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ACA

US District Court Denies Appeal to Resolve Risk Corridor Payments

November 7, 2018 - Federal judges for the US Federal District Court of Appeals denied a request to reopen a case that could provide over $12 billion in risk corridor payments to payers. Moda Health Plan, BlueCross BlueShield of North Carolina, and Land of Lincoln Mutual Insurance asked the court to reopen a hearing that determined healthcare payers in the risk corridor program are primarily responsible...


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CMS Broadens ACA Waiver Scope for State Insurance Programs

by Thomas Beaton

CMS has issued federal guidance intended to expand the scope and availability of state-level waiver programs.   State governments can now apply for State Relief and Empowerment Waivers that may result in weaker consumer protections...

CMS: ACA Premiums to Decline in 2019 for Silver Plan Consumers

by Thomas Beaton

CMS has announced it expects the average ACA health plan premium to drop by 1.5 percent for healthy consumers that purchase low-cost silver tier plans. The agency stated that it is the first time since 2014 that premiums in any part of...

AMA, Industry Orgs Object to Short-Term Health Plan Expansion

by Thomas Beaton

The American Medical Association and other industry trade groups have filed amici curiae in support of a lawsuit contesting the legality of short-term health plans. The Association for Community Affiliated Plans (ACAP) contends that the...

Payers Partner with Trade Orgs to Roll Out Association Health Plans

by Thomas Beaton

Healthcare payers are beginning to launch partnerships with trade organizations and chambers of commerce to provide association health plans (AHPs) to small businesses and contractors. The roll out of AHPs follows federal and state...

Montana Reinsurance Program May Cut Premiums Up to 20%

by Thomas Beaton

Montana is moving ahead with the idea of creating a reinsurance program for the state’s health insurance market.  The program may reduce premiums between 10 and 20 percent, said Governor Steve Bullock and Department of...

CA Plans Medical Loss Ratio Guidelines for Dental Insurance Plans

by Thomas Beaton

Consumers of dental plans may benefit from more transparency around the medical loss ratio (MLR) of dental insurance options, asserts the California Dental Association (CDA). In a recent research paper published in Health Affairs, the CDA...

Handful of States Propose Lower ACA Premium Rates for 2019

by Thomas Beaton

Several states have announced lower ACA premium rates for 2019, bucking a national trend brought on by unstable markets and regulatory changes.   While early proposals from a number of states, including Virginia, Maryland, and...

How to Curb Adverse Selection in the Individual Health Plan Market

by Thomas Beaton

Maintaining a profitable individual health plan product is already challenging, but adverse selection can create additional problems that impede a payer’s ability to control health plan costs. Policies within the Affordable Care...

ACA Health Insurance Tax to Cost $16B, Lead to Higher Premiums

by Thomas Beaton

The Affordable Care Act’s health insurance tax (HIT) is expected to levy $16 billion in fees for health insurers by 2020, leading payers to increase premiums by an anticipated 2.2 percent, according to a Oliver-Wyman report...

GOP Senators Propose to Reinforce Pre-Existing Condition Protections

by Thomas Beaton

Half a dozen Republican Senators have introduced a bill that would ensure the Affordable Care Act’s pre-existing condition protections would remain a federal law despite upcoming legal challenges. The Ensuring Coverage for Patients...

GAO Critiques HHS Actions on ACA Navigator Program Funding

by Thomas Beaton

The Government Accountability Office (GAO) has questioned the data-driven methodology behind significant reductions in funding for the ACA navigator program and subsequent declines in new enrollment in health insurance plans.   In a...

CMS Final Rule Extends Short-Term Health Insurance to 3 Year Max

by Thomas Beaton

CMS has issued a final rule that triples the length of time a beneficiary can keep short-term health insurance. The rule allows individuals to purchase a new short-term, limited benefit health plan that lasts for 12 months, or extend...

Insurance Coverage Rates Dip by 12% Due to High Premium Costs

by Thomas Beaton

Individual health plan enrollment between 2017 and 2018 fell by 12 percent as high premiums and a scarcity of subsidy assistance force consumers out of the market, according to an analysis from the Kaiser Family Foundation (KFF). Health...

CMS Approves Wisconsin State Reinsurance Program

by Thomas Beaton

CMS has approved Wisconsin’s plan to launch a state reinsurance program from 2019 to 2023 to help reduce individual state premiums and control the growth of state healthcare spending. The program, called the Wisconsin Healthcare...

12 Attorneys General File Lawsuit Over Association Health Plans

by Thomas Beaton

A dozen state attorneys general are suing the Department of Labor (DOL) over the expansion of association health plan (AHPs).   In the suit, which was filed in the DC District Court of Appeals, the officials argue that broad...

CMS: We Will Make $10.4B in 2017 Risk-Adjustment Payments

by Thomas Beaton

CMS has issued a final rule that will allow the agency to disburse $10 billion in 2017 risk adjustment payments that had been in doubt due to a court ruling.   To comply with the initial outcome of a New Mexico lawsuit contending the...

Pros and Cons of Small Business Health Options Program Health Plans

by Thomas Beaton

Health plans offered through the Small Business Health Options Program (SHOP) exchanges allow payers to provide the nation’s smallest businesses with affordable plan options that offer critical health benefits. SHOP health plans...

CMS Cuts ACA Navigator Funding Grants by $26M for 2019

by Thomas Beaton

CMS has announced a $26 million cut to funding grants for ACA navigators, from $36 million down to $10 million. CMS will provide a minimum of $100,000 in each of the states that operate a federally-facilitated exchange (FFE). The funding...

Transitional Health Insurance Plays Key Role in Coverage

by Thomas Beaton

Transitional health insurance, otherwise known as a short-term health plan, is a temporary insurance policy intended to provide stop-gap coverage when an individual is in between ACA compliant policies.  The National Association of...

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