ACA Round-Up: Hospital Nonprofit Status, ACA Nondiscrimination Litigation, And More

A round-up of ACA-related developments, including hospital compliance with requirements for nonprofit status, litigation over protections against gender identity and pregnancy termination discrimination, a decision to continue CSR payments next month, developments on “bare” counties, and more.

August 18, 2017

Terminating CSR Payments Would Increase Deficits, CBO Finds

On August 15, CBO and JCT released an analysis of the potential effects of terminating the ACA’s cost-sharing reduction (CSR) payments to insurers. The CBO affirms what earlier analyses have concluded: in the long run the primary loser if CSR payments are terminated would be the federal budget.

August 15, 2017

If The Trump Administration Terminates Cost-Sharing Reduction Payments, States Can Use 1332 Waivers To Fund Their Own

Creating a State-administered CSR mechanism will undoubtedly require expenditure from the State. While some will argue that the limited resources in State budgets would render the idea all but theoretical, it would be beneficial to examine how States can use Section 1332 to fund CSRs.

August 15, 2017

New Guidance On CSR Payments And Risk Adjustment: Answers … And More Questions

The ongoing saga of the cost-sharing reductions just got stranger. On August 10, 2017, the Centers for Medicare and Medicaid Services released at their website a guidance on risk adjustment methodology and rate filing deadlines.

August 11, 2017

Uncertainty On CSR Payments, Mandate Still Weighs On Insurer Exchange Participation And Premiums

As we approach the deadline for insurer decisions regarding the exchanges and then the beginning of open enrollment, uncertainty surrounding administration intentions on cost-sharing reduction payments and individual mandate enforcement continue to take a toll.

August 10, 2017

Suggestions For A Bipartisan Approach On Health Care

There are many differences between the ACA and GOP replacement proposals, and details matter. Nonetheless, the similarities provide a starting point for discussion that could bring about compromise on health reform.

August 10, 2017

Making The Exchanges More Competitive By Bringing Medicare Into The Fold

There is a better approach to bring more insurers into the individual market: allow Medicare to enter the market in counties where fewer than three health insurers participate on the exchange.

August 9, 2017

Insurers Score Another Risk Corridor Win; New Guidance On Consumer Assister Training

On August 4, 2017, judgment was awarded for another insurer in a risk corridor case in the Court of Federal Claims, this time for Molina. And CMS issued new guidance for the training of navigators and CACs.

August 7, 2017

Supporting The Individual Health Insurance Market

The current market status can be traced back to a series of regulatory and implementation failures that served to undermine the market. A set of regulatory and legislative changes, alongside the assurance of operational and regulatory certainty for issuers, could put it back on track.

August 7, 2017

Appellate Ruling Deals Setback To Opponents Of Contraceptive Coverage Mandate

A new appellate ruling holds that an employer that objects on moral, not religious, grounds to contraceptive coverage must still provide such coverage, and individuals who object to contraceptives on religious grounds need not be allowed to purchase insurance that does not cover them.

August 6, 2017