What’s New in Health Care Reform: Oct. 12

shutterstock_181677458-1024x683What'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.


Between ACA and Medicare, Some Americans May Have Too Much Health Coverage

Ever since the Affordable Care Act’s insurance marketplaces opened for business in 2014, the Obama administration has worked hard to get Americans to sign up. Yet officials now are telling some older people that they might have too much insurance and should cancel their marketplace policies. Via Washington Post.

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White House Economic Adviser Urges Support for "Cadillac" Tax

A top economic adviser to President Obama urged against repealing the so-called “Cadillac” tax on high-cost insurance plans. “Certainly, the administration feels that the excise tax remains a sensible way of sort of addressing the distortions created by the exclusion, focusing on the least efficient plans while retaining strong incentives for employers to continue to offer coverage” Matt Fiedler, the chief economist on the Council of Economic Advisers, said at a Mercatus Center event on the effects of health care costs on economic well-being. “It’s on the books, it is in law,” he later added. Via Morning Consult.

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States Struggle with Rising Medicaid Drug Costs

As prescription drug prices continue to rise, states are struggling to find ways to cover the costs to Medicaid, which could mean unwelcome changes for beneficiaries and health plans. States have implemented policies to prevent spending exorbitant amounts of money on drugs, but as prices continue to rise, experts said some hard decisions will have to be made. States can use tactics like preferred drug lists, prior authorization, and even comparative effectiveness reviews, but those may not be enough if recent pricing trends continue. States could dramatically scale back benefits by doubling down on policies that limit medications or cut reimbursements to health plans. Via The Hill.

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Rising Premiums Rankle People Paying Full Price for Health Insurance

About 10 million Americans buy individual insurance coverage without cost-reducing federal subsidies on the marketplaces on the open market, according to the Congressional Budget Office. In Georgia, consumers who don't get insurance through their employers or don't qualify for tax credits to help pay for policies they purchase are facing double-digit premium increases. Blue Cross Blue Shield of Georgia, the only insurer offering plans throughout the state, received an increase of more than 21% from the state insurance commissioner. Humana was awarded a 67.5% hike. Prices are going up in other states, too. BlueCross BlueShield of Tennessee was granted a 62% rate hike, while state officials approved a 46% increase for Cigna. Florida authorities gave plans there an average 19% bump. And last week, Minnesota officials announced that premiums for the seven insurers on the individual market are rising 50 to 67%. Via NPR.

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Government to Pick Plans for Displaced Health Law Customers

Worried that insurers bailing out of the health law's markets may prompt their customers to drop out, too, the Obama administration plans to steer affected policyholders to remaining insurance companies. But those consumers could get an unwelcome surprise if their new government-recommended plan isn't what they're used to. The backstop was outlined in an administration document circulating among insurers and state regulators. It also calls for reaching those "discontinued consumers" with a constant stream of reminders as the health law's 2017 sign-up season goes into full swing. Open enrollment for HealthCare.gov starts Nov. 1 and ends Jan. 31. A copy of the strategy was provided to The Associated Press. Via AP.

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Patient Groups Praise HHS for Plans to Standardize Insurance Plans

Dozens of patient advocacy groups that make up the I Am Essential Coalition praised the Department of Health and Human Services’ proposed standards for insurers during the 2018 coverage year. HHS in August proposed a rule meant to strengthen the marketplace, proposing, among other things, a modification to calculating risk adjustment for enrollees who don’t remain with one insurer for an entire year and use prescription drug utilization data as a source of information about patients. Via Morning Consult.

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What Happens if Congress Doesn’t Change Obamacare?

It’s common wisdom that the future of Obamacare depends on who occupies the White House come January 2017. But what remains unclear is whether Congress will be able to pass any form of health legislation under either a President Hillary Clinton or a President Donald Trump. If Congress can’t come to agreement on any sort of changes to the Affordable Care Act—a reasonable assumption, given the lack of action in the last six years—the law will continue operating on autopilot for another two to four years. What happens then? Via Morning Consult.

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GOP Seeks to Block Obamacare Settlements with Insurers

Republicans in Congress are plotting ways to block the Obama administration from paying insurance companies hundreds of millions of dollars as part of an Obamacare program. GOP lawmakers say they are looking at “a dozen” options—including a possible provision in the year-end spending bill—to prevent the administration from using an obscure fund within the Treasury Department to pay out massive settlements to insurers. Via The Hill.

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HHS Chief Hints at Tweaks to Obamacare Marketplace

Health and Human Services (HHS) Secretary Sylvia Mathews Burwell sought to calm fears about the still-shaky Obamacare marketplaces in the final stretch before this year’s sign-up period. Speaking to health insurance executives in Washington, Burwell stressed that the White House is listening to insurers as some of them worry about staying afloat in the Obamacare business. Via The Hill.

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"Big Data" Could Mean Big Problems for People's Health Care Privacy

The future of the U.S. health care system will be influenced to a large extent by a company that makes weapons of war. Defense giant Northrop Grumman has signed a nearly $92-million contract with the Centers for Medicare and Medicaid Services to build the second phase of a computer system that’s currently focused on reducing fraud but down the road will play a greater role in anticipating beneficiaries’ medical disorders. It’s the most prominent example of how public and private insurers are spending millions of dollars on “big data”—using advanced technology to predict people’s future health care needs based on their interactions with doctors, hospitals, and pharmacies, as well as information gleaned from other sources, such as social media. Via LA Times.

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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.