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Medicare

4. Rule Aims To Curb Huge Out-Of-Pocket Costs For Patients Kept In 'Observation Status'

Because the patients are never fully admitted to the hospital, Medicare will refuse to pay the sometimes astronomical costs of their nursing home stays. Now patients have to be notified of the loophole. Also in the news, Health and Human Services Secretary Sylvia Mathews Burwell's thoughts on value-based payments, stories about the program's new drug plan, an update on the Massachusetts "boondoogle" and a breakdown of the star ratings for New Hampshire hospitals.

The New York Times: New Medicare Law To Notify Patients Of Loophole In Nursing Home Coverage
In November, after a bad fall, 85-year-old Elizabeth Cannon was taken to a hospital outside Philadelphia for six and a half days of “observation,” followed by nearly five months at a nearby nursing home for rehabilitation and skilled nursing care. The cost: more than $40,000. The hospital insisted that Ms. Cannon had never been formally admitted there as an inpatient, so under federal rules, Medicare would not pay for her nursing home stay. The money would have to come from her pocket.The experience of Ms. Cannon and thousands like her inspired a new Medicare law — in force as of Saturday — that requires hospitals to notify patients that they may incur huge out-of-pocket costs if they stay more than 24 hours without being formally admitted. (Pear, 8/6)

Los Angeles Times: Obama's Health Secretary Wants To Make Patients Healthier By Transforming How Doctors And Hospitals Get Paid
Largely out of the spotlight, Obama administration officials have labored on an equally sweeping project to transform the way America’s doctors, hospitals and other medical providers deliver care. The foundation of this effort involves scrapping the way medicine has traditionally been paid for – a system akin to auto repair in which each service a doctor or hospital provides is billed separately, no matter how well it is performed and what the long-term outcome is.In place of that, the Obama administration is trying to build a system that pays doctors, hospitals and others based on how their patients recover and how much their care costs. (Levey, 8/5)

Politico Pro: Conservative Group Launches $4.8M Campaign Against Medicare Changes
The American Action Network on Monday is announcing a three-pronged, $4.8 million advocacy campaign that targets Medicare's plan to pilot a new way to pay for drugs, as well as the agency's long-gestating Independent Payment Advisory Board. It's the single largest issue-advocacy campaign in the conservative group's history — with $1.9 million in print ads, $1.7 million in direct mail, and $1.2 million in digital ads, all targeted at seniors — and it comes with Congress on recess. (Diamond, 8/8)

The Wall Street Journal: A New Medicare Charge Is Coming: Here’s How To Lessen The Blow
For high-income Americans covered by Medicare, now is the time to make tax moves to minimize an increase in premium surcharges. These surcharges apply because Congress has decided the top 5% or so of Medicare recipients should contribute more for their coverage than lower earners. Last year, about 3 million Americans owed extra premiums for Part B coverage for medical services, such as doctors, and about 2 million owed them for Part D coverage for drugs. (Saunders, 8/5)

Politico Pro: CMS Halts Payment Boost For Massachusetts Hospitals
Massachusetts won’t get its “boondoggle” next year. CMS this week said it won’t let a Nantucket hospital resubmit certain paperwork that, if it had been filed correctly, would have led to higher reimbursements for Massachusetts hospitals — and slightly lower payments for the rest of the country. The policy, which was part of Obamacare, has been derided by Republicans and hospitals in other parts of the country as a special benefit for Massachusetts that helped get the health law passed. But for one year at least, the “Bay State Boondoggle” is no more. (Haberkorn, 8/5)

Concord Monitor: Local Hospitals Get Three Of Five Stars From Medicare Rating System (For What It’S Worth)
Patients who were treated in Concord Hospital reported being much happier with their care than patients at many other New Hampshire hospitals, but that didn’t stop the facility from getting a middle-of-the-road three stars out of five in the latest Medicare ranking of thousands of hospitals.Franklin Regional Hospital also received three stars, as did the majority of hospitals around the country and about half of the 19 New Hampshire hospitals that received rankings. (Brooks, 8/6)

Health Law Issues And Implementation

5. In Conn., If Commissions End, Brokers Say They'll Exit Obamacare Exchanges

In other news, Modern Healthcare reports that fixes to the marketplaces are increasingly inevitable as large insurers send the message that, without changes, they will leave the exchanges.

The CT Mirror: Health Insurance Brokers Set To Exit Exchange If Commissions Go
As state regulators consider rate proposals for next year, both of the carriers set to remain on Connecticut's exchange – Anthem and ConnectiCare – could eliminate their commissions for brokers in 2017, creating uncertainty as brokers and customers plan for the coming year. Anthem said earlier this year it would eliminate broker commissions while ConnectiCare has yet to decide. Many brokers have indicated they will leave the exchange if they do not receive sufficient compensation. (Constable, 8/8)

Modern Healthcare: Fixes To Obamacare Insurance Exchanges Appear Inevitable 
Like basketball players who are sick of losing a game, many health insurers who ventured into the new marketplaces are sending a clear message: We're taking our ball and going home.And if the government wants them to play again, they want more of the rules changed.The large publicly traded insurers wrapped up second-quarter results last week. Adverse selection continued to weigh down the finances of health plans on the Affordable Care Act marketplace. (Herman, 8/6)

News outlets also report on developments in Florida and Texas —

Orlando Sentinel: Novel Health Insurance Plan Cancels 2017 South Florida Debut 
Weeks after announcing a new "relationship-based" health insurance plan that would provide patients unlimited access to health coaches and primary doctors with no co-pay, Harken Health Insurance withdrew its application to open in South Florida in 2017.Harken's withdrawal further narrows the number of health insurance choices for customers who qualify for federal subsidies under the Affordable Care Act exchanges. (Hurtibise, 8/5)

Houston Chronicle: No Job. No Insurance. No Chance At 'Obamacare.' No Safety Net In Texas. Welcome To Cuero 
Six years after President Barack Obama's health care law passed with its sweeping mandate for nearly universal coverage, Texas still leads the nation in the number of uninsured. More than 4.5 million Texans are without coverage, without consistent medical care.The story of the uninsured is told in political ideology and unmet promises - unfolding still, one town, one family, at a time.More than three-quarters of a million Texans now have no realistic entry to health insurance because of the state's vow not to expand Medicaid. (Deam, 8/6)

Campaign 2016

6. How Indiana's Worst Public Health Crisis In Years Swayed Pence's Needle-Exchange Stance

In 2015, HIV was burning a path through the state and experts told Gov. Mike Pence the only hope was to lift a ban on needle exchanges. He resisted, but then changed his mind.

The New York Times: Mike Pence’s Response To H.I.V. Outbreak: Prayer, Then A Change Of Heart
On the evening of March 24, 2015, Sheriff Dan McClain got an unexpected voice mail: “This is Gov. Mike Pence calling. I would welcome the opportunity to get your counsel on what’s going on in Scott County.”What was going on was unprecedented in Indiana and rare in the United States: H.I.V. was spreading with terrifying speed among intravenous drug users in this rural community near the Kentucky border. Local, state and federal health officials were urging the governor to allow clean needles to be distributed to slow the outbreak. (Twohey, 8/7)

Politico: How Pence's Slow Walk On Needle Exchange Helped Propel Indiana's Health Crisis
Indiana Gov. Mike Pence signed a pledge last month, along with most of the nation’s governors, to combat the opioid crisis, calling it “one of the deadliest drug epidemics in our nation’s history.” But when confronted with a spiraling HIV outbreak in his home state as a result of opioid addicts sharing contaminated needles, Pence dragged his feet before agreeing to lift a ban on programs that distribute sterile needles. (Demko, 8/7)

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