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Revising the Affordable Care Act without Replacing It: The Trump Administration Regulates and Litigates the ACA


Speaker(s): Jay A. Warmuth, Michael J. Nader, Michael S. Adelberg
Recorded on: May. 17, 2017
PLI Program #: 215027

Jay Warmuth has been at the leading edge of complex legal and regulatory matters in the health care and insurance sectors — and the intersection of the two — for more than a decade. His experience includes deep expertise in pharmacy benefit management services, as well as a thorough background in the Affordable Care Act and insurance mergers and acquisitions.

Before joining Faegre Baker Daniels, Jay was an executive at UnitedHealth Group, holding a variety of positions over his 13-year tenure, including:

  • General Counsel of OptumRx, providing pharmacy benefits management and pharmacy care services
  • General Counsel of UnitedHealthcare Employer & Individual, the company’s commercial health insurance business
  • Deputy General Counsel, UnitedHealthcare Mergers & Acquisitions, overseeing legal support for UnitedHealthcare’s M&A activity and other strategic transactions (joint ventures, affiliation agreements, etc.)

As in-house counsel at the nation’s largest health care services and health insurance company, Jay advised senior business leaders across a wide variety of complex matters in the pharmacy benefit management, health insurance and health care services industries, including:

  • Compliance program development and implementation
  • Customer and vendor contracts and negotiations
  • Government investigations
  • Litigation and pre-litigation strategies in both the private and government sectors
  • Strategic transactional matters, including mergers and acquisitions
  • Privacy issues
  • State and federal regulatory matters

Jay has become a trusted advisor with in-house legal, compliance and regulatory leaders through his skill at identifying and implementing legal and business concepts — and his success as a collaborator focused on building and maintaining relationships.

Personal Interests

  • When not working or simply spending time with his wife and twin boys, Jay enjoys golfing, the outdoors, traveling and reading (usually science fiction or fantasy). One of Jay's favorite places to be is Scooty Lake in Northern Minnesota, celebrating the Fourth of July each year with 100 of his closest family members ... and no cell service.

Services & Industries

  • Insurance
    • Health Care Reform
    • Health Insurance Companies
    • Insurance Company Litigation
    • Insurance Industry Associations
    • Insurance Regulation
  • Health Care
    • Compliance
    • Health Care Transactions
    • HIPAA Privacy & Security
    • Health Plan Regulation
    • Reimbursement

Education

University of Minnesota Law School J.D., cum laude (2000)Carleton College

B.A. in International Relations, cum laude (1997)

Bar Admissions

Minnesota


Mike Adelberg has 20 years of progressive experience with Medicare, Medicaid and the Health Insurance Exchanges that provide health care coverage to more than 100 million Americans. He is a thought leader in reforming the health care and health insurance oversight processes. Mike brings unique insights into the processes, policies and people behind the public programs that finance or subsidize health care coverage.

Before joining FaegreBD Consulting, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO). In these roles, Mike was responsible for setting policy and implementing critical Health Insurance Exchange operations in multiple areas, including plan management, eligibility and enrollment, the small-business health options program (SHOP), and the Co-Op loans. While in CCIIO, Mike led a team of 125 staff and oversaw a $300 million annual operating budget.

Prior to that, Mike was the Director of Medicare Advantage Operations, where he supervised the annual cycle for review and award of Medicare Advantage contracts and led monitoring of Medicare Advantage contractors. His other senior roles at CMS included serving as the associate regional administrator for Medicare operations (Chicago Region) and the director of education and assistance programs.

Mike gained private sector experience while serving as vice president of public policy and government affairs with Universal American Corporation — a medium-sized health insurer focusing primarily on the senior market. Mike also was a senior manager and senior advisor with international consultant BearingPoint (now part of Deloitte) in McLean, Virginia, where he co-led a successful health policy and program evaluation practice.

In his spare time, Mike is an author and historian. He has authored three novels, two non-fiction books, seven scholarly journal articles or book chapters, and other publications.

Faculty Positions

  • Adjunct Instructor of History and English — Various Colleges, 1991-2000

Honors

  • Department of Health and Human Services, Washington, D.C. — Secretary’s Certificate for Distinguished Service (twice)
  • Center for Medicare and Medicaid Services, Baltimore, Maryland — Administrator’s Achievement Award (twice)
  • Council for Excellence in Government, Washington, D.C. — Fellow
  • Office of Personnel Management, Washington, D.C. — Presidential Management Fellow

Civic Activities

  • Medicare Advantage News, Washington, D.C. — Editorial Board
  • Robert Wood Johnson Foundation — Policy-Relevant Insurance Studies Project Advisor, 2014
  • Care Continuum Alliance, Washington, D.C. — Medicare Committee Member (Chair, 2010-11)
  • National Technical Expert Panel, Baltimore, Maryland — Part D Medication Measures Co-Chair, 2005-06
  • Mature Market Resource Center, Libertyville, Illinois — National Mature Media Awards Judge, 2002-03
  • Baltimore County Department of Aging, Towson, Maryland — Commissioner, 1998-2002

Presentations

  • New CMS Rules on Exchanges: Impact on Health Plans, Providers and Brokers
    Co-presenter, Atlantic Information Services (AIS) Webinar, January 2016
  • Enhanced CMS Oversight of Network Adequacy: Strategies for Medicare Advantage Plans
    Atlantic Information Services (AIS) Webinar, November 2015
  • Health Care Trends and Issues
    Panelist, NOLHGA Legal Seminar, San Francisco, July 2015
  • Qualified Health Plan Certification Conferences
    Centers for Medicare & Medicaid Services, Bethesda and Baltimore, Maryland, 2013-15
  • Annual CEO Meeting
    National Association of State Healthcare Co-Operatives, Washington, D.C., 2015
  • Plan Management Forums
    National Association of Insurance Commissioners, Atlanta, Kansas City and Washington, D.C., 2012-14
  • State Exchange Best Practices Forums
    National Governors Association, Washington, D.C., 2012-14
  • Health Insurance Exchanges Conferences
    America’s Health Insurance Plans, Washington, D.C., 2013-14
  • Health Insurance Exchange Forums
    Blue Cross Blue Shield Association, Bethesda, Maryland, 2012-13
  • Converge: Annual Conference
    National Association of Dental Plans, Scottsdale, Arizona, and Orlando, Florida 2012-14
  • Annual Medicare Advantage and Part D Conferences
    Centers for Medicare and Medicaid Services, Baltimore, Maryland, 2007-08
  • National Health Policy Forum
    America’s Health Insurance Plans, Washington, D.C., 2008
  • Medicare Compliance Conference
    Healthcare Compliance Association, Baltimore, Maryland, 2007

Published Articles

  • Narrow Network Health Plans: New Approaches to Regulating Adequacy and Transparency
    Compliance Today, October 2015
  • After King v. Burwell, Viable Exchanges are ACA's Next Challenge
    Modern Healthcare, June 5, 2015
  • How Did We Get Here? A Brief History of Health Care Regulation in the United States
    Healthcare Compliance Today, July 2007
  • The Quiet Revolution in Healthcare Regulation
    The RPM Report, December 2006, pp. 43-45

Education

  • Northern Illinois University
    Master of Public Policy in Human Services, American Society for Public Policy Outstanding Student Award (1994)
  • Rutgers University
    Master of Arts in American History, Garden State Fellowship (1991)
  • Manhattanville College
    B.S. in History and Political Science, cum laude (1989)


Mike Nader concentrates his practice in all facets of employee benefits. In addition to the traditional aspects, he works closely with employers to develop strategies to eliminate or minimize risk when denying or reducing benefits or responding to government inquiries. Mike spent several years as the Manager of Compensation and Benefits for a large corporation, which provided him with a greater understanding of the day-to-day issues (both internal and external) facing employers and service providers.

Mike also provides counsel to selling shareholders, employers, trustees, third-party administrators and fiduciary ESOP committees regarding the structure, installation, drafting and administration of ESOPs, as well as counsel on matters related to the governance, sale or acquisition of ESOP-owned companies. He is a member of The ESOP Association.

Faculty Positions

  • University of Notre Dame Law School — Adjunct Professor

Honors

  • The Best Lawyers in America — Employee Benefits Law, 2005-17, and ERISA Litigation, 2012-17
  • Gibson — Peak Performance Award, 2009 and 2010

Professional Associations

  • Lex Mundi — Regional Vice Chair of Employee Benefits and Pensions Group, 2016, College of Mediators
  • American Bar Association
  • ESOP Association

Presentations

Mike speaks extensively on all aspects of ERISA, including health care reform. Recent engagements have included conferences by the American Conference Institute in New York City and Lex Mundi in Rome, Italy.

Published Articles

  • Winter Checkup — Affordable Care Act Readiness
    Feed & Grain, February/March 2014