Category: Implementation

Health insurer CareSource will offer Affordable Care Act exchange plans in Ohio’s Paulding County, leaving no place in the U.S. currently known to be at risk of lacking marketplace offerings under the law next year.

The decision by CareSource, a nonprofit that focuses largely on Medicaid, caps a triumph for state regulators around the country, who have fought hard to fill potential bare patches in their coverage maps after insurers announced pullbacks over the past several months amid uncertainty about the law’s future.

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Under the ACA, insurance companies must sell polices to people with chronic diseases and charge the same premiums paid by healthy people. But patients with pre-existing conditions in fact are being denied coverage when their insurance plans don’t cover medically-recommended treatments or when they place significant obstacles in the way. Many plans impose “utilization management” rules restricting access to drugs. Dr. Blinderman suggests a “preauthorized trial period” for all medications. Following this trial period, physicians could be asked to justify continuation of the therapy. Doing this would relieve patient suffering due to delays or disruptions in the amelioration of symptoms, reducing health-care costs in the process.

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Iowa on Tuesday submitted to the federal government a final request to make changes to try to shore up its struggling ObamaCare insurance marketplace.

The plan from the Iowa Insurance Division is intended to be a short-term market stabilization solution to entice more insurers into the marketplace. The state is facing what it calls a “collapse” of its ObamaCare marketplace after all but one insurer declined to offer plans for 2018.

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For all the attention on various ways to improve Medicaid’s finances and sustainability in recent months, another key area of Medicaid policy that deserves focus is improving the state waiver process. With all the recent calls for bipartisanship, this should be an area where Democrats and Republicans can work together to improve the program.

Medicaid is a state-federal partnership and a critically-important safety net for millions of our nation’s most vulnerable patients. The program dates back to the Great Society era and will cover up to 98 million people and cost taxpayers more than $600 billion this year alone.

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The government will make this month’s payments to insurers under the Obama-era health care law that President Donald Trump still wants to repeal and replace, a White House official said Wednesday.

Trump has repeatedly threatened to end the payments, which help reduce health insurance copays and deductibles for people with modest incomes, but remain under a legal cloud.

A White House spokesman said “the August payment will be made,” insisting on anonymity to discuss the decision ahead of the official announcement. The so-called “cost-sharing” subsidies total about $7 billion this year and are considered vital to guarantee stability for consumers who buy their own individual health insurance policies.

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The Affordable Care Act (ACA) requires insurers to offer plans with reduced deductibles, copayments, and other means of cost sharing to some of the people who purchase plans through the marketplaces established by that legislation. The size of those reductions depends on those people’s income. In turn, insurers receive federal payments arranged by the Secretary of Health and Human Services to cover the costs they incur because of that requirement. At the request of the House Democratic Leader and the House Democratic Whip, the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have estimated the effects of terminating those payments for cost-sharing reductions (CSRs). In particular, the agencies analyzed what would happen under this policy: By the end of this month, it is known that CSR payments will continue through December 2017 but not thereafter.
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The Trump administration is giving health insurance companies more time to calculate price increases for 2018 because of uncertainty caused by the president’s threat to cut off crucial subsidies paid to insurers on behalf of millions of low-income people.

Federal health officials said the deadline for insurers to file their rate requests would be extended by nearly three weeks, to Sept. 5.

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U.S. health insurer Anthem Inc said on Monday it will no longer offer Obamacare plans in Nevada’s state exchange and will stop offering the plans in nearly half of Georgia’s counties next year.

The moves come after Republican senators last month failed to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

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The federal government owes health insurer Molina $52 million for payments it was supposed to receive involving losses under Obamacare, the U.S. Court of Federal Claims ruled Friday.

The payments, called “risk corridors,” were diminished as part of a spending bill advanced by Republicans, who referred to them as a “bailout” for the insurance industry. Withholding them contributed to losses for insurers and to the shutdown of nonprofit insurance co-ops created under the law.

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President Trump likes to govern by Twitter threat, which often backfires, to put it mildly. But he’s onto something with his recent suggestion that Members of Congress should have to live under the health-care law they imposed on Americans.

Over the weekend Mr. Trump tweeted that “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” He later added: “If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?”

Mr. Trump is alluding to a dispensation from ObamaCare for Members of Congress and their staff, and the back story is a tutorial in Washington self-dealing. A 2009 amendment from Chuck Grassley (R., Iowa) forced congressional employees to obtain coverage from the Affordable Care Act exchanges. The Senate Finance Committee adopted it unanimously.

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