Description: Conditions and required solvency standards of federal waiver to PSOs to provide Medicare+Choice products. Effect on providers, beneficiaries and employers. Issue No. 36

Description: Republicans have promised to repeal and replace the Affordable Care Act for years. Now that they have power, what will Republican health care reform look like?

Description: This article discusses future benchmarks of Medicare and Medicare's rising costs and its relativity to the actuarial profession.

Description: Updates on the efforts of the Academy’s health practice council. its work groups and task forces, to educate health care policymakers on issues including principles for reform, Medicare, the individual insurance market, and risk factors.

Description: Discussion of the implications of the newly unveiled health care reform proposal by Senator Baucus. Key issues include abandonment of the CLASS Act, inclusion of LTC in cafeteria plans, funding and tax concerns, individual mandate, privacy concerns, play-or-pay employer mandate, impact on Medicare and Medicaid, and gridlock in the legislative finalization process.

Description: A discussion of fraud and abuse in the Medicare payment system, and steps to address these problems.

Description: A proposal to reform current health care market, from a 'preferred payer' system, in which Medicare and Medicaid pay less than the true cost while others must then pay more, to a 'value for money' system. This would be achieved by requiring providers to bill all patients the same rate for the same services, with a standard bundling format to make all providers' rate differences transparent. Differences between billed charges and what Medicare pays would be made up by the Medicare patient, rather than subsidized by those outside of Medicare.

Description: Two Medicare risk funding provisions that were radically changed by the BBA of 1997 funding variations by geographic area and risk adjustment. Issue No. 36

Description: An overview of the Medicare Supplement landscape and the critical factors for successfully pricing and managing this product line amidst the challenges that exist.

Description: This article focuses on the capitation rate development methodology for the Medicare-Medicaid Financial Alignment Demonstration. It also describes the background behind the establishment of the initiative and how it will be evaluated.