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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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Read our summary update on specialty tiers.
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In this week’s Health Reform Update, the Centers for Medicare and Medicaid Services (CMS) issues new rules allowing employers to delay new employee coverage for up to 120 days and automatically renewing coverage for enrollees in Affordable Care Act (ACA) Marketplaces. Proposed Marketplace premiums for 2015 continue to vary widely, with several insurers (particularly non-profit cooperatives) seeking substantial rate cuts. Premiums on average continue to show increases consistent with the in...
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In this week’s Health Reform Update, Senator David Vitter (R-LA) and Rep. Bill Cassidy (R-LA) continue to push the Centers for Medicare and Medicaid Services (CMS) to formally clarify that non-profit charities like PSI can assist with premiums and cost-sharing for Marketplace plans. CMS fends off Republican challenges against reinsurance payments for Marketplace carriers that incur substantial losses. Two leading House Democrats demand hearings on the impact of a costly new Hepatitis C drug u...
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In this week’s Health Reform Update, new data shows that more insurers are planning to participate in Affordable Care Act (ACA) Marketplaces and are offering broader provider networks (for a price). Drug manufacturers and the insurance industry argue over which is more to blame for high out-of-pocket costs for specialty tier drugs, while a separate study concludes that Marketplace plans turning out to be less costly than non-Marketplace plans. Despite wide variations, proposed Marketplace...
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