What’s New in Health Care Reform: Nov. 4


What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.

More Than Half Of ACA Co-Ops Now Out Of Insurance Marketplaces

More than half of the nonprofit health insurance co-ops formed through the Affordable Care Act are now off the market for the coming year, with the last-minute departure of a plan in Michigan. Two days after the start of the new enrollment season in insurance exchanges created under the health care law, the website of Michigan’s Consumers Mutual Insurance posted notice that it will not sell coverage for 2016. Via The Washington Post.

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Obamacare Co-ops Are In Trouble. So Far, Critiques Outweigh Solutions

Republicans on the House Ways and Means Oversight Subcommittee blamed Democrats for supporting a program that has cost taxpayers $3.4 billion in loans. “The co-ops have failed because we have people who don’t know how to run insurance companies running insurance companies,” Rep. Tom Price (R-Ga.) said at the hearing. Democrats, meanwhile, said the program could have been successful if Republicans had not reduced the $6 billion that was originally appropriated to the program to $3.4 billion. Via Morning Consult.

Researchers Say Their Path To Better Health Starts With Patients’ Input

It’s a program set up by the federal health law that many people have never heard about: an independent organization charged with bringing health care professionals and patients together in cooperative research ventures to find the best treatments for ailments ranging from diabetes to depression. The Patient-Centered Outcomes Research Institute (PCORI) already has funded 468 studies, and last month opened the second phase of a program to create research networks covering specific diseases and involving millions of patients across the country. Via Kaiser Health News.

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Will Cheaper Health Insurance Really Raise Wages? The Evidence Is Thin.

Obamacare slaps a 40 percent tax on the most expensive health plans — this is the much-maligned Cadillac tax. The argument for the Cadillac tax is it will cut health costs: Employers will choose cheaper insurance plans to stick beneath the Cadillac tax threshold, and then they'll move the money they would have spent on insurance over to wages. The result: America's health care spending falls, and its paychecks swell. No wonder economists love it. But why wouldn't companies just pocket the money instead? Via Vox.

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Third Year Of ACA Sign-Up Starts On Time But With Muted Fanfare

Around the country, the first day was relatively quiet. HealthCare.gov, the online enrollment system on which 38 states are relying this year, opened at about 7 a.m. Eastern time as scheduled. During its first six hours, about 40,000 applications were submitted through HealthCare.gov., according to federal officials. Separate exchanges established by a dozen states and the District also opened without incident. Via The Washington Post.

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Budget Deal Sets Back Key Health Care Bills

Congress’s two-year budget deal is throwing up hurdles for a pair of health care bills, taking away almost $13 billion in offsets that had been proposed to pay for the legislation. Both bills have already passed the House and are expected to reach the Senate sometime before 2016. One of those — the 21st Century Cures Act — passed with nearly 350 votes as lawmakers rallied behind the push for streamlined drug approvals and a boost in medical research funding. Via The Hill.

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Almost Half Of Obamacare Enrollees Will Keep Current Coverage

Premiums are slated to rise steeply next year for health plans across the board.  Yet almost half of voters who have health coverage under Obamacare say they will keep their current plan through 2016, according to a new Morning Consult online poll. Via Morning Consult.

Many Need To Shop Around On HealthCare.Gov As Prices Jump, U.S. Says

Health insurance consumers logging into HealthCare.gov for the first day of the Affordable Care Act’s third open enrollment season may be in for sticker shock, unless they are willing to shop around. Federal officials acknowledged that many people would need to pick new plans to avoid substantial increases in premiums. Via NY Times.

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Feds Are ‘Exploring Options’ On ObamaCare Co-Ops

The Obama administration is staying mum about the next step on its controversial healthcare co-op program, which has seen a half-dozen of the startup insurers fail in the last two weeks. In her first remarks since the string of co-op collapses this month, Health and Human Services Secretary Sylvia Mathews Burwell did not offer details about her involvement with the mostly state-run programs. Via The Hill.

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Medicare Softens Reimbursement Blow To Home Health Providers

The Medicare pay cut for home health providers in 2016 won't be as big as the CMS proposed in its draft payment rule, which the industry said would put some agencies out of business. The agency also finalized a small increase for dialysis providers and moved forward with new value-based payment model for home health agencies. The CMS said payments to home health providers would be reduced by about 1.4%, or $260 million, compared with $350 million as proposed in June. Via Modern Healthcare.

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Kelley Luedke

Kelley Luedke

Kelley Luedke is a Marketing Channel Manager at Mayo Clinic Laboratories. She is the principle editor and writer of Insights and leads social media and direct marketing strategy. Kelley has worked at Mayo Clinic since 2013. Outside of work, you can find Kelley running, traveling, playing with her kitty, and exploring new foods.