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What We're Reading: Expanding ACA Participation; Challenge to Association Health Plans; Better Flu Vaccine
Although the Trump administration has slowly been chipping away at the Affordable Care Act (ACA), health insurers are feeling more confident in the ACA marketplaces; New York and Massachusetts are suing the administration over the fact that association health plans can bypass many of the ACA's requirements; a new flu vaccine was slightly more effective in seniors during last winter.
Insurers Expanding Presence in ACA Marketplaces
Although the Trump administration has slowly been chipping away at the Affordable Care Act (ACA), health insurers are feeling more confident in the ACA marketplaces. According to The Wall Street Journal, more insurers are turning profits in the marketplaces and regulatory filings show some insurers feel confident enough to expand their footprints. For instance, Centene Corp and Molina Healthcare will newly enter North Carolina, Wisconsin, and Utah, while Oscar Insurance will enter Florida, Arizona, and Michigan, as well as add to its presence in Ohio, Tennessee, and Texas.
New York, Massachusetts Challenge Association Health Plans
When announcing the final rule for implementing association health plans, the Trump administration highlighted that the plans can bypass many of the ACA’s requirements. Now, New York and Massachusetts are suing the administration over that fact, reported The Hill. According to the states’ attorneys general, the health plans “invite fraud, mismanagement, and deception.” The association health plans allow small businesses and self-employed individuals to band together to purchase insurance, even across state lines. Since the plans don’t have to cover the ACA’s 10 essential benefits, they are cheaper than typical ACA plans.
New Type of Flu Vaccine Slightly Better
A new flu vaccine was slightly more effective in seniors during last winter. The Associated Press reported that Flucelvax was 26.5% effective at keeping people age 65 and older out of the hospital. In comparison, the average effectiveness of all vaccines was 24%. In general, most flu vaccines were not very effective against the strain from last winter. Those vaccines are typically made in chicken eggs, but Flucelvax was made in animal cells instead.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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