What’s New in Health Care Reform: Oct. 5

shutterstock_167773898What'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.

Feds Move to Throw out Obamacare Lawsuits

The Obama administration is seeking to toss out a pair of high-profile health care lawsuits in which insurers claim they are owed millions of dollars under the Affordable Care Act. The two insurers, Moda Healthcare and BlueCross BlueShield of North Carolina, have sued the federal government over a combined $338 million in Obamacare payments they argue are overdue. Via The Hill.

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Obamacare’s Millennial Problem

Despite repeated outreach—including entreaties from all manner of celebrities, including NBA stars and Obama himself—young people make up less than 30% of Obamacare customers. The White House had set a goal of 40% in that age bracket to sustain a healthy marketplace because millennials tend to be healthier and, therefore, balance the costs of sicker, older customers. Via Politico.

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House Members Tell CMS Officials to Limit Scope of Payment, Delivery Reform Tests

More than 100 House members wrote to top administrators at the Centers for Medicare and Medicaid Services, saying that the agency is overstepping its legal authority by mandating providers to participate in demonstration programs. The Center for Medicare and Medicaid Innovation is a program under CMS created by the Affordable Care Act to test and evaluate health care payment and delivery models that could lower health care costs. But the members say CMMI is overstepping its authority by mandating participation in three recently-proposed demo projects. Via Morning Consult.

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Ailing Obama Health Care Act May Have to Change to Survive

The fierce struggle to enact and carry out the Affordable Care Act was supposed to put an end to 75 years of fighting for a health care system to insure all Americans. Instead, the law’s troubles could make it just a way station on the road to another, more stable health care system, the shape of which could be determined on Election Day. Via NY Times.

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Obama Administration Ends Drive to Ban Bare-Bones Health Plans

The Obama administration has ended a bid to ban the sale of bare-bones health plans after losing a court fight on the issue this summer. Government lawyers told a federal court earlier this month they would accept its decision that they had overstepped by seeking to effectively end so-called fixed indemnity plans, which are low-cost but pay out only set cash amounts for medical events such as a hospital visit or prescription purchase. Via Wall Street Journal.

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Obama Administration May Use Obscure Fund to Pay Billions to ACA Insurers

The Obama administration is maneuvering to pay health insurers billions of dollars the government owes under the Affordable Care Act, through a move that could circumvent Congress and help shore up the president’s signature legislative achievement before he leaves office. Justice Department officials have privately told several health plans suing over the unpaid money that they are eager to negotiate a broad settlement, which could end up offering payments to about 175 health plans selling coverage on ACA marketplaces, according to insurance executives and lawyers familiar with the talks. Via Washington Post.

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Senate Republicans Change Tone on Obamacare Debate

For the first time in six years, some congressional Republicans are willing to engage in conversations about fixing—not repealing—Obamacare, should another Democrat occupy the White House. Via Morning Consult.

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2.5 Million More People May Be Eligible for ACA Subsidies

About 2.5 million more people may be eligible for financial assistance for buying insurance on the Affordable Act exchanges, the Obama administration estimates. The Department of Health and Human Services released an analysis showing that of the 6.9 million Americans who purchase individual health care plans not on the exchanges, 2.5 million may not know they qualify for subsidies meant to help make insurance more affordable. Via Morning Consult.

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ACA Hasn’t Changed Effects of "Churning," Study Finds

The Affordable Care Act hasn’t done much to change trends of low-income people seeing changes in their health insurance coverage, a new study finds. About a quarter of low-income adults in three states have experienced a change in their health insurance coverage, known as “churning” under the Affordable Care Act, according to a study released by the Harvard T.H. Chan School of Public Health in the journal Health Affairs. Maintaining insurance coverage over time can remain difficult under the law, the researchers found. Via Morning Consult.

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Republicans Ask Insurers for Communications with Administration about ACA Lawsuits

Republicans on the House Energy and Commerce Committee are asking insurers that have sued the administration for funds they say they are due under the Affordable Care Act for any communication they’ve had with the federal officials about the lawsuits. Committee Chairman Fred Upton (R-Mich.) and Reps. Joe Pitts (R-Penn.) and Tim Murphy (R-Penn.) wrote to the six health insurance companies that have sued the administration over the ACA’s risk corridor program, requesting a briefing and that they provide all documents and communication between their employees and executive branch employees regarding the lawsuits or potential legal action and for any documents referring or relating to potential settlements by Oct. 17. 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.