(AP) — An Oregon judge has ordered technology giant Oracle Corp. to continue hosting Oregon's Medicaid health insurance system for low-income Oregonians even after the company's contract expires this weekend. Oregon officials argued in court that Oracle had promised five months ago that the contract would be renewed, and as a result they did not seek alternate hosting services. Officials also said a termination of hosting would cause "irreparable harm" to thousands of people who would not be able to enroll or re-enroll in Medicaid and access health services. The court fight has occurred amid a larger legal battle over the failure of Oregon's health care exchange portal, Cover Oregon, which was also built by Oracle.
Reported by SeattlePI.com 5 hours ago.
Judge orders Oracle to keep hosting Oregon's Medicaid system
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MNsure audit could boost critics' case for more legislative control
Beneath a scathing audit of MNsure released last week are additional details that could bolster lawmakers' case to give the Legislature greater power over the state's health insurance exchange.
Reported by TwinCities.com 3 hours ago.
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Obamacare Cadillac Tax Is No Rolls Royce. New IRS Guidance Makes It A Lemon
The Affordable Care Act's Cadillac tax slaps a 40% excise tax on companies that provide health insurance that is too good. It is in the law, so debating its fairness if moot. Yet administering the tax will be untying a Gordian Knot, as the first IRS guidance reveals.
Reported by Forbes.com 18 hours ago.
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Now You Can Finally Figure Out How Much Your Medical Bills Should Be
This post was originally published by Kaiser Health News (KHN). Kaiser Health News (KHN) is a nonprofit national health policy news service.
Buying health care in America is like shopping blindfolded at Macy’s and getting the bill months after you leave the store, economist Uwe Reinhardt likes to say.
A tool that went online Wednesday is supposed to give patients a small peek at the products and prices before they open their wallets.
Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?
Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. That’s the real cost — not “charges” that often get marked down — based on a giant database of what insurance companies actually pay.
OK, this isn’t like Priceline.com for knee replacements. What Guroo hopes to do for consumers is limited so far.
It won’t reflect costs for particular hospitals or doctors, although officials say that’s coming for some. And it doesn’t have much to say initially about the quality of care.
Still, Guroo should shed new light on the country’s opaque, complex and maddening medical bazaar, say consumer advocates.
“This has the potential to be a game-changer,” said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. “It’s good for uninsured people. It’s good for people with high deductibles. It’s good for any person that’s kind of wondering: If I go to see the doctor for such-and-such, what might happen next?”
Guroo is produced by the Health Care Cost Institute (HCCI) working with three big insurance companies: UnitedHealthcare, Aetna and Humana, soon to be joined by a fourth, Assurant. The idea is to eventually let members of these plans use a companion site to see how differing provider prices affect their co-payments.
A nonprofit known for its cost and utilization reports, HCCI receives some industry funding but is governed by an independent board. This is its first tool for consumers.
Consumer advocates praised Guroo but cautioned that the movement toward “transparency” in medical prices is still in its very early stages. Data on insurer, employer or government Web sites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.
Even on Guroo, “the average user may not have a good sense of what they’re looking at and what they’re supposed to do with the resulting price,” said Lynn Quincy, a health care specialist at Consumers Union.
HCCI says its prices are what insurers pay for about 70 tests and “bundles” of services described in understandable terms so patients don’t need a medical textbook to figure out what they are. Users get the average as well as a range for local and national prices.
It plans to add more procedures later — all for “shoppable” services that can be scheduled, not emergency treatment of a heart attack.
“This at least arms consumers with information about the range of prices in their community [for] one of these care bundles,” said David Newman, HCCI’s executive director.
If you have a high deductible, for example, you might use Guroo as a starting point for checking prices from medical providers if your insurance company doesn’t provide such a tool.
That’s not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana track spending on a companion site and check how switching caregivers could lower their out-of-pocket costs.
Initially Guroo doesn’t have much information about quality of care, either, which is essential to help patients to make smart choices. Newman says that is coming, too. It’s also missing information for Alabama, Michigan and several other states.
BlueCross BlueShield of North Carolina set a high standard for disclosure recently by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy said. Guroo doesn’t do that.
Still, she said, it’s an important step.
Given its size, influence and openness, Guroo could become a dominant portal for health care prices, said Hempstead.
“Their stance as a neutral broker and the amount of data that they have and the amount of data that they’re going to have really puts them in a difference place,” she said.
jhancock@kff.org | @JayHancock1 Reported by Huffington Post 16 hours ago.
Buying health care in America is like shopping blindfolded at Macy’s and getting the bill months after you leave the store, economist Uwe Reinhardt likes to say.
A tool that went online Wednesday is supposed to give patients a small peek at the products and prices before they open their wallets.
Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?
Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. That’s the real cost — not “charges” that often get marked down — based on a giant database of what insurance companies actually pay.
OK, this isn’t like Priceline.com for knee replacements. What Guroo hopes to do for consumers is limited so far.
It won’t reflect costs for particular hospitals or doctors, although officials say that’s coming for some. And it doesn’t have much to say initially about the quality of care.
Still, Guroo should shed new light on the country’s opaque, complex and maddening medical bazaar, say consumer advocates.
“This has the potential to be a game-changer,” said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. “It’s good for uninsured people. It’s good for people with high deductibles. It’s good for any person that’s kind of wondering: If I go to see the doctor for such-and-such, what might happen next?”
Guroo is produced by the Health Care Cost Institute (HCCI) working with three big insurance companies: UnitedHealthcare, Aetna and Humana, soon to be joined by a fourth, Assurant. The idea is to eventually let members of these plans use a companion site to see how differing provider prices affect their co-payments.
A nonprofit known for its cost and utilization reports, HCCI receives some industry funding but is governed by an independent board. This is its first tool for consumers.
Consumer advocates praised Guroo but cautioned that the movement toward “transparency” in medical prices is still in its very early stages. Data on insurer, employer or government Web sites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.
Even on Guroo, “the average user may not have a good sense of what they’re looking at and what they’re supposed to do with the resulting price,” said Lynn Quincy, a health care specialist at Consumers Union.
HCCI says its prices are what insurers pay for about 70 tests and “bundles” of services described in understandable terms so patients don’t need a medical textbook to figure out what they are. Users get the average as well as a range for local and national prices.
It plans to add more procedures later — all for “shoppable” services that can be scheduled, not emergency treatment of a heart attack.
“This at least arms consumers with information about the range of prices in their community [for] one of these care bundles,” said David Newman, HCCI’s executive director.
If you have a high deductible, for example, you might use Guroo as a starting point for checking prices from medical providers if your insurance company doesn’t provide such a tool.
That’s not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana track spending on a companion site and check how switching caregivers could lower their out-of-pocket costs.
Initially Guroo doesn’t have much information about quality of care, either, which is essential to help patients to make smart choices. Newman says that is coming, too. It’s also missing information for Alabama, Michigan and several other states.
BlueCross BlueShield of North Carolina set a high standard for disclosure recently by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy said. Guroo doesn’t do that.
Still, she said, it’s an important step.
Given its size, influence and openness, Guroo could become a dominant portal for health care prices, said Hempstead.
“Their stance as a neutral broker and the amount of data that they have and the amount of data that they’re going to have really puts them in a difference place,” she said.
jhancock@kff.org | @JayHancock1 Reported by Huffington Post 16 hours ago.
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Obama Immigration Move Won't Solve Health Issues
This piece comes to us courtesy of Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.
President Barack Obama’s controversial executive action on immigration has highlighted a thorny health care issue for states: Potentially millions of immigrants could legally stay here and work, but still lack health insurance.
Unauthorized immigrants have limited access to health care coverage, and the president’s action likely will make them ineligible for most Medicaid services and bar them from purchasing insurance on the federal and state exchanges created under the Affordable Care Act (ACA).
Some states have sought to solve the problem for low-income immigrants with separate state-funded insurance programs. Those that have not are wrestling with the consequences of a population that is going without routine care, which can drive up costs when preventable illnesses become serious health emergencies.
Treating kidney disease as an emergency condition, for instance, costs almost five times what it would with routine care denied to unauthorized immigrants, according to a Baylor College of Medicine study published by the Texas Medical Association last year.
Unauthorized immigrants without health insurance present other problems for states. In Maryland, for instance, state attorneys face cases of criminally insane defendants who are no longer deportable but can’t get the follow-up care required for release into the community.
The issues arise from what the Annenberg Public Policy Center calls “a curious intersection” between the ACA and the president’s executive action that defers deportation for many unauthorized immigrants: The action allows them to live and work here legally, but not to get insurance under the ACA.
The president’s action, Deferred Action for Parental Accountability (DAPA), defers deportation for immigrant parents of U.S. citizens and it expands the 2012 program, Deferred Action for Childhood Arrivals (DACA), which deferred deportation for immigrants who arrived unlawfully before they turned age 16.
The action is on hold because of an injunction issued Feb. 16 by a federal judge in Texas after 26 states filed suit. The Obama administration is appealing. But even if the president wins, the health care issue likely remains for the immigrants who are allowed to stay and work.
“People granted DAPA or expanded DACA will not be eligible for federal health coverage programs,” the Georgetown University Health Policy Institute recently wrote on its policy blog.
Only states with state-funded alternatives, such as California’s Medi-Cal, are considering plans to accept expanded DACA/DAPA recipients. California, along with Washington, Massachusetts, Minnesota, New York and the District of Columbia use state or local funds to offer some health insurance to DACA recipients, according to the National Council of State Legislatures.
California and New York have been the most successful in bridging the gap, according to a Migration Policy Institute study of unauthorized immigrants. In both states, unauthorized immigrants are more likely to have health insurance than the general population.
Illinois was planning a state-funded insurance exchange open to all, including unauthorized immigrants, under Democratic Gov. Pat Quinn. Republican Gov. Bruce Rauner, who replaced Quinn in January, has not said whether he will continue the plan.
Many immigration and health care advocates hope the situation will change nationally, and DACA and DAPA recipients will be allowed to purchase insurance on all exchanges and be covered by employer plans under the ACA. Dozens of state and local advocacy groups have asked the federal government to open up more health insurance options for DACA and future DAPA recipients.
“There is some hope that the work authorization will allow people granted DACA or DAPA to obtain jobs that provide health insurance benefits,” Georgetown’s Health Policy Institute said. “However, many people in low-wage, part-time and seasonal jobs will continue to be left out of employer-sponsored health insurance or unable to afford their required share of the premiums.”
State Headaches
More than half of unauthorized immigrant adults have no health insurance, and one in five lives in poverty, according to Pew Hispanic Center estimates (Pew also funds Stateline). That creates problems, even in criminal cases.
At a meeting of the National Association of Attorneys General in Washington, D.C., this week, Assistant Attorney General Rhonda Edwards of Maryland said she’s finding it increasingly hard to deal with mental hospital inmates who are unauthorized immigrants because of their lack of insurance.
Without insurance, it’s difficult or impossible to release patients from mental hospitals and free the beds for other patients, she said.
“Treatment for mental illness is afforded to illegal mentally ill immigrants who are court-committed to state-run facilities at governmental expense,” Edwards wrote in a paper on the subject. “However, once these individuals are released, no governmental funding is allocated for their care and treatment for mental illness symptoms that may cause them to be a danger in the community.”
Unauthorized immigrants without insurance are entitled to emergency care, including childbirth care, through a federal-state Medicaid safety net fund costing $2 billion a year, according to a 2013 report from Kaiser Health News. Routine care is often left to safety net clinics that also get federal funding, but politically sensitive care like birth control can be inconsistent from state to state.
A recent University of Kentucky study found that lack of insurance drives many immigrant women to cross the border into Mexico to get oral contraceptives.
“If you’re an undocumented woman, you’re really reliant on these clinics,” said Kinsey Hasstedt, a public policy associate for the Guttmacher Institute, a reproductive health advocacy group.
An Employment Advantage?
The issue of health insurance came up in arguments before U.S. District Court Judge Andrew Hanen, who issued the injunction which blocked DAPA and the expansion of DACA.
States argued that DACA and DAPA recipients would have an unfair advantage over citizens in competing for jobs because employers wouldn’t have to buy insurance for them.
Expanding deferred deportation could “create a discriminatory employment environment that will encourage employers to hire DAPA beneficiaries instead of those with lawful permanent status in the United States,” Hanen wrote in a memorandum opinion in issuing the injunction. “If an employer hires a DACA beneficiary, it does not have to offer that individual healthcare nor does it incur a monetary penalty for the failure to do so.”
But employment experts said such a tactic is not as easy as it sounds. Any employer of more than 50 people must provide health insurance for all employees unless every single one is exempt, said Ken Jacobs of the University of California, Berkeley Labor Center.
“There is a penalty that applies to employers that do not provide affordable coverage,” Jacobs said. “That rule applies to all workers.”
Angel Padilla, a health policy analyst at National Immigration Law Center, agreed. He pointed to a brief released in December by the Annenberg Public Policy Center debunking the idea.
"It would be extremely unlikely for DACA and DAPA grantees to allow an employer to skirt the employer mandate and there are a number of existing protections to keep this from happening,” he said.
States Can Step In
States have always been free to make their own health care provisions for unauthorized and other immigrants, who are generally barred from government health benefits such as Medicaid for five years after they attain legal status.
Several states, such as Alaska and Massachusetts, provide state funding for selected unauthorized immigrants (such as children and pregnant women) for some services, according to a Pew report released last year. But other states, such as Alabama, Mississippi, North Dakota, Ohio, Texas, Virginia and Wyoming, deny Medicaid even to some immigrants with green cards who have been legal for five years.
Many states are opposed to providing help to unauthorized immigrants on ethical and financial grounds. Foes say it’s wrong to reward illegal entry into the country, and that more demand on health care resources will strain budgets and harm the quality of care. Opinion polls often favor withholding health care subsidies from illegal immigrants, according to a review by the Federation for American Immigration Reform (FAIR), a group seeking to stop illegal immigration.
But without affordable health insurance, advocates say unauthorized immigrants will continue to have health issues.
“With a growing undocumented immigrant population in Texas, our state legislators must be aware of and address this problem before it evolves into a health care crisis,” researchers warned in last year’s Baylor College of Medicine study on health care for undocumented immigrants. Reported by Huffington Post 16 hours ago.
President Barack Obama’s controversial executive action on immigration has highlighted a thorny health care issue for states: Potentially millions of immigrants could legally stay here and work, but still lack health insurance.
Unauthorized immigrants have limited access to health care coverage, and the president’s action likely will make them ineligible for most Medicaid services and bar them from purchasing insurance on the federal and state exchanges created under the Affordable Care Act (ACA).
Some states have sought to solve the problem for low-income immigrants with separate state-funded insurance programs. Those that have not are wrestling with the consequences of a population that is going without routine care, which can drive up costs when preventable illnesses become serious health emergencies.
Treating kidney disease as an emergency condition, for instance, costs almost five times what it would with routine care denied to unauthorized immigrants, according to a Baylor College of Medicine study published by the Texas Medical Association last year.
Unauthorized immigrants without health insurance present other problems for states. In Maryland, for instance, state attorneys face cases of criminally insane defendants who are no longer deportable but can’t get the follow-up care required for release into the community.
The issues arise from what the Annenberg Public Policy Center calls “a curious intersection” between the ACA and the president’s executive action that defers deportation for many unauthorized immigrants: The action allows them to live and work here legally, but not to get insurance under the ACA.
The president’s action, Deferred Action for Parental Accountability (DAPA), defers deportation for immigrant parents of U.S. citizens and it expands the 2012 program, Deferred Action for Childhood Arrivals (DACA), which deferred deportation for immigrants who arrived unlawfully before they turned age 16.
The action is on hold because of an injunction issued Feb. 16 by a federal judge in Texas after 26 states filed suit. The Obama administration is appealing. But even if the president wins, the health care issue likely remains for the immigrants who are allowed to stay and work.
“People granted DAPA or expanded DACA will not be eligible for federal health coverage programs,” the Georgetown University Health Policy Institute recently wrote on its policy blog.
Only states with state-funded alternatives, such as California’s Medi-Cal, are considering plans to accept expanded DACA/DAPA recipients. California, along with Washington, Massachusetts, Minnesota, New York and the District of Columbia use state or local funds to offer some health insurance to DACA recipients, according to the National Council of State Legislatures.
California and New York have been the most successful in bridging the gap, according to a Migration Policy Institute study of unauthorized immigrants. In both states, unauthorized immigrants are more likely to have health insurance than the general population.
Illinois was planning a state-funded insurance exchange open to all, including unauthorized immigrants, under Democratic Gov. Pat Quinn. Republican Gov. Bruce Rauner, who replaced Quinn in January, has not said whether he will continue the plan.
Many immigration and health care advocates hope the situation will change nationally, and DACA and DAPA recipients will be allowed to purchase insurance on all exchanges and be covered by employer plans under the ACA. Dozens of state and local advocacy groups have asked the federal government to open up more health insurance options for DACA and future DAPA recipients.
“There is some hope that the work authorization will allow people granted DACA or DAPA to obtain jobs that provide health insurance benefits,” Georgetown’s Health Policy Institute said. “However, many people in low-wage, part-time and seasonal jobs will continue to be left out of employer-sponsored health insurance or unable to afford their required share of the premiums.”
State Headaches
More than half of unauthorized immigrant adults have no health insurance, and one in five lives in poverty, according to Pew Hispanic Center estimates (Pew also funds Stateline). That creates problems, even in criminal cases.
At a meeting of the National Association of Attorneys General in Washington, D.C., this week, Assistant Attorney General Rhonda Edwards of Maryland said she’s finding it increasingly hard to deal with mental hospital inmates who are unauthorized immigrants because of their lack of insurance.
Without insurance, it’s difficult or impossible to release patients from mental hospitals and free the beds for other patients, she said.
“Treatment for mental illness is afforded to illegal mentally ill immigrants who are court-committed to state-run facilities at governmental expense,” Edwards wrote in a paper on the subject. “However, once these individuals are released, no governmental funding is allocated for their care and treatment for mental illness symptoms that may cause them to be a danger in the community.”
Unauthorized immigrants without insurance are entitled to emergency care, including childbirth care, through a federal-state Medicaid safety net fund costing $2 billion a year, according to a 2013 report from Kaiser Health News. Routine care is often left to safety net clinics that also get federal funding, but politically sensitive care like birth control can be inconsistent from state to state.
A recent University of Kentucky study found that lack of insurance drives many immigrant women to cross the border into Mexico to get oral contraceptives.
“If you’re an undocumented woman, you’re really reliant on these clinics,” said Kinsey Hasstedt, a public policy associate for the Guttmacher Institute, a reproductive health advocacy group.
An Employment Advantage?
The issue of health insurance came up in arguments before U.S. District Court Judge Andrew Hanen, who issued the injunction which blocked DAPA and the expansion of DACA.
States argued that DACA and DAPA recipients would have an unfair advantage over citizens in competing for jobs because employers wouldn’t have to buy insurance for them.
Expanding deferred deportation could “create a discriminatory employment environment that will encourage employers to hire DAPA beneficiaries instead of those with lawful permanent status in the United States,” Hanen wrote in a memorandum opinion in issuing the injunction. “If an employer hires a DACA beneficiary, it does not have to offer that individual healthcare nor does it incur a monetary penalty for the failure to do so.”
But employment experts said such a tactic is not as easy as it sounds. Any employer of more than 50 people must provide health insurance for all employees unless every single one is exempt, said Ken Jacobs of the University of California, Berkeley Labor Center.
“There is a penalty that applies to employers that do not provide affordable coverage,” Jacobs said. “That rule applies to all workers.”
Angel Padilla, a health policy analyst at National Immigration Law Center, agreed. He pointed to a brief released in December by the Annenberg Public Policy Center debunking the idea.
"It would be extremely unlikely for DACA and DAPA grantees to allow an employer to skirt the employer mandate and there are a number of existing protections to keep this from happening,” he said.
States Can Step In
States have always been free to make their own health care provisions for unauthorized and other immigrants, who are generally barred from government health benefits such as Medicaid for five years after they attain legal status.
Several states, such as Alaska and Massachusetts, provide state funding for selected unauthorized immigrants (such as children and pregnant women) for some services, according to a Pew report released last year. But other states, such as Alabama, Mississippi, North Dakota, Ohio, Texas, Virginia and Wyoming, deny Medicaid even to some immigrants with green cards who have been legal for five years.
Many states are opposed to providing help to unauthorized immigrants on ethical and financial grounds. Foes say it’s wrong to reward illegal entry into the country, and that more demand on health care resources will strain budgets and harm the quality of care. Opinion polls often favor withholding health care subsidies from illegal immigrants, according to a review by the Federation for American Immigration Reform (FAIR), a group seeking to stop illegal immigration.
But without affordable health insurance, advocates say unauthorized immigrants will continue to have health issues.
“With a growing undocumented immigrant population in Texas, our state legislators must be aware of and address this problem before it evolves into a health care crisis,” researchers warned in last year’s Baylor College of Medicine study on health care for undocumented immigrants. Reported by Huffington Post 16 hours ago.
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Outrage of the Month: Health Insurers Find Creative New Way to Discriminate Against Sick Patients by Increasing Drug Costs
Read more in Public Citizen's March Health Letter
Supporters of the seriously flawed Affordable Care Act often tout as one of the law's most important benefits provisions prohibiting health insurance companies from discriminating against patients with pre-existing medical conditions. Under these provisions, insurers may not charge exorbitant premiums or deny coverage to patients with chronic medical conditions -- such as cancer, diabetes or HIV infection -- that require expensive, long-term medical care.
But an analysis by researchers at the Harvard School of Public Health, published in the New England Journal of Medicine on Jan. 29, suggests that a significant number of health insurance companies are employing new schemes to discourage high-cost patients with chronic illnesses from enrolling in their plans^1. One such scheme, labeled "adverse tiering" by the researchers, targets coverage for prescription drugs -- one of the largest health care expenditures for many patients with chronic diseases.
For many years, health insurers have used "tiered formularies" under which enrollees are encouraged -- through different levels of cost-sharing copays and deductibles -- to use generic drugs and certain lower-cost brand-name medicines instead of more costly alternatives; out-of-pocket expenses for the low-tier generics are small, whereas those for more costly high-tier brand-name drugs are large.
However, under adverse tiering, some insurance companies place all drugs, both generic and brand-name, used to treat a particular disease in the highest cost-sharing tier. For example, looking at a sample of 48 health plans offered in 12 states, the Harvard researchers found that adverse tiering was used in 25 percent of the plans for a class of expensive drugs that are key to treatment of HIV infection^2. On average, the out-of-pocket expenses for these drugs under the adverse-tiering plans was three times higher than for plans not using adverse tiering ($4,900 versus $1,600 per drug, per year, respectively)^3.
The intended effect of such outrageous adverse-tiering practices undoubtedly is to dissuade certain high-cost patients with pre-existing conditions from enrolling in the companies' health plans and thus to maximize profits.
In the short term, the Department of Justice and the Department of Health and Human Services must investigate companies engaged in these discriminatory practices and punish them harshly. However, the only way to prevent similar conduct in the long term is to replace our current private, profit-driven health insurance system with a national, single-payer, improved Medicare-for-all system.
1. Jacobs DB, Sommers BD. Using drugs to discriminate -- Adverse selection in the insurance marketplace. N Engl J Med. 2015;372(5):399-402.
2. Ibid.
3. Ibid. Reported by Huffington Post 15 hours ago.
Supporters of the seriously flawed Affordable Care Act often tout as one of the law's most important benefits provisions prohibiting health insurance companies from discriminating against patients with pre-existing medical conditions. Under these provisions, insurers may not charge exorbitant premiums or deny coverage to patients with chronic medical conditions -- such as cancer, diabetes or HIV infection -- that require expensive, long-term medical care.
But an analysis by researchers at the Harvard School of Public Health, published in the New England Journal of Medicine on Jan. 29, suggests that a significant number of health insurance companies are employing new schemes to discourage high-cost patients with chronic illnesses from enrolling in their plans^1. One such scheme, labeled "adverse tiering" by the researchers, targets coverage for prescription drugs -- one of the largest health care expenditures for many patients with chronic diseases.
For many years, health insurers have used "tiered formularies" under which enrollees are encouraged -- through different levels of cost-sharing copays and deductibles -- to use generic drugs and certain lower-cost brand-name medicines instead of more costly alternatives; out-of-pocket expenses for the low-tier generics are small, whereas those for more costly high-tier brand-name drugs are large.
However, under adverse tiering, some insurance companies place all drugs, both generic and brand-name, used to treat a particular disease in the highest cost-sharing tier. For example, looking at a sample of 48 health plans offered in 12 states, the Harvard researchers found that adverse tiering was used in 25 percent of the plans for a class of expensive drugs that are key to treatment of HIV infection^2. On average, the out-of-pocket expenses for these drugs under the adverse-tiering plans was three times higher than for plans not using adverse tiering ($4,900 versus $1,600 per drug, per year, respectively)^3.
The intended effect of such outrageous adverse-tiering practices undoubtedly is to dissuade certain high-cost patients with pre-existing conditions from enrolling in the companies' health plans and thus to maximize profits.
In the short term, the Department of Justice and the Department of Health and Human Services must investigate companies engaged in these discriminatory practices and punish them harshly. However, the only way to prevent similar conduct in the long term is to replace our current private, profit-driven health insurance system with a national, single-payer, improved Medicare-for-all system.
1. Jacobs DB, Sommers BD. Using drugs to discriminate -- Adverse selection in the insurance marketplace. N Engl J Med. 2015;372(5):399-402.
2. Ibid.
3. Ibid. Reported by Huffington Post 15 hours ago.
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Highmark Health Appoints Joseph C. Guyaux Chairman of the Board of Directors
Highmark Health of Pittsburgh announced today that Joseph C. Guyaux, senior vice chairman of the The PNC Financial Services Group, Inc., and president and chief executive officer of PNC Mortgage, has been appointed chairman of the board of directors. In addition, Highmark Health president and chief executive officer David L. Holmberg will become chairman of the board of directors of Highmark Inc.
Pittsburgh, PA (PRWEB) February 26, 2015
Today, Highmark Health announced that longtime board of director Chairman J. Robert Baum, Ph.D. is stepping down as chairman of the board of directors and will be succeeded by Joseph C. Guyaux, senior vice chairman of The PNC Financial Services Group, Inc. and president and chief executive officer, PNC Mortgage. Additionally, Highmark Health President and Chief Executive Officer David L. Holmberg will become the chairman of the board of directors of Highmark Inc.; both changes are effective as of Wednesday.
“I am honored to have been elected as the chairman of the board for Highmark Health, the parent organization for a group of companies that are trusted partners to customers, members and patients in the communities we serve,” commented Mr. Guyaux. “This is a particularly dynamic time for our enterprise, as we successfully navigated the marketplace in the wake of health care reform, responded to heightened competition and continued the drive to diversify so that we have a broad base from which to serve customers. I am proud to follow Bob Baum, who has provided inspired leadership at critical junctures and helped position the company for growth and success. We will remember his calm presence, thoughtfulness and genuine interest in the people we serve and in the business he helped guide.”
“I appreciate the board’s confidence in allowing me the opportunity to serve as the chairman of the Highmark Inc. board of directors,” said Mr. Holmberg. “The businesses comprising Highmark Inc. show the depth of our diversity as we seek to transform health care to better meet the evolving needs of our customers. Additionally, on behalf of all the employees of Highmark Health, I want to express our appreciation to Bob Baum, who dedicated himself to our mission for 35 years.”
Prior to being named to his current position this month, Guyaux, who has worked at PNC for 42 years, was senior vice chairman and chief risk officer with responsibility for PNC’s enterprise-wide risk management program, including operating, compliance, credit and market risk.
Guyaux joined PNC in 1972 and, after holding several management positions, was named senior vice president and manager of Metropolitan Commercial Banking in Pittsburgh in 1989. In 1991, he was elected president of PNC’s northeast Pennsylvania market. Guyaux returned to Pittsburgh in 1993 as retail market manager and was named manager, PNC Private Bank in 1995. In 1997, he was appointed deputy manager of Retail Banking and later that year he was named chief executive officer of that business. In that role, Guyaux instituted a successful customer-focused strategy that has resulted in increases in net income, customer and employee satisfaction and extensive employee volunteerism. He became responsible for PNC’s middle market, corporate finance, capital markets, asset-based lending, treasury management, leasing and wealth management businesses in 2001 and 2002. Guyaux was appointed president of The PNC Financial Services Group Inc. in 2002, a position he held until February 2012, when he was named senior vice chairman and chief risk officer.
Guyaux previously served as a member of the Highmark Inc. board of directors from 2004–2012 and as a member of several committees. Guyaux is chairman of the board of directors for the Pittsburgh Civic Light Opera and a life trustee of the Carnegie Museums of Pittsburgh. In addition, he serves as chairman of the board of managers of DQE Holdings LLC. He was elected an emeritus member of the board of directors of Duquesne University in October 2009.
Guyaux and his wife are lifelong residents of western Pennsylvania.
Holmberg was appointed Highmark Health’s president and chief executive officer in May 2014, following seven years of service in a series of executive positions within the company. Most recently, he was president of diversified businesses for Highmark Inc., where he was responsible for businesses representing more than $3.5 billion in revenue. He has also served as chief executive officer for HVHC Inc. and chief executive officer and chairman for HM Insurance Group, United Concordia Dental and San Antonio, Texas-based Visionworks, formerly Eye Care Centers of America (ECCA).
Dr. Baum will continue to serve as a member of the board of directors of HVHC, Highmark Health’s vision affiliate, which is comprised of Davis Vision and Visionworks. He will also join the board of directors of HM Insurance Group as well as the board of directors of Highmark Health’s dental affiliate, United Concordia, and its subsidiaries.
About Highmark Health
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 35,000 people nationwide and serves 40 million Americans in all 50 states, is the third largest integrated health care delivery and financing network in the nation. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to 5.3 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, Davis Vision and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, a community-based network of physician organizations, and a group purchasing organization, ambulatory surgery centers, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. To learn more, please visit http://www.highmarkhealth.org. Reported by PRWeb 16 hours ago.
Pittsburgh, PA (PRWEB) February 26, 2015
Today, Highmark Health announced that longtime board of director Chairman J. Robert Baum, Ph.D. is stepping down as chairman of the board of directors and will be succeeded by Joseph C. Guyaux, senior vice chairman of The PNC Financial Services Group, Inc. and president and chief executive officer, PNC Mortgage. Additionally, Highmark Health President and Chief Executive Officer David L. Holmberg will become the chairman of the board of directors of Highmark Inc.; both changes are effective as of Wednesday.
“I am honored to have been elected as the chairman of the board for Highmark Health, the parent organization for a group of companies that are trusted partners to customers, members and patients in the communities we serve,” commented Mr. Guyaux. “This is a particularly dynamic time for our enterprise, as we successfully navigated the marketplace in the wake of health care reform, responded to heightened competition and continued the drive to diversify so that we have a broad base from which to serve customers. I am proud to follow Bob Baum, who has provided inspired leadership at critical junctures and helped position the company for growth and success. We will remember his calm presence, thoughtfulness and genuine interest in the people we serve and in the business he helped guide.”
“I appreciate the board’s confidence in allowing me the opportunity to serve as the chairman of the Highmark Inc. board of directors,” said Mr. Holmberg. “The businesses comprising Highmark Inc. show the depth of our diversity as we seek to transform health care to better meet the evolving needs of our customers. Additionally, on behalf of all the employees of Highmark Health, I want to express our appreciation to Bob Baum, who dedicated himself to our mission for 35 years.”
Prior to being named to his current position this month, Guyaux, who has worked at PNC for 42 years, was senior vice chairman and chief risk officer with responsibility for PNC’s enterprise-wide risk management program, including operating, compliance, credit and market risk.
Guyaux joined PNC in 1972 and, after holding several management positions, was named senior vice president and manager of Metropolitan Commercial Banking in Pittsburgh in 1989. In 1991, he was elected president of PNC’s northeast Pennsylvania market. Guyaux returned to Pittsburgh in 1993 as retail market manager and was named manager, PNC Private Bank in 1995. In 1997, he was appointed deputy manager of Retail Banking and later that year he was named chief executive officer of that business. In that role, Guyaux instituted a successful customer-focused strategy that has resulted in increases in net income, customer and employee satisfaction and extensive employee volunteerism. He became responsible for PNC’s middle market, corporate finance, capital markets, asset-based lending, treasury management, leasing and wealth management businesses in 2001 and 2002. Guyaux was appointed president of The PNC Financial Services Group Inc. in 2002, a position he held until February 2012, when he was named senior vice chairman and chief risk officer.
Guyaux previously served as a member of the Highmark Inc. board of directors from 2004–2012 and as a member of several committees. Guyaux is chairman of the board of directors for the Pittsburgh Civic Light Opera and a life trustee of the Carnegie Museums of Pittsburgh. In addition, he serves as chairman of the board of managers of DQE Holdings LLC. He was elected an emeritus member of the board of directors of Duquesne University in October 2009.
Guyaux and his wife are lifelong residents of western Pennsylvania.
Holmberg was appointed Highmark Health’s president and chief executive officer in May 2014, following seven years of service in a series of executive positions within the company. Most recently, he was president of diversified businesses for Highmark Inc., where he was responsible for businesses representing more than $3.5 billion in revenue. He has also served as chief executive officer for HVHC Inc. and chief executive officer and chairman for HM Insurance Group, United Concordia Dental and San Antonio, Texas-based Visionworks, formerly Eye Care Centers of America (ECCA).
Dr. Baum will continue to serve as a member of the board of directors of HVHC, Highmark Health’s vision affiliate, which is comprised of Davis Vision and Visionworks. He will also join the board of directors of HM Insurance Group as well as the board of directors of Highmark Health’s dental affiliate, United Concordia, and its subsidiaries.
About Highmark Health
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 35,000 people nationwide and serves 40 million Americans in all 50 states, is the third largest integrated health care delivery and financing network in the nation. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to 5.3 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, Davis Vision and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, a community-based network of physician organizations, and a group purchasing organization, ambulatory surgery centers, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. To learn more, please visit http://www.highmarkhealth.org. Reported by PRWeb 16 hours ago.
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Report: FBI close to finding Anthem hackers
The FBI says it is close to finding hackers responsible for the attack on health-insurance company Anthem Inc. that exposed the personal information of close to 80 million customers, including 13.5 million in California. According to Bloomberg, FBI officials are still deciding whether to reveal information about the attackers in one of the biggest thefts of medical-related customer data in U.S. history. Robert Anderson, the bureau's executive assistant director for cybersecurity, said agency officials…
Reported by bizjournals 14 hours ago.
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John Barrasso: Republicans Are Not Prepared To Fix Obamacare
NATIONAL HARBOR, Md. -- A Republican-run Congress will not support a quick legislative fix should the Supreme Court rule that a large chunk of Obamacare's health care subsidies are illegal, a leading GOP senator said Thursday.
Sen. John Barrasso (R-Wyo.) told conservatives gathered at the annual Conservative Political Action Conference that he and other Republicans view the Supreme Court's decision in the forthcoming King v. Burwell health insurance subsidy case as an opportunity to pass a conservative-minded replacement to the law. Should the court rule that subsidies can only be awarded to individuals shopping for coverage on state-run exchanges, he said, Republicans would resist efforts to restore subsidies for others.
"You can imagine if a Supreme Court rules against the president ... he is going to completely attack," said Barrasso. "He's going to call it a partisan court. And then he's going to say I have a simple one-page bill as the solution. Just make everything I've done, make it legal. And we are not prepared to do that."
Barrasso's comments foreshadow what could be an explosive and protracted political period if the court strikes down the subsidies. State and federal politicians would have to revisit health care reform as millions of Americans would face the possibility of higher premiums.
Congressional Republicans could help their case -- and alleviate some uncertainty -- by having their own health care bill in place by the time the court rules. But Barrasso's remarks, which came during a panel titled "The Conservative Replacement to Obamacare," made it clear that conservatives won't have a replacement in the near future or, perhaps, the distant one either.
"There is nothing that the president is going to sign that would do what we want to do in terms of repealing and replacing it," he said. Reported by Huffington Post 14 hours ago.
Sen. John Barrasso (R-Wyo.) told conservatives gathered at the annual Conservative Political Action Conference that he and other Republicans view the Supreme Court's decision in the forthcoming King v. Burwell health insurance subsidy case as an opportunity to pass a conservative-minded replacement to the law. Should the court rule that subsidies can only be awarded to individuals shopping for coverage on state-run exchanges, he said, Republicans would resist efforts to restore subsidies for others.
"You can imagine if a Supreme Court rules against the president ... he is going to completely attack," said Barrasso. "He's going to call it a partisan court. And then he's going to say I have a simple one-page bill as the solution. Just make everything I've done, make it legal. And we are not prepared to do that."
Barrasso's comments foreshadow what could be an explosive and protracted political period if the court strikes down the subsidies. State and federal politicians would have to revisit health care reform as millions of Americans would face the possibility of higher premiums.
Congressional Republicans could help their case -- and alleviate some uncertainty -- by having their own health care bill in place by the time the court rules. But Barrasso's remarks, which came during a panel titled "The Conservative Replacement to Obamacare," made it clear that conservatives won't have a replacement in the near future or, perhaps, the distant one either.
"There is nothing that the president is going to sign that would do what we want to do in terms of repealing and replacing it," he said. Reported by Huffington Post 14 hours ago.
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Conservatives Don't Have an Obamacare Replacement Because They're Too Busy Complaining About Obamacare
With the Supreme Court scheduled to hear the Obamacare challenge King vs. Burwell next week, Democrats and Republicans are both trying to influence the Court’s decision. For the left, that means focusing on the millions of people who could lose health insurance if the Court rules that th
Reported by The New Republic 13 hours ago.
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Consumers Looking for Pediatric Dental Benefits through Health Insurance Marketplaces Have More Choices, According to New Report from ADA Health Policy Institute
WASHINGTON, Feb. 26, 2015 /PRNewswire-USNewswire/ -- Consumers looking for medical plans with embedded dental benefits have more options than ever on the health insurance marketplaces, according to a new study by the ADA Health Policy Institute. Across 40 states examined for this study,...
Reported by PR Newswire 13 hours ago.
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Aetna and Barnabas hospitals reach deal to keep in-network insurance coverage intact
TRENTON — Major health insurance carrier, Aetna, and Barnabas Health, the largest hospital network in the state, have signed a new contract that will keep them working together and thousands of patients covered, according to a joint statement today. Thousands...
Reported by NJ.com 14 hours ago.
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Wonkblog: The Supreme Court is deciding a case that could derail Obamacare. Here’s what you need to know.
The fate of the Affordable Care Act, the president's signature domestic policy achievement, is once again in the hands of the Supreme Court this coming Wednesday. The justices will hear oral arguments in King v. Burwell, a legal challenge to the financial assistance that millions of Americans are receiving to purchase health insurance. The case is considered the greatest threat to Obamacare's future since the court considered a challenge to the law's individual mandate three years ago.
Reported by Washington Post 13 hours ago.
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If Supreme Court Says No, They'd Lose Health Insurance Help
If Supreme Court says no: Healthy or sick, insured say they'd miss health law subsidies
Reported by ABCNews.com 12 hours ago.
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If Supreme Court says no, they'd lose health insurance help
CHICAGO (AP) - Millions of Americans have a big personal stake in next Wednesday's Supreme Court challenge to the nation's health care law: Can they legally continue to get subsidies to help pay for their insurance? If the court says no, people across more than 30 states could lose federal subsidies for their premiums.
Reported by philly.com 11 hours ago.
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SpendWell Launches New Online Health Care Marketplace to Large Employer Group
SpendWell’s unique online marketplace is now open to Cambia Health Solutions employees and dependents.
Portland, Ore. (PRWEB) February 26, 2015
SpendWell Health, an online marketplace for health care services, celebrated its launch to its first customer today, opening its doors to Cambia Health Solutions employees and their covered dependents.
SpendWell delivers the next generation of online shopping for health care services, combining real-time price transparency with e-commerce. SpendWell’s unique platform shows actual prices for a variety of routine health care services and allows shoppers to buy those services directly from providers. Integration with the shopper’s insurance plan makes health care as simple as shop, compare and buy.
Through the SpendWell marketplace, employees can search and select providers and services based on cost, quality, location and more. By displaying pricing upfront, SpendWell empowers employees to make more informed decisions and gain greater control over how their health care dollars are spent. A range of services are available for purchase, including primary and urgent care, telehealth visits, lab tests, imaging, complementary and alternative medicine, behavioral health and more.
Cambia employees are the first in the nation to gain access to SpendWell’s platform—giving them the opportunity to shop the marketplace for routine care before anyone else. Their participation also will provide valuable insight to help SpendWell create the best possible experience for other health care consumers. SpendWell is a wholly owned subsidiary of Cambia Health Solutions.
“As a forward-thinking company, Cambia is dedicated to transforming health care—making it more accessible and affordable for all,” said Dudley Slater, President of Cambia’s Direct Health Solutions. “Our family of companies is constantly developing new tools and services to help support this cause. SpendWell is a perfect demonstration of our innovative approach, and we’re excited that our employees will have the opportunity to help redefine how consumers engage with health care services.”
As high-deductible health plan adoption continues to grow, consumers bear more responsibility for their health care costs. SpendWell is designed to give consumers a way to shop for routine health care services at competitive prices. In addition, it gives employers a tool to help their employees better manage their health care spending, while still receiving quality care.
“In today’s health economy, both employees and employers are looking for ways to better manage their health care costs,” notes Marcee Chmait, President of SpendWell. “Our marketplace helps demystify the costs of health care, so employees can make more informed decisions and employers can minimize their cost-sharing burden. By combining price transparency with an easy-to-use e-commerce platform, we’re providing a smart solution that aligns with consumer expectations.”
SpendWell also offers a unique opportunity to providers, helping them attract new patients while minimizing their financial risk. Since providers in the SpendWell marketplace are paid upfront for their services, they don’t have to worry about submitting claims or chasing down patient bills. Plus, they’ll gain access to new customers, allowing them to boost revenue and expand their practice.
With clear value propositions for employees, employers and providers, SpendWell delivers an innovative solution to common health care challenges—encouraging transparency, improving accessibility and increasing affordability. While SpendWell is currently only available to Cambia Health Solutions employees and their dependents, it soon will be offered to employer groups nationwide. For more information about SpendWell, visit SpendWellHealth.com.
About Cambia Health Solutions
Cambia Health Solutions, headquartered in Portland, Oregon, is a health solutions company dedicated to transforming health care by creating a person-focused and economically sustainable system. Cambia’s growing family of companies include software and mobile applications, health care marketplaces, non-traditional health care delivery models, health insurance, life insurance, pharmacy benefit management, wellness and overall consumer engagement. Through bold thinking and innovative technology, Cambia is delivering solutions that make quality health care more available, affordable and personally relevant for everyone. To learn more, visit CambiaHealth.com or twitter.com/cambia.
About SpendWell
SpendWell is an online marketplace where employees with high-deductible health plans can shop and buy health care services directly from providers. With clear pricing on everything from routine wellness exams and preventive care to screenings and urgent care, employees will be able to maximize the health care dollars they have to spend. And caring for direct-pay patients will give providers more time to focus on people, not paperwork. SpendWell is a wholly owned subsidiary of Cambia Health Solutions, Inc. Learn more at CambiaHealth.com. For more information about SpendWell, visit SpendWellHealth.com. Reported by PRWeb 10 hours ago.
Portland, Ore. (PRWEB) February 26, 2015
SpendWell Health, an online marketplace for health care services, celebrated its launch to its first customer today, opening its doors to Cambia Health Solutions employees and their covered dependents.
SpendWell delivers the next generation of online shopping for health care services, combining real-time price transparency with e-commerce. SpendWell’s unique platform shows actual prices for a variety of routine health care services and allows shoppers to buy those services directly from providers. Integration with the shopper’s insurance plan makes health care as simple as shop, compare and buy.
Through the SpendWell marketplace, employees can search and select providers and services based on cost, quality, location and more. By displaying pricing upfront, SpendWell empowers employees to make more informed decisions and gain greater control over how their health care dollars are spent. A range of services are available for purchase, including primary and urgent care, telehealth visits, lab tests, imaging, complementary and alternative medicine, behavioral health and more.
Cambia employees are the first in the nation to gain access to SpendWell’s platform—giving them the opportunity to shop the marketplace for routine care before anyone else. Their participation also will provide valuable insight to help SpendWell create the best possible experience for other health care consumers. SpendWell is a wholly owned subsidiary of Cambia Health Solutions.
“As a forward-thinking company, Cambia is dedicated to transforming health care—making it more accessible and affordable for all,” said Dudley Slater, President of Cambia’s Direct Health Solutions. “Our family of companies is constantly developing new tools and services to help support this cause. SpendWell is a perfect demonstration of our innovative approach, and we’re excited that our employees will have the opportunity to help redefine how consumers engage with health care services.”
As high-deductible health plan adoption continues to grow, consumers bear more responsibility for their health care costs. SpendWell is designed to give consumers a way to shop for routine health care services at competitive prices. In addition, it gives employers a tool to help their employees better manage their health care spending, while still receiving quality care.
“In today’s health economy, both employees and employers are looking for ways to better manage their health care costs,” notes Marcee Chmait, President of SpendWell. “Our marketplace helps demystify the costs of health care, so employees can make more informed decisions and employers can minimize their cost-sharing burden. By combining price transparency with an easy-to-use e-commerce platform, we’re providing a smart solution that aligns with consumer expectations.”
SpendWell also offers a unique opportunity to providers, helping them attract new patients while minimizing their financial risk. Since providers in the SpendWell marketplace are paid upfront for their services, they don’t have to worry about submitting claims or chasing down patient bills. Plus, they’ll gain access to new customers, allowing them to boost revenue and expand their practice.
With clear value propositions for employees, employers and providers, SpendWell delivers an innovative solution to common health care challenges—encouraging transparency, improving accessibility and increasing affordability. While SpendWell is currently only available to Cambia Health Solutions employees and their dependents, it soon will be offered to employer groups nationwide. For more information about SpendWell, visit SpendWellHealth.com.
About Cambia Health Solutions
Cambia Health Solutions, headquartered in Portland, Oregon, is a health solutions company dedicated to transforming health care by creating a person-focused and economically sustainable system. Cambia’s growing family of companies include software and mobile applications, health care marketplaces, non-traditional health care delivery models, health insurance, life insurance, pharmacy benefit management, wellness and overall consumer engagement. Through bold thinking and innovative technology, Cambia is delivering solutions that make quality health care more available, affordable and personally relevant for everyone. To learn more, visit CambiaHealth.com or twitter.com/cambia.
About SpendWell
SpendWell is an online marketplace where employees with high-deductible health plans can shop and buy health care services directly from providers. With clear pricing on everything from routine wellness exams and preventive care to screenings and urgent care, employees will be able to maximize the health care dollars they have to spend. And caring for direct-pay patients will give providers more time to focus on people, not paperwork. SpendWell is a wholly owned subsidiary of Cambia Health Solutions, Inc. Learn more at CambiaHealth.com. For more information about SpendWell, visit SpendWellHealth.com. Reported by PRWeb 10 hours ago.
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Obamacare Opponents Should Pick One Weird Conspiracy Theory And Stick To It
As you may have heard, congressional Republicans have embarked once again on their six-year mission to eventually one day get around to coming up with their own plan to replace the Affordable Care Act. At the same time, they're also keeping a hopeful eye on the Supreme Court, where a looming court case, King v. Burwell, could threaten the existence of critical health insurance subsidies.
But what if the Obama administration has a secret plan to thwart these efforts? A pair of Republican legislators have recently suggested that a conspiracy is afoot. Or rather, two conspiracies are both afoot, simultaneously, each of which seems to contradict the other. Maybe just pick one, guys?
Over at The Hill, Sarah Ferris reports on how a House subcommittee chairman is hot on the trail of a secret Department of Health and Human Services plan to rescue the law in the event that the Supreme Court rules for the plaintiffs in King v. Burwell:
Rep. Joe Pitts (R-Pa.), chairman of the House Energy and Commerce Health Subcommittee, says federal officials are hiding a roughly 100-page document on the looming court case. The case, King v. Burwell, could cut off ObamaCare subsidies in three-quarters of states and potentially collapse the national marketplace.
Pitts confronted the head of the Department of Health and Human Services (HHS) about the plan, which he says is being circulated among senior officials, for the first time on Wednesday.
"HHS secretary Sylvia Mathews Burwell said she does not know of a planning document," Ferris reported. But perhaps there is an explanation! According to HuffPost's Sam Stein, Sen. John Barrasso (R-Wyo.) was discussing the Affordable Care Act at the Conservative Political Action Committee on Thursday when he pointed to an even more nefarious scheme:
Sen. Barrasso: Ocare was "designed to fail so that they could get to the single payer system that the president has supported all along."
— Sam Stein (@samsteinhp) February 26, 2015
So what are the people at the Department of Health and Human Services playing at here? Do they have a secret plan to save the Affordable Care Act, or are they rubbing their palms together, hoping that the Supreme Court kills the law so they can spring their single-payer trap?
Can this contradiction be squared? Perhaps. Maybe this was Obama's plan, all along:
1. Pass a law called the Affordable Care Act, after a long, grueling, and political-capital absorbing legislative battle.
2. Bury some ambiguous language in one section of the bill governing the subsidies to state exchanges set up by the federal government.
3. Sit back and wait for the law's opponents to find that instance of ambiguous language and bring a lawsuit alleging that members of Congress always intended the law to do something they never actually intended it to do.
4. Hope that the Supreme Court will ignore multiple past instances in which they've had to make similar interpretative calls and rule in favor of the opposition, effectively gutting the subsidies and stripping beneficiaries of the means to "afford" this "care act."
5. Then there is this whole middle part I haven't quite figured out yet. Maybe it's what's in the secret 100-page HHS document.
6. EVERYONE GETS SINGLE-PAYER, SOMEHOW!
It's the perfect plan. The conspiracy goes all the way to the bottom and then back to the top of the slide where it stops and turns and goes for a ride till it gets to the bottom and it does it again.
Would you like to follow me on Twitter? Because why not? Reported by Huffington Post 10 hours ago.
But what if the Obama administration has a secret plan to thwart these efforts? A pair of Republican legislators have recently suggested that a conspiracy is afoot. Or rather, two conspiracies are both afoot, simultaneously, each of which seems to contradict the other. Maybe just pick one, guys?
Over at The Hill, Sarah Ferris reports on how a House subcommittee chairman is hot on the trail of a secret Department of Health and Human Services plan to rescue the law in the event that the Supreme Court rules for the plaintiffs in King v. Burwell:
Rep. Joe Pitts (R-Pa.), chairman of the House Energy and Commerce Health Subcommittee, says federal officials are hiding a roughly 100-page document on the looming court case. The case, King v. Burwell, could cut off ObamaCare subsidies in three-quarters of states and potentially collapse the national marketplace.
Pitts confronted the head of the Department of Health and Human Services (HHS) about the plan, which he says is being circulated among senior officials, for the first time on Wednesday.
"HHS secretary Sylvia Mathews Burwell said she does not know of a planning document," Ferris reported. But perhaps there is an explanation! According to HuffPost's Sam Stein, Sen. John Barrasso (R-Wyo.) was discussing the Affordable Care Act at the Conservative Political Action Committee on Thursday when he pointed to an even more nefarious scheme:
Sen. Barrasso: Ocare was "designed to fail so that they could get to the single payer system that the president has supported all along."
— Sam Stein (@samsteinhp) February 26, 2015
So what are the people at the Department of Health and Human Services playing at here? Do they have a secret plan to save the Affordable Care Act, or are they rubbing their palms together, hoping that the Supreme Court kills the law so they can spring their single-payer trap?
Can this contradiction be squared? Perhaps. Maybe this was Obama's plan, all along:
1. Pass a law called the Affordable Care Act, after a long, grueling, and political-capital absorbing legislative battle.
2. Bury some ambiguous language in one section of the bill governing the subsidies to state exchanges set up by the federal government.
3. Sit back and wait for the law's opponents to find that instance of ambiguous language and bring a lawsuit alleging that members of Congress always intended the law to do something they never actually intended it to do.
4. Hope that the Supreme Court will ignore multiple past instances in which they've had to make similar interpretative calls and rule in favor of the opposition, effectively gutting the subsidies and stripping beneficiaries of the means to "afford" this "care act."
5. Then there is this whole middle part I haven't quite figured out yet. Maybe it's what's in the secret 100-page HHS document.
6. EVERYONE GETS SINGLE-PAYER, SOMEHOW!
It's the perfect plan. The conspiracy goes all the way to the bottom and then back to the top of the slide where it stops and turns and goes for a ride till it gets to the bottom and it does it again.
Would you like to follow me on Twitter? Because why not? Reported by Huffington Post 10 hours ago.
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Robin Williams' Daughter Honors His Legacy By Vowing To Continue His Charity Work
Robin Williams' daughter, Zelda, is committed to honoring the late actor's life in a beautiful way.On Thursday, the "Today" show aired an interview with Zelda Williams, in which she talked about her father's death and legacy. While the 25-year-old touched on a variety of details in her dad's life, she emphasized his love for giving back.
"He’s done charity as long as he had the wherewithal and the ability to do it," she told "Today.""That was what his favorite thing, other than comedy, really was."
An enormous thank you to @tvkatesnow and the @todayshow, for allowing me the opportunity to raise awareness and help support one of Dad's favorite charities, the @cafoundation. Also, thank you to the Noble Awards, for letting me honor Dad's CAF triathlon teammates, Ironman Scott Tinley and Paralympian Rudy Garcia, and presenting them with a 50k donation to be allotted towards the endowment CAF is creating in my father's memory. The Challenged Athletes Foundation is a non-profit that provides education, community support and the sports adaptive prosthetics/specialty wheel chairs not often provided by health insurance that allow those in need the ability to regain the sort of mobility most believe they'd never have again. Whether they're veterans, children or adults, CAF does whatever they can to help them once more lead full, active lives. Dad did the 44 mile bike leg of the CAF triathlon with Rudy and Scott from 1998 until his health no longer allowed him to do so in 2009, and it meant the world to him. While I'm in no way capable (at least not yet ) of biking 44 miles, I will do everything else in my (decidedly less athletic) power to continue Dad's legacy and support the charities he loved that I've watched first hand change thousands of lives. Thanks everybody ❤ (btw, if you TL;DR this, you're a lazy bum! Ha ) fabulous hair and makeup by the lovebugs at @901too, and beautiful dress (and might I add, the comfiest ever) by @Prada
A photo posted by Zelda Williams (@zeldawilliams) on Feb 25, 2015 at 10:45pm PST
According to her Instagram page, the 25-year-old will present a $50,000 donation to her father's former triathlon teammates, Ironman Scott Tinley and Paralympian Rudy Garcia-Tolson, from the Challenged Athletes Foundation (CAF), a group with which Robin Williams frequently worked, that supports athletes with physical disabilities. The donation, which will be presented at Friday's Noble Awards honoring humanitarians, will go toward a fund created by CAF in the late actor's memory.
Zelda Williams also expressed her commitment to carrying out the work her father was so passionate about.
"I will do everything else in my (decidedly less athletic) power to continue Dad's legacy and support the charities he loved that I've watched firsthand change thousands of lives," she wrote on Instagram.
To learn more about the Challenged Athlete Foundation, visit their website here.Like Us On Facebook
Follow Us On Twitter Reported by PopEater 9 hours ago.
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Dems stop bill seeking oversight of Colorado health exchange bonuses
The House Health, Insurance and Environment Committee Thursday killed a Senate bill that would have required legislative approval of any pay bonus given to employees of the state health insurance exchange.
Reported by Denver Post 8 hours ago.
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U.S. Healthcare And The Tragedy Of The Commons
Submitted by Charles Hugh-Smith of OfTwoMinds blog,When the system is set up to encourage maximizing self-interest, accountability for the whole is lost.
*The lessons drawn from the U.S. healthcare system's failures can be fruitfully applied to a variety of large-scale problems around the world.* Let's start with an insightful look at the fixes that have largely failed to rein in costs and improve actual care/patient health.
Dilemma over Deductibles: Healthcare costs crippling middle class:
"Physician Praveen Arla is witnessing a reversal of health care fortunes: Poor, long-uninsured patients are getting Medicaid through Obamacare and finally coming to his office for care. But middle-class workers are increasingly staying away.
"It's flip-flopped," says Arla, who helps his father run a family practice in Hillview, Ky. Patients with job-based plans, he says, will say: " 'My deductible is so high. I'm trying to come to the doctor as little as possible. … What is the minimum I can get done?' They're really worried about cost."
It's a deep and common concern across the USA, where employer plans cover 60% of working-age Americans, or about 150 million people. Coverage long considered the gold standard of health insurance now often requires workers to pay so much out-of-pocket that many feel they must skip doctor visits, put off medical procedures, avoid filling prescriptions and ration pills — much as the uninsured have done."
The average hourly wage is nearly identical to what it was 50 years ago in today's dollars: $19.18 in 1964 compared with $20.67 in 2014, according to U.S. Bureau of Labor data analyzed by the Pew Research Center. Meanwhile, U.S. health spending ballooned from 5% of gross domestic product in 1960 to 17% in 2013."While I have often discussed unintended consequences of centralized policies such as ObamaCare, my focus today is how *U.S. healthcare perversely reflects the Tragedy of the Commons*, the seminal paper by Garrett Hardin which described the failure of the market to value/price communally owned assets, i.e. "the commons."
*Here is a basic example of the dynamic: *Each individual farmer will graze his cattle/sheep on the communally owned pastures ("the commons") to boost his own profit, since the commons are "free". This exploitation of what the market has determined is "free" leads to overgrazing and the destruction of the commons--a huge loss to the entire community as well as to the farmers who were grazing their animals in the commons.
*When everyone sees the commons as "free for the taking," then the commons is soon destroyed for all.*
To the degree that Central State (federal) revenue is a form of public commons (since it is collected from taxpayers), the siphoning of that resource to serve individual gain leads to the loss of the commons, *as well as the loss of any notion of the "common good."*
This dynamic is reflected in the extraordinary expansion of healthcare's share of the national economy, from 5% to 18% (on its way to 20%). While healthcare for practioners is about patients, from the financial point of view, healthcare is focused on increasing revenues and profits by whatever means are necessary.
Financially, the commons (tax revenues) are being stripped by those with the most political power.
*Though we don't normally think of the health of a nation's citizens as a commons, I think this makes a lot of sense.* After all, the healthier a population is, the more productive and happy it will be, and that serves the interests of the nation and its citizenry.
From this perspective, we have to ask if the enormous expense of healthcare is improving the health and happiness of the populace as much as it could, were it spent more effectively. I think it is fair to say *that the overall health of the U.S. populace is actually declining, despite modest advances in longevity and survival rates.*
This does not reflect any lack of effort from the often-overworked providers--rather, *it seems to reflect a deterioration of the populace's own habits and lifestyles, and the lack of focus and accountability of the entire system.*
We can trace this failure to the Tragedy of the Commons: when every participant is driven to seek maximum gain from exploiting the commons for their own interests, *no one is accountable for protecting the commons as a whole.*
When we ask, who is responsible for improving the overall health and well-being of the citizens, we get an answer that boils down to: *everyone and no one.*
*When the system is set up to encourage maximizing self-interest, accountability for the whole is lost*. And once accountability for the effectiveness and health of the whole system is lost, the system will degrade and eventually collapse, for the same reason that unrestricted grazing by individuals eventually destroys the commons.
Put another way: if I concern myself with the health of the commons (or the overall health of the populace), I earn nothing for this work. Even worse, while I devoted myself to the common good, someone else increased his herd grazing the commons. *I will eventually be forced to either join in the exploitation or go broke.*
That's the Tragedy of the Commons dynamic, and I think it applies to many systems around the globe.
For more on this topic: The Slide to Collapse Is Greased with Self-Interest (August 4, 2014) Reported by Zero Hedge 6 hours ago.
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