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CMS proposes methodology to calculate exchange insurers' 2018 risk-adjustment payments

August 13, 2018


CMS says under a newly proposed rule it intends "to adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year which uses the statewide average premium in the payment transfer formula."

Some insurers are planning to lower their premium rates for 2019

August 3, 2018


Insurers in many states are seeking single-digit premium rate increases for health plans sold on the Affordable Care Act's exchanges—and some are even seeking premium decreases, marking a significant change from several years of double-digit rate increases.

Senate Democrats want to rescind Trump's short-term health plan rule. Here's their plan.

August 3, 2018


Senate Democrats plan to introduce a resolution of disapproval that would repeal the Trump administration's final rule on short-term health plans, which they argue "would raise premiums and reduce plan choices for individuals with pre-existing conditions."

Lawsuit claims Trump admin is violating Constitution by 'undermining' ACA

August 2, 2018


Four cities in a lawsuit claim that President Trump and his administration are violating the Constitution by not ensuring the Affordable Care Act is "faithfully executed."

HHS just finalized Trump's rule on short-term health plans. Here's what it does.

August 1, 2018


The Trump administration's final rule will again allow insurers to sell short-term health plans that are valid for up to 12 months and will allow enrollees to renew the plans for up to three years.

KFF: US residents who don't get subsidies are dropping individual health plans

August 1, 2018


New Kaiser Family Foundation data show total enrollment in individual health plans decreased by about 12% from the first quarter of 2017 to the first quarter of 2018—and all of the decline occurred among individuals who had been enrolled in individual health plans that did not qualify for the Affordable Care Act's subsidies.

CMS approves reinsurance programs in two more states

July 31, 2018


Wisconsin Gov. Scott Walker says, under his state's reinsurance program, premiums for individual health plans in the state are expected to be 11% lower than they would have been if the state was not able to implement the program, while Maine officials project that premiums for individual health plans in the state will be about 9% lower than they would have been without its new reinsurance program.

Two states are looking to restructure exchange coverage. Here's how.

July 30, 2018


Alabama and Illinois so far are the only two states that have indicated they will seek CMS' permission to redefine the essential health benefits individual and small-group insurers in the states must cover for the 2020 coverage year, and the states appear to be approaching the changes in drastically different ways.

Why these states are suing the Trump admin over its rule to expand association health plans

July 27, 2018


Democratic attorneys general from 11 states and the District of Columbia are challenging the Trump administration's final rule to expand the types of small employers and self-employed individuals that are permitted to form so-called "association health plans."

Senate panel approves bill to ban pharmacy 'gag clauses' in exchange plans

July 27, 2018


The bill would prohibit health plans sold on the Affordable Care Act's exchanges from including so-called pharmacy "gag clauses," which prevent pharmacies from proactively informing customers that they would save on a prescription drug by paying for it out of pocket rather than by using their insurance.

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