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ACA results in $2.4 billion in consumer rebates since 2011

American consumers have received more than $2.4 billion in premium rebates since 2011 because of the Affordable Care Act (ACA), according to a recent report from the Centers for Medicare and Medicaid Services (CMS) . The rebates are the result of the ACA provision that requires health insurance companies to spend at least 80 percent of premium dollars on health care. In 2014 over 5.5 million consumers received nearly $470 million in rebates, for an average of $129 per family. California consumers received approximately $98 million in rebates for a ...

Supreme Court to hear ACA challenge by religious nonprofits

The U.S. Supreme Court announced last week that it would hear another group of court cases that challenge the Affordable Care Act (ACA) requirement that health plans provide a full range of contraceptive coverage to women at no cost. Under the law, religious institutions, including churches, temples and mosques, are automatically exempt from the ACA's contraceptive coverage requirement and do not have to file any paperwork. Nonprofit faith-based charities and religiously affiliated educational institutions and hospitals, however, must notify the health plan or the U.S. Department of Health and Human ...

California has the most exchange enrollees in the U.S.

California has enrolled more people through its Affordable Care Act (ACA) health insurance exchange of any state, with about 1.4 million enrollees as of June 30, according to new federal data. California surpassed Florida – with 1.3 million exchange enrollees as of the end of June – to have the highest exchange enrollment. Nationwide, 9.9 million U.S. residents signed up for the ACA. About 7.2 million consumers purchased coverage through the federal exchange and 2.7 million purchased coverage through state-based exchanges. Of those who purchased coverage in California, 9,302 people who ...

Gallup poll says rates of uninsured continue to drop in most states

According to a Gallup poll released Monday, the national uninsured rate has fallen to 11.7 percent, down from 17.3 percent in 2013. The poll shows that states that have expanded Medicaid under the Affordable Care Act – and have at least helped in the running of their health insurance marketplaces, rather than leaving it entirely to the federal government – have seen larger drops in uninsured rates. In the 22 states that took both of those measures, including California, the uninsured rate dropped to an average of 7.1 percent. California's uninsured ...

Spending for federal health programs is expected to remain 'modest' over the next 10 years

Total health care spending growth for federal health programs such as Medicare and Medicaid is expected to average 5.8 percent in aggregate over 2014-2024, according to a report published by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. The authors noted that this rate of growth is still substantially lower than the 9 percent average rate seen in the three decades before 2008.   “Growth in overall health spending remains modest even as more Americans are covered, many for the first time. Per-capita spending and medical ...

Anthem Blue Cross begins medical chart reviews in July

In July, Anthem Blue Cross will begin chart reviews on enrollees who purchased Affordable Care Act (ACA)-compliant plans in either the individual and small group insurance markets (both on and off the exchange, known as “Covered California”). The records requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to ...

Supreme Court upholds ACA subsidies

In a major victory for the Obama administration, the U.S. Supreme Court upheld a key provision of the Affordable Care Act (ACA), reaffirming that 6.4 million people in 34 states can continue to receive subsidies to purchase health care insurance. The question in the case, King v. Burwell, was what to make of a phrase in the law that seems to say the subsidies are available only to people buying insurance on “an exchange established by the state.” Chief Justice John Roberts and Justice Anthony Kennedy joined the court’s four Democratic ...

DHCS reopens window for NICU/PICU claims submission under ACA PCP rate increase

On May 18, the California Department of Health Care Services (DHCS) released additional information about Medi-Cal payment increases for primary care physicians under the Affordable Care Act (ACA) who file claims for patients treated in neonatal intensive care units (NICU) or pediatric intensive care units (PICU). In the past, NICU/PICU claims were billed to Medi-Cal using a local code. In order to be eligible for the ACA enhanced payments, physicians were required to submit claims with ACA modifiers beginning April 11, 2014, that linked the local code to an eligible ...

Survey: ER visits continue to climb under Affordable Care Act

A recent survey conducted by the American College of Emergency Physicians (ACEP) shows that emergency room (ER) visits are continuing to climb since the implementation of the Affordable Care Act (ACA), despite predictions that the law would result in less crowding. According to a news release, about three-quarters of the 2,098 ER physicians surveyed said that visits have risen since January 2014 — a significant increase from a year earlier, when less than half said they saw an upturn. More than one-quarter reported “significant increases in all emergency patients” since ...

Covered California board proposes to cut budget because of slower enrollment

Due to tepid enrollment numbers, Covered California’s board of directors has proposed to spend $58 million less in 2016, slashing its marketing and outreach program by 33 percent. Open enrollment in Covered California fell short of its goal of 1.7 million this year, ending with the number of enrollees at 1.4 million. Additionally, the exchange must pay its own way in the future after receiving $1 billion in federal money. And while it still has some $290 million in reserve for 2016, the exchange projects that fewer than 1.5 million ...