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In the Health Reform Update for the past week, the House averts a government shutdown with a full-year spending bill that largely extends current funding levels but targets select Affordable Care Act (ACA) provisions. However, it fails to include either a permanent Medicare “doc fix” or extension of the ACA’s two-year increase in Medicaid payments for primary care physicians. Marketplace enrollment through the first three weeks of the second open enrollment period far exceeds last year’s...
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In the Health Reform Update for the past week, the opening of the second enrollment period for the federally-facilitated Marketplace (FFM) brings in 765,000 new or returning subscribers in the first two weeks. However, modest premium increases resulting from a 25 percent increase in Marketplace competition may be offset by a dramatic increase in the use of specialty tier coinsurance to control drug costs. The Centers for Medicare and Medicaid Services (CMS) agrees with consumer advocates t...
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In the Health Reform Update for the past week, the federal appeals court for D.C. has delayed its review of the validity of Affordable Care Act (ACA) subsidies in federally-facilitated Marketplaces (FFMs) until the U.S. Supreme Court rules next year. Idaho becomes the only Republican-controlled state to transition to a state-based Marketplace, a move that could spare consumers from losing premium subsidies if the Supreme Court invalidates them for FFMs. Nevada and Oregon officials also cla...
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In the Health Reform Update for the past week, the U.S. Supreme Court shocks observers by agreeing to hear a challenge to Affordable Care Act (ACA) subsidies offered to more than 4.5 million consumers in federally-facilitated Marketplaces (FFM) before appellate challenges were resolved. Republican leaders promptly schedule repeal votes on the Affordable Care Act (ACA) after sweeping nearly all contested Senate races to gain control over both Congressional chambers. Broad Republican gains in ...
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In the Health Reform Update for the past two weeks, Republican lawmakers plot new strategies to derail the Affordable Care Act (ACA) as polls show them likely to gain control of the U.S. Senate. Meanwhile, Democrats focus on key governorships in ACA-resistant states. The Centers for Medicare and Medicaid Services (CMS) notifies federal Marketplace insurers that they can opt-out of their contracts should the U.S. Supreme Court invalidate ACA premium subsidies. The agency also delays another pr...
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In the Health Reform Update for the past two weeks, the Congressional Budget Office (CBO) downgrades the predicted cost of Affordable Care Act (ACA) subsidies, Medicaid and Medicare spending, and the federal budget deficit, while a second lawsuit seeks to prevent members of Congress and their staff from receiving ACA subsidized coverage in the District of Columbia Marketplace for small groups. The Centers for Medicare and Medicaid Services (CMS) has streamlined the online application proces...
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Our latest update on Specialty Tier is now available!
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In the Health Reform Update for this week, partisan divisions continue to hold in the legal battle over whether Affordable Care Act (ACA) subsidies can be offered to federal Marketplace consumers. Surveys of insurance departments show that at least 50,000 individual plans that fail to comply with the ACA may be canceled in the weeks leading up to the midterm elections. Meanwhile, the new federal website detailing manufacturer payments to physicians and providers suffers many of the same te...
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In the Health Reform Update for this week, three Republican-appointed judges reject the claim by a cash-only physician group that the delayed employer mandate under the Affordable Care Act (ACA) must be immediately implemented. A Health and Human Services (HHS) report finds that ACA Marketplaces will add 77 new insurers next year and argues that the increased competition will reduce premium costs. Colorado becomes the latest state to report only nominal average increases in Marketplace pre...
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Read about recent changes in Specialty Tiers.
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