Highmark Health is cutting reimbursement to doctors by 4 percent effective April 1 for care provided to patients with health insurance bought through the government exchange — the latest effort to trim losses in a market segment that has caused headaches for carriers nationwide.
All Pennsylvania doctors who participate in Highmark’s health insurance plans and treat patients with coverage required by the Affordable Care Act will be affected by the reimbursement cut, said Alexis Miller, senior vice president of individual and small group markets.
The doctors’ pay cut is needed to stem losses in individual health-law coverage as the insurer looks for other ways to stop the bleeding, Ms. Miller said.
Since the Affordable Care Act was signed into law on March 2010, the Obama administration has changed the law 43 times without Congressional approval. The Galen Institute has been keeping track of these administrative changes, which you can find here.
Apparently another illegal administrative action, which will cost the U.S. Treasury $3.5 billion, can be added to the list. Late last Friday, and conveniently before a long weekend, the Centers for Medicare and Medicaid Services announced in a guidance document it would have $7.7 billion in reinsurance payments to cover the losses Exchange plan insurers incurred in 2015. But CMS is not entitled to $3.5 of the $7.7 billion it is giving away.
According to the Kaiser Family Foundation (KFF), average premiums in the workplace were up 24 percent for individual plans and 27 percent for family plans. The vast majority of privately insured Americans – 9 out of 10 – purchase coverage through their employers.
Cost-sharing grew even faster. KFF reports that the average deductible for all workers was $1,077 in 2015, up from $646 in 2010—a 67 percent increase.
Over the past 5 years, a typical family of four faced 43 percent higher health costs, including both premiums and out-of-pocket expenses. The Milliman Medical Index also shows that employer costs increased by 32 percent, from $10,744 in 2010 to $14,198 in 2015. That’s nearly $3,500 that could have gone into paychecks if health costs had not soared.
A federal appeals court in Atlanta on Thursday upheld a contraceptive mandate included in the president’s health care law but is delaying the implementation of its ruling until the U.S. Supreme Court can weigh in on the issue.
A three-judge panel of the 11th U.S. Circuit Court of Appeals ruled 2-1 to reject challenges to the mandate in a single opinion addressing two separate cases, one filed by nonprofit organizations affiliated with the Catholic Church in Georgia and the other by Catholic broadcaster Eternal Word Television Network in Alabama.
The organizations had argued the mandate and a related rule against those entities would violate the Religious Freedom Restoration Act of 1993, which prohibits the government from imposing a substantial burden on a person’s religious practice.
A government report published Thursday shows ObamaCare is still far from achieving one of its goals.
President Barack Obama’s health care reform law, the Affordable Care Act, has brought the number of people lacking health insurance to a historic low. Yet it also aimed to reduce visits to emergency departments, where the uninsured would often go to receive care but which are often strained with high volumes of patients and deliver more costly services.
But findings from the Centers for Disease Control and Prevention suggest that not having health care coverage isn’t the only factor keeping people from defaulting to the ER for care, and that “ER use overall has not changed significantly after the first full year of ACA implementation.”
A big hospital chain’s surprise decision to write off a slug of bad debt may be a signal of much deeper consumer healthcare strains being caused by ObamaCare.
Community Health Systems surprised analysts this week, announcing that among other things, the company would take a $169 million provision for bad debt. The write off was a big part of Community’s dismal fourth quarter earnings report, leading to a 22% drop in the company’s stock on Tuesday.
In the lexicon of hospital finance, bad debt is another word for unpaid bills.
The rising amount of uncollected co-pays and deductibles may be an early sign of consumer stress as the economy weakens. But more likely, it also reflects changes in the healthcare market that are saddling consumers with a much bigger share of their medical costs. For this, ObamaCare is playing a big role.
The Affordable Care Act changed employers’ role in the U.S. health care system. The ACA fundamentally altered the employer-based system by making the provision of health benefits mandatory rather than voluntary for employers with more than 50 employees and establishing minimum criteria for affordability and coverage. In addition, a “play or pay” model was created, providing employers with an exit: employees would no longer become uninsured if their employers dropped benefits but could instead purchase guaranteed and potentially subsidized insurance through public exchanges.
Two financial milestones are leading employers to evaluate whether they want to play or pay. In 2015, employers with more than 100 employees became subject to a shared-responsibility penalty for coverage that didn’t meet federal standards; further down the road, a 40% excise tax on coverage over a maximum dollar value (the so-called Cadillac tax) is due to go into effect (implementation was originally set for 2018, but Congress recently voted to delay it by 2 years). Although it’s still early in the game, employers are making key decisions that affect patients, health care providers, and insurers.
The ObamaCare health exchange in Colorado faced “numerous weaknesses” and had “inadequate security settings,” leaving the personal information of enrollees vulnerable, according to a new audit.
The inspector general for the Department of Health and Human Services publicly released its review of Connect for Health Colorado on Wednesday, revealing the exchange had inadequate security measures in place for more than a year.
The report, which reviewed information security controls as of November 2014, did not go into specifics of Connect for Health Colorado’s vulnerabilities because of the “sensitive nature of the information.”
Medicaid’s complex federal-state financing structure has long created perverse incentives that discourage efficient care. Key to the problem is the federal government’s uncapped reimbursement of state Medicaid expenditures, which encourages states to artificially inflate their Medicaid spending. Such schemes have significantly increased over the past several years and they likely add tens of billions in generally low-value Medicaid spending each year.
This study examines states’ use of accounting schemes to inflate federal Medicaid reimbursements. The study focuses on the largest of the current schemes, provider taxes. These are assessments states levy on healthcare providers, often accompanied by the explicit or implicit guarantee of increased Medicaid payments to those same providers, financed from the federal matching funds. The study provides an economic and political analysis of these taxes and other strategies that states have employed to maximize federal Medicaid reimbursements, and recommends reforms. It contains an appendix with a case study of Arizona, which shows how the state imposed provider taxes to pay for Medicaid expansion.
California’s health exchange may require its health plans to pay sales commissions to insurance agents to keep insurers from shunning the sickest and costliest patients.
Covered California is working on a proposal that would force the plans to pay commissions effective next year, said Executive Director Peter Lee. The proposed rules could apply to regular and special enrollment periods, and would leave the specific commission amount or percentage up to insurers, he said.
Regulators in other states have warned insurers about altering commissions in a way that discriminates against higher-cost consumers, but Lee said Covered California may be the first exchange to adopt specific rules.