Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Health Insurance Exchange

Senate Has Released Bill to Revise ACA Repeal Legislation

June 22, 2017 - 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 contained many unpopular provisions and drew the ire of dozens of national healthcare organizations and patient advocacy groups.  The Senate’s...


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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...

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...

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...

Nevada Legislature: All Residents Should Have Medicaid Access

by Jesse Migneault

The Nevada State Assembly has passed a bill which would open Medicaid enrollment to all of the state’s residents, regardless of income or health status.   The Nevada Care Plan would allow every state resident without health insurance...

$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...

NC Payer Raises Health Insurance Rates Due to CSR Lawsuit

by Jesse Migneault

Blue Cross Blue Shield of North Carolina announced its 2018 individual premium rates will increase an average of 22.9 percent for coverage on and off the health insurance exchange in all 100 counties it serves.  The increase is a pinch lower...

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...

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....

MD Health Insurance Exchange Rates Up Double-Digits for 2018

by Jesse Migneault

Patients in Maryland looking for insurance in 2018 may have bigger bills than they bargained for. The health insurance exchange rates for individual and group plans in the state have risen by up to 58 percent as payers try to cope with uncertainty,...

Affordable Care Act Cuts Uninsured Rate by 6.4% Since 2013

by Jesse Migneault

From 2013 to the end of 2016, the percentage of individuals without health insurance dropped across the nation, according to a recent Gallup-Healthways study. The national percentage of those without health insurance went from 17.3 percent in...

CMS Issues ACA Health Insurance Exchange Stabilization Rule

by Jesse Migneault

CMS  issued the final version of the 2018 Market Stabilization rule for the Affordable Care Act (ACA) health insurance exchange.   The rule focuses on stabilizing the individual and small group health insurance markets while lowering...

Aetna Will Exit Iowa ACA Health Insurance Exchange in 2018

by Thomas Beaton

Aetna has announced that it will stop participating in the Iowa health insurance exchange in 2018, citing financial losses and market instability as primary reasons to exit.   "Earlier today we informed the appropriate federal and state...

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