The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
“Health insurance companies, now required to spend the lion’s share of premium revenue on patient care, are looking for higher investment returns elsewhere. As a result, they’re increasingly putting money into technology ventures where they expect to realize higher returns.
The medical-loss ratio standard under the Patient Protection and Affordable Care Act requires insurers to spend at least 80% of what they earn from premiums on patient care and related quality improvements. No more than 20% can be used for administrative, marketing and business expenses. The requirement is as high as 85% for large group plans.
Tied to that, insurers are trying to maximize their investment returns while also investing in businesses that are exempt from the 80/20 rule. Technology operations check off both those boxes for them.
“That’s been a catalyst for a substantial amount of investment,” said Joshua Kaye, a Miami-based partner at law firm DLA Piper. “We’re really seeing it on a national scale. Many insurers view health IT as being on the cutting edge.””
“When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network. (Plans that are grandfathered under the law don’t have to abide by these provisions.)
That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect.
Although the law protects patients from higher out-of-network cost sharing in the emergency room, if they’re admitted to the hospital, patients may owe out-of-network rates for the hospital stay, says Angela Gardner, an associate professor of emergency medicine at the University of Texas Southwestern in Dallas who is the former president of the American College of Emergency Physicians.”
“A new problem has emerged with the federal government’s Open Payments system, which is supposed to go live Sept. 30 and disclose payments to physicians by pharmaceutical and medical device companies.
A couple weeks ago, the U.S. Centers for Medicare and Medicaid Services said it would be withholding information on one-third of the payments, citing data inconsistencies in company submissions.
Now, a source familiar with the matter tells ProPublica that CMS won’t disclose another batch of payments: research grants made by pharmaceutical companies to doctors through intermediaries, such as contract research organizations. In these cases, doctors apparently have not been given a chance to verify and dispute payments attributed to them, as required by law.
Officials at CMS have not publicly disclosed anything about this latest batch of withheld data and did not answer questions from ProPublica about how many records are involved.
The data is required to be disclosed under the Physician Payment Sunshine Act, part of the 2010 Affordable Care Act. Sen. Charles Grassley, R-Iowa, one of the main proponents of the law, expressed frustration with the reporting system’s troubles.
“CMS has had more than four years to figure everything out,” Grassley said in a statement Thursday. “It’s disappointing and irresponsible that so many basic questions are unresolved at this late stage.””
“An announcement could be made soon on Pennsylvania Gov. Tom Corbett’s plan to use billions of federal Medicaid expansion dollars under the 2010 healthcare law to subsidize private health insurance policies, a spokeswoman said Wednesday.
Kait Gillis, a state Department of Public Welfare spokeswoman, said negotiations with the federal government are in the final stages, but details remain under wraps.
HHS officials did not immediately respond to a request for comment Wednesday, and the federal agency consistently has declined to publicly discuss details of Corbett’s plan. The 124-page plan was formally submitted in February, and closed-door negotiations began in April after a public comment period.”
“When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns.
But in the days since, it’s become clear: there’s little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign.
“It’s basically the first pro-Obamacare ad we’ve seen by a vulnerable Democrat for months,” said Elizabeth Wilner, senior vice president of Kantar Media Ad Intelligence, whose Campaign Media Analysis Group tracks political advertising. “It’s like seeing a unicorn – it just doesn’t happen very often.””
“We all know Obamacare is a pretty big law, with plenty of obscure provisions that don’t get much attention. For one, the law targets big executive pay packages at health insurance companies — and based on data released Wednesday, the provision is already going a long way.
Companies have long been able to deduct salaries to top executives from their federal tax bills, although since the early 1990s — in an effort to reduce excessive pay — the government has limited the amount to $1 million.
Starting last year, a piece of the Affordable Care Act lowered the limit to $500,000 for health insurers (although the $1 million limit still applies to the rest of corporate America). It also eliminates the tax carve out for what tends to be much more lucrative performance pay, like stock options, for health insurers. Finally, the cap applies to all health insurance employees, no longer just a firm’s four highest-paid executives.
This obscure provision resulted in a $72 million infusion to the Treasury last year from just the 10 largest publicly traded health insurers, according to an analysis from the left-leaning Institute for Policy Studies. The actual tax tab is probably higher when accounting for smaller insurers. And the Joint Committee on Taxation in 2009, a few months before the ACA became law, projected the provision would mean $100 million in revenue each year.”
“Hundreds of thousands of people risk losing their new health insurance policies if they don’t resubmit citizenship or immigration information to the government by the end of next week — but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying.
Consumers are being forced to send their information multiple times, and many can’t access their accounts at all, immigration law experts and insurance agents say.
The Centers for Medicare and Medicaid Services sent letters to about 310,000 consumers two weeks ago, telling them they need to submit proof of their citizenship or immigration status by Sept. 5 or their insurance will be canceled at the end of the month.
CMS spokesman Aaron Albright says letters were sent only to people for whom the government has no citizenship or immigration documentation. Yet agents and others who assisted immigrants with applications say they know documentation was sent during enrollment.
Marielena Hincapie, executive director of the National Immigration Law Center, says the problems don’t lie with the consumers. The federal databases for the Department of Homeland Security and the Social Security Administration are outdated, have mismatched Social Security numbers and names, and often transpose names for those from other countries, especially refugees from Africa, she says.”
“Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest — and costliest — patients from enrolling.
Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul.
Advocates and industry insiders say these practices may dissuade the neediest from signing up and make it likelier that the customers these insurers do serve will be healthier — and less expensive.
“It’s the same insurance companies that are up to the same strategies: Take in as much premium as possible and pay out as little as possible,” said Jerry Flanagan, an attorney with the advocacy group Consumer Watchdog.”
“Ascension Health, one of the nation’s largest hospital owners, is expanding rapidly with a string of announced deals that its CEO says will grow its reach beyond hospitals to keep pace with rapid Obamacare-induced changes in the marketplace.
But notably, Ascension is not on an acquisition spree. Its latest deals—in Illinois, Michigan, Arizona and Wisconsin—are not outright purchases, but rather agreements with regional rivals and other national players to jointly own, operate or contract for hospitals and insurance companies.
The deals pair Ascension with well-established players in each market and allow the system to avoid costly competition or wasteful duplication by capitalizing on partners’ resources that Ascension lacks, said Robert Henkel, Ascension Health’s chief executive. The strategy also will allow Ascension to jointly develop broader services to care for patients at home, in nursing homes and other locations outside of hospitals. “There are times we don’t have all the pieces,” he said.
The shift by healthcare systems away from providing care in hospitals has accelerated since the 2010 health reform law, as Medicare and Medicaid introduced new financial incentives for lower-cost care under reform and commercial health plans followed. An explosion of dealmaking across healthcare has followed as hospitals, medical groups, insurance companies and drug and devicemakers consolidated or diversified, depending on strategy.”
“Bill Jacobs spent four nights in a hospital in Florida battling pneumonia. His kids visited each day, fluffed his pillows, brought his favorite Sudoku puzzles and got regular updates from his nurses and doctors. Imagine their surprise when they found out that their 86-year-old father was never actually admitted; instead, he was treated as an outpatient under what Medicare refers to as “observation status.”
What difference does that make? Actually, more than you might think. If your parents are on Medicare, the difference between being considered an inpatient or an observation patient could be thousands of dollars out of their pocket, if not more.
First, Medicare Part A will cover all hospital services, less the deductible, but only if you’re admitted to the hospital as an inpatient. The one-time deductible covers all hospital services for the first 60 days in the hospital. Doctors’ charges are covered under Medicare Part B. After you meet the deductible for Part B, you’ll then owe 20 percent of the Medicare-approved amount for doctor services, according to the Centers for Medicare and Medicaid Services’ Are You A Hospital Inpatient Or Outpatient?”