Patient Protection and Affordable Care Act (PPACA) Health Insurance 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

Risk Adjustment Update: CMS and the states react to insurer exits

The close of 2016 will mark the end of the third full year that the Affordable Care Act (ACA) has been fully implemented. Data is available for the first two "reporting years," 2014 and 2015, for which health insurers and...more

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

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

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

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

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

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

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

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

Health Care Update - October 2015

Cuts in Mandatory Entitlement Programs Center of Budget Negotiations: As budget negotiators from both sides of the Hill come together to work out a two-year budget deal, determining how sequestration relief will be paid for...more

Manatt on Health Reform: Weekly Highlights - October 2015 #2

Iowa's largest insurer joins the State's Marketplace for coverage year 2017; carrier changes are announced for Marketplaces in Kentucky, Oklahoma and Wyoming; and South Dakota's Governor convenes the Health Care Solutions...more

Washington Healthcare Update

This Week: Senate Judiciary Committee Hearing Focuses on Health Insurers Merger... Arkansas to Delay Setting Up Its Own State Exchange...The Centers for Medicare and Medicaid Services (CMS) Announces Medicare Advantage...more

Manatt on Health Reform: Weekly Highlights - September 2015 #4

The Massachusetts Marketplace takes steps to ease consumer confusion by reducing choice among QHPs; North Carolina appears poised to pass Medicaid reform legislation; and bipartisan support is gaining for defining businesses...more No 2015 Employer Subsidy Notices

On September 18, 2015, the Centers for Medicare and Medicaid Services (CMS) published a set of “Frequently Asked Questions Regarding the Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program.”...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 6 of 24): Reporting Group Health Plan Opt-Out...

Under a common strategy for controlling group health care plan costs, employers sometimes adopt arrangements under which an employee is offered cash as an incentive to waive coverage. These arrangements are colloquially...more

A First Step on a Long Road: CMS Begins Implementation of ACA Transparency Standards

On August 11, 2015, the Centers for Medicare and Medicaid Services (CMS) posted for public comment notice of a new required data collection for health insurers. Its purpose is to begin the implementation of section 1311 of...more

The ACA and Staffing Agency Workers

Companies that use staffing agencies to supply workers face special issues in determining their risk for the significant penalties under the Affordable Care Act’s “play or pay” rules....more

Manatt on Health Reform: Weekly Highlights - August 2015

Increased plan choice on is linked to lower premium growth; Arizona seeks changes to Medicaid expansion; and California and New York release detailed Marketplace and Medicaid enrollment reports....more

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