New summary explores recently issued rules for market stabilization

In follow-up to Tom Entrikin’s article last week about the Centers for Medicare and Medicaid Services (CMS) proposed rules to stabilize health insurance markets, subject matter experts from PCG’s Health practice have released a new summary of the Proposed Affordable Care Act (ACA) Market Stabilization Rules. The proposed rules make changes to ACA-related regulations; they are not a part of a repeal effort but seek to increase flexibility in line with the President’s ACA Executive Order. With the goal of stabilizing the individual and small group markets, the rules tighten enrollment timelines and rules while expanding flexibility for the design of Qualified Health Plans (QHP). [More]

CMS proposes rules to stabilize health insurance markets

On February 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued draft proposed regulations intended to stabilize the individual and small group health insurance markets under the Affordable Care Act (ACA). The proposed rules would shorten the open enrollment period for 2018, amend standards on special enrollment periods, increase pre-enrollment verification of eligibility on the HealthCare.gov website, allow health insurance issuers to apply consumers’ payments to past unpaid debts for coverage, increase allowable variations in the actuarial value (AV) calculations, offer more flexibility in substantiating provider network adequacy, and facilitate insurers’ compliance with essential community provider (ECP) standards. [More]

The Obamacare Replacement Act

Senator Rand Paul introduced the Obamacare Replacement Act on January 25th, which would repeal much of Title 1 of the Affordable Care Act (ACA), including:

• Most consumer protections (except as outlined below)
• Rating restrictions
• Rate review requirements
• Essential Health Benefits
• Medical loss ratio requirements
• Individual and employer coverage mandates [More]

Patient Freedom Act of 2017

On January 23rd, Senators Bill Cassidy and Susan Collins introduced the Patient Freedom Act of 2017 to largely repeal and replace Title 1 of the Affordable Care Act (ACA), which includes insurance reforms. Certain ACA provisions would remain, including changes to the Medicaid program (e.g., Medicaid expansion) and Medicare and ACA revenue provisions. [More]

Administrative Action

Immediately upon entering office, President Trump signed an Executive Order on January 20th entitled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal” stating his commitment to repealing the Affordable Care Act (ACA) and directing administration officials to avail themselves of existing authority to provide flexibility in administration of the ACA. While the Executive Order provided no new authority and made no policy changes itself, it did provide examples of flexibility that should be exercised. [More]

Where is “Prevention” in the ACA Replacement Debate?

The main goal of the Affordable Care Act (ACA) was to extend insurance coverage to millions of Americans left out of the health insurance markets, such as low-income parents ineligible for Medicaid or individuals unable to access employer-sponsored coverage. Rightfully, the terms of the ACA “Replacement” debate have been framed around alternative ways for meeting this goal, with most replacement plans distinguished and measured by the various mechanisms they propose to substitute for the insurance exchanges and Medicaid expansion measures used by the ACA to improve Americans’ access to health care. [More]

Inauguration Day – Get up to speed on Medicaid Block Grants

With Inauguration Day upon us, the discussion on the future of healthcare in the US and specifically the Affordable Care Act (ACA) will continue to be a major headline as the new administration focuses its efforts to ‘repeal and replace’ the ACA. While much of the attention has been on the plans of the Republican administration and Republican-led Congress to ‘repeal and replace’ the ACA, the discussion on the future of healthcare in the US has included the possibility for a major shift in the funding for the Medicaid program. [More]

CMS issues final rule on eligibility, appeals, and enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and Exchanges pursuant to the Affordable Care Act (ACA)

On November 30, 2016, a final rule issued by the Center for Medicare and Medicaid Services (CMS) was published in the Federal Register (81 Fed. Reg. 86382), which, according to the preamble of the regulation, “continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the ACA.” [More]

Foster Care and Medicaid

Under the Affordable Care Act (ACA), youth who were in foster care and receiving Medicaid on their 18th birthday are categorically eligible for Medicaid until their 26th birthday, regardless of their income. The provision in the law aligned with the extended coverage of young adults whose parents have private health insurance. On October 18, 2016, Columbia University’s School of Public Health released a policy brief reporting that an estimated 180,000 young people who have aged out of foster care are eligible for extended health care coverage. [More]

JAMA reports on Medicaid expansion research findings

On August 8, 2016, the Journal of the American Medical Association published a report entitled, “Changes in Utilization and Health among Low-Income Adults after Medicaid Expansion or Expanded Private Insurance.” The report analyzes access to care, utilization of services, and self-reported health status among low-income adults in three states that have taken different approaches under the Affordable Care Act (ACA): a traditional Medicaid expansion, a “private option” Medicaid expansion, and non-expansion. [More]