Tag archives: ACA

ACA Survives “[T]hird Installment in [U.S. Supreme Court’s] epic Affordable Care Act [T]rilogy”

On Thursday, June 17, 2021, in a 7-2 opinion, the U.S. Supreme Court upheld the Affordable Care Act (“ACA”) in the case California v. Texas. The Court held that Texas, the other plaintiff states, and the two individual plaintiffs did not have standing to challenge as unconstitutional the ACA’s minimum essential coverage provision. The plaintiffs … Continue reading

Biden Administration Withdraws Work Requirement Approvals in Arkansas and New Hampshire

By Jeff Wurzburg (US) and Mary Ytterberg (US) on March 19, 2021 Posted in General, Regulatory

Medicaid is the largest health coverage source in the United States, covering approximately 70 million individuals including children, pregnant women, people with disabilities, elderly adults, and in states that have expanded their Medicaid programs under the Affordable Care Act, low-income adults without children with household income up to 138%. One of the unique designs of … Continue reading

COVID-19 Update: Biden Executive Order Creates Special Enrollment Period

By Yvonne Puig (US), Daphne Calderon (US) and Jeff Wurzburg (US) on February 1, 2021 Posted in Coronavirus, General, News from DC

On January 28, 2021, President Biden issued an Executive Order entitled Executive Order on Strengthening Medicaid and the Affordable Care Act (“Executive Order”). “In light of the exceptional circumstances caused by the ongoing COVID-19 pandemic”, the Executive Order creates a special enrollment period in states that operate Federally-facilitated exchanges from February 15, 2021 – May … Continue reading

Supreme Court to Hold Oral Arguments on Certain Republican States’ Challenge to the ACA on November 10

By Thomas Dowdell (US) and Jeff Wurzburg (US) on August 19, 2020 Posted in General, News from DC, Regulatory

The U.S. Supreme Court will hear oral arguments on certain red states’ challenge to the Affordable Care Act on November 10, one week after the November 3 presidential election, according to the court’s online docket released on Wednesday, August 19. The central argument in the case is whether the entire ACA is invalid without a … Continue reading

U.S. Supreme Court Rules that the Federal Government “Shall” Pay Health Insurers $12 Billion Under the Risk Corridors Program

By Thomas Dowdell (US), Jeff Wurzburg (US) and Hayley White (US) on May 6, 2020 Posted in Enforcement, General, News from DC

On Monday, April 27, 2020, the U.S. Supreme Court ruled, in an 8-1 decision, that the federal government is required to pay health insurers $12 billion under the Patient Protection and Affordable Care Act’s (ACA) risk corridors program. Background of the Case Congress in the ACA created three premium stabilization programs to support insurers during … Continue reading

U.S. Fifth Circuit Court of Appeals affirms the ACA’s individual mandate penalty is unconstitutional and remands the case to the lower court to examine severability

By Jeff Wurzburg (US) on December 19, 2019 Posted in Enforcement, General

On Wednesday, December 18, 2019, the U.S. Court of Appeals for the Fifth Circuit held in Texas v. Azar that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and remanded the case to the lower court for further review. In a split 2-1 panel decision, the Fifth Circuit held that the individual mandate is … Continue reading

Republican Study Committee Releases Affordable Care Act Replacement plan

By Jeff Wurzburg (US) on October 25, 2019 Posted in News from DC

The Republican Party will soon be the party of health care. You watch. -President Donald J. Trump, March 23, 2019 Opening with the above quote from President Trump, the Republican Study Committee (RSC) released the first part of its healthcare plan entitled: A Framework for Personalized, Affordable Care. An accompanying press release from the RSC … Continue reading

Medicaid update

By Jeff Wurzburg (US) on March 22, 2019 Posted in News from DC

The Trump Administration took several steps this past week in support of its efforts to transform the Medicaid program.… Continue reading

Hospital alert: CMS hospital transparency requirements in effect January 1, 2019

By Yvonne Puig (US) and Jeff Wurzburg (US) on December 31, 2018 Posted in Regulatory

On January 1, 2019, all hospitals are required to make public a list of their standard charges. As a reminder, Section 2718(e) of the Public Health Service Act, as enacted by the Affordable Care Act, requires: “each hospital operating within the United States” to “make public (in accordance with guidelines developed by the Secretary) a … Continue reading

Judge declares ACA unconstitutional

By Jeff Wurzburg (US) on December 17, 2018 Posted in News from DC

On Friday, December 14, Judge Reed O’Connor of the Federal District Court in the Northern District of Texas issued a declaratory judgment holding the shared responsibility provision (also referred to as the “Individual Mandate”), and with it, the entire Affordable Care Act (“ACA”), to be unconstitutional. The case is Texas v. United States and California … Continue reading

The US Departments of HHS, Labor, and Treasury finalize expanded access to short-term, limited duration insurance

By Jeff Wurzburg (US) on August 1, 2018 Posted in Regulatory

On August 1 the Departments of Treasury, Labor, and Health and Human Services (the Departments) published a final rule that will expand the availability of short-term limited duration insurance (STLDI). A Health Law Pulse summary of the proposed rule may be read here. STLDI is not required to comply with the Affordable Care Act (ACA) … Continue reading

GAO releases report on the differences between 340B and non-340B hospitals

By Thomas Dowdell (US) on July 26, 2018 Posted in News from DC

On June 18, the United States Government Accountability Office (GAO) released a report on the 340B program, entitled “Drug Discount Program: Characteristics of Hospitals Participating and Not Participating in the 340B Program.” The 340B Drug Discount Program requires drug manufacturers to provide discounts on outpatient drugs to certain categories of eligible hospitals. Hospitals that serve … Continue reading

CMS issues final rule to adopt risk adjustment methodology for 2017

By Jeff Wurzburg (US) on July 25, 2018 Posted in Regulatory

CMS has issued a Final Rule to adopt the risk adjustment methodology for the 2017 benefit year. The rule was issued without a notice and comment period and will become effective upon publication in the federal register. The risk adjustment program is a premium stabilization program established by Congress in section 1343 of the Affordable … Continue reading

CMS suspends 2017 benefit year risk adjustment payments

By Jeff Wurzburg (US) on July 12, 2018 Posted in News from DC

On Saturday, July 7, 2018, the Centers for Medicare & Medicaid Services (CMS) announced the suspension of risk adjustment payments for the 2017 benefit year until the resolution of risk adjustment litigation following the decision in New Mexico Health Connections v. United States Department of Health and Human Services et al., in the United States … Continue reading

Department of Labor publishes final rule to expand access to Association Health Plans

By Jeff Wurzburg (US) on June 25, 2018 Posted in Regulatory

The United States Department of Labor (DOL) published a final rule on June 19 that relaxes the regulation of, and expands access to, association health plans (AHPs). President Donald J. Trump’s October 12, 2017 Executive Order instructed the DOL to consider expanding access to association health plans and the Department released a proposed rule on … Continue reading

Coalition of conservative groups release outline of plan to repeal and replace the Affordable Care Act

By Thomas Dowdell (US) on June 20, 2018 Posted in News from DC

On June 19, the Health Policy Consensus Group, a coalition of conservative groups including the Heritage Foundation, the Galen Institute and the Hoover Institution, released an outline of a new proposal to repeal and replace the Affordable Care Act (ACA). The plan is similar to the Graham-Cassidy bill that Congress failed to enact last year. … Continue reading

Department of Justice will not defend ACA individual mandate

By Jeff Wurzburg (US) on June 11, 2018 Posted in News from DC

The Department of Justice (DOJ) announced on June 7, 2018 that it will no longer defend the constitutionality of section 5000A of the Affordable Care Act (ACA), a.k.a. the individual mandate. DOJ announced its policy change in a three page letter to Congress and a brief in response to the plaintiff’s motion for a preliminary … Continue reading

Virginia to expand Medicaid in January 2019; Utah will vote on Medicaid expansion this November

By Jeff Wurzburg (US) on June 4, 2018 Posted in News from DC

Virginia is expected to become the 33rd state (plus the District of Columbia) to expand Medicaid under the Affordable Care Act (ACA) following the passage of a budget by the Virginia legislature. The expansion will take effect on January 1, 2019 and it is expected to provide coverage to close to 400,000 individuals. Prior attempts … Continue reading

Legislation introduced to suspend health insurer tax for 2020

By Jeff Wurzburg (US) on May 29, 2018 Posted in News from DC

On May 25, 2018 legislation was introduced in the United States House of Representatives to suspend the annual fee on health insurance providers implemented by the Affordable Care Act (ACA) for 2020. HR. 5963 was introduced by Reps. Kristi Noem (R-SD), Jackie Walorski (R-IN), Kyrsten Sinema (D-AZ), and Ami Bera (D-CA). Section 9010 of the … Continue reading

CMS FY 2019 IPPS and LTCH PPS proposed rule targets interoperability, transparency and burden reductions

By Jeff Wurzburg (US) on April 27, 2018 Posted in Regulatory

On April 24, the Centers for Medicare & Medicaid Services (CMS) released its fiscal year (FY) 2019 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule. CMS proposes to reduce regulatory burdens for inpatient hospitals and increase price transparency and better data sharing between hospitals and other providers … Continue reading

CMS publishes annual exchange final rule for 2019

By Jeff Wurzburg (US) on April 16, 2018 Posted in Regulatory

On April 9, 2018, the Centers for Medicare and Medicaid Services (CMS) published the Notice of Benefit and Payment Parameters for 2019 final rule (Payment Notice) and related guidance affecting the health insurance markets, including: key dates for calendar year 2018; the final 2019 Letter to Issuers in the Federally-facilitated Exchanges; guidance extending the transitional … Continue reading

Twenty states file a lawsuit alleging the ACA is unconstitutional without the individual mandate penalty

By Jeff Wurzburg (US) on February 28, 2018 Posted in News from DC

A group of twenty states has filed a lawsuit against the Trump administration alleging that the Affordable Care Act (ACA) is unconstitutional. Plaintiffs take the position that the elimination of the individual mandate penalty in the Tax Cuts and Jobs Act (Pub. L. No. 115-97), without a corresponding elimination of the individual mandate, renders the … Continue reading

The US Departments of HHS, Labor, and Treasury propose expanded access to short-term, limited duration insurance

By Jeff Wurzburg (US) on February 21, 2018 Posted in Regulatory

On February 20, 2018, the Departments of Health and Human Services, Labor, and Treasury (the Departments) published a proposed rule to expand the availability of short-term, limited-duration insurance (STLDI) in order to “provide more affordable consumer choice for health coverage.” The proposed rule follows President Trump’s October 12, 2017 Executive Order directing the Departments to … Continue reading