Tag Archives: Insurance News

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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Viewpoints: The Meaning Of Skyrocketing Premiums; Congress’ Inaction On Zika


Slate:
The RNC Ignores Actual Science, But Embraces Pseudoscience


As 9 p.m. approached on the Wednesday of the 2012 Republican National Convention, delegates in Tampa, Florida, heard from South Dakota Sen. John Thune and Ohio Sen. Rob Portman. On Wednesday, as that same hour approaches in Cleveland, Republican delegates will hear a speech from someone named Michelle Van Etten, the senior vice chairman marketing director for a company called Youngevity. Whatever your political leanings may be, Thune and Portman were at least sitting elected officials with a public track record. Youngevity sells vitamins, purported weight-loss pills, and, also, dog shampoo. While Thune and Portman themselves have a shaky relationship with science, by the standards of the company Van Etten works for, those guys were basically Watson and Crick. (Jeremy Samuel Faust, 7/20)

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Congressional Republicans Ask Administration To Reject Calif. Request On Immigrants’ Insurance


Morning Consult:
California Reps Ask Feds To Reject Plan To Cover Illegal Immigrants


If California is granted such a waiver, it would be the first state granted the ability to offer insurance on its exchange to undocumented immigrants. Under the Affordable Care Act, undocumented immigrants are not eligible to purchase health insurance from states’ exchanges. … The letter was signed by California Republicans Darrell Issa, Tom McClintock, Ken Calvert, Dana Rohrabacher, Duncan Hunter, Doug LaMalfa, Paul Cook, Ed Royce, and Mimi Walters. (McIntire, 6/29)

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Ga., Calif. Hospitals Sue Blue Cross Plan For Sending ER Reimbursements To Patients

Blue Cross and Blue Shield of Georgia faces separate lawsuits accusing it of sending reimbursement money for emergency room care directly to patients — and not to the hospital because it isn’t part of the insurer’s network.

That’s costing the hospitals money since patients don’t always turn over the funds, according to the lawsuits, filed by Polk Medical Center in northwest Georgia and Martin Luther King, Jr. Community Hospital in Los Angeles — 2,000 miles apart. Each suit also says some patients have sought to profit from receiving the direct payments for their ER care.

By sending money directly to patients, Polk Medical Center says the insurer forces the hospital to find ways to collect it. Even though patients are obligated to pay the facility the amount sent to them by Blue Cross, in some cases they have spent the money, according to the lawsuit.

The Polk lawsuit said that Blue Cross, in its new payment process, was pursuing “retaliation’’ for the Cedartown, Ga., hospital’s not agreeing to “unreasonable and unfair” terms in order to be part of the insurer’s network. Hospital officials said the payment shift has hurt the hospital financially.

“Blue Cross insures a significant number of individuals in Polk County,’’ said Tommy Manning, the attorney for the Floyd Medical Center system, of which Polk Medical Center is a part.

Manning said that Blue Cross has sent ER payments to patients for several months.

And he said he was unaware of the Los Angeles lawsuit prior to the filing of the Polk complaint.

The lawsuit from Martin Luther King, Jr. Community Hospital alleges that “most of the MLK patients who receive checks from [Blue Cross of Georgia] are unaccustomed to receiving payments in such large amounts. Some of these patients do not know that they are required to endorse those checks over to MLK. Other patients know that they should endorse those checks over to MLK but instead use such funds to pay for their personal expenses. When MLK attempts to collect the amounts from these patients, the money is often spent.”

Emergency DepartmentIn the case of patient “B.G.,’’ the suit alleges that the patient went to the MLK emergency room 11 times between Oct. 19 and March 27 for various ailments, including complaints of chest or back pain. Blue Cross of Georgia paid the patient a total of more than $70,000 for these visits to MLK, according to the lawsuit.

The lawsuit said the practice overall has caused MLK to suffer damages in excess of $350,000.

Blue Cross declined comment on the lawsuits, citing pending litigation.

Patients are protected under federal law when seeking care in hospital emergency rooms. Under the Emergency Medical Treatment and Labor Act (EMTALA), they must at least be stabilized and treated, regardless of their insurance status or ability to pay.

Manning said this month that he’s not aware of any other insurer in Georgia paying the patient instead of the hospital.

At least one other major hospital that is not part of the suits has reported difficulty in getting payments from Blue Cross when it was out of the insurer’s network. Officials at Grady Memorial Hospital in Atlanta said that when it was out of Blue Cross’ network for the four months ending in March 2015, the insurer sent reimbursement payments to some patients and not to Grady.

Daron Tooch, a Los Angeles attorney representing MLK Hospital, said other Blue Cross plans in the United States use similar tactics. The Los Angeles patients worked for a company that has Blue Cross of Georgia coverage, he said. MLK is out of network for the Blue Cross plans in California.

“This is not unique to MLK,’’ said Tooch. “This happens to all out-of-network providers for Blue Cross of Georgia.”

Going after the patients for payment instead of the health plan simply hasn’t worked, attorneys for MLK said. The patients “are typically unable or unwilling to pay MLK for the medical services received,” according to the suit.

Manning agreed. “We will continue to pursue collection with patients, but filing numerous lawsuits would not be fruitful, particularly given that Blue Cross Blue Shield is the party ultimately at fault,” he said.

Asked about the Blue Cross of Georgia payment strategy, the national Blue Cross Blue Shield Association, through a spokesman, declined comment. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group, said that those types of reimbursement arrangements would vary by plan and by contract. She added that she did not have details on other plans that may do the same.

Paying patients directly is an insurer tool used more commonly in the West, “particularly when non-network facilities are unwilling to negotiate reimbursement related to out-of-network service,’’ said Janet Guptill of the Tatum firm, which provides interim chief financial officers and other executives to health care organizations.

“The insurer takes the position that the provider claim is a private pay issue between the provider and the patient, so the facility has the responsibility to collect the payment from the patient,’’ Guptill said.

Guptill said that when a hospital isn’t in network, its charges for ER and other care tend to be higher than the charges from facilities in the insurer’s network.

For insurers, paying patients directly is “a clever and probably effective tactic,’’ said Chris Kane, a consultant with DHG Healthcare. The hospital, he said, may already be dealing with other collection challenges, including those involving high-deductible health plans.

A hospital attempting to collect the money may end up alienating the patient and thereby discouraging future visits, Kane said.

And patients pocketing the money is another problem, he added. “It’s more troubling if a patient views this as a source of cash.’’

This story was done in partnership with Georgia Health News.

Categories: California, Health Industry, Insurance, Syndicate

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Catastrophic Insurance Could Help With Long-Term Care Expenses: Studies

As aging baby boomers swell the ranks of elderly Americans, we’re nowhere near a solution to providing the long-term care services many of them will need.

“Do you use those resources to assist people who might be able to take care of themselves, or do you use it to help people who couldn’t realistically be expected to take care of themselves?” asked Howard Gleckman, a senior fellow at the institute who has co-authored studies on the subject.

Adult Daughter Helping Senior Tie Shoelaces

The problem is large and growing. Researchers estimate that about half of people who are 65 today will need help with daily activities such as bathing or eating at some point in their lives. Most will need help for less than two years, but about 1 in 7 will have a disability that lasts for more than five years.

Even though many people rely on unpaid family help, a growing number will need care provided by home health aides or nursing homes. Someone who turns 65 today can expect to rack up about $138,000 in long-term care costs over the rest of her life, according to the Urban researchers. Once people exhaust their own resources, they often turn for help to Medicaid, which covers 40 to 60 percent of long-term care services in this country, providing nursing home and other services to low-income people who have few other assets.

In a recently released issue paper and in a study in the journal Health Affairs last year, the Urban researchers modeled the spending impact of two programs that each paid a $100 daily benefit, with a 3 percent annual inflation adjustment. The first would pay at the beginning — 90 days after someone needed help with at least two “activities of daily living” — for up to two years, while the second would pay at the end — for an indefinite period — after someone had needed assistance for at least two years.

The spending impact on consumers’ out-of-pocket costs and the Medicaid program would vary depending on when the coverage kicked in.

The program that paid on the front end would have a bigger effect on individuals’ out-of-pocket spending for long-term care services. Forty-five percent of spending on the front-end program would displace out-of-pocket spending by individuals, compared with displacing 33 percent of out-of-pocket spending in the back-end program. That makes sense, since many people pay for long-term care services on their own until they can no longer afford to do so and then turn to Medicaid.

Conversely, the insurance program that paid out on the back end after two years would be more advantageous for Medicaid. That program would displace 38 percent of Medicaid spending, compared with just 15 percent for the front-end program.

Consumer advocates have long championed plans to establish some sort of national insurance program to help cover long-term care services. But costs and political differences have stymied the efforts. The Urban researchers, in the most recent brief, suggest that although more studies are needed, the back-end program they modeled “could reduce Medicaid spending, providing financial relief to hard-pressed states” and “reduce out-of-pocket spending for families.”

Insurance is only one piece of the puzzle, said Bonnie Burns, a policy specialist and long-term care expert at California Health Advocates, a Medicare advocacy organization.

“What we need is a coordinated system of care,” she said. “We’ve spent 30 years of looking at this problem. There’s lots of data but there’s no action.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

Categories: Aging, Cost and Quality, Insurance, Insuring Your Health, Medicaid, Syndicate

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Viewpoints: Time For A Change In Course For FDA?; A Key Moment For The Health Law’s Medicaid Expansion


The Wall Street Journal:
It’s Time To Radically Change How The FDA Approves Drugs


I’m a big fan of the U.S. Food and Drug Administration (FDA) and the vital mission it has been performing since 1962: ensuring that all medications sold in the United States are both safe and effective. Everyone should want the FDA to succeed — now and in the future — because, without a strong FDA, being sick would be massively more horrible than it already is. But, although a fan, I think the FDA should change course. Specifically, the FDA should adjudicate new drug applications with a Consumer Reports approach, not its current approach, which copies Roman emperors who signaled a gladiator’s fate with either a thumbs-up or thumbs-down, and no other choice. (John Sotos, 6/29)

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