January 29, 2014
The health insurance system in America is plagued with problems, such as continually rising premiums and the difficulty of finding coverage. The Obama administration’s diagnosis of the situation was clear: health insurance companies have too much freedom. The solution, therefore, is for the government to restrict this freedom, through provisions of the Patient Protection and Affordable Care Act (ACA).
Many in America accept President Obama’s diagnosis and solution because they assume that the health insurance industry pre-ACA was an essentially free industry. This paper challenges that assumption.
A survey of some of the major controls pre-ACA reveals that health insurance was already one of the most government-controlled industries in America. This is the context in which we must assess the causes of our problems in health insurance.
Contrary to proponents of further intervention, evidence presented in this paper suggests that government regulation plays a major role in the poor state of health insurance today. We must be willing to entertain the possibility that our diagnosis is mistaken: the patient’s illness stems not from too much freedom but from too many controls.
via Pacific Research Institute: The Broken State of American Health Insurance Prior to the Affordable Care Act.
November 15, 2013
The 2008 law extended mental health parity to group health plans providing mental health and substance use services, but did not require plans to provide these services. The ACA extended MHPAEA to apply to health plans in the individual market, also requiring that all individual and small group plans must provide mental health and substance use services. As a result, the mental health parity provisions in MHPAEA will apply to most commercial plans. The final rule does not address the application of mental health parity in Medicaid managed care plans, which will be done through future rule-making.
via Avalere Health : Final Rule on 2008 Mental Health Parity Law Finally Released, Affecting Individual and Small Group Plans and Codifying Consumer Protections.
October 31, 2013
Are health insurance plans in the individual market substandard?
Not the overwhelming bulk of them.
How do I know that?
Because individual health insurance policies have been regulated for decades by the states. Every policy sold in a state has to be approved by that state\’s insurance commissioner. Have you heard about the longstanding debate over whether or not states over regulate this market with too many state health insurance coverage mandates and policy requirements?
This whole issue over whether the states regulate these policies too much has been at the heart of Republican calls for insurers to be able sell individual health insurance plans across state lines––to be able to buy individual health plans from states with fewer regulations.
In this context, it is kind of hard to argue that this is a \”substandard\” insurance market.
via Health Care Policy and Marketplace Review: “Substandard Plans” Offered by “Bad Apple Insurers”––Does the Obama Administration Understand How the Health Insurance Market Works?.
October 30, 2013
according to the fiscal year 2012 HCFAC report, the return-on-investment–the amount of money returned to the government as a result of HCFAC activities compared with the funding appropriated to conduct those activities–has increased from $4.90 returned for every $1.00 invested for fiscal years 2006-2008 to $7.90 returned for every $1.00 invested for fiscal years 2010-2012.
Several factors contribute to a lack of information about the effectiveness of HCFAC activities in reducing health care fraud and abuse. The indicators agencies use to track HCFAC activities provide information on the outputs or accomplishments of HCFAC activities, not on the effectiveness of the activities in actually reducing fraud and abuse. For several reasons, assessing the impact of the program is challenging. For example, it is difficult to isolate the effect that HCFAC activities, as opposed to other efforts such as changes to the Medicare provider enrollment process, may have in reducing health care fraud and abuse. It is also difficult to estimate a health care fraud baseline–a measure of the extent of fraud–that is needed to be able to track whether the amount of fraud has changed over time as a result of HCFAC or other efforts.
via U.S. GAO – Health Care Fraud and Abuse Control Program: Indicators Provide Information on Program Accomplishments, but Assessing Program Effectiveness is Difficult.
July 19, 2013
When the Obamacare subsidies go into effect (scheduled for 2014, unless the administration tries to delay it), the substantial percentage of consumers who are eligible for subsidies will pay a percentage of their income, and have the rest of the premium subsidized. That means, in effect, that they won’t care what the real premium is. They will be completely insulated from high premiums – but they will still – if the statute is read literally – get that rebate. In other words, they will get a fat taxpayer-funded subsidy to cover their insurance, and then a substantial rebate, which might even exceed the premium they paid. The MLR system – intended to keep premiums low – could end up becoming a system for funneling taxpayer dollars to subsidized consumers, all the while increasing the profits of insurers permitted to participate in the exchanges above what they could earn in a competitive market.
via Obama Touts False Benefits of Health Insurance Rebates – Forbes.
June 30, 2013
the HHS said the ObamaCare data hub will “interact” with seven other federal agencies: Social Security Administration, the IRS, the Department of Homeland Security, the Veterans Administration, Office of Personnel Management, the Department of Defense and — believe it or not — the Peace Corps. Plus the Hub will plug into state Medicaid databases.
And what sort of data will be “routed through” the Hub? Social Security numbers, income, family size, citizenship and immigration status, incarceration status, and enrollment status in other health plans, according to the HHS.
“The federal government is planning to quietly enact what could be the largest consolidation of personal data in the history of the republic,” noted Stephen Parente, a University of Minnesota finance professor.
via Think NSA Spying Is Bad? Here Comes The ObamaCare Database Hub – Investors.com.
March 28, 2013
The Affordable Care Act requires that now, after an insurance company has denied a healthcare claim, the company must provide an opportunity for external review of the denial. Both the Department of Labor and the press have heralded this change as a boon to consumers that will ease the healthcare claims appeal process. But will the average consumer benefit from this new level of review? As a practical matter, is a further level of review — usually available only after two internal levels of review — the kind of reform that will make a difference to most consumers? Or is this new level of review just one more barrier, set up to thwart the consumer’s efforts to be reimbursed for healthcare?
This article posits that the new external review rules are an imperfect substitute for more extensive ERISA claims reform. The external review rules should be revised so that payors rather than consumers suffer the negative effects of incorrect claims decisions. That is, the rules should internalize the real costs of incorrect denials by imposing a penalty on payors when claims are reversed on external appeal. In addition, to be useful to the average consumer, external review should also be more available, understandable, and independent.
via Hope or Hype?: Why the Affordable Care Act’s New External Review Rules for Denied ERISA Healthcare Claims Need More Reform by Katherine Vukadin :: SSRN.
March 11, 2013
This chapter, appearing in the book Risks and Challenges in Medical Tourism: Understanding the Global Market for Health Services (Praeger Publishing 2012), explores how the medical tourism market operates in an environment void of legal and regulatory oversight. Given this void, I address seven legal questions surrounding the medical tourism market: 1. Is it illegal for patients to leave the United States for health care? 2. Can patients injured overseas sue in the United States? 3. Can patients injured overseas sue overseas? 4. How might governments regulate medical tourism? 5. Can U.S.-based institutions regulate foreign hospitals and physicians? 6. Is it legal for U.S. insurers to ask patients to leave the country? 7. How will U.S. health reform affect the medical tourism market?
In confronting these questions, a unifying theme emerges: Very few laws and regulations govern medical tourism transactions, largely because these are cross-border transactions consummated in foreign jurisdictions. This creates legal risks for all parties. And the industry is shifting these risks to perhaps the least sophisticated party: patients.
via Chapter 9: Into the Void: The Legal Ambiguities of an Unregulated Medical Tourism Market by Nathan Cortez :: SSRN.
March 9, 2013
Medical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue is dominated by speculation and lacks meaningful input from people with specific expertise in patient health and safety. We consulted with patient health and safety experts in the Canadian province of British Columbia to explore their views concerning risks that medical tourists may be exposed to. Herein, we report on the findings, linking them to existing ethical and legal issues associated with medical tourism.
via Ethical and Legal Implications of the Risks of Medical Tourism for Patients: A Qualitative Study of Canadian Health and Safety Representatives’ Perspectives by Valorie Crooks, Leigh Turner , I. Glenn Cohen, Janet Bristeir, Jeremy Snyder, Victoria Casey, Rebecca Whitmore :: SSRN.