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Private Coverage & Exchanges

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Photo: Juan Pulido, Children’s Health Children’s Medical Center Dallas, Dallas, Texas

Understanding Private Coverage

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The House-passed American Health Care Act (AHCA) allows states to waive the Affordable Care Act (ACA) Essential Health Benefit (EHB) requirements and ban on plans imposing higher premiums on individuals with pre-existing conditions. The Senate recently introduced legislation of its own, retitled the Better Care Reconciliation Act of 2017, which would allow states to waive many of the private coverage provisions of the ACA, including EHBs, protections against high out-of-pocket expenses and network adequacy requirements. Both the House and Senate bills eliminate the law's individual mandate and cost-sharing subsidies, and revise the premium tax credit structure.

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Letter or Testimony
CHA Comments on RFI on Market Stabilization and Consumer Choice
July 13, 2017

CHA’s response to CMS focused on access to appropriate providers, affordable care for complex and chronic conditions, and the ability to make ...

Analysis or Summary
BCRA/AHCA Comparison with Current Law
July 7, 2017

CHA has developed a chart comparing the House and Senate ACA repeal legislation with current law.

Analysis or Summary
Key Provisions in the BCRA that Impact Children's Coverage
June 28, 2017

This CHA factsheet provides a brief overview of the Senate’s Better Care Reconciliation Act (BCRA) provisions with implications for children’s ...

Analysis or Summary
Better Care Reconciliation Act Bill Summary
June 23, 2017

CHA developed a summary of the relevant provisions in the discussion draft related to children’s health for the The Better Care Reconciliation Act of ...

Analysis or Summary
Summary of Request for Information on Regulatory Relief/Consumer Choice
June 16, 2017

CMS seeks input on ways to create a more patient-centered health care system and stabilize health insurance markets.

Analysis or Summary
American Health Care Act: Provisions Impacting Children
June 1, 2017

The American Health Care Act would convert Medicaid to a per capita cap system in 2020, limiting future federal funding to the states and risking ...

Analysis or Summary
Medicaid, Children's Health Insurance Program and Exchanges: Final Rule Summaries, Parts I and II
May 31, 2017

On July 15, 2013, CMS published the final rule implementing provisions of the ACA affecting Medicaid, CHIP and the Exchanges.

Analysis or Summary
Final Market Stabilization Rule Summary
May 5, 2017

CMS released the final Market Stabilization rule, which changes certain standards for Exchange plans as well as some requirements for plans in the ...

Analysis or Summary
CHA Summary of Invisible High-risk Pool Amendment to AHCA
April 13, 2017

The AHCA would create a federal invisible high-risk pool for private insurance plans in the individual market.

Letter or Testimony
Comment Letters on Market Stabilization Proposed Rule
March 9, 2017

CHA submitted comments with allied organizations to CMS on the agency's proposed Market Stabilization rule.

Analysis or Summary
CHA Summary of ACA Market Stabilization Proposed Rule
February 24, 2017

On Feb. 17, CMS released a proposed rule intended to stabilize the private insurance market and ensure families continue to have private health ...

Analysis or Summary
2016 State Policy Trends Memo
February 20, 2017

During the summer and fall of 2016, CHA reached out to government relations professionals to inform our understanding of the state policy issues ...

Analysis or Summary
CHA Summary of Cassidy, Collins ACA Repeal/Replace Bill
February 2, 2017

CHA summary of the Patient Freedom Act of 2017, introduced on Jan. 23 by Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME)

Talking Points
Key Provisions of the Affordable Care Act for Children
January 10, 2017

The ACA includes important provisions to make children's health care more age-appropriate, affordable, accessible and timely.It is important that ...

Analysis or Summary
Summary of Final 2018 Guidance for Health Plans
January 6, 2017

The CMS notice and letter set standards for qualified health plans and outline specific steps for plans to be certified for sale in the federally ...

Analysis or Summary
Children's Organizations Joint Comments on 2018 Draft Letter to Exchange Plans
December 8, 2016

The letter calls on CCIIO to define the pediatric Essential Health Benefit and adopt a network adequacy standard for appropriate access to care.

Letter or Testimony
CHA Comments on 2018 Draft Letter to Exchange Plans
December 8, 2016

CHA calls on CCIIO to define the pediatric Essential Health Benefit and adopt a network adequacy standard for appropriate access to care.

Analysis or Summary
CHA Summary of 2018 Draft Technical Guidance for Exchange Plan Certification
November 17, 2016

CHA Summary of 2018 Draft Technical Guidance for Exchange Plan Certification

Letter or Testimony
Habilitation Coalition Comments on Proposed Exchange Guidance
October 7, 2016

CHA joined with almost 50 disability and child advocacy organizations on a comment letter to CMS on the proposed 2018 Notice of Benefit and Payment ...

Letter or Testimony
CHA Comments on 2018 Exchange Guidance
October 6, 2016

The CHA comment letter addresses provisions in the proposed Notice that affect children’s access to care

Analysis or Summary
CHA Summary of Proposed Exchange Guidance
September 9, 2016

This CHA summary of the 2018 Proposed Notice of Benefits and Payment Parameters (NBPP) highlights those sections of the Notice that affect children’s ...

Analysis or Summary
Affordable Care Act Nondiscrimination Final Rule Summary
September 2, 2016

This summary outlines key provisions of the ACA Section 1557 final rule, which prohibits discrimination on the basis of race, gender, race, color, ...

Issue Brief
Strengthen Exchange Coverage for Children
June 10, 2016

CHA highlights key recommendations to improve the Exchanges for children.

Announcement or News
Participate in Patient Safety Initiatives to Qualify for Contracts with Exchange Plans
May 19, 2016

As of Jan. 1, 2017, hospitals with more than 50 beds must meet new federal requirements for participating in patient safety initiatives.

Letter or Testimony
Senate Democrat Dear Colleague Letter on Pediatric Essential Health Benefits
May 6, 2016

Eleven Senate Democrats sent a letter to HHS Secretary Burwell regarding the tenth category of pediatric essential health benefits.

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