Category Archives: Affordable Care Act (ACA)

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Midterms Bring New Focus to Healthcare

Tuesday’s midterm elections showed that healthcare is now a top issue among voters, according to exit polls. In an NBC News poll, healthcare was the top issue for a plurality of voters, ahead of the economy, immigration, and gun policy. [1] As voters made their voices heard, they also helped to solidify the position of … Continue Reading

CMS Proposes Massive Changes to ACO Program – Pushing Providers to Accept Downside Risk

On Thursday, August 9, 2018, the Centers for Medicare & Medicaid Services (“CMS”) published a Proposed Rule (the “Proposed Rule”)[1] regarding the Medicare Shared Savings Program (“MSSP” ) for Accountable Care Organizations (“ACOs”). The Proposed Rule would require ACOs to accept downside risk or shared losses sooner than under the current MSSP and would promote … Continue Reading

The Risk Corridor is Closed: Insurers Seek Recourse in the Federal Circuit

On July 30, 2018, two insurers – Moda Health Plan, Inc. (“Moda”) and Land of Lincoln Mutual Health Insurance Company – petitioned the U.S. Court of Appeals for the Federal Circuit to reconsider the Court’s June 14, 2018 ruling in which the Court held that the U.S. Department of Health and Human Services (“HHS”) is … Continue Reading

The Trump Administration Allows for Longer “Short-Term” Health Insurance Policies, but Coverage Stays the Same

On Wednesday, August 1, 2018, the Trump Administration issued the Short-Term, Limited-Duration Insurance Final Rule (the “Final Rule”), expanding the coverage length of “short-term, limited-duration insurance” policies under the Patient Protection and Affordable Care Act (“ACA”).… Continue Reading

No Longer in Suspense: CMS Issues Final Rule Announcing that Risk Adjustment Program Transfers for 2017 will be Distributed in September

The Final Rule. In a Final Rule posted by CMS last Tuesday, July 24, 2018, CMS announced that $10.4 billion in “risk adjustment transfers” (“Risk Transfers”) for benefit year 2017 (as calculated pursuant to the Affordable Care Act’s Risk Adjustment Program (the “Risk Program”)) would be distributed to eligible exchange-participating insurers in September, 2018. The … Continue Reading

Following Repeal of the Individual Mandate, Twenty States Challenge the Affordable Care Act

On February 26, 2018, twenty states (the “Plaintiffs”) jointly filed a lawsuit[1] in the U.S. District Court for the Northern District of Texas requesting that the court strike down the Patient Protection and Affordable Care Act (“ACA”), as amended by the Tax Cuts and Jobs Act of 2017 (the “TCJA”), as unconstitutional. The Plaintiffs’ suit … Continue Reading

CMS Proposes “Wind Down” Plan for Federal Exchanges

Despite the Trump Administration’s unsuccessful attempts to fully repeal and replace the Affordable Care Act (the “ACA”), the Administration has continued to target the ACA. In the Administration’s latest salvo, the Centers for Medicare & Medicaid Services (“CMS”) announced in its Fiscal Year 2019 Performance Budget (the “Budget”)[1] – as released by the federal Office … Continue Reading

Have the Reports of the Affordable Care Act’s Death Been Greatly Exaggerated?

The December 2017 Tax Reform Bill and the Repeal of the ACA’s Individual Mandate The tax reform bill signed into law by President Trump on December 22, 2017, notably includes the repeal of the Affordable Care Act’s (ACA’s) individual mandate penalty. The individual mandate, which requires most Americans to maintain a basic level of health … Continue Reading

President Trump Signs Tax Reform Bill Into Law

Today, President Trump signed into law a sweeping tax reform bill passed by the House and the Senate on Wednesday that will materially affect virtually every sector in the economy, including, perhaps to a greater degree than others, the healthcare sector. Between the bill’s repeal of the Affordable Care Act’s individual mandate penalty tax and … Continue Reading

Clean Up on Aisle 12! The Obamacare Pop-Up Store is Open but Stocks are Limited

The fifth Open Enrollment period under the Affordable Care Act (ACA) started on November 1st, and will continue for a scant 45 days ending on December 15, 2017. This year, not only has the Open Enrollment been cut in half, but obstacles abound – obstacles that were not part of the 2016 Open Enrollment Period. … Continue Reading

Recent Merger Reflects Enhanced Need for Revenue Cycle Management Platforms

Two of the nation’s most noteworthy companies in the Revenue Cycle Management (“RCM”) technology space, Navicure Inc., and ZirMed Inc., announced a merger on September 14, 2017. Navicure is a medical claims management, patient payment and data analytics company and ZirMed is known for its predictive analytics technology that helps healthcare organizations capture more revenue. … Continue Reading

Trump Administration Pulls the Plug on CSR Payments

After months of veiled threats, President Trump formally announced that his Administration will cease funding Cost-Sharing Reduction (“CSR”) payments, a key component of the Affordable Care Act (“ACA”) intended to help subsidize insurance coverage for low income individuals. As we have eluded to in prior articles, various industry stakeholders and interest groups have expressed anxiety … Continue Reading

Trump Administration Takes Aim at ACA With AHP Executive Order

Yesterday, Thursday, October 12th, on the heels of the recent and repeated failures to repeal and replace the Affordable Care Act (“ACA”), President Donald Trump signed an executive order nominally aimed at increasing competition in the healthcare marketplace, but widely believed to be driven by a desire to undermine the ACA. The executive order broadly … Continue Reading

Nine Days and Counting – The Fate of CHIP Remains Uncertain Amid Congressional Deadlock

While congressional Republicans spent much of September pushing for passage of the Graham-Cassidy “repeal and replace” bill, other time-sensitive legislative tasks were left to languish, including a September 30 deadline to reauthorize funding for the Children’s Health Insurance Program (“CHIP”) that has since come and gone. The failure to timely reauthorize the program has put … Continue Reading

Disproportionate Share Hospitals Facing Steep Payment Cuts

While September 30, 2017 has been an important procedural deadline for purposes of the GOP’s most recent legislative push to repeal the Affordable Care Act (ACA), it also serves a critical funding deadline for purposes of the Disproportionate Share Hospital (DSH) payment program. Absent legislative action, DSH payments are set to be reduced by $2 … Continue Reading

Effects of Insurance Marketplace Uncertainty

Even as Senators continue to consider “Graham-Cassidy,” the latest Affordable Care Act (ACA) repeal legislation, insurance markets are already reacting to uncertainty and instability brought about by persistent GOP efforts to upend the post-ACA insurance landscape. Between the Trump Administration’s ongoing refusal to commit to long-term funding of the ACA’s cost-sharing reductions (CSRs) and legislative … Continue Reading

ACA Cost-Sharing Reductions– A Momentary Reprieve and Ongoing Doubts

The Future of CSRs – A Tale Told in Tweets. In follow-up to our May 5, 2017 blog post, “ACA Cost-Sharing Reductions: An Uncertain Future,” on August 16, 2017, the Trump Administration made an announcement (Announcement) that it will continue to fund cost-sharing reduction (CSR) payments to insurers in accordance with the CSR provisions in … Continue Reading

ACA Cost-Sharing Reductions: An Uncertain Future

“Cost-sharing reductions” (CSRs) are one of the primary mechanisms under the Affordable Care Act (ACA) to make health coverage affordable for consumers. CSRs are government payments to insurance companies for the purpose of reducing out-of-pocket costs (e.g., copayments and deductibles) for individuals who purchase insurance coverage through the healthcare exchanges established under the ACA. In … Continue Reading

Part VI: An Update on the American Health Care Act

In Part V of our blog series, Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare, we outlined some of the key provisions of the American Health Care Act (AHCA). Roughly two weeks after our post was published, GOP congressional leadership pulled the legislation from a floor vote, recognizing that the bill … Continue Reading

CEO of Molina Healthcare Discusses Implications of Cuts to Affordable Care Act

Dr. Mario Molina, CEO of Molina Healthcare, discusses the implications of potential cuts to cost sharing reduction payments under the Affordable Care Act by the Trump Administration.  Cost sharing reduction payments are viewed by many as essential in the provision of healthcare to low income individuals as they help to reduce co-pays and deductibles that … Continue Reading

Final Market Stabilization Rules – How Stable is Stable?

The Department of Health and Human Services released the final Affordable Care Act marketplace stabilization rules (“Final Rule”) on April 13, 2017. The Final Rules become effective on June 19, 2017 and will, accordingly, apply to the 2018 state and federal Affordable Care Act health insurance exchanges. The Final Rule is available here.… Continue Reading

New OIG Exclusion Authority Rule Set To Go Into Effect on March 21, 2017

On January 12, 2017, just a week prior to President Trump’s Inauguration, the Department of Health and Human Service (HHS) Office of Inspector General (OIG) published a final Rule (Rule) regarding one of its most important enforcement mechanisms: its exclusion authority. The Rule, published nearly three years after it was initially proposed by the OIG … Continue Reading
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