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In the Health Reform Update for the week, House Republicans pass their first Affordable Care Act (ACA) bill since April, which would allow group plans that fail to comply with the ACA to be offered outside of ACA Marketplaces through 2018. The Federal Trade Commission (FTC) sues several drugmakers to block a “pay-to-delay” settlement, its first lawsuit since the U.S. Supreme Court put the burden on the FTC to prove that agreements to delay market entrance of lower cost generics will limit...
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In the Health Reform Update for the past two weeks, the full District of Columbia U.S. Court of Appeals agrees to reconsider a decision by a three-judge panel invalidating Affordable Care Act (ACA) subsidies offered to federally-facilitated Marketplace consumers. Oral arguments are set for December. Fears of “rate shock” in ACA Marketplaces continue to dissipate as premium data for 31 states still show only modest average increases for 2015, while rates for Arkansas are expected to decline ...
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Read our latest specialty tier update here!
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In the Health Reform Update for the past week, another legal challenge to Affordable Care Act (ACA) subsidies in federally-facilitated Marketplaces (FFM) is allowed to proceed, while the Centers for Medicare and Medicaid Services (CMS) is giving more than 300,000 FFM consumers until September 5th to document their citizenship or have their coverage cancelled. CMS has also restored the Open Payments website that will publicly disclose manufacturer payments to physicians starting September 30th,...
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Read our latest update on specialty tiers!
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In the Health Reform Update for the past week, the Congressional Budget Office predicts that the controversial individual mandate under the Affordable Care Act (ACA) will not apply to 90 percent of the uninsured population. The Centers for Medicare and Medicaid Services reports that more than 7.2 million Americans have gained Medicaid or SCHIP coverage since the ACA Marketplaces opened. The agency delays public release of data revealing drug manufacturer payments to physicians, while the Ins...
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In the Health Reform Update for the past week, a federal appeals court rejects the latest challenge to the Affordable Care Act (ACA) while conservative groups ask the U.S. Supreme Court for an expedited review of last week’s conflicting decisions on the law’s premium subsidies.  The House of Representatives authorizes an unprecedented lawsuit against President Obama in an effort to force implementation of the delayed employer mandate—a provision they previously sought to r...
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In the Health Reform Update for the past week, two federal appeals court split on whether the Affordable Care Act (ACA) allows premium subsidies to be offered to consumers in federally-facilitated Marketplaces, while a lower court dismisses a U.S. Senator’s effort to block ACA subsidies for members of Congress and their staff. The Centers for Medicare and Medicaid Services (CMS) plans to step-up their verification of consumer data claiming eligibility for the ACA subsidies and/or Marketpla...
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In the Health Reform Update for the past week, the Congressional Budget Office (CBO) lowers its health care spending estimate due to Affordable Care Act (ACA) cost controls. The Centers for Medicare and Medicaid Services (CMS) reverses course and exempts U.S. territories from most ACA market reforms. New Medicaid enrollments approach seven million, while CMS increases the number of states that must promptly address Medicaid application backlogs. A consultant review of initial rate filings ...
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In the Health Reform Update for the past two weeks, the U.S. Supreme Court narrows the preventive services mandate under the Affordable Care Act (ACA) while Congress increases its scrutiny of the $84,000 per treatment cost for the latest Hepatitis C drug. An Inspector General Report confirms that the Centers for Medicare and Medicaid Services (CMS) is still unable to fully verify income and citizenship data for Marketplace applicants. However, the agency is directing six states to develop pl...
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