A new study released last week adds to the growing evidence showing that many Americans go without medical care or skip filling a prescription because of high costs. Published in the journal Health Affairs, the study also shows that Americans are less happy with their health care than those in many other countries. Rising health care costs are clearly a major public policy challenge, but new research from the Center for Studying Health System Change shows where significant attention needs to be focused to meaningfully address the problem. The study found that some providers and hospital systems have significant market power to negotiate higher-than-competitive rates. In some cases, they command almost five times what Medicare pays for inpatient services and more than seven times more for outpatient care. As the author puts it: “Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market.” Easy To Insure ME has the answers
Congress returned last week for the first of two lame duck sessions; the first one for the week of November 15 and the second to start November 29 and last until mid-December. Given the results of the election and the size of the Republican majority in the House (largest since 1948), the first week back was more about organizing and posturing than anything called legislation. As to leadership, each party in the Senate re-elected the very same team from the last Congress to serve in the upcoming 112th Congress (2011-2012). As expected, the House Republicans elected Ohio Congressman John Boehner as the incoming Speaker, with the remaining Republican leadership posts aligning with the same pecking order as in the 111th Congress. House Democrats pretty much followed the same pattern with Nancy Pelosi (soon to be ex-Speaker) elected as Minority Leader, even though conservative Democrats waged a futile battle to oust her. Once Democrats created a brand new 4th spot within leadership for current # 3, James Clyburn (South Carolina), the battle for Minority Whip dissipated and went to current Majority Leader, Steny Hoyer (Maryland). As for legislation, Congress did nothing on many key issues but is expected to act in the second lame duck session on the expiring Bush tax cuts, the Continuing (budget) Resolution to keep the government operating (expires December 3), and repeal of the new 1099 reporting requirement that PPACA imposes on small business.
The Senate, however, took a baby step toward staving off a 23 percent cut to Medicare physicians, set to begin on December 1, by approving a measure halting the cut until until January 2011. The House is expected to pass this measure when Congress returns for its second lame duck session. Just in case there are Congressional delays, CMS has already announced a suspension of claims processing until December 14 so that any delay in House passage does not lead to an actual cut in physician payments. Just how Congress will deal with the scheduled 2011 cut of 26 percent remains an open question, one that must be answered by the next Congress.
Only the regulators are pumping out paper with meaning. This week HHS announced that it was issuing regulations that follow closely the National Association of Insurance Commissioner’s (NAIC) recommendations for implementing a new medical loss ratio (MLR) requirement as part of the Patient Protection and Affordable Care Act PPACA). Starting next year, PPACA requires that insurers spend 80 (small group and individual) to 85 percent (large group) of the premium dollar on medical services or face the prospect of providing rebates to consumers. The new regulations outline disclosure and reporting requirements and how insurers must calculate MLRs.
Last week key federal agencies (Labor, Treasury, HHS) issued a revision to a previously issued Interim Final Regulation on grandfathering that set forth the rules allowing consumers to “keep the coverage they have” as of March 23, 2010, the date the President signed PPACA. The revision announced last week provides additional flexibility for fully insured grandfathered plans by allowing them to change insurers without jeopardizing their grandfathered status the same way a self-insured plan can change third-party administrators (without losing grandfathered status).