Affordable Care Act

Aug 13, 2018
Enrollees in large employer health plans with inpatient admissions receive an out-of-network medical bill approximately 18% of the time, according to an analysis released today by Kaiser Family Foundation. Individuals who receive inpatient or outpatient care for mental health or substance use are…
Aug 9, 2018
The Centers for Medicare & Medicaid Services yesterday issued a proposed rule that would maintain the current methodology for calculating risk adjustment transfers in the individual and small group health insurance markets for benefit year 2018. CMS expects the rule to provide $9.6 billion…
Jul 30, 2018
The departments of Health and Human Services and the Treasury have approved Section 1332 waivers for Wisconsin and Maine to implement five-year reinsurance programs for their individual health insurance markets beginning in 2019. The waivers are expected to lower premiums by about 11% in Wisconsin…
Jul 26, 2018
The House of Representatives last night voted 242-176 to approve legislation (H.R. 6311) that would allow individuals purchasing health insurance in the individual market to purchase a lower value “copper” plan, which could drive more individuals to buy inadequate coverage and increase bad debt for…
Jul 25, 2018
The Centers for Medicare & Medicaid Services expects to begin $10.4 billion in risk adjustment transfers for benefit year 2017 in September, according to a final rule posted last night. The permanent risk adjustment program, created by the Affordable Care Act, transfers funds in the individual…
Jul 17, 2018
AHA, health organizations letter to CMS regarding its decision to suspend billions of dollars in annual payments to insurers as required under the Affordable Care Act’s risk-adjustment program.
Jul 16, 2018
The Palo Alto Accountable and Affordable Care Initiative, challenged by certain hospitals and the California Hospital Association in Stanford Health Care v. City of Palo Alto, would impose an “acceptable payment amount” on the compensation hospitals and other medical providers can receive from…
Jul 11, 2018
Eligible individuals and entities, including hospitals, can apply through Aug. 9 for funding to operate as “navigators” in states with a federally-facilitated health insurance exchange in plan year 2019, the Centers for Medicare & Medicaid Services announced yesterday. The agency expects…
Jul 9, 2018
The Centers for Medicare & Medicaid Services today announced that $10.4 billion in risk adjustment transfers for benefit year 2017 are on hold until certain litigation over the risk adjustment methodology is resolved. The permanent risk adjustment program, created by the Affordable Care Act,…
Jul 2, 2018
More than 10.6 million individuals had paid their first month’s premium to officially trigger their 2018 health insurance coverage through the federal and state-based exchanges in February, about 9% fewer people than selected a plan during open enrollment but 3% higher than the same time last year…