Government: Page 109
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State-run reinsurance programs helped lower ACA plan premiums by 20%
The seven states using reinsurance have saved the federal government almost $1 billion, according to a new report from Avalere.
By Les Masterson • March 14, 2019 -
PBMs called to give patients 'an explanation' by Senate panel
Cigna, CVS Caremark and CVS Health, Humana, UnitedHealth's OptumRx and Prime Therapeutics got invites to the latest Senate Finance Committee hearing. The panel said two of the companies have so far agreed to testify.
By Shannon Muchmore • Updated March 19, 2019 -
AMA says prior authorizations increasing, interfering with care continuity
A new survey of 1,000 physicians found that more than two-thirds said it's difficult for them to determine whether a prescription or service needs prior authorization.
By Les Masterson • March 13, 2019 -
House panel to launch investigation into short-term 'junk' plans
The Committee on Energy and Commerce will probe companies offering the short-term coverage and "hold them accountable," said Chairman Frank Pallone, D-N.J., including those run by UnitedHealth and Anthem.
By Rebecca Pifer Parduhn • March 13, 2019 -
HHS hints at cutting 'onerous' substance abuse record rules
Deputy Secretary Eric Hargan told attendees at AHIP's National Health Policy Conference to "watch this space very carefully" for changes to the law known as Part 2.
By Rebecca Pifer Parduhn • March 13, 2019 -
Hospital groups say public option would cut payments by 10%
The American Hospital Association and Federation of American Hospitals argue an opt-in government insurance plan would hit bottom lines and disrupt the insurance market.
By Tony Abraham • March 13, 2019 -
Trump admin proposes massive cuts to Medicaid, Medicare
Nearly all items on the wishlist hold zero chance of becoming law, but will likely give Republicans a headache come election time.
By Rebecca Pifer Parduhn • March 12, 2019 -
Population health program growth sputters, though execs agree they're needed
The potential of losing money in risk-based contracts is the most significant reason health systems are resistant to move into value-based care, according to a new Numerof & Associates report.
By Les Masterson • March 12, 2019 -
Pharmas, PBMs and payers all take a slice along drug supply chain, Pew says
As pharmaceutical spending and PBMs take fire in Washington, the report aims to suss out the players pocketing a share as drugs make their way through the system.
By Les Masterson • March 11, 2019 -
MedPAC eyes changes to ED coding, Part B drug pricing
Meanwhile, MACPAC discussed how shortfalls should be counted for Medicaid patients with third-party coverage in the DSH program.
By Les Masterson • March 11, 2019 -
Nashville program looks to tackle uncompensated care costs
The plan comes two years after then-Mayor Megan Barry proposed closing Nashville General as an inpatient facility. About 15% of the city's residents are uninsured or underinsured.
By Les Masterson • March 8, 2019 -
Trump admin floats publicizing provider-payer negotiated rates
While still just a request for comment, pushback from doctors and hospitals is likely to be fierce.
By Shannon Muchmore , Rebecca Pifer Parduhn • Updated March 8, 2019 -
CMS wants to make selling out-of-state insurance easier
Selling insurance across state lines is a policy idea long-championed by conservatives, but hardly adopted in part as it comes with a bevy of consumer protection and antitrust hangups.
By Tony Abraham • March 7, 2019 -
Why 2019 could be 'last easy year' for payers
Major U.S. insurers reported mostly positive quarterly and year-end financial results in the first months of this year, but political pressure and continued provider consolidation loom ahead.
By Shannon Muchmore • March 6, 2019 -
Rural areas hit hardest on unsubsidized ACA plans
In about one in five U.S. counties, a 40-year-old making $50,000 a year spends more than 10% of their income on the cheapest ACA plan, according to the Kaiser Family Foundation.
By Les Masterson • March 6, 2019 -
Moms who get surprise bill more likely to switch hospitals for second birth
Patients who chose a different facility had their chances of getting a surprise bill for the second delivery reduced by more than half, according to a Health Affairs report.
By Shannon Muchmore • March 6, 2019 -
Medicare for all (or some), buy in and other universal plans vary widely
Democratic presidential candidates like Sens. Kamala Harris and Bernie Sanders support a single-payer system. Sen. Amy Klobuchar backs a more modest Medicaid buy-in proposal.
By Les Masterson • March 5, 2019 -
FDA Commissioner Scott Gottlieb to step down in a month
The exit comes as the agency revamps its medical device approval pathways.
By David Lim • Updated March 5, 2019 -
Feedback for lowering healthcare costs focuses on surprise billing, value-based care
The American Medical Group Association suggested methods for decreasing administrative burdens, promoting price transparency and encouraging patient engagement and accountability.
By Les Masterson • March 4, 2019 -
US kidney care getting revamp, HHS officials say
Stocks of multiple dialysis providers plummeted Monday as Trump administration health chiefs previewed changes to kidney care payment models and transplant procedures.
By Rebecca Pifer Parduhn • March 4, 2019 -
CVS to close retail audiology centers ahead of over-the-counter regulations
FDA has made clear it believes consumers should be able to take a more active role in managing hearing loss.
By David Lim • March 4, 2019 -
Some VA facilities overlooked background info, inappropriately hired providers
A Government Accountability Office report found the Veterans Health Administration was not consistent in how it responded to adverse-action information from the National Practitioner Data Bank.
By Les Masterson • March 1, 2019 -
CMS updates hospital star ratings for the first time since 2017
The American Hospital Association and America's Essential Hospitals both decried the quality ratings update, with the AHA calling the program "flawed from the outset."
By Rebecca Pifer Parduhn • Feb. 28, 2019 -
With latest Grassley probe, hospitals can expect invitations to talk
The chairman of the Senate Finance Committee penned the public letter to exert pressure on the IRS and nonprofit hospitals alike, experts said.
By Samantha Liss • Feb. 27, 2019 -
ACA plans denied nearly 1 in 5 in-network claims in 2017
Fewer than 1% of those denials were appealed, according to an analysis from the Kaiser Family Foundation.
By Les Masterson • Feb. 27, 2019
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