The primary goal of the Patient Protection and Affordable Care Act (“ACA”) is to connect Americans with affordable, medically necessary health care. The first step toward achieving that goal is insurance expansion. The ACA's first two years of insurance expansion have allowed millions of...

The chorus in favor of integrating behavioral and physical health services is strong and diverse, both at the federal level and in New Jersey. Providers, payers, regulators, patients, and academics are uniting behind the strong clinical behavioral health literature highlighting integration's...

New Jersey's Medicaid Accountable Care Organization Demonstration Project became law in 2011, representing a broad consensus that accountable care organizations (“ACOs”) could improve the delivery of care in the Medicaid system. ACOs offer the promise of providing “the right care, at the...

This consumer guide, targeted to community assisters, highlights issues consumers should consider when selecting a health insurance plan, including the scope of a plan's network, how the plan tiers pharmacy prescriptions, and how cost-sharing varies for different services

The Sentinel Project at Seton Hall Law School set out to assess access to care through the Affordable Care Act (ACA) in New Jersey. The Project's goals are to evaluate whether the ACA's promising market reforms are fully implemented in the State and throughout the nation, and to understand how...

This Policy Brief focuses on the medical loss ratio (“MLR” or “loss ratio”) provision in the Patient Protection and Affordable Care Act (“ACA,” or “Affordable Care Act”). As part of sweeping health care reform in 2010, Congress established MLR requirements for health insurance...

Faced with increasingly inefficient, costly, poor quality, fragmented medical care for their citizens, several states are adopting accountable care organization (“ACO”) models of care delivery to improve access to quality health care while trying to bend the cost curve. ACOs are not one-size...

Congress, in the Patient Protection and Affordable Care Act, established uniform rating factors and bands throughout the country as a means of curbing premium variations. These standards, which go into effect on January 1, 2014, identify the limited range of considerations on which insurance...