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Watchdog.com
Chris Butler
Fri, 2014-08-29
"Internal Revenue Service officials must enforce a new Obamacare tax designed to collect money from medical device manufacturers, but they’re losing money because they don’t know which companies even qualify for the tax, a new audit shows. On top of that, the IRS wrongly penalized more than 200 of these companies for not paying their taxes when, in fact, they did pay, the audit from the Treasury Inspector General for Tax Administration reports. Why doesn’t the IRS know whom to tax? Medical device manufacturers have to register their products with the Food and Drug Administration. But the FDA’s registration requirements for medical device manufacturers never quite matched that of the IRS."
David Gorn, California Healthline
Fri, 2014-08-29
"The Assembly this week approved a bill to limit narrow networks in California's health plans. The legislation already passed a Senate vote and is expected to get concurrence today on the Senate floor and move to the governor's desk for final approval. SB 964 by Sen. Ed Hernandez (D-West Covina) directs the Department of Managed Health Care to develop standardized methodologies for health insurers to file required annual reports on timeliness compliance, and requires DMHC to review and post findings on those reports. It also eliminates an exemption on Medi-Cal managed care plan audits and requires DMHC to coordinate those plans' surveys, as well. "I introduced the bill in response to complaints we’ve heard about inadequate networks in the Medi-Cal program, as well as at Covered California," Hernandez said.
Nick Budnick,The Oregonian
Fri, 2014-08-29
"The price tag of the Cover Oregon health insurance exchange fiasco continues to grow. As Clyde Hamstreet, the corporate turnaround expert hired to lead Cover Oregon in April, wraps up his work he leaves behind a stabilized agency – and a hefty bill. Initially signed to a $100,000 contract, Hamstreet ended up staying longer than expected, with two associates joining him at Cover Oregon after Gov. John Kitzhaber essentially forced out three top officials there in a public display of house-cleaning. Through July, Hamstreet has billed $598,699 on an amended $750,00 contract. He hasn't submitted his August invoice. He says the price tag was driven by the exchange's increasing needs, as his firm stayed longer and did more than initially planned. "We didn't do this job to make a lot of money off the state," he said Thursday. "Our philosophy was to try and help get the boat righted and try to help clean things up and basically help the state. ...
Carol Ostrom, Seattle Times
Fri, 2014-08-29
"A lack of transparency in describing and fixing technical problems became an issue in Thursday’s Washington Health Benefit Exchange Board meeting. Board member Bill Hinkle grew testy at what he said was mutual staff back-patting and excuses for the problems still plaguing thousands of accounts. “C’mon you guys, let’s quit blowing smoke here,” Hinkle said. “I’m tired of patting people on the back….We’re not doing great yet.” Board member Teresa Mosqueda pressed staff for numbers of enrollees affected by technical problems. “We really need to have the data in front of us to manage some of these issues,” she said.
Modern Healthcare
Beth Kutscher
Fri, 2014-08-29
"Health insurance companies, now required to spend the lion's share of premium revenue on patient care, are looking for higher investment returns elsewhere. As a result, they're increasingly putting money into technology ventures where they expect to realize higher returns. The medical-loss ratio standard under the Patient Protection and Affordable Care Act requires insurers to spend at least 80% of what they earn from premiums on patient care and related quality improvements. No more than 20% can be used for administrative, marketing and business expenses. The requirement is as high as 85% for large group plans. Tied to that, insurers are trying to maximize their investment returns while also investing in businesses that are exempt from the 80/20 rule. Technology operations check off both those boxes for them. "That's been a catalyst for a substantial amount of investment,” said Joshua Kaye, a Miami-based partner at law firm DLA Piper. “We're really seeing it on a national scale.
Tue, 2014-08-26
"The Oregon Department of Justice jousted for nearly two months with Oracle America over the state's demand for documents from the California software giant relating to the health exchange debacle. In fact, Oracle flouted state law and stymied the demand, according to DOJ. The state filed papers in federal court Friday that provide a glimpse into high-stakes jockeying that for months took place largely out of public view. DOJ filed its federal papers shortly after the state's lawyers sued Oracle in Marion County Circuit Court on Aug. 22. In its federal filing, DOJ accuses Oracle of "stalling" and attempting to manipulate the legal system by filing its own federal lawsuit against Oregon on Aug. 8."
Kelsey Harkness, The Daily Signal
Wed, 2014-08-13
"Media coverage of the two Supreme Court cases challenging Obamacare’s HHS mandate for employers to provide workers with “free” coverage of abortion-inducing drugs largely focused on Hobby Lobby, the arts and crafts chain founded by the Greens, an evangelical Christian family. The case of another family-owned business also was heard by the high court, though — that of Conestoga Wood Specialties and the Hahns, Mennonite Christians from East Earl, Pa. The Hahns established their business — the manufacture of custom wood kitchen cabinets and parts — on Christian values and say they’re committed to applying those values in the workplace. Why did they go to court, represented by the Alliance Defending Freedom?
Jordan Rau, Kaiser Health News
Wed, 2014-08-06
"CHATTANOOGA, Tenn. — The dominion of Tennessee’s largest health insurer is reflected in its headquarters’ lofty perch above the city, atop a hill that during the Civil War was lined with Union cannons to repel Confederate troops. BlueCross BlueShield of Tennessee has used its position to establish a similarly firm foothold in the first year of the marketplaces created by the health law. The company sold 88 percent of the plans for Tennessee individuals and families. Only one other insurer, Cigna, bothered to offer policies in Chattanooga, and the premiums were substantially higher than those offered by BlueCross. Though insurers have been regularly vilified in debates over health care prices, BlueCross’ near monopoly here has been unusually good financially for consumers. Its cut-rate exclusive deal with one of three area health systems turned Chattanooga into one of the 10 least expensive insurance markets in the country, as judged by the lowest price mid-level, or silver, plan.
Stephanie Armour
Wed, 2014-08-06
"Some states that expanded Medicaid under the Affordable Care Act and set up all or part of their own insurance exchanges have seen a marked drop in the number of uninsured adults. The uninsured rates in states that opted to expand Medicaid, a health program primarily for low-income residents, and set up their own exchanges declined more in the first half of 2014 than in the states that didn’t take that approach, according to a study released Tuesday by Gallup. The survey was based on a random sample of adults through June 30. Arkansas saw the percentage of uninsured drop from 22.5% in 2013 to 12.4% through midyear 2014, according to the survey. Kentucky followed, with its percentage of uninsured dropping from 20.4% to 11.9% during the same time span. The other states with the largest drop in the percentage of uninsured were Delaware, Washington, Colorado, West Virginia, Oregon, California, New Mexico and Connecticut."
Melissa Quinn, The Daily Signal
Wed, 2014-08-06
"It’s one thing for President Obama to win an award for “Lie of the Year” for promising Americans “if you like your [health insurance] plan, you can keep it.” It must sting a bit more when a political ally like Barney Frank, the former congressman, flat out says the president “just lied to people.” In an interview with Huffington Post, the veteran Massachusetts Democrat said he was “appalled” at the “bad” rollout of Obamacare last October. “I don’t understand how the president could have sat there and not been checking on that on a weekly basis,” Frank said, then added: But, frankly, he should never have said as much as he did, that if you like your current health care plan, you can keep it. That wasn’t true. And you shouldn’t lie to people. And they just lied to people.""
Caroline F. Pearson, Avalere Health
Wed, 2014-06-04
"A new analysis from Avalere Health finds that consumers in exchanges receiving federal assistance to reduce their out-of-pocket costs may experience inconsistent reductions in spending depending on the plan they choose."
Caroline F. Pearson, Avalere
Thu, 2014-05-22
"A new analysis from Avalere Health finds that individuals choosing an exchange plan based on premiums are most likely to consider plans from Coventry (acquired by Aetna in 2013), Humana, and WellPoint in regions where they participate."
Matthew Eyles, Avalere
Wed, 2014-05-14
"According to a new Avalere Health analysis, 17 of the 26 states that did not expand Medicaid in the first three months of 2014 still reported growth in Medicaid enrollment, ranging from 0.1 percent in Texas to 10.1 percent in Montana. Since these states had decided not to expand Medicaid eligibility levels under the Affordable Care Act (ACA), these numbers show the impact of the “woodwork effect,” which is when individuals who were previously eligible, but not enrolled in Medicaid, newly sign up as a result of increased outreach and awareness. These enrollees may place a strain on state budgets, since states are required to contribute to the cost of their coverage based on traditional Medicaid matching rates."
Caroline F. Pearson, Avalere
Thu, 2014-05-08
The federal government will bear a disproportionate burden of premium increases in states with high rates of subsidized enrollees. Double digit premium increases are likely in many markets in 2014. Age distribution among enrollees varies by state, which may influence plans’ interest in each market.
Caroline F. Pearson, Avalere
Wed, 2014-05-07
"A new analysis from Avalere Health finds that exchange enrollment meets or exceeds expectations in 22 states (44%), even after accounting for any attrition due to nonpayment of premiums. Assuming 15 percent of enrollees do not take the final enrollment step and pay their premiums, over 6.8 million people who enrolled through April 19 will have coverage effective as of May 1."
Chris Butler
Watchdog.com
Fri, 2014-08-29
"Internal Revenue Service officials must enforce a new Obamacare tax designed to collect money from medical device manufacturers, but they’re losing money because they don’t know which companies even qualify for the tax, a new audit shows. On top of that, the IRS wrongly penalized more than 200 of these companies for not paying their taxes when, in fact, they did pay, the audit from the Treasury Inspector General for Tax Administration reports. Why doesn’t the IRS know whom to tax? Medical device manufacturers have to register their products with the Food and Drug Administration. But the FDA’s registration requirements for medical device manufacturers never quite matched that of the IRS."
Beth Kutscher
Modern Healthcare
Fri, 2014-08-29
"Health insurance companies, now required to spend the lion's share of premium revenue on patient care, are looking for higher investment returns elsewhere. As a result, they're increasingly putting money into technology ventures where they expect to realize higher returns. The medical-loss ratio standard under the Patient Protection and Affordable Care Act requires insurers to spend at least 80% of what they earn from premiums on patient care and related quality improvements. No more than 20% can be used for administrative, marketing and business expenses. The requirement is as high as 85% for large group plans. Tied to that, insurers are trying to maximize their investment returns while also investing in businesses that are exempt from the 80/20 rule. Technology operations check off both those boxes for them. "That's been a catalyst for a substantial amount of investment,” said Joshua Kaye, a Miami-based partner at law firm DLA Piper. “We're really seeing it on a national scale.
Michelle Andrews
Kaiser Health News
Fri, 2014-08-29
"When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network. (Plans that are grandfathered under the law don’t have to abide by these provisions.) That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect.
Matea Gold
The Washington Post
Thu, 2014-08-28
"When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns. But in the days since, it's become clear: there's little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign. "It’s basically the first pro-Obamacare ad we’ve seen by a vulnerable Democrat for months," said Elizabeth Wilner, senior vice president of Kantar Media Ad Intelligence, whose Campaign Media Analysis Group tracks political advertising. "It’s like seeing a unicorn – it just doesn’t happen very often.""
Nancy Scola
Washington Post
Thu, 2014-08-28
"Signed into law by President Obama on March 23, 2010, the Affordable Care Act has proven to be its own kind of jobs act, especially when it comes to the Washington-area IT community. When, in several places, the bill called for the creation of an "Internet website" to allow Americans to find and sign up for new health insurance coverage, it opened the tap on hundreds of millions of dollars that would eventually go to creating HealthCare.gov's front end and back end, as well as a small universe of accompanying digital sites. On Wednesday, the office of Daniel Levinson, the inspector general of the Department of Health and Human Services, put out a report detailing the dozens of contracts that went into building out the Federal Marketplace project.

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