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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Senator promotes price transparency, short-term insurance in healthcare plan

Sen. Bill Cassidy, MD, R-Louisiana, released a series of new healthcare proposals that would expand insurance which doesn’t comply with the Affordable Care Act, along with new ideas on requiring price transparency and incentivizing care settings that are less expensive than hospitals.

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AMA touts leadership combating opioid epidemic as story labels group a barrier to reforms

The American Medical Association (AMA) released a report on May 31 detailing how “physician leadership” has led to progress fighting the epidemic of opioid abuse and addiction. Just two days earlier, however, a story published by the Daily Beast labeled the AMA as a main roadblock to Congress addressing the prescription of opioids.

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New Jersey, Vermont enact their own individual mandates

New Jersey will maintain the penalty on a statewide level in 2019. Vermont's law will take more time, with a working group tasked with figuring out how to enforce the mandate beginning in 2020.

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S&P: 340B cuts will weaken nonprofit hospitals

The $1.6 billion in cuts to Medicare payments made under the 340B drug discount programs could add to the financial stress of smaller not-for-profit hospitals and health systems, according to Standard & Poor (S&P)’s Global Ratings.

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Industry groups overwhelmingly oppose short-term insurance, AHP proposals

“Basically, anybody who knows anything about healthcare is opposed to these proposals,” said Sandy Praeger, a former president of the National Association of Insurance Commissioners.

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WellCare to buy Meridian Health Plans for $2.5B

One of the largest insurers in the U.S. behind the Big Five of UnitedHealthcare, Aetna, Anthem, Cigna and Humana, WellCare would add more Medicaid and Medicare Advantage (MA) members with the purchase of Meridian Health Plans.

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California’s rate-setting bill shelved

The legislation, sponsored by California Assemblyman Ash Kalra, a Democrat from San Jose, would have created a state commission to set rates for many medical services currently covered by private insurers in the group and nongroup markets.

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Insurers’ secretive deals with hospitals can force patients to pay exorbitant rates

Michael Frank has worked for health insurance companies for decades, doing the actuarial science which determines how much people should pay in monthly premiums. He knows insurers are supposed to be his “advocate” to restrain costs and get him a fair rate—so he was shocked when Aetna agreed to pay $70,000 to NYU Langone Medical Center in New York City for his partial hip replacement.

Around the web

Compensation for heart specialists continues to climb. What does this say about cardiology as a whole? Could private equity's rising influence bring about change? We spoke to MedAxiom CEO Jerry Blackwell, MD, MBA, a veteran cardiologist himself, to learn more.

The American College of Cardiology has shared its perspective on new CMS payment policies, highlighting revenue concerns while providing key details for cardiologists and other cardiology professionals. 

As debate simmers over how best to regulate AI, experts continue to offer guidance on where to start, how to proceed and what to emphasize. A new resource models its recommendations on what its authors call the “SETO Loop.”