Category Archives: Affordable Care Act (ACA)

Subscribe to Affordable Care Act (ACA) RSS Feed

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

Physician-Owned Hospitals: Back in the Legislative Saddle Again or “I’m just a bill, I am only a bill.”

On February 16, 2017, Representative Sam Johnson (R-Texas) introduced a bill to the House of Representatives that brings to the forefront an ongoing and contentious debate regarding the propriety of physician-owned hospitals.  If adopted as proposed, the Patient Access to Higher Quality Health Care Act of 2017 would repeal sections of the Affordable Care Act … Continue Reading

Part V: The ACA, Post-Inauguration

In Parts I-III of our blog series, Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare, we considered the healthcare landscape before implementation of the Affordable Care Act (ACA), and explored potential market outcomes under partial repeal and potential “repeal and replace” scenarios.  Although we are just a couple weeks into the … Continue Reading

Food for Thought (and Health): Day 2 Notes from the JP Morgan Healthcare Conference

Addressing the Social Determinants of Health:  Is the healthcare industry pushing a rock up a hill?  We collectively are trying to provide healthcare with improved quality and reduced cost, but the structure of the nation’s healthcare system remains heavily siloed with the social determinants of health often falling wholly or partly outside the mandate and … Continue Reading

Medicaid Demonstration Waivers: A Shorter Path to Increasing State Control Over Healthcare Policy?

Seema Verma’s nomination to head the Centers for Medicare and Medicaid Services (CMS) places Section 1115 Medicaid demonstration waivers into increasing spotlight. This article explores some of the current applications of waiver authority and the role it may play in the new administration.… Continue Reading

Part 3: Exploring “Repeal and Replace”

In Part II of our blog series, Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare, we considered potential healthcare market consequences of a partial repeal of the Affordable Care Act (ACA).  In this Part III, we explore several potential “repeal and replace” scenarios that could unfold under the Trump Administration.… Continue Reading

Part 2: Implications of a Partial Obamacare Repeal

In Part I of our blog series, Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare, we discussed what the healthcare landscape looked like before the Affordable Care Act (ACA), how the law emerged from the healthcare reform policy debates and some of the major industry developments that have occurred since the … Continue Reading

Part I: How We Got Here: President Obama to Obamacare to President-elect Trump

One thing that has become clear since the election of Donald Trump last week is that efforts to repeal or amend the Affordable Care Act (ACA) will be a high priority legislative item for next year’s Congress and the incoming Administration. But to have a better grasp of what the future of health care might … Continue Reading

Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare

In a November 14, 2016 Forbes article entitled, “Under Trump, Americans Can Finally Put ObamaCare Behind Us,” Sally Pipes wrote, “ObamaCare in a full-on ‘death spiral,’ voters were clearly in no mood for Clinton’s plan to ‘build on’ the president’s healthcare law. Instead, they chose a president who has said that his first order of … Continue Reading

Vermont to Launch a First-in-the-Nation All-Payer System for All Healthcare Providers

As recently reported by Modern Healthcare and other major healthcare news outlets, the Obama administration has granted tentative approval for Vermont to establish an all-payer reimbursement system. If granted final approval, the Vermont All Payer Accountable Care Organization Model (Model) would be effective for five years from January 1, 2017 to December 31, 2022. The … Continue Reading
LexBlog