Friday, June 29, 2018
Senate Panel Targets Rising Health Costs; “Surprise” Medical Bills
Editor’ Note: During the 2018 state legislative session in Georgia, two bills aimed at addressing the “surprise medical bills” issue were considered and debated. In the end, both failed as proponents of each bill could not agree on a mutually satisfactory solution.
CQ NEWS
June 27, 2018 – 3:18 p.m.
June 27, 2018 – 3:18 p.m.
Senate Panel Targets Rising Health Costs; “Surprise” Medical Bills
By Mary Ellen McIntire, CQ
The leaders of the Health, Education, Labor and Pensions Committee voiced bipartisan concern about health care costs in a hearing Wednesday, with both Democrats and Republicans noting alarm particularly about surprise medical bills.
“The hard truth is that we will never get the cost of health insurance down until we get the cost of health care down,” said Chairman Lamar Alexander, R-Tenn.
Alexander said the panel would hold three or four additional hearings on the topic, including one on administrative burdens that medical providers face. Rising health care spending is a complex issue that also could include the costs of insurance premiums and prescription drugs.
Alexander and top committee Democrat Patty Murray of Washington seemed to agree on at least one issue: Both discussed constituents who were surprised with medical bills because they were treated by an emergency room physician who was out of their insurance networks although the emergency room was in network, and an anesthesiologist who was out of network although the hospital and surgeon were both in network.
Witness Ashish Jha, the director of the Harvard Global Health Institute, testified that some hospitals use an outside company to staff an emergency department, and then those doctors are out of patients’ insurance networks.
“That’s how they make their money,” he said. “It’s unethical, if not illegal, and it obviously is not illegal, but it ought to be.”
A handful of states have taken meaningful steps to combat such actions, Jha said. Those include holding the patient harmless if a provider does out-of-network balanced billing, which is when a provider charges a patient for the difference between the provider's charge and the covered amount.
Since so many people receive insurance from a self-insured employer, the federal government has a role to play under the Employee Retirement Income Security Act, which oversees employer-sponsored health insurance, he added.
He pointed to some steps that were successful in lowering Medicare spending growth somewhat. Those include accountable care organizations that were set up under the 2010 health law (PL 111-148, PL 111-152), which incentivize doctors and other providers to coordinate care and hold down costs.
The hearing largely moved the committee away from partisan discussions on the 2010 health care law, which Alexander said had distracted the panel from broader health policy conversations for years.
One of the few moments when the health care law was discussed came when Murray said actions taken by the Trump administration and Republicans in Congress are driving up premium costs for marketplace plans. She also noted that the Centers for Medicare and Medicaid Services rolled back bundled payment programs that were designed to lower costs and that the Centers for Medicare and Medicaid Innovation, which is designed to oversee demonstrations on lowering costs and increasing quality, was without a leader for a year.
Price Transparency and Quality Measures
Improving price transparency is frequently noted as a way to lower health care costs, but Sens. Susan Collins, R-Maine, and Tina Smith, D-Minn., raised questions about how to match more pricing information with details on the quality of care a patient receives.
“Researchers have also found that patients equate high prices with high quality,” Collins said. “When we have price transparency, we need to have some way to also have an evaluation of quality.”
Smith referenced a Minnesota database that includes data on both cost and quality, which Melinda Buntin, a professor and chair of the Department of Health Policy and Vanderbilt University, testified was a step in the right direction.
Still, people need to be able to incorporate more details, such as their insurance plan coverage or how close they are to reaching their deductible, to take the greatest advantage of such a resource.
“Fundamentally, I think that research has shown it’s very difficult to get people at the point in time when they're ill and need a service to do a lot of comparison shopping,” she warned.
Administrative Burdens
Reducing the administrative burdens that health care providers face appears to be a priority for some members, and is likely to get more attention later this year.
Many administrative costs, such as quality reporting, fall to private insurance companies, Jha said. Additionally, the growth of electronic health records have added to the administrative tasks for physicians and nurses, said.
“It does show up in burnout rates. It does show up in other negative ways,” he said.
The growth of administrative burdens could also lead to more consolidation. For example, a large hospital system may tell a small practice it can focus on providing care rather than administrative tasks, if it is acquired, Sen. Lisa Murkowski, R-Alaska, said.
One way to address that may be to build electronic quality reporting systems, Jha said.
“These are not separate phenomena, and one that may actually be feeding into the other,” he said. “It does make them much more susceptible to just giving up that part of their practice, becoming an employee, and consumers are not necessarily helped by that.”
Dave Hyman, a professor at the Georgetown University Law Center, testified that without increasing competition to lower prices, simply decreasing the administrative burdens wouldn’t do enough to lower costs.
“Even if we cut administrative overhead in half, providers could pocket that unless they were competing with one and other,” he said.
Thursday, June 28, 2018
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Friday, June 8, 2018
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Wednesday, June 6, 2018
'Medicaid-for-All' Rapidly Gains Interest in the States
'Medicaid-for-All' Rapidly Gains Interest in the States
More than a dozen states either have or are still considering the idea of letting people buy Medicaid -- regardless of how much money they make.
BY MATTIE QUINN | JUNE 4, 2018 | GOVERNING
Medicaid, as we know it, is the nation's government-run health care program for the poor. You have to make below a certain amount of money to qualify for it, and it's free for most. But what if people -- regardless of their income -- could buy a Medicaid plan?
That idea is gaining popularity among state lawmakers. Last year, a "Medicaid buy-in" or "Medicaid-for-all" bill made it as far as the governor's desk in Nevada. Gov. Brian Sandoval vetoed it, but it inspired similar efforts around the country.
Six states -- Iowa, Massachusetts, Minnesota, Missouri, New Jersey and Washington state -- have active legislation to establish a Medicaid buy-in program. In four others, bills were proposed but stalled. New Mexico has set up a task force to study a Medicaid buy-in program, and Connecticut may do the same.
The premise of these buy-in bills is like Nevada’s: Medicaid plans would be offered on each state's insurance marketplace, and people who don't traditionally qualify for Medicaid could pay premiums and co-pays. In Missouri, though, the Medicaid buy-in plans would only be expanded to people who have a disability and are employed.
According to experts, each state likely has a different reason for considering this option.
"States are still exploring what it would even mean," says Heather Howard, director of State Health and Value Strategies. “For one state, it could be about addressing a bare county. For another, it could be an affordability issue. For another, it could be about expanding competition. In the absence of federal legislation on health care, states are asking: 'What tools do we have?'"
For left-leaning lawmakers, Medicaid buy-in is considered a step toward single-payer health insurance. But conservatives are weary of expanding the government's role in health care and of funneling more money into Medicaid, which is already a huge slice of state budgets.
New Mexico state Sen. Jerry Ortiz y Pino -- who co-sponsored a bill to study the issue -- says Medicaid buy-in makes sense there because the majority of residents (54 percent) already have Medicaid or Medicare. It’s the only state where more than half the population uses government health care.
"Besides Medicaid, we have a high Medicare population, high VA [Veterans Affairs] population and high numbers in the Indian Health Service," says Ortiz y Pino. "So when we talk about non-governmental insurance, it’s a small number. That small population means it's hard to attract private insurers, particularly in the marketplace."
New Mexico's marketplace has four insurers covering the state, which is actually more than many part of the country. About half of Americans only had one or two insurers last open enrollment season. Still, like most other states, New Mexico's marketplace is facing increased premiums and possible insurer dropouts this year.
Despite the spike in interest, Medicaid buy-in is unlikely to be implemented -- or even passed -- in any state this year. The bills that still have a chance have barely moved. There’s even hesitation in blue states -- like Maryland, which killed buy-in bills this year. As health care uncertainty on the federal level continues -- Congress reportedly may try again this year to repeal the Affordable Care Act -- some think it's too risky of a proposition to take on right now. And it’s unlikely the Trump administration would agree to pay for additional costs of a buy-in, putting any new financial burden squarely on states.
“It’s hard to say if it’ll catch on. It’s a crystal ball question. But I will say that states are interested. We had a session at the end of our conference about Medicaid buy-in, and it was packed,” says Anita Cardwell, a policy associate with the National Academy for State Health Policy.
If New Mexico does move forward with a buy-in option, it wouldn’t be the most generous of plans, says Ortiz y Pino. He expects they would offer all that's required, like mental health and maternity care, but that the plans would be more like “Medicaid lite."
"It would cover the basics. I don’t think we could have long-term care, for instance. But I do think we could put together a nice package of benefits,” he says.
New Mexico’s study is expected to be complete by Thanksgiving. Depending on the results, Ortiz y Pino hopes the legislature can file an official Medicaid buy-in bill in early 2019.
“This is our shot at this," he says. "If the numbers look right, of course."
Tuesday, June 5, 2018
Monday, June 4, 2018
Friday, June 1, 2018
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