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A federal judge says Kentucky can't require poor people to get a job to keep their Medicaid benefits, chastising President Donald Trump's administration for rubber-stamping the new rules without considering how many people would lose their health coverage. According to Fox News, the decision is a setback for the Trump administration, which has been encouraging states to impose work requirements and other changes on Medicaid, the joint state and federal health insurance program for the poor and disabled. Kentucky was the first state in the country to get that permission, and the new rules were scheduled to take effect Sunday in a northern Kentucky suburb of Cincinnati.
Lisa French received a $229,112 lawsuit from St. Anthony North Health Campus hospital in Westminster for a spinal-fusion surgery she had nearly three years prior, according to The Denver Post. French had an ERISA employer-sponsored health plan and signed a contract before surgery agreeing to be financially responsible for all hospital charges not paid by her health insurance or other payer. But, before the surgery, hospital officials told her that she would only owe $1,336. The material for her surgery cost the hospital around $30,000, and the hospital charged French around $200,000--a nearly 500% markup. French’s bill was one of over 700,000 billing disputes being sent to court. A growing number of employers are refusing to pay full amount of hospital bills of their workers due to this alleged price gouging by the hospitals. The law firm representing French explained they are are trying to prevent patients from being subjected to predatory pricing.
The Missouri Department of Health and Senior Services has designated nine hospitals in St. Louis County (and 14 throughout the rest of the state) as priority heart attack centers to ensure that the highest-risk patients have best chance of recovery, according to St. Louis Public Radio. The recent designation is a part of a longstanding effort to develop a Time-Critical Diagnosis System (already in place for other time-sensitive health issues such as trauma and strokes), which directs emergency responders to facilities that are both nearby and well-equipped to meet the patient’s needs. Prior to the system’s introduction, emergency responders were required to transport patients to the nearest hospital, regardless of its ability to effectively treat certain conditions.
Chuck Gyukeri is a Navy vet who was homeless in 2009 and has been living in subsidized housing since then, but he now lives in a small apartment in Dorchester, supported by disability benefits and a Section 8 voucher, according to WBUR. One third of the units in this housing unit are uninhabitable, but an $800,000 investment from Boston Medical Center (BMC) will hopefully turn this building into a center for healthy living. Housing as a social determinant of health is one way we can invest in our population’s health and ensure healthy living, since medical care only makes up about 10% of a person’s health. BMC has invested around $6.5 million dollars into housing in Boston’s poorest areas to improve Boston’s social determinants of health.
Two Minnesota healthcare giants—Mayo Clinic and Blue Cross blue Shield of Minnesota—have agreed to a unique five-year contract that will downside risk and eliminate some prior authorizations, according to Modern Healthcare. This change will be implemented in part to lift restrictions on Mayo Clinic’s patients with serious or complex illnesses and make coverage more seamless under Blue Cross policies. Both companies have decided it is better to work together rather than aiming administrative artillery at each other. The agreement will add more conditions and treatments that don’t need prior authorization under the new contract, and will expand the amount of value-based care that will take place between the companies.
Portland nonprofit Project Access Now, working with charitable funding from the metro area’s nonprofit hospital systems, has expanded its program offering free or heavily discounted generic drugs to working-class people with high-deductible health plans. According to The Lund Report, program participants pay either $4 per prescription or get their medications at no cost. Linda Nilsen, the executive director of Project Access Now, stated that, “pharmaceutical access is key to assuring improved health outcomes -- the remaining uninsured and underinsured still face significant barriers to getting the medications they need.” She believes that access to pharmaceuticals is key to improving health outcomes.
Marilyn Bartlett, the director of Montana’s Health Care and Benefits Division got an urgent directive from state legislators in late 2014 to get healthcare costs under control, or else, according to Kaiser Health News. Bartlett designed a new way for the state to do business with hospitals, which accounted for 43 percent of employee healthcare costs. The state began giving these facilities a “reference price” or how much they would be willing to pay for each hospitalization, using Medicare rates as a baseline, and ultimately deciding to reimburse at 234 percent of Medicare rates. Despite some initial opposition from hospitals, after two the state is calling the effort a success. Montana saved $15.6 million compared to what they would have paid without the change. Their reserve fund has even grown so much the state has used it for other needs.
A California Nurses Association (CNA) analysis of hospital financial data reveals a 33 percent drop in the overall amount of charity care provided by California’s nonprofit hospitals from 2011 to 2016, reports State of Reform. The California Hospital Association suggests that the drop demonstrates that patients need less help covering medical bills due to increased insurance coverage under the Affordable Care Act. However, the CNA report shows that despite lower uninsured rates, there are still 12 million Californians struggling to pay medical bills. The analysis reveals that, during the same time period, nonprofit hospitals accumulated nearly $37 billion in profits.
The Alaska Division of Insurance solicited comments on two topics related to healthcare costs, according to State of Reform. The division is seeking proposals for amendments or alternatives to the 80th percentile rule, with particular focus on alternatives that address the potential impacts on the cost of care and protect consumers from surprise balance billing. A recent report by the University of Alaska found that the 80th percentile rule likely has driven up costs. The division is also surveying small business employers to identify issues and barriers to affordable coverage. This is the first step towards applying for a second 1332 Innovation Waiver to address costs in the small-group market, as premium increases have averaged more than 31 percent over the past two years.
New data from Ohio's Quantum Health reveals that its Precision Specialty Pharmacy Management program reduced cost by 55 percent, or an average of over $80,000 per case annually, for members transitioning from insurance carriers to the company's consumer healthcare navigation model. According to Markets Insider, Chief Medical Officer Dr. Dana Andrews attributes the results to the company's active collaboration with the members and their providers to identify those who could receive the medication in a more cost-effective site of care. Currently in the U.S., the 1 to 2 percent of people who take specialty medications drive nearly 40 percent of all drug spending.