Tag Archives: New York State of Health

NY exchange scores F’s on some consumer features

The New York State of Health exchange lacks many of the features that other public Obamacare marketplaces, including Healthcare.gov, have added to make it easier for users to compare plans, according to a report released Tuesday by the Clear Choices Campaign, an advocacy group that seeks greater transparency in health care quality and pricing. Rather than just allowing users to compare premiums, for instance, some exchanges include tools that let users calculate their out-of-pocket costs and search for plans that cover their preferred drugs and providers. The scorecard accompanying the report gave New York an F in several categories. Although the pending repeal of the Affordable Care Act introduces uncertainty into the future of the Obamacare exchanges, a less standardized health insurance marketplace could increase the need for such comparison-shopping tools, said Joel White, president of the Clear Choices Campaign. White is also founder and president of the health care lobbying firm Horizon Government Affairs.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New Contraceptive Regulations Announced by Governor Cuomo

“Governor Andrew M. Cuomo today announced a series of actions to firmly secure access to reproductive rights in New York State. Through regulatory action, the State will ensure that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles regardless of the future of the Affordable Care Act; contraceptives are available in amounts exceeding one month’s supply at a time; and all medically necessary abortion services are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles.”

Links to the circular letter and regulations can be found below.  High Deductible Health Plan deductions will apply to abortion services.

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/ContraceptiveLetter.pdf

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/AbortionRegulations.pdf

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/ContraceptionRegulations.pdf

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

NY health plans seek average 13.5% hike for 2016

Get ready to pay more for health care next year.

The battle over setting next year’s health insurance premiums in New York is underway after proposals seeking double-digit rate increases on average were submitted to state regulators.

Proposed rate adjustments vary widely, with an average increase of about 13.5 percent. While some health plans seek up to 30 percent rate increases, others have presented slight decreases, state records filed this month show.

Health insurance premium rates in 2016 for individual and small group plans — as opposed to larger employer-sponsored coverage plans — will ultimately be set by the state Department of Financial Services under the prior-approval process, which essentially gives the agency authority to approve or reduce the rates requested.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Republicans Proposed Plan to Replace The ACA

The Washington Times reports that the list of Republican plans “to deal with the potential fallout” from King v. Burwell “is growing longer, although Republicans have yet to coalesce around a game plan with just six weeks before the court is expected to rule.” Rep. Tom Price (R-GA) unveiled a “revamped version” of his ACA replacement bill last week. The proposal would repeal the health law in its entirety and offer tax credits to people to purchase insurance on their own. Another plan, from Sen. Bill Cassidy (R-LA), would allow states three ways to respond to a Supreme Court ruling against the ACA’s subsidies: “States could set up exchanges under Obamacare, do nothing and lose federal support or – and this is what the senator wants – opt into a third path titled the Patient Freedom Act.”

The Hill reported in a similar article that Republican lawmakers “are all over the map about what to do about the millions of people who could lose” subsidies if the Supreme Court rules against the ACA next month. Although Republicans agree that “they need a plan if the high court strikes down a subsidies next month,” they do “not agree about how to help people who’d lose access to healthcare – and even whether to help them at all.” Currently, “there are more than half a dozen plans floating around, with varying degrees of details.”

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Data Released to The Public on Medicare Prescription Spending

The heartburn drug Nexium — whose advertisements have long been ubiquitous on television — was prescribed to 1.5 million Medicare patients in 2013, for a total cost of more than $2.5 billion, the largest amount spent on any drug prescribed through the government program, according to data released by Medicare officials on Thursday.

The data was the most detailed breakdown ever provided by government officials about the prescription claims of Medicare beneficiaries. It included information about 36 million patients, one million prescribers and $103 billion in spending on drugs under the program’s Part D in the year 2013, the most recent year available. The data did not take into account rebates that the drug manufacturers pay to the insurers that operate the Medicare beneficiaries’ drug plans.

Although the government has previously released similar data to outside entities — including ProPublica, the nonprofit news group — officials said they decided to make the information available on a public website to encourage experts to weigh in, potentially leading to new solutions for policy challenges, like how to contain costs.

“We know that there are many, many smart minds in this country,” Sean Cavanaugh, a deputy administrator at the Centers for Medicare and Medicaid Services, said in a conference call with reporters on Thursday. “We are excited to unleash those minds and see what they can find in our data.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Most Doctors Don’t Follow Guidelines for Patients

For all their talk about evidence-based medicine, a lot of doctors don’t follow the clinical guidelines set by leading medical groups.

Consider, for example, the case of cataract surgery. It’s a fairly straightforward medical procedure: Doctors replace an eye’s cloudy lens with a clear, prosthetic one. More than a million people each year in the U.S. have the surgery — most of them older than 65.

“The procedure itself is relatively painless and quick,” says Dr. Catherine Chen, an anesthesiologist and researcher at the University of California, San Francisco. She calls it the “prototypical low-risk surgery.”

And since at least 2002, Chen says, clinical guidelines have stipulated that no preoperative testing is needed before cataract surgery. A large study showed that procedures like chest X-rays, blood tests and EKGs — tests sometimes recommended when older people undergo more complicated surgeries — do not benefit someone who is simply having a cataract removed.

But Chen noticed that a lot of patients are having these preoperative tests done anyway. How many? Digging into the numbers, she discovered that half the ophthalmologists who performed cataract surgery on Medicare patients in 2011 ordered unnecessary tests. That’s the same percentage as in 1995.

“In about 20 years, nothing has really changed in terms of physician performance,” Chen says. She recently published those findings in the New England Journal of Medicine.

Dr. Steven Brown, a professor of family medicine at the University of Arizona, has studied doctors’ reasons for ordering unnecessary tests before a scheduled surgery. A lot of it has to do with perceived safety, he says.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The War On Work and Sleep

There are a lot of advantages to earning more money, but getting a good night’s sleep may not be one of them.

It turns out that, in general, the more money people make, the less they sleep. That’s been true for decades in the United States, and in other countries as well. On average, adults earning the highest incomes — around $98,000 for a family of four — sleep 40 minutes less than people in the lowest-income families. And among short sleepers — those who are in the bottom 10 percent of nightly rest — high-income people are overrepresented, according to the government survey that sleep researchers trust most.

Sleeping too little is really bad for your health. Researchers have demonstrated that, for most people, sleeping less than six hours a night results in cognitive impairment. Poor sleep is also associated with a number of other health problems, and an increased risk of dying in a car accident.

In general, the factor that seems the most closely tied with how much sleep people get is how much they work. More hours of work tend to crowd out sleep. People who work two jobs sleep the least of anyone, according to a recent study, and are most likely to be in the bottom 10 percent of sleepers, sometimes called “short sleepers.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Lawmakers Are Seeking Transparency on Health Care Tax

Some lawmakers are challenging the Cuomo administration’s push for a $69 million annual tax to fund the state’s health exchange, wondering how the state spends the more than $5 billion in annual health care related taxes it already collects.
The Republican-led State Senate eliminated the proposed tax from its one-house budget.
Cuomo set up the exchange through an executive order after the Senate refused to consider creating it. The order Cuomo issued dictated that the exchange was to become self-sustaining by this coming fiscal year.But lawmakers are questioning why the tax, which would be funded through an increase in the Health Care Reform Act assessments paid by insurers, is necessary and wondering whether the money to fund the exchange can be found within the $5.5 billion the HCRA tax already generates each year.

That tax has recently come under new scrutiny with the arrest of former Assembly speaker Sheldon Silver, who allegedly used money from a slush pool funded with the tax money to make grants to a doctor who led lucrative clients to his law firm. The tax, originally intended to fund just graduate medical education and charity care, has ballooned over time into a general purpose fund that is used to prop up the state’s budget and trigger additional federal Medicaid money.

Under the HCRA law, details of how the money is collected and from whom, as well as how it is disbursed, should be easy to obtain. The details are supposed to be disseminated in quarterly reports written by Excellus Blue Cross Blue Shield, the company the state hired to manage all the HCRA money under a no-bid contract that pays Excellus $4.5 million a year.

State law requires Excellus to submit directly to the temporary president of the senate and the speaker of the assembly quarterly reports on the collection, pooling and distribution of funds in the HCRA Pool. The pool administrator is also supposed to submit reports detailing HCRA spending to the state’s comptroller. But lawmakers have said that the pool administrator hasn’t delivered any such reports for several years.

When lawmakers asked for those reports as part of this year’s budget negotiations, Cuomo administration officials gave them some numbers, a spokeswoman for Senate health committee chair Kemp Hannon said.

Reached Friday for comment, a spokesman for the Office of Pool Administration said he had no idea what the reports were. That’s something the Department of Health would handle, he said. Asked why the health department and not Excellus, would handle the reports, as required by law, the spokesman said, or one thing I don’t know what it is, and I don’t know who would be handling it. It’s something I don’t even know about.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Small Business Tasked to Tally Employee’s Health-Care Costs

Small employers are facing an unexpectedly onerous task: tallying their individual employees’ monthly health-care costs.

Starting in 2016, under the Affordable Care Act, employers with 50 or more full-time workers are required to file new tax forms laying out what individual employees are being charged for their employer-sponsored plans. The Internal Revenue Service released the new forms on Feb. 8.

Though completed forms aren’t due until next January, many employers are scrambling to get procedures in place now to collect the data. The new process entails measuring every individual full-time worker’s total monthly out-of-pocket cost for an employer health plan this year.

The IRS says tax officials will use this information to figure out whether employers are complying with the law’s requirement that businesses offer affordable health coverage to full-time employees and their dependents. Federal penalties for failing to provide an affordable health plan can run up to $3,000 an employee.

But small employers, especially those who keep their own books and prepare their own tax returns, say they’re finding the task of tracking employee costs for the plans to be confusing and time-consuming.

Rather than simply ask employers to record the price tag for a given health plan, the forms require employers to calculate the lowest-cost plan available to each full-time worker on a month-by-month basis—a figure that can vary as wages or working hours change, tax lawyers and workplace benefits consultants say.

That can be especially hard for retailers, restaurants, day-care services or other businesses where workers’ hours can vary from part-time to full-time, or so-called variable hour employees, they add. Under the law, employers aren’t required to offer coverage to part-timers.

“It’s a labor intensive process,” says Adam Okun, a senior vice president of Frenkel Benefits in New York, about completing the new IRS paperwork, Form 1095C. Employers who don’t start collecting this information today are heading for a “real nightmare next year,” he adds.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Single-Payer Health Care Bill Gets Wide Support

The Affordable Care Act has made an unwieldy system of health insurance even more complicated, and should be replaced with a centralized, tax-funded health care system.

That was the prevailing view at Tuesday’s all-day hearing on the New York Health Act, Assemblyman Richard Gottfried’s bill to create statewide single-payer health insurance that stands almost no chance of passing in the state Senate.

The handful of insurance representatives who testified for a wait-and-see approach followed their speeches with a swift exit, often to the tune of hisses and groans from patients, health care workers and unions in the audience who far outnumbered them.

“No one advancement is big enough to bend the cost curve in itself,” said Lawrence Thaul, president of Millennium Financial, an insurance brokerage. “It took many years to improve Medicare. Let us not be shortsighted and impatient—and you’ve been anything but that, chair,” he hastily added to Mr. Gottfried, who chaired the hearing.

Mr. Gottfried, who heads the Assembly’s committee on health, has carried a version of his single-payer legislation since 1999.

Many doctors and health care workers bemoaned the amount of time spent billing and collecting payment for medical care.

“I employ 24 separate billing people,” said Dr. Neil Calman, president of the Institute for Family Health, “each of whom develops a relationship with one or two paying companies.” Dr. Donald Moore, who recently stopped accepting commercial health insurance, said he used to spend the equivalent of three to four weeks every year billing for his work.

But without this back-and-forth between providers and insurance companies to drive down providers’ charges, health care would cost even more, argued insurance executives.

“Price controls would not work because there would be no one on whom to shift the excess costs,” said Craig Hasday, the legislative chair of the New York State Association of Health Underwriters. “Over time, the issue of affordability will return, but as a tax issue.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary