What’s New in Health Care Reform: Sept. 21

a-physician-examining-a-young-child-in-moms-lap-pressing-on-the-childs-abdomen-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.


Obama Steps in to Save Obamacare

Deep into the final year of his presidency, Barack Obama is working behind the scenes to secure Obamacare’s legacy, struggling to bolster a program whose ultimate success or failure will likely be determined by his successor. With no lifeline coming from the divided Congress, Obama, and his administration are redoubling their pleas for insurers to shore up the federal health care law and pushing uninsured Americans — especially younger ones — to sign up for coverage. The administration is nervously preparing for its final Obamacare open-enrollment season just a week before Election Day, amid a cascade of headlines about rising premiums, fleeing insurers, and narrowing insurance options. Via Politico.

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Studies Link Cancer Patient’s Survival Time to Insurance Status

Privately insured people with two types of cancer were diagnosed earlier and lived longer than those who were uninsured or were covered by Medicaid, according to two new studies. In one study, researchers examined data from more than 13,600 adult patients who had glioblastoma multiforme, the most common type of malignant brain tumor, between 2007 and 2012. The other study analyzed data from more than 10,200 adults who were diagnosed with testicular cancer between 2007 and 2011. Via Kaiser Health News. 

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Employer Costs Slow as Consumers Use Less Care, Deductibles Soar

Employer health insurance expenses continued to rise by relatively low amounts this year, aided by moderate increases in total medical spending but also by workers taking a greater share of the costs, new research shows. Average premiums for employer-sponsored family coverage rose 3.4 percent for 2016, down from annual increases of nearly twice that much before 2011 and double digits in the early 2000s, according to a survey by the Kaiser Family Foundation. Via Kaiser Health News.

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How Companies Are Quietly Changing Your Health Plan to Make You Pay More

While politicians have been embroiled in a fiery debate over President Obama's signature health-care law, a quiet but profound shift is fundamentally reshaping how health insurance works for the roughly 155 million Americans who receive coverage through their employers. A national survey of employer health benefits shows how much deductibles — the health care costs that people must pay out of their own pockets before insurance kicks in — have shot up. In 2016, 4 in 5 workers had a deductible as part of their individual coverage, averaging $1,478. During the past five years, deductibles have grown 10 times as fast as inflation and nearly six times as fast as wages, according to the new report. Via Washington Post.

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Official Hints at Settlement Talks with Obamacare Insurers

A top Obama administration health official indicated that there are discussions underway about a possible settlement with insurance companies over Obamacare payments. The possibility of settlements has drawn alarm from Republican lawmakers, who warn that the administration is seeking to get around limitations set by Congress. Via The Hill.

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Employer Premiums Higher Than ACA Rates, Report Says

Premiums in the individual health care market, on average, are lower than average employer-sponsored insurance premiums in 2016, according to a new analysis by the Urban Institute. The report offers perspective on the possibility of double-digit premium increases on Affordable Care Act exchanges next year. The analysis found that nationally, the average second-lowest silver plan premium on an Obamacare exchange is 10 percent lower than the average employer-sponsored premium. The researchers made adjustments for actuarial value, or the percent of costs covered by the insurer, as well as utilization and age distribution. Via Morning Consult.

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Hitch Keeps Many High-Deductible Plans from Covering Chronic Care Up Front

As the number of people covered by high-deductible health plans soars, some insurers and employers are easing the strain on consumers’ wallets by covering certain benefits like doctor visits or generic drugs before people have reached their plan’s deductible. But there’s a hitch: Under Internal Revenue Service rules, high-deductible plans that are set up to link to health savings accounts can only cover preventive services like vaccines and mammograms until patients buy enough services on their own to pay down their deductible. Via Kaiser Health News.

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Health Law Expanded Coverage for Ex-Inmates, but Gaps Remain

Insurance expansion in the early stages of the Affordable Care Act’s implementation boosted coverage for ex-prisoners but still left substantial gaps among a population with high rates of mental illness and chronic diseases such as hepatitis and diabetes, new research shows. Via Kaiser Health News.

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Health Insurers Fire Volley in New Battle Over the Public Option

When Senate Democrats announced a new push for a public option in Obamacare last week, the private insurance industry swung into action. And it did so quickly. The industry’s main trade group sent out an “action alert” to members, asking them to call Senate offices and offering a set of talking points critical of the public option ― that is, a government-run insurance plan for people buying coverage through one of Obamacare’s exchanges. Via Huffington Post.

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Medicare’s EpiPen Costs Increased 1,151 Percent, Report Says

Medicare’s prescription drug program increased spending on EpiPens from $7 million in 2007 to $87.9 million in 2014, an increase of 1,151 percent, according to a new Kaiser Family Foundation brief. Average spending per EpiPen prescription increased from $71 in 2007 to $344 in 2014. EpiPens come in a pack of two and must be replaced every 12 to 18 months. While the number of Medicare Part D enrollees using EpiPens also increased during the seven-year period that Kaiser examined, that increase (164 percent) was significantly lower than the increase in total spending on EpiPens. 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.