Patient Protection and Affordable Care Act (PPACA) Health Insurance Exchanges

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
News & Analysis as of

What Should You Do With a Marketplace Notice?

Employers of all sizes are receiving notices from Health Insurance Marketplaces (“Notice” or “Marketplace Notice”) alerting them that an employee or employees have obtained Exchange coverage and are eligible for and receiving...more

Seattle Ballot Initiative Targets Hotel Industry

According to Ballotpedia, 140 state ballot initiatives in 35 states have already been certified for the November 8, 2016 election. This number does not include the many city-wide measures that will be before voters on...more

We Received an Exchange Subsidy Notice…Now What?

The Affordable Care Act exchanges/marketplaces are required to notify employers of any employees who have been determined eligible for advance payments of the premium tax credit or cost-sharing reductions (i.e., subsidy) and...more

Responding to Marketplace Notices

Employers have begun to receive notices from the Health Insurance Marketplace Exchanges (Marketplace) notifying them that one or more of their employees is eligible for governmental subsidies under the Marketplace. Employers...more

Manatt on Health Reform: Weekly Highlights - July 2016 #4

CMS’ increase of the “income verification threshold” makes eligibility determinations easier for consumers; Oregon CO-OP policyholders can credit out-of-pocket spending towards new plans; and report finds that 13 million...more

The ACA’s Health Insurance Marketplace Begins Reaching Out To Employers

Last week, employers began receiving notices from the Federal Health Insurance Marketplace / Exchange regarding employees who applied for Exchange coverage and were determined eligible for a tax subsidy to defray part of the...more

Obama Administration Asks Court to Dismiss ACA Risk Corridor Litigation

Yet another challenge is being brought against the Affordable Care Act (ACA), this time regarding the ACA's risk corridor program. The first of several lawsuits over this program was filed in February 2016 by an Oregon health...more

Exchange Players File ACA Lawsuits Against CMS

The Affordable Care Act (ACA) has been the impetus for extensive litigation since it was enacted in 2010. The Supreme Court has heard oral argument in four cases, and scores of other cases have been filed in the lower courts....more

Federal Court Strikes Down ACA Cost Sharing Reduction Payments

In Depth - A federal district court judge in Washington, DC ruled on May 12, 2016, that Congress did not appropriate funds for the Affordable Care Act’s (ACA) cost-sharing reduction (CSR) subsidies. See United States...more

Judge rules HHS can't pay cost-sharing subsidies to QHPs, but allows funding to continue

More than six years after the Affordable Care Act (ACA) was enacted, legal challenges continue to thread their way through the judicial system. In a May 12, 2016 decision, US District Court Judge Rosemary M. Collyer, an...more

Affordable Care Act: Understanding Employer Notices From the Marketplaces

The Affordable Care Act (ACA) established Health Insurance Marketplaces (also called Exchanges) where individuals can shop and enroll in health coverage. Individuals who meet certain criteria are eligible for premium...more

Manatt on Health Reform: Weekly Highlights - May 2016 #3

Maryland becomes the first State to mandate over-the-counter contraceptive coverage; Missouri plans to increase Medicaid asset limitations by 500% by 2021; and HHS' final rule extends protections against sex discrimination to...more

House v. Burwell: Insurer Cost-Sharing Subsidies Unauthorized

A U.S. District Judge has ruled that HHS unlawfully has spent billions of dollars to reimburse insurers for cost-sharing reductions granted to individuals who bought health insurance through an ACA Exchange such as...more

House GOP Wins Challenge Against Affordable Care Act

The Affordable Care Act (ACA) has withstood several constitutional challenges. Most well-remembered perhaps, is when, in 2012, the U.S. Supreme Court upheld the individual mandate, which requires individuals to have health...more

Manatt on Health Reform: Weekly Highlights - April 2016 #4

CMS's sweeping final rule aligns Medicaid and CHIP managed care with QHP and Medicare Advantage regulations; New York's DSRIP is enabling change in the State's Medicaid delivery system; and Medicaid expansion reduces...more

Doing the Cha-Cha on Exchange Rules: CMS Moves Forward on Standardized Plan Offerings but Steps Back from Instituting Minimum...

On March 8, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule titled “Patient Protection and Affordable Care Act; CMS Notice of Benefit and Payment Parameters for 2017” (“Final Rule”)[1] setting...more

CMS Finalizes 2017 Requirements for ACA Marketplace Plans

CMS has published its annual Notice of Benefit and Payment Parameters, which governs participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017. The sweeping rule addresses protection of consumers...more

CMS Finalizes Funding Methodology for ACA Basic Health Program for 2017-2018

On February 29, 2016, CMS is publishing its final methodology for determining federal payment amounts to states that elect to establish a Basic Health Program (BHP) to offer health benefits to low-income individuals otherwise...more

IREG Update - Co-Op member migration: Giving "risk adjustment" a whole new meaning

Co-Op member migration: Giving "risk adjustment" a whole new meaning As the Co-Ops created under the Patient Protection and Affordable Care Act fail one after another and their members enroll in coverage with other...more

National Association of Insurance Commissioners Updates Model Network Adequacy Law to Address Narrow Networks and Surprise Bills

On November 22, 2015, the National Association of Insurance Commissioners (“NAIC”) approved an updated version of its Managed Care Plan Network Adequacy Model Act, now known as the Health Benefit Plan Network Access and...more

2015 Health Care Year in Review

In 2015, ICD-10 finally became a reality, and the dire predictions of problems seem to be wrong. Providers now have codes to describe just about every conceivable (and a few simply bizarre) medical occurrences. If a patient...more

Health Update - November 2015

Best Practices for Using Social Media in Healthcare: Maximizing Impact, Mitigating Risk - Editor's note: In a generation more likely to seek health information online than see a doctor, social media is playing an...more

IREG Update - October 2015 #3

Recent closures demonstrate weakness in ACA CO-OP program - Background - The Affordable Care Act (ACA) was signed into law five and a half years ago, dramatically changing health insurance regulations and creating a...more

More Data Vulnerabilities, Cyber Breaches Detected in Healthcare Exchanges

Government audits continue to reveal that millions of people’s personally identifiable information is at risk. Continuous audit reports by the Office of the Inspector General (OIG) of The Department of Health and Human...more

Washington Healthcare Update

Bicameral Bill Introduced to Provide HHS Authority to Reject Proposed Insurance Rates - Before Congress left for its Columbus Day recess, Rep. Jan Schakowsky (D-IL) and Sen. Diane Feinstein (D-CA) introduced the Health...more

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