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Kaiser Health News Original Stories

6. Political Cartoon: ‘Grave Consequences’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘Grave Consequences’" by Adam Zyglis, The Buffalo News.

Here's today's health policy haiku:


Gap is narrowing.
Teen boys not taught about sex,
Now girls missing out.

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Summaries Of The News:


7. Nonprofit Hospitals Dominate Top 10 Most Profitable Ranking

Market muscle — whether gained from size, prestige or a lack of competition — plays a key part in hospitals' power to negotiate with insurers, the study finds.

The Associated Press: Study: 7 Of 10 Most Profitable US Hospitals Are Nonprofits
Seven of the 10 most profitable U.S. hospitals are nonprofits, according to new research, including one in Urbana, Illinois, where hospital tax exemptions are headed for a contentious court battle that soon could determine whether medical facilities are paying their fair share of taxes. The "Top 10" list accompanies a study published Monday in the journal Health Affairs. (5/2)

Kaiser Health News: For Hospitals, Prestige Leads To Profits
The top three were nonprofits. Gundersen Lutheran Medical Center, part of the large Wisconsin-based health system, made the most money: $302.5 million just on its patients. California-based Sutter Medical Center, also part of a large system, came in second. Stanford Hospital, also in California, was third. Those hospitals share a key attribute, the authors argued. Whether because of their size, their prestige or their influence in the community, they have more power to negotiate prices, meaning they can charge insurers more for the care they give. “They are the only provider — or they are clearly the dominant provider — and the insurers in that community are relatively weaker, and there are a lot of them,” said Gerard Anderson, director of the Johns Hopkins University Center for Hospital Finance and Management, and one of the study’s authors. (Luthra, 5/2)

The Washington Post: These Hospitals Make The Most Money Off Patients — And They’re Mostly Nonprofits
The hospitals with the highest price markups earned the largest profits. Anderson thinks they should lower their prices or plow more back into the communities. "Mostly, the hospitals are able to charge more because they can, and they do," he said. "There's no need for nonprofit hospitals to earn substantial profits." Hospitals are among the largest property owners and employers in many communities. Those designated as nonprofits receive state and federal tax breaks for providing “charity care and community benefit.” (Sun, 5/2)

Health Law Issues And Implementation

8. Tenet Predicts Other Insurers Will Absorb UnitedHealth's Share Of Exchange Market

The hospital operator downplayed the effect UnitedHealth's departure from many Affordable Care Act marketplaces will have, saying insurers are expected to make adjustments.

Reuters: Tenet Sees Competitors Picking Up UnitedHealth Exchange Business
Tenet Healthcare Corp, the third-largest U.S. for-profit hospital operator, expects other insurers to step in and absorb UnitedHealth Group Inc's share of the exchange market when the largest U.S. health insurance provider exits that business, company executives said on Monday. UnitedHealth, one of the biggest sellers of plans on the exchanges, last month said it would exit the Obamacare individual insurance market in most states next year, citing losses from the program. (Kelly, 5/2)

The Wall Street Journal: Tenet Healthcare Hurt By Lawsuit Costs, Helped By Decline In Uninsured
Tenet Healthcare Corp. swung to an unexpected first-quarter loss as the hospital operator increased a reserve for a potential resolution of a whistleblower lawsuit that alleges the company’s Georgia hospitals took part in a kickback scheme. However, shares rose 4.6% to $33.10 in recent after-hours trading as per-share earnings, excluding certain one-time items, were mostly above expectations and revenue topped estimates. (Stynes, 5/2)

9. Governor Unveils 'Healthy Louisiana' Name For Medicaid Expansion

Meanwhile, Gov. John Bel Edwards faces key challenges as his administration rolls out the program to expand Medicaid coverage to more low-income residents while also battling to fix the state's budget shortfall.

New Orleans Times-Picayune: John Bel Edwards Debuts 'Healthy Louisiana,' The Replacement For Bayou Health
Gov. John Bel Edwards debuted a new website and name for Louisiana's Medicaid program on Monday (May 2), saying "Healthy Louisiana" will replace Bayou Health as a program aimed at making people across Louisiana healthier. The new name is expected to be printed on all new materials being distributed as part of Medicaid expansion, Department of Health and Hospitals Secretary Rebekah Gee said Healthy Louisiana will only be printed on new materials. That means no cost to the state for the new moniker, though the managed care organizations that run Bayou Health have expressed concern about the costs on their side. (Litten, 5/2)

New Orleans Advocate: At Baton Rouge Events, John Bel Edwards Attempts To Build Support For Budget Changes, Medicaid Expansion
Gov. John Bel Edwards on Monday made back-to-back appearances in Baton Rouge to appeal to supporters and community leaders on two of the key issues he’s facing — the state budget shortfall and expansion of the Medicaid health care program. The effort to plug a $600 million gap in the state budget that begins July 1 and the looming launch of looser qualifications for Medicaid, which Edwards has hailed as a way to save the state millions of dollars while providing health care coverage to hundreds of thousands of residents, present two of the biggest tests for the Democratic governor’s administration in the next three months. (Crisp, 5/2)

10. Covered California's Unique Negotiating Power Helps Slow Premium Increases

Other states and the federal marketplace accept any plan that seeks to participate, but California's exchange negotiates prices with insurers to help consumers get better prices. Meanwhile, pregnant women with Covered California plans are being transferred from the exchange into Medi-Cal without any consent or notice.

Kaiser Health News: Pregnant Women Dumped By Covered California Into Medi-Cal, Without Notice Or Consent
Lynn Kersey has some advice for pregnant women who bought health insurance policies from Covered California and want to keep them: Don’t report your pregnancy to the agency. “It’s not a requirement … and it’s actually worse to do so,” said Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County. Why? Two of Kersey’s clients with Covered California health plans recently were thrown into Medi-Cal — the state’s health program for low-income residents — without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange. (Bazar, 5/3)

Administration News

11. In Scathing Report, DOJ Says South

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