What’s New in Health Care Reform: Nov. 25

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What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.


End Of Medicare Bonus Program Will Cut Pay To Primary Care Doctors

Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10 percent bonus for caring for Medicare patients. Some say the loss may trickle down to the patients, who could have a harder time finding a doctor or have to wait longer for appointments. But others say the program has had little impact on their practices, if they were aware of it at all. Via Kaiser Health News.

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Conservative Groups Push ACA Rider On Risk Corridors

Conservative advocacy groups are hoping to reprise a rare Obamacare policy victory they scored during last year’s spending negotiations — curbing the government’s ability to pay for insurers’ losses. The request could create a potential flashpoint in December’s government funding talks. Via Morning Consult. 


Pfizer and Allergan Merge in $160B Tax Inversion Deal

U.S. pharmaceutical giant Pfizer (PFE) and Irish rival Allergan (AGN) announced a record-breaking $160-billion merger, the largest in health-care industry history and the biggest yet involving a controversial tax-saving strategy. In a chiefly-stock transaction expected to create the world's largest drugmaker by sales, Pfizer, the maker of erectile dysfunction medication Viagra and cholesterol-lowering drug Lipitor, will combine with Allergan, whose brands include cosmetic medication Botox. Via USA Today.

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Fewer Medicare-Subsidized Drug Plans Means Less Choice For Low-Income Seniors

Eight million people in traditional Medicare have drug plan subsidies, also called “Extra Help.” To qualify for the full subsidy, an individual must have an income below $17,655 in 2015 and less than $13,640 in assets. Some beneficiaries who do not choose a new plan will be randomly assigned to one. It’s up to these beneficiaries to check if their new plan covers their drugs. Via Kaiser Health News.

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Insurers Reassure Investors About ACA Exchange Business

Health insurers rallied to ease investor and customer concerns about the Affordable Care Act's public insurance exchanges a day after the nation's biggest insurer questioned its future in that still-developing market. Blue Cross-Blue Shield insurer Anthem and Medicaid coverage provider Molina Healthcare both said they are making money off their exchange business, and Anthem joined Aetna, the nation's third-largest health insurer, in reaffirming its 2015 earnings forecast. Via Associated Press.


U.S. Proposes Obamacare Changes to Ease Shopping, Lower Bills

The U.S. proposed new Obamacare rules that it says will make it easier for people to shop for health insurance, protect them from some out-of-pocket costs, and help states run the marketplaces where plans are sold. The changes would apply to insurance plans sold on the Affordable Care Act’s marketplaces for 2017, the law’s fourth year of coverage. Consumers will buy those policies starting on Nov. 1, 2016. The rules are still in proposal form and will have to be finalized after a period of public comment. Via Bloomberg.

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UnitedHealth Lowers Forecast, Blaming Affordable Care Act

UnitedHealth Group, one of the nation’s largest health insurance companies, stunned investors when it significantly lowered its profit estimates, placing the blame for an expected loss of hundreds of millions of dollars on selling individual policies under the federal health care law. In light of the losses, the company warned that it was also weighing whether it would continue to offer individual coverage through the online exchanges for 2017. Via NY Times.

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Feds Take Steps to Bolster Finances Of State-Run Health Exchanges

The Obama administration proposed a new type of partnership between state and federal health marketplaces in an attempt to address the mounting financial pressures on state-run exchanges. Under the new model, states would be allowed to use federal resources like call centers or website platforms while maintaining their own decision-making power. Via The Hill.

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Insurers: Obamacare Changes Needed Soon to Protect Us From Losses

Federal regulators proposed potential solutions to some of the Obamacare problems that led UnitedHealth Group to warn it may exit the health exchanges in 2017, but the government also may make it tougher for insurers to limit the number of doctors and hospitals in their plan networks. Via USA Today.

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Shopping For Health Insurance is New Seasonal Stress For Many

Over the past two years, the Affordable Care Act has created entirely new markets for health insurance, and a new way of buying it, via online exchanges that allow comparison shopping. They have brought coverage to nine million people, many of whom could not afford it or were rejected by insurers before. But these new markets have also seen sharp price swings, or changes in policies, that are driving many consumers to switch plans each year. Via NY Times.

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Kelley Schreiber

Kelley Schreiber is a Marketing Channel Manager at Mayo Medical Laboratories. She is the principle editor and writer of Insights and leads social media and direct marketing strategy. Kelley has worked at Mayo Clinic since 2013. Outside of work, you can find Kelley running, traveling, playing with her new kitten, and exploring new foods.