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Policy and Regulation News

HHS, CMS Announce Finalized Ruling for MACRA Legislation

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The Department of Health & Human Services (HHS) announced in a press release the discharge of the final ruling on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA legislation replaces the flawed Sustainable Growth...

VT All-Payer Model Aligns Costs for Public, Private Insurers

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The state of Vermont is moving forward with establishing an all-payer model that uses accountable care organizations and ensures a provider is reimbursed by an equal amount among all healthcare payers for a particular service. The Vermont government...

Revisions to Affordable Care Act May Improve Payer Performance

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Health insurance executives have faced various regulatory challenges since the Patient Protection and Affordable Care Act was passed in 2010. Payers have had to participate in new health insurance marketplaces and face different restrictions...

Marketplace Instability May Cause Affordable Care Act Reforms

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While the Patient Protection and Affordable Care Act has decreased uninsurance rates to historically low levels, the healthcare law also led to higher premium costs and insurance rates among health plans sold on the health insurance exchanges....

49M Americans Risk Losing Fixed Indemnity Health Insurance

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A new proposed rule called Expatriate Health Plans, Expatriate Health Plan Issuers, and Qualified Expatriates; Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance may negatively impact access to fixed indemnity...

Why Strengthening Affordable Care Act Could Cut Disparities

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The Patient Protection and Affordable Care Act has significantly improved healthcare coverage and access throughout the country, but there are still some obstacles remaining to ensuring that every American has access to health insurance. While...

Presidential Election Brings Two Opposing Healthcare Policy Proposals

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With the Presidential election heating up and the debate season upon us, last week The Commonwealth Fund detailed the stark differences seen between the two presidential candidates healthcare policy proposals in a new report. The research comes...

How MACRA Resolves Sustainable Growth Rate Formula Challenges

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The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will likely simplify and improve Medicare reimbursement processes due to the fact that it repeals the flawed sustainable growth rate (SGR) formula. The problems associated with...

Affordable Care Act Reduced Uninsurance Rate to 8.6% in 2016

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The latest data from the National Center for Health Statistics shows that the uninsurance rate during the first three months of 2016 has decreased to 8.6 percent, or 27.3 million Americans, thanks to the continued impact of the Affordable...

Lawmakers Push for Public Option on Health Insurance Exchanges

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A total of five senators and multiple organizations are looking to create a public option for healthcare coverage to be available among all Americans purchasing insurance through the Affordable Care Act’s health insurance exchanges. Senators...

2 Benefits and 2 Disadvantages of the Affordable Care Act

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The Patient Protection and Affordable Care Act has had many critics as well as those who have praised the landmark healthcare legislation. While the Republican Party is looking to repeal the Affordable Care Act, others consider that a revision...

Affordable Care Act Marketplace Consumers Face Fewer Choices

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A hefty number of health insurance companies have been dropping out of the Affordable Care Act’s state exchanges in recent months including Humana, Aetna, and UnitedHealthcare. These actions would leave fewer health plans to choose from...

Risk Pool Gains on Horizon for Health Insurance Marketplace

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With a number of healthcare payers including UnitedHealthcare and Aetna dropping out of the Affordable Care Act’s health insurance marketplace, the Centers for Medicare & Medicaid Services (CMS) issued an annual Notice of Benefit and...

Presidential Election Shakes Employer-Sponsored Health Insurance

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Healthcare policy of US presidential candidates depends on more than their perspective on the Affordable Care Act. With employer-sponsored health insurance still a major aspect of coverage among Americans since fewer are insured through Medicaid...

Prescription Drug Medical Costs Less Problematic due to ACA

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Recently, criticism popped up against the pharmaceutical company Mylan from the Hillary Clinton presidential campaign for its significant price increase for the life-saving EpiPen product. The EpiPen is vital in an emergency when a person who...

How Risk Adjustment Challenges the Health Insurance Market

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Ever since the provisions of the Patient Protection and Affordable Care Act came into effect on January 1, 2014, healthcare payers have been unable to deny health insurance or charge larger premium costs to those with pre-existing conditions....

Both Political Parties Seek to Replace the Affordable Care Act

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As previously reported, the major health payer Aetna is leaving the majority of health insurance exchanges it is currently operating in. Some critics have pointed at the failure of the Affordable Care Act to sustain payers within the public exchanges...

Is the ACA’s Health Insurance Provider Fee Unconstitutional?

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Last year, six states including Texas, Wisconsin, Kansas, Louisiana, Indiana and Nebraska filed a lawsuit arguing that a provision within the Affordable Care Act requiring states to cover a Health Insurance Provider Fee is unconstitutional and...

Will Divestitures Preserve the Health Insurance Mergers?

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As previously reported, the insurance companies Aetna and Humana are attempting to preserve their health insurance merger by divesting millions of dollars in assets in order to satisfy the concerns of the Department of Justice. David Balto, an...

How Health Insurance Industry Faces the Presidential Elections

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The upcoming US presidential elections may impact the future of the health insurance industry and the way healthcare costs are addressed in this country. Whether the Democrats or the Republicans take the White House, the continuing rise in the...

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