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Health-Exchange-Alert

August 29, 2019 | Daily News

California's rate-setting model has reduced the number of surprise bills consumers face, according to a study from the RAND Corporation, but it has also shifted bargaining power toward insurers and has led to physician group consolidation.

August 28, 2019 | Daily News

The Trump administration’s so-called public charge rule will deter many immigrant families from enrolling their children in Medicaid, potentially undermining decades of work to expand children’s coverage, the Georgetown University Center for Children and Families argues in a new report.

August 28, 2019 | Daily News

Republicans are pointing to the premium decreases in states with reinsurance programs established through the Affordable Care Act’s 1332 waivers as proof that working around the law’s mandates will lower prices, particularly for those ineligible for tax credits, while Democrats, who created the waivers, say efforts to boost the ACA must also help the lower income population.

August 27, 2019 | Daily News

The government is putting up new barriers to drug copay coupons, and pharmacy benefit managers say the new rules will help control drug spending.

August 26, 2019 | Daily News

California has seen a significant increase in the number of in-network doctors since implementing its surprise billing legislation in 2016, according to a new study funded by America’s Health Insurance Plans.

August 26, 2019 | Daily News

Large employers are increasingly open to the government negotiating prices of high-cost drugs, a notable change from previous years that reflects ongoing concern over skyrocketing costs, according to a new survey by the National Business Group on Health (NBGH).

August 26, 2019 | Daily News

CMS on Friday (Aug. 23) instructed state Medicaid agencies on how to take full advantage of federal rules that allow them to recoup money from the U.S. sponsors of legal immigrants if those immigrants use Medicaid benefits, including potentially suing the sponsors if they don’t pay up.

August 23, 2019 | Daily News

Air ambulance providers are taking issue with Wyoming’s proposal to eliminate air ambulance surprise medical bills, which would make all citizens Medicaid-eligible for ambulance services.

August 23, 2019 | Daily News

Colorado Sen. Michael Bennett (D-CO) Thursday took a jab at rival presidential candidate Bernie Sanders for what he called a “retreat” on his Medicare for All stance after the Vermont senator released a labor platform clarifying that unions can still negotiate wrap-around coverage and maintain their clinics, and also ensuring that any employer savings go back to the workers.

August 23, 2019 | Daily News

Colorado Sen. Michael Bennet (D-CO) Thursday took a jab at rival presidential candidate Bernie Sanders for what he called a “retreat” on his Medicare for All stance after the Vermont senator released a labor platform clarifying that unions can still negotiate wrap-around coverage and maintain their clinics, and also ensuring that any employer savings go back to the workers.

August 22, 2019 | Daily News

New Mexico’s insurance chief announced this week that Christus Health Plan will not be allowed to offer products on the state’s exchange for 2020 due to compliance issues including a failure to provide transgender services and discrepancies on policies related to prior authorization and evidence of coverage, among other problems.

August 22, 2019 | Daily News

The number of Medicaid-covered prescriptions for buprenorphine, a key drug used to treat opioid addiction, increased dramatically in states that expanded Medicaid under the Affordable Care Act while remaining relatively static in non-expansion states, according to a new study from researchers at the Urban Institute.

August 21, 2019 | Daily News

Overall enrollment in the individual market declined by 5% during the first quarter of 2019, the first quarter that the individual mandate penalty repeal was in effect, according to a new analysis from the Kaiser Family Foundation.

August 21, 2019 | Daily News

CMS on Wednesday (Aug. 21) approved Delaware’s request to tweak marketplace rules to set up a five-year reinsurance program through a state innovation waiver in 2020, marking the tenth state to establish such a program since the Affordable Care Act waiver provision went into effect.

August 19, 2019 | Daily News

The August recess has provided congressional staffers no reprieve from the onslaught of lobbying over surprise billing legislation as stakeholders continue to make their case for and against bills that set benchmark rates, which moved through House and Senate committees prior to the break.

August 16, 2019 | Daily News

CMS on Friday (Aug. 16) officially denied Utah’s request for enhanced federal funding for a partial Medicaid expansion -- as well as Utah’s proposed enrollment caps policy, which the agency said essentially amounted to a partial expansion with the higher match -- but the agency has yet to decide whether it will approve the state’s request for per-capita caps.

August 16, 2019 | Daily News

Seventeen states and the District of Columbia are involved in lawsuits challenging the controversial so-called public charge rule finalized Monday, arguing that the rule undermines the role of public programs such as Medicaid and does not improve self-sufficiency for immigrants.

August 15, 2019 | Daily News

Health insurance exchanges nationwide will be required to display where qualified health plans stand on a 5-star quality rating system for the 2020 plan year, CMS announced Thursday (Aug. 15), and the agency released data revealing that 95% of the 175 plans eligible for scoring in the 2019 plan year had a rating of 3 stars or more but only 19% (36) had a 5-star rating. 

August 15, 2019 | Daily News

Nevada’s attorney general is still considering whether to appeal U.S. District Judge Reed O’Connor’s refusal to let the state intervene in an under-the-radar class action case, DeOtte, et al v. Azar, that bars HHS from enforcing the Affordable Care Act’s contraceptive mandate on any members of two broadly drawn classes, a spokesperson for Nevada Attorney General Aaron Ford tells Inside Health Policy.

August 14, 2019 | Daily News

A group of 22 Democratic attorneys general warned the Trump administration that it will land in court if it finalizes a proposal to revise the Affordable Care Act’s non-discrimination provision by rolling back protections for transgender individuals, eliminating language requirements for people with limited English proficiency (LEP) and reducing the number of entities that must comply.

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