From Coverage to Prior Authorization
Without action to extend enhanced premium tax credits, enrollees in ACA Marketplace plans are facing a tough start to the year when it comes to handling their healthcare costs. The Center on Budget and Policy Priorities (CBPP) explains the unraveling affordability crisis facing consumers, with health insurance enrollment outcomes still coming into view over the coming months as consumers decide whether they can afford their premiums. These changes are part of a policy move to restrict overall enrollment and healthcare access. Caring Across Generations released a toolkit reviving the call for our national leadership to extend premium tax credits to ensure the health and wellbeing of care providers and recipients alike.
Kaiser Family Foundation (KFF) has tracked ongoing public sentiment around the Affordable Care Act since its passage. There has been a noted drop in favorability since the fall government shutdown over the expiring tax credits. As we’ve covered in previous newsletters, subsequent health coverage proposals raise more concerning questions for people with disabilities, and will not offer the comprehensive coverage supported by ACA-compliant plans.
Earlier this week, CMS released their proposed Notice of Benefit and Payment Parameters (NBPP) for the 2027 plan year. The NBPP is the regulatory framework which CMS uses to operate the federally facilitated marketplace (healthcare.gov). To learn more, you can read the proposed rules, the CMS press release and CMS’s summary fact sheet on the NBPP. If you want a good explainer on what is included in these rules, check out the blog post written by Katie Keith on Health Affairs. AAHD has concerns over some of the proposals in these rules, so look for more in the coming weeks. Comments on the proposed rules are due by March 13.
For Medicaid enrollees, work requirements (referred to as “community engagement” requirements) are being rolled out this year as well. These developments will affect people with disabilities, even with exemptions. CBPP outlines the technical changes that states will be implementing over the coming year to meet a January 2027 deadline for rolling out these new work reporting systems. As the affordability crisis becomes more tangible for millions of Americans, KFF Health News is sharing the stories of people who are struggling to stay insured through their Priced Out series. You can encourage people with disabilities to share their stories as part of this initiative on the project page.
The State of Prior Authorization
Amidst this health coverage access crisis, is also a health insurance utilization crisis. KFF’s Health Tracking poll has identified prior authorization determinations as the single biggest burden people face when accessing health care. For those with insurance, prior authorization continues to be a barrier for people trying to access the care they need. Prior authorization is the review process insurance companies use to determine whether to cover the cost of a treatment or medicine. These decisions act to gatekeep the care a patient is able to get from their provider. KFF’s Drew Altman addresses the complexities of prior authorization in a recent Beyond the Data column.
New Disability Research Listserv
AAHD is proud to share our Research Listserv where we share monthly updates on health-related research study opportunities for people with disabilities. You can subscribe by updating your newsletter preferences on AAHD’s newsletter page. Just check the box to receive our “Research Listserv” updates, and complete the follow-up survey to help us better match you with the studies relevant to you.
Archives of our weekly updates are available on the NDNRC website. Follow AAHD’s other newsletters to stay current on research opportunities and policy developments supporting people with disabilities.