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Policy and Regulation News

Senate to Vote on Funding CHIP for Five Additional Years

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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...

HHS Nixes Proposed Rule for Health Plan Compliance Documents

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HHS has withdrawn a proposal for a rule that would have required controlling health plans (CHPs) to submit additional information and documentation demonstrating compliance with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...

Medicaid Directors Voice Concerns for Graham-Cassidy Bill

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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...

Planning for Individual Insurance Exchange Stabilization in WA

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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...

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

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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...

Top 10 Healthcare Spending Categories in the United States

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The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based...

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

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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...

Healthcare Coverage, Access Disparities Remain Even After ACA

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While the Affordable Care Act has helped to significantly reduce care and access disparities between socioeconomic groups, more work is needed to create true coverage equity, according to a new study from Oregon Health and Sciences...

AARP: Congress Must Take Action on ACA Market Stabilization Solutions

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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...

NY Medicaid Inspector General Assists in $125M Fraud Takedown

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The New York Office of the Medicaid Inspector General (OMIG) assisted the Medicaid Fraud Strike Force in uncovering Medicaid fraud totaled $125 million, the office announced in a press release. OMIG and the Strike Force helped other law...

AHIP: Permanently Renew Medicare Advantage Special Needs Plans

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Congress should consider a permanent renewal of the Medicare Advantage Special Needs Plans (SNPs) because of the consumer protections they provide and their market implications, AHIP wrote in a letter to the House of Representatives. A...

AHIP, AMA, AHA to Congress: Fund Cost Sharing Reductions to 2019

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AHIP, AMA, and AHA and four other healthcare organizations urged Congress to continue funding cost sharing reductions (CSRs) through 2019, warning of continued instability in the health insurance marketplace and higher premiums if the CSRs...

GAO: Veterans Affairs Insurance Enrollment Standards Lacking

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The Department of Veterans Affairs is one of the largest healthcare organizations that provides health benefits, but their enrollment standards and processes lead to delays and errors, according to a new report from the Government...

Governors Propose Health Insurance Market Stabilization Plan

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Eight state governors have outlined their proposals for a health insurance market stabilization plan that would control premium increases and improve competition in the federal and state health insurance exchanges. In a letter sent to...

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

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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 period. Launched in 2013, the...

20.5 Million More Insured Since Start of Affordable Care Act

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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 Health Statistics (NCHS). In the...

Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

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Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release. Declared...

CMS: Payers Will Have More Time to File 2018 Health Plan Rates

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Payers still debating how uncertainty over cost-sharing reduction (CSR) subsidies will alter their insurance prices now have more time to submit 2018 health plan rates, CMS announced in a letter to insurers. While the letter says...

As ACA Debate Lingers, Non-Marketplace Members Present Risks

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While much of the national debate over health insurance has focused on the options open to ACA marketplace enrollees, payers should be careful not to neglect coverage choices for their private plan customers, who tend to be healthier and...

Payers, Providers Highlight the Pros of Cost-Sharing Reductions

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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, the group announced in a joint...

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