ACA - Health Care Compliance Brief

Elevance expands ACA plans in Florida, Texas, Maryland

Healthcare Dive

SEPTEMBER 9, 2024

The insurer’s Wellpoint subsidiary is expanding its ACA footprint for the 2025 coverage year, likely in a bid to capture enrollees who recently lost Medicaid coverage.

ACA

ACA Medicaid Medicaid

CVS enters into 4 new states for ACA exchange plans

Healthcare Dive

SEPTEMBER 10, 2022

The insurer has been bullish on expanding its ACA footprint since 2021, when its payer business Aetna said it would return to the exchanges after exiting them in 2017.

ACA

Millions of Americans Remain Uninsured or Underinsured Despite ACA Gains

HIT Consultant

NOVEMBER 22, 2024

What You Should Know: – A new report from the Commonwealth Fund reveals that despite significant progress in expanding health insurance coverage under the Affordable Care Act (ACA), millions of Americans still lack adequate and affordable healthcare.

ACA

ACA Health Insurance Medicaid Medicaid

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Extended subsidies boost ACA marketplace enrollment

Healthcare Dive

JANUARY 11, 2023

The Inflation Reduction Act passed last year extended boosted ACA subsidies to make coverage more affordable and helped drive signups, according to the HHS.

ACA

Senate Dems reach draft deal to extend ACA premiums, lower drug costs

Healthcare Dive

JULY 29, 2022

The bill, part of a more than $300 billion package, extends enhanced ACA premiums and allows Medicare to negotiate select prescription drug prices starting in 2026.

ACA

ACA Prescription Drug Pricing Medicare Medicare

Some patients still pay for ACA-mandated free preventive care, study finds

Healthcare Dive

APRIL 5, 2023

Researchers in the study found that more than a third of patients incurred out-of-pocket expenses on the day of their ACA-mandated free preventative medical care service.

ACA

Cigna to exit Missouri and Kansas ACA marketplaces in 2024

Healthcare Dive

AUGUST 28, 2023

The insurer will offer ACA marketplace plans in two fewer states after announcing it would expand its presence on the exchanges last year.

ACA

Beleaguered Bright slashes footprint, fully exiting ACA markets and restricting MA to 2 states

Healthcare Dive

OCTOBER 11, 2022

Bright is doubling down on its decision earlier this year to contract its business, halting the sale of ACA plans to focus on care delivery business NeueHealth as well as MA in higher-performing markets.

ACA

State exchange directors urge Senate to reconsider GOP megabill, citing harm to ACA enrollees

Healthcare Dive

JUNE 5, 2025

Seventeen states sent the letter to Senate leadership this week outlining how Republican’s reconciliation legislation will kick millions off coverage, sicken risk pools and trample on state autonomy.

ACA

ACA enrollment breaks records again in 2025

Healthcare Dive

JANUARY 21, 2025

million people signed up for Affordable Care Act plans during the open enrollment period for 2025, with huge increases in major Republican-led states.

ACA

The Sleeper Provision in the Reconciliation Bill That Could Hobble the ACA Marketplaces

Center for Health Insurance Reform

MAY 19, 2025

An obscure provision in the U.S. House reconciliation bill could have major consequences for the Affordable Care Act Marketplaces.

ACA

ACA Health Insurance

White House challenging ACA; Congress mulling permanent telehealth reform

Healthcare IT News - Telehealth

JULY 1, 2020

Primary topic: Government & Policy Disable Auto Tagging: Short Headline: White House challenging ACA; Congress mulling permanent telehealth reform Featured Decision Content: Region Tag: Global Edition Right Now:

ACA

ACA Governance

Judge tosses ACA preventive care mandate

Healthcare Dive

MARCH 30, 2023

The Thursday ruling means that, effective immediately, health plans nationwide are no longer required to fully cover certain preventative medical services like cancer, HIV and diabetes screenings.

ACA

Democrats introduce bill to make increased ACA subsidies permanent

Healthcare Dive

SEPTEMBER 26, 2024

If the enhanced tax credits expire, healthcare costs for millions of Americans will suddenly increase, and some could become uninsured, Democrats say. But Republicans argue the subsidies are costly and create opportunities for fraud.

ACA

ACA Fraud

If enhanced ACA subsidies expire, 4M could become uninsured: report

Healthcare Dive

NOVEMBER 19, 2024

The enhanced premium tax credits will expire at the end of next year without action from lawmakers. Republicans have previously criticized the subsidies’ cost.

ACA

ACA enrollment for 2024 reaches record high

Healthcare Dive

JANUARY 11, 2024

More than 20 million Americans have signed up for Affordable Care Act plans since open enrollment began in November. Sign-ups are expected to continue to grow.

ACA

CMS expands enforcement power over shady ACA brokers

Healthcare Dive

JANUARY 14, 2025

A rule finalized Monday makes it easier for regulators to suspend agents and brokers from selling Affordable Care Act plans if they pose a risk to the exchanges.

ACA

Record 14.5M Americans signed up for ACA coverage this year

Healthcare Dive

MARCH 24, 2022

But the generous subsidies that contributed to the increase in enrollment are temporary and set to expire at the end of the year absent congressional action.

ACA

CMS cracks down on ACA brokers to prevent plan switching

Healthcare Dive

JULY 22, 2024

Agents and brokers connecting consumers with Affordable Care Act plans now have to jump new hurdles to change their coverage, following mounting complaints about unauthorized plan switching.

ACA

Healthcare Providers Face Over $770B Revenue Loss Under House Bill, Potentially Exceeding $1 Trillion with ACA Credit Expiration, Report Warns

HIT Consultant

MAY 30, 2025

– The financial blow would stem from an estimated 11 million people losing health coverage through Medicaid and the Affordable Care Act (ACA) marketplaces. What You Should Know: – A new analysis from the Urban Institute, supported by the Robert Wood Johnson Foundation , projects that U.S.

ACA

ACA Medicaid Medicaid Hospitals

ACA marketplace premiums poised to jump

Healthcare Dive

JULY 19, 2022

Health insurers' preliminary filings with state regulators point to a 10% median bump in rates for enrollees in 2023, according to the Kaiser Family Foundation.

ACA

ACA Health Insurance

UnitedHealthcare latest payer to expand ACA reach with 4 new states for 2023

Healthcare Dive

OCTOBER 28, 2022

The payer has been steadily ratcheting up its presence on the Affordable Care Act exchanges after dramatically reducing its footprint in 2017.

ACA

ACA Reporting Deadline Extended and the End of “Good Faith” Compliance

Compliance Now

NOVEMBER 24, 2021

On November 22, 2021, the Internal Revenue Service (IRS) published proposed regulations that introduce significant changes to the Affordable Care Act (ACA) reporting process for both large and small employers. Since 2015, the IRS has also provided good faith transition relief to ACA reporting. Good Faith Transition Relief Eliminated.

ACA

ACA Compliance

Premiums for ACA plans to grow 7% next year: KFF

Healthcare Dive

AUGUST 7, 2024

Insurers cited workforce shortages, hospital consolidation and growing demand for pricey GLP-1 drugs as reasons driving the premium increases for 2025.

ACA

ACA Hospitals

The Shift from Traditional Employer-Sponsored Coverage to ICHRA: The Health Plan Perspective

HIT Consultant

NOVEMBER 3, 2024

ICHRA Gaining Traction as Employer-Sponsored Alternative Under the ACA, applicable large employers (ALEs) are mandated to provide health insurance that meets specific coverage and affordability standards, or face penalties. ICHRA represents a significant advancement in ACA market development.

ACA

ACA Health Insurance Governance Compliance

Appeals court upholds ACA’s preventive services mandate, but opens door to future challenges

Healthcare Dive

JUNE 24, 2024

However, it paves the way for future lawsuits from opponents of the ACA. The Fifth Circuit Court of Appeals’ decision Friday is a win for the upwards of 150 million people that receive health insurance through their employers.

ACA

ACA Health Insurance

Insurers seek steep marketplace premium hikes in Vermont

Healthcare Dive

MAY 16, 2022

Proposed 2023 plan year average increases on individual and family plans of 17% for MVP Health Care and 12% for Blue Cross Blue Shield in the state buck the national trend of declining ACA exchange premiums.

ACA

Centene tries to quell concerns of ACA overhaul during investor day

Healthcare Dive

DECEMBER 13, 2023

The Affordable Care Act has been under fire from Republican presidential candidates heading into an election year. But “once you giveth you cannot taketh away,” said the head of external affairs for the major marketplace carrier.

ACA

ACA-related coverage enrollment tops record at nearly 36M

Healthcare Dive

MAY 2, 2022

The expansion of health coverage to more Americans reflects pandemic-related policy efforts, but some of those flexibilities are set to expire this year.

ACA

Over 19M could enroll in ACA plans for 2024, CMS says

Healthcare Dive

DECEMBER 21, 2023

Enrollment in the Affordable Care Act exchanges could be boosted by extended subsidies and the effects of Medicaid redeterminations.

ACA

ACA Medicaid Medicaid

ACA open enrollment period drove record number of sign-ups

Healthcare Dive

JANUARY 27, 2022

Expanded tax credits through the American Rescue Plan made coverage more affordable and greater outreach efforts helped accelerate enrollment, health officials said.

ACA

Family glitch fix for ACA premium subsidies finalized

Healthcare Dive

OCTOBER 12, 2022

The new rule extends premium subsidies to previously ineligible dependents of workers with employer-sponsored coverage.

ACA

ACA plans denied one-fifth of in-network claims in 2023, KFF finds

Healthcare Dive

JANUARY 31, 2025

Insurers poked holes in the KFF’s methodology — a spokesperson for UnitedHealth called the study “grossly misleading” — to argue that they approve most of the claims they receive.

ACA

Medicaid redeterminations will restart Saturday. Here’s what we know

Healthcare Dive

MARCH 31, 2023

States can begin disenrolling ineligible beneficiaries from Medicaid on April 1, in an event the CMS has called the biggest health coverage transition since the first ACA open enrollment.

Medicaid

Medicaid Medicaid ACA

Federal Efforts Ostensibly Aimed at Marketplace “Fraud” Ignore Obvious Strategies to Counter Broker Misconduct

Center for Health Insurance Reform

JUNE 10, 2025

The proposed Marketplace Integrity rule and House-passed budget bill purportedly aim to curb ACA fraud but overlook basic steps to address broker misconduct. CHIR experts explain how these policies increase barriers for eligible enrollees without improving oversight of unethical brokers or implementing common-sense reforms.

Fraud

Fraud ACA Health Insurance

CMS to increase oversight on exchange brokers

Healthcare Dive

OCTOBER 7, 2024

The proposed rule comes after the CMS reported a growing number of complaints about ACA health plan applications submitted by brokers.

ACA

Appellate court pauses ruling blocking ACA preventive care mandate

Healthcare Dive

MAY 16, 2023

The temporary administrative stay, which now legally requires health plans to provide preventive care for over 150 million Americans, applies while an appeal of the March case is considered by the court.

ACA

CVS plans to exit ACA individual exchanges, strikes Wegovy deal with Novo Nordisk

Healthcare Dive

MAY 1, 2025

Aetna is once again retreating from the Affordable Care Act market, while its parent company notched a deal with Danish drugmaker Novo Nordisk that should expand access to its in-demand GLP-1 at the expense of Eli Lilly’s.

ACA

A blast from the past: Dusting off ACA Section 1333 compacts

Center for Health Insurance Reform

MARCH 27, 2025

Peter Nelson, the new director of the Center for Consumer Information and Insurance Oversight (CCIIO) has brought a long forgotten ACA provision back into the spotlight. CHIRs Stacey Pogue breaks down Section 1333 compacts, what it would mean for consumers, and concerns for implementation.

ACA

ACA Health Insurance

Biden’s proposed budget for 2025 boosts cybersecurity funds, extends ACA subsidies

Healthcare Dive

MARCH 13, 2024

The budget request includes proposals for “Medicaid-like” coverage in non-expansion states and future penalties for hospitals that don’t implement cybersecurity standards.

ACA

ACA Medicaid Medicaid Hospitals

AHA, hospital groups file court brief asking to restore ACA preventive services mandate

Healthcare Dive

MAY 8, 2023

The medical associations said preventive health services are essential to increase longevity and quality of life, and that medical evidence should dictate preventive care recommendations rather than political considerations.

ACA

ACA Hospitals

ACA navigators expected to quadruple in 2022 after $80M increase in funding

Fierce Healthcare

AUGUST 27, 2021

ACA navigators expected to quadruple in 2022 after $80M increase in funding. Fri, 08/27/2021 - 11:27.

ACA

Oscar Health racks up $55M net loss as all eyes turn to ACA enhanced subsidies

Fierce Healthcare

NOVEMBER 7, 2024

Oscar Health CEO Mark Bertolini’s implied message to Republicans eager to let the Affordable Care Act’s (ACA's) enhanced subsidies expire was clear: Do so at your own risk. Unwaveringly, Oscar CEO Mark Bertolini expects the ACA subsidies to be extended one way or another.

ACA

ACA marketplace premiums decline for third consecutive year, Urban Institute finds

Healthcare Dive

APRIL 13, 2022

The marketplace is bucking the trend of sustained premium increases for job-based coverage, which provides insurance to a majority of nonelderly Americans.

ACA

Elevance expands ACA plans in Florida, Texas, Maryland

CVS enters into 4 new states for ACA exchange plans

Webinars

Trending Sources

Millions of Americans Remain Uninsured or Underinsured Despite ACA Gains

Webinars

Extended subsidies boost ACA marketplace enrollment

Senate Dems reach draft deal to extend ACA premiums, lower drug costs

Some patients still pay for ACA-mandated free preventive care, study finds

Cigna to exit Missouri and Kansas ACA marketplaces in 2024

Beleaguered Bright slashes footprint, fully exiting ACA markets and restricting MA to 2 states

State exchange directors urge Senate to reconsider GOP megabill, citing harm to ACA enrollees

ACA enrollment breaks records again in 2025

The Sleeper Provision in the Reconciliation Bill That Could Hobble the ACA Marketplaces

White House challenging ACA; Congress mulling permanent telehealth reform

Judge tosses ACA preventive care mandate

Democrats introduce bill to make increased ACA subsidies permanent

If enhanced ACA subsidies expire, 4M could become uninsured: report

ACA enrollment for 2024 reaches record high

CMS expands enforcement power over shady ACA brokers

Record 14.5M Americans signed up for ACA coverage this year

CMS cracks down on ACA brokers to prevent plan switching

Healthcare Providers Face Over $770B Revenue Loss Under House Bill, Potentially Exceeding $1 Trillion with ACA Credit Expiration, Report Warns

ACA marketplace premiums poised to jump

UnitedHealthcare latest payer to expand ACA reach with 4 new states for 2023

ACA Reporting Deadline Extended and the End of “Good Faith” Compliance

Premiums for ACA plans to grow 7% next year: KFF

The Shift from Traditional Employer-Sponsored Coverage to ICHRA: The Health Plan Perspective

Appeals court upholds ACA’s preventive services mandate, but opens door to future challenges

Insurers seek steep marketplace premium hikes in Vermont

Centene tries to quell concerns of ACA overhaul during investor day

ACA-related coverage enrollment tops record at nearly 36M

Over 19M could enroll in ACA plans for 2024, CMS says

ACA open enrollment period drove record number of sign-ups

Family glitch fix for ACA premium subsidies finalized

ACA plans denied one-fifth of in-network claims in 2023, KFF finds

Medicaid redeterminations will restart Saturday. Here’s what we know

Federal Efforts Ostensibly Aimed at Marketplace “Fraud” Ignore Obvious Strategies to Counter Broker Misconduct

CMS to increase oversight on exchange brokers

Appellate court pauses ruling blocking ACA preventive care mandate

CVS plans to exit ACA individual exchanges, strikes Wegovy deal with Novo Nordisk

A blast from the past: Dusting off ACA Section 1333 compacts

Biden’s proposed budget for 2025 boosts cybersecurity funds, extends ACA subsidies

AHA, hospital groups file court brief asking to restore ACA preventive services mandate

ACA navigators expected to quadruple in 2022 after $80M increase in funding

Oscar Health racks up $55M net loss as all eyes turn to ACA enhanced subsidies

ACA marketplace premiums decline for third consecutive year, Urban Institute finds

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