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The fate of the Affordable Care Act is again on the line Tuesday, as a federal appeals court in New Orleans takes up a case in which a lower court judge has already ruled the massive health law unconstitutional.

If the lower court ruling is ultimately upheld, the case, Texas v. United States, has the potential to shake the nation's entire health care system to its core. First, such a decision would immediately affect the estimated 20 million people who get their health coverage through programs created under the law. But ending the ACA would also create chaos in oth...

Following a ruling in the U.S. Supreme Court, North Carolina's largest insurer says it will receive hundreds of millions of dollars to recover losses it incurred through the Affordable Care Act – money that could help offset huge expenses the company estimates it will face due to the coronavirus pandemic.

via bizjournals

Anthem Blue Cross filed a lawsuit against the federal government to recoup $100 million in payments under the ACA, according to Bloomberg Law.

In the Nov. 18 lawsuit filed in the U.S. Court of Federal Claims, Anthem argued it sold plans on the ACA individual exchange because the government said it would offset expected losses on the policies through the risk corridors program. 

Risk corridors payments, which expired in 2016, aimed to protect insurers from large deficits as they enrolled sicker members into their new individual exchange policies. While the program int...

Felicia Morrison is eager to find a health plan for next year that costs less than the one she has and covers more of the medical services she needs for her chronic autoimmune disease.

Morrison, a solo lawyer in Stockton, Calif., buys coverage for herself and her twin sons through Covered California, the state’s Affordable Care Act insurance marketplace. Morrison, 57, gets a federal subsidy to help pay for her coverage and she said that her monthly premium of $167 is manageable. But she spends thousands of dollars a year on deductibles, copayments and care not cover...

Have you ever stepped up to the pharmacy cash register only to learn your new prescription will cost you hundreds of dollars — instead of your typical $25 copay — because your insurance doesn’t cover it? Or received a painfully high bill for a medical test because your health plan didn’t think it was necessary?

Most people have, but only a tiny fraction ever appeal such decisions. In 2017, for example, enrollees in federally run Affordable Care Act marketplace plans appealed fewer than one-half of 1% of denied medical claims, according to an analysis by the Kaiser F...

WASHINGTON — Federal authorities have shut down a network of Florida companies that they say used aggressive, deceptive tactics to sell skimpy health insurance products that skirt requirements of the Affordable Care Act and left tens of thousands of people around the country with unpaid medical bills.

“There is good cause to believe” that the Florida companies have sold shoddy coverage by falsely claiming that such policies were comprehensive health insurance or qualified health plans under the Affordable Care Act, Judge Darrin P. Gayles of the Federal District Cour...

A federal judge has granted a temporary restraining order halting operations of a Florida company that allegedly collected more than $100 million for worthless health insurance plans from tens of thousands of customers.

The Federal Trade Commission filed a lawsuit Monday seeking to shutter Simple Health Plans LLC and recover money for consumers who were allegedly bilked by the company.

Simple Health Plans has operated a telemarketing operation since 2013, according to the complaint, selling plans across the country that claim to provide comprehensive coverage, includ...

CMS will not make $10.4 billion in payments that were due to insurers under the ACA. 

Here's what you should know:

1. The payments were required under the ACA's "risk adjustment program" to offset costs for insurers whose customers need expensive medical services. They were due to insurers in the fall for expenses from 2017.

2. CMS Administrator Seema Verma said the suspension is based on a legal dispute over the formula used to calculate risk adjustment payments. About three years ago, a New Mexico federal court ruled the formula was flawed, but a Massachusetts judge...

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