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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.
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.
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.
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.
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.
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.
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.
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.]
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?
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.
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.
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.
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.