What’s New in Health Care Reform: April 28


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.

United’s Departure from Marketplaces Could Impact Consumers’ Costs, Access

UnitedHealthcare’s decision to quit insurance exchanges in about 30 states next year has patient advocates concerned that fewer options could force consumers to pay more for coverage and have a smaller choice of network providers. The company’s departure could be felt most acutely in several counties in Florida, Oklahoma, Kansas, North Carolina, Alabama, and Tennessee that could be left with only one insurer, according to an analysis by the Kaiser Family Foundation. Via Kaiser Health News.

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Long-Awaited Managed Care Rules for Medicaid, CHIP Are Final

The Centers for Medicaid and Medicare Services announced a massive update to managed care in Medicaid and the Children’s Health Insurance Program. In doing so, it attempts to bring the program in line with the changes Medicaid has undergone over the last decade. The new rule is the agency’s guideline for modernizing the low-income health care program and strengthen its quality of care. Medicaid managed care services are offered by risk-based managed care organizations, which contract with state Medicaid programs to offer care to enrollees. Essentially, they are the private insurer alternative to traditional fee-for-service Medicaid. Via Morning Consult. 

Administration Says New Rules for Medicaid Plans Will Improve Service for Enrollees

The Obama administration tightened rules for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment, and requiring minimum levels of participating doctors. For consumers, the most visible change may eventually be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years. Via Kaiser Health News.

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Obamacare Premiums Expected to Rise Sharply Amid Insurer Losses

Health insurance companies are laying the groundwork for substantial increases in Obamacare premiums, opening up a line of attack for Republicans in a presidential election year. Many insurers have been losing money on the Obamacare marketplaces, in part because they set their premiums too low when the plans started in 2014. The companies are now expected to seek substantial price increases. Via The Hill.

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Medicare’s New Physician Payment System: A 2015 Law Has the Potential to Transform How Medicare Pays Physicians

An overwhelming body of research in recent years found that medical care in the United States was neither efficient nor as effective as it could be. Inappropriate and excessive care is common even as rising health care costs burden government, business, and families. Against this backdrop, government and private-sector leaders have resolved to transform how physicians are paid in a way that holds them more accountable for the care they deliver. The latest salvo in this effort was the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, signed into law April 16, 2015. This policy brief does not discuss MACRA's two-year extension of the Children's Health Insurance Program (CHIP) or provisions pertaining to issues other than physician payment. Via Health Affairs.

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Breaking the System: Budget Battles Gut Healthcare for the Most Vulnerable

Even as the White House touts the Affordable Care Act's successful coverage of nearly 20 million people, residents across the country are struggling to access and afford health care and social-service programs. State legislatures are seeing shrinking revenue because of tax cuts and low energy prices. North Dakota and Texas, which rely on oil tax revenue, are facing huge budget shortfalls. Via Modern Healthcare.

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Medicaid Aims to Foster Critical Care Talks with Doctors

Medicare wants more doctors and patients to talk about the tough care decisions that must be made if a person becomes seriously ill or incapacitated. The federal entity, which covers health care for people over age 65, has started reimbursing doctors for having face-to-face, advance-care planning discussions about a patient's treatment preferences should they become unable to speak for themselves. Via Associated Press.

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More Exchange Plans Offer Patients Easier Access to Some Expensive Drugs: Report

Some people with cancer, HIV, and multiple sclerosis have better access to high-cost specialty drugs in marketplace plans this year, yet a significant proportion of these plans still place many expensive drugs in cost-sharing categories that require the highest patient out-of-pocket costs, according to a new analysis. The report by Avalere Health examined how silver-level plans handled 20 classes of medications that are used to treat complex and expensive diseases such as HIV, cancer, hepatitis C, and bipolar disorder. Via Kaiser Health News.

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AHIP Head Warns that ACA Premium Increases Are Coming

Marilyn Tavenner, a premier spokeswoman for insurers, is concerned about 2017 health care premiums. As president and CEO of America’s Health Insurance Programs, she says the culmination of market shifts that insurers have faced over several years will cause a stark rise in health insurance rates on Obamacare exchanges. Via Morning Consult.

Obamacare Seems to Be Reducing People’s Medical Debt

A new study is showing that by giving health insurance to low-income people, Obamacare seems to have cut down on their debt substantially. It estimates that medical debt held by people newly covered by Medicaid since 2014 has been reduced by about $600 to $1,000 each year. The study, published as a working paper by the National Bureau of Economic Research, builds on earlier evidence from Oregon and Massachusetts that offering health insurance to low-income Americans can help them avoid debt and financial shocks. Via NY Times.

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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.