Costs Can Go Up Fast When E.R. Is in Network but the Doctors Are Not –

September 29, 2014

When legislators in Texas demanded some data from insurers last year, they learned that up to half of the hospitals that participated with UnitedHealthcare, Humana and Blue Cross-Blue Shield — Texas’s three biggest insurers — had no in-network emergency room doctors.

Out-of-network payments to emergency room physicians accounted for 40 to 70 percent of the money spent on emergency care at in-network hospitals, researchers with the Center for Public Policy Priorities in Austin found.

“It’s very common and there’s little consumers can do to prevent it and protect themselves — it’s a roll of the dice,” said Stacey Pogue, a senior policy analyst with the nonpartisan center and an author of the study.

via Costs Can Go Up Fast When E.R. Is in Network but the Doctors Are Not –

The Halbig Subpoena

September 29, 2014

But congressional investigators whom the agencies permitted to review the documents behind closed doors, and to interview the Treasury/IRS staff who wrote the challenged regulation, issued a report detailing troubling aspects of how the IRS developed the regulation.

According to investigators, prior to March 2011, the IRS’s draft regulations included the statutory requirement that subsidy recipients enroll in coverage through an Exchange “established by the State.” The employer and individual mandates are tied to the availability of the subsidies. In March 2011, however, IRS officials read a news article about how ObamaCare opponents were considering a constitutional challenge based on the fact that the PPACA offers subsidies only in states that establish Exchanges. That statutory requirement disappeared from the draft regulations at the same time IRS officials learned that opponents might challenge that feature of the law in court.

via The Halbig Subpoena.

The Rubes’ Revenge | The Weekly Standard

September 28, 2014

We got Obamacare because 12 Senate Democrats from states that voted for John McCain, and whose constituents overwhelmingly opposed Obamacare, nevertheless backed the president on this most important issue. These 12 had won election at various points by distancing themselves from the more leftist national Democratic party. But when national Democrats needed their votes, they fell into line.

via The Rubes’ Revenge | The Weekly Standard.

For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says –

September 28, 2014

Enrollment in Medicaid is surging as a result of the Affordable Care Act, but the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards, federal investigators say in a new report.

The report, to be issued this week by the inspector general at the Department of Health and Human Services, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.

via For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says –

Affordable Care Act Reduces Costs for Hospitals, Report Says –

September 27, 2014

“Because of the Affordable Care Act,” Ms. Burwell said, “we project that hospitals will save $5.7 billion in uncompensated care costs this year. Hospitals in states that have expanded Medicaid are projected to save up to $4.2 billion of the total amount.”

Charles N. Kahn III, the president of the Federation of American Hospitals, which represents investor-owned companies, said, “The increased payments for previously uncompensated care are a plus for hospitals.” But he added: “You have to remember the context. We are living with heavy cuts in Medicare, which were put in place by the Affordable Care Act.”

via Affordable Care Act Reduces Costs for Hospitals, Report Says –

Court tosses Obamacare mandate lawsuit brought by doctors – Jennifer Haberkorn –

September 23, 2014

A federal appeals court has summarily tossed a lawsuit challenging the Obama administration’s delay of Obamacare’s employer mandate — a case that is similar to the one that House Republicans plan to file against the president.This suit was filed by the Association of American Physicians and Surgeons, which argued that the delay could hurt doctors financially. But the 7th Circuit Court of Appeals in Chicago on Friday said the plaintiffs don’t have a right to sue.

via Court tosses Obamacare mandate lawsuit brought by doctors – Jennifer Haberkorn –

F.T.C. Wary of Mergers by Hospitals –

September 18, 2014

The commission is using a 100-year-old law, the Clayton Antitrust Act of 1914, to challenge some of the mergers and acquisitions, and it has had remarkable success in recent cases.“Hospitals that face less competition charge substantially higher prices,” said Martin S. Gaynor, director of the F.T.C.’s bureau of economics, adding that the price increases could be “as high as 40 percent to 50 percent.”Leemore S. Dafny, a professor and health economist at Northwestern University who used to work at the commission, said, “The Affordable Care Act has unleashed a merger frenzy,” and she said she saw antitrust enforcement as a powerful tool to slow “the march toward conglomeration.”

via F.T.C. Wary of Mergers by Hospitals –