Julie Appleby, Kaiser Health News
"In an effort to slow health care spending, more employers are looking at capping what they pay for certain procedures — like joint replacements — and requiring insured workers who choose hospitals or medical facilities that exceed the cap to pay the difference themselves.
But a study out Thursday finds employers might be disappointed with the overall savings. While the idea, known as “reference pricing,” does highlight the huge variation in what hospitals and other medical providers charge for the same services, the report says, it does little to lower overall health care spending.
“It’s zeroing in on a piece of the health spending puzzle that is critical, the unreasonably high negotiated prices paid by health plans … but it’s not going to get you there if you need to save a lot of money,” said co-author Chapin White."
Katie Kerwin McCrimmon, Health Colorado
"Colorado’s 2.0 “Kentucky-style” system that is supposed to simplify the way people get health insurance won’t be ready until days before the Nov. 15 open enrollment starts.
And as Colorado’s health exchange enters its busy season, a third “chief” has announced she’s leaving Connect for Health Colorado. Chief Executive Patty Fontneau departed in August. Chief Financial Officer Cammie Blais left two weeks ago. And Chief Operating Officer Lindy Hinman announced her resignation and plans to leave next month after open enrollment begins."
Chad Terhune, LA Times
"California's health insurance exchange is canceling Obamacare coverage for 10,474 people who failed to prove their citizenship or legal residency in the U.S..
Covered California, the state-run insurance exchange, enrolled more than 1.2 million people during the rollout of the Affordable Care Act this year. For most consumers, the exchange said, it could verify citizenship or immigration status instantly with a federal data hub.
But more than 148,000 enrollees were lacking proof of eligibility and needed to submit documentation. People living in the U.S. illegally aren't eligible for health law coverage.""
David Nather, Politico
"Deep down, Republicans who know health care know the truth: Obamacare isn’t about to be repealed.
But you won’t hear that in this election — and maybe not in 2016, either.
Republicans may be split on many issues, but they remain fiercely united in their loathing for the Affordable Care Act; they still see it as a terrible law, and they want it to go away. But GOP staffers and health care wonks also know that, even if they win the Senate, they’re not going to accomplish that in the next two years while President Barack Obama is still in office.
And after that? Well, think of the last time a major social program was repealed after three enrollment seasons, with millions of people getting benefits. That’s right — it hasn’t happened."
The Associated Press
"HealthCare.gov, the website for health insurance under President Barack Obama’s health care law, has been revamped as its second enrollment season approaches. But things are still complicated, since other major provisions of the Affordable Care Act are taking effect for the first time. A look at some of the website and program changes ahead:
Old: 76 online screens to muddle through in insurance application.
New: 16 screens — for the basic application that most new customers will use. But about a third of those new customers are expected to have more complicated cases, and how they’ll fare remains to be seen.
Old: Prone to crashing, even with relatively few users.
New: Built to withstand last season’s peak loads and beyond, at least 125,000 simultaneous users.
The Associated Press
"WASHINGTON — They have health insurance, but still no peace of mind. Overall, 1 in 4 privately insured adults say they doubt they could pay for a major unexpected illness or injury.
A new poll from The Associated Press-NORC Center for Public Affairs Research may help explain why President Barack Obama faces such strong headwinds in trying to persuade the public that his health care law is holding down costs.
The survey found the biggest financial worries among people with so-called high-deductible plans that require patients to pay a big chunk of their medical bills each year before insurance kicks in."
Jeffrey Anderson, The Weekly Standard
"A new poll finds that three-fifths of likely voters support the repeal of Obamacare. A large plurality — 44 percent — wants to see Obamacare repealed and replaced with a conservative alternative. A much smaller group —16 percent — wants to see it repealed but not replaced. Less than one in three respondents — 32 percent — would like to keep Obamacare, whether in its current form or in amended form. So, with a conservative alternative in play, 60 percent of Americans support repeal, while only 32 percent oppose it."
Virgil Dickson, Modern Healthcare
"Faced with the rising costs of generic prescription drugs, health insurers increasingly are turning to tiers and preferred lists on their formularies to keep costs down. Those strategies previously were used only for brand-name and specialty drugs. Experts say those approaches will increase out-of-pocket costs for patients and could make them less likely to adhere to drug regimens.
For years, insurers have encouraged patients to choose generic drugs because they were less expensive than their brand-name counterparts, and most prescription drugs currently used are generics.
But over the past year the cost of generic drugs has skyrocketed, including for products that have been on the market for many years. A study by Pembroke Consulting comparing CMS data for average generic drug acquisition costs between July 2013 and July 2014 found that half of the generic drugs listed rose in cost, with the median increase nearly 12%. Some drug prices saw extreme increases.
Darius Tahir, Modern Healthcare
"Healthcare information-sharing is largely stuck in neutral, according to the Office of the National Coordinator for Health Information Technology's annual report on electronic health-record adoption, released Thursday.
While standards and services have been established to support information-sharing, “practice patterns have not changed to the point that healthcare providers share health information electronically across organization, vendor and geographic boundaries,” the report argued.
Information-sharing is seen as a key component in the move from a fee-for-service approach in U.S. healthcare to a quality of care approach, so signs that the sharing isn't happening could spell trouble for progress toward that shift."
Michelle Stein, Inside Health Policy
"CMS says that states should reimburse Medicaid managed care plans for the Affordable Care Act's health insurance provider fee, and says that the fee itself should be incorporated into plans' capitation rates, however, as the firm JP Morgan notes, the agency leaves some “wiggle room” on whether states should also factor in other potential effects of the fee, such as its non-deductibility status. Medicaid Health Plans of America President Jeff Myers said CMS' recently released frequently asked questions document provides certainty for plans, particularly in states that hadn't yet agreed to cover those fees.
Myers said the plans are gratified CMS decided to move forward with the FAQ, and the release of the FAQ and the 2015 Managed Care Rate Setting Consultation guide suggest that CMS would like to play a more involved role in rate setting for managed care. Since plans have been asking for more transparency around rate setting, CMS' involvement could be a net positive, Myers said.