October 28, 2024

Coverage Expansion Saves Overall Healthcare Costs

I absolutely loved this Health Affairs Forefront Blog arguing for an expansion of coverage and getting to true affordable universal access. It explicitly asks: “It is thus an ideal time to ask: Why aren’t we covering everyone and working to make care affordable for all?”

The authors dissect well opponents’ positions that the Affordable Care Act (ACA) drove up costs and that trimmed down benefit packages are just fine. They beat down both arguments with good statistics.

First, citing national healthcare expenditure data, they show that the ACA insurance expansions did not lead to accelerated cost growth. Second, they note that high-deductible health plans have negative impacts. Third, they argue that expansion might actually drive down cost growth more.

They conclude that “we can have universal coverage, affordable cost sharing, and continued cost growth deceleration.”

These points line up with my proposals for healthcare reform here: https://www.healthcarelabyrinth.com/a-modest-election-year-proposal-for-healthcare-reform/ and https://www.healthcarelabyrinth.com/digging-into-my-modest-election-year-proposal-for-healthcare-reform-part-1-the-importance-of-price-reform/ and https://www.healthcarelabyrinth.com/digging-into-my-modest-election-year-proposal-for-healthcare-reform-part-2-pivoting-to-care-management-from-our-obsession-with-utilization-management/ and https://www.healthcarelabyrinth.com/digging-into-my-modest-election-year-proposal-for-healthcare-reform-part-3-driving-to-affordable-universal-access/

I will likely reflect more on this in a new blog soon.

(Article may require a subscription.)

#healthcare #healthreform #healthinsurance #coverage #aca #medicaid #obamacare #exchanges

https://www.healthaffairs.org/content/forefront/aca-did-not-increase-spending-growth-so-we-can-expand-coverage-further

Elevance Health To Buy Home Health Business; United Seeks Amedisys Approval

Elevance Health plans to acquire home health company CareBridge for $2.7 billion. It would serve as an important asset for its growing service entity, Carelon. At the same time, UnitedHealth Group is meeting with regulators to seek to clear approval of its acquisition of Amedisys, also a home health company. The Justice Department is expected to oppose the acquisition, but planned concessions could change the outcome. United already owns LHC Group. If Amedisys is approved, United could control 10% of the home health market.

Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/unitedhealth-group-amedisys-deal-doj-justice-department-ftc and https://www.fiercehealthcare.com/payers/unitedhealth-amedisys-meet-regulators-hopes-pushing-33b-merger-over-finish-line-report and https://www.beckerspayer.com/m-and-a/unitedhealth-to-meet-with-justice-department-on-amedisys-deal-bloomberg.html

(Some articles may require a subscription.)

#homehealth #healthplans #elevancehealth #unitedhealthcare #manda #mergers #acquisitions

https://www.fiercehealthcare.com/finance/elevance-health-scoop-value-based-care-company-carebridge

Trump Proposes Caregiver Tax Credit

Republican presidential candidate Donald Trump announced this weekend his support for a new caregiver tax credit to help family caregivers provide support for a family member or parent. His opponent, Vice President Kamal Harris, would add chronic home health support to the Medicare benefit.

(Article may require a subscription.)

#homehealth #medicare #election24 #harris #trump

https://insidehealthpolicy.com/daily-news/trump-supports-tax-credits-family-caregivers

Brand Drug Lobby Wants 340B And PBM Reforms

The brand drug lobby, PhRMA, wants Congress to pass reform legislation that would bring more transparency from hospitals and community health centers participating in the 340B drug discount program. The administration stopped Johnson & Johnson from implementing a rebate (vs. upfront discount) for some drugs, arguing it violated statute.

I am not usually a defender of the brand drug lobby, but there is every reason to believe that hospitals and other entities have abused the intent of the 340B program. Hospitals are known to pocket the discounts and not otherwise expand access to intended low-income populations.

In related news, a new survey from the drug lobby says more than half of insured Americans say they can’t predict how much their drugs will cost. The survey also reported rising out-of-pocket costs. The drug lobby also wants more transparency for pharmacy benefits managers. Of course, the drug lobby is moving the debate away from its high prices whether on a gross or net basis.

Additional article: https://www.axios.com/2024/10/28/health-insurance-americans-medication-costs

(Some articles may require a subscription.)

#340b #drugpricing #hospitals #branddrugmakers #pbms

https://insidehealthpolicy.com/inside-drug-pricing-daily-news/phrma-hrsa-s-pushback-against-drug-maker-policies-permits-program

MA Supporters Disagree With HHS OIG Audit

I reported on a new Health and Human Services Office of Inspector General (HHS OIG) analysis which said that Medicare Advantage (MA) plans received $7.5 billion related in risk adjustment payments tied to Health Risk Assessments (HRAs) and HRA-linked manual chart reviews when the diagnoses were never reported on any other healthcare service events.  Both the Better Medicare Alliance (BMA) and AHIP, the health plan lobby, say HHS OIG is misrepresenting the purpose of these clinically based HRAs.

Whatever the value of the HRAs in identifying disease states and conditions as well as care management, both groups failed to address the main issue HHS OIG found – the fact that these diagnoses were never reported by providers or potentially treated.

Additional article: https://www.beckerspayer.com/policy-updates/medicare-advantage-plans-made-7-5b-from-questionable-assessments-in-2023-oig.html

#riskadjustment #hras #overpayments #medicareadvantage

https://www.beckerspayer.com/payer/insurers-call-oig-medicare-advantage-audit-misleading.html

— Marc S. Ryan

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