November 27, 2023

Pro Publica Article on Health Plans Not Covering Mandated Services

Pro Publica article recounts where health plans have not covered mandated services in state laws.  It is easy to sensationalize mistakes, but health plans every day are approving treatments timely. (May require subscription.)

#plandenials #healthplans

Link to Article

Will New Marketing Rules Hurt Big Plan Performance?

Interesting article that says the new Medicare Advantage (MA) marketing rules could mean smaller plans now have a fighting chance against bigger ones, which seemed to enter into the variable and extraordinary compensation with agents and other entities to attract members.  A new marketing clampdown in the 2025 rule would stop most of this. Note, too, a plan official saying that there may be loopholes in the new proposed rule. (May require subscription.)

#marketing #medicareadvantage

Link to Article

Per Worker Healthcare Costs Increased 5.2% in 2023

More evidence that inflation is increasing for employer-provided healthcare.  This article places it at 5.2% in 2023, with smaller businesses seeing even greater cost increases.  Per employer costs now over $15,700. Other articles say that 2024 could see greater increases and the trend will continue for several years. Drug costs are driving much of the inflation. The article says that employers are attempting to limit cost-shifting to employees. 

#healthcare #employercoverage #healthinsurance

Link to Article

Insights Into Party Differences And What DeSantis White House Might Look Like On Healthcare

Two articles from Kaiser Health News on the election year.  At the link is one on DeSantis’ views and what his administration might do on healthcare.  Here is a link for upcoming DeSantis-Newsom Red/Blue Showdown: https://kffhealthnews.org/news/article/gavin-newsom-ron-desantis-health-care-debate-comparison/

#politics #newsom #desantis #healthcare

Link to Article

Battle Royale Over Budget Looming

Good article in The Hill on what looks to be a bruising budget battle as the CRs come due early in the year. 

#governmentshutdown #crs #speakerjohnson #schumer #biden

Link to Article

Utah Numbers Show 130,000 Who Lost Medicaid Are Uninsured

Utah officials say 130,000 of 500,000 who lost Medicaid coverage during redeterminations are now uninsured because they did not convert to other coverage, such as children’s health insurance, the Exchanges, or employer coverage. So far about 11 million nationwide have lost coverage in Medicaid.  That could mean our uninsured numbers increase by millions.

#medicaid #redterminations #coverage #healthinsurance

Link to Article

Trump Calls For Alternative To Affordable Care Act

Former President Trump says he may look for an alternative and repeal the Affordable Care Act (ACA).  As the article notes, most Republicans have given up on their cause celebre from several years back for a few reasons.  First, they know it has helped millions of families obtain coverage.  Second, many of those families right in the middle of GOP strongholds or districts that lean Republican. Third, even if a good alternative could be found, the chaos of transition would be huge.  As a Republican, I back the ACA as it is because it covers so many with affordable coverage.  Upfront coverage is a wise investment.  The block grant and other schemes that the GOP had as an alternative would not deliver affordable access to care. The fact is that Medicaid is a cheap way of granting affordable access.

#medicaid #aca #obamacare #exchanges

Link to Article

— Marc S. Ryan

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