Category Archives: Kaiser Insurance News

Viewpoints: Problems With Medicare’s Three-Day Rule; Politics, Premiums And Obamacare

A selection of opinions on health care from around the country.

The Boston Globe:
Unfair To Patients: Medicare’s Three-Day Rule 
Increasingly, hospitals have chosen to keep some patients … under observation — rather than formally admitting them — for days on end. Administrators hope to avoid the heightened attention that inpatient admissions can bring from private auditors hired by Medicare to root out what they consider excessive spending. Patients can become pawns in this game that pits providers against payers. For reasons that only a bureaucrat could attempt to justify, hours spent under observation don’t count toward the three days of care needed to trigger Medicare coverage for post-hospitalization nursing home care. (8/15)

The Wall Street Journal:
ObamaCare Sicker Shock
Hillary Clinton admits she’s running to extend the Obama legacy, and so far she’s had a free ride in defending it. She hasn’t even had to explain the increasingly …
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State Highlights: In Mass., Baystate Health Confronts $75M Budget Shortfall; Philly Firefighters Face New Requirement: Physicials

Outlets report on health news from Massachusetts, Pennsylvania, Florida, Minnesota, New Hampshire, Texas, Ohio, Iowa, California and Illinois.

The Boston Globe:
Baystate Health Plans 300 Layoffs To Fix $75M Budget Hole
Baystate Health, the dominant health care system in Western Massachusetts, plans to lay off about 300 people as it tries to close a $75 million budget shortfall spurred by shrinking federal payments, the nonprofit said Friday. In a memo to Baystate staff, chief executive Mark A. Keroack said the job cuts — about 2.5 percent of the company’s employees — could save Baystate about $20 million. … The health system, which has an annual budget of just over $2 billion, said it would still face a budget gap of about $15 million after those layoffs and another $40 million in unspecified spending cuts. (Woodward, 8/12)

The Philadelphia Inquirer:
Philly Firefighters Get Mandatory Physicals, For The First Time In Decades
The Philadelphia Fire Department has long conducted medical exams for new …
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States’ IVF Laws Get Scrutiny Following Same-Sex Coverage Battles

If a state has a law mandating that insurance companies cover treatments, it often requires the couple to prove infertility. Same-sex couples say that’s discriminatory, and a case out of New Jersey may help change that.

U.S. News & World Report:
Same-Sex Infertility Case Exposes Lack Of Access To Reproductive Treatment
A recent lawsuit involving lesbians in New Jersey who are trying to conceive is highlighting how unaffordable infertility treatments can be – and raising deeper questions about who has the right to assistance in conceiving a child. For many Americans, health insurance does not cover fertility treatment; the few for whom it does are usually in heterosexual marriages. But today’s modern family is different: same-sex marriage is legal, the government has lifted its ban on taxpayer dollars going toward gender reassignment surgery and single people choose to become parents on their own. But while these people don’t fit the description …
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Virtual Reality Could Circumvent Some Challenges To Diagnosing Pedophilia

Researchers have found the disorder difficult to study because they don’t want to use pictures of children, but virtual reality could help with that. Critics, however, are wary that it could lead to a missed diagnosis. In other health technology news, institutions delve into the ways computers can help diagnose cancer, a clinic in Georgia is hacked and Pokemon Go games prove “very useful” in getting people moving.

Stat:
Using Virtual Reality To Diagnose Pedophilia Stirs Up Controversy
A handful of scientists are testing a controversial practice of using virtual reality to diagnose pedophilia in men in hopes of helping them manage their sexual desires before they act on them. Pedophilia, a psychiatric disorder, affects up to 5 percent of men, according to the American Psychiatric Association. But it’s difficult to study because researchers don’t want to use real photos of children to measure arousal. So they’re turning …
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Secrecy Shrouds Boards That Wield Immense Power Over Prescription Drug Coverage

Pharmacy benefit managers release a list of drugs they’re excluding for coverage for the year, which helps pressure drugmakers into keeping prices affordable. But the people on the board that makes those decisions are undisclosed, and critics are calling for increased transparency.

St. Louis Post-Dispatch:
A Secretive Board Controls Access To Prescription Drugs For Millions Of Americans
Each year, Express Scripts releases a list of prescription drugs it will exclude from coverage for the upcoming year, and that list is determined by a secretive board of doctors and a pharmacist. The nation’s largest pharmacy benefit manager, which is based in St. Louis County, does not disclose the names of the board members or any actual or potential conflicts of interest they may have. Express Scripts is not alone. (Liss, 8/14)
Earlier, related KHN coverage: Filling A Prescription? You Might Be Better Off Paying Cash (Appleby, 6/24)

NPR:
Will Your Prescription Meds …
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Massachusetts Gets Approval To Delay Federal Rule On Small-Business Insurance


The Washington Post:
Obamacare’s Surcharge For Smokers May Have Backfired


A provision of the Affordable Care Act that allows insurers to charge smokers higher premiums may have discouraged smokers from signing up for insurance, undercutting a major goal of the law, according to a study published this month. The surcharges, of up to 50 percent over nonsmokers’ premiums, also showed no sign of encouraging people to quit. (Johnson, 7/19)

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Even If Justice Dept. Blocks Insurer Mega-Mergers, Consolidation Trend Likely To Continue


The New York Times:
Failure Of 2 Health Insurer Mergers Is Unlikely To Stop The Efforts


The Justice Department is expected to block two mergers involving four of the nation’s five largest health insurance companies, on the ground that the deals would harm competition. But don’t expect the action to stop the consolidation in the health care industry anytime soon. No matter the fate of the deals between Anthem and Cigna, and Aetna and Humana, hospitals, doctors’ groups and even insurers are almost certain to continue their scramble to find partners in a rapidly changing environment. Blockbuster deals may slow, but smaller combinations will remain attractive. (Abelson, 7/20)

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Study Finds Only A Third Of Insurers Made Money On Marketplace Plans In 2014


Star Tribune:
Report: 107,500 Minnesotans Who Qualify Aren’t Tapping Insurance Subsidies


A new report suggests that about 107,500 Minnesotans last year weren’t tapping federal tax credits to discount health insurance premiums, even though they qualified. In some cases, people eligible for subsidies might have simply skipped the tax credits, because the dollar value was small. But there also could be information gaps where people either didn’t realize they were eligible, or didn’t know where to go for subsidies, according to findings presented Wednesday during a MNsure board of directors meeting in St. Paul. (Snowbeck, 7/20)

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Viewpoints: Obamacare Court Challenges Continue; Examining The GOP Platform


The Texas Tribune:
Protecting Texans From Zika Requires Action, Not Gamesmanship


Last week, the first Zika-related case of microcephaly was reported in Texas. The next day, for the second time, Democrats in the United States Senate filibustered legislation that could have helped stop the spread of the Zika virus in Texas and across the United States. In doing so, they chose partisanship over sound public health policy and empty words over action. … Fortunately, this isn’t catching us by surprise. For months now, experts at the UT Medical Branch in Galveston, the Texas Medical Center in Houston and others in our state have highlighted the need to prepare for the arrival of mosquitos carrying the virus in the United States. (Sen. John Cornyn, R-Texas, 7/19)

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In 2017, Humana Will Reduce Its Health Marketplace Sales, Shrinking From 19 States To 11


Politico Pro:
Struggling MNsure’s Future Could Hinge On Election


After three years of tech problems, paltry enrollment and insurer dropouts, Minnesota’s Obamacare exchange is still struggling. And the future of one of the country’s most troubled exchanges may depend on down-ballot races in a turbulent election year.
Republicans, who have long criticized mismanagement of the exchange, are hoping to seize on its troubles to win full control of the Legislature this November and scrap the state-run marketplace entirely. Democratic lawmakers, meanwhile, hope to win back the Legislature and push through legislation to shore up the marketplace known as MNsure. (Demko, 7/21)

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