Health Care Delivery

Obama administration officials have warned that ambitious experiments run by the health law's $10 billion innovation lab wouldn't always be successful. Now there is evidence their caution was well placed.

Covered California's leader says its decision is only fair to those insurers who took on the risk of a brand new marketplace in 2014. But the state's insurance commissioner says limiting choices is unfair to consumers.

Marilyn B. Tavenner, the administrator of CMS, announced on Friday that she will be stepping down from her position at the federal agency.

Fears that Americans who signed up for Obamacare were more likely to be sicker than those with employer health programs may have been unfounded, according to data reviewed by Reuters.

The aging US population means that Medicare is taking care of more older, sicker people for longer periods of time. Population trends suggest this phenomenon will only increase, unless drastic management and healthcare delivery solutions are found.

The combination of 2 Medi-Cal primary care rate decreases could mean primary care providers who see a lot of Medi-Cal patients will have to scale back or stop seeing those beneficiaries.

Studies from RAND and the Urban Institute estimate that eliminating subsidies for the federally facilitated Marketplaces would increase premiums between 35% and 47% and cause at least 8.2 million people to drop coverage.

Cost cutting and new initiatives aimed at bringing in more patients will lead to another strong year in 2015 for for-profit hospitals. Meanwhile, their not-for-profit counterparts have been given negative outlooks by credit-rating agencies.

In command and ready for a fight, Republicans ignored a White House veto threat and advanced a bill in Congress that would curb President Barack Obama's healthcare overhaul by redefining full-time work as 40 hours a week.

If the Supreme Court invalidates Affordable Care Act subsidies for consumers on the federal exchange, states without their own Marketplaces will be unlikely to stave off "immediate destabilization" of their insurance market, according to experts.

North Carolina is the latest state to express interest in a possible waiver to expand Medicaid. But CMS and President Obama will have to rethink a position taken when Pennsylvania's request for a job training requirement was rejected last year.

The Affordable Care Act is on the move in Western states, with the governors of Utah, Wyoming, and Montana all working to hammer out deals with the Obama administration to expand Medicaid in ways tailored to each state.

By the end of 2014, the uninsured rate among American adults was down to just 12.9% compared with 17.1% when the Affordable Care Act's requirement for Americans to be covered went into effect a year prior.

The Republican Party's strategy to attack the Affordable Care Act's employer mandate by redefining a full-time employee as someone who works 40 hours a week instead of 30 hours could increase dependence on government-provided health insurance.

The percentage of people with high medical costs increased from 2007-2009 to 2011, but the Affordable Care Act's coverage provisions should substantially reduce cost burdens for many people, according to a Commonwealth Fund study.

For years, Harvard's experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

The Obama administration is continuing to compromise with Republican-led states that expand Medicaid.

In many ways, Kentucky, a poor state with a starkly unhealthy populace, has become a symbol of the Affordable Care Act's potential. But as the first year of coverage ends, potential obstacles to the law's success are also coming into sharp relief here.

A perspective published in the New England Journal of Medicine affirms that provisions of the Affordable Care Act will allow improved coverage of smoking cessation tools, which could be a big boost in the number of smokers planning to quit.

A large majority of people who selected health insurance plans through HealthCare.gov during the first month of open enrollment for 2015 will receive financial assistance for their monthly premiums, according to HHS.

A report from HHS notes that through December 15, 2014, 52% of enrollees were new consumers, which could indicate that the Obama Administration is on track to meeting its goal of signing up 9 million Americans for health coverage on the exchanges in 2015.

With the Affordable Care Act seemingly off to a good start, attention is likely to turn to an older program for children that will come to an end in 2015 if it is not reauthorized.

Matt Salo, executive director of the National Association of Medicaid Directors, is emerging as one of the most important observers in how the expansion of the leading healthcare program for poor Americans is unfolding across the country. In December's issue of The American Journal of Accountable Care, he addresses how the fallout of the 2014 midterms will affect Medicaid in the near term.

After website glitches stole the spotlight during the first open enrollment period for the Affordable Care Act, CMS hired Accenture to fix HealthCare.gov. Now, the consulting firm has been awarded a 5-year, $563 million contract to continue working on the website.

Several states hit backlogs enrolling the flood of new Medicaid recipients under the Affordable Care Act (ACA), but New Jersey's experience appears to be in a category of its own: an effort to upgrade antiquated computer systems and fold in the ACA at the same time failed miserably, leaving an estimated 11,000 residents without coverage as 2014 ends.

The plaintiff, John Doe, alleges that not having access to a community pharmacist will limit his ability to gain counseling on potential drug interactions. United Healthcare settled a similar action earlier in 2014. Consumer groups have also alleged discrimination against HIV patients by insurers over drug access in Florida.

The main barrier to widespread use of telehealth isn't technology or consumer acceptance; it's figuring out how to pay for it. Authors writing for The American Journal of Managed Care and The American Journal of Accountable Care discuss why today's payment models for accountable care organizations are a better fit for telehealth, and why regulatory changes make sense.

Consumers remain very confused about their health insurance coverage, but the federal government is looking to provide a better understanding of benefits for consumers shopping for coverage.

A year ago, some Maine residents would have described the Affordable Care Act (ACA) as "hellish." Since then, a lot has changed. And a lot has stayed the same.

Using a provision of the Affordable Care Act, many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care. The goal is to not only reduce costs, but to achieve better health outcomes for these patients.