Research Roundup - August 2015

State News

Massachusetts: How Much is that Eye Exam? Study Probes the Elusive Quest for Healthcare Prices

By Martha Bebinger, Kaiser Health News | August 14, 2015

The Pioneer Institute in Boston called the offices of 96 dentists, ophthalmologists, dermatologists and gastroenterologists across the state and asked for the price of five basic services. Researchers found that prices varied widely and obtaining the information from physicians’ offices was very difficult.

Florida: Florida to Review Proposed Obamacare Rate Hikes for First Time

By Chabeli Herrera, The Miami Herald | June 4, 2015

After two years with its regulatory hands tied, the Florida Office of Insurance Regulation is free this year to challenge insurers again — in a market seeing double digit hikes, according to the Miami Herald. A 2013 state law barred the Florida Office of Insurance Regulation from regulating proposed rates in Affordable Care Act plans, stating that the state office could not have a final say over federal laws and regulations such as the ACA. That law expired this year.

Maine: Among 23 Health Insurance Co-ops, Maine Stands Out for Its Success

By Joseph Burns, Covering Health | Aug. 18, 2015

Consumer-oriented health insurance co-ops were created by the ACA to increase competition and consumer choice in state insurance marketplaces. While most of the co-ops are losing money, only Maine's Community Health Options has turned a profit. The success is attributed to an extensive list of in-network providers and a value-based insurance design for those with chronic conditions that reduces financial barriers to receiving needed preventive care.

Ohio: Ohio’s Medicaid Costs Ohio $2 Billion Less than Expected

Catherine Candisky, The Columbus Dispatch | Aug. 13, 2015

State Medicaid officials announced that total spending was 7.6 percent less than projected and credited initiatives like capitated reimbursement policies, expanded managed care, shorter nursing home stays and increased use of home-based care for seniors. The state’s report did not assess the impact of these reforms on beneficiaries’ quality of care.

Recent Reports

National Health Expenditure Projections, 2014–24: Spending Growth Faster Than Recent Trends

By Sean Keehan, et. al., Health Affairs | July 2015

Total health spending in the United States is projected to grow an average 5.8 percent for 2014–24, reflecting coverage expansions, faster economic growth and the release of expensive new drugs . As a result, health spending as a share of gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024. However, researchers also point to evidence of continued modest growth in spending per person, after accounting for insurance status.

States With Stronger Health Insurance Rate Review Authority Experienced Lower Premiums in the Individual Market in 2010–13

By Pinar Karaca-Mandic, et. al., Health Affairs | August 2015

States have varying degrees of review authority over health insurance carriers’ rates, including prior approval authority over proposed rates and requirements for loss ratios--the proportion of premium revenues spent on medical claims. Researchers collected data on how states changed their rate review authority and requirements during 2010–13, and found  that states with prior approval authority and loss ratio requirements better constrained health insurance premium increases.

Exchange Plans Have 34% Fewer Providers than Other Commercial Plans

By Tamara Rosin, Beckers Hospital Review | July 15, 2015

The average provider network for plans offered on the health insurance exchanges under the Affordable Care Act include 34 percent fewer providers than the average commercial plan offered outside the exchanges, according to a new analysis from healthcare advisory services company Avalere.

Commentary/ News

HHS Pushes States To Negotiate Lower Obamacare Rates

By Julie Rovner, Kaiser Health News | July 22, 2015

Some analysts who have looked at health insurers’ proposed premiums for next year predict major increases for policies sold on state and federal health exchanges. Others say it’s too soon to tell. One thing is clear: There’s a battle brewing behind the scenes to keep plans affordable for consumers. Now the Obama administration is weighing in, asking state insurance regulators to take a closer look at rate requests before granting them. [See also,The New York Times.]

Obamacare Waiver Gives States Opening For Huge Reforms. But Will They Take It?

By Dylan Scott, National Journal | Aug. 18, 2015

Starting in 2017, the Affordable Care Act will allow states to use waivers to pursue virtually any type of proposals for healthcare reform that they can imagine, as long as the resulting approach is budget neutral to the federal government and does not leave consumers worse off in terms of coverage and other criteria. It's a huge opportunity for states interested in expanding or changing how healthcare is delivered. But will states actually take advantage of it?

Bigger May be Better for Health Insurers, but Doubts Remain for Consumers

By Reed Abelson, The New York Times | Aug. 2, 2015

Insurance companies have been consolidating rapidly. Consumer advocates, policy experts and former regulators say that what may be good for the insurers may not be good for consumers.

To Address Doctor Shortages, Some States Focus on Residencies

By Rebecca Beistch, Kaiser Health News | Aug.12, 2015

Many states have a shortage of doctors and medical resident matches, especially in primary care. States, schools and hospitals need to take a thoughtful approach to getting residents exposed to treating underserved patients and the illnesses and complexities they have—whether in rural or urban areas.

Medical Scopes and Superbugs: Infection Risk Greater than Previously Thought

By Ilene MacDonald, FierceHealthcare | Aug. 3, 2015

The risk of a serious infection from contaminated medical scopes is much broader than previously thought and can lead to costly complications and readmissions. Scope manufacturers claim that hospitals often do not properly clean the devices. But even if staff follow the recommended disinfection guidelines, a device may still contain bacteria.

Cadillac Tax: A Portion of Obamacare Both Parties Hate

By Kimberly Leonard, US News and World Report | Aug. 14, 2015

The ACA’s “Cadillac Tax” originally was intended to help pay for other portions of healthcare reform and to keep employers from offering overly generous plans that may lead to unnecessary spending. As employers change their benefits to stay under the threshold for the tax which begins in 2018, critics contend that consumers could skimp on preventive care and lead to higher overall costs. But others contend the the Cadillac tax is a needed  break on health spending.