Health Affairs

At the heart of the Affordable Care Act (ACA) health care reforms are the premium tax credits, which will extend health insurance coverage to 18 million lower and middle-income Americans.  The idea of using tax credits to purchase private health insurance for the uninsured is one of a number of the historically conservative policy positions... Read the rest of this entry »

On May 16, 2012, the Department of Health and Human Services moved three steps closer to the implementation of the Affordable Care Act’s health insurance exchanges, which will happen on January 1, 2014.  First, HHS announced the award of 5 new level 1 exchange establishment grants (Illinois, Nevada, Oregon, South Dakota, and Tennessee) and one... Read the rest of this entry »

The two most significant—and controversial–Affordable Care Act (ACA) insurance reforms of 2012 are the minimum medical loss ratio (MLR) rebate and the summary of benefits and coverage (SBC) requirement.  On Friday, May 11, 2012, further regulatory guidance was released on both of these initiatives. Tidying Up The MLR Rules The minimum medical loss ratio requirement... Read the rest of this entry »

On May 9, 2012, the Center for Medicare and Medicaid Services released proposed regulations to implement section 1202 of the Health Care and Education Reform Act of 2010. Section 1202 increases Medicaid payments made to primary care physicians for primary care services during the years 2013 and 2014 to Medicare payment rates, with the additional... Read the rest of this entry »

The Supreme Court continues to mull the fate of the Affordable Care Act.  The House of Representatives continues to push budget bills that would defund ACA programs.  Many state legislatures have adjourned for the year without taking significant action to implement state exchanges.  But ACA implementation continues its onward march as the federal agencies —... Read the rest of this entry »

Although the media and public have focused on the question of the constitutionality of the minimum coverage requirement, it is arguable that the most important question before the Court in the Affordable Care Act litigation is in fact the constitutionality of the statute’s Medicaid expansions.  The ACA provides that as of January 1, 2014, Medicaid... Read the rest of this entry »

The central issue in the Supreme Court Affordable Care Act (ACA) litigation is the constitutionality of the minimum coverage requirement (individual mandate).  If the Court decides that the requirement is unconstitutional, it must next decide how much of the rest of the ACA must be stricken with it. It could strike the requirement and leave... Read the rest of this entry »

The central issue in the Affordable Care Act (ACA) litigation, or at least the issue that has received the most media and public attention, is the constitutionality of the minimum coverage requirement, commonly called the individual mandate.  Section 5000A of the Internal Revenue Code, added by the ACA provides: An applicable individual shall for each... Read the rest of this entry »

The first day of Supreme Court oral arguments on the Affordable Care Act focused on the Anti-Injunction Act (AIA).  This statute, enacted in 1867, provides that “no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person, whether or not such person is... Read the rest of this entry »

On March 16, 2012, the Center on Medicare and Medicaid Services of the Department of Health and Human Services released its final rule on eligibility changes for Medicaid that will take effect under the Affordable Care Act (ACA) on January 1, 2014.  A notice of proposed rulemaking (NPRM)  had been published on August 17, 2011,... Read the rest of this entry »

On March 16, 2012, the Department of Health and Human Services published a final rule regarding student health plans, an advanced notice of proposed rulemaking explaining how it intends to handle coverage of contraception services, and a notice regarding the early retiree reinsurance program.  This blog post addresses these issuances.  Separate blog posts will address... Read the rest of this entry »

On March 16, 2012, the Department of Health and Human Services published a final rule on the implementation of the reinsurance, risk adjustment, and risk corridor programs which are to be put in place under the Affordable Care Act (ACA), effective January 1, 2014. HHS also published final (and interim final) rules on Medicaid eligibility... Read the rest of this entry »

On March 12, 2012, the Department of Health and Human Services promulgated final regulations governing the establishment of the American Health Benefit Exchanges.  The exchanges are at the heart of the Affordable Care Act strategy for making health insurance available and affordable to millions of Americans in the individual (nongroup) and small group markets. The... Read the rest of this entry »

On February 22, 2012, the Department of Health and Human Services (HHS) issued two final regulations implementing sections of the Affordable Care Act (ACA). The two regulations effectuate 1) an ACA provision that will offer the states flexibility in implementing key ACA requirements beginning in 2017, and 2) an ACA amendment to a section of... Read the rest of this entry »

Although public and media attention has been focused on the Affordable Care Act litigation pending in the Supreme Court, the Court’s February 22 decision in Douglas v. Independent Living Center is also of great importance.  The decision involved lawsuits brought by Medicaid providers and recipients claiming that California Medicaid payment cuts violated federal law. Medicaid... Read the rest of this entry »

On December 16, 2011, the Department of Health and Human Services issued a bulletin describing the approach that it intended to take to defining the essential health benefits (EHB) that individual (nongroup) and small group plans must cover under the Affordable Care Act.  In that bulletin, HHS indicated that each state will select a benchmark... Read the rest of this entry »

Editor’s note: Another Health Affairs Blog post, by Mila Kofman and Sabrina Corlette, also discusses the February 9 final rule implementing Affordable Care Act (ACA) requirements that health plans provide consumers with short, easy to understand summaries of benefits and coverage. Tim Jost’s post below discusses this new rule; additionally, it has also been updated... Read the rest of this entry »

Briefs continue to be filed at a furious pace in the Affordable Care Act Supreme Court litigation.  On January 6, the federal government led off with its brief challenging the decision of the Eleventh Circuit federal court of appeals that the ACA’s minimum coverage requirement (individual mandate) is unconstitutional.  The states and the National Federation... Read the rest of this entry »

As every reader knows, the Supreme Court has agreed to consider challenges that have been brought to the constitutionality of two provisions of the Affordable Care Act (ACA) by twenty-six states, the National Federation of Independent Businesses, and individual plaintiffs.  The Court has scheduled the case for five and a half hours of oral arguments... Read the rest of this entry »

On December 16, 2011, HHS released a “bulletin” describing the approach that it intends to take to establishing the “essential health benefits” under the Affordable Care Act.  A bulletin is a form of guidance that lacks the legal stature of a rule.  HHS believed, however, that the states, insurers, consumer advocates, and the public needed... Read the rest of this entry »