“Three Blue Cross Blue Shield plans operated by Health Care Service Corporation have decided to discontinue their “transitional” non-ACA compliant plans at the end of this year and cancellation notices will be sent to affected policyholders “shortly,” a company spokesperson tells Inside Health Policy. HCSC says the decision was made to help keep premiums for ACA plans affordable, because moving those enrollees into compliant plans will result in a more balanced mix of individuals.
Transitional plans that were on the market this year from Blue Cross Blue Shield of Texas, Blue Cross Blue Shield of New Mexico and Blue Cross Blue Shield of Oklahoma will be discontinued effective Jan. 1. One source tracking state developments said the Blues appear to be discontinuing the plans on its own volition. The Blues participated aggressively in the exchanges in the first year while many other carriers remained cautious about entering the new markets, though that is beginning to change for 2015. All of the aforementioned states are using the federal exchange for 2015 open enrollment for individual plans.”
“CMS on Tuesday goes live with a website that discloses what drug and device companies pay physicians, and the doctor lobby already is warning reporters not to misuse the data. Also this week, America’s Health Insurance Plans holds three conferences covering key health care issues, and drug-pricing policies are a hot topic with events on protected drug classes; insurance designs that encourage patients to use specialty medicines; and a briefing on the cost and value of new drugs.
The American Medical Association sent reporters a guide for appropriately handling data from the Open Payments website, which Congress created under the Physician Payments Sunshine Act. The law requires makers of drugs, devices and medical supplies to report financial relationships with physicians and teaching hospitals, and AMA worries that the public will misconstrue those relationships.
“Publicly reporting industry payments to individual physicians can imply, wrongly, that such payments are always inappropriate,” AMA warned reporters on Monday.”
“The Affordable Care Act changed the rules on how health insurance plans dealt with pre-existing conditions, outlawing the practice of turning away patients with expensive conditions or charging them a drastically higher cost for coverage. But an editorial alleges some health insurance companies operating on the new marketplaces created by Obamacare may have found a loophole that allows them to discourage sick patients from enrolling in a specific plan.
The change has to do with how drugs are categorized in health systems. From the editorial published online at the American Journal of Managed Care:
“For many years, most insurers had formularies that consisted of only three tiers: Tier 1 was for generic drugs (lowest copay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest copay). Generic drugs were automatically placed in Tier 1, thereby ensuring that patients had access to medically appropriate therapies at the lowest possible cost. In these three-tier plans, all generic drugs were de facto “preferred.” Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics, paralleling the similar split that one typically finds with branded products. Copays for generic drugs in the “non-preferred” tier are characteristically much higher than those for drugs in the first tier.””
“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.”
“After a long list of Obamacare failures in Alaska, one physician is shutting down his decades-old practice, charging that the health-care law and other federal programs are “unsustainable” for practicing doctors.
Dr. William Wennen, a plastic surgeon, is closing his Fairbanks practice after 38 years of working in the state. Dr. Wennen blames federal health insurance programs, citing Obamacare, Medicaid and Medicare, for shutting down his practice.”
“A survey of American physicians released this week paints a restless picture of the nation’s doctors—especially when it comes to Obamacare.
“The system is broken and I am out of here as soon as I can,” one doctor wrote. “I am tired of being used, abused, and lied to. Has anyone here woken up to the fact that we are always the last ones to be considered in the equation of change?”
Roughly 20,000 of 650,000 doctors responded to the Physicians Foundation’s survey, and voluntary surveys are prone to finding those with strong opinions. But of those strong opinions, 46 percent of doctors gave the Affordable Care Act (ACA) a “D” or “F,” while only 25 percent gave it an “A” or “B.””
“It’s hard to get a good accounting of what we’ve spent on the Affordable Care Act so far.
The Barack Obama administration has never really tried to count the cost of all the different elements and put them in one place. The Congressional Budget Office, meanwhile, has pretty much given up. Luckily, we have Bloomberg Government, my employer’s government intelligence service, which has thoughtfully totted up all the data it can glean from public records and come up with a figure for spending to date: $73 billion.”
“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.”
“The Obama administration has spent at least $3.7 billion to build and promote online marketplaces under the Affordable Care Act, but it can’t prove exactly where it all went, according to an audit released Monday.
Federal investigators said the Centers for Medicare and Medicaid Services (CMS) does not properly track certain data that public officials need in order to determine whether the healthcare law is working.
The government tracks its healthcare spending in an outdated records system that cannot easily respond to data requests such as salaries or public relations contracts in certain departments. Instead, officials rely on manually prepared spreadsheets that can take months to produce.”
“New survey data show that companies are passing on to their employees additional costs they have incurred as a result of the Affordable Care Act, according to a management professor at the University of South Carolina’s Moore School of Business.
And that means employees who get their health insurance through work are bearing the cost of subsidizing people newly covered under President Obama’s healthcare reform law, said Professor Patrick M. Wright.”