Results are in: Reinsurance and risk adjustment

Dawn Carter, Edifecs

The seminal reporting period for Marketplace-participating plans has closed and the results are in. Where does the industry go from here?

For ACA marketplaces, the near-poor are the sweet spot

Andrew Sprung

Among the near-poor, the proportion of the newly insured who gain their insurance through the marketplace was likely to be particularly high.

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The Obama Administration recruited Seattle Seahawks quarterback Russell Wilson and cornerback Richard Sherman to the game of selling the Affordable Care Act.

President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.


Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

An old Yankee insurance company is taking over the younger, Louisville-based Humana. It’s a deep dive into Medicare, government-funded health plans and new ways of delivering and paying for healthcare.

The U.S. Supreme Court has dismissed the challenge to the Affordable Care Act's subsidies in federally-facilitated exchanges, a victory for the Obama Administration but certainly not the last health reform battle.

Despite looming consolidation, health plans and insurers broadly need to attract more younger workers as Baby Boomers retire and markets evolve.

There will soon be one less member company of America's health insurance trade group, a sign of the industry's evolutionary turmoil.

The country's largest state insurance exchange wants to be an active purchaser negotiating on behalf of consumer, and a data-driven convener of affordability and quality.

Taking a cue from Aetna, Ascension Health and companies beyond the healthcare industry, Tufts Health Plan is raising its minimum base wage.

Anthem is scrambling to save a $53 billion takeover of Cigna, while encountering some deep criticisms of its own future potential.

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