Illinois' getting far more signups than GOP-dominated Missouri
Mar 11, 2014 By Tara Kulash
Free food and music are notorious for attracting young people; at least that’s the hope of Missouri insurance enrollment counselors.
Before the March 31 deadline under the Affordable Care Act, groups are beefing up their campaigns to bring last-minute customers to the federal health insurance marketplace—especially young people.
Denver Firm Acts as Clearinghouse on How 2015 Premiums, Costs Are Trending
Mar 11, 2014 By Jay Hancock
Now that medical insurers must accept all applicants no matter how sick, what will these new customers cost health plans? How will they affect coverage prices for 2015 and beyond? Few questions about the Affordable Care Act are more important. How it all plays out will affect consumer pocketbooks, insurance company profits and perhaps the political fortunes of those backing the health law.
A few Denver actuaries, bound to confidentiality, will be the first to glimpse the answers.
Manufacturers Are Churning Out Products At An Increasing Clip
Mar 11, 2014 By Daniela Hernandez
Eric Topol, M.D., a cardiologist at the Scripps Clinic in San Diego, knows when his patients’ hearts are racing or their blood pressure is on the rise, even if they’re sitting at home.
With high-risk patients hooked up to “personal data trackers” — a portable electrocardiogram built into a smartphone case, for instance — he and his researchers can track the ups and downs of patients’ conditions as they go about their lives. “It’s the real deal of what’s going on in their world from a medical standpoint,” said Topol, whose work is part of a clinical trial. “The integration of that with the classical medical record is vital.”
Allegedly Bilked Four Insurers Out of Millions
Mar 4, 2014 By Payers & Providers Staff
A Chicago-area chiropractor and physician are facing federal healthcare fraud charges after being accused of bilking four large insurance companies out of millions of dollars.
The physician, Eguert Nagaj, M.D., and the chiropractor, Igor Sher, operated three separate medical and chiropractic practices in the town of Buffalo Grove. They were among six people involved in the alleged scheme named in indictments that were unsealed in federal court earlier this week. Both are facing 16 counts of mail fraud, with an additional obstruction of justice charge against Sher.
Backers Say They Receive Care Legal Residents Can't Obtain
Mar 4, 2014 By Julie Appleby and Patricia Borns
Florida lawmakers backing expansion of the state’s Medicaid program plan to mount a new argument this legislative session: That voting against extending the program would deprive low-income U.S. citizens of access to insurance that’s available to some legal immigrants.
At issue is a little-noticed provision of the federal health law that allows some low-income immigrants who are living here legally to qualify for subsidies to help them buy private insurance through online marketplaces.
A Single Treatment Costs $84,000
Mar 4, 2014 By Julie Appleby
There's a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C. But it costs $84,000 -- or $1,000 a pill. And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug —and who pays for it.
Called Sovaldi, the drug is made by California-based Gilead Sciences Inc. and is the latest in handful of new treatments for hepatitis C, a chronic infection that afflicts at least 3 million Americans and is a leading cause of liver failure. It was approved by the U.S. Food & Drug Administration in December.
Insurers Claim Reductions Are Far Deeper Than Thought
Feb 25, 2014 By Mary Agnes Cary
An Obama administration announcement about payment rates for Medicare Advantage plans in 2015 has set off a dispute about how large – or small – the changes really are.
Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program.
Wide Price Variations Among Providers
Feb 25, 2014 By Eric Whitney
Coffee is important to many of us, but let’s say your coffee maker breaks. Finding a new one is as easy as typing “shop coffee maker” into your browser. Voila – you’ve got models, prices and customer reviews at your fingertips.
But say you need something less fun than a coffee maker, like a colonoscopy. Shopping for one of those is a lot harder. Actual prices for the procedure are almost impossible to find, and Bob Kershner said there's huge variation in cost from one clinic to the next.
Chronic Conditions Tackled With Varying Rates of Success
Feb 25, 2014 By Jordan Rau
Networks of doctors and hospitals set up under the Affordable Care Act to improve patients’ health and save money for Medicare are having varying rates of success in addressing their patients’ diabetes and heart disease, according to government data released Friday.
The release is the first public numbers from Medicare of how patient care is being affected by specific networks. These accountable care organizations, or ACOs, are among the most prominent of Medicare’s experiments in changing the ways physicians and health care facilities work together and are paid. The ACOs will be able to keep some of the money they save, but they also take on some of the financial risk if their patients end up being costly.
Technology Helping to Bridge The Gap
Feb 17, 2014 By Karen Bouffard
A new study shows more Michigan residents are depressed than those in other states, and mental health care workers are using telephone and video conferencing to reach out to patients in areas without psychiatric services.
Already overburdened with high case loads, mental health professionals statewide are expecting increased demand under the federal Affordable Care Act, which requires insurance companies to provide mental health coverage that is equal to what’s provided for physical-health conditions. Health advocates worry that the load will keep some patients from getting mental health care, despite their new benefits.
Many More Are Taking on Clinical Roles
Feb 17, 2014 By Anna Gorman
Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.
"I was freaking out," said Freedman, 55. "You get very emotional when you think you could drop dead at any moment."
Numbers Topped 3 Million Through January
Feb 16, 2014 By Phil Galewitz
Nearly 3.3 million Americans have signed up for private health insurance plans since October through the online marketplaces created by the health law, with enrollment continuing to surge through January, an Obama administration report said last week.
But the number of young adults signing up continues to lag expectations, which could impact insurance premiums next year. Insurance industry officials have been closely watching the mix of customers to make sure they get enough healthy people to balance the cost of covering older Americans who generally require more medical care.
Some Midwesterners Price Out of Affordable Coverage
Feb 11, 2014 By Julie Appleby
The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies.
But the promise comes with a catch for almost 3 million people earning between three and foutimes the federal poverty rate: They may have to pay up to 9.5 percent of their income toward that premium before the subsidy kicks in.
Many Offering Supplemental Plans
Feb 11, 2014 By Jay Hancock
Out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers.
Insurers are increasingly marketing these limited policies that pay cash after a hospital stay or specific disease diagnosis, such as cancer.
Lawmakers Could Take a Variety of Approaches
Feb 11, 2014 By Mary Agnes Cary
Now comes the hard part.
After negotiating for months over how to overhaul Medicare’s troubled payment system for physicians, the bipartisan leadership of three Senate and House committees has reached a deal on the policy. Their next task could be even harder – finding a way to finance repeal of the “doc fix,” the shorthand for the 1997 formula used to set physician payments, the sustainable growth rate (SGR).
Most Are Delineated by Race And Income
Feb 4, 2014 By Payers & Providers Staff
Despite having some of the best health indicators in the country, there remain some troubling gaps in outcomes in Minnesota, with most clearly delineated by race and income.
That's the conclusion of a new report by the Minnesota Department of Health submitted to the Legislature earlier this week. Lawmakers had requested the report to obtain more data about health inequities in the state. Department officials conducted interviews with more than 1,000 individuals at 180 different healthcare organizations statewide.
Variety of Market Factors Drive Up The Price
Feb 4, 2014 By Jordan Rau
If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month. If he lived in Beverly Hills, he would pay $1,405.
But Mullins, who builds custom swimming pools, lives in Southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.
They Only Want To Change Law Now, Not Eliminate It
Feb 4, 2014 By Eric Whitney
Some influential conservatives are now saying the healthcare law is too entrenched to repeal.
Take the U.S. Chamber of Commerce, the powerful business lobbying group. When the Affordable Care Act Passed in 2010, the Chamber got behind a major business lawsuit to fight it at the U.S. Supreme Court. And in January, 2011 during his annual State of American Business address, Chamber President Tom Donohue said, "It's time, in my opinion, to go back to the drawing board...and thus we support legislation in the House to repeal it."
More Than 350,000 Cases Are on Backlog
Jan 28, 2014 By Susan Jaffe
Medicare beneficiaries who have been waiting months and even years for a hearing on their appeals for coverage may soon get a break as their cases take top priority in an effort to remedy a massive backlog.
Nancy Griswold, the chief judge of the Office of Medicare Hearings and Appeals (OMHA), announced in a memo sent last month to more than 900 appellants and health care associations that her office has a backlog of nearly 357,000 claims. In response, she said, the agency has suspended acting on new requests for hearings filed by hospitals, doctors, nursing homes and other health care providers, which make up nearly 90 percent of the cases. She said that she expected the suspension would last about two years.
Billings Ballooned to Nearly $1 Million a Month
Jan 28, 2014 By Payers & Providers Staff
An Illinois attorney and part-owner of a hospice is facing criminal allegations that he overbilled the Medicare and Medicaid programs by as more than $20 million.
Prosecutors announced a single federal healthcare fraud charge against 46-year-old Seth Gillman, as well as a charge of obstructing a federal audit.
Exchange's Operation is Widely Dysfunctional
Jan 28, 2014 By Ron Shinkman
A new report has criticized the utility of Minnesota's health insurance exchange, saying it will fall short of enrollment goals and satisfying consumers trying to purchase coverage.
The MNSure exchange was built with $155 million in federal funds dispersed under the Affordable Care Act. It is one of 16 exchanges operated at the state level.
Jan 21, 2014 By Payers & Providers Staff
Michigan, Illinois Among Worst in U.S.; Minnesota Fares Better
Jan 21, 2014 By Ron Shinkman
The state of emergency healthcare services varies widely in the Midwest, but a new study by the American College of Emergency Physicians concludes it is mostly subpar all around.
Michigan, Ohio, Iowa Resist GOP Pressures To Craft Programs
Jan 21, 2014 By Eric Whitney
Nationally, Republican party leaders say their number one campaign issue for the midterm elections is opposition to the Affordable Care Act. But at the same time, a growing number of Republican states are now embracing a major provision of the law – expanding Medicaid, the government-funded health benefit program for the poor. The Supreme Court made doing that optional for states in 2012 and most Republican-led states said “no”. But now, some states like Ohio, Iowa and Michigan are forging compromises with the White House on Medicaid.
To understand why this happened in Michigan, drop in on the cavernous, busy emergency room at Henry Ford Hospital in the heart of Detroit. About one in three patients being treated by the blue-scrubbed swarm of doctors, nurses and techs is uninsured. It's a much higher rate than in Michigan or the rest of the country, and that means hospitals like this one had been providing a lot of health care for free.
Hospital Fees And Other Charges Tacked On
Jan 21, 2014 By Michelle Andrews
The new healthcare law encourages people to get the preventive services they need by requiring that most health plans cover cancer screenings, contraceptives and vaccines, among other things, without charging patients anything out of pocket. Some patients, however, are running up against coverage exceptions and extra costs when they try to get those services.
Advocates and policy experts agree that more federal guidance is needed to clarify the rules.
But 77,000 low-income residents will get coverage via exchange
Jan 14, 2014 By Ron Shinkman
Wisconsin has just received approval from the U.S. Department of Health and Human Services to create a public-private hybrid for expanding its number of low-income residents who are able to obtain healthcare insurance under the Affordable Care Act.
The plan calls for expanding BadgerCare, Wisconsin's state Medicaid program, to cover 83,000 more low-income residents.
Less Than A Quarter Are Ages 18-34
Jan 14, 2014 By Phil Galewitz
Nearly a quarter of the 2.2 million people who have enrolled in health coverage in the health law's insurance marketplaces are young adults — the population that's hardest to reach and yet most vital for the financial stability of the new exchanges, the Obama administration announced Monday.
While federal officials say they are pleased with the early turnout, they want to increase the proportion of young adults buying plans before open enrollment ends March 31. Almost 40 percent of the potential market for the exchanges is people 18 to 34 years old. Based on the Congressional Budget Office estimate that 7 million people would enroll this year, that would be 2.7 million young adults.
Medicaid Expansion Under ACA May Help
Jan 14, 2014 By Judith Graham
Five years ago, Joseph Hale didn't care whether he lived or died. He was unemployed, hooked on drugs and deeply depressed.
Help came after Hale swallowed a bottle of pills and landed in South Shore Hospital in Chicago. There, an outreach worker persuaded him to seek help at a local mental health agency. Within a few months, Hale was living in a men's residence, going to group therapy every day, and beginning to feel secure for the first time in his life.
Many New Enrollees May Be Challenged
Jan 7, 2014 By Michael Ollove
Signing up for health insurance on the new state and federal exchanges was supposed to be the easy part of the Affordable Care Act. The really dicey part, lots of health policy experts have always feared, will come on and after Jan.1.
That is when Americans who have enrolled in health insurance for the first time under the ACA are likely to discover that having coverage doesn’t guarantee them easy access to a primary care doctor, dentist or mental health professional.
Those With Chronic Conditions Particularly Vulnerable
Jan 7, 2014 By Michelle Andrews
People with chronic conditions will be better protected from crippling medical bills starting in January as the health law’s coverage requirements and spending limits take effect. But a recent analysis by Avalere Health found that many may still find themselves “underinsured,” spending more than 10 percent of their income on medical care, not including premiums, even if they qualify for cost-sharing subsidies on the health insurance marketplaces.
Enrollment Starting a Slow Surge
Jan 7, 2014 By Ron Shinkman
Jan 7, 2014 By Payers & Providers Staff
Moody's Issues New Report
Dec 17, 2013 By Jay Hancock
Insurers responded softly if not sweetly to the Obama administration’s latest requests and rule changes for individuals trying to buy coverage in online marketplaces by Jan. 1.
Moody’s Investor Service, which is watching Obamacare from the outside, isn’t so tactful.
Patients Get To Stay Home, Have Better Pain Management
Dec 17, 2013 By Jenny Gold
When palliative care specialist Tim Ihrig, M.D., crosses the threshold of the Avelleyras home, he steps over a doormat that says, "One nice person and one old grouch live here."
It doesn’t take long to figure out who the nice person is.
Dec 17, 2013 By Payers & Providers Staff