Friday, July 19, 2019


Both the pace and scope of changes in the healthcare/health insurance space accelerated this past week (7/15/19-7/19/19) with several important developments. Here’s a recap of what all took place…

Thursday, May 9, 2019

Accountable Care…The Savior of U.S. Healthcare?

Since the passage of the Affordable Care Act (ACA) in March of 2010, much has been discussed, debated, written, and deployed relative to healthcare FINANCING reforms (see insurance, Medicare, Medicaid, self-insured employers, fees/taxes, pre-existing conditions, essential health benefits, community rating, minimum loss ratio, etc.).  But very little has been written, or even revealed for that matter, about the ACA’s healthcare DELIVERY reforms and incentives.  This is too bad, since we know that $.80 to $.85 of every dollar of billed health insurance premium is directly related to healthcare delivery.  So it stands to reason that if we could reduce health CARE costs, health insurance PREMIUMS would follow suit.  Enter Accountable Care Organizations (ACO) into the equation.  Let’s examine what ACO’s are…who they are…and why many are looking to them to save America’s healthcare system from imploding.

Thursday, April 12, 2018

ACA Modifications for 2018 and 2019

Earlier this week (4/9/2018) the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued final regulations and guidance that profoundly alter the Affordable Care Act (ACA) both immediately, and in 2019 and beyond.  The objective of the new guidance is “…to increase coverage access in the ACALEARN MORE

Wednesday, January 24, 2018

More ACA (Tax) Delays

The recently signed (1/22/2018) “short-term spending bill”, also referred to as the “continuing resolution” (CR) does more than keep the United States government open and fully functioning until February 8, 2018.  It also delivers yet another set of Affordable Care Act (ACA) delays.  Employers offering group health insurance to their employees can breathe a collectiveLEARN MORE

Friday, September 8, 2017

The ACAs Health Insurance Subsidies

In order to accomplish its objective of “affordable health insurance coverage”, the Affordable Care Act (ACA) created three (3) separate, cost reducing initiatives: 1. Premium Tax Credits – reduce out of pocket PREMIUM costs; 2. Cost Sharing Reductions (CSR) – reduce point of service out of pocket costs such as copays, deductibles, and coinsurance; andLEARN MORE

Wednesday, August 2, 2017

Individual Health Ins. When’s Who’s and What’s

This particular blog post is primarily directed to residents of my adopted home state of Nebraska. However it may shed light on some of the “when’s, who’s and what’s” that health care/insurance stakeholders may be facing in other parts of the country next year. As we inch closer to the 2018 individual health insurance openLEARN MORE

Thursday, May 25, 2017

ACA Update – Phase 1 of 3 Toward Change

On May 4, 2017, the U.S. House of Representatives passed an amended version of the “American Health Care Act” or AHCA, on a 217-213 vote tally. In and of itself, this vote DOES NOT ALTER THE HEALTHCARE/HEALTH INSURANCE LANDSCAPE! There are a number of phases (at least 3, but likely several more procedural steps) that must be completed in order for the Affordable Care Act (ACA) to be partially repealed. And to be clear, the AHCA would represent a partial, piecemeal repeal of the ACA, and would in fact, retain much of the ACA. So here’s where we are and what we know, as of today…

Thursday, May 11, 2017

PCORI Fee/CERF – payment schedule

Patient Centered Outcomes Research Institute (PCORI) Fee, also known as the Comparative Effectiveness Research Fee (CERF)Fee periods and payment schedule For CERF payments, ERISA plan year is important, and determines both the timing and amount of payment to the IRS. If your ERISA plan year and renewal date differ, the ERISA plan year should be usedLEARN MORE

Thursday, April 6, 2017

Health Insurance Mandate(s) Still in Effect!

  The Affordable Care Act’s (ACA) “health insurance mandates” are still in effect, and have most definitely not been abolished.   Had the Republican party’s – The American Health Care Act (AHCA) – passed, it would have, among other things, retroactively eliminated both the Individual and Employer mandates.  As such, it did not go to aLEARN MORE

Monday, February 27, 2017

ACA’s Replacement…A Sneak Peek

Until recently (late February, 2017), talk of “repealing/reforming/replacing” the Affordable Care Act (ACA), aka Obamacare, has been largely speculative.  We now have our first look at draft legislation that aims to replace major aspects of the ACA.  It is important to note that what is being considered is not a wholesale repeal of the ACA,LEARN MORE