A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Study finds less market competition contributes to higher premiums

Posted on August 13, 2014 | Comments Off

A study by the Urban Institute analyzed marketplaces in 10 states finding that in states largely dominated by one insurer, such as Alabama, Arkansas, Rhode Island and West Virginia, premiums are generally higher. In the more competitive markets- Colorado, Maryland, Massachusetts, New York, Oregon, and Virginia, the authors often found limited provider networks, which allows insurers to keep premiums low. However, these limited networks may hinder access to certain providers

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Report proposes theoretical ACA alternative

Posted on August 13, 2014 | Comments Off

Manhattan Institute Senior Fellow Avik Roy proposed a health care plan that guarantees “near universal coverage and permanent fiscal solvency.” The Universal Exchange Plan would repeal the Affordable Care Act’s (ACA) individual and employer mandates and would transition Medicaid beneficiaries and future retirees into reformed health exchanges. The Manhattan Institute predicts the plan would expand coverage to 12.1 million more Americans than the ACA by 2025 and decrease individual market premiums 17 percentage points by 2020.

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CMS publishes Medicare pay final rule

Posted on August 5, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued a final rule revising the Medicare hospital inpatient prospective payment systems (IPPS). In adherence to the Affordable Care Act (ACA), part of the rule would effectively reduce payments to disproportionate share hospitals (DSH), which serve the most vulnerable patients. DSH payment reductions are a result of the expansion of Medicaid, however in states that chose not to expand, hospitals still risk losing some payment for uncompensated care.

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Issue brief examines health plan quality improvement efforts

Posted on July 29, 2014 | Comments Off

In a new issue brief published by the Commonwealth Fund, researchers from Georgetown’s Center on Health Insurance reforms reviewed state action in selective contracting, informing consumers about health plan quality, and collecting data on insurers’ quality improvement efforts. The study found that 13 state-based marketplaces have taken action to implement the Affordable Care Act’s (ACA) quality improvement goals. The authors also assess technical and operational challenges states face in using the Marketplace to help drive system wide change in health care delivery.

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Study looks at remaining uninsured

Posted on July 29, 2014 | Comments Off

A new study by the Urban Institute funded by the Robert Wood Johnson Foundation finds that two-thirds of the nation’s remaining uninsured adults have incomes at or below 138 percent of the federal poverty level (FPL). While this is the target population of the Affordable Care Act’s (ACA) Medicaid expansion, 40 percent of the uninsured live in states that chose not to expand Medicaid. The study found that affordability was the main reason people did not get health insurance, yet many uninsured individuals had limited awareness of potential financial help available to them.

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CMS issues regulations on premium payment

Posted on July 24, 2014 | Comments Off

The Center for Consumer Information and Insurance Oversight (CCIIO) and the Centers for Medicare & Medicaid Services (CMS) issued Federal guidance which gives individuals a three-month grace period to pay a premium without losing coverage. However, the same guidance states that if individuals choose enroll in a new policy for 2015, insurance companies cannot apply new premiums to outstanding 2014 debt. Some have suggested that this inconsistency could allow consumers to avoid paying their December premiums. However, nothing bars an insurer from making a bona fide effort to collect any unpaid premiums, as the consumer would still owe this amount to the insurer.

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IRS releases final rules on tax credit and drug fee

Posted on July 24, 2014 | Comments Off

The Internal Revenue Service (IRS) published a final rule clarifying its premium tax credit policy for those enrolling in health plans through Affordable Insurance Exchanges with complicated family and household situations. The rule clarifies that certain married individuals, including spouses in abusive relationships, and divorced or separated taxpayers, can be considered not married for the purposes of the Internal Revenue Code, under Section 7703(b).

The agency also released a final rule regarding the implementation of the Affordable Care Act’s (ACA) branded prescription drug fee. The rule  provides guidance on the annual fee imposed on covered entities engaged in the business of manufacturing or importing branded prescription drugs.

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10.3 million adults estimated to have gained coverage under the ACA

Posted on July 24, 2014 | Comments Off

A new study published in the New England Journal of Medicine found that an estimated 10.3 million adults gained insurance coverage under the Affordable Care Act (ACA).  The study, performed by Harvard researchers, reported a 5.2% decline in the uninsured rate during the first open enrollment period.  Data analyzed for this project included Gallup polls and ACA enrollment statistics from the US Department of Health and Human Services (HHS).

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HRSA removes orphan drug exemption under 340B

Posted on July 22, 2014 | Comments Off

A rule released yesterday by the Health Resources and Services Administration (HRSA) clarifies a portion of the 340B program, which requires drug manufacturers to offer their pharmaceuticals at a discounted rate to covered entities.  Under 340B, a covered entity typically refers to healthcare providers treating medically vulnerable populations, such as Ryan White Clinics or Disproportionate Share Hospitals.  The new rule specifically removes the discount exemption for orphan drugs sold for off-label usage.  A recent lawsuit led to the promulgation of this interpretative rule,  as many orphan drugs are used to treat conditions other than the rare conditions for which the drugs were created.

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Courts issue conflicting ACA decisions

Posted on July 22, 2014 | Comments Off

Today, two federal appeals courts issued contradictory decisions regarding the availability of advanced premium tax credits, or subsidies, for federally-facilitated marketplaces (FFM).  In a 2-1 decision in Halbig v. Burwell, the US Court of Appeals for the DC Circuit ruled that the Internal Revenue Services (IRS) did not possess the authority to issue subsidies for qualifying individuals enrolling in FFM.  In a similar case entitled King v. Burwell, the Fourth Circuit Court of Appeals in Richmond unanimously upheld that subsidies may be offered by the IRS in both federally-facilitated and state-based Marketplaces.  Under the Affordable Care Act (ACA), individuals earning 400% or less of the federal poverty level may receive subsidies in order to offset some of the premium costs for obtaining health insurance through the ACA Marketplaces.  The differing opinions issued today indicate that this issue will likely be taken up by the Supreme Court.

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