What’s New in Health Care Reform: April 6


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.

Senate Health Committee Faces Deadline For Medical Innovation

The Senate faces a tight deadline if it’s going to pass a medical bill this year designed to speed drug and precision medicine developments. The legislation needs to be smoothed of kinks and on the floor within two weeks unless GOP leaders alter their overall schedule for the year. Via Morning Consult.

Cancer Moonshot Unveils Panel Of Advisers

The National Institutes of Health (NIH) unveiled a blue-ribbon panel of experts and researchers that will advise the NIH's work on Vice President Biden’s cancer moonshot. The board will help decide the best opportunities for breakthroughs in cancer research, which will become part of a research plan issued in late summer 2016. The panel, which includes experts from institutions such as MD Anderson Cancer Center and the Dana Farber Cancer Institute, will issue recommendations that will inform a final report from government leaders on the cancer moonshot task force. The task force will issue a report to President Obama by Dec. 31. Via The Hill. 

Read article

Sicker Patients Seem At a Disadvantage With Medicare Advantage

New evidence suggests Medicare Advantage may not serve some sicker Medicare beneficiaries as well as it does healthier ones. Medicare Advantage’s private health insurance plans offer at least the same benefits as the public, traditional Medicare program for older Americans, as well as some who are disabled or have certain diseases. The private plans may also offer additional benefits not available from traditional Medicare — like coverage for hearing aids and eyeglasses — and lower patient cost sharing. These features make Medicare Advantage attractive and help explain why the program is surging in popularity. Via NY Times.

Read article

Despite Fears, Affordable Care Act Has Not Uprooted Employer Coverage

The Affordable Care Act was aimed mainly at giving people better options for buying health insurance on their own. There were widespread predictions that employers would leap at the chance to drop coverage and send workers to fend for themselves. But those predictions were largely wrong. Most companies, and particularly large employers, that offered coverage before the law have stayed committed to providing health insurance. Via NY Times.

Read article

IRS Could Help Find Many Uninsured People, But Doesn’t

Nearly a third of people without health insurance, about 10 million, live in families that received a federal earned income tax credit (EITC) in 2014, according to a new study. But the Internal Revenue Service doesn’t tell those tax filers that their low and moderate incomes likely mean their households qualify for Medicaid or subsidies to buy coverage on the insurance exchanges. Via Kaiser Health News.

Read article

Medicare Is Often Overbilled by Hospices, and Pays Twice for Some Drugs

Hospices often bill Medicare for a higher level of care than patients need, and Medicare often pays twice for the prescription drugs provided to people who are terminally ill, federal investigators say in a new report. The extra cost to Medicare was put at more than $260 million a year. The investigators found that Medicare was paying hospices almost four times as much as it should have for some patients. The patients were receiving “inpatient care” when all they needed was less-expensive routine care in their homes, the report said. Via NY Times.

Read article

Insurers Cut Commissions To Restrict When and What Plans People Buy

Insurers increasingly are dropping agents' commissions to discourage the sale of the Affordable Care Act plans they're losing the most money on, especially when the consumers are more likely to be sick, according to health care industry officials and experts. The moves by nearly every major insurer over the last few months are often focused on times of the year and plans that attract the sickest people and starting to prompt action by state officials and legislators. Some, including the head of California's state insurance exchange, say federal regulators should help assure consumers get the help and plans they need, especially during special enrollment periods when they lose jobs, move or have babies. Via USA Today.

Read article

Obama Tells Holdout Governors To Expand Medicaid, Few Comply

In its final year, the Obama administration is pulling out all the stops to convince the 19 states that have not expanded Medicaid under the Affordable Care Act to do so. States that have not adopted Medicaid expansion, mostly in the South and Midwest, are nearly all led by Republican governors. The White House has been offering financial incentives to persuade them to expand the program to cover people whose incomes are above 138 percent of the federal poverty line but don’t make enough money for Obamacare subsidies. A 2012 Supreme Court ruling made expansion optional for states, though it was originally meant to be national under the law. Via Morning Consult.

Many Of The Current Uninsured Won’t Gain Coverage, Study Suggests

Barring any major policy changes, most of the remaining non-elderly uninsured people in the U.S. likely won’t gain coverage, a new study released today suggests. The study, from the Urban Institute and funded by the Robert Wood Johnson Foundation, says that while some higher-income people who are uninsured will surely gain coverage as the penalties for not having insurance increase, the possibility for increased coverage is actually lower among those who have higher incomes than those who are eligible for financial assistance to cover insurance. Via Morning Consult.

New Health Insurance Customers Are Sicker. Should We Be Surprised?

Before Obamacare, health insurance companies routinely refused to sell policies directly to patients who had illnesses like AIDS, hepatitis C, or heart disease. It should be no surprise to anyone, then, that once the Affordable Care Act required insurers to offer insurance to sick people, a lot more sick people signed up. That is the basic conclusion of a new report on health insurance customers from the Blue Cross and Blue Shield Association analyzing health insurance for 4.7 million Americans in 27 states and the District of Columbia. The report, which shows that new customers are sicker and costlier than people in the old individual insurance market, made a big splash Wednesday, because it implied that the Obamacare markets are more troubled than many had expected. Via NY Times.

Read article


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.