The state’s antitrust lawsuit against Sutter Health is a welcome move to stop Sutter from inflating health care costs across the Northern California market.
The lawsuit alleges that Sutter has illegally used its market power to compel commercial health plans to contract with all or none of its hospitals, extract exorbitant prices and prohibit use of financial incentives to encourage use of lower-cost providers.
The problem is not just Sutter, however, but insurance-contracted provider networks (preferred provider organizations and health maintenance organizations), where insurers negotiate medical service prices, keep those prices hidden and make other private deals that maximize revenue at purchaser and consumer expense.
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California’s government would set prices for hospital stays, doctor visits and other health care services under legislation introduced Monday, vastly remaking the industry in a bid to lower health care costs.
The proposal, which drew swift opposition from the health care industry, comes amid a fierce debate in California as activists on the left push aggressively for a system that would provide government-funded insurance for everyone in the state.
Across the country, rising health care costs have put the industry, lawmaker and employers and consumers at odds.
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President Donald Trump signed a broad executive order urging a revamp of federal government aid programs Tuesday, invigorating a contentious debate from which Republicans hope to gain momentum before the November elections.
The executive order lays out broad principles for overhauling government aid programs to require that more participants prove they are working or trying to find jobs, senior administration officials said. It also instructs federal agencies to propose changes to the programs they oversee and craft new regulations if necessary. The order is primarily aimed at programs such as food stamps, which covers about 43 million Americans, Medicaid, which covers 74 million people, and housing programs, an official said.
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The federal health insurance exchange allows people to enroll for insurance coverage outside of the annual open enrollment period under certain circumstances, such as losing coverage from an employer. Insurers are concerned that some people are misusing this flexibility by reenrolling after their coverage was terminated for nonpayment of premiums. Not only is this against the rules, but it undermines the stability of the exchange. CMS doesn’t collect complete data that would allow it to gauge the extent of the problem. GAO recommends gathering data on coverage terminations for nonpayment of premiums.
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The White House on Friday cleared the CMS to scale back efforts to evaluate Indiana’s conservative approach to Medicaid expansion. The move could prevent the agency from gathering adequate data to determine if the state’s method of expansion harmed access to care.
Some feel that even with a scaled-back study, the CMS could still glean pertinent information from Indiana about the impact its expansion approach has had on Medicaid beneficiaries.
“Surveys were just one element, and getting rid of them is not enough to make or break an evaluation” said Doug Badger, a senior fellow at the Galen Institute, a conservative think tank.
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CBO is anticipating a 21% jump in the cost of federal subsidies this year, driven by a 34% jump in premiums for the “benchmark” plans to which those subsidies are pegged.
But after that, CBO expects a big slowdown. Federal spending on the ACA’s premium subsidies will likely grow by about 5% per year for the rest of the next decade, the budget office said. Those annual increases are mainly a result of rising health care costs.
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A revival movement is sweeping the nation. Millions of souls have already been converted, thanks to a charismatic preacher and his passionate disciples.
I’m talking, of course, about the doctrine of “Medicare for All” and its chief evangelist, Vermont Sen. Bernie Sanders. The socialist senator’s sermons appear to have swayed the masses. In 42 states, a majority of residents now support a Medicare-for-All system, according to new research from Data for Progress, a left-wing think tank. That’s a significant increase from September of last year, when fewer than half of Americans supported single-payer.
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During Fiscal Year (FY) 2017, the Federal Government won or negotiated over $2.4 billion in health care fraud judgments and settlements, and it attained additional administrative impositions in health care fraud cases and proceedings. As a result of these efforts, as well as those of preceding years, in FY 2017 $2.6 billion was returned to the Federal Government or paid to private persons. Of this $2.6 billion, the Medicare Trust Funds received transfers of approximately $1.4 billion during this period, and $406.7 million in Federal Medicaid money was similarly transferred separately to the Treasury as a result of these efforts.
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A couple of years ago, the health insurance exchange in Minnesota – MNsure – was in deep trouble. Health insurance premiums for individual policies had shot up by as much as 67 percent, among the steepest increases in the country. Insurers were abandoning the market, leaving 116,000 Minnesotans with scant choices.
The Minnesota Legislature offered a solution: a $271 million, publicly funded reinsurance pool that would help health insurance companies pay the most expensive medical claims, thereby lowering overall insurance premiums. The hope was that backstopping the insurers would stabilize the market and halt the rocket-like rise in premiums.
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Congress has been unable to agree on “market stabilization” for the Affordable Care Act (ACA), and it was left out of the recently passed omnibus. Yet, a key discussion has been missing from the conversation, the need to rethink the single risk pool in the ACA.
Throwing money at the status quo will simply slow a market decline, which could leave millions with no access to affordable coverage. Splitting subsidized lives from nonsubsidized into two different risk pools could provide structural relief that allows markets to stabilize longer term.
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