News

Insurance startups Gravie, SimplyInsured close on funding

The good news for health insurance startups continues. One day after Oscar Insurance announced $145 million in funding, Gravie and SimplyInsured--two startups that aim to help consumers and small businesses find and administer health plans--also announced investments.

Price transparency, provider collaboration will drive payer analytics adoption

As the Affordable Care Act's rules and regulations continue to evolve, payers need health IT tools and analytics to better asses overall clinical and financial performance across multiple dimensions, according to a recent report from IDC Health Insights.

Medicaid expansion battles escalate, expand

The fight over Medicaid expansion in Florida and Texas escalated this week, as the Centers for Medicare & Medicaid Services warned Tennessee and Kansas that their special funding to pay hospitals and doctors for treating the poor could be pulled if they don't expand Medicaid.

CHIP funded through 2017 but future still uncertain

The Obama administration last week extended the Children's Health Insurance Program (CHIP) for two additional years, but the program's future is still up in the air as lawmakers and administrators determine whether or how to continue it, reported Governing.

Report: Drug plan regulations hurt consumers

Negotiating drug plans, benefits and costs is a competitive process. It's meant to control costs, but it ends up hurting consumers, according to a report from the National Center for Policy Analysis. 

Nemours sues United Healthcare of Delaware over breach of contract

The Nemours Foundation, which owns the Alfred I. du Pont Hospital for Children in Wilmington, Delaware, filed a federal lawsuit against United Healthcare of Delaware Monday in a dispute over pediatric care covered by Medicaid, the SF Gate reported.

Latest King v. Burwell interpretation: New exchanges may not be allowed

If the Supreme Court rules in favor of the plaintiffs in King v. Burwell and strikes down federal subsidies for residents in the 34 states that rely on the federal insurance exchange, one legal expert suggests that residents of those states may never qualify for subsidies.

Oscar raises $145M in funding, now worth $1.5B

New York-based startup Oscar Insurance Corp. raised $145 million in its latest round of funding. That investment values Oscar at about $1.5 billion, or three times its January value, according to the New York Times.

Will state insurance markets change with a new President?

Insurers could be operating in vastly different marketplace conditions across the country when the Affordable Care Act's "state innovation" provision goes into effect in two years. That's because the ACA includes a waiver allowing states to use federal dollars to redesign their own healthcare systems--without Congressional approval.

BCBSMA approves mastectomy coverage amid policy confusion

An updated Blue Cross Blue Shield of Massachusetts policy blindsided a patient recently because it would not cover the full cost of a her mastectomy, saying removing the breast without cancer was unnecessary.

EEOC's proposed wellness program guidelines up for debate

The Equal Employment Opportunity Commission issued proposed rules last week for employer-based wellness programs which aim to reconcile guidelines under both the Affordable Care Act and Americans with Disabilities. However, the guidelines may be up for debate with other federal agencies.  

ACA doesn't affect health plans at large companies

Employer-sponsored health plans remain strong five years into the Affordable Care Act, according to the latest health benefits report from the ADP Research Institute.

GOP shifting focus away from repealing Affordable Care Act

Republican efforts to repeal the Affordable Care Act may be off the table for now. The GOP-controlled Congress could push ACA-repealing legislation to President Barack Obama's desk. However, Obama would likely veto the maneuver. For the time being, Republicans appear to focus on other legislative issues, such as proposing changes to the Medicaid and Medicare programs.

HIMSS15: Population health management is this year's biggest buzzword

My favorite aspects of the annual Health Information and Management System Society's annual conference, in no particular order, include reconnecting with friends and colleagues, hearing health...

HIMSS15: Payer tech plays to consumers' hands, wrists

Payers made several product and partnership announcements at the Health Information and Management System Society's annual conference in Chicago. Here's a sampling of payer news from HIMSS15.

CMS provides update on reinsurance collections, sets 2016 rate filing date

The Centers for Medicare & Medicaid Services (CMS) made statements this week about the Affordable Care Act's reinsurance program as well as rate-filing requirements for 2016 plan year. Here's a quick look at how both announcements will impact health insurers.

Florida Gov. Rick Scott to sue Obama administration over Medicaid expansion

Florida Gov. Rick Scott (R) announced he is suing the Obama administration in a dispute over Medicaid expansion, The Hill reported. 

Report: Contraception coverage varies across health plans

The Affordable Care Act mandates that most private health plans cover women's preventive healthcare--including all prescribed Food and Drug Administration-approved contraceptives--without cost-sharing. But not every insurer follows this requirement.

Small wellness initiatives, big savings for North Carolina State Health Plan

Even the simplest of wellness initiatives can reap big savings for payers, the North Carolina State Health Plan said at the Health Information and Management System Society's annual conference in Chicago.

ACA lowers uninsured by 15M people, mostly in Medicaid expansion states

It's good to be an insurer in a state that expanded Medicaid. That's because expansion states lowered their uninsured rate by more than 50 percent, compared to just 30 percent in nonexpansion states, according to the Urban Institute's latest Health Reform Monitoring Survey.