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News Items, by Subject

Health plans - policy

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CMS May Be Restarting ACA Risk-Adjustment Payments
"[An] interim final rule CMS sent [July 19 to OMB] for review suggests one of those options could be to restart the program.... The title of the potential regulatory item, 'Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the [ACA],' indicates that CMS is looking to recalibrate the way it calculates payments. Doing so could accomplish what critics said CMS should have done in the first place, instead of halting the payments." (HealthLeaders Media)
CBO Follow-Up About the Budgetary Treatment of Cost-Sharing Reductions
"CBO and the staff of the Joint Committee on Taxation project that, under current law, the entitlement for subsidies for CSRs will continue to be funded [through higher premiums and larger tax credits based on those premiums]. So in its baseline, CBO no longer projects direct payments for CSRs and, instead, reflects the current form of funding. This letter responds to questions from Congressman Mark Meadows about that change in the baseline and the consequences for estimating the budgetary impact of legislation that would restore and fund direct payments." (Congressional Budget Office [CBO])
How Would State-Based Individual Mandates Affect Health Insurance Coverage and Premium Costs?
"If all states implemented individual mandates, the number of uninsured would be lower by 3.9 million in 2019 and 7.5 million in 2022. On average, marketplace premiums would be 11.8 percent lower in 2019. State mandate penalty revenues would amount to $7.4 billion and demand for uncompensated care would be $11.4 billion lower. The impact on coverage and on premiums varies in significant ways across states." (The Commonwealth Fund)
Supreme Court Antitrust Ruling May Have Big Impact on Health Insurance
"The U.S. Supreme Court has decided its first antitrust case in almost three years, establishing a new rule that in the two-sided credit card network market, a plaintiff must analyze both the merchant services side and the consumer cardholder side for anti-competitive effects ... The parallels between two-sided credit card markets and two-sided insurance markets are clear ... Given the recent appeal of vertical transactions, and several ongoing antitrust cases involving health insurance networks, the applicability of a two-sided market analysis in the health insurance space will inevitably be in front of courts in due course." [Ohio v. American Express Co., No. 16-1454 (U.S. June 25, 2018)] (Sheppard Mullin)
Health Insurers Are Vacuuming Up Details About You
"Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing.... Insurers contend they use the information to spot health issues in their clients -- and flag them so they get services they need.... [P]atient advocates and privacy scholars say the insurance industry's data gathering runs counter to its touted, and federally required, allegiance to patients' medical privacy." (ProPublica)
Physician Groups Sue Anthem Over 'Dangerous' ER Coverage Policy
"A long-running disagreement over Anthem's policy of denying payment for emergency department visits that are later deemed non-emergent escalated ... Two groups, the American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG), sued Anthem's Blue Cross Blue Shield of Georgia, alleging that the ER policy violates the 'prudent layperson' standard in the [ACA] -- which, the plaintiffs say, requires Anthem and other insurers to cover emergency care based on a patient's symptoms rather than their final diagnosis." (HealthLeaders Media)
House Subcommittee Examines State Efforts to Increase Transparency in Midst of Skyrocketing Health Care Costs
"The Subcommittee on Oversight and Investigations ... held a hearing [on July 17] to examine recently adopted state laws and policies that improve transparency of health care costs for consumers, making information more readily available." (Energy and Commerce Committee, U.S. House of Representatives)
Judge Kavanaugh's Health Care Opinions
"In two [ACA] cases, Kavanaugh dissented from the majority opinion that had rejected a challenge to the ACA. In both, however, he objected only to the reasoning of the court; he agreed with the majority that the complaint against the ACA should have been rejected.... In none of these cases did Kavanaugh stake out a strong ideological position ... In several of the cases he made a point of following existing precedent and in none would he have radically changed the law." (The Commonwealth Fund)
ERISA Advisory Council to Meet August 14-16
"[T]he 192nd meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on August 14-16, 2018.... The purpose of the open meeting is for Advisory Council members to hear testimony from invited witnesses and to receive an update from [EBSA]. The EBSA update is scheduled for the morning of August 16, subject to change." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
No Funding for DOL Association Health Plan Rule in Budget Bills
"The House and Senate appropriations bills didn't address a request from the White House in its February budget proposal to increase funding for [EBSA] 'to develop policy and enforcement capacity to expand access to AHPs.' Both bills would cut funding to the Labor Department overall." (Bloomberg BNA)
CMS Halts ACA Risk Adjustment Transfers
"CMS' decision presents two sets of issues for payers. One is an immediate question of cash flow for payers that were expecting to receive, in some cases, millions of dollars in payments ... for example, one Florida insurer was set to receive $666 million ... Longer term, for payers, the decision creates a large amount of uncertainty about the viability of remaining in the ACA markets." (PwC)
[Official Guidance] Text of CMS Memo: Implications of the Decision by U.S. District Court for the District of New Mexico on the Risk Adjustment and Related Programs (PDF)
"CMS will not collect or pay the specified amounts [for the 2017 benefit year] at this time. CMS will inform stakeholders of any update to the status of collections or payments at an appropriate future date.... CMS will not collect or pay any specified amounts remaining for the 2014-2016 benefit years at this time.... CMS will collect 2017 benefit year risk adjustment user fees in the August 2018 payment cycle ... Issuers must continue archiving and maintaining 2014, 2015, 2016, and 2017 EDGE data consistent with normal operations.... CMS will cease issuing any further discrepancy resolution decisions at this time." [Unnumbered document, July 12, 2018] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] Freezing Risk-Adjustment Payments Will Cause More Instability in the Individual and Small-Group Insurance Markets
"The court ruled in February that the formula is arbitrary and capricious because CMS did not adequately justify key assumptions. The court left open that the formula may be allowed, if justified through notice and comment rulemaking.... CMS could have waited for the court to issue an opinion on a motion to reconsider the decision ... then appeal and request a stay to keep the formula in place through the appeals process. Reversal on appeal may not be a long shot given that a court in Massachusetts upheld the formula in a similar case." (The Commonwealth Fund)
[Opinion] The Health Care Choices Proposal: Charting a New Path to a Down Payment on Patient-Centered, Consumer-Driven Health Care Reform
"The proposal ... would repeal the Obamacare federal spending scheme and replace it with a more fiscally responsible block grant to the states. The proposal ... [restore] state authority over some critical health insurance regulation. Thus, states would have the ability to adjust insurance rules to their own insurance market conditions, which differ sharply from state to state.... [It] recommends changes to health savings accounts (HSAs), enabling consumers to use them with greater flexibility in meeting their health care wants and needs." (The Heritage Foundation)
House Committee Contemplates Bill That Would Reduce Employer Health Benefit Costs
"Among one of the bills considered is legislation ... [which] would provide retroactive relief from the ACA's employer mandate from 2015 through 2018 and delay for one additional year (until 2023) the 40% Cadillac Tax." (PLANSPONSOR)
[Opinion] Ways and Means Bills Would Expand HSA Tax Breaks, Weaken Insurance Marketplaces
"The House Ways and Means Committee is marking up several bills this week that would raise contribution limits for [HSAs] and expand the allowable uses of these accounts, at a cost of $41 billion over ten years ... The bills also include other problematic provisions providing premium tax credits to people who buy plans offered outside the [ACA] marketplaces and delaying the ACA's excise tax on high-cost plans ... In all, the bills would cost $92 billion over the next decade[.]" (Center on Budget and Policy Priorities)
The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors
"Under a range of scenarios that reflect alternative assumptions about responses to these factors, we find that enrollment falls by 2.8 million to 13 million people and premiums for bronze plans increase by 3 percent to 13 percent when the mandate penalty is removed. The impact on the federal budget deficit is more uncertain, with effects ranging from a reduction of $8 billion to an increase of $3.6 billion in 2020." (The Commonwealth Fund)
[Opinion] Thoughts On Risk Adjustment
"[T]he Trump Administration has temporarily suspended all payments and collections of RA until the lawsuit is resolved.... [T]his is something that could have been avoided and fixed by the prior administration.... They could have issued interim rules to circumvent the problem. They could have adjusted the 2017 Notice of Benefit and Payment Parameters that were rushed through in late 2016 to mitigate the problem too. But they didn't." (InsureBlog)
Republican Attorneys General Ask That a Partial Injunction Against ACA Apply Only in Their States
"On July 5, 2018, the plaintiffs in Texas v. United States -- ongoing litigation over the constitutionality of the [ACA's] individual mandate and, with it, the entire ACA -- filed a brief in support of their request for a preliminary injunction.... The plaintiffs continue to ask Judge O'Connor to enjoin the entire ACA on a nationwide basis and request an injunction in advance of January 1, 2019, when the mandate penalty is zeroed out. If, however, the court only grants a limited injunction (for the mandate, guaranteed issue, and community rating), the plaintiffs now ask the court to apply that injunction to only the 20 plaintiff states." (Katie Keith, in Health Affairs)
DC Requires People to Buy Health Insurance or Risk Property Seizure
"[T]he District of Columbia City Council [recently] approved a requirement for all DC residents to purchase health insurance. The mandate would take effect in January, right when the federal mandate penalty drops to $0 ... .. [If] a district resident won't buy 'government-approved' health insurance, and won't (or can't) pay the tax for not doing so, the district has the right to seize, and sell, that person's property." (The Federalist)
United States District Court Ruling Puts Risk Adjustment on Hold
"On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating use of the statewide average premium by [CMS] in the risk adjustment transfer formula established under section 1343 of the [ACA] for the 2014-2018 benefit years ... In light of a contrary decision by the United States District Court for the District of Massachusetts, the government moved the New Mexico district court to reconsider its decision, and CMS is currently awaiting the court's ruling.... The New Mexico district court's ruling currently bars CMS from collecting or making payments under the current methodology[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
To Bring Health Information Privacy Into the 21st Century, Look Beyond HIPAA
"Even though HIPAA remains 'surprisingly functional,' significant gaps persist. These gaps, however, derive not from HIPAA per se, but from the patchwork of health information privacy rules outside of HIPAA.... [O]ne element of this patchwork: the complex rules around and new challenges created by big data analytics. [Additional examples are] ... Social Media ... The Role of States ... Veterans ... Following the European Union's Lead." (Health Affairs)
Early 2018 Effectuated Enrollment Snapshot (PDF)
12 pages. "As of March 15, 2018, 10.6 million individuals had effectuated coverage through the Federal and State-Based Exchanges for February 2018, meaning that they selected a plan, paid their first month's premium, if applicable, and had coverage in February 2018. The total number of members with February 2018 coverage is about 9 percent lower than the number of individuals (11.8 million) who made plan selections during the 2018 Open Enrollment period." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Trends in Subsidized and Unsubsidized Individual Health Insurance Market Enrollment (PDF)
"Average monthly enrollment in individual market plans decreased by 10 percent between 2016 and 2017 at the same time premiums increased by 21 percent. Most of the decrease in enrollment between 2016 and 2017 occurred among people who did not receive APTC subsidies.... 10 states experienced declining individual market enrollment between 2015 and 2016.... The decline in the non-APTC portion of state markets grew larger and more widespread between 2016 and 2017." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] Federal Subsidies for Employer-Based Coverage Expected to Total $3.7 Trillion Between 2019 and 2028
"It will cost the federal government $685 billion this year to subsidize health insurance for people under 65. Of that, $272 billion will go to those with some form of employer-sponsored coverage.... [CBO] says net subsidies for those covered by employers will total $3.7 trillion over the 2019-2028 period.... For those with employer-based coverage, the subsidies are not direct but come in the form of untaxed benefits.... The CBO estimates that a monthly average of 158 million Americans (about 58% of the population under age [65] have employer-based insurance this year. That's expected to decline to 154 million (or 55% of the population) by 2028." (Managed Care)
Amazon's PillPack Deal Gives It Access to Sensitive Health Data
" Inc. knows more about consumers' online-shopping habits than any other retailer. Now it is about to get its hands on the most intimate of personal data: people's health conditions. Last week's acquisition of online pharmacy startup PillPack will give Amazon insight into people's prescriptions, putting the tech company into the highly regulated realm of health information with more restrictions than it is accustomed to on data-mining." (The Wall Street Journal; subscription may be required)
[Guidance Overview] DOL Final Rule Expands Availability of Association Health Plans (PDF)
"[T]he AHP Final Rule creates 'two tracks' for AHPs, by allowing both new and existing associations to sponsor AHPs under either the current set of DOL sub-regulatory guidance, or the new AHP Final Rule. The most important consequence for federal law purposes is that AHPs that qualify under existing DOL guidance (limited to the same industry and no 'working owners,' i.e., no self=employed persons) may be able to continue to set premium rates employer-by-employer based on the claims experience of each employer." (Groom Law Group)
Moda Decision Affecting Risk Corridor, CSR Litigation; Sen. Alexander Pushes for Sec. 1332 Waiver Flexibility
"As expected given the stakes, Moda Health Plan has indicated that it will appeal the Federal Circuit's decision. In the meantime, other litigation over risk corridor payments -- which had been stayed pending the Federal Circuit's decision -- can proceed. There are currently two additional cases on risk corridor payments before the same panel of judges on the Federal Circuit." (Katie Keith, in Health Affairs)
[Guidance Overview] MEWAs and AHPs: What You Need to Know About the Association Health Plan Final Rule
"This Legal Alert provides brief background on the Final Rule's single-employer AHP criteria, and includes a chart that outlines some of the key differences between the requirements for MEWAs, single-employer AHPs established pursuant to existing guidance, and single-employer AHPs according to the alternative criteria established under the Final Rule." (Eversheds Sutherland)
[Guidance Overview] Final Association Health Plan Regs Provide Opportunity for Small Employers ... Maybe
"[We] now know that the DOL does not intend to alter existing ERISA preemption rules, which authorize State insurance regulation of AHPs ... We now also know that existing AHPs that meet current sub-regulatory guidelines to be considered an AHP do not need to satisfy these new rules to maintain that AHP status. The nondiscrimination provisions in the new rule also limit the opportunity for new AHPs to engage in risk selection by effectively eliminating the ability to medically underwrite individual employer members." (Porter Wright Morris & Arthur LLP)
New Plaintiffs' Firms Bring Increased ERISA Litigation Risks for Employers (PDF)
"Until recently, a small group of specialized plaintiffs' firms has dominated the ERISA class action space, beginning with untested theories of liability that are eventually leveraged into portfolios of lawsuits. Those portfolios (and the plaintiffs' attorneys who created them) have become well-known. But an interesting trend has emerged in the day-to-day ERISA litigation docket: new plaintiffs' firms have begun to enter the space in a significant way. This development, which has significant implications for plan sponsors and fiduciaries, has been picking up significant speed in the last several months." (Jenner & Block, via Employee Relations Law Journal)
[Guidance Overview] Association Health Plan Final Rule Brings New Coverage Options for Small Businesses and Self-Employed
"The final rule will be applicable in three phases starting on September 1, 2018. This alert provides an overview of key aspects of the rule, with an emphasis on its nondiscrimination requirements, and highlights several clarifications or modifications to the proposed rule that the DOL made in the final rule." (Faegre Baker Daniels)
[Guidance Overview] DOL Finalizes Rule for Association Health Plans
"[H]ealth insurance issuers may not constitute or control a bona fide group or association in their capacity as health insurance issuers. However, health insurance issuers may act as employers in sponsoring an AHP for the benefit of their employees and may also provide administrative services to an AHP.... Sole proprietors and self-employed individuals will be eligible to participate in AHPs without the need to employ at least one other person." (McDermott Will & Emery)
Thinking About an Association Health Plan? Read the Fine Print
"What are association health plans and what did the administration change? ... When will the plans be available? ... The ACA added some popular protections, including requiring plans to cover preventive care without charging consumers anything out-of-pocket and allowing people to keep their kids on their plan until they reach age 26. How will these provisions be handled under association health plans? ... How are preexisting medical conditions handled in the new rule? ... Will the plans cover a broad range of benefits? ... How could premiums be affected? ... Who's likely to benefit under the rule? ... What if an employer offers a really skimpy plan? Are workers stuck with it?" (Kaiser Health News)
[Guidance Overview] DOL Finalizes Rule to Expand Associated Health Plans
"AHPs will be open to the self-employed (working owners) if they meet certain hours worked requirements or have a level of income from self-employment that supports the cost of the individual's coverage. The proposed rule would have allowed an AHP to simply accept the certification of the working owner that he/she met those qualifications. The final rule ... offers flexibility while at the same time making it clear that AHP fiduciaries have a duty to reasonably determine and monitor that working owners meet the final rule's conditions for coverage." (Benefit Revolution)
When Retail Giants Like Walmart and Amazon Invade Healthcare
"Walmart and Amazon have each revolutionized other industries: What's to keep either or both of them from turning healthcare on its head, dethroning the sector's traditional powerbrokers in the process? ... Walmart's accessibility and its rapport with a wide range of consumers, especially among aging populations, could make it a logical partner for some providers. It could even be helpful in developing chronic care models[.]" (HealthLeaders Media)
[Guidance Overview] Green Light for AHPs
"The final rule [requires] that a group or association of employers have at least one substantial purpose other than the provision of health benefits to its members. This is defined quite broadly, and could include simply offering conferences, classes or educational material on business issues to members or conducting public relations activities such as advertising and education on business issues. The primary purpose of the group can be the provision of health insurance." (Kilpatrick Townsend)
[Guidance Overview] DOL Expands Access to Association Health Plans
"Opposition to the expansion of AHPs has primarily focused on: [1] The potential for fraudulent and thinly capitalized AHPs that fail to pay participants' medical claims; [2] The reduced consumer protections applicable to AHPs, because large AHPs would be able to obtain health coverage on the large group market; and [3] The potential that the expansion of AHPs could make the small group and individual health insurance markets less stable by diverting healthy individuals to AHPs. The Attorney Generals for New York and Massachusetts intend to file a lawsuit challenging the legality of the new regulations." (Mazursky Constantine LLC)
The Economic Cost of Disease
"Originally released in 2015 ... [this] study provided an assessment of the cost of absenteeism, presenteeism, and early withdrawal from the workforce.... This year ... the study has been updated to capture the costs associated with workforce withdrawal for informal caregiving. The findings are alarming, showing a 7.7% loss in GDP in 2015, projected to rise to 8.6% of lost GDP by the year 2030." (U.S. Chamber of Commerce)
The Latest in Texas v. United States
"A range of stakeholders ... filed briefs. Only one of these briefs ... was filed in support of the lawsuit; all the others highlight the positive impact of the ACA and the harm and chaos that will ensue if the states' legal challenge is successful.... The brief by the legal experts is a worthwhile read on the issue of severability." (Katie Keith, in Health Affairs)
[Guidance Overview] DOL Releases Association Health Plan Regulations
"The final rule does not remove the current facts and circumstances-based commonality of interest rules test. Rather, the final rule contains additional ways in which groups may come together ... [T]he commonality of interest test is an 'or' test rather than an 'and' test, meaning that groups or association members are either all in the same trade or business or the members are in the same region." (Holland & Knight)
[Guidance Overview] A New Pathway to Healthcare Delivery: Association Health Plans
"At least two states (Massachusetts and New York) are threatening to sue the Trump administration over this new rule.... In several states, group health insurance laws will need to be revised to permit individuals and small groups to participate in AHPs if they are not otherwise members of pre-existing tax-qualified bona fide associations.... [M]any states do not permit the inclusion of sole proprietors and individuals in group insurance arrangements." (Winston & Strawn LLP)
[Opinion] Reasons Why Employers -- And New Ventures -- Won't 'Disrupt' U.S. Healthcare
"Employer Sponsored Insurance (ESI) isn't the product of intelligent system design. In fact, there's no clinical, fiscal or moral argument to support this unique financing model at all.... Whatever the business of private industry ... unless they are literally in the business of healthcare, the vast majority have no specific healthcare domain expertise ... Unlike Medicare or Medicaid, ESI ... supports inelastic healthcare pricing because it is literally whatever the market will bear based on group purchasing dynamics.... ESI -- and the employment process known as open-enrollment -- is arbitrarily tied to our annual tax calendar, but that has no correlation or applicability to how healthcare actually works." (Dan Munro, in Forbes)
[Guidance Overview] DOL Issues Final Rule Expanding Opportunities for 'Bona Fide' Association Health Plans Under ERISA
"[T]he final rule's preamble states that the new rule is not intended to replace or supplant the Department's existing 'sub-regulatory' guidance regarding 'bona fide' AHPs. Instead, the final rule provides an additional basis for groups or associations to meet the definition of 'employer' under ERISA section 3(5). Thus, only those arrangements established pursuant to the new rule are subject to the new rule's standards.... It is widely expected that multiple states and some insurers will challenge the legality of the new rule. Such challenges may delay (or even eliminate) implementation of AHPs pursuant to the new rule." (ERISA Law Practice, LLC)
Administration Proposal Rolls Out Proposal to Combine DOL and DOE
"The White House unveiled a proposal to combine the Labor and Education departments into a single agency with four subgroups, blending everything from enforcement to workforce development. The June 21 reorganization report calls for the two departments' sprawling assortment of subdivisions to be folded into agencies called K-12; the American Workforce and Higher Education Administration (AWHE); Enforcement; and the Research, Evaluation, and Administration agency. The new Cabinet agency would be called the Department of Education and the Workforce." (Bloomberg BNA)
Five New Members Appointed to 2018 ERISA Advisory Council
"Current members Cynthia Levering and Srinivas Dharam Reddy will serve as the chair and vice chair, respectively, of the council.... The newly appointed members and the expertise they represent are: [1] Employers: David J. Kritz is General Attorney for Norfolk Southern Corporation ... [2] Corporate Trust: Linda M. Kerschner is a Senior Vice President of CAPTRUST Financial Advisors ... [3] General Public: David Blanchett is Head of Retirement Research at Morningstar Investment Management ... [4] Investment Management: Jason Bortz is Senior Vice President and Senior Counsel at Capital Group ... [5] Employee organizations: Bridget O'Connor is General Counsel of the International Union of Bricklayers & Allied Craftworkers (BAC)." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
DOL Finalizes AHP Rule in Slightly Narrower Form
"Like the version proposed in January, the final rule allows employers with a 'commonality of interest' to offer joint coverage without many of the restrictions that previously applied to coverage provided through associations. Under the final rule, however, a group offering an AHP must have at least one 'substantial business purpose' besides providing benefits, though doing so still may be its principal purpose.... DOL deleted a provision from the proposed rule that would have disqualified individuals eligible for group health coverage from another employer or a spouse's employer." (HR Daily Advisor)
[Guidance Overview] Final Rule Rapidly Eases Restrictions on Non-ACA-Compliant Association Health Plans
"The changes finalized by the Department include relaxing a long-standing 'commonality of interest' requirement that associations must exist for a reason other than offering health insurance and allowing self-employed 'working owners' to enroll in AHP coverage.... The rule does not disturb state regulatory authority over AHPs, but the Department leaves open the potential of granting exemptions for AHPs from state requirements in the future." (Katie Keith, in Health Affairs)
[Guidance Overview] DOL Issues Final Rules for Association Health Plans
"Employers may band together in an association for the purpose of obtaining health coverage.... These rules will be implemented in three stages based on complexity and beginning with the least complex.... [S]tate MEWA laws will play a vital role in the overall adoption of AHPs as they may limit the viability of these plans in certain markets." (HUB International)
New Association Health Plan Rules Present Opportunity for Small Businesses
"Key highlights of the new rules ... [1] Permits associations in different industries or businesses that share a common geographic locale (such as, state or city) to offer health plans.... [2] Allows sole proprietors to participate in an AHP. [3] Allows existing AHPs to continue on under the previous regulations.... [4] Associations that are interested in forming a fully-insured health plan are expected to be able to do so beginning on September 1, 2018. [5] The final regulations say associations must still have a substantial purpose other than providing healthcare coverage." (Mercer)
[Opinion] Texas v. United States: What Did The DOJ Do? (PDF)
"The error in the DOJ's position is that it views Congress's decision to repeal the individual mandate through the lens of the 2010 decision to pass the ACA and the Supreme Court's decision in NFIB. In 2010, Congress made explicit findings that the individual mandate was essential to the guaranteed issue and community rating provisions, implying that the other two would not function if the individual mandate was struck down." (National Health Law Program [NHeLP])
Administration Eases Way for Small Businesses to Buy Insurance in Bulk
"By effectively shifting small-business coverage into the large-group market, it exempts such plans from ACA requirements for 10 'essential' health benefits, such as mental health care and prescription drug coverage, prompting warnings of 'junk insurance' from consumer advocates. Supporters say the new [DOL] rules, which the government estimated could create health plans covering as many as 11 million people, will lead to more affordable choices for some employers." (Kaiser Health News)
Association Health Plan Expansion Sparks Fraud Concerns
"Without effective state oversight, fake association health plans could saddle patients with large and unpaid medical bills and even threaten their health ... [T]he final rule has to be clear that states have broad authority to regulate association health plans in tandem with the federal government." (Bloomberg BNA)
HHS Secretary Pressed by Senate Committee on Administration's Drug Pricing Plan
"[HHS Secretary Alex Azar] outlined the strategies in the President's blueprint and argued, 'We have begun to take action on each of them already.'... He cited creating incentives for lowering list prices set by drug companies, better negotiating for Medicare Part B and D, stopping drug companies who are unfairly blocking competition, and curbing out-of-pocket costs by ensuring that patients pay the lower-cost drug option." (HealthLeaders Media)
Appeals Court Finds Insurers Not Entitled to Risk Corridor Payments
"The court agreed with the Trump administration that insurers are not owed any money, because congressional Republicans passed legislation that required the program to be budget neutral.... Dozens of other insurers have filed similar lawsuits over the risk corridors. All told, insurers say the government owes them nearly $12 billion." [Moda Health Plan, Inc. v. U.S., No. 2017-1994 (Fed. Cir. June 14, 2018)] (The Hill)
ACA Lawsuit Could Have Spillover Effect on Employer-Provided Health Plans
"[If] the Texas lawsuit is successful, it could ... put a squeeze on the support system and affordability of employer-provided insurance, particularly those employers with 50 or fewer workers.... [As] 130 million U.S. adults under age 65 have a health issue that could be considered as pre-existing, particularly if they were to apply for new health insurance or have a lengthy coverage gap between jobs." (Winston-Salem Journal)
Following Repeal of the Individual Mandate, Twenty States Challenge the ACA
"Attorney General Jeff Sessions delivered a letter to House Speaker Paul Ryan on June 7, 2018, indicating that the Attorney General's Office, with approval from President Trump, will not defend the constitutionality of the individual mandate ... While the merits of the litigation appear to be dubious, it nonetheless represents a mortal threat to the ACA and its popular protections for pre-existing conditions." (Sheppard Mullin)
Insurers Not Owed Risk Corridor Payments
"The Federal Circuit concluded that Section 1342 does obligate the government to make full risk corridors payments. However, this obligation was temporarily suspended by subsequent appropriations riders that required HHS's risk corridors payments to be budget neutral (meaning that HHS could pay out no more than it received in risk corridors payments). The court found that Congress intended to cap risk corridors payments in this way via the appropriations process, even though it did not amend the underlying statute, Section 1342." [Moda Health Plan, Inc. v. U.S., No. 2017-1994 (Fed. Cir. June 14, 2018)] (Katie Keith, in Health Affairs)
Physician Groups Wade Into Latest ACA Legal Battle
"Physicians are siding with the [ACA], and Democrats, in a lawsuit brought by GOP state leaders and supported by the Trump administration.... Groups on the amicus brief include the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry. They argued that Republican attorneys general lacked standing because they could not prove their states had suffered harm or injury from the ACA." (FierceHealthcare)
House Committee Considers HDHP/HSA Enhancements (PDF)
"[T]he House Ways and Means Committee's Subcommittee on Health held a hearing focusing on ways to improve access to and increase flexibility in establishing HSA-compatible, high-deductible health plans. While Congress is not likely to act on these proposals before mid-term elections in the fall, they could ultimately propel future legislation on this topic." (Conduent)
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