In This Edition:
From Kaiser Health News:
Doctor and hospital switching is a recurring scramble for these consumers who face rising premiums and plan exits. (Jordan Rau, 10/17)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'No One Is Spared'" by Signe Wilkinson .
Here's today's health policy haiku:
IS THIS WHAT MOMMA MEANT WHEN SHE SAID TO SHOP AROUND?
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:
An early draft of the rule sparked an outcry from physician groups that feared doctors in small medical practices would suffer under the new formula, but Centers for Medicare & Medicaid Services officials sought to allay those concerns by making it easy to avoid penalties in the first year.
The Associated Press: Medicare Unveils Far-Reaching Overhaul Of Doctors' Pay
Changing the way it does business, Medicare on Friday unveiled a far-reaching overhaul of how it pays doctors and other clinicians. The goal is to reward quality, penalize poor performance, and avoid paying piecemeal for services. Whether it succeeds or fails, it's one of the biggest changes in Medicare's 50-year history. (10/14)
The Wall Street Journal: U.S. Officials Finalize Rule For Medicare Payments To Doctors
The Centers for Medicare and Medicaid Services released the highly anticipated rule, which introduces new bonuses and penalties tied to performance for 712,000 doctors and other clinicians starting in 2019. The new bonuses and penalties would be paid or imposed depending on how well doctors do on measures of quality, electronic health records and managing costs. Doctors can also enter Medicare contracts that include quality and cost-control incentives and earn bonuses. (Evans, 10/14)
Modern Healthcare: Final MACRA Rule Expands Exemptions, Flexibility
Nearly a third of physicians could be exempt from Medicare's new Merit-based Incentive Payment System under a final rule the CMS issued Friday for implementing the Medicare Access and CHIP Reauthorization Act. The CMS also signaled it would broaden the opportunities for physicians to participate in alternative models that make them eligible for bigger rate increases and bonuses. (Dickson, Muchmore and Livingston, 10/14)
The Hill: White House Rolls Out Major Shift In Medicare Payments
The Obama administration on Friday rolled out its long-awaited rules for shifting how Medicare pays doctors, implementing changes made by a bipartisan law Congress passed last year. The changes are part of the administration’s larger effort to shift healthcare payments away the traditional system of paying doctors a fee for each test or procedure provided, and toward a system that rewards doctors for improving patient health. In the long run, the goal is to save Medicare money and encourage doctors to provide higher quality care. (Sullivan, 10/14)
The Fiscal Times: Medicare Unveils Big Changes In How It Makes Payments
For decades, doctors and hospitals have routinely received a set fee for their services and tests in treating elderly Americans under the Medicare program, regardless of the outcome. This fee-for-service approach provided virtually no incentives for physicians to achieve better outcomes and assure that the patient wasn’t coming back for more treatment or hospitalization anytime soon. The new rule, an outgrowth of bipartisan legislation approved by Congress last year to change the way physicians are paid, is designed to shift the medical system toward rewarding quality over quantity of treatment while saving hundreds of billions of dollars in the coming years, starting in 2019. (Pianin, 10/15)
Morning Consult: CMS Gets Kudos For New Medicare Payment Rule
Reaction was positive to a Centers for Medicare and Medicaid Services rule released Friday finalizing changes to how doctors are paid through Medicare. Health provider groups said they were pleased that the agency has been, and expects to continue to be, responsive to their concerns. The changes implement a new law aimed at saving the Medicare program money by rewarding providers for high quality care. Under the rule, providers will have two paths to choose from to start shifting away from the traditional fee-for-service system. (McIntire, 10/14)
The vice president will deliver his final report, outlining the challenges that face cancer researchers in its goal to make a decade’s worth of progress against the disease in just five years.
The Washington Post: Biden’s Final ‘Cancer Moonshot’ Report Outlines Progress And Hurdles
Vice President Biden is expected to tell President Obama on Monday that the administration’s “cancer moonshot” effort infused new urgency in the fight against the disease but that formidable challenges remain, including a lack of coordination among researchers, an “antiquated” funding culture and unacceptably slow dissemination of important information about new treatments. (McGinley, 10/17)
The health law's marketplaces will open Nov. 1 for customers to buy 2017 coverage, and many people are worried about steep increases in premiums and deductibles and the prospects of having to change plans. Also, a look at the varied experiences of insurers serving those marketplaces.
The Washington Post: In North Carolina, ACA Insurer Defections Leave Little Choice For Many Consumers
More than 250,000 people in North Carolina are losing the health plans they bought under the Affordable Care Act because two of the three insurers are dropping out — a stark example of the disruption roiling marketplaces in many parts of the country. The defections mean that almost all of the state, from the Blue Ridge to the Outer Banks, will have just one insurer selling ACA policies when the exchanges open again for business in November. The remaining company, Blue Cross Blue Shield of North Carolina, agonized over whether to leave, too. Instead, it is raising its rates by nearly 25 percent. (Goldstein, 10/14)
Kaiser Health News: Frustration Runs Deep For Customers Forced To Change Marketplace Plans Routinely
Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. The instability, which preceded the health law, is intensifying in the fourth year of the Affordable Care Act’s marketplaces for people buying insurance directly instead of through an employer. “In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.” (Rau, 10/17)
Modern Healthcare: Latest Filings Show Exchange Plan Health Premiums Rising Sharply In Some States
States where insurers underpriced individual plans in the early years of the federal healthcare exchanges are posting sharply higher premiums for next year, although subsidies will moderate the increases for many low- and moderate-income consumers. Illinoisans learned Friday that people buying insurance on the state's exchange will face steep price increases for next year. The Illinois Department of Insurance published an analysis of 2017 health plans Friday based on final price increases approved by state and federal regulators. Statewide, the average rate increase for the lowest cost "silver" plan is 45%. (Silver is a label of a middle-tier plan that's been a popular choice.) (10/15)
Modern Healthcare: How Some Blues Made Obamacare Work While Others Failed
The individual health insurance marketplace is not a small capillary for Blue Cross and Blue Shield of Arkansas, the dominant insurer in the fourth-poorest state in the country. It's a main artery. And the good news for the Arkansas Blues is that the individual market—a “disaster” according to presidential hopeful Donald Trump—is pumping black ink, not the blood-red ink reported by some insurers selling individual plans on the Affordable Care Act exchanges across the country. ... Next door, in Tennessee, a much different story unfolded. Blue Cross and Blue Shield of Tennessee posted an underwriting loss of $195.7 million on $866.4 million of revenue in 2015 just from its individual plans—a negative margin of almost 23% that gets worse when administrative expenses are tacked on. (Herman, 10/15)
Meanwhile, a fight is brewing between congressional Republicans and the health insurance industry —
The Hill: House GOP Files Brief In ObamaCare Case
House Republicans are wading into the heated legal battle between the White House and several insurers that claim they are owed money under ObamaCare. The House GOP announced Friday it has filed a brief in a major ObamaCare lawsuit that involves a multibillion-dollar shortfall in a fund intended to cushion health insurers from financial losses under the law. The $5 billion class-action lawsuit was filed by the now-shuttered insurance company called Health Republic of Oregon. It is one of about a dozen companies that have sued over the still-delayed payments, which they say crippled their businesses. (Ferris, 10/14)
Morning Consult: AHIP Preparing To Fight GOP Attempts To Stop Insurer Payments
Health insurers do not want congressional Republicans to block potential settlements of their lawsuits against the administration involving Obamacare, according to Marilyn Tavenner, president and CEO of America’s Health Insurance Plans. Within the Republican conference, options are being discussed about how to stop any lawsuit-related payments to the industry. Conservative groups are loudly urging against such settlements. (Owens, 10/14)
Despite the added protections of the health law, many immigrants are still unable to get coverage and local groups are looking for ways to help them —
Modern Healthcare: Safety Net Systems Step Up Care For Immigrants Barred From ACA Coverage
While the Affordable Care Act cut the number of uninsured by about 32%, millions of immigrants don't qualify for the law's coverage expansions. They still have few options for primary care. People living in the U.S. without authorization can't buy health insurance from the ACA's exchanges and aren't eligible for Medicare, Medicaid or the Children's Health Insurance Program. Even lawful residents who have lived in the U.S. for less than five years can't get Medicaid or CHIP. Local governments in areas with large numbers of new immigrants have stepped up to become their health safety net. (Johnson, 10/15)
The pharmaceutical industry has taken to treating secondary symptoms of opioid abuse with more pills. Meanwhile, even as the U.S. tries to regulate the trade of chemicals used to make fentanyl, a new, extremely potent drug is hitting the streets.