Health Care Delivery

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Health plans on the Affordable Care Act (ACA) exchanges will be required to display quality ratings starting with the 2020 plan year, according to an announcement from CMS, which is expanding the 5-star rating system it uses on Medicare plans to the health insurance exchanges.

This week, the top managed care stories included the Trump administration looking to bar legal immigrants from using public benefits; a study in The American Journal of Managed Care® finding that a law to limit surprise medical bills is working; data on Affordable Care Act enrollment showing the effect of subsidies.

A. Mark Fendrick, MD, professor of Medicine in the School of Medicine, professor of Health Management and Policy in the School of Public Health, and director of the VBID Center at the University of Michigan, discusses how low or no cost sharing for high-value services is particularly important for public health issues or epidemics, such as HIV.

In the event that the Affordable Care Act is overturned, Republic senators are working on a plan to preserve protections for people with pre-existing conditions and allow children to stay on their parents’ health plan until age 26; urinary tract infections (UTI) are increasingly becoming resistant to antibiotics; a study is highlighting how lifestyle choices can impact dementia risk.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

As the fate of the Affordable Care Act (ACA) remains uncertain, 21 million people are at risk of losing their health insurance. In addition to large coverage gains as a result of the ACA, the law resulted in various other sweeping changes to the US healthcare system. Here are 5 things that would be impacted if the ACA is overturned.

This week, the top managed care news included uncertainty surrounding the fate of the Affordable Care Act's individual mandate; a study finding Medicare beneficiaries may be paying more for some generics than brand-name drugs; the Trump administration proposing 5 new payment models to transform kidney disease care.

During oral arguments at the 5th Circuit Court of Appeals, Republican-appointed judges voiced their skepticism over the constitutionality of the individual mandate without the imposed tax while Judge Carolyn Dineen King—appointed by President Jimmy Carter in 1979—did not ask any questions or make any comments about the case.

The 5th Circuit Court of Appeals in New Orleans will hear arguments Tuesday in a lawsuit backed by the Trump administration seeking to reverse the Affordable Care Act (ACA); legislators return from a holiday break to try and reach an agreement on healthcare cost issues; a growing number of Americans in rural areas are turning to telehealth appointments amid hospital closings and a shortage of local primary care doctors, specialists, and other providers.

Individuals in traditional blue-collar jobs were the main beneficiaries of the Affordable Care Act because they were less likely to have employer-based coverage before the law, according to a new study.

A federal appeals court rejected a request to delay next week's hearing on the constitutionality of the Affordable Care Act (ACA); Senator Elizabeth Warren, D-Massachusetts, is calling on former FDA Commissioner Scott Gottlieb, MD, to immediately resign from Pfizer's board of directors; Maine is joining a handful of other states in expanding access to abortion.

Last week, a panel of diverse stakeholders took the stage at the National Comprehensive Cancer Network Policy Summit in Washington, DC, to discuss shifting regulatory action from the federal to the state level, and the possible implications for patient access to high-quality cancer care.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included President Trump issuing an executive order for more healthcare transparency; provisional data indicating that overdose deaths may be falling; the Supreme Court agreeing to hear insurers' Affordable Care Act lawsuit.

The US Supreme Court will decide a case involving 2 insurance companies that claimed they were shorted $12 billion by the federal government for "risk corridor" payments related to the ACA; Missouri's last abortion clinic will stay open until at least Friday after a state circuit court judge extended a preliminary injunction he previously issued; City of Hope will invest $1 billion in a new cancer research center and hospital in Irvine, California.

In a letter to CMS Administrator Seema Verma, Energy and Commerce Committee Chairman Frank Pallone Jr, D-New Jersey, and Ways and Means Committee Chairman Richard E. Neal, D-Massachusetts, have demanded information on the Trump administration’s changes to the federal marketplace, which they say can cause confusion for enrollees, weaken consumer protections, and further compromise the Affordable Care Act (ACA).

The Illinois Senate passed an abortion rights bill; a new study presented last weekend at ASCO 2019 found the Affordable Care Act (ACA) reduced racial disparites in cancer care; Johnson & Johnson has been ordered to pay an additional $300 million in NY talcum powder case.

The Trump administration’s Department of Justice (DOJ) is urging federal courts to strike down the entire Affordable Care Act; a Florida hospital is suing Aetna over the insurer’s Readmission Payment Policy; diabetic amputations disproportionately affect black and Latino individuals.

The Trump administration is planning an Affordable Care Act replacement plan; a drug-resistant fungus has been spreading and causing severe issues for hospitals; protesters gather in Washington, DC, to criticize the FDA's handling of the opioid crisis.

Medicare Advantage (MA) plans will see a 2.53% increase in payments in 2020; the FDA is developing a framework for regulatory oversight of artificial intelligence (AI); a federal court is allowing Wisconsin to withdraw 2 lawsuits from the state challenging the Affordable Care Act (ACA).

The American Medical Association and the AARP issue briefs in defense of the Affordable Care Act (ACA), while President Trump is delaying an ACA alternative until after the 2020; top hospitals offer unproven stem cell treatments; the measles outbreak hits a new high.

A study found that out of hundreds of specialty drugs, only 16% were covered in the same way by 17 commercial payers in the United States, meaning that 84% of those specialty drugs had differing coverage, explained James D. Chambers, PhD, MPharm, MSc, associate professor, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.

Another federal district court judge has handed the Trump administration a major defeat this week in its attempts to redo rules about US health insurance, saying that its efforts to expand association health plans (AHPs) were “clearly an end-run” around the Affordable Care Act (ACA).

A US District Court judge in Washington, DC, agreed with plaintiffs who argued that the HHS Secretary did not act reasonably in allowing states to create work requirements for beneficiaries to receive healthcare. Orders sending both state waivers back to HHS are expected today.