Insurers and PBMs Taking Action on Opioid Abuse 

Opioid health risk and medical crisis with a prescription painkiller addiction epidemic concept as a group of people running away from a dangerous falling bridge of pills as a medicine addict problem with 3D illustration elements.

Pharmacy Benefit Mangers (PBMs), which run the drug plans for health insurers, are paid on the volume of drugs they sell and have been criticized for lack of transparency and focus on profits. Likewise, health insurers are generally focused on controlling claims costs and don’t fully consider the effects of their decisions to limit access… [Read More]

Insurance Carriers Reducing the Cost of Care

Man at the table fills in the form of health insurance. Healthcare concept. Vector illustration flat design style. Life planning. Claim form. Medical equipment, money, prescription medications.

This week I am attending the Cigna National Producer Advisory meeting. I am pleased to say that Cigna, as well as all the national insurance carriers, are busy moving forward the goal of reducing healthcare costs by aligning interests. Physicians will receive additional compensation if results establish quality care, a favorable member experience and affordability… [Read More]

States Petition to Chart Their Own Healthcare Course

States Petition to Chart Their Own Healthcare Course

­­The Trump administration has indicated a willingness to liberalize the Section 1332 State Innovation Waiver under the Affordable Care Act (ACA) to make it easier for states to provide affordable coverage. So far, only Hawaii has been granted the ability to deviate from the ACA, but now Iowa will be testing the President’s stomach on… [Read More]

The Biggest Issue in Healthcare Reform Today

presidential election health policy

Now that the GOP’s plan to remake healthcare by fiat seems to be failing, the Trump administration has once again pulled out one of its aces in the hole. Funding of cost sharing subsidies is the biggest issue today in the debate, viewed by the health insurance industry as “the single most destabilizing factor in… [Read More]

It’s a Legislative Circus Out There

It’s a Legislative Circus Out There

My predictive skills have been working pretty well on healthcare reform. I suggested that it wouldn’t be easy or quick. I thought the House would fall in line and the Senate would eke something out – and that it ultimately will come to a thumbs up / thumbs down in both houses of Congress. With… [Read More]

Healthcare. Okay. Now What Do We Do?

Flag and Stethoscope

What a week it’s been. I am not sure why President Trump thinks that his latest attempt to coerce the Republican Congress will work better than his past efforts. The Democrats relied on 50 votes to get the Affordable Care Act (ACA) through and now the Republicans are trying to rely on 50 votes to make… [Read More]

Republican Senate Makes One More Go at Healthcare Reform

Making Healthcare Sausage

Senate Republicans are at it again, and this one may be their last chance to deliver on healthcare reform. And it is simply amazing to me how this has morphed into a bill that no one will like. Even though an additional $70 billion has been provided to subsidize care over the next 10 years… [Read More]

Healthcare…What’s the Answer?

Healthcare…What’s the Answer

As the Senate wrestles with finding the balance to pass its version of healthcare reform, a proposal by Senator Ted Cruz looks like it is gaining popularity. This amendment would allow insurers to offer plans which do not comply with the Affordable Care Act so long as they offer at least one plan which does… [Read More]

Take Advantage of Health Insurer Cherry Picking

Take Advantage of Health Insurer Cherry Picking

I frequently witness the frustration of small group employers over the inability to customize plan design or receive premiums that reflect the health of their employee population. Growing companies often look forward to hiring their 51st employee, the magical threshold where many state insurance laws allow rate negotiation and some plan design flexibility. Some states even… [Read More]

More Details on the Senate Healthcare Bill

Are Association Health Plans a Good Idea

Debate is now raging in Washington over healthcare reform. Republicans are hoping to use the 2017 budget reconciliation process, reducing the required number of yes votes from 60 to 50, to pass this bill. However, there is a September 30 deadline that looms heavily over the Senate Chamber if reconciliation is to be used. Without reconciliation,… [Read More]