Publications: Private Insurance
State Advocate To-Do List for 2013 outlines issues that advocates may want to address in 2013 in anticipation of the changing health care environment. 10 pp. (January 2013)
Help Wanted: Preparing Navigators and Other Assisters to Meet New Consumer Needs explains the requirements for navigator programs and answers seven key questions that states will face as they seek to establish effective navigator programs. It is available as an online tool kit and as a PDF. 29 pp. (Updated January 2013)
Filling in Gaps in Consumer Assistance: How Exchanges Can Use Assisters explains the key differences between navigator and assister programs and how in-person assistance can function in the different types of exchanges. It also recommends actions advocates can take. 9 pp. (Updated January 2013)
Consumer-Friendly Standards for Qualified Health Plans in Exchanges: Examples from the States outlines the minimum standards for qualified health plans as set out in the Affordable Care Act. It then provides examples from eight state-based exchanges and one partnership exchange state on how to implement those standards in consumer-friendly ways. 20 pp. (January 2013)
The District of Columbia Health Benefits Exchange Proposal provides answers to questions about how the exchange will work and how it will help District residents and small businesses obtain affordable health coverage. 5 pp. (October 2012)
Exchange Implementation: To Partner or Not to Partner? lists questions to consider in determining whether a partnership exchange would be in the best interest of consumers and small businesses in states that are unlikely to establish state-based exchanges. 6 pp. (October 2012)
State Responsibilities in a Partnership Exchange explains the options for states that choose to implement a partnership exchange, and it describes the functions that partner states will need to perform. 7 pp. (October 2012)
Brokers and Agents and Health Insurance Exchanges discusses how brokers and agents will interact with the new health insurance exchanges opening in states in 2014 and highlights issues that advocates and states may want to think about. 16 pp. (September 2012)
Worry No More: Americans with Pre-Existing Conditions Are Protected by the Health Care Law provides estimates of how many people will be protected from discrimination based on their health status thanks to the health care law. For the first time, the state reports include county-level data, and they include state-level data that are broken down by age, income, and racial or ethnic group. 21 pp. (July 2012)
Working toward Wellness: A Checklist for Creating Consumer-Friendly Workplace Wellness Programs lays out the components for building a workplace wellness program that promotes health and well-being while protecting participants' health coverage and privacy. Our companion piece includes profiles of five wellness programs from across the country. 12 pp. (July 2012)
Designing the Essential Health Benefits for Your State: An Advocate's Guide describes how states will establish their essential health benefits packages for 2014 and 2015 and explores avenues for advocacy during this process. 16 pp. (July 2012)
Wellness Programs: Evaluating the Promises and Pitfalls presents an overview of current programs, identifies how their role could soon change, explains how certain programs can limit access to coverage and care, and provides recommendations for policies that will help prevent these programs from limiting access. 23 pp. (June 2012)
When a Health Insurer Leaves the Individual Market: What States Can Do before Certain Affordable Care Act Changes Take Effect in 2014 discusses specific actions states can take to protect consumers who need to buy coverage in the individual market. It examines existing protections and explains how states can supplement them. 14 pp. (May 2012)
Decoding Your Health Insurance: The New Summary of Benefits and Coverage provides national and state-level data on the nearly 173.5 million people with private insurance who will be helped by these plain-language summaries that are required by the health care law. 17 pp. (May 2012)
Good Business Sense: The Small Business Health Care Tax Credit in the Affordable Care Act provides national and state-level estimates of the number of small businesses that will be eligible for this tax credit and of how much the credits will be worth. It also includes data on how many workers could benefit as a result, broken down according to racial and ethnic group. 21 pp. (Families USA and Small Business Majority, May 2012)
Good Business Sense: The New Small Business Health Care Tax Credit in California provides state-specific estimates of the number of small businesses that will be eligible for this tax credit and of how much the credits will be worth. It also includes data on how many workers could benefit as a result, broken down according to racial and ethnic group. 17 pp. (Families USA and Small Business Majority, May 2012)
Getting Covered: Finding Health Insurance When You Lose Your Job is designed to help consumers who've lost their health coverage sort through possible options for new coverage, including COBRA, Medicaid, CHIP, other federal and state programs, and the individual market. 12 pp. (Updated February 2012)
Making the Most of Accountable Care Organizations (ACOs): What Advocates Need to Know provides an overview of ACOs; the promise they hold; and how they could change Medicare, Medicaid, and the health care landscape. It also identifies key challenges in their development and suggests how advocates can get involved in ways that benefit patients. 12 pp. (Updated February 2012)
Implementing the Patient Protection and Affordable Care Act: A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid gives state advocates an in-depth blueprint for action in 2012, outlining issues to start thinking about and tasks that deserve immediate attention. 4 pp. (February 2012)
Putting the Accountability in Accountable Care Organizations: Payment and Quality Measurements examines some of the challenges that advocates will face when working with policy makers, insurers, and providers to develop mechanisms that ensure that beneficiaries receive high-quality care at a lower cost. 9 pp. | Determining Shared Savings or Losses 6 pp. (January 2012)
Designing Consumer-Friendly Beneficiary Assignment and Notification Processes for Accountable Care Organizations discusses the challenges advocates will face when developing these processes, and it recommends certain notification requirements and beneficiary protections. 8 pp. (January 2012)
The Bottom Line: How the Affordable Care Act Helps America's Families shows the net financial effects of the Affordable Care Act on family budgets. We found that lower- and middle-income families, both uninsured and insured, will be financial winners. | State Reports 18 pp. (October 2011)
Simplifying Enrollment and Eligibility with Modified Adjusted Gross Income (MAGI) explains the benefits of aligning income calculation rules in Medicaid, CHIP, premium tax credits, and Basic Health programs (where applicable) through MAGI. 6 pp. (October 2011)
States Making Progress on Rate Review highlights state efforts to protect consumers from unreasonable increases in insurance premiums. It also explains provisions of the Affordable Care Act that encourage improvements to states' rate review processes. 24 pp. (October 2011)
The Perils of Health Insurance Sold Across State Lines explains the hidden dangers in legislation—being pushed at the state and the federal level—that lets out-of-state insurers evade state regulation. 11 pp. (July 2011)
The Basic Health Option: Will It Work for Low-Income Consumers? provides a framework for advocates to think about whether this option, created by the health care law, will work for their state. It covers program basics, discusses the problems it might address, and raises key issues that can affect the direction such a program might take. 12 pp. (July 2011)
Implementing Exchanges: A series of guides on implementing state health insurance exchanges.
The Affordable Care Act: Patients' Bill of Rights and Other Protections is a compilation of all of our fact sheets to date on consumer rights and protections. 31 pp. (April 2011)
Worry Less Spend Less: Out-of-Pocket Spending Caps Protect America's Families examines how the Affordable Care Act will protect insured people from high medical costs through new caps on out-of-pocket spending. It provides estimates of how many Americans will have spending that exceeds these caps and by how much, and it looks at how many of those people work for small businesses. 17 pp. | State Reports (March 2011)
States Are Benefitting from Provisions of the Affordable Care Act lists the number of people in each state who are already benefiting from each of five provisions. The provisions include measures that are helping small businesses provide coverage to their workers, helping seniors get free preventive care, and protecting children with pre-existing conditions. 3 pp. | Table (March 2011)
Preventing Unwarranted Exceptions to the Affordable Care Act's Medical Loss Ratio (MLR) Requirements explains the opportunities for advocacy if state insurance regulators file for adjustments to the MLR requirements. It also provides a list of questions to ask regulators if your state seeks an adjustment; these questions can be adapted for your state. 5 pp. (January 2011)
Building an Effective State Exchange offers 15 benchmarks to guide advocates and legislators as they develop the new health care exchanges that are required by the Affordable Care Act. Advocates are free to take this document and adapt it to the needs of their states. 3 pp. (December 2010)
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. 6 pp. (Updated December 2010)
Buyer Beware: Unlicensed Insurance Plans Prey on Health Care Consumers reports on actions that states have taken against American Trade Association, Serve America Assurance, and Smart Data Solutions. It also discusses the sale of phony insurance more generally, weaknesses in oversight of association health plans, and new protections under the Affordable Care Act. 11 pp. (October 2010)
How States Are Making Sure Coverage Is Available to Children notes that, under health reform, insurers are required to accept children regardless of any pre-existing conditions in all group plans and in newly sold individual plans, and it examines what several states are doing to make sure that child-only policies are still available. 7 pp. (October 2010)
Families USA had prepared a series of fact sheets on the Patients' Bill of Rights and other consumer protections in the Affordable Care Act that took effect on September 23. (September 2010)
Lower Taxes, Lower Premiums: The New Health Insurance Tax Credit examines how this tax credit will help both insured and uninsured Americans. It provides data on the number of people eligible, the total dollars available, and on how it will help working families in particular. | State Reports (September 2010)
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. 10 pp. (July 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. 2 pp. (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. 6 pp. (May 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. 25 pp. | State Reports (May 2010)
Efforts to Halt Health Reform: Playing Politics with Our Health counters the misinformation that is being spread by opponents of reform, particularly regarding the individual responsibility requirement, and presents the facts about their efforts to block reform. 2 pp. (April 2010)
The First 90 Days: A State Advocate's To-Do List provides an overview of the provisions to be implemented in the first 90 days, including coverage for uninsured people with pre-existing conditions, grants for consumer assistance offices, and Medicaid and CHIP maintenance of effort requirements. | pdf version 8 pp. (April 2010)
A Summary of the New Health Reform Law describes the major changes in health coverage that health reform will bring, including Medicaid and CHIP coverage, the affordability provisions, the exchanges, individual and employer responsibility requirements, improvements in private market coverage, and changes to Medicare and long-term services. 21 pp. (April 2010)
What Will the New Health Reform Law Do in the First Year? discusses how health reform will help people with pre-existing conditions, young adults, people on Medicare, small businesses, community health centers, and others in its first year. 3 pp. (April 2010)
Health Coverage in the States: How Will Health Reform Help? discusses the major gaps in each state's health coverage system and how health reform will address these gaps and help state residents, including the insured, the uninsured, people in Medicare, and small businesses. 7 pp. (March 2010)
Help Is on the Way: 12 Reasons to Embrace Health Reform discusses key improvements in the new health reform law, including clamping down on insurance company abuses, offering tax credits to small businesses, expanding Medicaid, and improving Medicare. 8 pp. (March 2010)
The Dangers of Defeat: The Cost of Failure to Pass Health Reform analyzes the many consequences for America's families and businesses if health reform is—or is not—enacted. It examines what will happen to health insurance premiums, out-of-pocket health care costs, and businesses struggling to provide coverage to workers. 11 pp. (March 2010)
Rate Review: Holding Health Plans Accountable for Your Premium Dollars discusses common problems with the process of reviewing health insurance premium rates, the lessons learned from state rate review procedures, and how health reform will address these problems. 11 pp. (March 2010)
Medical Loss Ratios: Making Sure Premium Dollars Go to Health Care—Not Profits discusses medical loss ratios, state requirements regarding medical loss ratios, and why medical loss ratio requirements are so important for protecting consumers. 8 pp. (February 2010)
Expiration of COBRA Subsidy: Millions of Unemployed Workers and Their Dependents Are at Risk; Many Will Lose Their Subsidy as of December 1, 2009 provides state-specific data on what will happen to family COBRA premiums when the subsidy ends, and it argues for extending the COBRA assistance. 7 pp. Print copies free (December 2009)
Your Medical Bills: A Consumer's Guide to Coping with Medical Debt covers steps for paying your medical bills, understanding your rights, and other information you need to know if you are struggling with medical debt. The guide also includes links to many useful online resources. 19 pp. Print copies free | Fact Sheet | State Protections (November 2009)
Senate Amendment on Wellness Program Surcharges Jeopardizes Access to Affordable Coverage and Care describes the concerns with an amendment under consideration in the Senate health reform bill that would allow employers and insurers to charge heath insurance enrollees larger surcharges for failing to meet "wellness" plan goals than are currently allowed. 2 pp. Print copies free (October 2009)
Help for Small Businesses discusses how small businesses face a disadvantage when it comes to providing health insurance and how health reform will help remedy this situation. 3 pp. Print copies free (October 2009)
Health Coverage in the States: How Will Health Reform Help? analyzes how the House health reform bill, America's Affordable Health Choices Act of 2009, would address many of the gaps and problems in the health care systems of specific states. 8 pp. Print copies free (September-October 2009)
The Essential Benefits Package in the House Health Reform Bill (H.R. 3200) examines the proposed benefits package for the plans in the exchange, discusses the benefits committee and its responsibilities, and outlines issues that advocates should monitor as health reform moves forward. 6 pp. Print copies free (September 2009)
Got health insurance? Think you don't need reform? Think Again! discusses five ways that health reform will help insured people. 1 p. Print copies free (August 2009)
Better Coverage for Children discusses how the health reform legislation that is before Congress will help cover uninsured children, and their families, by making insurance more available and affordable and by expanding Medicaid. 4 pp. Print copies free (August 2009)
Costly Coverage: Premiums Outpace Paychecks examines how the combination of stagnant wages and skyrocketing health insurance costs is placing a growing strain on family budgets. These state-specific reports show how health insurance premiums for families and individuals have risen over the last decade compared to earnings. 13 pp. Print copies $5.00 (August 2009)
Understanding the Role of the "Exchange" or "Gateway" discusses the new health insurance marketplace, or exchange, that is being developed in national health reform proposals. This short piece looks at how an exchange would work and how it could help middle-class and low-income families find and keep the affordable, quality health care they deserve. 4 pp. Print copies free (July 2009)
10 Reasons to Support the Health Care Reform Bills provides a quick rundown of the most exciting provisions in the health reform bills pending in Congress, including provisions that will help middle-class and low-income families, small businesses, and seniors and people with disabilities. 7 pp. Print copies free (July 2009)
The Clock Is Ticking: More Americans Losing Health Coverage provides the first ever state-by-state data on the number of people who may lose health coverage between the beginning of 2008 and the end of 2010. Numbers are broken down per week, per month, and per year. 5 pp. Print copies $5.00 (July 2009)
Why Is a Public Insurance Plan an Important Part of Health Reform? looks at how a high-quality, affordable public plan will help lower health care costs and add a solid option to the health insurance marketplace. 3 pp. Print copies free (July 2009)
What Is a "Special Enrollment Opportunity" and Why Should I Care about It? discusses who may have the option of signing up for job-based health coverage when it isn't open season. 4 pp. Print copies free. (June 2009)
Why Employers Should Share the Responsibility of Paying for Health Care discusses five reasons why it makes sense to require employers to contribute to the cost of health coverage, known as an "employer responsibility requirement." 3 pp. Print copies free. (June 2009)
Hidden Health Tax: Americans Pay a Premium discusses how private health insurance premiums are higher, in part, because the costs of uncompensated care for the uninsured are shifted to those who have insurance, a "hidden health tax." The report quantifies this "tax" for family and individual coverage. 32 pp. Print copies $10.00 (May 2009)
CoverTN, Tennessee's Barebones Health Plan: A Case Study uses Tennessee's barebones health plan as an example to examine how limited-benefit plans fail to meet the health coverage needs of consumers. 16 pp. Print copies free. (May 2009)
Too Great a Burden: Americans Face Rising Health Care Costs reveals how many Americans face very high health care costs and shows the magnitude of the health care cost crisis. The report provides data on how many people are in families that will spend more than 10 percent or 25 percent of their pre-tax income on health care in 2009. 30 pp. Print copies $15.00 (April 2009)
States Act to Help People Laid Off from Small Firms: More Needs to Be Done discusses how, in response to pressure from advocates, some states are taking steps toward passing "mini-COBRA" laws to help laid off workers from small firms get the federal subsidy guaranteed through the American Recovery and Reinvestment Act (ARRA). 8 pp. Print copies free. (April 2009)
Have health insurance? Think you're well protected? Think Again! This one-page fact sheet provides quick stats on how health care expenses overwhelm even insured working families, forcing many into bankruptcy. 1 p. Free (Updated March 2009)
Getting Covered: Finding Health Insurance When You Lose Your Job is designed to help consumers who've lost their health coverage sort through possible options for new coverage, including COBRA, Medicaid, CHIP, other federal and state programs, and the individual market. 11 pp. Print copies $2.00 (February 2009)
The American Recovery and Reinvestment Act: House Bill Health Coverage Provisions for the Unemployed Are Essential describes key differences in the health coverage provisions in the Senate and House versions of the economic recovery package, namely temporary Medicaid for unemployed workers and COBRA subsidies, and explains why the House provisions are crucial for helping unemployed workers and their families keep health coverage. 2 pp. Print copies free. (February 2009)
Protecting Unemployed Workers' Health Coverage: What States Can Do discusses how states can help unemployed workers keep or obtain health coverage during these turbulent economic times. 16 pp. Free (January 2009)
Squeezed! Caught between Unemployment Benefits and Health Care Costs examines COBRA coverage and unemployment benefits and finds that, to maintain their employer-based coverage under COBRA, most unemployed workers would have to devote an unrealistically high proportion of their unemployment check to health insurance. 13 pp. Print copies $10.00 (January 2009)
The Hidden Link: Health Costs and Family Economic Insecurity examines the crisis in family health care costs and shows why it will be impossible to restore family economic security without health reform that achieves quality, affordable coverage for all. 5 pp. Print copies $2.00 (January 2009)
Limited-Benefit Plans: Expanding Coverage or Holding Your State Back? examines the negative effects of limited-benefit insurance plans (also known as "barebones" or "mandate-lite" plans) based on how these plans have fared in some states. This brief also discusses how advocates can respond to limited-benefit proposals in their states. 8 pp. Print copies $2 (October 2008)
Failing Grades: Illinois Fails to Protect Consumers in the Individual Health Insurance Market focuses the broader discussion of inadequate consumer protections for the individual market on Illinois, examining how the state falls short in protecting consumers, leaving them vulnerable to insurance company abuse. The report also includes recommendations for reforms needed in the private market. 28 pp. Print copies $10 (September 2008)
Premiums versus Paychecks: A Growing Burden for Workers: Throughout the first eight years of the new millennium, health care costs have skyrocketed, while working families’ wages have stood still, putting a significant strain on family budgets. This series of state-by-state reports, which are based on data from the U.S. Census Bureau, the Department of Labor, and the Department of Health and Human Services, examine what these trends mean for working families. 12 pp. Print copies $2 (September-October 2008)
An Unequal Burden: The True Cost of High-Deductible Health Plans for Communities of Color discusses the full costs associated with high-deductible health plans and why these expenses are disproportionately unaffordable for racial and ethnic minorities. It also examines several myths about health savings accounts (HSAs), which are often coupled with such health plans. 12 pp. Print copies $2 (September 2008)
Empty Promise: Searching for Health Insurance in an Unfair Market discusses how the individual health insurance market differs from the employer market and examines what happens to consumers who seek coverage in the individual market. Problems in the individual market include policies that don't provide quality coverage; policies that are very expensive or that cost more than advertised; and the fact that many applicants cannot obtain a policy at any price. 8 pp. Print copies $2 (August 2008)
Fighting Revocations and Limitations of Health Insurance Policies addresses the insurance company practice of revoking an individual's health insurance or suddenly eliminating coverage for health services long after the person has enrolled (known as "post-claims underwriting"). It also discusses what consumers and advocates can do about the practice. 8 pp. Print copies $2 (July 2008)
Failing Grades: State Consumer Protections in the Individual Health Insurance Market. Laws protecting consumers purchasing health coverage in the individual market vary across the country. In many states, insurance companies can deny coverage, raise premiums significantly, refuse to cover treatment for certain conditions, and even revoke the coverage of policyholders who have been paying premiums for years. 36 pp. $10.00 (June 2008) More in-depth resources that supplement the report:
- The Facts about Prior Approval of Health Insurance Premium Rates discusses several insurance industry myths about the consequences of prior approval. The prior approval process is used by most states to make sure that insurance companies' proposed premium increases are not excessive. 4 pp. Free (June 2008)
- Medical Loss Ratios: Evidence from the States presents the results of a 50-state survey we conducted in March and April 2008 that determined which states have laws or regulations that establish a minimum "medical loss ratio" (a percentage of premium dollars that must be spent on medical care). 8 pp. Print copies $2 (June 2008)
- Post-Claims Underwriting Survey presents the findings of a survey we conducted in April and May 2008 of all state insurance departments regarding laws in their states that prohibit insurers from limiting or rescinding health insurance policies after they have been issued. 8 pp. Print copies $2 (June 2008)
Families USA comments on proposed accreditation standards for wellness programs, developed by the National Committee for Quality Assurance (NCQA). Click here to see the draft standards. (June 2008)
Reinsurance: A Primer aims to help policymakers and advocates better understand what reinsurance is and how it can make coverage easier to obtain and more affordable. It also identifies some of the benefits of reinsurance to aid lawmakers as they design reinsurance programs to meet the needs of their states. 20 pp. Print copies $5 (April 2008)
Reward/Penalty Plans for Wellness: Coming Soon to an Office Near You? Encouraging healthy lifestyles is important, but might some wellness plans place your access to health care at risk? This piece explores some of the hidden effects that reward/penalty plans for wellness may have on consumers, as well as the problems that these plans might present in both employer-sponsored coverage and Medicaid. 8 pp. Print copies $2 (January 2008)
Too Great a Burden: America's Families at Risk finds that more and more American families are spending a substantial share of their incomes on health care costs, and most of these families have insurance. Faced with high health care costs and tight budgets, families are turning to credit cards to finance their care, and many are falling into medical debt. 28 pp. $15.00 (December 2007) l state reportsPrint copies $2
Maine's Dirigo Health Reform of 2003 is a thorough examination of the state's health care expansion. It discusses program eligibility, how much people pay for the different types of coverage, what benefits they receive, how the expansion is financed, how it reforms the state's insurance regulations, lessons learned so far, and the future of health reform in Maine. 16 pp. Print copies $2 (November 2007)
Massachusetts Health Reform of 2006 is a thorough examination of the state's far-reaching expansion in health coverage. The report discusses who is eligible, how much enrollees pay for the different types of coverage available, what benefits they receive, who is providing coverage, the individual mandate, and how the reform is being financed. It also discusses what lessons state advocates have learned from the process of getting the legislation passed. 14 pp. Print copies $2 (August 2007)
Retail Medical Clinics: Okay in a Pinch, but No Substitute for Real Health Coverage provides an overview of the growing trend of clinics popping up in stores such as Wal-Mart, Target, and CVS. While their convenience is appealing, the tradeoff may be piecemeal services that lack appropriate oversight. Consumers should use such clinics only to supplement care from their regular primary care physician. 6 pp. Print copies $2 (August 2007)
Pennsylvania's 2007 Health Care Proposal: Prescription for Pennsylvania examines the governor's plan for comprehensive health reform. This report looks at who is eligible for new coverage, how much they'll pay, what benefits they'll get, and how the state will finance the expansion. It also discusses strengths of the plan, as well as areas of concern. 10 pp. Print copies $2 (July 2007)
State Guides to Finding Health Insurance (updated March 2007)
If you are looking for health coverage, Families USA has created a guide for each state that can help point the way. Whether you have recently lost your job, are an early retiree, or have a serious medical condition, these guides include numerous resources that may help you find the coverage you need. 8 pp. Print copies $2
A Pound of Flesh: Hospital Billing, Debt Collection, and Patients' Rights provides an overview of some of the progressive reform measures that state policymakers have implemented to help families struggling with medical debt. 8 pp. Print copies $2 (March 2007)
Premiums versus Paychecks: A Growing Burden for State Workers. A series of state-specific reports detailing the increased cost of health care premiums versus stagnant pay. (December 2006). Go to State Information, click on the state from drop-down menu in the right-hand column, and scroll down to Other Resources. Print copies $2.
Six Reasons to Be Wary of High-Deductible HSA Plans 2 pp. Free (December 2006)
Stop Bad Ideas—How HSAs Can Drain Your Wallet and Harm Your Health presents three examples that illustrate what can happen to employees working for a hypothetical company that purchases a high-deductible health plan. 8 pp. Free (December 2006)
Vermont's Health Reform Laws discusses the basics of the state's two new laws, known as "Catamount Health." The piece also examines how Catamount Health will be financed, how the laws build on existing health coverage programs, and pros and cons of the laws. 6 pp. Print copies $2 (December 2006)
Stop Bad Ideas—HSAs: Missing the Target examines the effects that HSAs will have on those without health insurance and on the health care system overall. 8 pp. Print copies $2 (November 2006)
Understanding How Health Insurance Premiums Are Regulated discusses the state and federal regulation of health insurance premiums. Print copies $2 (September 2006)
Employers Should Pay Their Fair Share for Health Care explains what employer responsibility legislation is and discusses its benefits and potential drawbacks using examples of states that have implemented such legislation. 7 pp. Print copies $2 (September 2006)
H.R. 2355, The Health Care Choice Act: The Wrong Prescription for America's Health Care Needs discusses how this legislation, sponsored by Rep. Shadegg and favored by the Administration, would undermine state laws designed to protect health care consumers. 2 pp. Free (August 2006)
Making History: Maryland's Fair Share Health Care Law discusses how the law works, who it affects, and the key strategies advocates used to get the law passed. It also includes a timeline of critical events. 8 pp. Print copies $2 (May 2006)
High-Risk Health Insurance Pools provides answers to key questions about high-risk pools, including who they help and how they are financed. The report also includes a list of questions consumers should ask if they are considering joining a high-risk pool, as well as a checklist for advocates. 12 pp. Print copies $2 (May 2006)
The Enzi Bill: Bad Medicine for America summarizes the flaws in this legislation and provides state-by-state listings of consumer protections that will be lost and the numbers of people affected if the Enzi bill is enacted. 9 pp. Print copies $2 (May 2006)
Summary of S. 1955: The Health Insurance Marketplace Modernization Act outlines the legislation that introduces Small Business Health Plans (SBHPs) and exempts private insurers from many state laws and regulations governing health insurance. 5 pp. (March 23, 2006)
President Bush's Fiscal Year 2007 Budget: Analysis of Key Health Care Provisions Includes discussion and commentary on Health Savings Accounts (HSAs), Medicaid, and Medicare. 13 pp. Print copies $2 (February 22, 2006)
Proposed Health Reform in Massachusetts: Net Gain for the Business Community examines the health reform bill passed by the Massachusetts House of Representatives, which is designed to expand coverage to the state's uninsured. It finds that, overall, the bill would result in a net benefit for the state's business community. 15 pp. Print copies $2 (January 2006)
Stop Bad Ideas—AHPs: Bad Medicine for Small Employers Association Health Plans (AHPs) are a major part of the President's package of health care proposals aimed at reducing the growing number of uninsured Americans. This fact sheet finds that AHPs are not a solution for the number of uninsured, are not an effective way to control costs, and provide fertile ground for fraud and abuse. 5 pp. Free (December 2005)
Stop Bad Ideas—HSAs: Missing the Target This fact sheet examines the effects that health savings accounts (HSAs) will have on the uninsured and on the health care system overall. It finds that HSAs won't reduce the number of uninsured, are not an effective way to control costs, are inequitable, and are a radical threat to our current health insurance system. 7 pp. Free (December 2005)
Stop Bad Ideas—Too Little, Too Late: Why a $1,000 Tax Credit Won’t Help the Uninsured Every year since 2001, President Bush has proposed a $1,000 tax credit to help uninsured people purchase health insurance in the individual market. This fact sheet finds that his tax credit is justified by questionable studies, is tied to the flawed individual market, and wouldn't make insurance affordable. 4 pp. Free (December 2005)
What Consumers Need to Know about Buying Health Coverage from Associations 2 pp. Free (July 2005)
What Consumers Need to Know about Health Savings Accounts 2 pp. Free (July 2005)
What Consumers Need to Know about Purchasing Health Insurance as an Individual 2 pp. Free (July 2005)
Paying a Premium: The Added Cost of Care for the Uninsured
This report quantifies, for the first time, the dollar impact on private health insurance premiums of care provided to the uninsured. 35 pp. $15.00 (June 2005)
Have health insurance? Think you're well protected? Think Again! This one-page fact sheet provides quick stats on how health care expenses overwhelm even insured working families, forcing many into bankruptcy. 1 p. (February 2005)
HSAs: Why High-Deductible Plans Are Not the Solution
This fact sheet examines the effects that health savings accounts (HSAs) will have on those without health insurance and on the health care system overall. 7 pp. Free (January 2005)
Ideas that Work: Expanding Health Coverage for Workers
A Tool Kit for those who want to build a state-based health coverage initiative based on employer-provided insurance. Includes case studies of California and Hawaii, a "decision guide," and tables with state-by-state data about employment and insurance coverage. $20.00 (October 2004)
Health Care: Are you better off today than you were four years ago?
Health care has emerged as one of the top concerns of Americans in recent years. To understand what forces are driving this change, Families USA posed a variation of a question raised by Ronald Reagan more than two decades ago: When it comes to health care, are we better off today than we were four years ago? The results of our analysis show that the answer is a clear no. | en espanol 52 pp. $15.00 (September 2004)
The Illusion of Group Health Insurance: Discretionary Associations
Discretionary associations enable insurance carriers to market individual health insurance policies under the guise of group insurance to consumers seeking low-cost insurance that appears to offer group protections. This Issue Brief identifies problems in the discretionary association marketplace and suggests a number of regulatory and legislative solutions. 18 pp. $3.00 (March 2004)
The Trade Act Health Insurance Subsidy: An Update from the States: This Issue Brief analyzes the implementation of the new subsidy offered by the Trade Adjustment Assistance Reform Act of 2002 (TAARA) and suggests changes that might strengthen the existing program. 28 pp. $5.00 (December 2003)
What's Wrong with Tax-Free Savings Accounts for Health Care?
Tax-free personal savings accounts for health care have become the latest cure-all for the problems facing our health care system. This Issue Brief uses a hypothetical company to examine how such accounts undermine the pooling of risk--the basis for insurance. 6 pp. Free (November 2003)
A Shelter in the Storm: How a Subsidy Could Help Unemployed Workers Get Health Insurance The rise in unemployment over the past three years has contributed to a substantial increase in the the number of uninsured Americans. This Issue Brief discusses the Trade Adjustment Assistance Reform Act of 2002 (TAARA) health insurance subsidy as one possible model for providing financial assistance to unemployed workers for the purchase of health coverage. 12 pp. Free (October 2003)
Private Plans: A Bad Choice for Medicare The role of private plans in Medicare up to this point. The evidence so far indicates that, for seniors and people with disabilities, particularly those living in rural areas, the traditional Medicare program works better than private plans. 2 pp. Free (September 26, 2003)
The Health Insurance Tax Credit in the Trade Adjustment Assistance Reform Act of 2002
This issue brief defines the TAARA tax credit and discusses who is eligible for it. It also provides answers to many other questions about how the tax credit will be administered, what kinds of insurance quality insurance will be provided, and the role states have in implementing the credit. Includes advocate suggestions for shaping the credit. 16 pp. Free. (April 2003)
Protecting Consumers from Unfair Rate Hikes: The Need for Regulation of Health Insurance Renewal Premium Increases This Issue Brief examines the insurance industry practice of re-underwriting at renewal and discusses current efforts to regulate the practice at the federal and state levels. 7 pp. Free. (February 2003)
Medicaid Managed Care Final Regulations Issued A Field Report. In June, the Bush Administration released final regulations implementing patient protections for Medicaid beneficiaries enrolled in managed care. This report summarizes the main provisions of these regulations, including state plan requirements, enrollee rights, and grievance systems. 11 pp. $3.00 (September 2002)
More than 725,000 Laid-off Workers Have Lost Health Coverage Since the Recession Began in March A Special Report. 4 pp. Free. (December 2001)
The Bush Administration's Health Proposals in the Economic Stimulus Package A Health Policy Memo. 2 pp. Free. (October 8, 2001)
Consumer Health Assistance Programs: Report on a National Survey Consumer health assistance programs come in many shapes and sizes. Some serve Medicare beneficiaries, for example; some serve people in long-term care facilities or those who are privately insured. Families USA conducted a nationwide survey of these programs, and the findings are summarized in this report. 48 pp. $15.00 (July 2001)
Designing a Consumer Health Assistance Program As health care becomes more complex, many states and localities are developing consumer health assistance programs to meet the needs of consumers within their jurisdictions. This guide reviews some key considerations to keep in mind when designing such programs. 24 pp. $15.00. (June 2001)
Healthy Pay for Health Plan Executives The managed care industry claims that the cost of patients' rights legislation will make families lose health insurance coverage--a charge that is both misleading and self-serving. This report examines the compensation for the highest-paid executives of 10 for-profit, publicly traded companies that own health plans serving multiple states. A Special Report. 27 pp. $8.00. (June 2001)
Medicaid Managed Care Consumer Protection Regulations: No Patients' Rights for the Poor A Special Report. 12 pp. $2.00. (May 2001)
A Guide to Monitoring Medicaid Managed Care This guide will help community organizations determine how well managed care plans are serving Medicaid beneficiaries. Provides the how-to's of monitoring projects, from simple "do-it-yourself" efforts to the gathering and analysis of data from many sources. 84 pp. $20.00. (September 2000)
Rural Neglect: Medicare HMOs Ignore Rural Communities A look at the availability of Medicare HMOs in non-metropolitan counties in the U.S., which finds that 73 percent of rural Medicare beneficiaries have no access to any Medicare HMO. Concludes that Medicare reform should not be predicated on HMOs. 19 pp. $15.00. (September 1999)
The Quality of Maryland and District of Columbia Medicaid Managed Care Plans: External Reviews looks at the external quality review process for Medicaid HMOs and finds problems in how external reviews are administered. (December 1998)
The Best from the States II: The Text of Key State HMO Consumer Protection Provisions offers the relevant text of state laws and regulations addressing important managed care consumer protections, including emergency room services, access to providers, liability, and more. $10.00 (October 1998)
Premium Pay II: Corporate Compensation in America's HMOs examines 1997 executive compensation for the 15 for·profit, publicly traded companies that owned HMOs with enrollments over 100,000. These 15 companies owned 75 of the nation's largest HMOs in 1997. 33 pp. $15.00. (September 1998)
Hit and Miss: State Managed Care Laws surveys state legislation addressing common problems with managed care. It analyzes state-by-state activity on 13 illustrative consumer protections and finds that many Americans are left unprotected. The spottiness of state consumer protections is compounded by ERISA, which preempts state laws for those in "self-insured" plans--one out of three people with employer-provided coverage. $15.00. (July 1998)
Monitoring Medicare HMOs: A Guide to Collecting and Interpreting Available Data is aimed at groups working with Medicare beneficiaries. It provides step-by-step instructions for gathering and making sense of Medicare HMO data from federal agencies, state governments, and other sources. Parts of the guide will be useful to those interested in Medicaid and/or commercial HMOs. 86 pp. $15.00. (May 1998)
Premium Pay: Corporate Compensation in America's HMOs examines the 1996 costs of compensation for top level executives of some of the nation's most profitable HMOs (April 1998)
A Guide to Access to Providers in Medicaid Managed Care
This 62-page guide examines how managed care has affected Medicaid beneficiaries' access to primary care physicians and specialists, including "traditional Medicaid providers." Explores problems in access to care, explains access requirements in federal law, and gives suggestions for steps advocates can take to help assure provider availability. Features tables of provider access requirements in state Medicaid managed care contracts. $20.00. Print only. (April 1998)
A Guide to Meeting the Needs of People with Chronic and Disabling Conditions in Medicaid Managed Care
This 44-page guide, written by National Health Law Program and Families USA, examines issues confronting states as they move toward mandating managed care for people with chronic and disabling conditions. The guide discusses problems experienced when either populations or services are "carved out," looks at steps states have taken to ensure quality care, and provides advocates with information about where to make their voices heard. $20.00. Fact sheet also available. Free. Print only. (January 1998)
A Guide to Complaints, Grievances, and Hearings Under Medicaid Managed Care
This 43-page guide, written by National Health Law Program and Families USA, provides an overview of Medicaid managed care enrollees' legal rights, common problems that prevent beneficiaries from receiving an impartial review, examples of what states have done to protect the rights of beneficiaries, and suggestions for ways advocates can help ensure an adequate complaint process is in place. $20.00. Fact sheet also available. Free. Print only. (January 1998)
Comparing Medicare HMOs: Do They Keep Their Members?
This 44-page report looks at Medicare HMOs to see how many beneficiaries quit, or disenroll. Includes state-by-state and plan-by-plan data on the overall disenrollment rates as well as "rapid" disenrollment rates. The report finds that the lowest disenrollment rates, indicating that beneficiaries are generally satisfied, are in nonprofit plans with a long history of serving Medicare beneficiaries. $15.00. (December 1997)
A Guide to Cost-Sharing and Low-Income People
This 40-page guide addresses the imposition of cost-sharing (co-payments, deductibles, premiums) in both the Medicaid program and the new State Children's Health Insurance Program. Current legal requirements are presented and research on the effects of cost-sharing is summarized. $20.00. Fact sheet also available. Free. Print only. (October 1997)
A Guide to Marketing and Enrollment In Medicaid Managed Care
This guide reviews common problems experienced when states move their Medicaid populations into managed care and discusses solutions to those problems. Includes a chart comparing provisions of various state RFPs used to solicit enrollment brokers. 34 pp. $20.00. Fact sheet also available. Free. (June 1997)
Medicare Managed Care: Securing Beneficiary Protections
This 66-page report outlines the policy changes needed to ensure that Medicare Beneficiaries who join HMOs are adequately protected. $15.00. Print only. (April 1997)
HMO Consumers at Risk: States to the Rescue
An overview of 14 key HMO consumer protection issues addressed by a number of states through legislation or regulation during 1995 and the first half of 1996. 48 pp. $15.00. Print only. (July 1996)
Doing Without: The Sacrifices Families Make to Provide Home Care
This report examines the amount of unpaid care that family and friends provide to the elderly; the income, age and health status of unpaid caregivers; and consumers' high out-of-pocket costs for paid home care. 24 pp. $10.00 Print only. (July 1994)
Skyrocketing Health Inflation 1980-1993-2000: The Burden on Families and Businesses
A analysis of health care spending of American families and businesses, nationally and state-by-state. Also includes data on sources of payment by families and businesses. 40 pp. $10.00. Print only. (November 1993)
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