Politics and Policy

Uncertainty is the theme for 2011. Insurers have to implement a multitude of new requirements for providing coverage, often with scant information.

The certification of rules regarding medical-loss ratios brings some clarity to an issue that has tried the patience of health plans, but now the hard work begins, according to analysts.

The worst case scenario for health plans would be if the planned expansion of healthcare coverage under the Patient Protection and Affordable Care Act evaporates, leaving insurers with added fees, onerous market regulations and fewer customers

Ever since the Patient Protection and Affordable Care Act passed in March, plans have talked about simply leaving certain markets

Only about one in five respondents said their company has a program in place to analyze the impact of the Patient Protection and Affordable Care Act on their health benefits

When Republicans talk about repealing the Patient Protection and Affordable Care Act, they really mean that they want to eliminate the individual coverage mandate

Few plan organizations are whole-heartedly in favor of the Patient Protection and Affordable Care Act. In fact, there might be just one--the Association for Community Affiliated Plans

When it comes to insurance, the latest figures from the U.S. Census Bureau show 2009 was a year of superlatives, and none of them good.

The most powerful person in the nation's healthcare system made a heartfelt call for industry assistance in reforming healthcare.

The adoption of healthcare reform has created an environment that encourages insurers, health plans, hospitals and clinicians to seek common ground

California is making a statement as the first state to create an oversight board for insurance exchanges, in compliance with the requirements established by the Patient Protection and Affordable Care Act

There is great optimism that new payment models and comparative effectiveness research will improve quality of care and curb unwarranted spending

Republicans introduced a bill to abolish Medicare's Independent Payment Advisory Board (IPAB) before it even gets off the ground

For health reform to be a success, employers must continue to provide healthcare benefits

Beyond basic compliance with the regulations, the market fallout could be anything from a pin drop to a sonic boom

Most existing benefit plans will lose their grandfathered status by 2019, according to observers

Many fear that the $5 billion allocated by the federal government for high-risk insurance pools won't last until 2014

Insurers have been complaining loudly about the proposed methods for calculating a health plan's medical loss ratio (MLR), which has been recently developed by the National Association of Insurance Commissioners.

Now is the time for collaboration of payers, billers and providers to lead the industry by reducing inefficiencies

A cumulative 23% cut is scheduled for this December. Another 6.5% cut in January 2011 and a 2.9% cut in January 2012 are scheduled.

The health reform law will be moderately successful, but it's only going to get half the job done

Assumptions about long-term healthcare spending are not likely to become reality. The reductions in Medicare spending under the Patient Protection and Affordable Care Act wll extend solvency of the hospital insurance trust fund for 12 years.

State health directors breathed a loud sigh of relief last month when Congress finally managed to approve added funding for Medicaid just before leaving Washington for its summer recess.

Exchanges could bring in millions of potential customers. Insurers need to begin formulating marketing plans now.

While many health plans already have an appeals process in place for self-insured employers under the Employee Retirement Income Security Act, new federal rules clarify the process for consumers to challenge denials and rescissions.

Controversy continues to swirl around Medicare's two-year-old policy of not paying for what it considers preventable hospital-acquired condtions. CMS has decided for now not to expand its list of 12 serious adverse events for which it does not reimburse hospitals.

One of the first visible payoffs of the Patient Protection and Affordable Care Act is the $250 rebate checks sent to thousands of seniors with high drug costs. Other strategies are built on questionable long-term outlooks.

Accountable care organizations have become a hot commodity since the Patient Protection and Affordable Care Act opened the door for health plans to contract through an ACO for commercial enrollees. The momentum of ACOs will likely increase.

Stakeholders seek uniformity of standards for several types of electronic health information transactions and specific operating rules, n one of which will be easy to implement.

President Barack Obama nominated Donald Berwick to head the Centers for Medicare and Medicaid Services, the first confirmed leader in this role since 2006. Berwick has been an outspoken critic of waste and inefficiency.