“House Ways & Means health subcommittee chair Kevin Brady (R-TX) questions HHS’ authority to settle hospitals’ appeals of denied inpatient claims and is urging HHS Secretary Sylvia Burwell to retract what he views as an “ill thought” settlement process. Brady wants Burwell to work with lawmakers to come up with a different “fair, transparent and conclusive settlement process.”
Brady wrote to Burwell Tuesday (Sept. 16) that he is dismayed by HHS’ reluctance to work with the committee on an equitable settlement process that is fully legal, adding that the “lack of engagement makes it challenging for the Congress to solve the current appeals problems and prevent similar problems in the future.”
CMS announced late last month (Aug. 29) that it will pay hospitals 68 percent of denied inpatient status claims in the appeals queue if hospitals take them out of the backlogged appeals process. The agency has been encouraging hospitals to take advantage of the settlement to “alleviate the burden of Medicare appeals on both the hospital and Medicare systems,” according to the CMS website.
Hospitals should decide whether to participate by the end of October, and CMS in a Frequently Asked Questions document released Sept. 9 says that four hospitals have already stepped forward to take the settlement offer. The document also states that this is a one-time offer from CMS.”
“Three little words is all it takes to change voters’ minds about Medicaid expansion.
Morning Consult polling shows using the term “Affordable Care Act” can make a difference in how a voter feels about expanding Medicaid. When asked if Medicaid should be expanded for low income adults below the federal poverty line, 71 percent of registered voters said yes. When asked if Medicaid should be expanded “as encouraged under the Affordable Care Act”, support dropped nine percentage points.”
“A Republican-controlled Senate cannot repeal Obamacare, no matter how fervently GOP candidates pledge to do so on the campaign trail this fall. But if they do win the majority, Senate Republicans could inflict deep and lasting damage to the president’s signature law.
Republicans are quick to say they are not yet measuring the proverbial drapes. But they are taking the political measurements of repealing large parts of the health law, considering which pieces could be repealed with Democratic support, and how to leverage the annual appropriations and budget process to eliminate funding or large pieces of the law.
Initial targets are likely to include the medical device tax, the individual and employer mandates, the 30-hour workweek to qualify for coverage, and spending on a preventive health fund that Republicans call a slush fund.”
“The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved prescription contraceptives and services for women. Since the implementation of this provision in 2012, some nonprofit and for profit employers with religious objections to contraceptives have brought legal challenges to this rule. For many women today, their contraceptive coverage depends on their employer or when they purchased their individual insurance plan.”
“CVS Health is investigating a potential glitch in its drug pricing system that appears to have charged women copayments for prescription birth control – though the scope of the error is unclear.
The problem came to the attention of Rep. Jackie Speier, D-Calif., after one of her staffers attempted to buy generic prescription birth control in Washington D.C. and was charged a $20 copay.
The retailer’s error, highlighted in a letter to the company from Speier, runs counter to a provision of the federal health law that mandates insurance coverage of women’s preventive care – a category including generic prescription birth control – without cost sharing.”
“Employers have complained for years about their rising health-care costs. But over the past decade, as the chart above shows, premium increases for employer health insurance have moderated sharply and stabilized. Premiums for family policies in the group market grew 72% between 1999 and 2004; 34% between 2004 and 2009; and 26% between 2009 and 2014. Even as premium growth moderated, health insurance costs still outpaced inflation and wage growth. But this year premiums grew 3%, about the same rate as wages and inflation. Despite fears that premiums would rise in the group market because of the Affordable Care Act, they have remained stable.
Policy experts do not fully understand why health-care costs have moderated or when and how rapidly they might begin to again rise more quickly. And coverage is still very expensive: The average family policy costs $16,834 a year, with employers paying, on average, 71% of the expense and employees 29%.
Corporate benefits managers will continue to do what they can to tamp down annual premium increases, and companies will continue to raise deductibles and other forms of cost sharing to help constrain premium increases. But as long as these more modest increases in their health insurance premiums continue, corporate CEOs will see their health costs more like a chronic illness to be managed than an acute problem or crisis, and they will no doubt focus their energies on other problems.”
“A report out today puts numbers behind what hit many workers when they signed up for health insurance during open enrollment last year: deductible shock.
Premiums for employer-paid insurance are up 3% this year, but deductibles are up nearly 50% since 2009, the report by the Kaiser Family Foundation shows.
The average deductible this year is $1,217, up from $826 five years ago. Nearly 20% of workers overall have to pay at least $2,000 before their insurance kicks in, while workers at firms with 199 or fewer employees are feeling the pain of out-of-pocket costs even more: A third of these employees at small companies pay at least $2,000 deductibles.”
“An NBC affiliate in Virginia reports that nearly 250,000 people in that state will lose their health care plans due to Obamacare:
“Nearly a quarter million Virginians will have their current insurance plans cut this fall,” said the local anchor. “That is because many of them did not–are not following new Affordable Care Act rules, so a chunk of the companies that offer those individuals their policies will make the individuals choose new policies.”
Says the reporter, “This goes back to that now heavily-criticized line we heared before Obamacare was put in place: ‘If you like your plan, you can keep it.’ Ultimately, that turned out not to be true for thousands of Virginians and companies in the commonwealth. … Wednesday Virginia lawmakers on the health insurance reform commission met for the first time this year. Turns out, a staggering number of Virginians will need new plans this fall.””
“Welcome back from the summer.
It’s been pretty quiet lately on the Obamacare front.
So quiet, that there has been a flurry of articles recently over how Obamacare has dropped to a second or even third tier issue and will hardly matter come election-time.
Wishful thinking.
Obamacare has largely been out of the news cycle for a couple of months but that is about to change.
A few thoughts.
The 2015 rate increases have been largely modest. Does that prove Obamacare is sustainable? No. You might recall that on this blog months ago my 2015 rate increase prediction was for increases of 9.9%.
You might also recall my reason for predicting such a modest increase. With almost no valid claims data yet and the “3Rs” Obamacare reinsurance program, insurers have little if any useful information yet on which to base 2015 rates and the reinsurance program virtually protects the carrier from losing any money through 2016. I’ve actually had reports of actuarial consultants going around to the plans that failed to gain substantial market share suggesting they lower their rates in order to grab market share because they have nothing to lose with the now unlimited (the administration took the lid on payments off this summer) Obamacare reinsurance program covering their losses.”
“The Obama administration has decided to continue its legal battle against Little Sisters of the Poor, a Catholic charity that objects to Obamacare’s mandate that employee health plans cover contraceptives and abortion-inducing drugs.
The order of Catholic nuns argues that the rule fashioned by the Department of Health and Human Services requires them to violate their religious beliefs by offering insurance coverage for 20 specific drugs and devices — some of which the nuns believe could destroy what they consider a human life.
If the Little Sisters of the Poor choose not to abide by the HHS mandate, they face devastating fines by the Internal Revenue Service that could result in millions of dollars a year being diverted from their mission of caring for elderly women and men.”