Cost of Family Health Insurance Now Nearly $20,000 a Year

https://www.thefiscaltimes.com/2018/10/03/Cost-Family-Health-Insurance-Now-Nearly-20000-Year

 

Annual premiums for employer-provided health insurance hit an average of $19,616 for a family this year, a rise of 5 percent over 2017, according to a new survey by the Kaiser Family Foundation. Employees paid an average of $5,547 for their coverage, with employers covering the rest.

The average premium for family coverage has risen 55 percent since 2008 — about twice as fast as wages, which are up 26 percent, and three times as fast as inflation, up 17 percent over a decade.

Faced with relentlessly rising health care costs, many companies have required employees to pay for more of their care before insurance kicks in, and the Kaiser survey found that deductibles are rising even faster than premiums. Among workers who have a deductible — about 85 percent of insured workers — the average deductible amount has risen to $1,573, a 212 percent increase since 2008. Deductibles have risen eight times faster than wages over the last 10 years, the survey said (see the chart below).

Kaiser President and CEO Drew Altman said that he expects health care costs to be an important political issue for the foreseeable future. “As long as out-of-pocket costs for deductibles, drugs, surprise bills and more continue to outpace wage growth, people will be frustrated by their medical bills and see health costs as huge pocketbook and political issues,” Altman said.

Read a summary of the Kaiser Family Foundation’s 2018 Employer Health Benefits Survey here, and the .

 

4 Key Fact Checks on Trump and Medicare for All

https://www.thefiscaltimes.com/2018/10/10/4-Key-Fact-Checks-Trump-and-Medicare-All

President Trump published an op-ed in Wednesday’s USA Today, warning in dire language of the consequences of Democrats’ Medicare-for-all proposals. “Democrats would gut Medicare with their planned government takeover of American health care,” Trump says.

The problem: Nearly every line of Trump’s piece “contained a misleading statement or a falsehood,” writes Washington Post fact-checker Glenn Kessler.

We’ll provide a few examples below, but for a more complete analysis of Trump’s problematic, misleading or outright false claims, read Kessler’s piece or this Associated Press fact-check of claims the president has made in recent speeches at campaign rallies.

Why it matters: Trump’s op-ed and other recent criticisms of Democratic health-care proposals echo other GOP attacks claiming that Medicare for all would destroy traditional Medicare. Combined, they read less like a serious policy critique and more like cynical scare tactics — a ploy to muddy the waters around an idea that’s growing in popularity but still poorly defined in voters’ minds.

“There definitely are serious questions about ‘Medicare for All,’ including the massive tax increases that would be needed to pay for it and longstanding differences in society about the proper function of government,” the AP piece notes. Trump’s attacks skirt those serious questions, and differences of opinions among Democrats on Medicare for all, in favor of false or misleading campaign-style attacks.

Will it work? It very well might, at least in the short run. But at the Washington Examiner, Philip Klein critiques Trump’s line of attack from the right, arguing that it will backfire on conservatives in the long run and actually make socialized healthcare more likely. … By perpetuating the idea that Medicare is a great program that needs to be protected at all costs (rather than an unsustainable entitlement) it only makes it easier for liberals to make the case for socialized medicine. It also makes it harder to make the case for overhauling entitlement programs to avert the looming debt crisis.”

The four key fact checks:

* “Dishonestly called ‘Medicare for All,’ the Democratic proposal would establish a government-run, single-payer health care system that eliminates all private and employer-based health care plans and would cost an astonishing $32.6 trillion during its first 10 years.”

The facts: There are numerous “Medicare for all” proposals. Some would eliminate private and employer-based plans in favor of a single federally run health insurance program, but others would introduce a public plan option alongside existing private coverage choices. A new Kaiser Family Foundation report provides a useful overview of eight different legislative proposals introduced in the current session of Congress.

Trump is right that studies, like the one he links to by the libertarian Mercatus Center, have estimated that Bernie Sanders’ plan would add more than $30 trillion to federal health care costs. Proponents of a single-payer system argue that those price tags simply represent a shift in spending from the private to the public sector — a change, they say, that will wring costs out of the system overall while also providing for universal coverage.

* “As a candidate, I promised that we would protect coverage for patients with pre-existing conditions and create new health care insurance options that would lower premiums. I have kept that promise, and we are now seeing health insurance premiums coming down.”

The facts: Trump’s Justice Department argued in an ongoing Texas court case that Obamacare’s protections for patients with pre-existing conditions should be invalidated, and his administration has pushed insurance options that could weaken such protections. Trump’s claim about premiums coming down applies only to benchmark Obamacare plans, and is based on recent comments by HHS Secretary Alex Azar. Experts say that Obamacare premiums are stabilizing in 2019, but would have fallen if not for Trump administration policies. Meanwhile, premiums for employer-provided insurance, by far the most common type in the U.S., are still rising.

* “I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats’ plan that would eviscerate Medicare.”

The facts: “Under Trump, the date for when the Medicare Hospital Insurance (Part A) Trust fund will be depleted keeps advancing,” Kessler notes. “If the trust fund is depleted, that means the government would not be able to cover 100 percent of estimated expenses. Yet because of Trump’s tax cut, the budget deficit is soaring even as the economy is booming, in contrast to previous periods of under-4-percent unemployment. That leaves the government less prepared to deal with the consequences of baby-boom retirements.”

* “The Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised.”

The facts: Not true. None of the plans would cut benefits for seniors, and the most frequently cited promises to be more generous. “The Sanders plan would be a fundamental change, expanding Medicare to cover almost everyone in the country,” the Associated Press notes. “But current Medicare recipients would get improved benefits. Sanders would eliminate Medicare deductibles, limit copays, and provide coverage for dental and vision care, as well as hearing aids. A House single-payer bill calls for covering long-term care.”

 

 

 

Coverage for pre-existing conditions lives on, even though the Affordable Care Act seemed doomed

Coverage for pre-existing conditions lives on, even though the Affordable Care Act seemed doomed

The most enduring legacy of the Affordable Care Act may be emerging now in midterm races across the country, and our health care system may never be the same.

For the first time in our history, Americans are agreeing that even if you are sick you should be able to find private health insurance coverage you can afford. Not only do 81 percent of voters now think it should be illegal for insurance companies to deny coverage to people with pre-existing conditions, but both political parties have embraced this central tenet of Obamacare.

Responding to Democratic attacks and polling data, Republicans are backpedaling from opposition to the Affordable Care Act’s guarantees that the more than 50 million Americans with pre-existing conditions should be able to find coverageWriting last month in the Wall Street Journal, Republican strategist Karl Rove urged candidates to embrace the pre-existing condition guarantee, but to find new conservative strategies for securing it.

This development is historic. Before the passage of the Affordable Care Act, Americans broadly embraced a national obligation to insure the elderly, the poor, and the disabled. We’ve now added the sick to this list. If the past is prelude, there will be no retreating from this commitment. Once acknowledged, commitments like Medicare and Medicaid are virtually impossible to claw back.

As policymakers look to respond to this newfound promise to the sick, they will be confronted with the harsh reality of private health insurance markets: The only way insurers can offer affordable coverage to the sick is if they have a substantial number of healthy enrollees.

Many of the ACA’s most controversial provisions are aimed at providing private insurers a steady supply of good risks. This includes the much-vilified individual mandate, as well as restrictions on the sale of skimpier, cheaper policies, such as short-term health plans, that appeal to healthy purchasers and siphon them away from the risk pools that cover less-healthy consumers. The ACA also provided temporary reinsurance that protected private plans against unpredictable, catastrophic losses likely to occur when they cover very sick clients. That provision, however, has expired.

The challenge facing policymakers going forward will be how to execute this new guarantee that the sick have access to private insurance. A wide variety of options spanning the political spectrum exist, but virtually all require some form of government involvement.

The left proposes that, if private companies don’t step up, the federal government should fill in by allowing consumers with pre-existing conditions (or even those without them) to buy into Medicare or Medicaid. As Medicare and Medicaid are among our nation’s most cost-effective insurers, this could be a way of expanding coverage while keeping costs in check.

Another alternative would be to build on the Affordable Care Act’s current provisions that require insurers to cover pre-existing conditions, prevent insurers from charging more for those conditions, and provide strong financial incentives for healthy individuals to purchase private marketplace plans. Despite the repeal of the individual mandate and other attempts to undermine the ACA, private insurance markets created by the ACA have shown considerable resilience, with premiums actually declining this year for the first time since the ACA was enacted.

Republicans have released legislation that would amend the Health Insurance Portability and Accountability Act to require insurance companies to sell plans to people with pre-existing conditions and not charge them more because they have been, or are, sick. Insurers, however, would be able to deny coverage for specific illnesses. In other words, insurers would have to sell coverage plans to people with pre-existing conditions, say diabetes, but would not have to cover their diabetes. Insurance companies could also increase premiums based on age, gender, or occupation.

Another Republican approach, discussed during the “repeal and replace” debate, would make available subsidized plans, such as the ACA, but increase premiums over time if individuals failed to purchase them at the outset. In theory, healthy individuals would jump into the pool to avoid paying a penalty at a later date. This is an approach used under Medicare Part B, a voluntary program that covers outpatient services, that has been fairly effective and politically acceptable.

Whether it would work outside of Medicare and avoid the need for more intrusive government intervention remains to be seen. The elderly are much more likely to feel that they need insurance and to respond to incentives to get it earlier rather than later, while younger, healthier people may be more reluctant to buy and then end up priced out of the insurance market.

These and other routes toward coverage for sick Americans will be fiercely debated in the coming years. As we do so, we shouldn’t lose track of the profound change in attitude and expectations around health insurance for the sick that will animate this debate.

Elected officials should expect to be held accountable this November, and for many Novembers to come.

 

 

 

How are hospitals complying with patient medical record requests? Not well, study finds

https://www.beckershospitalreview.com/legal-regulatory-issues/how-are-hospitals-complying-with-patient-medical-record-requests-not-well-study-finds.html

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Most hospitals were found to be noncompliant with federal and state regulations when completing patient medical records requests, according to a study published in JAMA Network Open.

Through a simulated patient experience, researchers analyzed 83 U.S. hospitals across 29 states that maintained independent medical records request processes and medical records departments reachable by telephone. The hospitals were among the top 20 hospitals for each of the 16 adult specialties in the 2016-17 U.S. News & World Report Best Hospitals National Rankings.

Under HIPAA, patients have a right to access their protected health information. Federal law requires medical record requests must be fulfilled within 30 days of receipt, in the format the patient requests and for a fair cost to the patient.

Information on records request authorization forms differed from that obtained from patient telephone calls in terms of requestable information, formats of release and costs, according to the researchers. Additionally, 8 percent of hospitals were noncompliant with state requirements for processing times.

On telephone calls, all 83 hospitals said they were able to release entire medical records to patients, but on the forms, fewer than 9 hospitals (11 percent) provided the option of selecting one of the categories of requestable information, such as laboratory test results, medical history and discharge summaries, and only 44 hospitals’ forms (53 percent) gave patients the option to acquire the entire medical record.

There were also differences between the formats hospitals said they could use to release information. On telephone calls, 83 percent of hospitals stated they would allow the patient to pick up their records in person, compared with 48 percent of forms listing this option. Forty-seven percent of hospitals indicated they could email patients their records when patients asked on the telephone calls, while only 33 percent of hospitals’ forms listed email as an option.

The researchers also identified 48 hospitals that charged well above the federal government’s recommendation of $6.50 for electronic records — charging as much as $541.50 for a 200-page record.

“Requesting medical records remains a complicated and burdensome process for patients despite policy efforts and regulation to make medical records more readily available to patients,” the study reads. “As legislation, including the recent 21st Century Cures Act, and government-wide initiatives like MyHealthEData continue to stipulate improvements in patient access to medical records, attention to the most obvious barriers should be paramount.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7 latest healthcare industry lawsuits, settlements

https://www.beckershospitalreview.com/legal-regulatory-issues/7-latest-healthcare-industry-lawsuits-settlements-100518.html?origin=cfoe&utm_source=cfoe

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From the U.S. Equal Employment Opportunity Commission suing a Tennessee health system over its flu shot policy to a Montana health system paying $24 million to settle a whistle-blower lawsuit, here are the latest healthcare industry lawsuits and settlements making headlines.

1. EEOC sues Saint Thomas Health over mandatory flu shot policy
The U.S. Equal Employment Opportunity Commission filed a lawsuit against Nashville, Tenn.-based Saint Thomas Health Sept. 28, alleging Murfreesboro, Tenn.-based Saint Thomas Rutherford Hospital violated federal law by ordering an employee to receive a flu shot despite his religious belief

2. Montana hospital pays $24M to settle ex-CFO’s whistle-blower suit
Kalispell (Mont.) Regional Healthcare System and six subsidiaries and related entities agreed to pay the federal government $24 million to resolve allegations they violated the False Claims Act, Stark Law and the Anti-Kickback Statute.

3. DaVita resolves false claims, whistle-blower allegations for $270M
HealthCare Partners Holdings, which does business as DaVita Medical Holdings, will pay $270 million to settle False Claims Act violations and a whistle-blower lawsuit.

4. AmerisourceBergen to pay $625M to settle civil fraud charges linked to repackaging scandal
Drug wholesaler AmerisourceBergen will pay $625 million to resolve allegations that the company improperly distributed tampered and repackaged drugs.

5. Kansas physician awarded $29M in wrongful termination suit
A jury awarded a Kansas emergency physician $29 million for his lawsuit claiming he was wrongfully terminated by the emergency room staffing company he worked for after voicing concerns about the organization’s business practic

6. Disability advocacy firm sues Arizona hospital over access to patients
The Arizona Center for Disability Law filed a lawsuit Sept. 12 against Phoenix-based Arizona State Hospital, claiming hospital officials violated federal law by refusing to provide the center with access to the facility, patients and their records.

7. Louisiana health system stuck in antitrust suit brought by ex-hospital operator, health plan
BRF, a hospital operator in Shreveport, La., and the regional Vantage Health Plan are surging forward with an antitrust lawsuit against Shreveport-based Willis-Knighton Health System, even though BRF left the hospital business Oct. 1.

 

12 recent hospital, health system outlook and credit rating actions

https://www.beckershospitalreview.com/finance/12-recent-hospital-health-system-outlook-and-credit-rating-actions-10-5-18.html?origin=cfoe&utm_source=cfoe

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The following hospital and health system credit rating and outlook changes or affirmations occurred in the last week, beginning with the most recent:

1. S&P assigns ‘AA+’ rating to OhioHealth‘s bonds
S&P Global Ratings assigned its “AA+” long-term rating to Columbus-based OhioHealth’s $125 million series 2018A and $50 million series 2018B. Concurrently, S&P assigned its “AA+/A-1+” dual rating to the health system’s $37.5 million series 2018C and $37.5 million series 2018D.

2. S&P assigns ‘AA-‘ long-term rating to Atrium Health‘s bonds
S&P Global Ratings assigned its “AA-” long-term rating to Charlotte, N.C.-based Atrium Health’s series 2018A-E bonds. Concurrently, S&P affirmed its “AA-” underlying rating on the health system’s existing bonds.

3. S&P revises Mercy Health Services‘ outlook to positive
S&P Global Ratings revised Baltimore-based Mercy Health Services outlook to positive from stable.

4. Fitch assigns ‘BBB+’ issuer rating to ProMedica
Fitch Ratings assigned its “BBB+” issuer default rating to Toledo, Ohio-based ProMedica. Concurrently, Fitch assigned its “BBB+” long term rating to ProMedica’s $300 million series 2018A bonds and $1.15 billion series 2018B taxable bonds.

5. Fitch upgrades St. Francis Healthcare System to ‘AA’
Fitch Ratings upgraded Cape Girardeau, Mo.-based St. Francis Healthcare System’s rating to “AA” from “AA-,” affecting $139.3 million of debt. Concurrently, Fitch assigned the health system its “AA” issuer default rating.

6. S&P downgrades South Georgia Medical Center‘s rating to ‘BBB+,’ assigns negative outlook
S&P Global Ratings downgraded its long-term rating on Valdosta, Ga.-based South Georgia Medical Center’s certificates to “BBB+” from “A-.”

7. Fitch assigns ‘A’ rating to Edward-Elmhurst Healthcare‘s bonds
Fitch Ratings assigned its “A” rating to Naperville, Ill.-based Edward-Elmhurst Healthcare’s series 2018 bonds, affecting about $249.74 million of debt. Concurrently, Fitch affirmed its “A” issuer default and revenue bond ratings.

8. S&P revises PeaceHealth‘s outlook to positive for improved operations
S&P Global Ratings affirmed its “A” long-term and underlying rating on Vancouver, Wash.-based PeaceHealth and assigned its “A” rating to the health system’s series 2018A bonds. Concurrently, the outlook was revised to positive from stable.

9. S&P revises SSM Healthcare‘s outlook to stable
S&P Global Ratings affirmed its “A+” long-term and underlying rating on St. Louis-based SSM Health. Concurrently, the outlook was revised to stable from negative.

10. S&P downgrades Crawford Memorial Hospital‘s rating to ‘BBB’
S&P Global Ratings downgraded Robinson, Ill.-based Crawford Memorial Hospital’s long-term and underlying rating to “BBB” from “A.”

11. S&P downgrades Lexington Medical Center to ‘A’ after error correction
S&P Global Ratings downgraded West Columbia, S.C.-based Lexington Medical Center’s series 2011, 2016 and 2017 revenue bonds to “A” from “A+.

12. S&P assigns ‘AA-‘ rating to Parkview Regional Medical Center
S&P Global Ratings assigned its “AA-” rating to Fort Wayne, Ind.-based Parkview Regional Medical Center’s series 2018 and 2019A bonds, affecting about $162 million of debt.

RWJBarnabas hospital exec placed on administrative leave after Facebook comment

https://www.beckershospitalreview.com/hospital-management-administration/rwjbarnabas-hospital-exec-placed-on-administrative-leave-after-facebook-comment.html?origin=cfoe&utm_source=cfoe

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Michellene Davis, an executive vice president and chief corporate affairs officer for West Orange, N.J.-based RWJBarnabas Health, was placed on administrative leave pending an investigation into a racially charged Facebook comment, according to the North Jersey Record.

Ms. Davis commented on a NorthJersey.com article that her friend shared on Facebook.
“Who is going to train them not to shoot black children first?!?” Ms. Davis commented.

The comment has since been deleted. It did not appear on a public post, but screenshots began circulating on social media.
A few days later Ms. Davis posted an apology on Facebook for what she called “an insensitive and offensive comment.”
She has reportedly deleted her Facebook page.

“My concern for the safety of schoolchildren and gun violence led me to react to a headline without thinking,” she wrote in the apology post, according to the North Jersey Record. “Having a late sister and other family in law enforcement I deeply respect the law enforcement community and appreciate their service and admire their sacrifice.”

RWJBarnabas Health is conducting an internal investigation into the incident.

Ellen Greene, a spokesperson for RWJBarnabas, told the North Jersey Record, “statements posted by RWJBarnabas Health official social media outlets are the only statements that represent the views and policies of the organization.”

Read the full article here.