A project of the Galen Institute

Issue: "Business Impact"

Insurers Fight Hospital Mergers As ACA Snubs Fee For Service Medicine

Bruce Japsen
Forbes magazine
Sun, 2014-09-21
"A wave of hospital mergers and acquisitions spreading across the U.S. has the health insurance industry attempting to stand in the way with legalese, Congressional lobbying and in the court of public opinion. America’s Health Insurance Plans, the powerful lobby and trade group representing the biggest names in commercial insurance appears to be leading the charge battling deals in New York, Chicago and beyond. “Consolidation promises greater efficiency, but all that ever materializes is greater costs,” Brendan Buck, former press secretary to Speaker of the U.S. House John Boehner, who was tapped this spring to be vice president of communications at America’s Health Insurance Plans (AHIP) told the Chicago Sun-Times following news two of the wealthiest hospital operators in the city would merge."

Voters, Administration Don’t Expect Perfection on Exchanges

Marissa Evans
Morning Consult
Sun, 2014-09-21
"The Obama administration has found their line when it comes to setting expectations for the second roll-out of the federal exchange website: “Improvement but not perfection.” It’s the semi-optimistic catch-phrase officials have used in congressional testimonies over the past few weeks to describe how well Healthcare.gov will work come November. Andy Slavitt, principal deputy administrator at CMS said it during his testimony with the House Ways and Means Committee last week. Marilyn Tavenner, CMS administrator used the line during her testimony Thursday morning for the House Committee on Government Oversight and Reform. Voters also seem to be preparing for problems and not perfection as they head back to the site. Open enrollment begins November 15. Morning Consult polling shows more than half of registered voters — 54 percent — are very concerned or somewhat concerned about security breaches on HealthCare.gov and the state exchange sites.

Low-Wage Workers Feel the Pinch on Health Insurance

Drew Altman
Wall Street Journal
Fri, 2014-09-19
"We did not see big changes in employer-based coverage in the Kaiser-HRET annual Employer Health Benefit Survey released last week. Mostly this is good news, particularly on the cost side where premiums increased just 3%. But one long-term trend that is not so good is how this market works for firms with relatively large shares of lower-wage workers (which we define as firms where at least 35% of employees earn less than $23,000). These low-wage firms often do not offer health benefits at all. And, as the chart below shows, when they do offer coverage, it has lower premiums on average (likely meaning skimpier coverage) and requires workers to pay more for it. Workers in low-wage firms pay an average of $6,472 for family coverage, compared with $4,693 for workers in higher wage firms."

The Problems With the Census Bureau’s New Estimates on How Many Americans Have Health Insurance

Edmund Haislmaier
The Heritage Foundation
Wed, 2014-09-17
"If you are looking for information on how Americans are engaging with the Affordable Care Act, the Census Bureau’s recently released latest annual estimates of health insurance coverage is probably not the place to look—at least for now. The Census Bureau, which derives its information on healthcare from the Annual Social and Economic Supplement—the same survey where it asks how many toilets, computers, microwaves, etc., people have in their homes—does provide some useful insights. It catalogues the demographic characteristics of the population based on participation in different types of health insurance coverage—government health care programs, private employer and individual plans, and the uninsured.

Getting There: How to transition from Obamacare to real health care reform

James Capretta and Yuval Levin
Weekly Standard
Wed, 2014-09-17
"Obamacare—or at least the version of it that the president and his advisers currently think they can get away with putting into place—has been upending arrangements and reshuffling the deck in the health system since the beginning of the year. That’s when the new insurance rules, subsidies, and optional state Medicaid expansions went into effect. The law’s defenders say the changes that have been set in motion are irreversible, in large part because several million people are now covered by insurance plans sold through the exchanges, and a few million more are enrolled in Medicaid as a result of Obamacare. President Obama has stated repeatedly that these developments should effectively shut the door on further debate over the matter. Of course, the president does not get to decide when public debates begin or end, and the public seems to be in no mood to declare the Obamacare case closed.

Companies race to adjust health-care benefits as Affordable Care Act takes hold

Aaron Gregg
Washington Post
Tue, 2014-09-16
"Large businesses expect to pay between 4 and 5 percent more for health-care benefits for their employees in 2015 after making adjustments to their plans, according to employer surveys conducted this summer. Few employers plan to stop providing benefits with the advent of federal health insurance mandates, as some once feared, but a third say they are considering cutting or reducing subsidies for employee family members, and the data suggest that employees are paying more each year in out-of-pocket health care expenses."

How many people are poised to lose 2014 ObamaCare coverage?

Ed Morrissey
Hot Air
Tue, 2014-09-16
"The Obama administration bragged about its enrollment numbers in the compulsory ObamaCare system, but the lack of eligibility-confirmation systems in the exchanges may take a big bite out of those numbers shortly. Just how big a bite is anyone’s guess, however, with warnings to multiple groups that either their coverage or their subsidies may stop at any time. Last night, HHS warned that 115,000 people currently covered by ObamaCare might lose their insurance thanks to immigration issues:"

Brady Questions HHS Authority To Put Forward Hospital Appeals Settlement

http://insidehealthpolicy.com/brady-questions-hhs-authority-put-forward-hospital-appeals-settlement
Tue, 2014-09-16
"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.

Doctors Get Stuck with Bills for Deadbeat Obamacare Patients

J.D. Tuccille, Reason
Tue, 2014-09-16
"Last year I wrote that Obamacare could leave doctors holding the bag for claims for patients who don't pay their insurance premiums. That's because the law includes a three-month grace period during which health insurers must continue to cover patients who sign up, but don't pay the price of their insurance. If the patients eventually make good, there's no problem. But if patients don't pay the owed premiums, the insurance company has to cover the cost of claims filed during the first month. Providers are stuck with the tab for any claims filed during months two and three. The piece I wrote last July was theoretical. The notification letter I'm holding in my hand, addressed to my wife's pediatric practice, is reality. And reality costs, in this case, over $600. That's the outstanding balance owed the practice by a patient insured by BlueCross BlueShield of Arizona. It's a balance that my wife might have to eat, or else try to collect herself."

ACA open enrollment for 2015 causing anxiety for plans, providers

Paul Demko
Modern Healthcare
Mon, 2014-09-15
"During the 2014 open enrollment for Obamacare coverage, Mary Denson, 21, a student at Columbia (Mo.) College, qualified for a federal premium subsidy that reduced her premium contribution for buying health insurance to less than $20 a month. But she fears that when she renews her coverage for 2015, she won't have enough income from her nanny job to reach the subsidy income threshold of 100% of the federal poverty level and continue qualifying for premium tax credits. She isn't eligible for Medicaid because Missouri hasn't expanded that program for low-income adults. Denson says she's considering looking for another job to reach the $11,670 income threshold but worries she may have to drop classes. Without the subsidy, her coverage would cost nearly $400 a month, far more than she can afford. “I'm just going to have to re-apply and pretty much hope that I make the cut again,” Denson said."

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