Tag Archives: exchanges

Market Stabilization: To Be or Not to Be?

The Centers for Medicare and Medicaid Services (CMS) published a Final Rule intended to stabilize the individual and small group insurance markets on April 18, 2017. Reflecting the urgent need to address the uncertainty afflicting the markets, CMS advanced the rule from proposed to final form in just two short months despite receiving more than … Continue Reading

AHCA: The Republican House Leadership Proposal to Change the ACA

Late Monday afternoon, House Republican leaders released a two-bill legislative package to “repeal and replace” the Affordable Care Act (ACA). Collectively called the “American Health Care Act” or “AHCA,” the two bills drafted by the Energy and Commerce and Ways and Means Committees reflect efforts by the GOP to identify provisions in the ACA that … Continue Reading

Reducing the Regulatory Stranglehold on Federally Facilitated Exchanges: Will It Work?

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule aimed at improving the individual and small group markets that have been plagued with instability as issuers continue exiting the Exchanges. While the proposed rule is primarily focused on the Federally-facilitated Exchanges (FFEs), CMS is encouraging state-based Exchanges to adopt similar policies. … Continue Reading

Capitol Hill Healthcare Update

At GOP retreat, consensus on healthcare elusive House and Senate Republicans emerged from a policy retreat last week in Philadelphia with no agreement on next steps in their plan to repeal and replace the Affordable Care Act (ACA). Most congressional leaders, including House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), urged rank-and-file lawmakers to … Continue Reading

U.S. House of Representatives v. Burwell: A Failure to Appropriate, Not a Failure in Drafting

“A most curious and convoluted argument whose mother was undoubtedly necessity,” wrote Judge Rosemary M. Collyer in describing the argument made by the U.S. Department of Health and Human Services (HHS) to uphold the constitutionality of cost-sharing reduction payments to insurers under Section 1402 of the Affordable Care Act (ACA). On May 12, 2016, the … Continue Reading

The 2017 Exchange Regulations: Network Adequacy Challenges Remain

The impact of these rules will be felt widely among the provider community as it struggles to face increasing pressures resulting from the plans’ continually narrowing networks The Centers for Medicare and Medicaid Services (CMS) recently issued the final 2017 Benefit and Payment Parameters Rule (Final Rule) and concurrently released a final 2017 Letter to … Continue Reading

King v. Burwell: “Thy name is an opinion on the Affordable Care Act”

The U.S. Supreme Court in King v. Burwell, upheld the availability of subsidies to individuals who purchase health insurance on either a state or federal Exchange. While the Court’s 6-3 decision is being hailed politically as a major victory for the Obama Administration and the continuation of the Affordable Care Act (ACA), the legal implications … Continue Reading

The Sliding Scale of Health Coverage: Finding the Intersection of Cost, Access and Quality

While not a new concept, the use of narrow networks has become a lightning rod for the controversy surrounding qualified health plans (QHPs) offered on the insurance exchanges created under the Affordable Care Act (ACA) and the consumer satisfaction with access to physicians and care they expect they are purchasing. Narrowly tailored network designs, including … Continue Reading

Susan Feigin Harris and Christopher J. Swift Author Article on Hospital Premium Subsidies for Law360

In a June 24, 2014, article authored for Law360, partners Susan Feigin Harris and Christopher J. Swift discuss questions surrounding whether healthcare entities may subsidize premium payments for individuals enrolling in insurance through the health insurance exchange marketplaces established under the Affordable Care Act (ACA). In the article (“Risks and Rewards from Hospital Premium Subsidies”), … Continue Reading

Is It a Violation to Help?

In a May 21, 2014, letter to the President of the American Hospital Association (AHA), U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius confirmed HHS’s position that private, not-for-profit foundations may, within certain parameters, pay for premiums and cost-sharing expenses for enrollees in qualified health plans (QHPs) sold through the health insurance … Continue Reading
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