Category: Health Insurance

Price’s Health Reform Hit From The Right

I recently discussed Rep. Tom Price, MD’s Empowering Patients First Act in quite positive terms. Not everyone is on board. My good friend Dean Clancy labels the bill Health Care Cronyism:

Section 401, for example, authorizes new federal “best practice” guidelines written by medical societies, designed to give physicians extra protections from malpractice lawsuits. These guidelines aren’t merely educational, though. They’re established as powerful litigation tools in state courts. If a physician can show he followed them, his accuser must meet a higher burden of proof to establish negligence. That may be a good idea, but it’s unconstitutional. The power to regulate civil justice is reserved to the states under our federal system. There’s neither a legal nor a practical justification for federal medical malpractice reform. States have this. They can reform their tort systems, and many have done so, with success.

Mr. Clancy and I are in complete agreement that Congress has no role meddling in medical malpractice. So, why did I ignore this part of Dr. Price’s bill and leave Mr. Clancy prime real estate in U.S. News & World Report to lay into it?

Most Employers Will Use Private Benefits Exchanges by 2018

A new survey from Array Health reports four of five insurance executives anticipate that most employers will use private exchanges to offer benefits by 2018. According to the survey, private exchanges are a win-win situation because they reduce administrative costs.

We like private exchanges because they pave the way for individual health insurance to be the standard. The Array report seems to support this conclusion:

More exciting, perhaps, is the future outlook around business savings as single-insurer private exchanges start to move with consumers – from group settings to individual plans – keeping loyal consumers tied to particular insurance brands through the exchange model.

Maybe The Government Should Just Not Ask People If They Are Uninsured?

Sir John Cowperthwaite was the Financial Secretary of the British Colony of Hong Kong when it began to boom in the 1960s:

Asked what is the key thing poor countries should do, Cowperthwaite once remarked: “They should abolish the Office of National Statistics.” In Hong Kong, he refused to collect all but the most superficial statistics, believing that statistics were dangerous: they would led the state to to fiddle about remedying perceived ills, simultaneously hindering the ability of the market economy to work. This caused consternation in Whitehall: a delegation of civil servants were sent to Hong Kong to find out why employment statistics were not being collected; Cowperthwaite literally sent them home on the next plane back. (Alex Singleton, The Guardian)

What does this have to do with health insurance? The Wall Street Journal’s Jo Craven McGinty reports on the Census Bureau’s rejigging of its measurement of how many Americans are without health insurance:

Have Employer-Based Health Benefits Dropped?

Just the other day, my analysis of the RAND Corporation’s survey of health insurance from September 2013 through February 2015 led me to conclude that “economic growth improved coverage more than Obamacare did.”

However, there are other sources that contradict the RAND survey’s conclusions about employer-based benefits. My Forbes colleague Scott Gottlieb, MD, reviews a new report from Goldman Sachs that estimates small employers dropped 2.2 million beneficiaries from coverage, a reduction of 13 percent from 2013.

Last year, Ed Haislmaier and Drew Gonshorowski of the Heritage Foundation concluded that nearly 3.8 million people lost employer-based coverage through June 2014.

Both the Goldman Sachs and Heritage Foundation analysts relied on data from insurers rather than beneficiaries. Nevertheless, I am at a loss to understand how people who lost employer-based benefits would not say so in a phone survey.

At the Health Affairs blog, Marc Berk issues a caution about the “quick turnaround” surveys that are exciting the Obamacare debate, noting that the government itself is relying especially on the Gallup-Healthways survey instead of sober estimates produced by its own Census Bureau and Centers for Disease Control and Prevention.

The surveys agree that more people are dependent on Medicaid and Obamacare exchanges have enrolled a few million. The great divergence is with respect to employer-based health benefits.

Why Would Health Insurers Learn From Life or Auto Insurers?

Businessman Sitting at His DeskDori Zweig at FierceHealthPayer has written a good article with examples of how life and auto insurers provide excellent customer service, and encouraging health insurers to do the same. It would be a great idea and there are no shortage of consultants providing advice on health insurers to do exactly that. There are entire conferences dedicated to the topic.

Unfortunately, there are significant differences between health, life, and auto insurance that mitigate health plans’ interest in replicating the excellent service we’ve seen from other types of insurer:

Who’s To Blame For Doctors’ Cash Flow Crisis?

Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.

(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)

The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.

“Next Frontier” – Health Plans Covering Yoga?

When a leading benefits consultant writes an article in the Harvard Business Review recommending that health plans should cover yoga, it should be glaringly apparent that we have perverse incentives in U.S. health benefits:

Cigna insurance CEO David Cordani says the Centers for Medicaid and Medicare Services’ recent payment changes that emphasize quality over quantity in healthcare will shift the focus on “sick care to more well care.” But a widespread embrace of diet, fitness and other wellness programs is still a way off……”

Insurers should cover “new wellness- and prevention-oriented treatments such as yoga and meditation, Sukanya Soderland, a partner in consulting firm Oliver Wyman’s health practice, wrote recently in the Harvard Business Review. (Jayne O’Donnell & Laura Ungar USA Today)

The Kline-Ryan-Upton Republican Off-Ramp from Obamacare

Tomorrow is the day the Supreme Court hears oral arguments in King vs. Burwell, and all the talk is about what Congress will do if the Supreme Court directs the Administration to obey the law by not paying subsidies in the majority of states, which have declined to establish their own Obamacare exchanges and defaulted to the federal one.

The Wall Street Journal ran an op-ed (available by subscription) by John Kline, Paul Ryan, and Fred Upton, who chair committees of jurisdiction in the House of Representatives that will be tasked with proposing a Congressional response to this decision. Here’s what they write:

Let people buy insurance across state lines. Stop frivolous lawsuits by enacting medical-liability reform. Let small businesses band together so they get a fair deal from insurance companies.

When Will Obamacare Enrollment Close?

When I last wrote about Obamacare’s open enrollment (on January 23), I promised readers that I would not write about it again until open season had wrapped up.

I thought we’d be there by now. After all, it was supposed to close on February 15.

No such luck. First, because of glitches in the website and other hassles, the federal government and some states extended open season by one week.

Now, the Administration has been caught by surprise by April 15, tax day. The problem seems to be that six million Americans will be required to pay the (unconstitutional) fine for not having bought Obamacare insurance in 2014. Unfortunately, 40 percent of adults are unaware of the penalty.

Are Employers Who Dump Workers Onto Medicaid Corporate Welfare Queens?

There have been a lot of predictions about the future of employer-based health benefits under Obamacare. Reports suggest that increasing numbers of small businesses are dropping health benefits and sending their employees to Obamacare’s insurance exchanges, where they are partially subsidized.

Other businesses have found a bigger cost-shifting approach. BeneStream, a new benefits advisor, advises employers how to make their workers dependent on Medicaid, a welfare program fully funded by taxpayers. And businesses are taking advantage of its advice.

So: Are these employers corporate welfare queens?