Consumers Would Benefit from State Bans on Copay Adjustment Programs

Last month, the Ohio House Legislature voted unanimously 89-0 to end a controversial practice known as accumulator adjustment, or copay adjustment, that Pharmacy Benefit Managers (PBMs) and insurance companies use to restrict patient access to drug manufacturers provided copay coupons used to help meet their deductibles. Should the bill be approved by the Ohio Senate, […]

The New Year Sees an End to Surprise Medical Bills

As Americans welcomed 2022, they had extra reason to celebrate as the No Surprises Act (NSA) became effective at one minute past midnight on January 1st, 2022. While the enactment of the NSA saw substantially less fanfare than the ball drop in Times Square, the new law represents a real win for American patients who […]

AI Offers Substantial Benefits for Patients

On April 21, the European Commission released its much-anticipated proposal for a regulation laying down harmonized rules on artificial intelligence. If implemented, Brussels’ proposal would govern artificial intelligence (AI) across 27 member countries and for over 445 million people. In outlining the need for the Commission’s proposed AI regulations, Margrethe Vestager, Executive Vice-President for a Europe fit for […]

ACI Joins Coalition in Support of New Healthcare Proposal

Today, a group of organizations representing millions of Americans wrote in support of a new healthcare plan — A Framework for Personalized, Affordable Care. The plan would replace the current Affordable Care Act, while empowering consumer choice, providing patient access to affordable coverage, and increasing innovation. The plan would also expand the size and role of […]

Government Healthcare Plans Shouldn’t Offer Everything to Everyone

Federal and State governments use four major structures to provide access to health care coverage – namely, Medicaid, Medicare, TriCare and the Affordable Care Act’s (ACA) Marketplace.  The ACA and Medicaid face severe funding difficulties.  Beyond these are private health care plans supported by employers and individuals. The ACA created Marketplace has about 9 million […]

The Affordable Care Act Chokes on Costs, Drives Away Insurers

There is wide agreement that access to health care is important for everyone. A large segment of the 325 million US population is covered by government health programs such as Medicare (55.5 million enrollees in 2015), Medicaid and CHIP (74.5 million in 2017), and Veterans Health (about 10 million in 2013). These government run health […]

10 Essential Health Benefits in Health Plan Design

The ten Essential Health Benefits (EHBs) listed by CMS are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and […]

Experience Must Shape the Next Affordable Care Act

To jumpstart the process of repealing and replacing the Affordable Care Act (ACA), Republicans recycled Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 (aka H.R. 3762) a bill that they had approved earlier.  This “partial repeal bill does not get rid of Obamacare’s tens of thousands of pages of insurance regulations, the regulations that are […]

A Short Review of the President-Elect’s 100-Day Plan

A compact outline of what to expect from the early days of President-Elect Trump is revealed in his Contract with the American Voter.  A more compact version of the Contract is available in the last 2 pages below.  The Contract states President-Elect Trump’s intentions for the early days of his presidency.   The 100-day time frame […]

ACA Flaws Are Not Fixed by a Public Option

From the beginning of the Affordable Care Act (ACA), we expected that Americans with pre-existing conditions would be more in need of intensive treatments and more likely to be eligible for premium subsidies.  Most of us doubted that ACA would attract healthy young enrollees willing to pay full-sized premiums.  Indeed 7.5 million workers paid a […]