Viewing entries tagged with 'MR'
MUST READ: Former US Comptrollers Question Cost Containment in New Law
Posted by The Campaign on August 16, 2010 at 9:09 AM
This blog has spilled much e-ink (and many megabytes) on the need to address the ever increasing problem of out of control growth in health care costs. We have highlighted many experts who have talked about this issue and the need for the nation to get health care costs under control or risk crowding out of other priorities.
Today's OpEd in The New York Times on the latest Medicare trustees' report offers another example of independent experts questioning the cost containment provisions of the new law.
Here is the line from Stanford Ross and David Walker: "...we just don't know how effective its cost containment provisions will be." Click here for the full OpEd, definitely worth the read.
MUST READ: Center for American Progress Study on the Personal Coverage Requirement
Posted by The Campaign on August 05, 2010 at 1:49 PM
In Case You Missed It: A new report released by the Center for American Progress, Health Care Reform Is a “Three-Legged Stool”, validates the need to pair an effective personal coverage requirement with insurance market reforms.
Here are a few highlights:
· Repeal of the requirement to buy insurance would mean more people would wait until they get sick to buy insurance in the new nongroup exchanges, which would increase the average premium by 27 percent in 2019.
· Retaining the law’s insurance reforms, but repealing the subsidies as well as the requirement to purchase insurance, would further discourage people from buying insurance when they’re healthy. Premiums in 2019 would cost twice as much as projected under the law as a result.
· Retaining the law but repealing the mandate would newly cover fewer than 7 million people in 2019 rather than the 32 million projected to be newly covered by the law. Federal spending, however, would decline by only about a quarter under this scenario since the sickest and most costly uninsured are the ones most likely to gain coverage.
· If insurance companies must charge the same price to people whether they’re sick or healthy many healthy people will view this as a “bad deal” and not buy insurance. This results in higher prices that chase even more people out of the market. The result is a “death spiral” that leads only the sick to purchase insurance at very high prices. Several states tried such community rating reforms—offering health insurance policies within a given territory at the same price to all persons without medical underwriting— in their nongroup markets over the past two decades, and sharp rises in insurance prices ensued along with rapidly shrinking market size.
COST ALERT: Florida Paper Draws Attention to Emergency Room Costs -- $4 Aspirins
Posted by The Campaign on August 02, 2010 at 10:11 AM
It is known that underlying medical costs continue to increase every year. These costs are seen in higher prices for prescription drugs, medical imaging tests and even doctor's visits. And an article in the Florida paper "Highlands Today" shows trips to the emergency room can't avoid higher costs either.
The article picks up on costs that individual Floridians have been charge upon visits to the emergency room. The article does not draw any conclusions, but it does provide a few anecdotes to highlight the ever increasing cost of care including:
One patient said "...it cost $36 to have an X-ray read and $4 for an aspirin."
For the full article click here.
MUST READ: The Wall Street Journal Examines How Health Plans Are Helping Patients Stay Out of the Hospital
Posted by The Campaign on July 28, 2010 at 1:18 PM
With the debate about MLR definitions still ongoing, we thought this story from The Wall Street Journal offered a great example of the types of programs health plans use to help keep patients healthy and safe and ultimately save them money. These are the types of programs that all health plans use to improve quality and value and are at the core of health plans' role in the system.
Here is a key excerpt from the story:
"It is more important than ever for health plans and patients to combat medical costs, growing at a clip of between 6% and 9% a year, according to various estimates. Heart failure-which can be triggered by simple mistakes such as consuming too much salt-is a leading cause of hospital readmissions, with about 25% of patients returning to the hospital within 30 days. It's also one of the biggest single claims expenses at insurance companies. Aetna estimates that 40% of readmissions are avoidable.
"For patients, the extra surveillance could cut down on trips to the hospital and provide peace of mind. That's what Carolyn Brown, a 63-year-old retired teacher's aide from Bronx, N.Y., found when she started using a new monitoring system covered by her insurer, MetroPlus Health Plan Inc., after she suffered two heart attacks."
For the full story, click here.
MUST READ: Maine An Unlikely Voice in the MLR Debate
Posted by The Campaign on July 12, 2010 at 8:07 PM
While the NAIC and HHS continue deliberating on the finer points of the MLR, other groups are continuing to weigh in. The most recent, and some would say unlikely voice, in the MLR debate is that of the Maine Insurance Commissioner. According to an article posted late tonight on CQ.com, the Maine insurance commissioner "holds the distinction of being the first commissioner in the nation to request that Department of Health and Human Services officials exempt her state from the rules governing the so-called medical loss ratio, or MLR..."
Why?
According to a letter from the Maine Insurance Commissioner to HHS: "Absent a waiver, I believe that the federal MLR standard may disrupt our individual health insurance market."
The CQ article also notes that many experts in other states do not think Maine's situation is unique. In fact the article has a quote from Matt Salo, the NGA's health policy director, who says "Insurance markets are very different in each of the states. Since there are a lot of unknowns with respect to how health care reform will impact these markets, if there were a relatively simple waiver authority available, I imagine a lot of states might be interested in that."
To read the full article (which requires a CQ subscription) click here and to read the Maine Insurance Commissioner's letter click here.
MUST READ: The New Health Dialogue Outlines Why Just Attacking Health Plans Doesn't Solve the Cost Conundrum
Posted by The Campaign on June 22, 2010 at 12:20 PM
This is a great piece that ran as a blog entry on The New America Foundation’s blog “The New Health Dialogue.” It smartly makes the point that just focusing on health insurers does not solve the problem of ever increasing costs. Here are some key excerpts and the full piece is below:
“But it's important to remember that to the extent that the focus remains on health insurers' rate increases we may miss the point on overall rising health care costs, and maybe even accelerate their growth.”
"This is because the amount that we pay for private health insurance is primarily determined by the prices that insurers negotiate on our behalf with doctors and hospitals."
"But the logic of rising health care costs is inexorable. Until the people who negotiate with doctors’ offices and hospitals are in a position to get a better deal on our behalf, they will not get a better deal."
"Standing in the middle of this road, it is largely the same group of insurers who have to keep fighting to keep health care costs down for businesses and families. And it’s not at all clear that they will be successful in this fight on our behalf if we focus the majority of our own attention on beating up on them."
MUST READ: Time -- What Will It Cost
Posted by The Campaign on March 25, 2010 at 6:07 AM
This week, Time magazine explores the new reforms and what it will mean for America. One part of the article focuses on what the reforms will mean for costs. As many independent experts and economists have pointed out: the reforms will not do enough to lower costs.
Here are some key excerpts:
"Unlike plans to expand coverage and end discrimination against the sick, there's no proven strategy in the reform bill - or anywhere else, for that matter - guaranteed to fix the most daunting problem in U.S. health care: medical costs that are rising at twice the rate of inflation."
"...premiums will continue to rise, just with more predictability."
"Despite the demonization of the health insurance industry - some of it deserved - the business operates on a simple principle: collect enough premium dollars to cover overhead and claims plus, in the case of commercial insurers, earn a profit margin of 3% to 6%."
"Contrary to the rhetoric that has permeated the reform debate, insurance rates in most cases are rising steadily not because of price gouging but rather because underlying health care costs are increasing at an unsustainable and possibly unstoppable rate."
"Slowing the rate of increase is the only solution to a health care crisis that is still looming. On its own, the law does not necessarily do that. The reform's ultimate success will hinge on whether it can transform an industry that now rewards volume and accounts for one-sixth of the U.S. economy to one that pays for results."
Click here to read the full article.
MUST READ: The Christian Science Monitor -- Health Reform Must Cut Costs First
Posted by The Campaign on March 16, 2010 at 7:35 PM
The Christian Science Monitor hits the nail on the head in its latest editorial on health care reform. The editorial writers argue that health care reform must first address ways to get costs under control or reform will not be sustainable.
Here are some key excerpts:
"Insurance companies are easy political targets but they are not the main drivers of medical inflation. The causes are more fundamental, from Americans living longer to ever more costly medical procedures to too few incentives for consumers to control costs. Those issues need to be addressed first before taking an expensive leap into making sure the uninsured are insured."
"But in implicit admission that such reform probably wouldn’t bring enough savings, he proposes the creation of a seven-member federal board – the Health Insurance Rate Authority – that would bluntly set price controls on rate increases in health insurance. In other words, don’t expect much savings from the Obama plan, and so government will need to keep a cap on insurance premiums."
Click here to read the full editorial -- it's definitely a must read.
MUST READ: The Washington Examiner Puts Health Plan Profits in Perspective
Posted by The Campaign on March 16, 2010 at 7:21 PM
The Washington Examiner shines a spotlight on one of the industry deals and how the campaign to vilify health plans is misdirected.
Here are some highlights:
"...the battle at this point is not reformers versus industry, as Obama would have you believe. Rather, it is a battle between most of the health care industry and the insurance companies."
"Of all the single-industry lobbies in Washington, the largest is the Pharmaceutical Researchers and Manufacturers of America. PhRMA spent $26.2 million on lobbying last year — that's nearly three times as much as the insurance lobby, America's Health Insurance Plans, which spent $8.9 million."
"Let's look at those profits. Drug makers' combined profit margin last year was 22.2 percent, compared with insurers' 4.4 percent. Drug maker Merck's net income, $12.9 billion, exceeds that of the 10 largest insurers combined."
For the full article click here.
MUST READ: Politico looks at prospects for cost containment
Posted by The Campaign on February 25, 2010 at 6:41 AM
Politico takes a look at the latest health care reform proposal and what it means for lowering health care costs. Here are some key excerpts:
“They thought [the tax] was a major part of their ability to slow the growth in private-sector premiums. And now, at least until after 2017, it doesn’t look like they will bend the cost curve,” said Ken Thorpe, an Emory University professor and Democratic health policy adviser.
“This was designed to get more support from the Democratic Caucus. Not surprisingly, there’s higher overall costs and fewer steps to get the savings necessary to pay for those costs,” said Mark McClellan, a former Clinton and Bush administration official who is now a health care economist at the Brookings Institution.
The insurance industry has been making the cost-containment case for months and reiterated it when Obama’s plan was released Monday. Democrats have singled out insurers as the poster child for skyrocketing health care costs, and the president’s plan proposed giving the federal government authority to block unjustified rate increases. Karen Ignagni, the president of America’s Health Insurance Plans, said it was wrong to single out her industry when total health care costs as a share of the economy jumped by 1.1 percent last year — the largest increase in history.
“There’s a heavy dose of politics at work. There’s been a strenuous effort to focus on health plans because very few policymakers want to take on the real issue of why costs are rising,” Ignagni said.
Those reasons include the high cost of medical services, a lack of transparency that prevents comparative shopping and payment systems that reward volume instead of value. Premium increases, she said, reflect the underlying increases in the cost of medical services. “Regulating premiums won’t do anything to reduce the soaring costs of medical care,” she said. “This would be like capping the price automakers can charge consumers, but letting the steel, rubber and technology manufacturers charge the automakers whatever they want.”
For the full article click here.
