On May 12, 2021, the Institute for Clinical and Economic Review (ICER or the Institute) released plans to begin an annual examination into health insurance drug coverage policies to assess “fair access” to prescription drugs....more
Medicare Advantage (MA) is the private plan option in the Medicare program. Enrollment in the program has grown nearly 10% a year in recent years and now tops 25 million. More than one-third of Medicare beneficiaries (people...more
Cost-Sharing Reduction (CSR) Payments Take Effect. Under Section 1402, the Affordable Care Act (ACA) implements a plan for reducing the amount of out-of-pocket costs, such as deductibles and co-payments, that lower-income...more
Many health insurers and HMOs may be considering entering or reentering the individual health insurance market, either on or off a federal or state-based health insurance marketplace. Over the last two years, the individual...more
Medicare Advantage (MA) is the private plan option in the Medicare program. Over the last few years, the program has grown rapidly, nearly 10% a year. More than one-third of Medicare beneficiaries (people with Medicare) have...more
A federal judge has ruled that health insurers under the Affordable Care Act are entitled to unpaid cost-sharing reduction (CSR) payments from the government. Insurers sued following the Trump administration’s October 2017...more
A federal district court in Fort Worth, Texas struck down the entire Affordable Care Act (ACA) last Friday in a ruling that’s prompting questions about whether its legal reasoning will withstand further scrutiny, and whether...more
On October 12, 2017, the Trump administration announced that it would immediately stop making cost-sharing reduction (CSR) subsidy payments under Section 1402 of the Affordable Care Act (ACA). CSRs allowed — and in fact...more
In a crowded courtroom on January 10, the U.S. Court of Appeals for the Federal Circuit held oral argument on appeals of two Risk Corridors decisions from the Court of Federal Claims. The two cases, Land of Lincoln and Moda,...more
In what may be the first enforcement action taken by a state regulator against an “Obamacare” health plan for provider network problems, the Washington State Office of the Insurance Commissioner imposed a fine and suspended...more
On Friday, October 27, the Centers for Medicare and Medicaid Services (CMS) published its draft annual Proposed Notice of Benefits and Payment Parameters for Calendar Year 2019. This proposal follows on the heels of a Request...more
On October 12, 2017, the Trump administration announced that it will immediately stop making cost-sharing reduction (CSR) subsidy payments, which allow health insurers to defray out-of-pocket costs to insure low-income...more
Last week, the Senate unveiled the Graham-Cassidy Bill, Republican legislators’ latest attempt to repeal the Affordable Care Act (ACA). Crafted by Sens. Bill Cassidy, R-LA, Lindsey Graham, R-SC, Dean Heller, R-NV, and Ron...more
On June 22, the Senate unveiled its counterpart to the House of Representatives’ American Health Care Act (AHCA) — the Better Reconciliation Act (BCRA) — and Republican leaders have reportedly indicated a desire to vote on...more
Since last November’s election, the future of the Affordable Care Act (ACA) has been very much in doubt. It can be debated whether the health insurance exchanges (Exchanges) are in a “death spiral” as President Trump...more
For health insurers concerned about when they may receive government payments through the Affordable Care Act’s (ACA) risk corridor program, court decisions have provided little clarity. An April 18 decision by Judge Griggsby...more
On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized its Marketplace Stabilization Rule. This is the first Trump administration regulation that applies to the health insurance markets remade by...more
The House plans to vote on the American Health Care Act (AHCA) on Thursday. While this is only the beginning of the political and legislative process for the so-called Obamacare repeal bill, it’s important for health care...more
After months of intense debate, raucous town hall meetings and a fair share of leaks, House Republicans on Monday officially released their bill to repeal the Affordable Care Act (ACA) and to reform the Medicaid program—less...more
Based on QHP Certification instructions issued on July 22, 2016, the Centers for Medicare and Medicaid Services (CMS) will collect administrative and performance data from health insurers that participate in the federally-run...more
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