Insurance companies will be directly affected by President Donald Trump’s executive order requiring removal of at least two previously implemented regulations for every new one issued, according to Modern Healthcare magazine.
The order has major ramifications for healthcare, one of the most regulated industries in the U.S. economy. Providers and vendors face a myriad of rules drafted by numerous agencies and departments, including the CMS, the Health Resources and Services Administration, the Food and Drug Administration and the Office of the National Coordinator for Health Information Technology.
There are dozens of regulations leveled against the healthcare industry every year. They include licensing requirements; quality and safety inspections; and standards to adhere to payment policies. Among the major ones released last year: a rule that mandated the medical loss ratio for managed-care plans; a ban on discrimination at federally funded hospitals, physician practices and clinics; a rule that allowed claims data to be sold; and a rule on the new payment models outlined in the Medicare Access act. The article is here:
Could California Go It Alone on Healthcare Reform?
That’s the question asked by the San Jose Mercury News, and also this other one: How much would Californians be willing to spend to keep Obamacare in the Golden State?
Lawmakers might be asking that to residents in the months to come as President Donald Trump and the Republican Congress scurry to repeal the Affordable Care Act and scramble for a plan to replace it.
One GOP-generated proposal would allow individual states to keep Obamacare-style health insurance – for a price. And that ultimately could force California voters to decide whether they’d be willing to pay more in taxes to continue providing subsidized insurance coverage for at least 5 million residents.
How much – and to cover how many? That’s still a wide-open question.
“The big issue with California is the federal in-flow of dollars,’’ said Christine Eibner, a senior economist at Rand Corp.
That amounts each year to $22.5 billion in federal funds – more than $17 billion of that to add millions of uninsured low-income adults to Medi-Cal, the state’s health program for the disabled and poor. The rest of that money provides subsidies to lower the cost of health plans for most of the 1.3 million who buy their insurance through the state’s health exchange. The article is here.
Republican Healthcare Plans Return
A number of Republican healthcare policy proposals that seemed out of favor in the Obama era are now being given new life, the New York Times reports. One of these involves Medicare, the government health insurance program primarily for older Americans, and is known as premium support.
Right now, the federal government subsidizes Medicare premiums – those of the traditional program, as well as private plan alternatives that participate in Medicare Advantage. The subsidies are established so that they grow at the rate of overall per enrollee Medicare spending. No matter what Medicare costs, older Americans can be sure that the government will cover a certain percentage of it. That’s the main thing that panics fiscal conservatives, because that costs the government more each year.
Premium support could quiet that fear. Subsidies would be calculated so they don’t grow as quickly, thus protecting taxpayers from runaway spending. The article is here.
Medicaid Platform Launched
Nuna, a San Franciso company participating as a partner in the development of a national modernized data platform for Medicaid, is officially launching. The new Medicaid data platform has the potential to collect and contain eligibility, provider, and managed care plan and other data for 74.5 million lives from all 50 states and the District of Columbia.
The company also announced that it has closed more than $90 million in funding to date, led by Kleiner Perkins Caufield & Byers and John Doerr, to continue to scale its team and operations to deliver its health data platform to even more customers.
“The healthcare industry is the largest part of the U.S. economy, with more than 12 million jobs and $3 trillion of annual spend,” said John Doerr, Nuna investor and Chair at Kleiner Perkins. “Nuna’s team of data and computer scientists transform health data into powerful insights which employers, governments, and health plans are using to save costs, improve quality of care, and change lives.”
Court Rejects Regulation on Dialysis
Advocates for dialysis patients, including Dialysis Patient Citizens, are welcoming a federal court ruling in Texas that granted a preliminary injunction preventing the U.S. Department of Health and Human Services from implementing a regulation that could force patients off their current health insurance and jeopardize their access to care.
In enjoining the regulation’s enforcement, the U.S. District Court for the Eastern District of Texas held that the rule was first procedurally defective because HHS adopted it without first giving the public notice of it and seeking comment on it, and second “arbitrary and capricious” because HHS failed to consider the benefits of private coverage and ignored the disadvantages of adopting the rule.
The court concluded that the regulation cannot be implemented because HHS “failed to consider the benefits of private qualified health plans and ignored the disadvantages of the Rule,” including that “the rule would leave thousands of Medicare-ineligible dialysis patients without health insurance.”
The court went beyond invalidating the rule on procedural grounds and questioned the policy itself.
“Congress has long recognized the importance of dialysis treatment for end-stage renal disease patients and has afforded patients the opportunity to elect coverage that best serves their needs,” the opinion stated. The court added that, “For decades, dialysis patients have had the choice of selecting private insurance options over Medicare if those options better served their treatment needs. Private insurance is particularly attractive to dialysis patients with families because Medicare does not provide coverage for spouses and dependents.”
Employers Overwhelmed by Managing Benefits
Guardian Life Insurance Co. in New York, released findings that highlight the increasing challenges employers face in managing benefits costs, improving administrative efficiency, and maintaining plan compliance, all while trying to improve workforce health and productivity. Among them:
Six in 10 employers feel overwhelmed with the increased complexity of managing their benefits programs. Companies with more than 100 employees are struggling the most, especially with new coverage, changing carriers, and employee communication and enrollment.
Controlling costs and keeping benefits affordable for their workforce remain employers’ top benefits priorities, but traditional approaches are proving to be less effective, causing some employers to shift strategies. Less than one-third of companies believe that employee cost-sharing and high deductible health plans have been highly successful in achieving cost-cutting objectives.
Compliance is the number one benefits-related concern for more than one in four employers surveyed, yet less than one-third indicates that their companies are well-prepared to address it. Seven in 10 believe their firms are unable to keep up with changes to federal, state or local laws, including the Affordable Care Act, paid parental leave laws, the Family and Medical Leave Act and the Americans with Disabilities Act.
Aetna Signs Reinsurance Deal
Aetna in Hartford, Conn., signed a four-year reinsurance arrangement with Vitality Re VIII as part of its long-term capital management strategy. The arrangement allows Aetna to reduce its required capital and provides $200 million of collateralized excess of loss reinsurance coverage on a portion of Aetna’s group commercial health insurance business. Vitality Re VIII is a new insurance company which issued health insurance-linked notes in a private offering in connection with this transaction.
“Today’s transaction marks the successful completion of our eighth such reinsurance arrangement,” said Aetna’s Treasurer David Buda. “This reinsurance arrangement improves our capital efficiency and reduces our weighted average cost of capital.”
Anthem Donates to USA Warfighter Sports
Anthem Blue Cross is supporting the Disabled Sports USA Warfighter Sports program to help severely injured service men and women rebuild their lives through sports. The Woodland Hills insurer is giving $25,000 in support to this year’s winter ski event.
The 2017 Ability Celebration and Winter Ski Festival will host approximately 28 wounded warfighters and their families free of cost. They will receive instruction in adaptive alpine skiing, snowboarding and snowmobiling through Achieve Tahoe at four ski resorts in the north Lake Tahoe region of California January 24 through January 29. Through a combination of Anthem Foundation grants and corporate sponsorships, Anthem has given DSUSA more than $800,000 since 2009 in support of the Warfighter Sports program and other winter and summer activities.
“At Anthem, we are very proud to once again be the lead sponsor for this ski event,” said Mike Wozny, president of Anthem Life. This event is one way we can support those who have served our country.”
Warfighter Sports offers sports rehabilitation for severely wounded warfighters in major military hospitals and communities across the U.S. through a nationwide network of more than 120 community-based chapters. Disabled Sports USA has served wounded warfighters, including those injured in the Iraq and Afghanistan wars, since 1967.
Cincinnati Appointments and Promotions
Cincinnati Financial Corp. said boards of its subsidiary companies appointed directors, officers and counsel, including the following promotions and new appointments: Sean M. Givler, senior vice president responsible for sales and marketing, was appointed as a director for all property casualty insurance subsidiaries. Teresa C. Cracas, chief risk officer and senior vice president; John S. Kellington, chief information officer and senior vice president; and Lisa A. Love, senior vice president, general counsel and corporate secretary were appointed as directors of Cincinnati Life Insurance Co.
Giuditta Named Epic Vice President
Epic Insurance in Stamford, Conn., has hired Christopher J. Giuditta as a vice president. Giuditta will focus on the cultivation and development of new revenue opportunities throughout EPIC’s Northeast Region. He will be based in Stamford, Conn. and report to Craig de Gruchy, Managing Principal.
“We are excited to have CJ join our growing operation in the Northeast Region,” said de Gruchy. “He is well regarded in our industry and his commitment to customers is strongly aligned with Epic’s core values.”
Giuditta joins Epic from H.D. Segur Insurance, where he provided individuals and business owners with customized risk management and insurance solutions while overseeing the service team regarding client satisfaction and retention.
Additionally, Giuditta worked with third party referral partners to enhance their offerings, including ensuring their clients’ awareness of and protection from a wide range of risk exposures. Giuditta was also a top producer for new affinity groups along with maintaining and growing the firm’s Travelers Benefits Plus programs.
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