Compliance
This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.
A provision of Obamacare that opponents once saw as a potential loophole allowing a Republican president to unravel the law by executive order is now being used by some states to steady their shaky Obamacare markets.
Health-care-related bankruptcies, touted as a key justification for passing Obamacare in 2010, are not nearly as prevalent as reform proponents such as Sen. Elizabeth Warren have claimed, researchers say.
The U.S. agency that administers Obamacare is freezing payments to insurers that cover sicker patients, saying a federal court ruling ties its hands. The move brought a sharp response from health insurers warning of market disruptions and higher costs.
Millennial employees—who now outnumber Baby Boomers—are more comfortable with nontraditional ways of engaging with their health care providers and are more likely to apply shopping habits associated with online retail to their health care decision-making, whether in a traditional or a high-deductible health plan, a survey by the nonprofit Employee Benefit Research Institute (EBRI) found.
The guidance reflects concerns CMS has expressed regarding consumer complaints, including some about brokers. CMS is considering a program to advise individual brokers if they have received complaints or have reason to believe that a broker has not adhered to Marketplace rules. The program which is under review and has been described to NAHU would be advisory in nature and would not be reported to state regulators.
The number of registered brokers and agents who help people sign up for coverage through the federal ACA insurance exchange continued to decline in 2018, despite the CMS' efforts to encourage their participation by making it easier for them to sign up customers during open enrollment.
Last year, as insurance prices rose by an average of just over 20 percent around the country, people who qualified for Obamacare subsidies hung onto their insurance. But the increases appear to have been too much to bear for many customers who earned too much to qualify for financial help.
President Trump may think top drugmakers are ready to step up with price cuts, but Pfizer, for one, is going the other way instead.
Billions of investment dollars have been poured into apps and websites that offer this virtual consultations with physicians, ranging from Doctor on Demand to American Well. The theory behind them is that millennials would opt for a digital alternative to an in-person physician's visit, if the option were available. And patients in remote, rural areas who are miles away from the nearest doctor would have few alternatives.
Doctors and teaching hospitals received $8.4 billion in payments from drug companies in 2017, according to the latest Open Payments data released by the Centers for Medicare & Medicaid Services.