Menu Close


Virginia, Richmond Region Fare Relatively Well in Health Insurance Analysis

Competition counts in Virginia’s health insurance marketplace.

The availability of insurance options will remain relatively robust and increases in premiums relatively low in the Richmond region when enrollment begins Tuesday in the federally operated marketplace under the Affordable Care Act, according to an analysis by The Associated Press called “Dwindling Choices, Higher Costs.”

In comparison, five states will have only one insurer in their marketplaces. Eight states, including North Carolina and Tennessee, will have just one for a majority of their local jurisdictions, according to the national AP analysis, which found that about one-third of all U.S. counties will have just one insurer.

“When you look nationally, we’re in a much better position,” said Jill A. Hanken, senior attorney at the Virginia Poverty Law Center, which operates the Enroll Virginia navigator site to help people shop on the federal exchange. “Virginians are seeing lower costs and more choice than many other states.”

The analysis also reinforced federal data released early this week that showed an average increase of 22 percent nationally in premiums for a “silver” benchmark plan bought by a 27-year-old, but an increase of 10 percent in Virginia. The AP analysis, using the second-lowest silver plan for a 50-year-old participant, showed an average increase of 9.7 percent in Virginia.

Read the full article here.

“Now What Do We Do?” Trumpcare?

Of course, “Now what do we do,” is the famous line from Robert Redford’s character in The Candidate, stunned by his victory and confused about what to do next.

But it doesn’t really apply here.

A few thoughts as all of this sinks in:

  • Some will tell you the Republicans are unprepared for repeal and replace. Wrong. There is a plan. Don’t let anyone tell you there is not. The plan was written by Paul Ryan as part of his “Better Way” document released in June of this year. It is not in legislative form, but it is as detailed as the plan Bill Clinton or Barack Obama had the morning after they were elected. I fully expect Speaker Ryan to take the point on putting the legislative details on the table, which will generally follow this outline.
  • As I pointed out in my blog post earlier this morning, Obamacare will effectively be repealed. No ifs, ands, or buts about it. The Trump voters voted for him expecting that he and the Republicans would do it and there is no turning back. This will be the first if not one of the first agenda items. Speaker Ryan, at his press conference this morning, reaffirmed that.
  • The repeal part will be the easiest part––not a literal repeal but a defunding of the money used for the exchange subsidies, the Medicaid expansion, and that run the exchanges.
  • The much harder part will be the replacement. Republicans will say to Democrats, “Help us create the new insurance system or be responsible for the consequences.” Some are saying the Democrats won’t cooperate. Here is why they will. In 2018, there are 23 Democratic and two Independent Senators (who caucus with the Dems) that will be up for reelection––a great many in states that Donald Trump won last night! There is a clear mandate here to replace Obamacare. If these Democrats fight it and that arguably results in millions of people thrown off their coverage they will do so at their peril.

Read the full article here.

Anthem Threatens Obamacare Retreat If Results Don’t Improve

Health insurer Anthem Inc., which has so far stuck with the Obamacare markets as rivals pulled back, said it may retreat in 2018 if its financial results under the program don’t improve next year.

Anthem’s comments up the stakes for the Obama administration as the enrollment season for 2017 Affordable Care Act plans begins, with consumers already facing fewer choices and higher premiums in many markets.

“If we do not see clear evidence of an improving environment and a path towards sustainability in the marketplace, we will likely modify our strategy in 2018,” Anthem Chief Executive Officer Joseph Swedish said on a call Wednesday discussing third-quarter results. “Clearly, 2017 is a critical year as we continue to assess the long-term viability of our exchange footprint.”

Anthem expects to post a narrow profit margin next year in exchanges created under the ACA, following losses that Swedish called “disappointing.” Profitability will improve thanks to plan changes and premium increases averaging more than 20 percent, but Anthem said it will take more than that to stabilize markets that have so far drawn about half the membership it was planning for. The company called for eliminating a tax on health insurers, as well as changes to regulations that govern how plans are sold and administered.

Read the full article here.

Between ACA and Medicare, Some Americans May Have Too Much Health Coverage

Ever since the Affordable Care Act’s insurance marketplaces opened for business in 2014, the Obama administration has worked hard to get Americans to sign up. Yet officials now are telling some older people that they might have too much insurance and should cancel their marketplace policies.

Each month, the Centers for Medicare and Medicaid Services (CMS) is sending emails to about 15,000 people with subsidized marketplace coverage. The message arrives a few weeks before their 65th birthday, which is when most become eligible for Medicare.

“In most cases you won’t want to keep your Marketplace plan because once your Medicare coverage starts, you’ll no longer be eligible for any premium tax credits or other cost savings you may be getting,” says the email, which goes to enrollees in the 38 states using the federal “To avoid an unwanted overlap in Marketplace and Medicare coverage . . . tell us you want to end your Marketplace plan.”

And last month, CMS also began mailing letters to people already covered by Medicare as well as enrolled on the marketplace and getting financial assistance. That notice, required under the health-care law, says that they can keep dual coverage — without subsidies — but urges them to discontinue their marketplace policy since in most cases it duplicates their Medicare benefits.

Enrollees who do not follow that advice — and only the individual can terminate marketplace coverage in this situation — will have their subsidies cut. Inaction also means paying back any coverage assistance received after they should have joined Medicare.

Read the full article here.

The Ethical Stain on U.S. Medical Care

Bill Bestermann, MD, Medical Director at QualityImpact (COSEHC) Practice Transformation Network in Greenville, South Carolina, has spent the past few years training other physicians to optimize the care of patients with cardiometabolic disease. In a project sponsored by Louisiana Blue Cross, Dr. Bestermann worked with 700 primary care physicians to improve care and outcomes for patients with multiple risk factors. In 3.5 years, the percentage of hypertensive patients who achieved their goals rose from 47% to 67%, a 42.5% increase. Even more noteworthy, diabetics reaching their goals rose from 14% to 30%, a 114% improvement.

These results are clearly strong, no question. But most striking is that the treatments Dr. Bestermann advocates for are based on solidly established science. They have been disregarded, not because most physicians don’t believe in science, but because healthcare’s scientific foundation has been trumped by financial incentives. 

Dr. Bestermann’s most difficult ethical dilemma

A few days ago Dr. Bestermann shared a short response he had written to an ethics survey that, among other questions, asked this: “What is the most difficult ethical dilemma that you have faced in your career?” He wrote:

“A mountain of evidence shows that, in stable angina patients, optimal medical therapy (OMT) alone—simple application of proven drugs and lifestyle changes rather than surgical interventions—is as effective as OMT plus a stent. After a heart attack, OMT compared with usual care saves $22,000 per patient per year while reducing cardiovascular- and all cause-mortality 10-fold. In patients with type 2 diabetes, OMT reduces heart attack 4-fold, reduces stroke 5-fold, and reduces dialysis 6-fold. Louisiana Blue Cross has shown that, with the proper support, ordinary practices can easily produce OMT. Despite irrefutably strong evidence, financial incentives continue to dominate, framing bypasses and stents as answers.

The pervasiveness of inappropriate care is our medical system’s biggest ethical stain. We harm by delivering high-risk care that patients should not receive and by not providing the safe inexpensive care they should receive. This ethical collapse is everywhere, occurring every day in every state. We violate that fundamental medical aphorism ‘First do no harm!’”

This is a remarkable and heartrending statement, and all the more damning from a respected and field-experienced physician. It articulates the profound frustration of a doctor who puts patients’ welfare first, and whose confrontation with medicine’s “ethical collapse” is professionally and personally excruciating.

Read the full article here.