Any momentum gained by President Obama when the issue of exorbitant insurance premium hikes was the healthcare topic du jour last month seems to be all but forgotten as Insurance continues to conduct business as usual. In Mass., the Blues in that state face fighting caps on their rates as its governor, Duval Patrick, reviews requests for increases of anywhere from 8 to 32 percent.
In California, the apparent epicenter of the firestorm over rate hikes, insurance companies seem loathe to change as well, citing the “increasing costs of healthcare” as a reason for those hikes. All of this movement by Insurance is forcing Obama to take his message to the public to get support for reform. He’ll begin his week by doing so today in Philadelphia.
Wise move? It’s perhaps his only move. With the GOP urging going back to the drawingboard, moderate Dems uneasy over the pricetag of reform ($1T), and House liberal Dems suspicious of Senate motives once the bill is passed; it appears that Obama is turning to the only group left to fully convince the utility of a healthcare overhaul — the American people. | LINK
Tuesday § February 23, 2010
Legislative grilling in California begins today for Anthem Blue Cross, the insurer whose efforts to increase some average premiums by almost 40% did not go unnoticed by the White House. Wellpoint, the payer’s parent company, will begin its time being questioned before a special state House committee tomorrow. Although the most likely effect of such questioning will be the negative national PR that has accompanied it, the excessive scrutiny of the company’s books will almost certainly provide the impetus for local reform in this area at the hands of state legislatures as it applies to other insurers — eventually leveling the playing field in the Insurance marketplace.
In other Anthem Blue Cross news, a California man’s breach-of-contract trial with the insurer has just begun.
Friday § February 19, 2010
Last Februrary, Medicare fraud once again took center stage; a Tampa, FL-based managed care outfit was outed by the federal government for intentionally hiding Medicare payments in a specially created private entity called Harmony Behavioral Health. 
Citing administrative costs as the reason for diversion, WellCare Health kept for itself state funds meant for mental health services and delivery. If there were any reason in the heat of Obama’s reform rhetoric in 2009 to rail against the government’s mishandling of its own Medicare reimbursement policies (as part of shoddily run MA plans) as being part and parcel of the overall increase in the cost of healthcare delivery — it was quite apparent with this case.
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In a move that many will be watching closely, no doubt, NY Governor Paterson announced that the state of New York, not the insurance companies themselves, should determine when to raise policyholders’ premiums. The charismatic and glib chief executive seems to be introducing many a progressive bill these days, as this one was preceded by a (slightly) more newsworthy one he has recently introduced — the bill greenlighting same-sex marriage in the state.
However, this motion by Paterson is significant for another reason. In the new environment of healthcare reform under the Obama administration, the roles and concerns of third party reimbursers are becoming reactionary — some say out of fear of the loss of competition in the face of increased government interference. This scenario was essentially foreign during the early days of the George W Bush administration. The spectre of mild Republican support on this issue only adds to those wary stances by insurance companies, for example. It will be interesting to see what state governments will do in response to this proposal by Paterson. Do they call his bluff or not? | LINK
As President Obama begins to road to securing the cooperation of major corporate players in his ambitious healthcare reform package, on the legislative side of things, the Senate is laying out its proposals for the president — namely the introduction of a government-run system (the infamous “option”) to compete with the private healthcare sector.
The bipartisanship on this legislation is unprecedented, as senate Republicans are gladly working with the Dems to ensure, at least on the surface, a kinder market-driven approach to the “skin-in-the-game” strategy that may be palatable to both sides. Says Republican Sen. Charles Grassley,
“Congress has an obligation to make insurance more available and more affordable and still give people the option to keep what they have if they like it,” Grassley, of Iowa, said in the joint statement.
LINK
A new trend in healthcare “financing” is resulting in physicians who choose to “opt out” of Medicare and Medicaid provider networks. The number one reason? Why, declining reimbursements, of course. While the promise of a fair and equitable system for patient access to care and — by extension — proper reimbursement for phsyicians giving that care have been promised by the Obama administration, many physicians are simply getting tired of waiting for that Change promised by the president on the campaign trail. The problem is compounded by patients who must scramble to find participating providers. Specialists are not immune because primary care referrals in many Medicare Advantage plans and Medicaid managed care offerings rely on those providers who stick with the government as a payer. The proverbial vicious cycle of shrunken provider access and increased patient demand contracts the healthcare economy further. | LINK
To take the current mix of financing healthcare in this country into a form which pleases everyone is essentially impossible. Those who decry government run healthcare fear lower quality and rationed care, just as those on the ideological left loath the the corporatization of healthcare delivery. It is an inescapable fact that the concept of the “divided nation” scenario also applies to fragments of the overall political debate, namely healthcare. The financing of healthcare in this country is not immune to such divergent schools of thought. The Obama administration (along with practically everyone else in the country) knows the only way to begin to even think about reforming this broken system is to reach a magical place similar to the political “middle” — that perfect mix of government involvement and private negotiation that pleases everybody. Still impossible? Perhaps not as much, according to this WaPo OpEd.
Barack Obama is firing on all cylinders this March (the mid-term of his First 100 Days) by mulling over his latest plan for changes in the fractured healthcare system: how to properly deal with Medicare Advantage plans. He proposes making cuts in the programs (popular with Republicans) which allow seniors to search the market for private third-party Medicare managed care coverage. Overall, MA plans are beneficial; they allow participants to esentially cover all gapped expenses in acute and ambulatory care (and, in some plans — drug coverage) all for a single monthly premium. Of course, not all healthcare organizations accept payments from all private insurers, or at similar rates. For many organizations and CMS, the thought of dealing with more and more MA plans is an increasingly expensive administrative nightmare. Therein lies the rub. Obama shouldn’t be worried, however, as well informed decisions in this area will go a long way in proving his leadership — at least as far as his commitment to healthcare cost savings is concerned. | LINK
Sunday § February 22, 2009
A 19-year old who uses vigorous exercise to sweat off a viral illness. A 23-year old asthmatic who uses his inhalers only during a severe attack finds himself back in the ED when he runs out in the middle of one. A 28-year old who racked up almost $20 000 in hospital charges for a two-day stay for the treatment of a common gastrointestinal ailment. A 27-year old journalism student and type I diabetic who has taken the desperate step of using needle syringes to inject insulin at the risk of severe complications after running out of stockpiled ($900/month) tubing needed to maintain his continuous insulin-infusing pump. Are the health behaviors of these patients irresponsible, reckless, and shortsighted — or are they merely necessary?
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Monday § February 16, 2009
During tough economic times, the vicissitudes of human nature essentially dictate that something good has to come out of all this negativity everyone is experiencing in this severe economic downturn. So, it comes as no surprise that a recent poll found that the majority of Americans think the future is, indeed, brighter. It just has to be. With respect to healthcare, attidues toward the concept of access as more of a right than a privileged commodity are in the majority. Most Americans surveyed thought that nationalization of healthcare is the way of the future, a complete reversal of 30 years ago, when less than a third of all citizens thought such a plan is best equipped for emergencies on a national scale. Will this info be enough to shake Obama out of his current stoicism on healthcare policy? Perhaps he’s just waiting for the right HHS Secretary for that notion. | PDF LINK
Sunday § February 1, 2009
Until as recently as last month, the prevailing wisdom — at least among leading healthcare policy watchers — was that the healthcare industry, as an economic sector, was immune from the short term effects of a recession. As long as there are people getting sick, they’ll always come to the doctor, right? With all of the recent reports detailing job losses week after week, it was only a matter of time before the ripple effect would be felt by healthcare organizations and their providers. Job lay-offs and losses mean lost benefits, which means a loss of margin for healthcare orgs. Consider the financial squeeze felt by the insurance companies (the providers of reimbursements to healthcare) and cuts to government payers (Medicare and Medicaid) as states get the pinch; one doesn’t have to think that lay-offs occuring among healthcare line and support personnel will not occur in short order. In fact, they already have — starting with the least senior staff in many healthcare organizations. Hit especially hard are markets in which managed care is king — like the Twin Cities region in Minnesota. | LINK
Wednesday § January 28, 2009
To go along with all of the planning in deciding just how to cover a balooning Boomer population, healthcare policy wonks and legislators now have to consider the future costs of cancer drugs into the mix.
Medicare has quietly expanded its coverage for cancer drugs to include some treatments that haven’t gotten the Food and Drug Administration’s full seal of approval.
The change was announced last summer with little fanfare and took effect in the fall. It means that doctors and patients seeking Medicare reimbursement for certain novel treatments won’t have to negotiate with the billing department for payment. But it’s also certain to increase Medicare spending, since cancer medications often cost thousands of dollars a month.
Cancer and other high-profile illnesses of aging constantly receive press similar to this item. Isn’t it time for legislators and third parties to sit down and discuss coverage of aging HIV+ patients? Although sheer numbers may argue otherwise, one cannot deny the unforseen consequences patients in the latter population will have on the financing of chronic care. | LINK
