Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Affordable Care Act

PwC: Digital Experiences, High Costs Will Challenge Payers in 2019

December 12, 2018 - Healthcare payers that hope to succeed in 2019’s competitive business environment will need to meet the strong demand for more consumer-centered digital experiences that help members control their spending and understand how to improve their own health, according to PwC. The nation’s healthcare spending will continue its “unsustainably high” upward trajectory...


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Verma Shares Vision for More State “Flexibility” in Affordable Care Act

by Jessica Kent

CMS has released new policies that purport to help states create “alternatives” to the Affordable Care Act (ACA) and improve health insurance options, according to CMS Administrator Seema Verma. In an address to the States and...

Regulatory Uncertainty Continues to Disrupt ACA Marketplaces

by Chuck Green

New research published by the Kaiser Family Foundation provides insight into the forces driving health payers to participate in certain ACA marketplaces while wholly quitting others. Insurer participation in the Affordable Care Act health...

HealthCare.gov Breach Exposes Data of 75K Individuals

by Chuck Green

Last month, a breach of HealthCare.gov took place that affected those applying for coverage under the Affordable Care Act, HHS reported last Friday. The intrusion led to inappropriate access to the personal information of about 75,000...

CMS Relaxes Affordable Care Act Health Plan Regulations

by Thomas Beaton

CMS has issued a final rule that relaxes certain Affordable Care Act health plan regulations in an effort to drive competition and affordability within state health insurance markets. The agency said that the new rule will give payers...

11.8M Members Bought Health Plans Via Affordable Care Act Exchanges

by Thomas Beaton

Nearly 11.8 million beneficiaries have enrolled or re-enrolled in a health plan through the Affordable Care Act exchanges, reaching close to 2017 enrollment totals (12.2 million) despite federal changes in how the exchanges are funded and...

Federal Tax Bill, Individual Mandate Repeal Passes House and Senate

by Thomas Beaton

GOP lawmakers in both the House and Senate passed a federal tax bill that includes a repeal of the ACA’s individual mandate to purchase health insurance.  The bill now heads back to the House for a procedural vote and afterwards...

Trump Plans to End Cost Sharing Reduction Subsidies for Payers

by Jennifer Bresnick

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

$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...

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