Health Care Delivery

The recent mergers between healthcare payers continue the trend of consolidation that has swept the healthcare industry since passage of the ACA.

More employers are requiring prior authorization and the use of select specialty pharmacies for high-cost drugs.

Although the Affordable Care Act has helped many uninsured Americans receive coverage over the last couple years, the health law is essentially underfunded by approximately $500 billion.

The Pregnancy Discrimination Act of 1978 prevents questions about status from being asked, and does not require a woman to disclose her pregnancy in an interview.

Medicare and Medicaid billing fraud scams-upcoding and unbundling schemes, double and triple billing, phantom billing and illegal kickback schemes -cost the United States an estimated $100 billion annually, inflating the size of government, escalating healthcare costs and burdening taxpayers.

A Gallup survey found that only Texas still has 20% of adults who lack insurance. In 2013, 14 states had uninsured rates above 20%.

States that are unable to accelerate their efforts to slow Medicaid spending will face long-term budget imbalances, according to a new report from Fitch Ratings.

For many US community cancer centers, keeping the doors open has often meant making the difficult decision to consolidate with hospitals and large hospital systems. Site neutrality is a critical step in the journey toward better healthcare for all Americans and a healthy future for Medicare.

Donald Trump's call to "get rid of the artificial lines" references a discussion about the optional federal insurance charter, which has been going on in business circles for more than 15 years.

Households that received financial help for health insurance under the Affordable Care Act are now having tax return issues, which could jeopardize their eligibility for subsidies next year.

Defining what is "medically necessary" is a judgment call, and patients may lack access to the criteria insurers use to make coverage decisions.

Safety net hospitals in California are using a car manufacturer's model to improve efficiency while saving on care costs.

The most recent issue of the CDC's Morbidity and Mortality Weekly Report analyzed the first data available on the functional types of disability in a state-based health survey and determined prevalence of functional disability.

Proposed mergers of Aetna and Humana, and Anthem and Cigna, raise questions of whether consumers will continue to see competition in health insurance markets.

Fifty years ago today, President Lyndon B. Johnson signed the law that created Medicare and Medicaid, setting in motion not only the greatest change in healthcare in the nation's history at that point, but also a lasting change for society.

Healthcare spending growth between 2014 and 2024 is projected to be substantially lower than the 3 decades prior to 2008, according to a new report from CMS. In addition, the average premium for a basic Medicare Part D prescription plan will remain stable in 2016.

Increasing health insurance enrollment is only one part of the goal of the Affordable Care Act-the law also aims to improve population health and lower healthcare costs, but less attention has been paid to these critical steps.

A quirk in Alaska law allowed Governor Bill Walker to move ahead without support from the legislature.

While growing marketplace enrollment in state-based exchanges is important, retaining enrollees is equally so, and a new report from the Robert Wood Johnson Foundation and the Urban Institute analyzed the renewal process for 6 states.

Officials say the number of enrollees and their relative good health made it possible to negotiate lower rate increases. However, premium increases are higher in Northern California, where there is less competition.

The HHS Secretary told the National Governors Association that she needed their help in fighting substance abuse and in moving the healthcare system from a volume-based to a value-based system.

The high cost of running a state-based health insurance exchanges created under the Affordable Care Act could lead to states turning over operations to the federal government or joining forces with other states.

This week Bristol-Myers Squibb's phase 3 nivolumab study ended early because renal cell carcinoma patients were experiencing significantly better overall survival, the American Society of Clinical Oncology called for the inclusion of more geriatric patients in trials, and Medicaid expansion states are finding more people enrolling than they planned.

Some safety-net hospitals are seeing the best bottom lines in years. But for those in states that refused to expand Medicaid, little has changed.

Despite concerns that an increasing number of insured individuals could mean longer wait times for doctors' appointments, a new study found that the availability for primary care physicians improved for individuals obtaining Medicaid improved in Michigan after the implementation of the Affordable Care Act.

The Exchange Pulse Report published by Express Scripts predicts that compared with 2014, the year 2015 will see a greater number of younger enrollees signing up on healthcare exchanges, which could potentially drive down drug costs for specialty medications.

In a pattern repeated among those who gained insurance on the Marketplace exchanges, it's clear the uninsured had more pent-up medical needs than policymakers realized.

The Affordable Care Act mandated an end to cost sharing for mammograms and colonoscopies if these screenings were preventive. So far, according to a study just published in The American Journal of Managed Care, the change has had little impact, but the verdict may still be out.

Nearly 50 years after President Johnson signed the law that created them, Medicare and Medicaid have become part of the fabric of the US healthcare system. A Kaiser Family Foundation poll finds little support for proposals to alter the basic structure of the programs.

A report released by the healthcare research group Avalere Health claims that health insurance exchanges have a significantly narrow network compared with their commercial counterparts.