In this summary, you’ll find new developments on health insurance exchanges, essential health benefits, and Medicare Rx benefits under the ACA, new regulations that will make it easier for Veterans to receive care for Traumatic Brain Injury, and more!
Affordable Care Act
The New York Times examines new rules proposed by the Department of Health and Human Services to continue implementation of the Affordable Care Act. Many states have opted to let the federal government run insurance exchanges instead of setting up state-run initiatives. Under the new rules, insurance companies will be charged a fee if they want to offer a plan on an exchange run by the federal government. States that are running exchanges can also charge fees to insurers. In both federal and state exchanges insurers can pass the cost of the fee on to consumers (Pear, 12/1).
The Commonwealth Fund released a study this week that found consumers saved nearly $1.5 billion in 2011 as a result of rules in the Affordable Care Act that limit what insurance companies can spend on expenses unrelated to medical care. The study’s findings suggest that these changes forced insurers to become more efficient by limiting their administrative expenses.
USA Today reports that 5.8 million Medicare patients have saved $5 billion from prescription drug discounts. As part of the Affordable Care Act, pharmaceutical companies participating in Medicare agreed to give the government a 50% discount on premium drugs and 14% on generic drugs, and to extend those discounts to seniors who have exhausted their Medicare coverage and are forced to pay for the drugs themselves. The Department of Health and Human Services announced the savings this week and lauded the discount program for giving government the ability to predict lower health care costs.
The New York Times profiles efforts by various healthcare industries to lobby state regulators regarding the each state’s definition of essential health benefits under the Affordable Care Act. It was initially thought that the federal government would set a uniform standard for plans sold in the individual and small group market. However, recent regulatory guidance has left the definition of essential health benefits up to states-sparking intense advocacy efforts by groups to ensure their services are a covered benefit (Goodnough, 12/5).
The December issue of Health Affairs includes an article on the success of Medicare Advantage HMO plans. The article concluded that Medicare Advantage HMO plan enrollees use fewer services and might be experiencing more appropriate utilization of services than traditional Medicare patients. The study examined the service utilization patterns of Medicare Advantage HMO and traditional Medicare enrollees in categories that can demonstrate the impact of integrated care. The authors found 25-35 percent lower emergency department use and 20-25 percent lower inpatient medical days among the HMO patients.
The Wall Street Journal reports that the White House has alerted police and border agents to prepare for a possible influx of addictive pain drugs from Canada, where cheaper, generic versions of OxyContin will soon become available. The United State’s drug czar has reached out to Canada’s health minister to discuss the issue and offer assistance to address the wave of prescription-drug abuse sweeping both countries (Barrett, Catan and Vieira, 12/4).
USA Today writes about a new study that casts doubt on one of hospitals’ primary fall-prevention measures, bed alarms, which were designed to alert medical staff when patients are getting up when they should not. The study highlights a persistent problem for hospitals and the leading cause of injury and death for adults older than 65. U.S. emergency departments treat more than 2 million such injuries a year, according to the Centers for Disease Control and Prevention, at a cost of about $30 billion (Gluck, 12/5).
The New York Times reports that the federal Department of Veterans Affairs will propose new regulations that will make it easier for thousands of veterans to receive health care and compensation for certain illnesses that have been linked to traumatic brain injury. The proposed regulations list unprovoked seizures, certain dementias, depression and hormone deficiency diseases related to the hypothalamus, pituitary or adrenal glands as eligible for the expanded benefits (Dao, 12/7).
The Democrat and Chronicle reports on the findings of a recent study from the American Cancer Society. The report shows a 2 percent rise in the number of cancer cases in New York which is attributed to an increase in melanoma and prostate cancers (Bakeman, 12/2).
-Jaime Venditti, 12/7/12