Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Federal Marketplace

AHA Makes Suggestions for In-State Insurance Market Stabilization

January 19, 2018 - In order to stabilize in-state insurance markets, stakeholders should consider strategies including reinsurance, Medicaid-sponsored health plans, and high-risk pools, according to the AHA. Several factors are contributing to unstable state insurance markets, including demographic characteristics, limited payer competition, a lack of Medicaid expansion, continued use of transitional health...


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Proposed Rule Details Association Health Plan Expansion Guidelines

by Thomas Beaton

The Department of Labor (DoL) released a proposed rule that allows small businesses and employee groups to purchase association health plans (AHPs) in lieu of employer-sponsored or individual health insurance. The rule follows an executive order...

ACA Cost Concerns Offer Payers a Member Engagement Opportunity

by Thomas Beaton

Consumers purchasing health insurance through the ACA exchanges are likely to actively seek out lower-cost options when enrolling or re-enrolling in individual health plans, says new data from GAO, giving payers a chance to practice their member...

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

by Thomas Beaton

As a potential repeal of the ACA’s individual mandate faces the US Senate, the Congressional Budget Office (CBO) and Joint Tax Committee (JTC) found that a repeal would cut the number of insured individuals by four million in 2019. In an...

Reinsurance Changes Payers Can Expect Under the ACA in 2018

by Thomas Beaton

ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have gone from...

CBO: Alexander-Murray Healthcare Bill Could Save $3.8B

by Thomas Beaton

The Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander-Murray compromise bill, would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance, the Congressional...

Narrow Provider Networks are 16% Cheaper for ACA Plans

by Thomas Beaton

Economists from Harvard Business School and Northeastern University found individual ACA silver plans with narrow provider networks were 16 percent cheaper for consumers and offer payers a promising savings opportunity in the commercial market....

20.5 Million More Insured Since Start of Affordable Care Act

by Thomas Beaton

20.5 million more individuals have gained health insurance coverage since the implementation of the Affordable Care Act (ACA) in 2010, according to a new report from the CDC and the National Center for Health Statistics (NCHS). In the first three...

As ACA Debate Lingers, Non-Marketplace Members Present Risks

by Thomas Beaton

While much of the national debate over health insurance has focused on the options open to ACA marketplace enrollees, payers should be careful not to neglect coverage choices for their private plan customers, who tend to be healthier and wealthier,...

Anthem to Withdraw from ACA Individual Market Exchanges in NV

by Thomas Beaton

Anthem BlueCross BlueShield (BCBS) will completely withdraw from Nevada’s ACA exchange for individual health plans in 2018, the health payer announced on Monday. The payer’s decision follows discussion with state leaders and regulators....

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...

CMS Outlines Special Enrollment Period Rules for ACA Exchanges

by Jesse Migneault

Starting on June 23, 2017, CMS will be enacting its new rules regarding special enrollment periods (SEP) for the ACA marketplace.  The agency released the new special enrollment rules earlier this year that will alter participation criteria...

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...

Aetna Will Abandon All Health Insurance Exchanges for 2018

by Jesse Migneault

Aetna is ending participation in the Delaware and Nebraska ACA health insurance exchanges, completing its retreat from the public marketplace.   The company also made announcements earlier this year that it would be leaving the Virginia...

BCBS Moves into Vacant TN Health Insurance Exchange

by Jesse Migneault

Blue Cross-Blue Shield (BCBS) has announced its plans to offer coverage options on Tennessee’s Affordable Care Act health insurance exchange in 2018.  The separate rating area consists of 16 counties in the greater Knoxville area....

CHIP Funding Cuts Would Leave 8M Low-Income Kids Uninsured

by Thomas Beaton

More than 8 million low income children living with chronic diseases would lose healthcare coverage and incur higher costs if CHIP funding is not extended beyond 2017, says new research from the Yale School of Medicine. In a study published in...

2017 ACA Open Enrollment Data Shows 12.2M Marketplace Signups

by Thomas Beaton

During the 2017 ACA Open Enrollment Period (OEP), more than 12.2 million healthcare consumers purchased or renewed insurance through Healthcare.gov or their local state exchanges, said CMS in a new data brief.   Marketplace consumers either...

VT Agency Wrongly Allotted $13M for Health Insurance Marketplace

by Vera Gruessner

The Department of Vermont Health Access went against federal laws when it failed to allocate funds to establishment grants in order to create a public health insurance marketplace, the Office of the Inspector General (OIG) found in a new report....

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