Modern Healthcare - - LATE NEWS -

An­them may aban­don many of the 14 states in which it pro­vides in­di­vid­ual in­sur­ance cov­er­age through the Af­ford­able Care Act ex­changes. But the in­surer, one of the largest in the ACA mar­ket­place, may also be us­ing the warn­ing to gain lever­age as it seeks sig­nif­i­cant pre­mium hikes in 2018, ac­cord­ing to Bloomberg. CEO Joseph Swedish ear­lier this year said the com­pany was con­sid­er­ing strate­gic re­treats from the mar­ket­place and had asked for short-term fixes to sta­bi­lize the mar­ket while Congress fig­ured out an ACA re­place­ment plan. Now that the first or­ga­nized at­tempt to dis­man­tle the ACA has failed, An­them and other in­sur­ance com­pa­nies are push­ing for other pol­icy changes.

The CMS has de­layed a rule that would have cut clin­i­cal labs’ Medi­care pay­ments by $3.93 bil­lion over 10 years. The fi­nal rule re­leased last year low­ered Medi­care pay­ments for lab­o­ra­tory tests to put them on par with pri­vate in­sur­ance re­im­burse­ment. Al­though the rule was slated to go into ef­fect Jan. 1, 2018, labs told the agency they needed ad­di­tional time to re­view data and en­sure their ac­cu­racy be­fore sub­mit­ting the in­for­ma­tion to the CMS by March 31. The labs have un­til May 30 to sub­mit their re­ports.

Se­nate Repub­li­cans needed Vice Pres­i­dent Mike Pence to break a tie on leg­is­la­tion to re­verse an Obama ad­min­is­tra­tion rule pro­tect­ing funds for Planned Par­ent­hood and other fam­ily plan­ning providers. The GOP was forced to keep a pro­ce­dural vote open for just over an hour af­ter two Repub­li­cans sen­a­tors, Alaska’s Lisa Murkowski and Maine’s Su­san Collins, voted against mov­ing ahead on the mea­sure. The Obama ad­min­is­tra­tion fi­nal­ized the rule just a few weeks be­fore Pres­i­dent Don­ald Trump was in­au­gu­rated. It would bar states from deny­ing fed­eral fam­ily plan­ning funds to or­ga­ni­za­tions like Planned Par­ent­hood that also per­form abor­tions.

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