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Healthcare Policy

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

November 17, 2017 - 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 analysis released this week, CBO and JTC estimated that a repeal of the mandate would reduce the federal deficit by $338 billion between 2018 and 2027,...


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Top 5 Most Common Healthcare Provider Fraud Activities

by Thomas Beaton

Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale.  The largest healthcare provider fraud takedown in US history was announced just recently, resulting charges against 400 defendants in...

Providers Caught in Medicare Fraud Schemes Topping $200M

by Thomas Beaton

Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law enforcement...

Maine Referendum Expands Medicaid Despite Governor Opposition

by Thomas Beaton

The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine residents...

More Choices for Federal Health Plans Doesn’t Spread Market Share

by Thomas Beaton

The federal health plan market contracted under the Office of Personnel Management (OPM) has remained heavily concentrated over the last decade, despite OPM’s efforts to improve health plan choice for employees enrolled in the Federal Employees...

CMS Adjusts Medicaid 1115 State Innovation Waiver Processes

by Thomas Beaton

CMS is attempting to streamline the approval process for Medicaid 1115 state innovation waivers by implementing new policies that prioritize transparency, the agency announced in a bulletin. The agency has adjusted 1115 waiver policies in an...

Why the Generic Drug Market is a Growing Payer Opportunity

by Thomas Beaton

As payers try to ease the rising costs of prescription drugs, which account for 10 percent of national healthcare spending, they may wish to turn to the generic drug market to help curb unnecessary spending and improve profitability.   Generics...

Improving Price Transparency around Generic Drugs for Payers

by Thomas Beaton

Increasing pricing transparency around generic drugs could offer significant advantages to payers, including lower prices and more favorable reimbursement negotiations, according to a report from USC Brookings. Better understanding of contracting...

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...

ACA Open Enrollment Rate Expected to Drop Up to 13% in 2018

by Thomas Beaton

Analysts expect up to a 13 percent drop in open enrollment on the ACA marketplace exchange in 2018,  according to Standard and Poor’s Global (S&P Global). Only 10.1 million to 11.4 million individuals are expected in enroll in...

Providers Seeing Even Mix of Public, Commercially Insured Patients

by Thomas Beaton

Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey. In 2016, forty-three percent...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

by Thomas Beaton

(CSRs) under the Affordable Care Act, payers were expecting only modest premium increases and some continued profitability, according to a USC Brookings report. However, the uncertainty resulting from federal waffling over the continuation of...

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...

AMA: Payers Operate in Extremely High Concentrated Markets

by Thomas Beaton

Payers have significant control of their respective healthcare markets as 69 percent of payers offering HMO, PPO, POS, and public health exchanges operate in very high concentrated markets, AMA found in a study of national insurance markets....

Alexander-Murray Bill Offers ACA Market Stabilization, Flexibilities

by Thomas Beaton

A new bipartisan bill proposed by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) is an attempt to stabilize and protect provisions of the ACA while allowing for greater state flexibility to manage healthcare. The Bipartisan Health Care...

Iowa Withdraws 1332 Waiver for Insurance Market Stabilization

by Thomas Beaton

Iowa Insurance Commissioner Doug Ommen has withdrawn his state’s application for a 1332 waiver to stabilize its insurance markets in 2018.   The proposed stopgap measure  included a single, standardized plan available to every...

Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

by Thomas Beaton

Senators Lamar Alexander (R-TX) and Patty Murray (D-WH)  have floated a bipartisan deal to reinstate the ACA’s cost-sharing reductions (CSRs) and boost individual enrollment outreach in exchange for alterations to the state 1332 waiver...

States Approve Premium Hikes after Loss of Cost Sharing Reductions

by Thomas Beaton

Several states have decided to either increase or maintain expected premium increases on individual and small group plans following the President’s decision to end the cost-sharing reductions (CSRs) that cover the cost of many Affordable...

Payers Express Concern Following Cost-Sharing Reduction Cuts

by Thomas Beaton

Several payer organizations have expressed deep concerns after President Trump announced plans to end the cost-sharing reduction (CSR) subsidies for ACA individual plans.. Organizations including AHIP, AMA, and AHA have previously urged Congress...

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 just...

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