The California Department of Managed Health Care has fined Wellpoint $1 million because it says Wellpoint "routinely" violated state law when it canceled (or rescinded) individual health insurance policies after the policyholders filed claims. The state said that Wellpoint made no attempt to determine whether the policyholders merited such "harsh" treatment when it canceled the policies.From a
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Browse » Home » Archives for March 2007
Medicare Advantage “Overpayments”—Not As Simple As It Seems
Bill Boyles, Publisher of Health Market Survey, gives us another insider's view of the day-to-day debate over the appropriateness of the Medicare Advantage payments to HMOs.It seems that when you have seen one Medicare Advantange Plan you have seen one Medicare Advantage Plan. The "overpayments" reported by MedPAC and the CBO are nowhere near across the board.The debate is clearly getting into
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House Ways and Means Health Subcommittee Goes After Medicare Advantage Payments on Wednesday and Humana Stock Up 5% by Thursday Close
Apparently Wall Street doesn’t take Pete Stark and the Congressional Democratic Majority very seriously.The House Ways and Means Health Subcommittee held hearings on Medicare Advantage payments to HMOs on Wednesday morning. It’s no secret the Democrats have every intention of cutting those payments.No health plan has made the strategic bet on the Medicare Advantage program that Humana has. And
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The Latest Health Wonk Review
For all of you health care policy addicts, who spend your free time cruising cyberspace in search of the latest health care policy ruminations, the latest Health Wonk Review is up over at Matt Holt's "The Health Care Blog."
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The Reauthorization of the State Children's Health Insurance Program (S-CHIP)--A Surprising Contrary View
Bill Boyles, the publisher of Health Market Survey, fills the role of guest commentator again today reporting on a very different view on the issue of the reauthorization of the State Children's Health Insurance Program (S-CHIP).His report just goes to show that nothing in health care policy is simple:House Black Caucus Not Buying S-CHIP ExpansionIt seems like every interest group in the country
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Senate Budget Committee Adopts Budget Blueprint––Need for Revenue Continues to Endanger Medicare Advantage Funding
The Senate Budget Committee voted along party lines this past week to adopt a 2008 budget blueprint that includes substantial funding for the State Children’s Medicaid Program (S-CHIP), additional veterans care, and many other health care needs.Most notably, the blueprint has only identified $15 billion of the $50 billion needed to expand the S-CHIP program. They plan to get that $15 billion from
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Bush Administration Rejects Bipartisan Health Care Reform Recommendations From "Citizens' Working Group" Created by Medicare Act
The 2003 Medicare Modernization Act the Bush administration pushed through--it also created Part D--included a provision that established a "Citizens' Working Group" to study the American health care challenge and report back to the President and the Congress with suggested solutions.Their mission was to "promote a public debate" on solutions to the cost, coverage, and quality challenges we face.
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Medicare Advantage HMOs Gearing Up for Payment Cuts--Could They Come as Early as 2008?
Bill Boyles--Publisher of Health Market Survey--returns as a guest commentator. Bill keeps a sharp eye on the Medicare Advantage business and on Capitol Hill. Here's his take on what the Congress--and the health plans --are up to:We are hearing that the health insurers are getting ready to dump markets in response to the Democratic threat to cut Medicare Advantage payments. But first they will
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United Health Buys Sierra Health Plans--The Consolidation Begins Again--But What's the End Game?
After a period of quiet on the merger and acquisition front, it seems to be beginning again.Today, UnitedHealth announced an agreement to acquire Sierra Health Plans for $2.4 billion.With little in the way of growth in the commercial health insurance markets, and the recent surge in Medicare products about to settle down as the new Medicare Part D and Medicare Advantage opportunities reach a
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Bush Administration Ducking Its Own Commission on Health Care Reform
Joe Paduda reminds the Bush administration of its obligation to pay attention to its own commission over at "Managed Care Matters" today:Bush's non-responseActions, or lack thereof, speak louder than State of the Union addresses.From California HealthLine comes the news that the Administration has failed to comply with it's legal obligation to respond to the Citizen's Health Care Working
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It's a New Day in the Health Care Debate--New Efforts to Reform the U.S. Health Care System are Real and Serious
The following is a guest column I authored which recently appeared in the Employee Benefit Adviser:It Is a New Day in the Health Care Debateby Robert LaszewskiMarch 1, 2007 - New efforts to reform the U.S. health insurance system are real and serious, and it would be wise not to ignore what's happening.Health insurance reform is breaking out everywhere; 2007 is shaping up to be the "Year of the
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The Latest "Health Wonk Review"
The best and the brightest in the health blog world are at it again with their latest "Health Wonk Review" over at Joe Paduda's "Managed Care Matters."
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Part D Was “Financially Irresponsible”—The Medicare Part D Drug Plan Liability is Twice That of the Social Security System!
The passage of the Medicare prescription drug benefit—Part D—was a “financially irresponsible” thing to do. Those were the words of U.S. Comptroller General David Walker on CBS’ “60 Minutes" this past weekend.Amen to that.The Medicare Trustees, in May of 2006, reported that Medicare’s long-term debt is estimated to be $32.4 trillion dollars (over 75 years). The new Part D drug benefit is a
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The Massachusets Health Plan's Inability to Offer Affordable Health Insurance Premiums Will Stall-Out Other State's Efforts in Health Reform
Now that we know Massachusetts is not going to be able to offer affordable health insurance to the middle class, we can expect to see other similar state health reform efforts stall-out.Both California and Pennsylvania have already started down the Massachusetts health care reform road. But when state legislators find that families making $50,000 or $60,000 a year would be mandated under state
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More on the Massachusetts Health Plan's Unaffordable Costs
My old friend and colleague, Richard Eskow, has a great post on the affordability problems with the new Massachusetts health plan over on his blog, The Sentinel Effect.
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The Massachusetts Health Plan Will Turn Out to Be Little More Than a Fancy Expansion of Medicaid--Bids Come In At $250 Per Person Per Month
For weeks we have been warning that the Massachusetts health reform plan is at a critical point. The second round of health plan bids came out no better than the first. That did nothing to alleviate concerns that Massachusetts will not be able to mandate that its citizens buy the costly coverage.The first health plan bids averaged $380 per person per month. A family of three would have to pay
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Sierra Health Announces It's Already Losing Money in its 2007 Part D Medicare Prescription Drug Plan
Sierra Health, the leading health plan in Nevada, is already losing money in its 2007 senior Medicare Part D prescription drug program.For 2007, Sierra offered two primary Part D programs--a basic Part D drug plan and an enhanced plan that covers senior's medication in the "gap" or "donut hole." This "gap" lies between the first layer of coverage and the catastrophic insurance that Part D
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Medicare Payment Advisory Commission (MedPAC) Finds Medicare Advantage Plans “Overpaid” by 12%
Told you so—Part Deux.On top of this week’s CBO report saying Medicare could save $65 billion by equalizing Medicare Advantage payments made to HMOs with the traditional Medicare plan, MedPAC dropped the second shoe saying the very same thing in their annual report released yesterday.MedPAC is a commission created by Congress to advise on Medicare payment policy. It is composed of 17 members from
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