CBO: Hospitals’ future finances depend on increasing productivity

http://www.healthcaredive.com/news/cbo-hospitals-future-finances-depend-on-increasing-productivity/426036/

  • A new analysis from the Congressional Budget Office (CBO) has recognized that changes in laws and regulations, prompted primarily by the ACA–notablyreduced Medicare payment updates and expanded insurance coverage–can be expected to significantly impact hospitals’ future finances.
  • To help provide a sense of the impacts, the CBO’s working paper predicted hospitals’ profit margins, and the share of hospitals that could lose money in 2025 under several different scenarios.
  • The researchers noted that they provided a wide range of estimates due to “substantial uncertainty” around the predictions and how hospitals will respond to the pressures of the federal healthcare law.

Aetna faces probe over ‘politically motivated’ Obamacare exit

http://www.healthcaredive.com/news/aetna-faces-probe-over-politically-motivated-obamacare-exit/426035/

  • A group of senators is seeking answers from Aetna about its abrupt decision to leave the ACA marketplaces following the DOJ’s challenge to the company’s proposed $37 billion merger with Humana.
  • The letter came Thursday from Senators Elizabeth Warren (D-Mass.), Bernie Sanders (I-Vt.), Edward J. Markey (D-Mass.), Sherrod Brown (D-Ohio), and Bill Nelson (D-Fla.).
  • While other insurers have also scaled back their ACA participation, the probe into Aetna comes in response to a letter from Aetna CEO Mark Bertolini in which the company is perceived to have directly threatened the government that it would leave the exchanges if the merger was not approved.

Aetna’s Bertolini counters accusation of power play against DOJ

http://www.healthcaredive.com/news/aetnas-bertolini-counters-accusation-of-power-play-against-doj/426236/

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http://www.courant.com/news/connecticut/hc-bertolini-senators-20160912-story.html

  • Aetna CEO Mark Bertolini has responded to a letter from a group of senators who accused the company last week of exiting the majority of its ACA markets as a ploy against the federal government for challenging Aetna’s proposed merger with Humana.
  • Bertolini dismissed the senators’ arguments as”unfounded accusations,” the Hartford Courant reported.
  • Aetna spokesman T.J. Crawford told the Courant the company had not received a response from the senators.

California Moves to Allow Undocumented Immigrants to Buy Insurance

In a move that is sure to draw the ire of Republicans, California officials are asking the Obama administration this week to approve a plan that would allow undocumented immigrants to buy health insurance on the state’s public exchange.

Officials say that up to 30 percent of the state’s two million undocumented adults could be eligible for the program, and that roughly 17,000 people are expected to participate in the first year, if the plan is approved. But the proposal faces serious hurdles in Washington, where it must be approved by both the Treasury and the Health and Human Services Departments.

During debates over health care in his first term, and again when Congress considered an immigration overhaul in 2013, President Obama made it clear that health insurance subsidies under the Affordable Care Act would not go to immigrants who are living in the United States illegally. And two provisions of the health care law limit coverage to residents who are here legally. But advocates of California’s initiative argue that the plan should be approved under what is known as an “innovation waiver,” which allows states to have provisions of the federal law modified, because no federal dollars will be used to fund the program.

 

Studies: Employer Costs Slow As Consumers Use Less Care, Deductibles Soar

http://khn.org/news/studies-employer-costs-slow-as-consumers-use-less-care-deductibles-soar/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=34365867&_hsenc=p2ANqtz-8KEto_GP9_uQqUz3i-mPzdbfQDEppu8jP4OnWeCEXc0J1QCOvNd0hi84YGIhj1horx7qHfq8_4658aqWRUhtoQ9n9XQQ&_hsmi=34365867

Pocketbook pain: Workers’ contributions to health-plan premiums have been rising faster than their pay. Deductibles have risen even more. (Courtesy of Kaiser Family Foundation)

Employer health insurance expenses continued to rise by relatively low amounts this year, aided by moderate increases in total medical spending but also by workers taking a greater share of the costs, new research shows.

Average premiums for employer-sponsored family coverage rose 3.4 percent for 2016, down from annual increases of nearly twice that much before 2011 and double digits in the early 2000s, according to a survey by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

But 3.4 percent is still faster than recent economic growth, which determines the country’s long-run ability to afford health care.

And the tame premium increases obscure out-of-pocket costs that are being loaded on employees in the form of higher deductibles and copayments. Another new study suggests those shifts have prompted workers and their families to use substantially fewer medical services.

For the first time in Kaiser’s annual survey, more than half the workers in plans covering a single person face a deductible of at least $1,000. Deductibles for family plans are typically even higher.

Rich hospital, poor hospital divided by politics and a river

http://www.chicagotribune.com/news/sns-wp-blm-health-states-972aeae8-7a71-11e6-8064-c1ddc8a724bb-20160914-story.html

Image result for rich hospital poor hospital divided by a river and politics

When hospital executive Jeanette Wojtalewicz visits CHI Health’s Mercy Council Bluffs facility across the Missouri River in Iowa, she sees the new clinics and doctors’ offices partly paid for by the state’s decision to expand Medicaid to thousands of residents.

Back on her side of the river is CHI Health’s Creighton University Medical Center in Omaha, Nebraska, a state that opposed making more low-income people eligible for the government health-insurance program. While Mercy thrives about seven miles away, Creighton is cutting 250 beds to raise efficiency amid slumping financial results.

“There’s not a big geographical difference, but because of the regulations, there are big differences in the numbers,” said Wojtalewicz, chief financial officer at CHI Health, a 15-facility, nonprofit hospital system.

President Barack Obama’s Patient Protection and Affordable Care Act is as divisive as ever six years after its passage, with Republicans including presidential candidate Donald Trump vowing to repeal it. Yet as critics focus on the legislation’s insurance mandates and penalties, the biggest impact has come from Medicaid expansion, a decision made at state level.

How the ACA’s Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums

http://www.commonwealthfund.org/publications/issue-briefs/2016/sep/aca-expansions-and-out-of-pocket-spending?omnicid=EALERT1098015&mid=henrykotula@yahoo.com

Abstract

Issue: One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law’s individual mandate also protect from high health spending.

Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket.

Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds.

Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.

While uninsured rate hits historic low, young adults still not sold

http://www.healthcaredive.com/news/while-uninsured-rate-hits-historic-low-young-adults-still-not-sold/425890/

A survey found adults in states with a federally facilitated marketplace more likely to be uninsured than those in states operating a state-based marketplace or a partnership marketplace. This indicates another way in which states’ support (or lack thereof) for the ACA has impacted their uninsurance rates.

Value-based Care is Ripping Into Health System Profits

http://www.healthleadersmedia.com/finance/value-based-care-ripping-health-system-profits?spMailingID=9500406&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=1000981859&spReportId=MTAwMDk4MTg1OQS2#

capitation

Large health systems and hospital operators are reporting falling profits, revenue, income, and share value. The promise of population health management may eventually restore financial order, says one industry expert.

How a bite from a stray dog shows the sick state of U.S. healthcare

http://www.latimes.com/business/lazarus/la-fi-lazarus-rabies-vaccine-prices-20160906-snap-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=34073641&_hsenc=p2ANqtz-_UzP0FJwNSr06pbn6txjInxbNNHUAh9wO8NHxkBnVs85MxYQFyPtYaPatHWZG7uvo1VuZtlGtNcs7YcTj5-1_zPdkfkQ&_hsmi=34073641

Image result for How a bite from a stray dog shows the sick state of U.S. healthcare

Jan Kern was bitten by a stray dog while traveling abroad and ended up with a jaw-dropping illustration of why the U.S. healthcare industry is completely sick.

That’s because she underwent a series of rabies shots in three countries at four medical facilities. What that revealed, and which will surprise no one, is that Americans pay way more for the exact same treatment than people in other nations.

Moreover, her experience highlights the lack of uniformity for drug prices, including commonly used medications. One facility might charge a few bucks for the same drug that costs thousands of dollars at a U.S. hospital.

“There’s no rhyme or reason to our medical system,” said Rick Kern, 61, who contacted me about his 62-year-old wife’s global healthcare adventure after reading my recent column on drug prices.

What’s great about his story as well is that, after I shared it with about a dozen healthcare experts, the consistent reaction was one of utter disbelief. We’re accustomed to shaking our heads at U.S. healthcare costs. Things become significantly more absurd when a couple of overseas medical facilities are stirred into the mix.

“It’s obvious that our system is unlike any other health system,” said Uwe Reinhardt, a healthcare economist at Princeton University. “Other systems were set up to care for patients. Ours was set up by the providers — the hospitals and drug companies — for their own benefit.”