From Kaiser Health News

Are Surprises Ahead For Legislation To Curb Surprise Medical Bills?

May 22, 2019

Surprise medical bills — those unexpected and often pricey bills patients face when they get care from a doctor or hospital that isn’t in their insurance network — are the health care problem du jour in Washington, with congressional lawmakers from both sides of the aisle and the White House calling for action.

These policymakers agree on the need to take patients out of the middle of the fight over charges, but crafting a legislative solution will not be easy.

Surprise medical bills — those unexpected and often pricey bills patients face when they get care from a doctor or hospital that isn’t in their insurance network — are the health care problem du jour in Washington, with congressional lawmakers from both sides of the aisle and the White House calling for action.

These policymakers agree on the need to take patients out of the middle of the fight over charges, but crafting a legislative solution will not be easy.

A hearing of the House Ways and Means health subcommittee Tuesday, for example, quickly devolved into finger-pointing as providers’ and insurers’ testimony showed how much they don’t see eye to eye.

“I’m disappointed that all participants that are going to be here from critical sectors of our economy could not come to find a way to work together to protect patients from these huge surprise bills,” Rep. Devin Nunes (R-Calif.), the ranking Republican on the subcommittee, said in his opening statement….

Read the full Kaiser Health News article

The Money and Politics of Prescription Drugs: What You Need to Know

May 8, 2019

If there’s one area of health care where Republicans and Democrats might strike a deal, it’s prescription drugs.

President Donald Trump has floated a plan to cut drug prices. Democratic and Republican ideas abound in Congress, where lawmakers have put more than 40 bills on the table. In 2018, 39 states passed 94 laws targeting pricing and costs. Florida’s House recently approved a move backed by the state’s Republican governor to allow imports from Canada. So far, Vermont is the only state to take that step.

If there’s one area of health care where Republicans and Democrats might strike a deal, it’s prescription drugs.

President Donald Trump has floated a plan to cut drug prices. Democratic and Republican ideas abound in Congress, where lawmakers have put more than 40 bills on the table. In 2018, 39 states passed 94 laws targeting pricing and costs. Florida’s House recently approved a move backed by the state’s Republican governor to allow imports from Canada. So far, Vermont is the only state to take that step.

Why do prescription drugs draw so much attention? Because millions of Americans rely on them, and 8 out of 10 say the cost is “unreasonable.”

America spends about $460 billion a year on these drugs, roughly as much as the combined revenues of the top three car makers….

Read the full Kaiser Health News article

Even Doctors Can’t Navigate Our ‘Broken Health Care System’

May 2, 2019

Dr. Hasan Shanawani was overcome by frustration. So, last week he picked up his cellphone and began sharing on Twitter his family’s enraging experiences with the U.S. health care system.

It was an act of defiance — and desperation. Like millions of people who are sick or old and the families who care for them, this physician was disheartened by the health care system’s complexity and its all-too-frequent absence of caring and compassion.

Dr. Hasan Shanawani was overcome by frustration. So, last week he picked up his cellphone and began sharing on Twitter his family’s enraging experiences with the U.S. health care system.

It was an act of defiance — and desperation. Like millions of people who are sick or old and the families who care for them, this physician was disheartened by the health care system’s complexity and its all-too-frequent absence of caring and compassion.

Shanawani, a high-ranking physician at the Department of Veterans Affairs, had learned the day before that his 83-year-old father, also a physician, was hospitalized in New Jersey with a spinal fracture. But instead of being admitted as an inpatient, his dad was classified as an “observation care” patient — an outpatient status that Shanawani knew could have unfavorable consequences, both medically and financially….

Read the full Kaiser Health News article

Association Insurance Pushes On Despite Court Ruling

April 25, 2019

When the Trump administration in June issued rules making it easier for small employers to band together to buy health insurance, “we started looking immediately,” recalled Scott Lyon, a top executive at the Small Business Association of Michigan.

Although he offered traditional small-group health insurance to his association’s employees and members, Lyon liked adding a new option for both: potentially less expensive coverage through an association health plan, which doesn’t have to meet all the rules of the Affordable Care Act.

When the Trump administration in June issued rules making it easier for small employers to band together to buy health insurance, “we started looking immediately,” recalled Scott Lyon, a top executive at the Small Business Association of Michigan.

Although he offered traditional small-group health insurance to his association’s employees and members, Lyon liked adding a new option for both: potentially less expensive coverage through an association health plan, which doesn’t have to meet all the rules of the Affordable Care Act.

Now, a few months in, “we’ve got 400 companies and a couple of thousand workers signed up,” said Lyon last week.

Nationally, an estimated 30,000 people are in such association health plans, a type of health insurance seeing a nascent resurgence following an initial drop-off after the ACA took effect in 2014….

Read the full Kaiser Health News article

The Blame Game: Everyone And No One Is Raising Insulin Prices

April 10, 2019

A casual observer of Wednesday’s House Energy and Commerce subcommittee hearing might think insulin prices just go up by themselves.

After all, the key industry executives filed opening statements to the congressional panel outlining patient-assistance programs, coupons and discounts — a range of price reductions that might make one think this life-or-death diabetes medication is easily affordable to the patients who need it.

A casual observer of Wednesday’s House Energy and Commerce subcommittee hearing might think insulin prices just go up by themselves.

After all, the key industry executives filed opening statements to the congressional panel outlining patient-assistance programs, coupons and discounts — a range of price reductions that might make one think this life-or-death diabetes medication is easily affordable to the patients who need it.

In fact, the price of insulin nearly doubled from 2012 to 2016 alone, triggering national headlines about the resulting hardships — sometimes deadly — suffered by people with the Type I-version of the condition who are left to ration insulin because it is too expensive for them to use as prescribed.

The three drug manufacturers that make insulin — Eli Lilly, Novo Nordisk and Sanofi — joined three pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — to testify before the Oversight and Investigations panel at its second hearing probing the corporate maneuvers behind the skyrocketing costs….

Read the full Kaiser Health News article