What’s New in Health Care Reform: Jan. 20


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.

Biden: Expect Executive Action to Spur Cancer Initiative

President Obama will issue an executive order tasking major government agencies, not just the Department of Health and Human Services, to work toward the cancer-cure initiative announced during the State of the Union address, according to Vice President Joe Biden. Via Morning Consult.

New Guidelines Nudge Doctors to Give Patients Access to Medical Records

The Obama administration is tearing down barriers that make it difficult for patients to get access to their own medical records, telling doctors and hospitals that in most cases they must provide copies of these records within 30 days of receiving a request. In theory, patients have long had a right to obtain copies of their records, but federal officials say they receive large numbers of complaints from consumers frustrated in trying to exercise that right. In new guidelines, issued this month, the administration says doctors and hospitals cannot require patients to state a reason for requesting their records, and cannot deny access out of a general concern that patients might be upset by the information. Via NY Times. 

Medicare’s New ACO Model Preps Providers for Insurance Ventures

Hospitals and doctors have expressed a clear willingness to start their own Medicare Advantage plans. The latest iteration of Medicare's accountable care experiment paves the way for more of them to head that direction. Via Modern Healthcare.

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Affordable Care Act Has Yet to Boost Medicare Preventive Screenings

Medicare beneficiaries are not seeking more preventive screenings, even though the Affordable Care Act makes them available at no cost—and the CMS is trying to figure out why. Via Modern Healthcare.

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Study: Some Marketplace Customers Spend 25 Percent of Income on Health Expenses

Even with subsidies to make coverage more affordable, many people who buy health insurance on the marketplaces spend more than 10 percent of their income on premiums, deductibles, and other out-of-pocket payments, a recent study found. Among those hit hardest, the researchers said, are people who spend nearly a quarter of their income on health care expenses. Via Kaiser Health News.

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Fueled By Health Law, ‘Concierge Medicine’ Reaches New Markets

A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered “health care for billionaires” to middle-income, Medicaid, and Medicare populations. Via Kaiser Health News.

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Replacing Obamacare is Easier Said Than Done

For Republicans determined to repeal and replace Obamacare, the devil is not necessarily the man in the White House. It’s in the details. “Once Republicans vote to repeal Obamacare, the hard part begins. Health reform never gets more popular as the details get filled in,” Larry Levitt, senior vice president of the Kaiser Family Foundation, tweeted after the House vote to repeal the law. Via Morning Consult.

Critics Say Affordable Care Act ‘Risk’ Strategies Are Having Reverse Robin Hood Effect

The goal is to help keep insurance markets stable by sharing the “risk” of sicker people and removing any incentive for plans to avoid individuals who need more medical care. Such stability is likely to encourage competition and keep overall prices lower for consumers, while its absence can undermine both and limit coverage choices — the basic principles of the law. Yet the way the Obama administration has carried out this strategy shows another unexpected consequence of the 2010 health-care law. The administration defends its approach, but critics say the “risk adjustment” program is having a reverse Robin Hood effect — taking money from some plans that are small, innovative or fast-growing, while handing windfalls to some of the industry’s most entrenched players. Via Washington Post.

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U.S. Toughens Rules for Latecomers Trying to Enroll in Health Care Act

The Obama administration, responding to complaints from insurance companies, announced several steps that will make it harder for consumers to obtain health insurance after the annual open enrollment period. Via NY Times.

UnitedHealth's ACA Exchange Losses Reach $720 Million

UnitedHealth Group's first foray with the health insurance exchanges turned out to be a little worse than expected. UnitedHealth lost $720 million on its individual-market health plans in 2015, the company said, several million dollars above estimates made a few months ago. In 2015 and 2016, UnitedHealth expects to lose approximately $1 billion on exchange plans. Via Modern Healthcare.

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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.