Timely Health Plan News and Commentary
Health care in the United States is governed by an overlapping set of federal laws, state laws, agency rules and court decisions. The Affordable Care Act (ACA), the Medicare and Medicaid statutes, the Employee Retirement Income Security Act (ERISA) for employer plans, the No Surprises Act for out-of-network billing, and the Health Insurance Portability and Accountability Act (HIPAA) for privacy all shape what health plans may do and what patients can expect.
This section reports on legislation in Congress and state legislatures, rules issued by the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), state insurance department actions, enforcement by state attorneys general, and the lawsuits, settlements and court rulings that affect health plans, providers and patients. Medical malpractice litigation and patient safety cases are also covered here.
Policy changes ripple through the rest of the site. Marketplace and employer coverage rules appear in our Health Insurance Coverage reporting. Program rules for older adults and low-income households appear in Medicare and Medicaid and CHIP. Drug pricing and pharmacy benefit manager reform is covered in Prescription Drugs and Pharmacy, and price transparency and data privacy rules that affect technology vendors appear in Health Technology and AI.
Our reporting relies on primary sources wherever possible: the text of bills and regulations, agency announcements, and court filings. This content is news and general information, not legal advice.
The latest healthcare policy and law news appears below, newest first.
A single health insurer controls at least half of the commercial health insurance market in 15 states, and a Blue Cross Blue Shield company is the largest insurer in 43 of 50 states and the District of Columbia, according to the latest American Medical Association (AMA) study of insurer competition. In Alabama, Blue Cross and Blue Shield of Alabama holds 84% of the market.
Workers can set aside up to $3,500 in a health flexible spending account (FSA) in 2027, up $100 from this year, under inflation adjustments the IRS released November 5. The FSA carryover limit rises to $700, and health savings account (HSA) limits climb to $4,500 for self-only coverage and $9,000 for family coverage.
ACA Marketplace sign-ups fell in 41 states for 2026, with North Carolina down 21.9% and Ohio down 19.5%, according to final Open Enrollment data from the Centers for Medicare & Medicaid Services (CMS). Nationally, 23.1 million people picked a plan, about 1.2 million fewer than in 2025.
Medicare Advantage plans denied 65.3% of requests for long-term care hospital stays in June 2024, the HHS Office of Inspector General (OIG) found in a data brief released this year. Aetna, Humana and UnitedHealth Group each denied more than 70% of those requests.
Luigi Mangione, the 28-year-old accused of fatally shooting UnitedHealthcare CEO Brian Thompson on a Manhattan sidewalk in December 2024, is scheduled to appear in federal court on Monday. The hearing comes ahead of his federal trial on stalking charges, now set for November before U.S. District Judge Margaret Garnett in Manhattan.
Medical malpractice cases aren’t simple, and most patients don’t know where to begin when something goes terribly wrong. The right law firm makes all the difference in securing justice, accountability, and answers. Some firms take on headline-making cases. Others deliver quiet, consistent wins that change lives one family at a time. This list shines a spotlight on the groups doing standout work in 2025. [Read more…]
A showdown is brewing in Texas over what patients have the right to know before undergoing medical procedures. Kay Van Wey, a top medical malpractice attorney and fierce advocate for patient rights, took the fight straight to state lawmakers. She testified before the Texas House Judiciary and Civil Jurisprudence Committee, urging support for House Bill 923 (HB 923), which could change the way medical risks are disclosed to patients. [Read more…]
Federal Court Approves Largest Settlement Against Clark County School District in History
In a landmark decision, the United States District Court for Nevada has approved a historic $9.95 million settlement against the Clark County School District (CCSD). This settlement, the largest ever against the school district, stems from a case involving severe physical and emotional abuse of a student with autism. [Read more…]
Houston’s Baylor St. Luke’s Medical Center faces two new lawsuits alleging severe surgical errors during heart transplants, marking the latest in a series of legal challenges and investigations against the institution. The suits, filed last week in Harris County District Court, bring the total number of malpractice complaints involving the hospital’s heart transplants to five since a ProPublica and Houston Chronicle investigation last year exposed critical issues in the program. [Read more…]
The Employers’ Forum of Indiana has unveiled a significant upgrade to its innovative hospital price and quality dashboard, Sage Transparency™. Launched at the National Healthcare Price Transparency Conference, Sage Transparency™ 2.0 introduces an array of new features, backed by the latest data from the RAND Employer Hospital Price Transparency study, designed to empower employers, policymakers, and the public with unprecedented insights into healthcare costs. [Read more…]
In a momentous achievement, Delta Dental of Arkansas has been recognized with a 2023 Governor’s Quality Award, cementing its status as one of Arkansas’s leading organizations committed to excellence. This coveted accolade was presented at the 29th Annual Awards Celebration, held at the Clinton Presidential Center in Little Rock on September 21, 2023, and was bestowed by Arkansas Secretary of Commerce, Hugh McDonald. [Read more…]
The American College of Emergency Physicians and the American College of Radiology (ACR) brought a lawsuit against federal government. The lawsuit claimed that the interim final ruling (IFR), on surprise medical billing, goes against the No Surprises Act language and will ultimately hurt patients and access to care. [Read more…]
Today, the Muscular Dystrophy Association, I AM ALS and the ALS Association issued the following statement regarding today’s passage of ACT For ALS in Congress: [Read more…]
A lawsuit against healthcare entities related to Hudson Regional Hospital and its proprietor Yan Moshe has been dismissed (Eastern District Federal Court Docket Number 20cv01098). [Read more…]
SAN DIEGO, March 4, 2020 /PRNewswire/ — MedCrypt Inc., the proactive healthcare security provider, today announced Seth Carmody as the new vice president of regulatory strategy. Prior to MedCrypt, Carmody worked as the cybersecurity program manager in the Office of the Center Director, Emergency Preparedness/Operations & Medical Countermeasures, within the U.S. Food and Drug Administration (FDA)’s Center for Devices and Radiological Health (CDRH). Carmody brings over eight years of experience in guiding medical device cybersecurity regulatory strategy as well as managing regulatory response to cybersecurity matters. [Read more…]
ATLANTA, Feb. 20, 2020 /PRNewswire/ — Lawrence Thompson, Chief Strategy and Revenue Officer at Advanced Medical Pricing Solutions (AMPS) has been selected to moderate the opening keynote, “Election 2020: The Future of Health Care in America,” on February 25, 2020, at the HCAA Executive Forum at the Wynn Hotel in Las Vegas, Nevada. [Read more…]
Symbility Solutions (TSX.V: SY) (“Symbility”), a global software company focused on modernizing the insurance industry, is pleased to announce that they have signed a multi-year agreement with Ageas Insurance Limited. Ageas is a recognized leader in the United Kingdom insurance sector for the exceptionali customer experience delivered to their policyholders. [Read more…]
The American College of Emergency Physicians (ACEP) has issued a statement deeply critical of the draft health care legislation introduced yesterday in the Senate, known as the Better Care Reconciliation Act, or BCRA. ACEP’s president, Dr. Rebecca Parker, said: [Read more…]
The American Diabetes Association has grave concerns about the impact the draft Senate health care bill will have on people with diabetes. Individuals with diabetes need access to continuous health care to effectively manage their disease and to prevent dangerous and costly complications. The proposed legislation could significantly limit access to care and yield increased costs for people with diabetes, and particularly for older Americans, who are at greater risk for diabetes. The bill also does not guarantee comprehensive coverage. [Read more…]
SACRAMENTO, Calif., June 2, 2017 /PRNewswire/ — CAHU is dismayed that the California State Senate saw fit to pass the $400 billion per year tax plan to pay for universal single payer legislation, SB 562 (Lara/Atkins). [Read more…]
AARP sent a letter to every member of the U.S. Senate urging them to start from scratch on the health care legislation passed by the U.S. House of Representatives last week. The letter comes as AARP also begins to inform its members how each House member voted on the bill. [Read more…]
The Texas Association of Freestanding Emergency Centers (TAFEC) supports legislation introduced in the Texas Legislature aimed at increasing oversight of health insurance companies and protecting consumers from surprise medical costs. [Read more…]
Don’t repeal the Affordable Care Act (ACA) without specifying what will replace it. This is among the policy recommendations issued by the National Alliance of Healthcare Purchaser Coalitions (National Alliance), a nonprofit, membership association of employer led coalitions across the country serving 12,000 purchasers and 41 million Americans.
Additional recommendations include:
— Preserve employer-sponsored coverage by refraining from capping the individual tax exclusion for premiums and continue to allow businesses to fully deduct the costs.
— Avoid increasing the number of uninsured individuals, as the cost of their inevitable medical care will get shifted to those who do pay the bills.
— Continue to move away from fee-for-service (or “volume-based reimbursement”) toward alternative payment models that reward providers for good outcomes and high quality, not medical errors, unnecessary procedures and other low value care. Preserve the ability of the federal government to partner in these efforts (Center for Medicare & Medicaid Innovation and other value-promoting elements of the ACA, and the Medicare Access and CHIP Reauthorization Act of 2015).
— Expand assistance to states, regions, and local communities promoting transparency by pushing hospitals and medical groups to report on the quality of care they provide.
— Support comparative effectiveness research. Employer-purchasers need to know which new or higher cost therapies result in outcomes that are significantly better, somewhat better, about the same, or worse than current or less costly options.
— Allow employer-purchasers maximum flexibility in experimenting with benefit designs.
A Purchaser Viewpoint on Health Policy in Transit is the result of a collaboration of the National Alliance’s Government Affairs Affinity Group led by members including the Louisiana Business Group on Health, Midwest Business Group on Health, Minnesota Health Action Group, Pacific Business Group on Health, and Wyoming Business Coalition on Health.
For more reporting on this topic, see our Healthcare Policy and Law news hub.
In three new issue briefs, the American Academy of Actuaries examines a number of key public policy considerations that policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act. Developed by the Academy’s Individual and Small Group Markets Committee, the papers address high-risk pools, selling health insurance across state lines, and association health plans. [Read more…]
AMSUS, The Society of Federal Health Professionals, announced the creation of a new board, the Executive Advisory Board (EAB), during its Annual Meeting in Maryland recently. [Read more…]
Former Walmart associate Jacqueline Cote and her lawyers filed a motion today asking the U.S. District Court for the District of Massachusetts to grant preliminary approval of a class action settlement in Cote’s action that challenged Walmart’s lack of health insurance benefits for same-sex spouses of Walmart associates prior to 2014. [Read more…]
Centene Corporation (NYSE: CNC) announced recently that its subsidiary, Kentucky Spirit Health Plan, Inc. (Kentucky Spirit), has settled all lawsuits and complaints associated with its contract with the Commonwealth of Kentucky (the Commonwealth). [Read more…]
The National Association of Professional Insurance Agents (PIA) has hailed passage of the Policyholder Protection Act. The measure was included in the omnibus appropriations agreement that was passed 316-113 in the House and 65-33 in the Senate on December 18.
The Policyholder Protection Act prohibits federal regulators from using assets designated to pay out insurance claims to “prop up” an affiliated bank. [Read more…]
The Medical Tourism Association® and Beijing Great-Idea Business Resources Company Ltd. have partnered to hold the World Medical Tourism and Global Healthcare Congress Asia-Pacific 2015, Nov. 14-16, 2015, in Guilin, China.
Renée-Marie Stephano, President of the Medical Tourism Association®, said the multi-year event will also include a five-day, three-city B2B and B2G trade mission with top Chinese executives. To register, go to www.asiamedicaltourismcongress.com/
Asia-Pacific will also be a major focus — including several sessions dedicated to health and wellness in the region — at the World Medical Tourism and Global Healthcare Congress, Sept. 27-30, 2015, in Orlando, Fla.
The World Medical Tourism & Global Healthcare Congress attracts some 3,000 key stakeholders – hospital administrators, doctors and clinicians, employers, government policy makers, insurance executives, facilitators, and hospitality and tourism interests – from across the globe to share their experiences and identify and solve issues that bear significantly on the industry. Participants, sponsors and invited speakers can keep abreast of Congress updates or register at www.MedicalTourismCongress.com
For more reporting on this topic, see our Healthcare Policy and Law news hub.
We Care Insurance Broking Services announced the launch of its online portal http://www.wecareinsurance.in for searching, comparing and buying insurance policy over the web. With an ambitious library of 1000+ products covering 50 insurance companies, this online platform of We Care Insurance Broking, provides personalized, up-to-date and accurate information.
The search results are unbiased and all searches are anonymous. Currently, one can search for health, home, life or motor policies. An average search will display 25 to 40 policies of various companies and with various features.
All industry research and product related information is provided by http://www.policylitmus.com. Policylitmus has introduced scientific rating methodologies to rate insurance companies based on their sales, claims and customer satisfaction parameters.
In an industry which has seen misselling complaints, We Care aims to put all the relevant information in the public domain so that even the least savvy customer can make an informed choice.
For more reporting on this topic, see our Healthcare Policy and Law news hub.