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Politico Summarizes What's New for Health Care As of January 1, 2011

Excerpt: Here's their list:[.]  MORE >>

'Don't Be a Wimp,' Mark Cuban Tells Lawmakers Cowed by Big PBMs

"Speaking [April 21] at Politico's Health Care Summit, the celebrity entrepreneur and cofounder of Cost Plus Drugs, a direct-purchase marketplace for generic drugs, painted the picture of an industry cowed by major insurers and pharmacy benefit managers."  MORE >>

Federal Employee Pension Benefit Reform Clears House Oversight Committee

"The package advanced by the committee [on April 30] calls for hiking the required pension contribution for federal employees to 4.4 percent of salary, while cutting a benefit for leaving the workforce before age 62."  MORE >>

'The 401(k) Industry Owns Congress': How Lawmakers Quietly Passed a $300 Billion Windfall to the Wealthy

"SECURE 2.0 and its predecessor bills have expanded the system well beyond its goal of helping the middle class. Today, wealthy taxpayers can protect up to $452,500 per year in tax-advantaged accounts in a single year, saving up to $203,600 on their taxes.... [T]op retirement industry lobbying groups have increased their PAC spending to lawmakers between six to eight times since the early 2000s, with the PACs and executives of member companies of one industry juggernaut providing $98.6 million to lawmakers in the 2022 election cycle leading up to SECURE 2.0."  MORE >>

Hospitals Blame Insurers for Not Helping Enough After Crippling Cyberattack

"Hospitals are still struggling to get paid even as the damage from last month's Change Healthcare cyberattack is slowly remediated -- and they are pointing the finger at insurers. Thirty to 40 percent of claims continue to be denied, compared with 5 percent before the attack[.]"

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White House Turns to Health Care in Latest Move Against 'Corporate Greed'

"The White House plans to announce a new federal task force focused on easing health care costs ... Officials from the Justice Department, the Federal Trade Commission and the Department of Health and Human Services will be on the task force, focused on enforcement ... [D]rug pricing and health provider costs will be among the task force's central focus."

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Before Slashing Social Security, Cut 401(k)s

"According to the [JCT], the tax advantages for DBs, DCs and IRAs will cost the federal government $371 billion this year. There is no similar tally for state tax breaks, but including those would likely bring the total bill close to half a trillion dollars. Given these tremendous expenses, it is initially hard to understand why people who seem so worried about the costs of old-age benefits choose to focus solely on Social Security. But it becomes easier to understand once you realize who benefits the most from the various parts of the old-age system."

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These States Tried an Obamacare Public Option; It Hasn't Worked as Planned

"A trio of Democratic Western states hailed passage of their public health insurance options as important steps toward finishing Obamacare's work of providing universal health coverage. But an early look at Washington, Colorado and Nevada show their plans to provide more affordable coverage to hundreds of thousands of people aren't working out as hoped."

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Ire Over PBMs Fuels Lobbying Blitz

"Lobbyists for drugmakers, pharmacists and large employers are ... pressing lawmakers to rein in pharmaceutical middlemen, who they say are behind soaring drug costs. The effort to paint pharmacy benefit managers as villains has sparked a multimillion-dollar campaign to influence Democrats, who are ... eager to show they are taking on the powerful drug industry and lowering out-of-pocket costs for Americans."

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New Jersey May Allow Some Workers Back Into Pension System, a Decade After They Were Removed

"[As] the state ramps up its contribution to a system that's underfunded by tens of billions of dollars, it's also considering restoring eligibility to some public employees -- state and county prosecutors, administrative law judges and workers compensation judges -- after new hires were taken out of the system more than 10 years ago to lighten the financial burden."

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House Passes $2 Trillion Coronavirus Package

"The House passed a sweeping, $2 trillion coronavirus relief package that will provide immediate assistance to many Americans, small businesses and major industries on the brink of economic collapse amid the ongoing pandemic.... President Donald Trump is expected to quickly sign the bill — the largest rescue package in U.S. history."

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Judge Freezes Trump Administration Contraception Rule

"U.S. District Judge Haywood Gilliam, Jr. ruled the policy would cause harm to the Democratic states suing over the rules, and he issued an order staying the rules from going into effect while the lawsuit proceeds. His temporary block is limited to just the 13 states plus the District of Columbia involved in the lawsuit. However it's possible that a court in Pennsylvania, considering a similar request for an injunction, could issue a broader national order." [California v. Azar, No. 17-5783 (N.D. Cal. Jan. 13, 2019)]  MORE >>

The Problem of Doctors' Salaries

"The United States pays more than twice as much per person for health care as other wealthy countries. We tend to blame the high prices on things like drugs and medical equipment, in part because the price tag for many life-saving drugs is less than half the U.S. price in Canada or Europe. But an unavoidable part of the high cost of U.S. health care is how much we pay doctors -- twice as much on average as physicians in other wealthy countries."  MORE >>

Why Marilyn Tavenner Is Worried About Obamacare This Fall

"[Marilyn Tavenner, head of America's Health Insurance Plans,] rattled off her wish list for the Obamacare exchanges, including the need to market to more young, healthy Americans. She also noted that two of the '3Rs' -- risk corridors and reinsurance, meant to help health plans through the first difficult stages of the ACA -- are scheduled to be phased out. That places more of a burden on the last 'R' -- the risk-adjustment program, which has been frustrating for insurers."  MORE >>

New York Approves Largest Insurance Rate Increase Since Start of Obamacare

"The Cuomo administration on [Aug. 5] announced that health insurance rates on the individual market would increase by a weighted average of 16.6 percent, the largest individual market hike since the [ACA] began in 2014. The new rates take effect in January; open enrollment on the state's exchange begins Nov. 1. Rates in the small group market will increase by a weighted average of 8.3 percent."  MORE >>

Jonathan Gruber: What We Didn't See Coming with the ACA

"More people are in Medicaid than anticipated; fewer bought health plans through the exchanges. The reasons why this has happened ... include some surprises, even for those of us who have tracked the law closely and rooted for its success.... CBO projected more than 20 million people would be enrolled in these new online markets by this year. In fact, only about half that many are covered. One big reason is yet another ACA surprise, and a fortunate one: The employer insurance market is much more stable than expected."

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Humana to Significantly Reduce Marketplace Offerings in 2017

"Humana will stop marketing Obamacare exchange plans in several states next year and will exit many off-exchange individual markets as well ... The decision means the company will only offer individual plans in 156 counties in 11 states, down from 1,351 counties across 19 states this year. It had sold plans on [ACA] exchanges in 15 states this year."  MORE >>

CMS Introduces New Primary Care Payment Initiative for Healthcare Providers

"In a sharp departure from the current 'fee-for-service' system, which offers reimbursements per visit or procedure, providers who volunteer to participate will received fixed monthly fees for every patient and bonuses for meeting various quality goals. When their patients stay healthier and require less-expensive care, many primary care doctors will also share in the savings to Medicare, Medicaid or private insurers.... This summer, the administration will choose 20 states and regions that will be eligible for CPC-Plus, and will partner with private insurers so that the reforms will not just apply to government payments."

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IRS to Forego Collecting Underpaid Taxes Arising from HHS Mistake

"The Obama administration took a step on Tuesday toward containing the damage from sending the wrong Obamacare tax data to hundreds of thousands of taxpayers. The 50,000 taxpayers who filed returns based on inaccurate subsidy data they got from the government will not need to file amended returns and the IRS won't collect for any underpayment, the Treasury Department said.... Taxpayers who are owed a larger subsidy can file an amended return."  MORE >>

Can Public Sector Defined Benefit Plans Survive?

"Despite many politicos' vow to introduce extensive reforms that will address the needs of state and local pension plans, the switch from defined benefit to defined contribution might now be irreversible based on one key figure: The average funded ratio of public pension systems has dropped from 90% in 2004 to 71% in 2013.... According to Census Bureau data, in 2012 there were about 4,000 state and local government public employee retirement systems, with approximately 19.6 million active and inactive members. But retirees were 9 million. At that rate, with almost one-third of the public worker population inactive or receiving benefits and with Baby Boomers ready to retire as well, public pension systems will come under tremendous pressure."

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