What’s New in Health Care Reform: Aug. 24

a-physician-examining-a-young-child-in-moms-lap-pressing-on-the-childs-abdomen-original-1024x713What'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.

Aetna Plans to Leave All but 4 State Exchanges

Aetna, one of the nation’s largest health insurers, announced it is pulling out of all but four state exchanges in 2017. It is currently offering exchange plans in 15 states. Aetna is only the latest insurer to reduce its marketplace presence, citing losses. The news also comes amid reports of double-digit premium hikes next year, another sign of financial trouble for insurers. Most of the nonprofit co-op plans created under the health care law have also shuttered. Via Morning Consult.

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Hidden Plan Exclusions May Leave Gaps in Women’s Care, Study Finds

Buried in the fine print of many marketplace health plan documents is language that allows them to refuse to cover a range of services, many of which disproportionately affect women, a recent study found. It’s unclear the extent to which these coverage “exclusions” have prevented patients from getting needed treatments. An insurance industry representative said patients are generally able to get the care they need if it’s appropriate for them. Yet, some women with hereditary breast and ovarian cancer, advocates say, may have gaps in care because of the exclusions. Via Kaiser Health News. 

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Retirees Need $130,000 Just to Cover Health Care, Study Finds

Today's 65-year-olds can expect to spend an average of $130,000 on health care during their retirement, from premiums to co-payments to eyeglasses, according to new estimates. The average single 65-year-old woman can expect to need $135,000 to spend on health care in retirement, while a man will spend $125,000, according to estimates from Fidelity Investments. (The difference is because the woman is expected to live longer—an additional 22 years, vs. 20 years more for the man.) Via Bloomberg.

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Report Suggests Medicare Advantage, Part D Policy Fixes Could Be Applied to ACA Exchanges

The insurance marketplaces created under the Affordable Care Act face some similar challenges that public insurance programs have faced as they’ve gotten off the ground. Steps that were taken to stabilize Medicare Advantage and Medicare Part D could be a starting point to stabilize the ACA insurance exchanges, a policy brief released by the Robert Wood Johnson Foundation suggests. Via Morning Consult.

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Aetna Decision Exposes Weaknesses in Obama’s Health Care Law

Insurance giant Aetna’s decision to stop offering much of its individual coverage through the Affordable Care Act is exposing a problem in President Obama’s signature health-care law that could lead to another fraught political battle in Congress. Aetna’s announcement was the latest sign that large insurers are losing money in the Affordable Care Act’s marketplaces, heightening concerns about the long-term stability of a key part of Obama’s domestic policy legacy. But addressing this issue could open the door to a nasty political fight, given that some Republicans have vowed to repeal the law outright. Via Washington Post.

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Obama Allies Cry Foul over Aetna Snub

Obamacare backers are suspicious of the timing of Aetna’s decision to back out of most of the law’s insurance markets, suggesting the nation’s third largest carrier was trying to strong-arm the Obama administration into approving its controversial merger with another insurer. And a letter emerged overnight in which Aetna CEO Mark Bertolini warned the Department of Justice that the health insurer would scale back Obamacare market participation if the administration tried to block Aetna's merger with Humana. Two weeks later, DOJ sued to stop the deal. Via Politico.

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As Insurers Like Aetna Balk, U.S. Makes New Push to Bolster Health Care Act

The administration is eyeing an advertising campaign featuring testimonials from newly insured consumers, as well as direct appeals to young people hit by tax penalties this year for failing to enroll. But as many insurers continue to lose money on the exchanges, they say the administration’s response is too late and too weak. The companies point to a fundamental dynamic in the marketplace in which too few healthy people are buying policies and too many sick people are filing costly claims. Via NY Times.

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The Unstable Economics in Obama’s Health Law

The problem isn’t technical or temporary; it’s intrinsic to how the law was written. By incentivizing insurers to misprice risk, the law has created an unstable dynamic. Total enrollment this year will be barely half the 22 million the Congressional Budget Office projected just three years ago. Premiums, meanwhile, are set to skyrocket, which will further hamper enrollment. It isn’t clear how this can be fixed. Via Wall Street Journal.

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Study Finds Obamacare Increased Prescription Drug Use, Reduced Spending

A new study suggests that because Obamacare has increased access to care, it has also increased prescription drug use while reducing out-of-pocket spending for consumers. It’s unclear how this affects health care spending in other sectors. The study, conducted by the RAND Corporation and appearing in Health Affairs, examined prescription transaction data among 6.7 million prescription drug users to track changes in coverage, usage and spending between 2013 and 2014. The Affordable Care Act’s Medicaid expansion and individual insurance exchanges were both implemented in 2014. Via Morning Consult.

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Obama Administration Pledges $17M to Fight Drug Trafficking

The Obama administration announced it would provide $17 million to a handful of states considered to be high intensity drug trafficking areas to strengthen efforts to disrupt the spread of drugs. 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.