Inside Health Policy
"The federal exchange is set to cut thousands of individuals from its coverage rolls this week because of unresolved inconsistencies related to immigration status, with HHS saying 115,000 will lose coverage as of Tuesday (Sept. 30). Tuesday is also the deadline for about 279,000 households to submit current income information to the exchange or risk seeing changes in their tax credits and cost-sharing subsidies that could result in higher costs for enrollees.
Furthering the saga on coverage data matching issues, the National Immigration Law Center has filed an administrative complaint under the ACA's anti-discrimination section due to HHS' failure to communicate with consumers in languages other than English and Spanish. The center also filed a Freedom of Information Act request in order to glean more insight into why that decision was made."
"CMS decided not to include some payments disputed by doctors and teaching hospitals in the Open Payments database published Tuesday (Sept. 30) in order to give physicians and hospitals more time to review the information, but the highly anticipated database includes de-identified data in cases where it was unclear exactly to which physician the payments should have been linked.
The Open Payments site will include 4.4 million payments valued at almost $3.5 billion, according to CMS. Payments from drug and device makers, as well as group purchasing organizations, which were disputed by physicians or hospitals and not corrected before the end of the review and dispute period (Sept. 11) were not included in the most recent batch of Open Payments data because of timing issues, CMS officials said on a call."
Jayne O'Donnell, USA Today
"Consumers searching this fall for the best doctor covered by their new public or private insurance plan won't get very far on a federal database designed to rate physician quality.
The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It's so limited, health care experts say, as to be useless to many consumers.
This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament."
Paul Demko, Modern Healthcare
"In a legal setback for the Obama administration, a federal judge in Oklahoma ruled Tuesday that people in states that rely on the federal insurance exchange are not eligible for Obamacare premium subsidies to help them pay for coverage.
Judge Ronald White, a George W. Bush appointee, invalidated an Internal Revenue Service rule interpreting the Patient Protection and Affordable Care Act to allow the premium tax credits in states that have not established their own exchange. “The court holds that the IRS Rule is arbitrary, capricious, an abuse of discretion or otherwise not in accordance with law,” White wrote.
In his ruling, White rejected the argument that striking down the subsidies would cripple the entire healthcare reform law. “Congress is free to amend the ACA to provide for tax credits in both state and federal exchanges, if that is the legislative will,” he wrote."
The Associated Press
"The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features.
Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud."
Dan Way, Carolina Journal
"RALEIGH — A sizable number of North Carolina residents are learning they are no longer eligible for Obamacare, and some health policy premiums could jump 60 percent within two years, an insurance official says.
Rufus Langley, an Apex insurance agent and state leader of the North Carolina Association of Health Underwriters, said Coventry Health Care of the Carolinas CEO Tracy Baker recently told his group that substantially higher consumer costs are anticipated.
“He can see in 2016 this thing shooting up anywhere from 30 to 60 percent in costs” as delayed taxes start to kick in this year and next year, and medical care costs still rising, Langley said Monday at a Raleigh panel discussion."
Susan Tompor, Detroit Free Press
"A significant benefit of the Affordable Care Act is the opportunity to receive money-saving tax credits upfront to reduce the overall cost of health insurance.
But hundreds of thousands of consumers could owe more money for federal income taxes come April if they received advance payments of the premium tax credit for health insurance. Some married couples could owe $600 or $1,500 or $2,500 or even more."
Christopher Cadelago, Sacramento Bee
"The Affordable Care Act continues to divide Californians, who remain skeptical four years after its passage despite the state’s relatively smooth launch in which more than 1.2 million people enrolled in health insurance coverage.
A new survey released late Tuesday found some 42 percent of state residents generally view the law favorably, while 46 percent harbor unfavorable opinions. Support is down somewhat since May, before a wave of targeted TV ads began in a handful of competitive congressional districts."
Los Angeles Times
"The 2010 federal healthcare law experimented with a number of ways to limit healthcare costs, but the real impetus to hold down spending has come from those who pay for coverage — most notably large employers and governments — and from doctors, hospitals and insurers seeking more sustainable business models. A good illustration is the HMO established recently by Anthem Blue Cross and several top Southern California hospitals, which will reward healthcare providers if they cut waste while improving patients' results. It's a welcome development, although the industry will have to go even further to rid itself of the perverse incentives that drive up costs."
John R. Graham, Forbes
"Are death panels on the rebound? Obamacare envisioned Medicare paying physicians to discuss end-of-live-care with their patients. When this sparked fierce blowback from citizens who feared that “death panels” would ration care to elderly patients, the Administration backed off.
However, the American Medical Association (AMA) has been lobbying for the execution (pun intended) of this provision. The AMA is a business which profits from its monopoly over the billing codes that physicians use when they submit claims to Medicare. The more billing codes there are, the better it is for the AMA.
For patients, however, it is risky to allow the government to pay physicians to counsel us on end-of-life issues. There is another approach, but it is so emotionally challenging that it may be impossible to implement."