ICYMI: The market clout of Massachusetts providers is a “main driver of the state’s spiraling health care costs”, investigation finds
Posted by The Campaign on January 29, 2010 at 4:30 PM
A year-long investigation into the rising costs of health care in Massachusetts, which are growing by 7.5 percent each year, found that hospitals and physicians are leveraging their market power and driving up health care costs in the state. The Boston Globe reports on the investigation by the state attorney general’s office. Here are some key findings:
- “Massachusetts insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care, according to a preliminary report by Attorney General Martha Coakley. It points to the market clout of the best-paid providers as a main driver of the state’s spiraling health care costs.”
- “Coakley’s staff found that payments were most closely tied to market leverage, with the largest hospitals and physician groups, those with brand-name recognition, and those that are geographically isolated able to demand the most money.”
- “’These rising costs are unsustainable. If we don’t do something about it, the only thing we’ll be able to afford is health care. No one will have money for food or housing,’[said Coakley].’’
- “The report shows that a small group of about 10 hospitals statewide command significantly higher payments than the other 55, ranging from 10 to 100 percent more than their competitors for similar work.”
- “Investigators found that Massachusetts health care costs, which are growing by 7.5 percent annually, are mostly the result of rising prices, not patients getting more imaging tests, surgery, and other procedures.”
For the full article, click here.
To read the preliminary report, click here.
Fact Check: Fast Facts about Fraud
Posted by The Campaign on January 28, 2010 at 10:14 AM
$60 billion: the estimated amount of fraud within Medicare each year
$17 million: the average annual amount of money saved by each health plan’s anti-fraud operations
$7.60: the average amount of money a health plan returns to the company and policyholders for every one dollar invested in anti-fraud operations – which keeps health care costs down for businesses and working families
Source: Anti-Fraud Management Survey Report for 2007 by the National Health Care Anti-Fraud Association
Health care fraud leads to higher costs for businesses, workers, and families. The overwhelming majority of health claims are legitimate and paid on-time, but for those that might be fraudulent, health plans use a variety of measures to prevent and detect them, including:
· Education and awareness campaigns: Policyholders, providers, and the public are encouraged to report any suspected fraud through telephone hotlines and websites.
· Commitment to safety: Health plans ensure their networks include only credentialed providers to protect consumers from unlicensed providers.
· Cross-disciplinary teamwork: Employees from a variety of backgrounds investigate potential fraud and collaborate across a health plan in order to weed out only potentially fraudulent claims for investigation.
· Communications with policyholders: Policyholders are encouraged to monitor their explanation of benefit forms for medical services they did not receive and to report known instances of health fraud.
· Monitoring and collaboration: Working with external law enforcement agencies at the state and federal levels, health plans prevent and protect consumers from fraud.
· Use of sophisticated software: Analyzing claims data helps predict potential fraud and weed out the “outliers” for further investigation, allowing effective and efficient investigation of the few claims with potential for fraud.
· Commitment to professional excellence: Health plans require credentialing and ongoing annual training for their staff dedicated to investigating health fraud in order to keep up with changes in technology and laws and effectively weed out health fraud and abuse.
FACT CHECK Redux: Polls Show American People Satisfied With Their Health Plan
Posted by The Campaign on January 27, 2010 at 2:50 PM
Much of the focus of recent polling has been on specific reform proposals. However, a number of surveys conducted throughout 2009 showed a common thread -- people's satisfaction with their own health insurance or health coverage.
We have included a number of these findings below:
CNN/Opinion Research:
- 74% of people are satisfied with their personal health insurance coverage.
- 83% of people are satisfied with their own health care.
Employee Benefits Research Institute:
- Fifty-eight percent of those with health insurance coverage are extremely or very satisfied with their current plan, and approximately one-third (30 percent) are somewhat satisfied.
Fox News/Opinion Dynamics:
- 84% of people surveyed said the quality of their personal health insurance was either excellent or good.
- 83% of people surveyed said the quality of care they receive is either excellent or good.
Quinnipiac University:
- 85% of Americans are very or somewhat satisfied with their own health insurance plan.
The University of Texas/Zogby International:
- 84% of people are satisfied with their health care.
The Washington Post:
- 81% of people are satisfied with their health insurance coverage.
- 88% of people are satisfied with the quality of care they receive.
The New York Times:
- 77% of people are satisfied with the quality of their own care.
- 77% of people said that basic medical care covered by their health insurance plan is affordable.
Democracy Corps:
- 72% of people are satisfied with their own health insurance coverage vs. 75% in 1993 - not a significant change.
- 76% of self-identified independents are satisfied with their coverage as are 72% of Democrats and 78% of Republicans.
Gallup:
- "Among all Americans, 83% say the quality of healthcare they receive is either ‘excellent' or ‘good.' Only 16% say it's either ‘only fair' or ‘poor.'"
- "Americans are only a bit less positive about their own healthcare coverage, with 67% describing the coverage they now have as excellent or good."
- Gallup's conclusion: "At the same time, [Americans surveyed] are pleased with the quality of medical treatment in the country, and are mostly satisfied with their own healthcare quality, coverage, and costs."
CNN/Opinion Research Poll:
- In March 2009, 73% of Americans were satisfied with their own health insurance coverage. NOTE: In November 2007, the satisfaction rating was 69%.
Employee Benefits Research Institute:
- 93% of people enrolled in a traditional health care plan were satisfied with the quality of coverage they received through their health plan (including 31% extremely satisfied).
- 93% of people enrolled in a traditional health care plan were satisfied with their plan.
- 86% of people enrolled in a traditional health care plan were likely to stay with their current plan.
BREAKING NEWS: Forbes Magazine Examines How Current Reform Proposals Will Not Lower Costs
Posted by The Campaigns on January 18, 2010 at 12:08 PM
The debate over whether the current reform proposals will lower costs continues, and it seems that the CW is moving toward the idea that we have talked about in this blog -- current reform proposals will not do enough to lower costs.
Forbes magazine picks up on this story and examines what will happen to people's health insurance costs.
Here are a few key excerpts:
"If you're thinking the legislation will tamp down overall health care spending, reconsider. Policy analysts ranging from the neutral Congressional Budget Office to the HMO lobby see no abatement in the growth rate of health care spending."
"The premium hikes will result from cost shifting, better known as passing the buck. The House and Senate insurance bills aim to cover their costs in part by cutting annual Medicare reimbursements to hospitals, doctors and drug companies by $45 billion. Those providers will likely try to offset the cuts by negotiating higher rates with private HMOs--which then get passed along through higher premiums. That's exactly what occurred after past Medicare and Medicaid cuts, according to the CBO analysis."
"Also, the legislation requires HMOs to pay $7 billion annually in new fees. That will get passed on to individuals and employers who buy the policies."
"The biggest losers, or rather spenders, will be those who currently pay for their own insurance but make more than four times the federal poverty level, a multiple that comes to $88,200 for a family of four. They will not be eligible for subsidies. The CBO calculated premiums for that group will rise 10% to 13% above and beyond the increases that could be expected without new laws."
"...rest assured premium increases will occur as costs trickle down from doctors, hospitals and HMOs looking to cover their costs."
For the full article click here.
ICYMI: AHIP, BCBSA, Employer Group Joint Letter on Immediate Reforms in Current Legislation
Posted by The Campaign on January 15, 2010 at 3:10 PM
ICYMI: American Academy of Actuaries Comment Letter on Health Care Reform Legislation
Posted by The Campaign on January 15, 2010 at 10:43 AM
The American Academy of Actuaries sent a letter to Speaker Pelosi and Majority Leader Reid providing comments on the Senate-passed health care reform legislation.
From the press release:
“The individual mandate language should be strengthened,” Uccello said. “The viability of health care reform depends on attracting lower-risk individuals. Strengthening the mandate through higher financial penalties and non-financial incentives would increase the likelihood that these individuals will purchase coverage.”
Here are a few highlights from the letter:
On individual mandate:
- An individual mandate is an integral component of both bills. Such a mandate is necessary to ensure that adverse selection will not lead to dramatic premium increases or a premium spiral. However, the financial penalties associated with the bills’ individual mandates are fairly weak compared to coverage costs, especially during the first years of the Senate plan when the financial penalties are being phased in.
On age rating:
- Moving to a narrow limit on premium variations by age, such as the proposed 2-to-1 and 3-to-1 limits, could result in dramatic premium changes, compared to what individuals are facing currently. In particular, younger individuals in states that currently allow underwriting and wider premium variations by age could see much higher premiums than they face currently (and may have chosen to forgo).
On MLR requirements:
- Imposing unrealistically high medical loss ratio requirements may threaten plan solvency by making it difficult for premiums to cover claims and expenses. In particular, it would be difficult for insurers in the individual market to satisfy the loss ratios that are typical in the current small and large group markets. Imposing such requirements could result in individual market insurers exiting the market.
- From a practical standpoint, it would be difficult to impose a minimum loss ratio requirement in 2010, as contained in the House bill. Plans typically file their premiums six to 12 months before they become effective, and need time prior to rate filing in order to develop the rates. Therefore, a sufficient lag time would be needed between the enactment of the legislation and the effective date of the minimum loss ratio provision.
On CLASS Act:
- However, given the way the program is structured, severe adverse selection would result in very high premiums that are likely to be unaffordable for much of the intended population, threatening the viability of the program.
- Without significant program changes to minimize adverse selection, the program would not be sustainable in the long term without premium increases or benefit reductions.
POLL VAULT: Health Care Costs Continues to Be #1 Issue in Many States, Nation
Posted by The Campaign on January 14, 2010 at 2:29 PM
Poll after poll continues to show that Americans are the most worried about health care costs and the impact the current reform proposals will have on their own personal health care costs.
Here is a sampling of recent national and state surveys on health care costs:
Pew Research: “By two-to-one (40% vs. 21%) more Americans believe the health legislation, if passed, would increase, not decrease their out-of-pocket costs, and this concern spans demographic groups. Among those 65 and older, 46% believe their costs would rise, as do 44% of Americans 50 to 64.” (p.15)
“In both middle-income households ($30,000-$74,999) nearly half (47%) expect their out-of-pocket costs to rise, while just 18% believe they would pay less, and the balance is similar among those with higher incomes.” (p. 15)
Nevada: 54% say cost is the biggest problem with health care vs. 15% lack of universal coverage vs. 18% quality of care
New Hampshire: 55% say cost is the biggest problem with health care vs. 28% lack of universal coverage vs. 10% quality of care
Ohio: 52% says costs is the biggest problem with health care vs. 20% who say lack of universal coverage vs. 14% quality of care
POLL VAULT: New Pew Poll Shows Americans Trust Health Plans More than Government
Posted by The Campaign on January 14, 2010 at 10:40 AM
Pew Research Center released its latest poll today, and there was an extensive section on health care and health care reform. One of the questions posed was "Who do you trust more when it comes to deciding what kinds of medical procedures should be covered by health insurance?"
Here are the results from that question:
“More Americans trust private insurance companies rather than the government to make decisions about what kinds of medical procedures should be covered by health insurance. A 45% plurality is more confident in insurance companies, 31% are more confident in the government, with 16% volunteering that they do not trust either.” (p. 16)
NOTE: This is a net positive of 8% of people trusting private insurance companies more than the government with respect to decisions over medical procedure coverage decisions from July 2009. (p.48)
“Among the 54% of Americans who say they have insurance through a private insurance company, more trust private insurers (45%) than the government (29%). Among the 24% who say their main source of insurance is a government program, 47% trust private insurers more, while 27% trust the government more.” (p. 17)
Click here for the full results.
ICYMI: Tulane University Dean Says Coverage Requirement Important to Help Control Costs
Posted by The Campaign on January 14, 2010 at 5:19 AM
Here at the Campaign for an American Solution blog we have talked a lot about our support for ending pre-existing condition restrictions coupled with a coverage requirement. Policymakers and economists have recognized that these two policies go hand in hand because if they are not coupled the cost of coverage for Americans could skyrocket (see this study.)
Here is a quote from Tulane University Dean Dr. Karen DeSalvo from today's New Orleans Times-Picayune:
But Dr. Karen DeSalvo, vice dean for community affairs and health policy at Tulane University, said that without a mandate for younger healthier Americans to purchase insurance, the cost of providing coverage for the uninsured will remain high, mainly because pools of insured will disproportionately consist of people facing potential health problems.
"In the absence of some sort of mandate for people, you run the risk that young people are going to gamble and not get insurance," DeSalvo said.
For the full article, click here.
FACT CHECK: Premium Tax Fact Sheet
Posted by The Campaign on January 13, 2010 at 7:43 AM
While much of the attention lately has been on the tax on Cadillac plans another tax on health insurance has escaped some of the same attention but it could have equally troubling and unintended consequences -- higher costs for individuals, families and small businesses.
Below are four key facts about the premium tax (click here to download this fact sheet in an easy to print format):
The new $70 billion premium tax will directly raise the cost of coverage for tens of millions of Americans.
Takes effect in 2011 - three years before the market reforms and coverage expansions go into effect.
Raises the cost of coverage for individuals and families who don't have access to employer-sponsored coverage and must purchase coverage on their own.
Exacerbates tax inequity for people who purchase coverage on their own (unlike group coverage, individual coverage cannot be purchased with pre-tax dollars).
