Unbiased Analysis of Today's Healthcare Issues
Today, Aetna, the third-largest U.S. health plan, agreed to buy Coventry Health Care for $5.6 billion. Aetna paid a 20 percent premium for Coventry. Why is Coventry such an attractive target? The answer is that President Obama’s Health Reform will greatly expand the number of people eligilbe for Medicaid. Since many states are moving towards…
Governor Chris Christie vetoes a bill today that would form have created a health exchange in New Jersey. “While I appreciate the Legislature’s attempt to find steady policy footing in these shifting legal sands, I am concerned that a hastily created exchange in New Jersey will impose unnecessary obligations upon the state’s citizens,” Christie said…
Joe Paduda has some interesting points: “requiring insurers accept all applicants is favored by most Republicans (according to Politico) but a) some senior Republicans hate the idea and b) there’s zero consensus re how to actually make that work. Do they forbid upcharging for older/sicker people? Adopt some form of risk-adjustment and/or financial transfer among/between insurers based…
Today, the Supreme Court is deciding whether to let many of the provisions of the Affordable Care Act (a.k.a. ACA, a.k.a. Health Reform, a.k.a. Obamacare) stand. One of the key provisions is the individual mandate. The individual mandate requires all individuals to purchase health insurance. If you don’t buy health insurance, you must pay a…
Although Health Reform did little to reduce the cost of health care, it did make significant strides to expand access to care. For low-income individuals, the increased access comes along two dimensions: expanded Medicaid eligibility and increased physician fees. Specifically, Health Reform required to Make all individuals with incomes below 138% of the Federal Poverty…
Health reform not only changes the health care market for the demand side (e.g., patients, insurers), but also for the supply side (e.g., hospitals, physicians). In the Medicare setting, a number of initiatives have aimed to pay providers who provide high-quality or low-cost care more money, and pay providers who provide low-quality or high-cost care…
The answer depends on the state. Today, I examine an Urban Institute research paper that looks at this progress in more detail. Dividing States into 3 Group The most advance States fall into Group 1 (CA, CO, CT, DC, HI, IN, MA, MD, NV, OR, RI, UT, VT, WA, WV). These states have either enacted…
One of the provisions in the Patient Protection and Affordable Care Act (a.k.a ACA, a.k.a. Health Reform, a.k.a. Obamacare) is that it limits the profits of health insurance companies. The ACA imposes a minimum medical loss ratio (MLR) on all insurers. The MLR is the amount of money spent on covered person medical care divided…
For many years, fee for service payment was the status quo. FFS model encourages hospitals to adopt the following strategies to maximize market share and profits: Centered on short-term acute care Focused on specialist alignment Driven by a volume-based service-line strategy Using expensive medical equipment purchases to encourage physician referrals Attracting patients with new construction…
Health Reform’s Accountable Care Act (ACA) mandates the creation of Accountable Care Organizations (ACOs). Dartmouth researcher Elliott Fisher stimulating much of the interest in ACOs by introducing the concept of an “extended hospital medical staff” at a 2006 meeting of the Medicare Payment Advisory Commission (MedPAC). Today, I review an article by Berenson and Burton (2011) describing…