Fund:

Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010 looks at how women will benefit from provisions that improve coverage and reduce premiums, eliminate pre-existing condition exclusions, eliminate gender rating, and others. Given that women, on average, use more health services over their lifetimes, the new law is likely to greatly improve women’s experience with the health care system. (July 2010)

From Consumers Union:

How Much Is Too Much: Have Nonprofit Blue Cross Blue Shield Plans Amassed Excessive Amounts of Surplus? reports that out of the 10 plans sampled, seven held more than three times the minimum amount needed for solvency protection. In addition, many of these plans with large surpluses continued to raise premiums. The report recommends that states take surpluses into consideration when reviewing rate increases and establish better standards for what is an appropriate surplus for a nonprofit plan. (July 2010)

From the Kaiser Family Foundation:

Survey of People Who Purchase Their Own Insurance looks at the types of people who purchase individual insurance, how much they are spending on premiums and out-of-pocket costs, and their experiences with and responses to premium increases. (June 2010)

From the National Women’s Law Center:

What Women Need to Know about Health Reform: Improving Access to Affordable Preventive Care looks at how women will benefit from provisions in health reform that expand coverage for preventive care in private plans, Medicare, and Medicaid, and that eliminate cost-sharing for those services. (June 2010)

What Women Need to Know about Health Reform: Insurance Reforms explains how women will benefit from these reforms given that plans have routinely discriminated against women by using gender rating, treating domestic violence as a pre-existing condition, and denying coverage because they’ve had a c-section or breast cancer. New insurance reforms and the “exchanges” will make it easier for women to get coverage in a private market that treats everyone fairly. (June 2010)

What Women Need to Know about Health Reform: Making Health Care More Affordable explains that, on average, women are poorer and spend a greater share of their income on care than men. Therefore, provisions aimed at preventing medical bankruptcy and increasing access to affordable coverage, whether through public programs or the private market, will greatly benefit women. (June 2010)

From the Urban Institute and the Robert Wood Johnson Foundation:

How Will the Patient Protection and Affordable Care Act of 2010 Affect Young Adults? describes how different elements of health reform will help young adults, specifically the Medicaid expansion, subsidies for private insurance, the expansion of dependent coverage, and insurance market reforms. (July 2010)

From U.S. PIRG:

Delivering on the Promise: A State Guide to the Next Steps for Health Care Reform describes the issues and opportunities that states will face when implementing the law, such as the state exchanges, consumer protections, provisions focused on lowering costs and improving quality, and ways that states can continue improving health care beyond the new law. The guide is a useful tool for policy makers and advocates alike. (June 2010)

From the White House:

Patients' Bill of Rights: President Obama has released new rules to implement key consumer protections that were part of the new Patient Protection and Affordable Care Act. | Families USA Press Release (June 22, 2010)