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AHA: Stop Centene WellCare

“The American Hospital Association urged the Trump administration on Wednesday to halt Centene’s $17.3 billion acquisition of WellCare Health Plans, claiming it will reduce competition in Medicaid managed-care and Medicare Advantage services.

“Centene and WellCare are both major players in government-sponsored health plans, with both having a presence in Medicaid and on the Affordable Care Act’s exchanges. All told the two insurers would cover nearly 22 million people in Medicare, Medicaid and the exchanges.

“The insurers’ markets overlap in several states, the AHA said in its letter, and they control over half of the Medicaid market in Florida, Georgia and Illinois.”
Source: Modern Healthcare.

Workplace Injuries Cost

“Workplace injuries cost US companies more than $1 billion per week, according to new data from Liberty Mutual.

“According to Liberty Mutual, the 10 costliest causes of workplace injury and illness are:

  1. Overexertion involving outside sources ($13.11 billion)
  2. Falls on same level ($10.38 billion)
  3. Struck by object or equipment ($5.22 billion)
  4. Falls to lower level ($98 billion)
  5. Other exertions or bodily reactions ($3.69 billion)
  6. Roadway incidents involving a motorized vehicle ($2.7 billion)
  7. Slip or trip without falling ($2.18 billion)
  8. Caught in or compressed by equipment or objects ($1.93 billion)
  9. Repetitive motions involving microtasks ($1.59 billion)
  10. Struck against object or equipment ($1.15 billion)

Source: Ryan Smith, “Insurance Business America”

Doing More Harm Than Good

Several healthcare groups, including the American Hospital Association and Blue Cross and Blue Shield plans, have joined coalitions that oppose “Medicare for All” plans, according to The New York Times.

Three things to know:

1. While 2020 presidential hopefuls incorporate Medicare for All into their platforms, hospitals, physicians, drugmakers and insurers are lobbying against the idea and proposed legislation.

2. In June 2018, the Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America created a coalition to combat Medicare for All proposals. The lobbying group, the Partnership for America’s Health Care Fund, also includes the American Medical Association, the AHA and Blues plans, according to the NYT.

3. The AHA’s president and CEO, Rick Pollack, recently cautioned against Medicare for All proposals in a Feb. 22 blog post, writing that such legislation “could do more harm than good to patient care.”

Source: Morgan Haefner, Becker’s Hospital Review.

Drug Coverage Proposal

Improvements in the cost of medications for Medicare-eligible customers may not be too far off. The Centers for Medicare and Medicaid (CMS) has proposed some new ways to lower drug costs for those in the Medicare program, and with drug coverage through a stand-alone prescription drug plan or with a Medicare Advantage plan that includes drug coverage.

One provision in the proposal targets e-prescribing and would require the person’s plan “to adopt a provider Real Time Benefit Tool by the start of 2020.

“‘RTBTs have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit, which can improve medication adherence, lower prescription drug costs, and minimize beneficiary out-of-pocket costs,’ CMS stated.

Another provision of the CMS proposal is that drug coverage Explanations Of Benefits (EOBs) that people receive from their plans will be tasked with including drug pricing information and lower cost therapeutic alternatives as part of these EOBs to give customers the information in hand that can also potentially help them lower their out-of-pocket costs for their particular medications.

This is not a comprehensive list of the provisions of the CMS proposal which could become a set of new rules in the near future. However, we do want to get info about these two particular provisions out there, so everyone can have confidence in any changes to come and know there will be tangible things for American households coming that can help lower their drug costs.

Source: Kyle Murphy, “HealthPayer Intelligence.”

CMS Encourages Innovation!

On Monday April 9, 2018 the Centers for Medicare and Medicaid finalized the rule that “eliminates (Affordable Care Act) standardized options starting in 2019 to encourage innovative plan designs among insurers.”

This is a good move for the coming years in the, non-Medicare, individual/family health insurance markets of America!  This change indicates that our current government recognizes that health insurance plans are not a one-size-fits-all financial product.  We have been saying this all along and CMS Director Verma has now been quoted saying as much- and we are thankful.

At this time it is unclear if ACA-compliant plans this fall, for the 2019 calendar year, will reflect this change in standardization requirements, and make health insurance plans more reflective of the coverage needs of the people in each state.  However, since the standardization requirements are eliminated in 2019- we do expect the individual/family plans, for the 2020 calendar year, to be more fitted to each state.

As everyone anticipates smart changes coming in the years ahead to the individual/family health insurance market we should be aware that according to Director Verma, the states are still subject to the ACA requirement that insurers offer 10 essential health benefits.  Although the standardization requirements are eliminated, this doesn’t mean states can allow ACA-compliant plans to exclude maternity care or mental health benefits.

We do expect to have more appropriate premiums and coverage choices for individuals and families in the coming years.  All in all, a good day.

Reference: Shelby Livingston and Susannah Luthi, Modern Healthcare.

Anthem ’18 ACA Only in 5 IN Counties

Anthem has confirmed that in Indiana, next year, it will only be offering Affordable Care Act individual/family plans in 5 counties.  The 5 Northwest Indiana Counties include:  Newton, Jasper, White, Benton, and Warren.

Current Anthem individual/family plan customers will be able to continue with their current coverage through December 31, 2017.  These plans will terminate effective January 1, 2018.

All Indiana residents with an individual/family plan that is terminating will receive notification via US Mail in early September.

Anthem Will Not Offer ACA Plans in Indiana in ’18

Just Anounced:  Anthem will not be offering Affordable Care Act plans on the federal exchange in Indiana in 2018.  At this time it appears that it will only be offering off-exchange (subsidy in-eligible) plans in 5 counties: Benton, Newton, White, Jasper and Warren.

Additionally, MD Wise has announced they will not be offering ACA plans in Indiana in 2018.  It will instead be focusing on its Medicaid business.

The loss of these insurers in 2018, in the ACA market, will affect about 76,800 Hoosiers.

Source: Indy Star.

Insurance Companies Have Deadline

“The federal deadline for insurers to file rate proposals with the federal government is June 21. Many insurers had been hoping that the Trump administration would say for certain whether it would continue to pay cost-sharing reduction (CSR) subsidies for covering low-income enrollees.

“No such assurances from the administration appear to be coming, leaving insurers with a difficult choice.

“Next week’s filings will give the most comprehensive look yet at what the ObamaCare markets could look like next year. It’s not clear whether the Trump administration will make the requests public, though sometimes individual states will release the information for their insurers.

“Still, early filings already show several insurers requesting double-digit rate increases. Some have already announced they won’t participate in the law’s marketplaces next year, leaving an unprecedented 47 counties with no options on the exchanges for 2018.

“‘We’ve seen so far pretty high premium increases in a number of states. Some of that seems to be because of uncertainty insurers are facing over CSR payments and individual mandate enforcement,’ said Cynthia Cox, an insurance expert with the Kaiser Family Foundation.”  Source: The Hill.

States Stand Up for People

In today’s news there is still talk of US House of Representatives continuing with the lawsuit against the government demanding an end to deductible and co-pay cost-sharing subsidies.   These subsidies help Americans pay for their Affordable Care Act (ACA) health plan deductibles, co- insurance,  and co-pays.

Up to 87% of people with an Affordable Care Act plan get help paying for their insurance premium and/or out-of-pocket costs.

Insurers know there would be devastating effects to them and American households both, if the cost-sharing subsidies were to be stopped.  Many, if not most, households with an ACA plan would simply be forced to incur medical bills that they have no way to pay.  This would end up creating waves and waves of medical care by providers all across the country to go completely unpaid.

In light of this situation: “16 state attorneys general have asked a federal appeals court to let them intervene in a legal case to keep those payments flowing.

“On Thursday, attorneys general from both Republican- and Democratic-led states filed a motion to intervene in House v. Price, a case originally brought by House Republicans to block federal payment to insurers to fund the Affordable Care Act’s cost-sharing reductions for low-income exchange plan members.

“The U.S. Court of Appeals for the District of Columbia Circuit is scheduled to hear a status report in the case on May 22. Meanwhile, insurers around the country, citing uncertainty about the cost-sharing reduction payments, have filed requests for 2018 premium hikes in the double digits. The CSR payments are estimated to total $7 billion this year.”

So the natural question is: What happens to the healthcare industry in America if nearly $7 billion dollars goes missing to pay for medical care?

If we are going to be forced to live under the law called the  Patient Protection and Affordable Care Act, those in Congress need to develop understanding about the current situation that American households are in, and they need to free insurance companies to manage premiums, claims, and their own business.

Source:  Modern Healthcare.