What’s New in Health Care Reform: June 29


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.

HHS Official Hints at Changes to Medicare Payment Proposal

An administration official hinted that the White House may change pieces of its controversial proposal to alter the way Medicare reimburses providers for drugs administered by hospitals and physicians’ offices. At a heavily attended Senate Finance Committee hearing, Patrick Conway, CMS Deputy Administrator, testified before a panel of lawmakers who are at best hesitantly approving of the proposal and at worst outright opposed. Every Republican on the committee signed a letter to CMS demanding its withdrawal. Via Morning Consult.

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Even With Private Insurance, Out-of-Pocket Costs for Hospital Visits Shot Up 37%

The amount that people with private insurance still had to pay for hospital visits grew 37 percent from 2009 to 2013, a study finds. And it's probably still going up. The study, conducted by the University of Michigan and published in JAMA Internal Medicine, adds to a growing body of evidence that suggests employers are using high-deductible plans to keep premium costs down.. Via Bloomberg. 

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States Offer Privacy Protections to Young Adults on Their Parents’ Health Plan

The health law opened the door for millions of young adults to stay on their parents’ health insurance until they turn 26. But there’s a downside to remaining on the family plan. Chances are that mom or dad, as policyholder, will get a notice from the insurer every time the grown-up kid gets medical care, a breach of privacy that many young people may find unwelcome. With this in mind, in recent years a handful of states have adopted laws or regulations that make it easier for dependents to keep medical communications confidential. Via Kaiser Health News.

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More Transparency Needed in Covering Substance Use Disorder, Report Argues

Health insurers should be more transparent about what substance abuse disorder services are covered under their plans, a report released by the Robert Wood Johnson Foundation says. Coverage for treating substance abuse disorders varies greatly across the country, depending on the market, the report says. Additionally, FDA-approved drugs to treat alcohol disorders are generally more available and in lower cost-charing tiers than drugs approved to treat opioid abuse. Via Morning Consult.

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Health Insurer’s Limit on Insulin Pumps Worries Patients

UnitedHealth Group Inc. has made a deal with device maker Medtronic that will slash options for diabetics who use the portable pumps, which costs thousands of dollars. The move has angered Rodenberg-Lewis and others who will be limited to three pump choices instead of nine. Via AP.

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Without Federal Funding, Counties Brace to Confront Zika on Their Own

Communities across the country are preparing for the arrival of the Zika virus, but they aren’t preparing equally. One county is ready to leap into action with a fleet of helicopters and planes to spray for disease-transmitting mosquitoes. Others facing a similar risk of the disease can’t afford much more than educational coloring books. Some localities have signed up private contractors to wage war on disease-carrying mosquitoes. For others, the only line of defense is an overworked parks employee responsible for all kinds of maintenance — “Chuck in the truck,” as one expert put it. Via Washington Post.

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Why the GOP Health Plan Doesn’t include Numbers

House Republicans have estimates from the Congressional Budget Office on how their health care plan would affect the federal deficit. They’re just not releasing them. The 37-page white paper doesn’t include cost and savings estimates, according to a senior GOP aide, because Republicans may want to break up the plan into smaller bills and some of the numbers depend on major decisions yet to be made. Via Morning Consult.

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Filling a Prescription? You Might Be Better off Paying Cash

Some consumers who use health insurance copays to buy prescription drugs are paying far more than they should be and would be better off paying with cash, especially for generics. The added cost runs as high as $30 or more per prescription, say pharmacists, and the money is largely being pocketed by middlemen who collect the added profit from local pharmacies. Cash prices started to dip below copays a decade ago when several big box stores started offering dozens of generics for as little as $4 per prescription. But as copays have risen and high-deductible insurance plans become more common, more consumers are now affected. Via Kaiser Health News.

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Social Security Trust Fund Will Be Empty in Less Than 20 Years

The fund for Medicare is on track to run out of money by 2028, which is earlier than expected from last year but still 11 years later than projected before the Affordable Care Act was implemented. After the fund is depleted, the program will only have enough tax revenue to pay out 87 percent of hospital costs, projections show. Financing for the program suffered last year because of a drop in tax revenue and an increase in spending for inpatient hospital services. Via Washington Post.

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Blue Cross Says Individual Market Plans Will Offer Limited Choices Next Year

In a sign of continuing tumult in the health insurance industry, the state’s largest insurer said it will no longer offer its traditional suite of flexible and broad-reaching policies for those consumers who don’t get coverage through the workplace. Instead, Blue Cross and Blue Shield of Minnesota will sell only health plans with a narrow network, which limits patient coverage to specific doctors, hospitals, and prescription drug benefits. Via Star Tribune.

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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.