American Health Line's Top 10 Stories of 2015

Topics: Care Delivery, Access to Care, Costs and Prices, Payments and Reimbursement, Health Care Reform, Exchanges, Employer-Sponsored Coverage, Individual Mandate, Medicaid, Medicare, Federal Government, Health Care Legislation, Regulatory, Providers

From Supreme Court cases challenging the Affordable Care Act to the ongoing saga of Medicare's two-midnight rule, American Health Line's coverage in 2015 focused on issues that would most affect U.S. residents and providers. What were the most popular stories among our readers? Look below for American Health Line's top 10 stories of 2015, based on clicks.

1) SCOTUS Seems Split on ACA Subsidies Challenge

In oral arguments in the case King v. Burwell in March, the Supreme Court's justices appeared to be split on the issue of whether subsidies to help U.S. residents purchase health plans through the federal exchange were permitted under the Affordable Care Act. At issue in the case was that while the ACA says subsidies are available to help certain U.S. residents purchase coverage offered "through an exchange established by the State," a May 2012 IRS rule allowed the subsidies to be used in an exchange administered either by a state or by the federal government.

2) Congress Approves Bill To Stop ACA's Change to Definition of Small Business

The House and Senate this year voted unanimously to pass a bill (HB 1624) to prevent an Affordable Care Act provision that would have changed the definition of "small employer" from taking effect. Under the ACA, small businesses must offer employees health plans that meet the law's essential benefits requirements. A provision in the law defines a small business as one with 100 or fewer employees, whereas most states define a small business as one with 50 or fewer employees. Companies falling into the new small business definition would have had to comply with the ACA's requirements on employee health plans and enter the small-group insurance market as of Jan. 1, 2016.

3) GOP Sens Unveil ACA Subsidies Backup Plan

Senate Republican leaders in March announced that they had agreed on a backup plan in case the Supreme Court struck down the Affordable Care Act's subsidies to help U.S. residents purchase coverage through the federal exchange. Sens. Lamar Alexander (R-Tenn.), John Barrasso (R-Wyo.) and Orrin Hatch (R-Utah) broadly outlined a plan they said would protect people affected by the ruling and "create a bridge away from [the ACA]." The senators wrote that the plan would include temporary financial assistance for individuals affected by the ruling so that they could keep their exchange coverage "for a transitional period."

4) ACA's Third Open Enrollment Begins

The Affordable Care Act's third open enrollment period launched Nov. 1, and no problems were reported among the federal and state-based exchanges. According to federal officials, about 40,000 applications were submitted through HealthCare.gov during the first six hours of the open enrollment period. The Obama administration has said it estimates that about 10 million U.S. residents will be enrolled in health coverage purchased through the ACA's exchanges by the end of 2016.

5) DOL Will Delay Enforcement of Home Care Worker Wage Rule

The Department of Labor in September said it would delay enforcement of a rule that would extend minimum wage and overtime pay protections to home care workers. In 2013, DOL issued a rule aimed at changing the wage and overtime rules exemption for many home care workers. Under the rule, workers would be required to receive pay at least equal to the federal minimum wage, which is $7.25 per hour, as well as overtime compensation. The rule was scheduled to take effect Oct. 13.

6) CBO: Repealing ACA's Individual Mandate Would Save $300B, Increase Uninsured

Repealing the Affordable Care Act's individual mandate would save more than $300 billion in federal health care spending over the next decade, but it also would increase premiums and the uninsured rate, according to Congressional Budget Office estimates released in September. Under the ACA's individual mandate, U.S. residents who did not have health coverage in 2014 had to pay $95 or 1% of their incomes, whichever was higher, as they filed their 2014 taxes. According to CBO's estimates, government health departments would save about $311 billion over 10 years if the individual mandate were repealed.

7) GOP-Led Congress Likely To Consider ACA Changes

Republican lawmakers in January said that the then-new, GOP-led Congress would consider measures that would alter parts of the Affordable Care Act. During an interview on NBC's "Meet the Press," Sen. John Barrasso (R-Wyo.) said that while Congress would hold a vote to repeal the ACA, President Obama would veto such a bill. Therefore, Barrasso said the GOP was focused on striking down portions of the ACA that have been unpopular with both Republicans and Democrats. Sen. Amy Klobuchar (D-Minn.), who also appeared on "Meet the Press," added that she was working with incoming Senate Finance Committee Chair Orrin Hatch (R-Utah) to push through legislation that would repeal the ACA's medical device tax.

8) CMS Delays SGR Cuts, Medicare's 'Two-Midnight' Rule

CMS on April 6 said that, barring congressional action, it would not begin processing a 21% cut to physician reimbursements under Medicare's sustainable growth rate formula until April 15. A CMS official said that while the agency would delay processing the cuts until April 15, "[a]ny delay in processing claims beyond April 15 would negatively impact providers' cash flow." The agency previously had said that it was preparing to process the payment cuts if Congress did not act on the measure, which it eventually did.

9) HHS Announces Initiative To Move Toward More Alternative Payment Models

HHS in January announced it would seek to make 30% of Medicare payments for hospitals and physicians through alternative payment models like accountable care organizations and bundled payments by 2016. Medicare -- which paid $362 billion to providers caring for more than 50 million U.S. residents in 2014 -- began to tie payments to performance as part of the Affordable Care Act. About 20% of payments made by the insurance program are now made through alternate payment models.

10) Federal Judge: CMS Must Provide More Information on Pay Cut Under Two-Midnight Rule

A federal judge in September ruled that CMS needed to provide more information about Medicare hospital payment reductions included in the two-midnight rule. The two-midnight rule has been in place since 2013 but has never fully been enforced. The rule calls for a 0.2% reduction to hospital payment rates to offset the regulation's expected costs.

-- by Julia Haskins, staff writer