What’s New in Health Care Reform: Feb. 17


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.

Insurers and Medicare Agree on Measures Tracking Doctors’ Quality

The federal government and the insurance industry released an initial set of measures of physician performance that they hope will reduce the glut of conflicting metrics doctors now must report. The measures are intended to make it easier for Medicare, patients, insurers, and employers to assess quality and determine pay. Via Kaiser Health News.

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Costs, Changes Led Obamacare Enrollment to Fall Far Short of Estimates

The number of people who signed up for health insurance for 2016 on the state and federal exchanges was up to 40% lower than earlier government and private estimates, which some say is evidence that the plans are too expensive and that people would rather pay a penalty than buy them. Via USA Today. 

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Cancer Patients Snagged in Health Law’s Tangled Paperwork

Hundreds of thousands of people lose subsidies under the health law, or even their policies, when they get tangled in a web of paperwork problems involving income, citizenship, and taxes. Some are dealing with serious illnesses like cancer. Advocates fear the problems, if left unresolved, could undermine the nation's historic gains in health insurance. Via AP.

CMS Readies $7.7 Billion for Affordable Care Act Reinsurance Payouts

Health insurers that sold plans on the exchanges in 2015 and enrolled droves of high-cost members, could haul away as much as $7.7 billion this year, as part of the health care law's reinsurance program. The CMS released a memo that said the agency expects its jar of reinsurance money will total $7.7 billion. The payouts, to be issued this year, will reflect data from the 2015 benefit year. Via Modern Healthcare.

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Insurers Lose Billions on Obamacare Plans, Win on Medicaid Expansion

Though the nation’s health insurance industry is having a tough time turning a profit selling individual policies on the public exchanges under the Affordable Care Act, the health law’s Medicaid expansion is churning big profits. Via Forbes.

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Surge in Medicare Advantage Sign-Ups Confounds Expectations

Five years into Medicare spending cuts that were supposed to devastate private Medicare options for older Americans, enrollment in private insurance plans through Medicare has shot up by more than 50 percent, confounding experts and partisans alike and providing possible lessons for the Affordable Care Act’s insurance exchanges. Via NY Times.

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How Obama Would Fix Obamacare if Congress Would Let Him

Obama signed off on a bunch of small changes to Obamacare and reluctantly agreed to delaying some key provisions last year, but most of his ideas for further reforming the health care system aren't likely to get so much as a hearing in today's rancorously partisan political atmosphere. Drawn mainly from the budget request the White House released this week and proposals from previous years, here are some of the big ways Obama would improve Obamacare if he had his way. Via The Huffington Post.

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Top Hospitals Likely Are Available on a Marketplace Plan, Study Finds

Despite much hand-wringing over the size and quality of provider networks on the health insurance marketplaces, many top-notch hospitals are available in-network in marketplace plans this year, a new study found. However, more than half of those hospitals participated in fewer plans than last year, limiting their in-network availability to just one marketplace plan in a growing number of cases. Via Kaiser Health News.

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A Reality Check on Obama’s Billion-Dollar Opioid Addiction Plan

President Obama wants to spend $1 billion over two years to tackle the nation’s opioid epidemic. That’s a big commitment, and many in the addiction field are highly encouraged. But for the plan to make a dent in a crisis that’s now killing nearly 30,000 Americans a year, it will have to overcome several big hurdles. Here are five of them. Via Stat News.

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Senate Committee, White House Negotiating Mental Health Package

The Senate Health, Education, Labor and Pensions Committee is quietly working with the Obama administration on an ambitious bill to overhaul the nation’s mental health and substance abuse treatment systems. Chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) are working with members of the committee, as well as the administration, to put together broad legislation that goes beyond current proposals. The bill will likely be considered in committee sometime next month. Via Morning Consult.



Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Clinic Laboratories.

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