“The number of Connecticut residents covered by health insurance purchased through the state’s individual market rose by nearly 60,000 since last year, a 55 percent increase since the implementation of major provisions of Obamacare, according to figures released by the Connecticut Insurance Department.
The data also show that more than half the people who bought their own health insurance last year have maintained their old policies or other plans purchased late in 2013. But more than 50,000 of them won’t be able to keep their health plans beyond this year, potentially setting up a repeat of last fall’s turmoil and frustration among people whose policies were discontinued.”
“The deadly Ebola outbreak spreading through Africa is so extreme, it is driving health officials to do something that they would instinctively resist in normal circumstances: Subject patients to unproven experimental drugs.
The drugs are risky. Some have not even been tested on humans. Even so, a World Health Organization ethics committee just declared such use ethical, and its reasoning is hard to dispute, at least for patients who would otherwise die. Some chance is better than none, even with unknown side effects.
Too bad American patients suffering from terminal illnesses have so much trouble getting the same chance.
The process for getting experimental drugs is so daunting that fewer than 1,000 people sought and got federal approval to take such drugs last year.
Food and Drug Administration rules require patients to clear a series of hurdles. First, they and their doctors must find a company to provide its drug. Many drug makers — worried that a patient’s death will spur a lawsuit or harm their chances for final FDA approval — refuse.”
“WASHINGTON — Ending insurance discrimination against the sick was a central goal of the nation’s health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.
The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there’s reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.
With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act’s anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years.
More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that “are highly discriminatory against patients with chronic health conditions and may … violate the (law’s) nondiscrimination provisions.”
Among the groups were the AIDS Institute, the American Lung Association, Easter Seals, the Epilepsy Foundation, the Leukemia & Lymphoma Society, the National Alliance on Mental Illness, the National Kidney Foundation and United Cerebral Palsy. All supported the law.
Coverage of expensive drugs tops their concerns.”
“New information related to physician-industry interaction is scheduled to be released to the public for the first time on September 30. The public database from the Centers for Medicare & Medicaid Services (CMS), which is part of the Sunshine Act implementation, will focus on payments that biopharmaceutical and medical technology companies have made to physicians. Although the release date is less than six weeks away, concerns about what the data will look like and its effect on medical innovation are already being brought to light by stakeholders across the board.
One of the primary concerns that PhRMA shares with more than two dozen other patient and industry organizations is that the data needs to include context to explain what the payments represent – collaborations that benefit patient health and innovation. It’s critical to note that the new database will include information on many different types of interactions. For example, the data could reflect an oncologist partnering with a biopharmaceutical company to lead a clinical trial on an innovative cancer treatment or a family practice physician’s attendance at an industry-sponsored speaking event led by a peer to further her education about geriatric care. However, if the data released includes only names and numbers, the public is likely to be confused and the information is left subject to misinterpretation.
Additionally, many physicians are not aware about the Sunshine Act, what it means for them and their ability to be part of this collaborative process. It is important for CMS to provide physicians with more information about their ability to register and review data reported on them.
To compound this lack of information, physicians also face a confusing registration process with a very short timeline. Given how instrumental relationships between companies and physicians are to driving future innovation, we want to ensure that both groups can provide input on the process of Sunshine Act reporting.”
“There has not exactly been an overabundance of good news on Obamacare. So it did come as some surprise two weeks ago when the Department of Health and Human Services issued a press release with the headline: “Consumers have saved a total of $9 billion on premiums,” and the subheading; “Health care law will return to families an average refund of $80 each this year.”
There is nothing unusual or even untoward about the Obama administration doing what it can to put a positive spin on the law. But what makes this item interesting is it reveals how little the administration actually has to tout about Obamacare and how far it must reach to manufacture a success story.
The purpose of the press release was to announce data on the effects of Obamacare’s “medical loss ratio” regulation, which “requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities. If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers.”
For the 2013 plan year, insurers will be required to pay $332 million in premium refunds to 6.8 million individuals. That works out to $43.78 a person, or HHS’ figure of $80 per household for 4.1 million households. In other words, HHS is crowing that Obamacare benefited 2 percent of Americans by getting them small refunds from their insurers.
And by small, we mean small. The $332 million in refunds are out of the $270 billion insurers collected last year in premiums for individual and group major medical coverage subject to the MLR. That means about a penny in refunds for every $10 of premiums.”
“A mix-up of information about two physicians with the same name in different states has opened a window on wide-ranging technical problems the CMS is facing with its Open Payments website reporting industry payments to doctors and teaching hospitals. Registration for the system, which was scheduled…”
NOTE: This article is behind a paywall.
“Nearly one company in six in a new survey from a major employer group plans to offer health coverage that doesn’t meet the Affordable Care Act’s requirements for value and affordability.
Many thought such low-benefit “skinny plans” would be history once the health law was fully implemented this year. Instead, 16 percent of large employers in a survey released Wednesday by the National Business Group on Health said they will offer in 2015 lower-benefit coverage along with at least one health plan that does qualify under ACA standards.
The results weren’t unexpected by benefits pros, who realized last year that ACA regulations would allow skinny plans and even make them attractive for some employers. But the new survey gives one of the first looks at how many companies will follow through and offer them.”
“When benefits enrollment season arrives this fall, employees around the country can expect to see the impact of corporate cost-cutting on their finances.
Benefits costs will rise only 5 percent for employers that take certain cost-reduction measures, instead of 6.5 percent for companies that do not, according to a June survey of employers representing 7.5 million workers by the National Business Group on Health.
Although costs are not rising as quickly, employees are still being squeezed.
The main way companies are keeping healthcare costs in line is by shifting workers into high-deductible health plans, defined by the Internal Revenue Service as having deductibles above $1,250 for an individual. (here)
For 2015, 81 percent of employers will offer a high-deductible plan as an option, up from 72 percent last year; while 32 percent will offer such plans as the only option, up from 22 percent last year.
The challenge employers face is: “How do you keep costs from spiraling out of control but not shift all of it to the employee?” said Karen Marlo, a vice president at NGBH who authored the report.”
“Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital or United Way.
Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care.
But the hospitals’ efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services.
“Entities acting in their [own] financial interest” could drive up costs for everyone and discourage healthier people from buying coverage, insurers wrote recently to the Obama administration.
Insurers are asking the federal government, which regulates the health insurance marketplaces, to restrict the practice.”
“Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor’s Rating Services.
The rating agency warned the healthcare sector was at “a tipping point where negative forces have started to outweigh many providers’ ability to implement sufficient countermeasures.” Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate.
In particular, stand-alone providers are under greater pressure from physician departures, rising bad debt, and higher employee benefit costs.”