What Would Be the Impact of Capping Private Plan Rates?

About half of non-maternity inpatient hospital admissions among large-group employer-sponsored plans were paid above 150% of Medicare rates, according to a recent analysis by Kaiser Family Foundation. To address high health care costs, some states have considered capping prices paid by private insurers at a multiple of Medicare rates. By analyzing in-network payment rates for inpatient hospital admissions, the study found that a cap set at 150% of Medicare rates could affect 36% of in-network spending in the large group market, while a cap at 300% could affect 13%. The study concluded that capping prices paid by employer-sponsored plans could be disruptive but could also make health care more affordable — “tradeoffs that warrant careful attention.”

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Jinghong Chen

Jinghong Chen Reporter

Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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