When Anthem Blue Cross Blue Shield became embroiled in a contract dispute with Exeter Hospital in N.H. in 2010, its negotiators came to the table armed with a new weapon: public data showing the hospital was one of the most expensive in the state for some services.
Local media covering the dispute also spotlighted the hospital’s higher costs, using public data from a state website.
When the dust settled, the insurer had extracted $10 million in concessions from Exeter. The hospital “had to step back and change their behavior,” said health policy researcher Ha Tu, who studied the state’s efforts to make health care prices transparent.
New Hampshire is among 14 states that require insurers to report the rates they pay different health care providers —and one of just a handful that makes those prices available to consumers.
The theory is that if consumers know what different providers charge for medical services, they will become better shoppers and collectively save billions.
In most places, though, it’s difficult, if not impossible to find out how much you will be charged for medical care. And with more people enrolled in high-deductible insurance plans, there is a growing demand for accurate price information.Continue reading →
About a quarter of the 243 groups of hospitals and doctors that banded together as accountable care organizations under the Affordable Care Act saved Medicare enough money to earn bonuses, the Centers for Medicare & Medicaid Services announced Tuesday.
Those 64 ACOs earned a combined $445 million in bonuses, the agency said. Medicare saved $372 million after accounting for the ACOs that did not show success, including four that overspent significantly and now owe the government money.
The bonuses, losses and Medicare savings are teensy sums in the context of a program that spends half a trillion dollars a year on care for the elderly and disabled.
But the Obama administration views the results so far as evidence that reorganizing the financial incentives for doctors and hospitals — a key element of the health law – can translate to substantial savings if the program expands nationwide.Continue reading →
It is time for conversations about death to become a part of life.
That is one of the themes of a 500-page report, titled “Dying In America,” releasedWednesday by the Institute of Medicine.
The report suggests that the first end-of-life conversation could coincide with a cherished American milestone: getting a driver’s license at 16, the first time a person weighs what it means to be an organ donor.
Follow-up conversations with a counselor, nurse or social worker should come at other points early in life, such as turning 18 or getting married.
The idea, according to the IOM, is to “help normalize the advance care planning process by starting it early, to identify a health care agent, and to obtain guidance in the event of a rare catastrophic event.”
The IOM plans to spend the next year holding meetings around the country to spark conversations about the report’s findings and recommendations. “The time is now for our nation to develop a modernized end-of-life care system,” said Dr. Victor Dzau, president of the IOM.Continue reading →
In response to budget cuts, the public health department for King County and Seattle is forming an oversight committee to keep tabs on, and hopefully replenish, county-run family planning health services that might slip through the cracks and leave clients with nowhere else to turn.
This story was co-published with The New York Times’ The Upshot.
Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions.
But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.
By charging higher prices for generic drugs that treat certain illness, health insurers may be violating the spirit of the Affordable Care Act, which bans discrimination against those with pre-existing conditions.
Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments.
But according to an editorial to be published Thursday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.Continue reading →
For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services.
The health law contains provisions aimed at curbing this piecemeal approach to coverage. States, however, continue to pass new mandates, but with a twist: Now they’re adding language to sidestep the health law, making it tougher than ever for consumers to know whether they’re covered or not.
Confused? Policy experts fear consumers will be too.
State coverage mandates vary widely. They may require coverage of broad categories of benefits, such as emergency services or maternity care, or of very specific benefits such as autism services, infertility treatment or cleft palate care.
Some mandates require that certain types of providers’ services be covered, such as chiropractors.
They may apply to all individual and group plans regulated by the state, or they may be more limited.
The federal government’s first survey of the nation’s insured rate since the health care law’s new marketplaces began found a decrease in the number of adults without coverage, particularly among young adults.
The National Health Interview Survey of people during the first three months of this year found that the number of adults under 65 without health insurance dropped to 18.4 percent from 20.4 percent in 2013.
Among all ages, the survey found that the uninsured rate dropped to 13.1 percent from 14.4 percent in 2013; 41 million people still lacked insurance.Continue reading →
The uninsured rate for kids under age 18 hasn’t budged under the health law, according to a new study, even though they’re subject to the law’s requirement to have insurance just as their parents and older siblings are.
Many of those children are likely eligible for coverage under Medicaid or the Children’s Health Insurance Program.
The Urban Institute’s health reform monitoring survey analyzed data on approximately 2,500 children, comparing the uninsured rate in June 2014 with the previous year, before the health insurance marketplaces opened and the individual mandate took effect.
It found that rates remained statistically unchanged at just over 7 percent for both time periods.
Part of the explanation is that even before the health law passed, the uninsured rate for children was already quite low, says Genevieve Kenney, a senior fellow at the Urban Institute and the lead author of the study.Continue reading →
An increasing number of seniors who spend time in the hospital are surprised to learn that they were not “admitted” patients — even though they may have stayed overnight in a hospital bed and received treatment, diagnostic tests and drugs.
Because they were not considered sick enough to require admission but also were not healthy enough to go home, they were kept for observation care, a type of outpatient service.
The distinction between inpatient status and outpatient status matters: Seniors must have three consecutive days as admitted patients to qualify for Medicare coverage for follow-up nursing home care, and no amount of observation time counts for that three-day tally.
That leaves some observation patients with a tough choice: Pay the nursing home bill themselves — often tens of thousands of dollars – or go home without the care their doctor prescribed and recover as best they can.
Angry seniors have sued Medicare and appealed to Congress to change the rules they say make no sense. Although Medicare officials recently began experimenting with limited exemptions, they have been unable to resolve the problem.
But most observation patients with private health insurance don’t face such tough choices. Private insurance policies generally pay for nursing home coverage whether a patient had been admitted or not.
Here’s a primer comparing how Medicare and private insurers handle observation care.Continue reading →
This week, I am answering questions from readers about whether people can wait until they get sick to buy health insurance and who’s allowed to buy plans on the state marketplaces, as well as a query about the tax on so-called Cadillac plans.
Q. Let’s say an uninsured person is in a car accident, has emergency surgery and is hospitalized, and after awaking from surgery asks to purchase insurance right away. Under the health law, would his medical costs be covered since he can’t be denied insurance because of a pre-existing medical condition? An article I saw said the hospital would even enroll people and pay their premiums. Is that correct?
It’s unlikely . . .
It’s unlikely that this hypothetical person would be able to sign up for coverage after being injured, says Judith Solomon, a vice president for health policy at the Center on Budget and Policy Priorities. Continue reading →
Premiums for job-based insurance rose modestly for the third consecutive year, reflecting slowed spending, even as key elements of the federal health care law went into effect.
Family premiums rose 3 percent in 2014, one of the lowest increases tracked since the Kaiser Family Foundation and the Health Research & Educational Trust began surveying employers in 1999. (Kaiser Health News is an editorially independent program of the foundation.)
Family premiums rose 3 percent in 2014, one of the lowest increases since 1999.
Nonetheless, the cost of the average family plan rose to $16,834 annually, according to the survey of more than 2,000 employers nationwide.
While both critics and supporters of the Affordable Care Act are likely to find fodder for their positions, the report portrays 2014 as a relatively stable year for employer coverage, with little change in the type of plans offered or their costs.
The percentage of firms offering health benefits (55 percent) and the percentage of workers covered at those firms (62 percent) were statistically unchanged from 2013, despite predictions of the law’s critics that many firms would drop coverage.Continue reading →
Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.
Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve.
.Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014.
The administration initially announced a transitional policy that, with state approval, would allow insurers to renew plans that didn’t comply with coverage or cost standards starting in December 2013 and continue doing so until October 2014.
In preliminary but encouraging news for consumers and taxpayers, insurance filings show that average premiums will decline slightly next year in 16 major cities for a benchmark Obamacare plan.
Prices for a benchmark “silver” or mid-priced plan sold through the health law’s online marketplaces aren’t all moving in the same direction, however, a report from the Kaiser Family Foundationn (KFF) shows. (Kaiser Health News is an editorially independent program of the foundation.)
In Nashville, the premium will rise 8.7 percent, the largest increase in the study, while in Denver it will fall 15.6 percent, the largest decrease.
But overall the results, based on available filings, don’t show the double-digit percentage increases that some have anticipated for the second year of marketplace operation.
The controversial federal court decision that threatened the future of the Affordable Care Act is no more.
The full District of Columbia Court of Appeals Thursday agreed to rehear Halbig v. Burwell, a case charging that the federal government lacks the authority to provide consumers tax credits in health insurance exchanges not run by states.
A majority of judges on the full appeals court are Democratic appointees, including four appointed by President Barack Obama.