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Market—ACA Health Reforms
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ACA health reforms include consumer protection provisions (e.g., relating to pre-existing conditions), health insurance exchanges, Section 1332 waivers and other state actions relating to the ACA.
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Market—Cost Containment
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Cost containment measures for individual consumers, states and health spending overall—including controlling health insurance premiums, addressing hospital prices and spending, leveraging health care costs growth benchmarks and other actions.
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Market—Coverage
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Coverage efforts include defining or expanding enrollment, consumer rights and assistance, establishing limits on deductibles and copayments and other topics relating to private health insurance coverage.
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Market—Delivery Reform
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Health provider delivery reforms include medical homes, accountable care organizations (ACOs), and use of primary care networks.
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Market—Exchanges and Health Marketplaces
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Exchanges and health marketplaces include actions relating to state-based marketplaces, Section 1332 waivers, reinsurance, premium subsidies and other topics.
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Market—Free Market, Challenges and Alternatives
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Free market actions and alternative coverage options include short-term limited duration plans, association health plans, farm bureau health plans, direct primary care, health savings accounts and other related topics.
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Market—Health Insurance Reforms
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Health insurance reforms include single-payer efforts, public option plans, premium rate review, state-level individual mandates, step-therapy and prior-authorization, medical loss ratios and other actions related to health insurance reforms.
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Market—Mandates and Essential Health Benefits
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State laws that define health insurance mandates and affect federally created essential health benefits, including requirements, restrictions and flexibility as enacted by states.
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Market—Payment Reform
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Commercial and private market payment reforms can include incentives or requirements for value-based purchasing, pay-for-performance, accountable care organizations, and bundled and global payments.
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Market—Price Transparency
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Price disclosure and transparency initiatives include all-payer-claims databases, requirements to publish or publicly post charges and rates, right-to shop programs and related privacy issues.
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Market—State-Run Programs
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State-run programs include state and local public employee benefits, single payer proposals, public option proposals, state-funded public-private partnerships and other measures not tied to federal structures.
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Market—Surprise Billing and Network Adequacy
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Surprise billing and network adequacy includes actions to protect consumers from surprise medical bills or balance billing, as well as state laws to ensure insurers include a sufficient number and type of providers in their insurance network.
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Market—Other
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New and emerging innovations that do not fit typical or widespread policies may be listed here.
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Medicaid—Expansion and Waivers
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Waivers allow states to design expansion options as well as other aspects of the traditional Medicaid program to meet their unique needs.
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Medicaid—Payment Reform
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Payment reform seeks to reward value and create financial incentives for health care providers to focus on primary and preventive care, improve access and adopt more effective, efficient models of care delivery to improve quality and reduce costs.
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Medicaid—General
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These laws amend or change state Medicaid in ways other than expansion and payment reform. (Users may check all three Medicaid search options to view program changes from a broader perspective.)
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Telehealth Policies
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Telehealth legislation includes Medicaid and private payer reimbursement and parity, licensure and compacts, and prescribing, among others.
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