In This Edition:
From Kaiser Health News:
These non-medical workers are increasingly being seen by hospitals as a critical point of contact for patients and a way to help hold down readmission rates and improve health outcomes. (Shefali Luthra, 4/11)
In a sweeping overhaul of its contracts, the state’s insurance exchange will require health plans to hold doctors and hospitals accountable for quality and cost. (Ana B. Ibarra and David Gorn, 4/8)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Not Quite Ready'" by Harley Schwadron.
Here's today's health policy haiku:
CONSUMERS DON’T ALWAYS LINK HEALTH CARE COST AND QUALITY
Is it really true?
That you get what you pay for …
Not clear with health care.
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
Summaries Of The News:
The move follows reports and complaints that insurance companies are struggling to make a profit by selling plans under the Affordable Care Act.
Bloomberg: UnitedHealth Quitting Obamacare Markets In Georgia, Arkansas
UnitedHealth Group Inc., the largest U.S. health insurer, has decided to call it quits in two state Affordable Care Act markets in the latest challenge to President Barack Obama's health-care overhaul. The insurer won't sell plans for next year in Georgia and Arkansas, according to state insurance regulators. Tyler Mason, a UnitedHealth spokesman, confirmed the exits and declined to say whether the company would drop out of additional states. Many insurers have found it difficult to turn a profit in the new markets created by the Affordable Care Act, where individuals turned out to be more costly to care for than the companies expected. (Tracer, 4/9)
The Fiscal Times: UnitedHealth Makes Good On Threat To Pull Out Of Obamacare
The Affordable Care Act suffered another jolt late last week with the news that UnitedHealth Group, the nation’s largest health insurer, was making good on its threat to pull out of Obamacare, beginning with its operations in Georgia and Arkansas. ... This development is troubling, especially if it UnitedHealth pulls out of other bigger states, or if other major insurers such as Aetna and Anthem follow suit. But experts have cautioned not to make too much of UnitedHealth’s flight from the market. While it is one of the largest insurers on the national scene, UnitedHealth nonetheless is a bit player in Obamacare and holds a much smaller market share than other rivals like Aetna and Blue Cross Blue Shield. (Pianin, 4/10)
Georgia Health News: United Quitting Georgia Exchange For Next Year
UnitedHealthcare will not offer any health plans on Georgia’s insurance exchange in 2017, state officials say. The giant Minnesota-based health insurer also said this week that it will pull out of Arkansas’ exchange for next year. ... UnitedHealthcare is the only company so far that has informed Georgia’s insurance department that it won’t be participating in the exchange next year, Glenn Allen, a department spokesman, said Friday. The company is one of nine offering plans in Georgia’s exchange this year. Under the Affordable Care Act (ACA), all states have exchanges — most of which are federally run — that help consumers find and buy health coverage. (Miller, 4/8)
Some Republican lawmakers are threatening to withhold funding for the program when they meet Wednesday. News outlets also report about Medicaid expansion issues in Alaska, Utah and Delaware.
Arkansas Online: Medicaid Plan Funds Fiscal Session's Target
The Republican-dominated Legislature convenes Wednesday for its fiscal session. At stake is the future of the Arkansas version of Medicaid expansion that provides health insurance to about 267,000 low-income Arkansans. ... Twenty-seven votes are required in the 35-member Senate and 75 votes in the 100-member House to reauthorize use of federal Medicaid dollars to purchase private health insurance for low-income Arkansans in fiscal 2017, which starts July 1. "It is going to be a hard lift, absolutely," said Sen. David Sanders, R-Little Rock, one of three legislative architects of the private-option program that Gov. Asa Hutchinson calls Arkansas Works. (Wickline, 4/10)
Times Record: Medicaid Issue Looms Over Arkansas Fiscal Session
Hutchinson has said that while he opposes the Affordable Care Act, continuing Medicaid expansion is the best path forward for the state. The program is projected to save Arkansas $757 million over the next five years and help rural hospitals stay afloat. Thirty House members and 10 senators, all Republicans, voted against the bill to create Arkansas Works last week. ... The opponents’ votes were not enough to stop the legislation from passing during the special session, but they would be enough to block an appropriation bill. (Lyon, 4/10)
The Associated Press: Arkansas Medicaid Plan Approved As Funding Showdown Looms
Arkansas Gov. Asa Hutchinson signed into law Friday his plan to keep the state's first-in-the-nation hybrid Medicaid expansion and urged fellow Republicans to avoid a Washington-style shutdown fight over their efforts to defund the program. The bills outline Hutchinson's proposal to rework the program, which uses federal funds to purchase private insurance for more than 250,000 low-income people. (DeMillo, 4/8)
Juneau (Alaska) Empire: Frustrated Democrats Make Futile Stands On House, Senate Floor
Democrats frustrated at the Republican-led House and Senate majorities’ pursuit of a lawsuit against Gov. Bill Walker for authorizing Medicaid expansion attempted Friday to de-fund continued legal action. In both bodies, the attempts were defeated along majority/minority lines. (Brooks, 4/10)
The Associated Press: Democrats Fail To Get Vote On Medicaid Suit Appeal Decision
Minority Democrats unsuccessfully sought to force a vote on whether the Legislature should continue pursuing a challenge to Gov. Bill Walker's authority to expand Medicaid on his own. (4/8)
The Associated Press: Utah Limited Medicaid Plan Still Needs OK From Washington
Utah's governor and lawmakers have agreed on a pared-down plan to expand Medicaid after wrestling with the issue for years, but the law still needs approval from federal officials. The plan, which Gov. Gary Herbert approved in late March, is estimated to insure about 16,000 people, mostly childless adults who are homeless or in treatment and offender programs. (4/10)
Wilmington (Del.) News Journal: More Del. Women Than Men Enrolled In Medicaid
Women outnumber men 2 to 1 in new Delaware Medicaid enrollees, which officials say signals a concerning trend around the number of women in poverty in the state. Since Delaware expanded its Medicaid program through the Affordable Care Act in January 2014, women have overwhelmingly enrolled for benefits. New data unveiled at the monthly Delaware Health Care Commission meeting showed that at the end of January women made up 63 percent of the 9,896 new enrollees. (Rini, 4/11)
The Essential Plan, available under the Affordable Care Act starting in 2016, is aimed at consumers who can't afford private coverage and don't qualify for Medicaid. In other news, California unveils a sweeping set of reforms for its exchanges.
The Associated Press: NY Health Exchange Expects 470,000 To Insure With New Option
The state's health exchange expects to enroll more than 470,000 New Yorkers in its new low-cost option for coverage this year. Testifying at an Assembly hearing this week, exchange Executive Director Donna Frescatore said New York chose to participate with the Essential Plan. The plan is an option under the federal Affordable Care Act starting in 2016. It's aimed at adults who don't qualify for Medicaid but have been unable to afford private coverage. (4/9)
Kaiser Health News: California Insurance Marketplace Imposes New Quality, Cost Conditions On Plans
Kaiser Health News staff writers Ana B. Ibarra and David Gorn report: "Moving into a realm usually reserved for health care regulators, the California health marketplace Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers. The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation." (Ibarra and Gorn, 4/8)
The Obama administration announced a new formula for paying doctors in an effort to tackle the nation's high drug prices, but doctors say the change will hurt their patients.
The Associated Press: Medicare Plan On Payment For Cancer Drugs Stirs Battle
A Medicare proposal to test new ways of paying for chemotherapy and other drugs given in a doctor's office has sparked a furious battle, and cancer doctors are demanding that the Obama administration scrap the experiment. The vehement reaction is raising questions about the government's ability to tackle high drug costs, the top health care concern for the public. (Alonso-Zaldivar, 4/11)
In other drug pricing news, PhRMA and Hillary Clinton can agree on one thing, Boston is hit especially hard with sky-high pharmaceutical costs and California tries a new approach —
STAT: The One Drug Pricing Idea Hillary Clinton And PhRMA Can Agree On
The pharmaceutical industry has opposed most of Hillary Clinton’s proposals to bring down drug costs, but there’s one idea its chief lobbyist supports: limiting the amount that consumers have to pay out of their own pockets. (Nather, 4/11)
STAT: Drug Prices In Boston Are Dozens Of Times Higher Than Overseas
Prescription drugs generally cost more in the US than in other countries. And a new analysis found this is especially true in Boston, where consumers can expect to pay many times more for their medicines than the international benchmark pricing used by the World Health Organization. The median costs of brand-name and generic drugs in Boston were 158 and 38 times higher, respectively, than the international benchmark. Similarly, median costs for brand-name and store-brand over-the-counter medicines were 21 and 11 times higher than the benchmark, according to the analysis, which was published in the Journal of Pharmaceutical Policy and Practice. (Silverman, 4/8)