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Insurers Notch Legal Wins in Cost Sharing Reduction Fights

February 19, 2019 - Multiple court cases have been decided in the favor of insurers looking to recoup millions of dollars in cost sharing reduction (CSR) payments withheld by the Trump Administration in 2017. Health payers have fought vigorously against the cuts, which have contributed to rising premiums and instability in the Affordable Care Act insurance marketplace – four separate decisions in...


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Bipartisan Bill Suggests Another Health Insurance Tax Delay

by Jennifer Bresnick

Senators from both sides of the aisle have sponsored a bill that would delay implementation of the ACA’s health insurance tax (HIT) once again, this time for two years. The $16 billion tax, designed to be levied on payers, would...

CMS Mulls End of Auto-Reenrollment, Silver Loading in ACA Market

by Jennifer Bresnick

CMS has issued its proposed Payment Notice for the 2020 plan year, which contains provisions that would significantly alter the operations and structure of the ACA individual marketplace. Continuing a pattern of using CMS regulatory...

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...

FTC Clamps Down on Allegedly Fraudulent Health Plans

by Kyle Murphy, PhD

A federal judge temporarily closed a Florida-based firm accused of fraudulently collecting over $100 million from Americans. Simple Health allegedly collected more than $100 million by preying on consumers shopping for health insurance by...

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...

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...

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...

CMS: Individual Health Plan, Federal Exchange Challenges Remain

by Thomas Beaton

CMS has released three new reports indicating that the individual health plan and federal exchange markets faltered somewhat in 2017 because of increasing premiums, decreasing competition, and stagnant enrollment. The agency believes that...

How to Drive Enrollment in the ACA Health Plan Marketplaces

by Thomas Beaton

Payers and states wishing to increase enrollment in the ACA health plan marketplaces should  create targeted advertisements, benchmark silver-tier plans as their primary exchange plan, and help consumers navigate health plan...

US Court: Payers Are Responsible for Risk Corridor Program Costs

by Thomas Beaton

Federal judges in the US Federal Circuit Court of Appeals have issued an opinion stating that healthcare payers, and not HHS, are responsible for the costs of the ACA’s risk corridor program. Chief Judge Sharon Prost filed the...

How Payers Can Succeed in Association Health Plan Markets

by Thomas Beaton

Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize...

Maryland Creates State Reinsurance Program to Control Premiums

by Thomas Beaton

Maryland governor Larry Hogan has signed legislation to create a state reinsurance program aimed at stabilizing health plan premium increases. The reinsurance program will use state and federal reinsurance funding to pay catastrophic...

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...

Payers Will Face Individual Health Plan Market Challenges in 2019

by Thomas Beaton

Payers participating in the individual health plan market will face challenges in 2019 based on the planned expansion of association health plans (AHPs), increased competition, and changing provider negotiations, according to the Urban...

Proposed Legislation May Lower Individual Premiums by 40%

by Thomas Beaton

Senator Lamar Alexander (R-TN), Senator Susan Collins (R-ME), House Energy and Commerce Committee Chairman Greg Walden (R-OR) and Representative Ryan Costello (R-PA) have proposed legislation that aims to lower individual health plan...

Individual Insurance Premiums to Soar Without Policy Actions

by Thomas Beaton

Individual insurance premiums may rise between 12 and 32 percent nationally by 2019, with cumulative increases of 34 to 94 percent by 2021, according to new research conducted by health plan actuaries and experts at Harvard, UCLA, and UC...

BCBS Earned Positive ACA Health Plan Revenues in Uncertain Market

by Thomas Beaton

BlueCross BlueShield of North Carolina (BCBS of NC) earned positive ACA health plan revenues after years of financial losses, citing low medical claims and more available consumers after other payers exited the sale of plans through...

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