New York AG Andrew Cuomo recently announced an investigation into how insurers pay for out-of-network services. He charged that consumers were being "defrauded" by insurers who were "manipulating reimbursement rates."Cuomo used the example of a charge for an office visit of $200 that the insurer cut back to $77--the insurer claimed the lower amount was reasonable and the maximum that should be
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Bush Administration Now Willing to Increase SCHIP Spending by $19 Billion Only Weeks After Vetoing a Bipartisan Compromise
At a February 7th Senate Finance Committee hearing, HHS Secretary Leavitt testified about the 2009 Bush budget request.This time, the Bush Administration is asking for $19.3 billion more for SCHIP over the next five years.Just a few weeks ago, President Bush vetoed the $35 billion bipartisan SCHIP extension yet again. Bush and Leavitt maintained all of last year that the program should be
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Lifetime Health Care Costs For the Obese and Smokers Lower Because They're Dead Sooner
This was the impressive conclusion of a study published by the Public Library of Science Medicine. The study was sponsored by the Dutch Ministry of Health Welfare and Sport.Obese people had the highest health care costs between the ages of 20 and 56. Obese folks and smokers were found to have a higher rate of heart disease than others.However, the authors found that the obese and those who smoke
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Mom, Dad, the Kids and Medicare––Would an Obama Presidency Energize Young Adults to Demand Entitlement Reform?
Barack Obama has made this election-year different. Not since the 1960s have young voters been so energized. One college town after another has voted big for him.On entitlement issues like Social Security and Medicare, the political debate has always been dominated by what senior voters want. They have been the big and effective voter block that have managed to insulate these programs from any
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Haley Barbour or Hillary Clinton?
Here's a test.Who just proposed the following, Hillary Clinton or Haley Barbour:A government authorized health insurance purchasing exchange program for the purpose of marketing health insuranceRun as a not-for-profit clearing house from which consumers could purchase health insuranceTarget the uninsuredAvailable to workers in small businessesDesigned to reduce the overhead costs of small group
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Employers Finally Figuring Out They Can Shift Retiree Costs to Medicare
Employers are finally showing signs that they have figured out they can take advantage of the generous Medicare payments to Medicare Advantage plans.With Medicare Advantage plans paid 13% more than for the same beneficiary under traditional Medicare, many seniors have figured out the benefits are better in the private plans. Private Fee-For-Service (PFFS) plans even get more than that.What is
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No One Ever Did Understand "Customary and Reasonable"
New York Attorney General Andrew Cuomo is suing Ingenix over its operation of the longtime "customary and reasonable" database.In the days before provider networks, insurers relied on this survey of insurance company claim data to determine an appropriate payment level. It was a survey of what all participating insurers paid by service in a particular market thereby ensuring that any one payer
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Bush Budget Dead On Arrival But It Underscores the Trouble With Entitlements and The Choices That Must Be Made
President Bush is calling for $560 billion in cuts from Medicare over the next decade.He would make these cuts by reducing the payments doctors and hospitals would have received.What is amazing about the Bush budget numbers is that the administration is only trying to cut Medicare's annual growth rate from 7% to 5%. At one level, that ought to be easy. After all we aren't talking about reductions
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When it Comes To Health Care Policy It Really Doesn't Matter Which Democrat Or Which Republican Wins Their Nomination
With "Super Tuesday" upon us, I am once again bringing back a post that argues there is little difference among the candidates in each of their respective parties.My suggestion is that you not cast your caucus or primary vote for a candidate based upon their health care reform plan.From “thirty thousand feet” the leading Republicans are offering much the same health care policy ideas—a more
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"Plumpy"––A Reminder That Good Policy Works on Many Fronts
Brian Klepper joins us again today with a post that reminds us that good health care policy doesn't have to be complicated health care policy and can work for us on many fronts at once. Plumpy'nut by Brian KlepperThe NY Times recently had an important op-ed by Susan Shepherd, a pediatrician and medical advisor to Doctors Without Borders. The core of her message is that as the farm bill progresses
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