On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
Predicting the Effects of the Affordable Care Act: A Comparative Analysis of Health Policy Microsimulation Models
Jean M. Abraham, Ph.D., University of Minnesota
Microsimulation models were utilized throughout the legislative process that led to the passage of the Affordable Care Act, and these models continue to play a prominent role in understanding the likely effects of federal health care reform provisions on insurance coverage and cost at both the national level and, increasingly, within individual states. This brief examines five major federal health policy simulation models. Components of these models vary, and the similarities and differences between the models have important consequences for states as they evaluate model outputs and/or contract options for state specific policy microsimulations. The issue brief explains the basics of microsimulation modeling so that policymakers and analysts are better able to assess modeling outputs and make informed decisions when contracting with a microsimulation vendor. A related webinar provided an overview of the five major models, discussed how one state has utilized microsimulation modeling and highlighted questions states should consider when contracting for or using modeling outputs. An archived replay of the webinar is available here.