Category Archives: Health Care Reform

Supreme Court Upholds Exchange Subsidies

The U.S. Supreme Court in a 6-3 vote affirmed that subsidies may go to individuals in states with exchanges established by the federal government, and the statute did not restrict subsidies to only states that themselves ran exchanges. Such a…

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Employer Groups Don’t Want Expansion of ACA’s Small Group Market Threshold

Employer groups are urging repeal of the Affordable Care Act’s expansion of the small group market to include groups up to 100, due to occur in January 2016, and are supporting legislation to keep the definition of small group at…

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Reform FAQs Solidify Rules on OOP Maximums, Provider Nondiscrimination

Non-grandfathered employer-sponsored group health plans must abide by out-of-pocket maximums for every individual covered, whether they are enrolled in “self-only” or in “other than self-only” (family) coverage. And the government stayed enforcement of the Affordable Care Act’s provider nondiscrimination rules,…

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IRS Further Explains Large-employer ACA Reporting

Large employers learned more details in new IRS guidance about how to both report about their coverage and fill out and file IRS forms designed to determine whether they are meeting the Affordable Care Act’s coverage requirements for employers. Under the…

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DOL: Plans Must Cover All Contraceptives, Not Some

Plans and insurers must cover all 18 contraception methods approved by the U.S. Food and Drug Administration, according to a new set of questions and answers on the Affordable Care Act’s preventive care coverage requirements. “Reasonable medical management” still may…

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Reform Reinsurance Fund Refund Requests Due Soon

The Centers for Medicare and Medicaid Services announced an April 30 deadline for claiming certain overpayments of the transitional reinsurance fee. The announcement covers overpayments due to miscalculating enrollment counts on which the fee is based. Such miscalculations occur for…

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The ACA After Five Years: Disasters Did Not Materialize, But More Change Is Needed

Five years ago, in March 2010, the Affordable Care Act was signed into law by President Obama to resolve problems in the U.S. health system, including: the high number of uninsured Americans; Americans unable to get coverage due to pre-existing…

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High Court Sees Problems in King Petitioners’ Arguments

Petitioners in King v. Burwell could run up against the same logic that brought down Medicaid expansion under health care reform: it could be unconstitutional for the federal government to use draconian coercion to force states to set up exchanges. Justice Anthony…

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IRS Rules Further Define Payment of ACA Insurer Fees

New IRS regulations define the way health insurers will pay fees under Section 9010 of the Affordable Care Act. In the rules, the IRS applies Notice 2014-47 and provides further guidance on how covered entities will pay the fees for 2015 and subsequent…

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Employers must cover physician and hospital services to avoid ACA fines

On Feb. 23, the Centers for Medicare and Medicaid Services put on public display final rules that require employer health plans to cover physician and hospital services in order to meet health care reform’s minimum value requirement. The rules also set the…

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