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
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
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
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
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
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
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
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
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
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
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 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
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
On June 29 Judge James Boasberg of the United States District Court for the District of Columbia vacated the approval by the Secretary of Health and Human Services of Kentucky HEALTH. Kentucky HEALTH was to be implemented on July 1. Kentucky HEALTH is the state of Kentucky’s section 1115 demonstration project that would have required … Continue reading
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
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
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 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
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
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
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
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
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