A project of the Galen Institute

Issue: "Quality/Access"

Obamacare doctor networks to stay limited in 2015

Chad Terhune, Sandra Poindexter, Doug Smith, LA Times
Tue, 2014-09-30
"Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year.. The state's largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state's insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans."

Blues Plans In Three States To Cancel Non-ACA Individual Plans This Year

Rachana Dixit Pradhan, Inside Health Policy
Tue, 2014-09-30
"Three Blue Cross Blue Shield plans operated by Health Care Service Corporation have decided to discontinue their “transitional” non-ACA compliant plans at the end of this year and cancellation notices will be sent to affected policyholders “shortly,” a company spokesperson tells Inside Health Policy. HCSC says the decision was made to help keep premiums for ACA plans affordable, because moving those enrollees into compliant plans will result in a more balanced mix of individuals. Transitional plans that were on the market this year from Blue Cross Blue Shield of Texas, Blue Cross Blue Shield of New Mexico and Blue Cross Blue Shield of Oklahoma will be discontinued effective Jan. 1. One source tracking state developments said the Blues appear to be discontinuing the plans on its own volition. The Blues participated aggressively in the exchanges in the first year while many other carriers remained cautious about entering the new markets, though that is beginning to change for 2015.

Open Payments Goes Live

Inside Health Policy
Tue, 2014-09-30
"CMS on Tuesday goes live with a website that discloses what drug and device companies pay physicians, and the doctor lobby already is warning reporters not to misuse the data. Also this week, America's Health Insurance Plans holds three conferences covering key health care issues, and drug-pricing policies are a hot topic with events on protected drug classes; insurance designs that encourage patients to use specialty medicines; and a briefing on the cost and value of new drugs. The American Medical Association sent reporters a guide for appropriately handling data from the Open Payments website, which Congress created under the Physician Payments Sunshine Act.

The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features.

Sat, 2014-09-27
"The Affordable Care Act changed the rules on how health insurance plans dealt with pre-existing conditions, outlawing the practice of turning away patients with expensive conditions or charging them a drastically higher cost for coverage. But an editorial alleges some health insurance companies operating on the new marketplaces created by Obamacare may have found a loophole that allows them to discourage sick patients from enrolling in a specific plan. The change has to do with how drugs are categorized in health systems. From the editorial published online at the American Journal of Managed Care: "For many years, most insurers had formularies that consisted of only three tiers: Tier 1 was for generic drugs (lowest copay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest copay).

Obamacare's $73 Billion Question

Megan McArdle
Bloomberg
Fri, 2014-09-26
"It’s hard to get a good accounting of what we’ve spent on the Affordable Care Act so far. The Barack Obama administration has never really tried to count the cost of all the different elements and put them in one place. The Congressional Budget Office, meanwhile, has pretty much given up. Luckily, we have Bloomberg Government, my employer’s government intelligence service, which has thoughtfully totted up all the data it can glean from public records and come up with a figure for spending to date: $73 billion."

At Raleigh forum, underwriter anticipates 60-percent increase within two years

Dan Way, Carolina Journal
Fri, 2014-09-26
"RALEIGH — A sizable number of North Carolina residents are learning they are no longer eligible for Obamacare, and some health policy premiums could jump 60 percent within two years, an insurance official says. Rufus Langley, an Apex insurance agent and state leader of the North Carolina Association of Health Underwriters, said Coventry Health Care of the Carolinas CEO Tracy Baker recently told his group that substantially higher consumer costs are anticipated. “He can see in 2016 this thing shooting up anywhere from 30 to 60 percent in costs” as delayed taxes start to kick in this year and next year, and medical care costs still rising, Langley said Monday at a Raleigh panel discussion."

White House reassessing Obamacare enrollment goal for 2015

Noam Levey, LA Times
Thu, 2014-09-25
"The Obama administration, which is scrambling to prepare a new push to enroll Americans in health coverage under the federal health law, is reassessing how many more people will sign up, Health and Human Services Secretary Sylvia Mathews Burwell said Wednesday.. About 7.3 million people are enrolled in health plans being sold through marketplaces created this year by the Affordable Care Act, according to federal figures."

Burwell Steers Clear of Specific Pledges on HealthCare.Gov

Louise Radnofsky
Wall Street Journal
Thu, 2014-09-25
"Health and Human Services Secretary Sylvia Mathews Burwell told reporters Wednesday that officials are “continuing, step by step” in their effort to get HealthCare.gov ready to open for its second year of business in 50 days’ time but steered clear of specific commitments that have haunted officials who preceded her. In her first on-the-record question session with reporters since taking the top job at HHS, Ms. Burwell got several inquiries about whether the department’s preparations to fix and revamp the site were on schedule, and answered all of them without making the kinds of comments that people could hold against her later. “Right now, what we are doing is prioritizing,” she said. “Every day we are continuing, step by step.”"

Consumer Group Sues 2 More Calif. Plans Over Narrow Networks

Julie Appleby, Kaiser Health News
Thu, 2014-09-25
"Insurers Cigna and Blue Shield of California misled consumers about the size of their networks of doctors and hospitals, leaving enrollees frustrated and owing large bills, according to two lawsuits filed this week in Los Angeles. “As a result, many patients were left without coverage in the course of treatment,” said Laura Antonini, staff attorney for Consumer Watchdog, a Santa Monica-based advocacy group that filed the case. Both cases allege that the insurers offered inadequate networks of doctors and hospitals and that the companies advertised lists of participating providers that were incorrect. Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status."

Governors: States Should Consider Easing Physician Assistant Limits

John Wilkerson, Inside Health Policy
Thu, 2014-09-25
"Governors suggest in a new report that states consider easing restrictions on physician assistants to help deal with swelling Medicaid rolls. The National Governors Association says states should consider including PAs in the definition of "provider," loosening so-called scope-of-practice laws to let physicians delegate more tasks to PAs, opening clinical training sites and encouraging PAs to work in primary care. "To increase the use of the physician assistant workforce, states should review the laws and regulations affecting the profession and consider actions to increase the future supply of PAs," an NGA release states."

ObamaCare Watch Weekly

* indicates required

View previous campaigns.

Check out Jim Capretta's new book.

ObamaCare Primer