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The Governor of New Mexico announced that the state will seek federal approval to reverse cost-sharing and enrollment provisions instituted by the previous Governor that were designed to conserve state spending on Medicaid, reports AP News. Specifically, the state will reverse course on its plans to charge some Medicaid patients a monthly insurance premium of $10 and co-payments of $8 on certain brand-name drugs and visits to the emergency room for routine medical care. According to the Governor, these provisions threaten to limit access to emergency services and disrupt health coverage for hundreds of thousands of state residents who are poor and disabled.
North Dakota lawmakers voted down legislation that would have enabled dental therapists to practice in the state by a margin of 2 to 1. Report by The Bismarck Tribune, the bill would have allowed dentists to hire dental therapists, mid-level clinicians comparable to physician assistants and nurse practitioners, in certain settings including Indian Health Service clinics and nonprofit dental practices. Sponsors and advocates of the legislation believed that it would increase access to dental care for vulnerable populations such as Native Americans, children, the elderly, and low-income families, while opponents cited quality and safety concerns as the main reason for voting against the bill.
A large backlog in patients seeking government help left state regulators unable to provide timely support to thousands of Texans who requested mediation from the short-staffed Texas Department of Insurance, according to the Texas Tribune. The overwhelmed state mediation program highlights the widespread problem of surprise emergency medical bills after the Texas Legislature gave state regulators increased authority to force insurers and providers to the negotiating table. The demand for the mediation program has increased from just 43 requests in 2013 to 4,519 in 2018, accounting for $8.8 million in qualifying surprise bills. Though the agency is able to get insurance companies to agree to pay more, lowering the amount a consumer owes, the department does not keep track of how much the consumer pays at the end of the mediation process. Agency officials said they have already made strides to improve internal processes to prevent another backlog from choking the system.
Utah Gov. Gary Herbert signed legislation adopting a limited expansion of the state’s Medicaid program, defying voters who in November approved the full Obamacare program through the ballot, according to Politico. Under the new GOP-written plan, Utah will ask the Trump administration for permission to implement unprecedented restrictions on the health coverage program for the poor, while insuring about 60,000 fewer people than the Obamacare expansion would have and initially costing the state tens of millions of dollars more.
Colorado is joining a growing number of states that wants to cut certain prescription drug prices by importing licensed drugs from Canada, according to the Highlands Ranch Herald. This idea is central to Governor Polis' campaign to rein in healthcare costs for Coloradans, many of whom (especially those in rural and mountain regions) pay some of the nation's highest insurance premiums. The Colorado Senate Health & Human Services Committee advanced a bill that would direct the Department of Health Care Policy and Financing to design a program in which the state takes on the responsibility to act as a wholesale importer of prescription drugs from licensed Canadian suppliers and distribute them to Colorado pharmacies and hospitals. Opposition to this proposal includes the Colorado Competitive Council and Colorado Chamber of Commerce, citing a lack of safety for patients to use drugs without FDA scrutiny.
States are instituting regulations in efforts to slow healthcare spending growth, but which regulations are effective remains unclear. A recent report in Health Affairs assessed Rhode Island’s 2010 affordability standards, which imposed price controls on contracts between commercial insurers and hospitals/clinics and required commercial insurers to increase their spending on primary care and care coordination services. Researchers concluded that total spending growth decreased, driven by lower prices concordant with the adoption of price controls, and quality measures were unaffected or improved. The Rhode Island experience indicates that states may be able to slow total commercial healthcare spending growth through price controls while maintaining quality.
Achieving widespread exchange of health information is a national health policy objective to boost treatment efficiency, reduce healthcare costs and improve patient outcomes. A recent study of Florida hospitals found that participation in health information exchange (HIE) was associated with a greater reduction in the probability of unplanned, thirty-day readmissions for acute myocardial infarction compared to nonparticipating hospitals. These findings indicate that HIE can be leveraged to improve quality measures targeted by the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program and may hold promise for achieving broader policy goals.
The Rhode Island Healthcare Cost Trends Project – which represents providers, payers, policymakers and consumers – has agreed to establish and commit to an annual healthcare cost growth target, according to the Peterson Center on Healthcare. In coming months, the steering committee will develop a methodology to analyze healthcare spending growth on an annual basis and create a “sustainability plan” for the project going forward. These actions are part of a larger effort to better understand how actionable data insights, analytic tools, state regulatory authority and stakeholder engagement can drive meaningful, durable changes in healthcare performance.
Baylor Scott & White Health of Dallas and Memorial Hermann of Houston have discontinued merger discussions, which may be in the best interest of patients, according to Dallas News. Baylor and Memorial operate some of the leading hospitals in Texas and their combined revenue approaches $15 billion a year. Together, they would have had over 73,000 employees, nearly 14,000 affiliated and employed physicians, and 68 hospitals stretching from Dallas to Austin to Houston. Mergers can give health systems increased negotiating power, however they often don’t provide savings or higher quality. Experts have found that mergers tend to lead to rising prices and profits, and benefits rarely get to patients or employers.
The 2019 legislative session is about to start in Colorado, and healthcare, especially funding healthcare will be one of the most actively debated, according to the Colorado Sun. One particular point of tension is the rising costs of insurance, which has risen over 50 percent over the last decade for individuals who had coverage through an employer. Another area of high costs for individuals are health plan deductibles whose costs are rising even faster than premiums; over 65 percent between 2010 and 2017 (more than five times the rate of inflation). Colorado's out-of-pocket costs for healthcare are among the highest in the nation, according to a recent analysis from the Colorado Health Institute. These charts show that the rising costs of healthcare are complicated and connected, involving many different players in the system.