Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Affordable Care Act

Trump Plans to End Cost Sharing Reduction Subsidies for Payers

October 13, 2017 - The White House has announced plans to scrap the Affordable Care Act cost sharing reduction subsidies for health insurers that have helped to keep premiums low and stabilize markets subject to the individual mandate. The announcement came just hours after President Trump signed an executive order allowing payers to offer short-term, bare-bones association health plans (AHPs) which are not...


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ACA “Skinny Repeal” Dies in Senate, Leaving Next Steps Uncertain

by Jennifer Bresnick

In the early hours of Friday morning, the Senate failed to pass its attempt at a “skinny repeal” of the Affordable Care Act, which would have eliminated the tax penalties associated with the individual mandate for insurance coverage...

Senate Nixes Better Care Reconciliation Act, But Isn’t Done Yet

by Jennifer Bresnick

After a nail-biting procedural vote on Tuesday afternoon that required Vice President Mike Pence to break the tie, the Senate continued its tumultuous afternoon by voting down the Better Care Reconciliation Act, which included deep cuts to Medicaid...

Narrow Insurance Networks Can Limit Options for Cancer Care

by Jesse Migneault

Cancer patients may have limited access to top-tier healthcare options if enrolled in narrow insurance networks, according to a study from the Perelman School of Medicine at the University of Pennsylvania.  Policymakers and payers have a...

CMS: Reinsurance, Risk Adjustment Programs Worked Well in 2016

by Jesse Migneault

CMS has released the results from 2016 for reinsurance and risk adjustment transfers, two of the “three R’s” used to stabilize premiums in the Affordable Care Act (ACA) marketplaces.   This marks the third year the agency...

Texas Requests Medicaid Waiver Extension for $6.2 Billion

by Jesse Migneault

Although Texas refused federal funds in the 2014 ACA Medicaid expansion, it has recently submitted documents requesting its second Medicaid waiver extension for $6.2 billion.   Originally approved in 2011, the 1115 Medicaid Waiver was...

Senate Has Released Bill to Revise ACA Repeal Legislation

by Jesse Migneault

The Senate has released the working draft of the Better Care Reconciliation Act of 2017, revising the recently House-passed AHCA.   Both bills aim to repeal and replace the Affordable Care Act (ACA), which was passed in 2010. The AHCA...

Medica Will Stay in NE and IA Health Insurance Exchanges

by Jesse Migneault

Medica has announced plans to stay in the Nebraska and Iowa health insurance exchanges for 2017.   Although committed to the Nebraska exchange, the payer had previously indicated it was going to leave the Iowa marketplace. Both states...

Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan

by Jesse Migneault

If Iowa’s health insurance exchanges are completely abandoned, the state will request that the federal government allow the establishment of a state health care plan for 2018. If approved by CMS, the stopgap measure would create the Iowa...

Centene Will Enter Health Insurance Exchanges in 3 New States

by Jesse Migneault

Centene Corporation will expand its presence in a number of state health insurances exchanges in 2018, building on its successful 2017 marketplace results.  The payer is planning to enter the Kansas, Missouri and Nevada...

Payers Leaving Affordable Care Act Insurance Exchanges in 2017

by Jesse Migneault

Questions over the future of the Affordable Care Act (ACA) and its cost-sharing reduction (CSR) payments have prompted many payers to abandon ACA state health insurance exchanges in part or entirely in 2017.  Insurers cited the usual suspects...

PA Payer Market Stable, but OH Loses ACA Exchange Participants

by Jesse Migneault

Pennsylvania and Ohio are having very different experiences with their Affordable Care Act health insurance exchanges as they move into 2018. While Pennsylvania’s existing five payers will continue to offer exchange plans at roughly the...

$18M Claimant Case Challenges Affordable Care Act Payers

by Jesse Migneault

In April of 2017, Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, announced it would exit the 2018 health insurance exchanges.  The payer cited higher than expected claims costs, including Member X, who had claims...

AHIP: Congress Must Stabilize Payer Market, Consider Reforms

by Jesse Migneault

With passage of the AHCA, the insurance industry group AHIP has sent its response to congress and presented its recommendations for what direction to go in with healthcare reform The payer industry organization submitted recommendations in four...

BCBS of Kansas City Will Leave ACA Health Insurance Exchange

by Jesse Migneault

The exit of Blue KC from the ACA health insurance exchange in 2018 will affect a 32-county service area in Kansas and Missouri, and leave both urban and rural counties without any marketplace exchange insurers. The payer blamed losses exceeding...

AHCA CBO Score Predicts 23M Uninsured, Higher Out-of-Pocket Costs

by Jesse Migneault

The CBO report on the American Health Care Act (AHCA) found the bill would result in 23 million people losing insurance coverage over the next decade.  Other impacts of the bill include higher out-of-pocket costs for most patients and significant...

WA Health Insurance Exchange In Flux With CSR Confusion

by Jesse Migneault

Washington State has thus far been a success for the health insurance exchange marketplace.  The state has seen robust payer participation, increased enrollment and a trend-bending eight percent benchmark premium increase in 2017, versus...

Kaiser Permanente Will Stay in ACA Health Insurance Exchange

by Jesse Migneault

Kaiser Permanente will continue to offer coverage options through the ACA health insurance exchanges during 2018, the payer and provider announced this week. “Kaiser Permanente will continue to offer coverage -- including access to our...

CMS Adds Stricter Health Insurance Exchange Enrollment Rules

by Jesse Migneault

Slated to begin in June 2017, the Centers for Medicare and Medicaid Services (CMS) will be rolling out a pilot program aimed at tightening scrutiny of those using the special enrollment period on the ACA health insurance exchanges. The program...

Two-Thirds of Physicians Disapprove of American Health Care Act

by Jesse Migneault

Two-thirds of physicians in a new Merritt Hawkins survey reported having a negative impression of the American Health Care Act (AHCA).  This includes 58 percent of physicians who have a “strongly” negative take on the newly...

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