Open Enrollment 2020 Reflection

Open enrollment officially ended on December 18. The original closing date was December 15, but on this last day, the website glitched, preventing consumers from enrolling. This was the second time the site glitched during the enrollment period. During the first day of open enrollment on November 1, consumers also had trouble enrolling prompting members of Congress to write a letter to Administrator Seema Verma of Centers for Medicare and Medicaid Services (CMS).

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Long-term Benefits Outweighs Risks of Running an SBM, Report Finds

A growing number of reports have showed it is in states’ interests to run their own health insurance marketplace.  

Most recently, a report from the Urban Institute and the Georgetown Center on Health Insurance Reforms uncovered the primary factors driving states to switch from the HealthCare.gov platform to a full state-based marketplace (SBM). The authors of the report spoke with 22 stakeholders from Nevada, New Jersey, New Mexico, Oregon and Pennsylvania—all states transitioning to an SBM model—to gather evidence 

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What You Need to Know: Proposed Reforms to the Federal Anti-Kickback Statute and the Stark Law

Last week, the Department of Health and Human Services (HHS) published two proposed rules: “Modernizing and Clarifying the Physician Self-Referral Regulations” and “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements.” This piece provides a recap of the main points and motivations in each rule.

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Waste Accounts for 25% of Health Care Spending. Addressing Fraud and Abuse Can Help.

It already hurts to hear that the United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product and more than $10,000 per individual.

A report published last week in The Journal of the American Medical Association makes those numbers even more painful as it reveals the estimated cost of waste in the United States ranges from $760 billion to $935 billion, accounting for approximately 25% of total health care spending. This amount exceeds national military spending, as well as total primary and secondary education spending.

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Don’t Leave Money on the Table: Five Steps to Addressing SDOH

PricewaterhouseCoopers Health Research Institute recently released their new report: “Action Required: The Urgency of Addressing Social Determinants of Health.” Anyone in health care eager to save on costs and create efficient medical interventions should review this report. This piece provides a review of report, highlighting the five steps PwC recommends taking to lead in social determinants of health (SDOH).

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Rising Uninsured Rate and How States Can Respond

Earlier this month, many noted the Census Bureau’s report of the increasing number of uninsured Americans. 8.5 percent, about 27.5 million people, lacked health insurance in 2018, up from 7.9 percent in 2017. It was the first year-to-year increase in the uninsured rate since the Affordable Care Act (ACA) in 2010.

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