http://www.healthcaredive.com/news/merge-ahead-healthcare-deals-adapting-as-industry-evolves/418868/
There’s little doubt healthcare consolidation will continue as demand increases and the population ages. However, it remains to be seen whether the potential cost savings trickles down to consumers.
http://www.healthcaredive.com/news/us-uninsured-rate-hits-all-time-low-in-2015/419381/
Of course, the uninsured rate only tells part of the story. Debate continues over whether coverage under the ACA has sufficiently equated to accessibility and affordability of care, and just how much premiums are likely to balloon in 2017.
The Affordable Care Act obligates the federal government to reimburse health plans for cutting their low-income customers a break on their out-of-pocket payments. Whether or not there’s an appropriation for the cost-sharing reductions, that statutory obligation is enforceable in court—specifically, in the Court of Federal Claims.
Health plans that get stiffed can therefore sue the federal government for the cost-sharing reductions. Winning those cases should be easy: the plans will just have to show that they’re owed money under the ACA. And here’s the kicker: Congress has permanently appropriated the money to pay court judgments, even if it hasn’t appropriated money for the cost-sharing reductions.
The right question isn’t whether health plans will get paid. It’s when.
Federal Trade Commission chairwoman Edith Ramirez is concerned that consolidation in health care is driving up prices for consumers.
Rosemary Myers and her husband came to the oncology clinic with no major treatment decisions to make. Her breast cancer had metastasized to her brain many months ago, but after the metastasis was removed surgically, it had not shown signs of recurrence in any follow-up tests. So today’s visit wasn’t going to involve talking about chemotherapy or radiation; it wasn’t going to center upon end-of-life decision-making. Myers (a pseudonym) was here to see if her doctor could improve her quality of life. Eventually, that quality-of-life discussion would focus on the cost of Myers’ care.
