Take Politics Out of Healthcare

Medical politics and health reform challenges or universal healthcare system stress concept as a group of opposing ropes pulling on a doctor stethoscope as a medicine management symbol with 3D illustration elements.

Three additional states have joined California in an investigation of the third largest insurer in the United States – Aetna – alleging their medical director denied a $20,000-per-dose infusion, admitting in a deposition that he never looked at [the] patient’s medical records. The media and public have cried out that the insurer has put profits over patient… [Read More]

It’s Time to Get Real About Medical Insurance Costs

healthcare cost medical insurance

Intuit, the tax preparation software company, has said that three-fourths of filers who might be subject to the individual mandate were able to find an exemption in 2015.  It’s no surprise with the liberal policies put in place by regulators that this watered down threat provides little leverage to bring the healthiest Americans into the… [Read More]

Politics and Healthcare

health policy

In the shadow of the failure of federally sponsored co-op: Health Republic, New York hospitals and other providers are lobbying hard for a healthcare guaranty fund to indemnify them against failures by other insurers. A common theme in this blog (see related posts here, here and here) is that the governmental role in healthcare should… [Read More]

One More Provision of ACA is Repealed: Auto Enrollment

Flag and Stethoscope

Signaling an end to the partisan bickering that has plagued Washington for the past several years, Congress has agreed to a deal on government funding through March 2017. If, as expected, President Obama signs this measure, the government will go on through the upcoming election settling the threat of sequestration in what is seen as… [Read More]

Federal Government Trims 2016 Forecast for Exchange Enrollment

Medical touch screen

Last week, the government announced their 2016 estimate for enrollment through the healthcare.gov website and various state exchanges. The expected enrollment of 10 million is marginally greater than the 9.9 million enrolled as of June 2015, and 50% less than the 20 million that was projected three years ago by the Congressional Budget Office. Currently,… [Read More]

As Expected, Another Co-op Collapse – What Health Republic’s Fate Says about Government Involvement in Healthcare


Another health co-op has failed. Health Republic of New York becomes the fourth nonprofit startup created under the ACA to meet the unsurprising fate of a forced shutdown following massive losses. I previously wrote about the shaky outlook that co-ops were facing when CoOportunity Health collapsed in Iowa and Nebraska earlier this year. While the… [Read More]

Healthcare Is In Even More of a Crisis Under ACA

healthcare us government aca

As healthcare is restructured, the key constituencies are fortifying their positions and as can be expected, taking advantage of the renegotiation, market gyrations and general confusion. Fraud (intentional or otherwise) is rampant and uncontrolled. During a recent congressional hearing on the website, a GAO official testified about efforts to test healthcare.gov by enrolling 18 completely… [Read More]

Moving Forward Amidst Continuous Change and Consolidation


The most recent news in healthcare consolidation is certainly the insurer mergers: Anthem’s purchase of Cigna and Aetna’s of Humana. Consolidation has ramped into high gear throughout the healthcare industry – and it means we are in store for continuous change. Since I started in this business, I have watched the market shrink from in… [Read More]

Doc Fix – Is it Finally Fixed?

Doc Fix – Is it Finally Fixed

Price controls don’t work to control cost inflation. Politicians are not the most steadfast policymakers; over time, changing and re-changing direction. Nowhere have these two truisms been more evident than in the debate surrounding the Medicare sustainable growth rate (SGR) formula. In 1997, Congress imposed a formulaic price control to reign in the escalating budget… [Read More]

The Government Wants to Tell Us How Much to Pay Our Doctors


You should take note of an article appearing in Capital New York. In March 2015, they discuss how Albany politicians want to take control of changing healthcare delivery by using their authority to set health insurance premiums. Did you read that right? Yes…you did! A similar “value-based payment” proposal has been espoused by the Department of… [Read More]