Author: Scott Welch
Centene pulled back its guidance for the year after receiving an actuarial report suggesting its growth in the Affordable Care Act marketplaces will be lower than expected. The insurer said an analysis from Wakely predicted that market growth in 22 of its states will fall short of expectations, and “aggregate market mobility” in those regions ...
A new report from federal actuaries estimates national health spending will increase by 7.1% in 2025, with spending growth set to outpace growth in the U.S. gross domestic product. The Centers for Medicare & Medicaid Services Office of the Actuary released its annual look at spending projections last week, and it estimates that from 2026 ...
Doctors for America, the Main Street Alliance and three cities have sued the Centers for Medicare & Medicaid Services (CMS) over a recent Affordable Care Act (ACA) final rule the agency said will help counter improper enrollments. The plaintiff cities named in the lawsuit are Baltimore, Chicago and Columbus. The groups and cities say the ...
House fiscal hawks are looking at the math underlying Senate Republicans’ sprawling domestic policy legislation, and they don’t like what they see.
California Gov. Gavin Newsom signed on Friday a budget that pares back a number of progressive priorities, including a landmark health care expansion for low-income adult immigrants without legal status, to close a $12 billion deficit. It’s the third year in a row the nation’s most populous state has been forced to slash funding or stop some ...
The Affordable Care Act (ACA) established the Patient-Centered Outcomes Research Institute (PCORI) to fund research into the effectiveness, benefits, and harms of various medical treatments and interventions. This research is funded in part by the PCORI fee – an annual fee paid by: Health insurance carriers on fully insured medical plans, and Employers that sponsor self-funded medical plans (including ...
Effective July 1, 2025, Optum Rx is removing reauthorization for more than 60 drugs that treat chronic conditions. The newly added medications include treatments for seven chronic conditions, such as behavioral health, HIV, dry eye disease, high cholesterol and hypertension. “Chronic conditions affect about 60% of Americans and are the leading cause of death in ...
UC Health and Blue Shield of California, which are at an impasse over the terms of a new contract that could disrupt health care for thousands of Californians, have extended the deadline for reaching a new agreement from July 9 to Aug. 9. This means the thousands of Californians who get medical care at UC ...
Blue Shield of California is cutting broker commissions for new enrollments into Medicare Advantage PPO plans in Alameda, Orange and San Diego counties, effective July 1. The new policy does not affect commission payments of existing membership, according to a June memo sent to brokers. Several large insurers have cut MA commissions recently, including UnitedHealthcare, Elevance Health ...
The Supreme Court upheld a key preventive services task force in a 6-3 ruling issued Friday morning. The high court determined that members of the U.S. Preventive Services Task Force, which makes recommendations for coverage requirements under the Affordable Care Act, are selected within the bounds of the Constitution. In the case, Braidwood Management, an ...