Highmark could soon be in good company in suing the federal government over Affordable Care Act reimbursement.
Other insurers have contacted Highmark since the Pittsburgh carrier filed a lawsuit Tuesday over reimbursement for losses incurred in providing coverage under the ACA, president and CEO David Holmberg said Wednesday. The companies are weighing their options to recoup billions of dollars they say are owed, he said.
“The losses were pretty significant,” Mr. Holmberg said. “We ended up with the other companies standing here holding the bag. We saw no path forward.”
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Top Republicans on the House Energy and Commerce Committee sent letters this week seeking more information about the financial status of the 11 remaining co-ops created under the Affordable Care Act.
Reps. Fred Upton (R-Mich.), Tim Murphy (R-Pa.) and Joe Pitts (R-Pa.) say they want to better understand the financial challenges the co-ops are facing and ensure the Centers for Medicare and Medicaid Services is taking the “necessary and appropriate steps” to keep the co-ops functioning. The agency has placed eight of the remaining co-ops on corrective action plans, and 12 had closed by the start of 2016.
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Americans’ spending on prescription drugs has soared over the past few years. Hillary Clinton has blamed “price gouging” by drug companies and called for more Washington control. A far more likely culprit is actually ObamaCare. The health care law was sold on the false promise that costs would come down if Americans gave Washington more control over their health care. Instead, costs have soared in every aspect of health care, including prescription drugs.
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It’s been six years since the passage of the Affordable Care Act and it’s still unpopular with the voters. Hardly a week goes by without the discovery of new problems and new victims.
Paul Ryan says he wants an alternative. Donald Trump does too. Republicans in the House are actually trying to come up with something. But if past Republican proposals are a guide, there is a danger they will propose something most people see as Obamacare lite. There is even a chance they could propose something that is more unpopular than Obamacare itself.
John C. Goodman lists eight ideas Republican health reformers should avoid if they want to be successful in the November elections.
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Though it was more a TKO than a straight-up ruling, the Little Sisters of the Poor prevailed at the Supreme Court on Monday in their fight against the ObamaCare contraceptive mandate.
True, the justices made clear that they were not ruling on the merits, which is why so many headlines speak of the court’s having “punted” on the case. Even so, in a unanimous decision they made the path forward much easier for the sisters and much more difficult for the Obama administration.
To begin with, the justices vacated the lower-court rulings the sisters were fighting. The parties, the court said, should have another opportunity to work out a way to deliver contraceptives that doesn’t violate the religious objections of the Little Sisters and their co-plaintiffs.
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Last Thursday, the Obama administration suffered a legal setback, when a federal judge in Washington ruled that the administration exceeded its authority by paying out cost-sharing subsidies to health insurers under the Affordable Care Act.
The administration will doubtless appeal the case, which was brought by the Republican-led House of Representatives, but whether those appeals succeed may well depend on whether courts view the case as one of statutory interpretation, or one with constitutional implications.
In its briefs in the case, the administration tried to portray House v. Burwell as a successor case to King v. Burwell, another lawsuit surrounding Obamacare subsidy payments, which the Supreme Court decided in June 2015.
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Major insurer Highmark Inc. is suing the federal government, saying the feds failed to live up to obligations to pay the insurer nearly $223 million from an ObamaCare program known as “risk corridors,” which aimed to limit the financial risks borne by insurers entering the new health-law markets. The suit is likely to draw close attention because it comes from a company that continues to be a major player in the exchanges.
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Obamacare has caused health insurance premiums to skyrocket. It has caused millions of Americans who liked their health plans to lose their health plans. It has caused doctor and hospital networks to narrow. Now the Wall Street Journal reports that the Obamacare exchanges in Alabama and Alaska will each have one—that’s right, one—insurer offering plans. We’re moving toward “single insurer” health care.
In short, Obamacare is wrecking the private health insurance market.
The Congressional Budget Office says that the Obamacare subsidies for private insurance will cost $43 billion this year alone. That’s an average of $5,375 per person for those who have been added to the private insurance rolls—or $21,500 per family of four. Meanwhile, the typical 36-year-old (or younger) who makes $36,000 a year (or more) gets $0 under Obamacare.
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The Supreme Court unanimously remanded a case challenging the ACA’s contraceptive mandate back to the United States Courts of Appeals for the Third, Fifth, Tenth and D.C. Circuits. The decision will give the parties an opportunity to reach a compromise that “accommodates petitioners’ religious exercise” while ensuring women covered by the petitioner’s health plans receive coverage that includes contraception. The Beckett Fund for Religious Liberty, which brought the lawsuit one behalf of the Little Sisters of the Poor, called the ruling a win for the petitioners.
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The third open enrollment period (OEP) for the public exchanges concluded in January. Many carriers—both early-OEP entrants and “wait-and-see” latecomers—believed this new market would achieve stability and sustainable margins in its third year. However, recent events— including carrier turnover (both entrances and exits), plan terminations, and pricing volatility—suggest the market is still in flux.
One reason for the flux is the variability of individual market financial performance many carriers have disclosed publicly. For some carriers, significant losses are causing marked changes in enterprise-level capital, cost structures, and strategy. Early indications of 2015 performance suggest aggregate negative margins may have doubled; to date, however, only 86% of carriers have released preliminary data publicly. We anticipate that our estimates will evolve as more information is released, such as final 3R results and rebates, as well as 2015 claim run-out and adjustments. Whether carriers’ performance in the individual market will improve in 2016 remains unclear.
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