What’s New in Health Care Reform: Sept. 28

shutterstock_96827071What'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.


Expert Panel Recommends Expansion of Services with No Cost-Sharing for Women

The list of preventive services that women can receive without paying anything out of pocket under the health law could grow if proposed recommendations by a group of mostly medical providers are adopted by federal officials later this year. The draft recommendations, which are open for public comment until Sept. 30, update the eight recommended preventive services for women. That list was developed by the Institute of Medicine—now called the National Academies of Sciences, Engineering, and Medicine—to build on existing recommendations and fill in gaps that weren’t addressed in the health law. Under the IOM list, which took effect in 2012, most health plans are required to cover well-woman visits, screening and/or counseling for sexually transmitted infections, domestic violence, and gestational diabetes as well as breastfeeding support and supplies. Via Kaiser Health News.

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Blue Cross of Nebraska Dropping out of Obamacare Market

Blue Cross Blue Shield of Nebraska announced that is pulling out of the Obamacare marketplace in the state, becoming the latest insurer to cite financial losses when reducing participation in the health care law. The move is especially significant given that it is a Blue Cross plan, which form the backbone of the Obamacare marketplaces. In a few states, the Blue Cross plan will be the only one available on the marketplace next year. Via The Hill. 

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Consumers Are Slow to Embrace Health Care Changes

It’s a brave new world for health care consumers. Patients are faced with an avalanche of new technologies and developments that are supposed to revolutionize the way they manage their health care. But according to a study released from the PwC Health Research Institute, the revolution is slow in coming. “Most [consumers] don’t shop for care, ask about prices, email with their clinicians, or use telehealth options. Most don’t send their physicians data from their activity trackers. Most remain skeptical of the value of electronic medical record systems despite their ubiquity in examination rooms,” says the report, entitled “Surviving Seismic Change: Winning a Piece of the $5 trillion U.S. Health EcoSystem.” Via CBS.

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Failing Obamacare Nonprofit Co-ops Add to "Death Spiral" Fears

Failing insurers. Rising premiums. Financial losses. The deteriorating Obamacare market that the health insurance industry feared is here. As concerns about the survival of the Affordable Care Act’s markets intensify, the role of nonprofit “co-op” health insurers— meant to broaden choices under the law—has gained prominence. Most of the original 23 co-ops have failed, dumping more than 800,000 members back onto the ACA markets over the last two years. Via Bloomberg.

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Average Medicare Advantage Premiums to Fall in 2017

Monthly premiums for seniors enrolled in the Medicare Advantage program are expected to be about 4% less expensive in 2017, the Centers for Medicare and Medicaid Services said Thursday. The agency estimates that the average monthly premium for Medicare Advantage enrollees next year will be $31.40, compared to the average $32.59 consumers pay this year. About two-thirds (67%) of enrollees will see no premium increase next year, the agency projects. Via Morning Consult.

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Some Medicare Beneficiaries Could Face Premium Increases, Again

Congress will likely need to take action for the second year in a row to keep out-of-pocket health care costs from significantly rising in 2017 for some seniors. A group of 75 health care and employer groups sent congressional leaders a letter urging them to prevent this from happening. Via Morning Consult.

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Cracks Appear in Blue Cross' Obamacare Fire Wall

The nation’s Blue Cross and Blue Shield plans have been a firewall of sorts by continuing to offer coverage under the Affordable Care Act even as three of the nation’s largest health insurers—Aetna, Humana, and UnitedHealth Group—scale back their participation. But two Blue Cross and Blue Shield plans that are dominant providers in their respective states this week said they are scaling back or pulling products off exchanges, complaining of financial losses. In Nebraska, the Blue Cross plan in the state says it will not participate on exchanges for 2017, according to media reports. Meanwhile, the Blue Cross plan in Tennessee said it would pull out of three markets in the state, companies have said in news reports there. Via Forbes.

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It’s Easy for Obamacare Critics to Overlook the Merits of Medicaid Expansion

Three years into Obamacare and it seems as if much of the news is bad: private insurers exiting the exchanges, networks being narrowed, premiums rising, and competition dwindling out of existence. But it’s important to remember that many, if not most, of the newly covered Americans became insured through an expansion of Medicaid. Here, too, you hear a lot of bad news: that Medicaid offers poor quality and little choice of providers, that it is expensive for the states to administer and that its growing cost will eventually bankrupt states. As of today, 19 states have still refused to participate in the expansion. Such declarations consider only one side of the equation, though. In most ways, Medicaid offers an excellent return on investment. Via NY Times.

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Committees Disagree Ooer Proposed Change to MNsure Funding

MNsure is getting conflicting advice about whether its funding mechanism should be changed. Currently, the state-run health insurance exchange is funded in part by a 3.5% tax applied to premiums of insurance plans bought on MNsure. MNsure has about 70,000 enrollees, with hopes to sign up more at this fall’s open enrollment, and the 3.5% tax on these plans is projected to bring in about $13 million next year. At the beginning of the year, a Health Care Financing Task Force convened by Gov. Mark Dayton recommended a change: Lower the 3.5% tax significantly, but apply the tax not just to the 70,000 current MNsure plans, but also the 180,000 plans purchased on the individual market without involving MNsure. Via Pioneer Press.

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Opioid Epidemic Enters Funding Debate

Senate Majority Leader Mitch McConnell's proposal to keep the government funded included one below-the-radar addition: funding to combat the opioid epidemic. While senators in both parties support addressing the issue, the move had some Democrats crying foul. The Kentucky Republican unveiled last week a draft continuing resolution to fund the government through Dec. 9, after spending talks stalled between Senate leaders. His proposal included $37 million in annual funds for implementing the Comprehensive Addiction and Recovery Act, or CARA, which became law in July. Via Roll Call.

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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.