What’s New in Health Care Reform: Aug. 17

Lab-worker-with-test-tubes-doing-research-16x9What'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.


Medicare Changes Fiercely Resisted

The Obama administration is hitting resistance from industry groups as it tries to change Medicare payments before leaving office. The administration argues its Medicare proposals will make payments smarter, save money and incentivize quality care. Opposition to the plans, it says, is mainly coming from entrenched interests that are seeking to protect their profits. But opponents say administration officials are overstepping their authority and rushing to make changes before the clock runs out. Via The Hill.

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More Tweaks Coming for Value-Based Medicare Advantage Project

The federal government will expand a new Medicare Advantage program to three states in 2018, as part of an effort to change behaviors and cost-sharing for seniors who have chronic diseases. In addition, plans that want to join the Medicare Advantage Value-Based Insurance Design model can offer expanded benefits to two new types of chronically ill members, the CMS said. Last year, the CMS Innovation Center, created and funded by the Affordable Care Act, unveiled the five-year experiment, building on the request of doctors and consumer advocates who wanted to see more so-called value-based insurance design. Via Modern Healthcare. 

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CMS Suggests New Obamacare Exchange Rule Is Coming

The Centers for Medicare and Medicaid Services hinted that a new rule to help strengthen Obamacare exchanges is in the works. In a blog post, Kevin Counihan, CEO of the health insurance marketplace, discussed Obamacare’s reinsurance program. This three-year program, which expires this year, was included in the law to help insurers with high-cost enrollees on Obamacare exchanges and stabilize premiums. Via Morning Consult.

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More Small, Midsized Firms Choose to Pay Workers’ Medical Costs Directly

Instead of buying a health insurance policy to cover their workers, a growing number of small and midsized companies are opting to pay their employees’ medical claims directly, a potentially riskier practice financially called self-insuring, a recent study found. Between 2013 and 2015, the proportion of midsized companies with 100 to 499 employees that were self-insured increased 19%, to 30.1%, according to the analysis published in July by the Employee Benefit Research Institute. The percentage of small firms with fewer than 100 employees that self-funded their health plans grew 7%, to 14.2%, the study found. Meanwhile, self-funding by large companies declined slightly, to 80.4%. Via Kaiser Health News.

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Should Big Insurance become Like Walmart to Lower Health Costs?

Retail titan Walmart uses its market dominance to inflict “ruthless,” “brutal” and “relentless” pressure on prices charged by suppliers, business writers frequently report. What if huge health insurance companies could push down prices charged by hospitals and doctors in the same way? The idea is getting new attention as already painful health costs accelerate and major medical insurers seek to merge into three enormous firms. Now that hospitals have themselves combined, in many cases, into companies that dominate their communities, insurance executives argue the only way to fight bigness is bigness. Via Kaiser Health News.

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Obamacare Costs Level as Private Insurance Increased, HHS Says

The costs per person for Obamacare enrollees were essentially unchanged between 2014 and 2015, while per-person costs in the broader private health insurance market rose by at least 3%, according to data released by the Department of Health and Human Services. The data suggests that Obamacare’s individual marketplace improved and became healthier as more people enrolled. Experts say this is crucial to the long-term stability of the Affordable Care Act exchanges. Via Morning Consult.

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Health Insurers Use Process Intended to Curb Rate Increases to Justify Them

After the Affordable Care Act took effect in 2010, it created a review mechanism intended to prevent exorbitant increases in health insurance rates by shaming companies that sought them. But this summer, insurers are turning that process on its head, using it to highlight the reasons they are losing money under the health care law and their case for raising premiums in 2017. That has ignited an election-year fight between insurers and consumers, who are complaining bitterly about the double-digit increases being sought across the country. Via NY Times.

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Cost, Not Choice, Is Top Concern of Health Insurance Customers

The unexpected laser focus on price has contributed to hundreds of millions of dollars in losses among the country’s top insurers, as fewer healthy people than expected have signed up. And that has created two vexing questions: Will the major insurance companies stay in the marketplaces? And if they do, will the public have a wide array of plans to choose from—a central tenet of the 2010 Affordable Care Act? Via NY Times.

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Medicaid Estimate Renews Cost Concerns over "Obamacare"

A government report finds that the cost of expanding Medicaid to millions more low-income people is increasing faster than expected, raising questions about a vital part of President Barack Obama's health care law. The law provided for the federal government to pay the entire cost of the Medicaid expansion from 2014 through the end of this year. Via AP.

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Health Spending Grew Slightly in June, Faster Than Overall GDP

Health spending grew 5.2% in the 12 months leading up to June, while the overall gross domestic product grew 2.3%, according to a report from the Altarum Institute. Spending also increased slightly from the previous month, growing to $3.36 trillion from $3.34 trillion in May, the report says. June’s spending made up 18.2% of the GDP, up from 18.1% the prior month. Via Morning Consult.

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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.