Where we’re going

Prior to the election, on almost every cable channel and many newspaper opinion pieces had headlines that blared something like: ‘The Trump-infused Supreme Court will overturn the entire Affordable Care Act.’  ‘Tens of millions, no hundreds of millions of currently covered individuals who have pre-existing conditions will be denied coverage and medical bankruptcies will dramatically … Continued

Beyond Health Reform This is the second of a two-part series.  Part 1 provided an update on Health Reform.  Many plan sponsors anticipate significant rate increases in the post-COVID-19 era – due to pent-up demand for medical services.  Here are some strategies adopted by plan sponsors that focus on cost management.  2020 Election Regardless of … Continued

Health Reform 10+ Years Later Health Reform – The Path Ahead Most provisions of the Patient Protection and Affordable Care Act of 2010 (Health Reform)[i] have either been implemented or eliminated (discussed in more detail later). As coverage costs continued their increase, and as Health Reform added new costs to insured plans, more and more … Continued

The Consumer Credit Protection Act contains numerous and varied provisions to curb consumer abuse, including requirements for debt collection, credit reporting, and credit repair.  One such provision is found in 15 U.S.C.  1679, et seq., commonly referred to as the Credit Repair Organizations Act (CROA). The intent of CROA is to prevent credit repair organizations … Continued

On September 18, 2020, RAND Corporation released its Nationwide Evaluation of Health Care Prices Paid by Private Health Plans “designed to allow an easy comparison of hospital prices using a single metric.”[1] This was Round 3 of its employer-led transparency initiative. Round 3 evaluated data from 2016 to 2018 from 49 of 50 states and … Continued

KaufmanHall, a consulting services and software provider to 80 of the 100 largest health systems in the United States, recently published an article entitled, “The Effect of COVID-19 on Hospital Financial Health.”[1] “For any organization, a positive operating margin is essential for long-term survival. Few organizations can maintain themselves for an extended period when total … Continued

On August 25, 2020, the Centers for Medicare & Medicaid Services (CMS) promulgated regulatory changes via an interim final rule dated August 21, 2020,[1] requiring nursing homes to test staff and offer testing to residents for COVID-19. Laboratories and nursing homes using point-of-care testing devices will be required to report diagnostic test results as required … Continued

As if the standard issues facing businesses related to healthcare were not enough, businesses now have to deal with the COVID-19 pandemic. As it was, annual premiums were on the rise – increasing 5% in 2019 and predicted to increase 6% in 2020.[1] The health care costs related to COVID-19 are immense. Kaiser Family Foundation … Continued

Section 1332 of the Affordable Care Act (ACA) allows states to apply for a State Innovation Waiver to pursue innovative strategies for achieving high quality, affordable health insurance and to to alter key ACA requirements in the individual and small group insurance markets in furtherance thereof. A January 7, 2020 Kaiser Family Foundation article reported … Continued