What’s New in Health Care Reform: May 18


What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.

Supreme Court Sends Latest Obamacare Challenge back to Lower Court

Saying they now have new information that significantly changes the case before them, the Supreme Court justices sidestepped a constitutional decision on the latest Obamacare challenge and sent the government and the religious organizations back to the drawing board. In a unanimous decision, the court said it was not deciding the central question in the case: whether Obamacare's contraceptive mandate substantially burdens some organizations' right to exercise their religion. Via MPR News.

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Obamacare Insurers' Losses Grew in 2015, Study Finds

Insurers’ losses on the Obamacare marketplaces increased in 2015, but the market is still expected to remain viable, according to a new study. The study from McKinsey & Company finds that in 2014, insurers had a margin of minus-4.8 percent, translating to an overall loss of $2.7 billion on the individual health insurance market, which includes Obamacare’s marketplaces. The study finds those losses roughly doubled in 2015 to between -9% and -11% margins, based on preliminary data. Via The Hill. 

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House Challenge to Health Law Could Raise Premiums, Administration Says

Victory for House Republicans in federal court last week could mean significantly higher health insurance premiums for millions of people if the decision is upheld on appeal, the Obama administration said. And much of the cost for those higher premiums could be passed on to the federal government and taxpayers, administration officials, and health policy experts said. Via NY Times.

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Insurers Dive into ACA's Exchanges as Big Names Exit

UnitedHealth Group and Humana are bailing on multiple exchanges that sell individual health insurance, and more than half of the not-for-profit co-ops have closed up shop. But other companies are willingly, and quietly, taking their place. The loss of insurance carriers, many of which have been burned by adverse selection, is problematic for the Affordable Care Act and especially for consumers who live in rural counties and states like Alabama and Alaska, where there is only one option for exchange coverage next year. Via Modern Healthcare.

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Obama Administration Releases Rules on Wellness Programs

A federal agency released final rules on how employers can offer workers financial incentives of up to 30% of the cost of their cheapest health insurance plans to participate in wellness programs without violating federal laws protecting the confidentiality of medical information. Via Reuters.

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Obama Administration: Insurers Must Provide Services Regardless of Gender Identity

The Department of Health and Human Services finalized a rule mandating that patients have access to services and facilities even if they apply under a gender different from the one on their birth certificate, the second time in a single day that the administration has framed transgender rights as a central civil-rights issue. While the new rule does not require insurers to automatically approve all gender-transitioning services, it means that they cannot categorically deny coverage as they have in the past. Via Washington Post.

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Insurance Options Dwindle in Some Rural Regions

Health-insurance customers in a growing number of mostly rural regions will have just one insurer’s plans to choose from on the Affordable Care Act’s exchanges next year, as some companies pull out of unprofitable markets. Via Wall Street Journal.

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New Hope for GOP after Early Win in Obamacare Lawsuit

The legal war over Obamacare is back. A federal judge gave House Republicans a significant victory when she ruled that the administration is illegally making certain Obamacare payments without a congressional appropriation. Still, the case is far from over. Democrats are turning their attention to the appeal of the ruling, and experts say the case does not pose the same mortal threat to the health care law that previous challenges did. Via The Hill.

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Uninsured Rate Hits Record Low under Obamacare

The uninsured rate fell to 9.1% in 2015, a record low, according to a new survey. The survey from the Centers for Disease Control and Prevention is the latest evidence of a steep drop in the uninsured rate due to Obamacare’s coverage expansion. Via The Hill.

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White House Threatens to Veto House Zika Bill

The Obama administration threatened to veto a House bill that would provide $621.1 million to fight the Zika virus, well below the administration’s $1.9 billion request. “While the administration appreciates that the Congress is finally taking action to address the Zika virus, the funding provided in H.R. 5243 is woefully inadequate to support the response our public health experts say is needed,” the administration said in a statement. “Specifically, the administration’s full request of $1.9 billion is needed to: reduce the risk of the Zika virus, particularly in pregnant women, by better controlling the mosquitoes that spread Zika; develop new tools, including vaccines and better diagnostics to protect the nation from the Zika virus; and conduct crucial research projects needed to better understand the impacts of the Zika virus on infants and children.” Via Morning Consult.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.