Policy and Regulation

HHS to Spend $10M on Affordable Care Act Navigator Program

by Thomas Beaton

HHS and CMS announced that they will allocate $10 million to support the Affordable Care Act Navigator program, which helps health insurance consumers find coverage solutions during the Open Enrollment...

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...

Low Medicaid Payment Rates Decrease Residential Care Quality

by Thomas Beaton

Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support...

Payers, Providers Highlight the Pros of Cost-Sharing Reductions

by Thomas Beaton

A joint group of America’s Health Insurance Plans (AHIP) and provider organizations came together to promote the benefits of cost-sharing reductions (CSRs) on consumer and payer healthcare costs,...

ACA “Skinny Repeal” Dies in Senate, Leaving Next Steps Uncertain

by Jennifer Bresnick

In the early hours of Friday morning, the Senate failed to pass its attempt at a “skinny repeal” of the Affordable Care Act, which would have eliminated the tax penalties associated with...

Senate Nixes Better Care Reconciliation Act, But Isn’t Done Yet

by Jennifer Bresnick

After a nail-biting procedural vote on Tuesday afternoon that required Vice President Mike Pence to break the tie, the Senate continued its tumultuous afternoon by voting down the Better Care...

Tiebreaker Vote in Senate Opens ACA Repeal, Replacement Debate

by Thomas Beaton

In a 50-50 procedural vote, Vice President Mike Pence broke the tie as the US Senate voted to open debate for a future vote on American Health Care Act (AHCA), and the possible addition of...

CMS: Reinsurance, Risk Adjustment Programs Worked Well in 2016

by Jesse Migneault

CMS has released the results from 2016 for reinsurance and risk adjustment transfers, two of the “three R’s” used to stabilize premiums in the Affordable Care Act (ACA) marketplaces....

Texas Requests Medicaid Waiver Extension for $6.2 Billion

by Jesse Migneault

Although Texas refused federal funds in the 2014 ACA Medicaid expansion, it has recently submitted documents requesting its second Medicaid waiver extension for $6.2 billion.   Originally...

CBO Score Finds 22 Million People Will Lose Health Coverage

by Thomas Beaton

UPDATE: GOP Senators delayed the vote on the BCRA until after the July 4th congressional recess.  The Congressional Budget Office (CBO) released their revised cost estimate on the new...

Senate Has Released Bill to Revise ACA Repeal Legislation

by Jesse Migneault

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...

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...

AMA, AHA Call for Stronger Patient Insurance Protections

by Jesse Migneault

The American Medical Association (AMA) has joined seven prominent health industry groups in calling for the Senate to address patient protection concerns regarding health insurance coverage.  The...

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...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

by Jesse Migneault

Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill...

650 Medical Groups Sign On to Abolish Medicare Budget Panel

by Jesse Migneault

Over 650 medical organizations have signed a letter to Congress from the Healthcare Leadership Council (HLC) supporting the elimination of the Independent Payment Advisory Board (IPAB).  The HLC...

CMS Offers Resources for High-Risk Pools, Reinsurance Waivers

by Jesse Migneault

The Centers for Medicare and Medicaid Services (CMS) has just released a checklist for states to use on applications for Section 1332 waivers.    The waivers are specifically targeted at...

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...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

by Jesse Migneault

In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality,...

Maine Medicaid Waiver Would Increase Patient Responsibility

by Jesse Migneault

Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its...