ACA ruling could upend Medicaid expansion

Policy experts say it's hard to overstate the chaos the ruling would create if it stands, although many legal scholars doubt it will be upheld. Still, some managed care companies have contingency plans.

By Samantha Liss • Dec. 19, 2018

Reinsurance program, higher subsidies would further ACA coverage gains

In a new report, the Urban Institute suggested a variety of policy changes that it said would insure more than 12 million additional people.

By Les Masterson • Dec. 19, 2018

Judge calls for expedited briefings in ACA case

The parties have until Friday to file their responses on whether a stay is warranted, whether the court should enter partial final judgment on the order and whether the court should certify the order for immediate repeal.

By Shannon Muchmore , Tony Abraham • Dec. 19, 2018

Federal judge suggests CVS-Aetna be monitored by outside appointee

Judge Richard Leon of the D.C. District Court also rebuked the DOJ for its "tone deaf" brief questioning Leon's right to review the merger under 2004's Tunney Act.

By Rebecca Pifer Parduhn • Dec. 18, 2018

Labor board will charge Kaiser for refusing to bargain, union says

NLRB will prosecute Kaiser before the end of the year if it does not settle with union workers, according to an email obtained by Healthcare Dive. The health system said the decision is not a verdict, but the start of a hearing process.

By Tony Abraham • Dec. 18, 2018

Most Medicaid managed care programs consider social determinants of health

Still, few payment incentives involve those factors, according to a new report by the Association for Community Affiliated Plans and the Center for Health Care Strategies.

By Les Masterson • Dec. 17, 2018

What to expect after whirlwind ACA ruling

The decision, now being challenged by a coalition of Democratic attorneys general, would effectively wipe out Medicaid expansion and pre-existing condition protections and could affect a number of hospital payment reforms.

By Rebecca Pifer Parduhn • Updated Dec. 18, 2018

A case of the Blues: BCBS plans' appeal rejected, must face antitrust allegations

The 11th U.S. Circuit Court of Appeals upheld a ruling that 36 Blue Cross Blue Shield plans' agreement to limit competition while staking claim in exclusive markets is a per se violation of the Sherman Antitrust Act.

By Tony Abraham • Dec. 14, 2018

Texas judge rules ACA unconstitutional

Providers blasted the ruling, which will appealed to a higher court.

By Tony Abraham • Updated Dec. 18, 2018

HHS seeks ideas on HIPAA tweaks to boost care coordination

The aim is to reduce regulatory burden and facilitate care, with a focus on the opioid crisis.

By Meg Bryant • Dec. 13, 2018

DOJ takes up lawsuit accusing Sutter Health of cheating Medicare

The whistleblower lawsuit alleges the California health system and an affiliate manipulated diagnosis codes to inflate payments.

By Meg Bryant • Dec. 13, 2018

ACO trade group says Medicare program saved $859M in 2016

The program, which includes 561 accountable care organizations and 10.5 million patients, saved more than $660 million between 2013 and 2016 after bonuses paid to providers for meeting spending and quality targets.

By Les Masterson • Dec. 13, 2018

PwC: 'New Health Economy' finding its feet, but challenges remain

Providers are embracing digital treatments, with 77% saying they have suggested an app or digital program to a patient, according to the industry trends report.

By Meg Bryant • Dec. 12, 2018

1 in 5 patients at high risk of socioeconomic health problem, survey finds

Patients who discuss their social determinant of health challenges with a clinician are more likely to accept help, according to the study. Younger patients, while twice as likely to discuss, are less receptive to assistance.

By Tony Abraham • Dec. 12, 2018

4.2M Americans eligible for free ACA coverage, KFF says

In Iowa, Nebraska, Delaware and Utah alone, roughly half of potential marketplace shoppers could get a 2019 bronze plan with a $0 premium, according to the analysis.

By Rebecca Pifer Parduhn • Dec. 12, 2018

Lawmakers impatient for ONC interoperability rule

"It is hard to explain to people that Congress provided the tools necessary for doctors and patients to better coordinate their care through the sharing of patient data, but nothing has changed," Rep. Michael Burgess, R-Texas, said at a House health subcommittee hearing.

By Rebecca Pifer Parduhn • Dec. 11, 2018

Payer, hospital groups trade blame on surprise billing

The problem of patients unexpectedly getting a bill for out-of-network services is common and growing, especially for people getting emergency room care.

By Les Masterson • Dec. 11, 2018

Middle-income Americans paying more for health insurance

Americans in the South are hardest hit — spending a bigger share of their income on healthcare than other parts of the country.

By Les Masterson • Dec. 10, 2018

CMS reinstates risk adjustment program for ACA exchanges

In February, a federal judge in New Mexico vacated the risk adjustment program, namely the statewide average premium in the HHS methodology.

By Les Masterson • Dec. 10, 2018

Hospital labor skirmishes — 2018 in review

The year was marked by heated negotiations over staffing and wages. Here's a month-by-month breakdown of how it went down.

By Tony Abraham • Dec. 10, 2018

VA invests in medical messaging system, brings services to Walmart

The country's second-largest government agency has also reportedly been in talks with Apple on a deal that would see the tech giant build software for veterans to access their EHRs via their mobile devices.

By Tony Abraham • Dec. 10, 2018

MedPAC pitches 2% boost in hospital Medicare payments, merged quality incentive program

The adviser to CMS and Congress on Medicare has been focused on the shift to value-based care in recent months. Its new linked proposals are no exception.

By Rebecca Pifer Parduhn • Dec. 7, 2018

Hospitals speak out against Trump proposed 'public charge' immigration rule

NYC Health + Hospitals said the system could lose up to $362 million the first year following the change. The AHA and the National Association of Community Health Centers have also criticized the plan.

By Les Masterson • Dec. 7, 2018

National health spending slowed for 2nd straight year, at $3.5T

The spending growth rate, which fell to 3.9% in 2017 from 4.6% in 2016, was primarily held back by slowdowns in use of goods and services, with fewer people insured and getting care.

By Tony Abraham • Dec. 7, 2018

Lack of provider competition raising healthcare prices, Center for American Progress argues

The left-leaning think tank offered suggestions for creating a system that produces more competition with fairer prices, including more regulatory enforcement and site neutral payments.

By Les Masterson • Dec. 6, 2018