News

BCBSA: Specialty drug spending rose 26 percent per member in 2014

Insurer costs for specialty drugs skyrocketed 26 percent per member between 2013 and 2014, or $87 per member for the year, according to a new report.

Uninsured rate dips into single digits for first time

The uninsured rate has officially reached a new low in the United States--dipping into the single digits for the first time at 9.1 percent, according to the CDC.

Highmark sues feds over risk corridor payments

Highmark has filed a lawsuit against the federal government claiming that it did not hold up its end of the bargain on risk corridor payments promised during the first year of Affordable Care Act exchanges.

5 ways to improve provider directories

With hundreds of thousands of dollars in fines, millions of dollars in customer rebates and customer loyalty at risk, payers can no longer afford to manage inaccurate or inadequate provider directories, according to a new report.

Oscar among insurers seeking steep premium increases

Health insurance startup Oscar is asking for premium increases as high as 30 percent in New York--a significant departure from the modest rate hike it asked for last year and another sign the Affordable Care Act exchanges are headed for a market correction.

 

Battle lines drawn over new drug payment model

Lawmakers, physicians and patient advocates voiced a wide range of reactions to the Obama administration's proposed drug reimbursement model in a House subcommittee hearing on Tuesday, with some arguing the demonstration project should be scrapped entirely and others advocating for slight tweaks to address provider concerns.

Diabetes offers prime care management opportunity for health plans

Diabetes, a disease that costs the U.S. at least $245 billion each year, can be a health insurer's nightmare--or the perfect candidate for programs that attempt to bend the cost curve, improve health and save lives, according to an article in Managed Care Magazine.

 

What would happen to a state exchange with no insurers?

With three rural states poised to have just one health insurer participating in their Affordable Care Act exchanges next year, it's worth asking what would happen if in the future some states ended up with no carriers on their exchanges, according to Vox.

 

Poll: Majority of Americans support federally funded healthcare system

The majority of American adults, 58 percent, support the idea of replacing the Affordable Care Act with a federally funded system of universal coverage, according to a new Gallup poll. 

Critics: EEOC wellness program rules create opportunities to discriminate

While one national group praised the Equal Employment Opportunity Commission's final rules on corporate wellness programs as providing the much-needed clarification, others lambasted the rule as creating "opportunities to discriminate." 

Cigna's disclosure signals trouble ahead for insurer mergers

Like a commuter who runs to catch the closing doors of a train only to wait an interminable time for it to depart, leaders at one of the major health insurers seeking permission from the Justice...

Some consumers say ACA creates a two-tier system

Consumers in New York and other markets report that the plans available through the Affordable Care Act offer inferior coverage compared to those provided by employers.

Insurers' individual market losses worsened in 2015

Health insurers that struggled to make a profit in the individual market in 2014 found little relief in 2015, according to a new analysis from consulting firm McKinsey & Co.

Feds finalize privacy rules for employer wellness programs

Two new federal rules issued Monday outline how employer-based wellness programs must handle the health information they request from employees and their spouses.

 

Supreme Court remands contraception coverage case to lower courts

The Supreme Court has declined to rule in the case Zubik v. Burwell, instead leaving it up to lower courts to hash out a compromise over the ACA's contraception coverage requirements.

 

An argument against Paul Ryan's high-risk pool proposal

House Speaker Paul Ryan and his fellow Republicans are correct in some of their criticisms of the Affordable Care Act, but their idea to switch back to risk segmentation through state-based high-risk pools is not a workable solution, argues UVA School of Medicine's Carolyn Long Engelhard.

Rural regions hit hard by dwindling health insurer competition

Rural regions of the country are absorbing the brunt of reduced competition as shifts in the ACA exchanges will leave a growing number of counties with just one insurer in the marketplace next year.

 

Final rule bans discrimination against transgender patients, other protected classes

A final rule from HHS protects individuals from discrimination in healthcare on the basis of race, color, national origin, age, disability and sex, including discrimination based on pregnancy, gender identity and sex stereotyping.

House v. Burwell ruling: What it means for insurers, providers

A judge's ruling for the plaintiffs in House v. Burwell represents a setback for the Obama administration and a potential financial hit for health insurers. Yet that's not all at stake with such legal challenges to the ACA, Rita Numerof, Ph.D., president of healthcare strategy consulting firm Numerof & Associates, tells FierceHealthPayer.

 

GOP close to new plan to replace the ACA

House Republicans are in the homestretch in their effort to develop a long-awaited plan to replace the Affordable Care Act, The Hill reports.