Articles on the implementation of ObamaCare.
“CMS says that states should reimburse Medicaid managed care plans for the Affordable Care Act’s health insurance provider fee, and says that the fee itself should be incorporated into plans’ capitation rates, however, as the firm JP Morgan notes, the agency leaves some “wiggle room” on whether states should also factor in other potential effects of the fee, such as its non-deductibility status. Medicaid Health Plans of America President Jeff Myers said CMS’ recently released frequently asked questions document provides certainty for plans, particularly in states that hadn’t yet agreed to cover those fees.
Myers said the plans are gratified CMS decided to move forward with the FAQ, and the release of the FAQ and the 2015 Managed Care Rate Setting Consultation guide suggest that CMS would like to play a more involved role in rate setting for managed care. Since plans have been asking for more transparency around rate setting, CMS’ involvement could be a net positive, Myers said. The Government Accountability Office has also said that CMS’ oversight of the rate-setting process needs improvement.”
“Healthcare information-sharing is largely stuck in neutral, according to the Office of the National Coordinator for Health Information Technology’s annual report on electronic health-record adoption, released Thursday.
While standards and services have been established to support information-sharing, “practice patterns have not changed to the point that healthcare providers share health information electronically across organization, vendor and geographic boundaries,” the report argued.
Information-sharing is seen as a key component in the move from a fee-for-service approach in U.S. healthcare to a quality of care approach, so signs that the sharing isn’t happening could spell trouble for progress toward that shift.”
“Faced with the rising costs of generic prescription drugs, health insurers increasingly are turning to tiers and preferred lists on their formularies to keep costs down. Those strategies previously were used only for brand-name and specialty drugs. Experts say those approaches will increase out-of-pocket costs for patients and could make them less likely to adhere to drug regimens.
For years, insurers have encouraged patients to choose generic drugs because they were less expensive than their brand-name counterparts, and most prescription drugs currently used are generics.
But over the past year the cost of generic drugs has skyrocketed, including for products that have been on the market for many years. A study by Pembroke Consulting comparing CMS data for average generic drug acquisition costs between July 2013 and July 2014 found that half of the generic drugs listed rose in cost, with the median increase nearly 12%. Some drug prices saw extreme increases. For instance, the per-unit price for a 500 mg capsule of tetracycline, a common antibiotic, increased from $0.05 cents to $8.59, a more than 17,000 % increase.”
“If the Congressional Budget Office is close to the mark, in the second open-enrollment season we will see about a doubling of the 7 million people enrolled in the Affordable Care Act insurance marketplaces. Open enrollment, which begins Nov. 15, is three months this year, or half as long as last year, and the remaining eligible uninsured are a more difficult-to-reach population. Here are the biggest challenges this time around:
First, the overwhelming reason the remaining uninsured cite as to why they have not already gotten coverage is that they believe they could not afford it. The message that most needs to reach the uninsured is that there are tax credits available to help make coverage more affordable. For a 30-year-old making $25,000 per year, the ACA tax credit would reduce the average cost of the most commonly selected “silver plan” from $2,877 per year to $1,729. Eighty-five percent of those who got coverage in the new insurance exchanges qualified for credits this year, but in our Kaiser Family Foundation survey of the uninsured in California, 73% of those eligible for assistance did not know they could get help.”
“Consumers keep price top of mind when they purchase prescription drugs and they’re unafraid to buy against the big labels, a new Morning Consult poll found.
Nearly three quarters of respondents said if given the choice between a brand name drug and a generic version, they’d be more willing to choose the generic version. What’s more, 65 percent of respondents disagreed that brand name drugs were more effective than generic drugs.”
“CHICAGO — There is a “better than 50/50” chance the ACA’s device tax will be repealed if Republicans win the Senate in November, Evan Bayh, former Democratic Indiana senator and governor, said Tuesday (Oct. 7) at the Advanced Medical Technology Association’s medtech conference. A Republican-controlled Congress likely would first vote to repeal the Affordable Care Act, and after that measure is vetoed would settle on other changes to the law, such as a repeal of the industry-opposed excise tax, said Bayh, now a partner at McGuireWoods.”
“President Obama and some of his most ardent media acolytes are insistent. No matter what you may have heard, Obamacare ‘is working’ in the ‘real world.’ That’s the new mantra. Learn it, love it, etc. The Lean Forward network, unsurprisingly, has served as the vanguard of this propaganda push. Their working theory seems to be that if you repeat an assertion often enough to the same tiny audience, you can wish-cast your dreams into reality:”
“Thousands of consumers who were granted a reprieve to keep insurance plans that don’t meet the federal health law’s standards are now learning those plans will be discontinued at year’s end, and they’ll have to choose a new policy, which may cost more.
Cancellations are in the mail to customers from Texas to Alaska in markets where insurers say the policies no longer make business sense. In some states, such as Maryland and Virginia, rules call for the plans’ discontinuations, but in many, federal rules allow the policies to continue into 2017.”
“SEATTLE — As Washington’s health care exchange prepares for its second open enrollment period, officials were still trying to resolve billing and computer problems involving about 1,300 accounts from the previous round of sign-ups.
Exchange officials began with about 24,000 problem accounts that were detected as people started to use their insurance earlier this year.”
“This time last year there seemed to be a new catastrophe or scandal every day related to the roll-out of the Affordable Care Act, a.k.a. ObamaCare: many predicted the federal website would never be up and running by the looming deadline, the cost kept escalating, private contractors publically blamed bumbling bureaucrats and vice versa. Meanwhile, individuals who attempted to sign up ran into technical problems, and there were horror stories about people being told they would be dropped by their current insurance provider despite the fact the president had assured them this would not happen. Confusion was everywhere. Ultimately, key players got fired or resigned in disgrace.
So, where do we stand today, one year later?
That’s what the non-profit Transamerica Center for Health Studies (TCHS) wanted to know.”