Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Policy

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

by Thomas Beaton

Had cost-sharing reductions (CSRs) under the Affordable Care Act remained in place payers would only expect modest premium increases with some continued profitability, a USC Brookings report found. However, the uncertainty resulting...

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Iowa Insurance Commissioner Doug Ommen has withdrawn his state’s application for a 1332 waiver to stabilize its insurance markets in 2018.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...

Executive Order Eases ACA Rules on Association Health Plans

by Thomas Beaton

An executive order signed by President Trump will lighten rules on association health plans (AHPs), which could allow groups of businesses to provide lower cost insurance without essential health benefits (EHBs), as reported by multiple news...

Medicare Fraud Schemes Bring Jail Time, Admissions, Repayments

by Thomas Beaton

Medicare fraud is always a risk for such a large program, but federal crackdowns on waste, abuse, and improper payments are serving as a stern warning to providers who may be considering taking advantage of the system.   The Office of the...

Senate to Vote on Funding CHIP for Five Additional Years

by Thomas Beaton

A bipartisan bill to continue CHIP funding for five more years and transition to a state-federal partnership will move to a Senate vote after being approved by the Senate Finance Committee.   The “Keep Kids’ Insurance Dependable...

HHS Nixes Proposed Rule for Health Plan Compliance Documents

by Thomas Beaton

HHS has withdrawn a proposal for a rule that would have required controlling health plans (CHPs) to submit additional information and documentation demonstrating compliance with HHS operating rules, the agency posted in the Federal Register....

6 Ways VA Can Improve Administrative Management of Care Delivery

by Thomas Beaton

Even though VA has taken steps to improve administration and management of its healthcare delivery systems, the Government Accountability Office (GAO) found six action items that allows the VA to adjust policies that improve data sharing and...

Medicaid Directors Voice Concerns for Graham-Cassidy Bill

by Thomas Beaton

The National Association of Medicaid Directors (NAMD) argues that a hasty passage of the Medicaid reforms presented in the Graham-Cassidy bill will have significant consequences for public payer programs and the health outcomes of their beneficiaries....

Planning for Individual Insurance Exchange Stabilization in WA

by Thomas Beaton

State health insurance markets and their individual insurance exchanges have faced regular instability in the form of payer exits, imbalanced risk pools, and rising premiums that push out new and returning insurance consumers. As premiums go...

AHIP: Graham-Cassidy Bill a Poor Choice for Payers, Patients

by Thomas Beaton

AHIP believes that passage of the Graham-Cassidy Bill making the rounds in the Senate would adversely affect payer market through policies that destabilize the health insurance markets, reduce patient access to healthcare, and fail to meet the...

More Payers, More Providers Increase Price Negotiation Power

by Thomas Beaton

Payers that operate within healthcare markets with a high concentration of payers and providers prices can negotiate the price of services up to 19 percent lower than those operating in low-concentration payer-provider markets, found a new study...

Veterans Gained Coverage under ACA, but May Lose Big from Repeal

by Thomas Beaton

While the Affordable Care Act (ACA) produced significant coverage gains for veterans, currently proposed repeal actions could hit this population particularly hard, according to a study from RAND Corporation. Prior to the ACA, 9.1 percent of...

AARP: Congress Must Take Action on ACA Market Stabilization Solutions

by Thomas Beaton

In order to protect healthcare consumers and stabilize the ACA marketplace, Congress must pass legislation that creates affordable and accessible coverage options, protects Medicaid and Medicare program funding, and expands prescription drug...

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