What’s New in Health Care Reform: March 9

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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.


Health Law Insurance Plans to be Rated by Network Size

The Obama administration, responding to consumer complaints, says it will begin rating health insurance plans based on how many doctors and hospitals they include in their networks. At the same time, the maximum out-of-pocket costs for consumers under the Affordable Care Act will increase next year to $7,150 for an individual and $14,300 for a family, the administration said. Under new rules to be published in the Federal Register, insurers will still be allowed to sell health plans with narrow networks of providers. Via NY Times.

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In Medicare Advantage Fight, a New Battle Over Retiree Plans

The fight over Medicare Advantage payment rates has entered a new front this year as employers, unions, and trade groups embark on an intense lobbying campaign to head off proposed rate increases to insurers for certain retiree health care plans. They hope to persuade the Centers for Medicare and Medicaid Services to reject some aspects of proposed rate changes for 2017. Via Morning Consult. 


Can’t Get In to See Your Doctor? Many Patients Turn to Urgent Care

In a recent poll conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health, most people reported going to urgent care because they believe it is more convenient and takes less time than going to their regular doctor. One in five said that at least once in the past two years, they were unable to see their regular doctor when they needed medical care, mostly because the doctor didn't have any available appointments, the office was closed, or the doctor was out of the office. Via NPR.

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The Affordable Care Act Isn’t Wiping Out Unpaid Hospital Bills

The promise of the Affordable Care Act for hospitals was that bad debt—a figure that reflects bills a hospital can't collect—would shrink substantially under the law's coverage expansions. The reality, so far, is less uniformly dramatic, even though 20 million fewer Americans are uninsured. Even in states that agreed to expand Medicaid, the popularity of high-deductible plans in those insurance exchanges has added to hospitals' mounting concerns over how patients can pay those bills, if at all. Via Modern Healthcare.

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Consumer Choices Have Limited Impact on U.S. Health Care Spending: Study

A new study throws cold water on the popular idea that consumers can save themselves and the health care system loads of money if they become savvier shoppers for health care services. The analysis by the Health Care Cost Institute focused on what consumers paid out of pocket, where comparison shopping can result in lower costs. The study found that less than 7 percent of total health care spending in 2011 was paid by consumers for “shoppable” services. Via Kaiser Health News.

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Estimated 20 Million People Gained Health Insurance Under Affordable Care Act

About 20 million people have gained health insurance because of the Affordable Care Act, the Obama administration said. The estimate is based on declines in the number of people who have gained coverage because of provisions linked to the health law, according to the Department of Health and Human Services. Via Morning Consult.


Medicare To Test New Payment Approaches For Some Prescription Medications

Medicare plans to test new ways to pay for prescription medications given in doctors’ offices and hospital outpatient centers – moves likely to win praise from some policy experts, but opposition from facilities and practitioners. Under a two-part proposal, regulators aim to reduce what some economists and policy experts say are financial incentives for doctors to choose higher-cost medications even when less expensive drugs may be equally or more effective. Via Kaiser Health News.

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Obamacare Official Touts 'Maturing' Marketplace Amid Insurer Anxiety

A top Obamacare official touted the increasingly stable health care marketplace, looking to assuage concerns from an insurance industry that remains jittery about some parts of the law. Addressing the nation’s largest insurance group, HealthCare.gov CEO Kevin Counihan highlighted the younger and healthier customers who signed up in the most recent enrollment season. Ticking off statistics about the latest open enrollment season, he said the figures are showing “just want you want to see in a risk pool.” Via The Hill.

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Medical Bills Still Take a Big Toll, Even With Insurance

Radley is among the 26 percent of people in a recent poll who say health care expenses have taken a serious toll on family finances. The poll, conducted by NPR, The Robert Wood Johnson Foundation, and Harvard's T.H. Chan School of Public Health, shows that even people with medical insurance are still struggling to pay medical bills. Via NPR.

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Obama’s Emergency Request For Zika Funding Stalls in Congress

The emergency money the Obama administration wants to fight the Zika virus is stuck in Congress — and so far, there’s no sign that congressional Republicans are about to budge. Via Stat News.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.