Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

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Insurance leaders warn big ACA premium hikes coming for 2019

Insurance companies are beginning to decide what they’ll charge and whether to participate on the Affordable Care Act (ACA) exchanges for 2019, with Matt Eyles, the next CEO of America’s Health Insurance Plans (AHIP), saying it’s “not a pretty picture right now” for individual market insurers.

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It’s Optum, not Amazon, that is ‘scaring the crap' out of hospitals

For all the attention given to forays from Amazon, Apple and Walmart into the healthcare space, traditional providers are more worried about the continued expansion of UnitedHealthGroup’s Optum into clinical care, according to an article in Bloomberg.

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California would control healthcare prices for privately insured under new legislation

A new bill introduced in California’s state legislature would put the state in charge of setting rates for medical services covered by private insurers, setting up a battle between consumer groups and the lobbyists for the healthcare industry.

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$2.6B collected from healthcare fraud cases by HHS, DOJ

In fiscal year 2017, HHS and the U.S. Department of Justice (DOJ) recovered nearly $2.6 billion from settlements and judgments in healthcare fraud cases, with $1.4 billion being transferred to the Medicare Trust Funds.

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How Anthem may win by sitting out healthcare’s merger mania

Four of the five major health insurers in the U.S. are involved in major mergers and acquisitions discussed over the past few months. The lone exception has been Anthem, which may put the company in a stronger position, according to the Wall Street Journal.

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VA: ‘There is no effort underway to privatize VA’

The U.S. Department of Veterans Affairs (VA) is fighting claims from fired VA Secretary David Shulkin, MD, that the agency is moving toward privatizing veterans’ healthcare, issuing a press release calling such talk “completely false and a red herring designed to distract and avoid honest debate on the real issues."

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The 10 largest ACOs

A new report from IQVIA has collected information on the largest accountable care organizations (ACOs) in the country based on the number of participating facilities, along with portions of organizational and professional rosters as well as the largest organizations in four of the ACO models offered by CMS.

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Democrats in California at odds over push for single-payer

In Democrat-dominated California, an intraparty fight is brewing over how to remake the state’s healthcare system. In one corner, advocates are trying to achieve universal healthcare by expanding the Affordable Care Act’s gains in insurance coverage. In the other, there are diehard supporters of moving to a single-payer system.

Around the web

The FTC alleges that pharmacy benefit managers have set up a system where they get rich, while patients are forced to pay rising insulin costs. The agency also called out drug manufacturers such as Eli Lilly, Sanofi and Novo Nordisk, saying their own actions have raised serious concerns.

In the post-COVID era, wages for permanent RNs are rising, and wages for travelers are decreasing. A new report tracked these trends and more. 

Two medical device companies have announced a transaction that could shake up the U.S. electrophysiology market. 

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