Tag Archives: Affordable Care Act (ACA)

Will COVID-19 Prompt “Holdout States” to Reconsider Medicaid Expansion?

Matthew GoldmanJordan GrushkinMelissa GertlerBy Matthew Goldman, Jordan Grushkin and Melissa Gertler on Posted in Coronavirus, Medicaid
In 2012, the U.S. Supreme Court in NFIB v. Sebelius struck down a provision in the Patient Protection and Affordable Care Act (the “ACA”) which, for all intents and purposes, made the expansion of the Medicaid program voluntary for individual states.  As a consequence, the Medicaid expansion provided for in the ACA has been rolled … Continue Reading

Supreme Court Issues Long Awaited Ruling on Affordable Care Act Risk Corridors Program

Christine ClementsAytan DahukeyVinay BhupathyDhara WaghelaBy Christine Clements, Aytan Dahukey, Vinay Bhupathy and Dhara Waghela on Posted in Affordable Care Act (ACA)
The Supreme Court issued a long-awaited ruling on April 27, 2020, directed at a more than $12 billion challenge related to the temporary risk corridors program established by the Affordable Care Act (the “ACA”).  Challenges were brought under multiple consolidated cases, Maine Community Health Options v. United States, Moda Health Plan v. United States, Land … Continue Reading

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

Matthew GoldmanJordan GrushkinDavid SolbergBy Matthew Goldman, Jordan Grushkin and David Solberg on Posted in Affordable Care Act (ACA)
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

Effects of Insurance Marketplace Uncertainty

Matthew GoldmanJordan GrushkinBy Matthew Goldman and Jordan Grushkin on Posted in Affordable Care Act (ACA)
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

Pioneer ACOs Exit the Program

By Sheppard Mullin on Posted in Affordable Care Act (ACA)
On July 16, 2013, the Centers for Medicare and Medicaid Services (CMS) announced the first year results from its Pioneer Accountable Care Organization (ACO) program. The program, launched by the CMS Innovation Center, is part of the Affordable Care Act’s efforts to promote lower cost, high quality, coordinated care for Medicare beneficiaries. In 2012, there … Continue Reading

Obama Administration Delays ACA’s Employer-Coverage Mandate Until 2015

Eric KleinBy Eric Klein on Posted in Affordable Care Act (ACA)
The Obama Administration announced on Tuesday that it is delaying implementing a key component of the Affordable Care Act for a year following complaints from the private sector about reporting requirements. The so-called “employer mandate”, which penalizes employers with more than 50 employees if they fail to provide a minimum standard of affordable health insurance, … Continue Reading

Final Rule Implementing ACA Wellness Program Requirements Increases Financial Incentives to Participate and Allows Financial Penalties

Eric KleinBy Eric Klein on Posted in Affordable Care Act (ACA)
On June 3, 2013, the Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury (collectively, the Departments) published joint final regulations in the Federal Register implementing the Affordable Care Act (ACA) requirements for wellness programs. More specifically, the final rule applies to group health plans that offer wellness programs with a financial … Continue Reading

Health Benefit Exchanges: False Claims Gold Mines?

By Sheppard Mullin on Posted in Affordable Care Act (ACA)
The Affordable Care Act enables the establishment of Health Benefit Exchanges of several types, including (i) State-based, (ii) State-Federal partnerships and (iii) Federally Facilitated Exchanges.[1] The purpose of the Exchanges is to, among other things, “provide competitive marketplaces for individuals and small employers to directly compare available private health insurance on the basis of price, … Continue Reading

Time to Revamp Primary Care?

Aytan DahukeyBy Aytan Dahukey on Posted in Affordable Care Act (ACA)
Will bundled payments lead to restructuring of our primary care healthcare delivery system? Healthleaders has a great article discussing the vision for healthcare delivery system reengineering proposed by Thomas H. Lee, MD, the network president of Partners Healthcare and Michael E. Porter, PhD, Bishop William University Professor at the Harvard Business School. The two advocate … Continue Reading

Supreme Court Upholds Individual Mandate in the Affordable Care Act, but Medicaid Expansion is in Question

By Sheppard Mullin on Posted in Affordable Care Act (ACA)
By Eric Klein The Supreme Court ruled today 5-4 that the Affordable Care Act is constitutional and upheld the individual mandate, requiring most Americans to maintain "minimum essential" health insurance coverage. The decision was written by Judge Roberts for the majority. The Court held that the argument relying on the Constitutional commerce clause would not … Continue Reading

No Mandatory Antitrust Review for ACOs

David GarciaBy David Garcia on Posted in Affordable Care Act (ACA)
The Department of Justice and Federal Trade Commission recently issued their final “Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program” pursuant to the 2010 Patient Protection and Affordable Care Act. The final statement was issued in conjunction with the Department of Health and Human Services’ Centers for … Continue Reading

Accountable Care OrganizationsPayment Options for ACOs Pursuant to the Proposed Rule

By Sheppard Mullin on Posted in Affordable Care Act (ACA)
By Eric Klein, Kenneth Yood, Aytan Dahukey and Lynsey Mitchel The Affordable Care Act (the “ACA”) establishes the general requirements for payments to participating Accountable Care Organizations (“ACOs”) pursuant to the Shared Savings Program, described in Section 3022 of the ACA.  The ACA provides that ACO participants will continue to receive payment under the original … Continue Reading

Levels of Antitrust Scrutiny for ACOs

By Sheppard Mullin on Posted in Affordable Care Act (ACA)
By David R. Garcia The Department of Justice and Federal Trade Commission have recently proposed new guidelines delineating a three-tiered structure of antitrust scrutiny for accountable care organizations — the new healthcare delivery model mandated by the 2010 Patient Protection and Affordable Care Act — based on certain calculations of market shares of independent provider … Continue Reading

Proposed Rule: Legal Structure and Governance of ACOS

By Sheppard Mullin on Posted in Affordable Care Act (ACA)
By Eric Klein, Kenneth Yood, Aytan Dahukey and Lynsey Mitchel This blog entry will be the first of a series of entries discussing the long anticipated 400 plus-page Accountable Care Organization proposed regulations (the “Proposed Rule”) released on March 31, 2011, by the Centers for Medicare & Medicaid Services (“CMS”). The Proposed Rule is designed to … Continue Reading
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