Extreme Healthcare Chaos

Stethoscope with American Flag Reflection on Wooden Table.

Turmoil by executive order again… On Thursday, President Trump threw two more giant logs on the raging healthcare marketplace fire by ordering the discontinuance of federal funding for cost-sharing subsides for low income Americans and by directing the Secretary of Labor to provide guidance on liberalizing association healthcare plan rules. Cost-sharing subsidies made healthcare affordable… [Read More]

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]

2017 Kaiser Family Foundation Survey Results

medical cost, stethoscope on dollar banknote money. concept of health care costs, finance, health insurance fund.

Kaiser has just published its 2017 annual benefits survey and I think the folks in Washington, D.C. all need a copy. Approximately half of the United States’ non-elderly population gets healthcare coverage through their employer, so this survey reveals what many Americans are experiencing. While employer coverage is far better, in many respects, than the coverage… [Read More]

Healthcare Reform… More of the Same

Healthcare in the Trump Era Takes Its First Step

The Senate is making one last-gasp effort to repeal ACA… Well, not actually repeal, just reconfigure. Lindsey Graham and Bill Cassidy have sponsored a bill, which will be eligible for consideration under budget reconciliation rules (i.e. 51 votes required to pass and not subject to filibuster). Under the bill the amounts paid by the federal… [Read More]

Anthem Gets Tough with Hospitals

Anthem Gets Tough with Hospitals2

One of the greatest frustrations our self-funded (and to a lesser extent, fully-insured) clients voice is that – despite the hundreds of thousands or millions of dollars they pay the insurers to assist in managing their health plan spend – too often it appears the insurers are complicit in the rising healthcare spend by not… [Read More]

Another Blow to the Healthcare Exchanges as CareConnect Shutters

No Easy Answers Another Blow to Healthcare as CareConnect Shutters

CareConnect, the upstart insurance company founded in 2014 by Northwell Health in the Downstate New York marketplace, has made the decision to cease operations. It made a lot of sense that Northwell, a hospital chain with extensive provider connections, could cut out the middleman insurance company and offer insurance protection directly to its customers. It didn’t… [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]

Insurers, Providers and Employers on a Collision Course 

Insurers, Providers and Employers on a Collision Course 

Trying to control healthcare costs is like trying to pick up Jell-O pudding with a pair of chop sticks. It is virtually impossible. The employer-based healthcare system relies on their intermediaries – primarily the large national insurers – to negotiate discounts, provide claims-paying acumen, fraud oversight and clinical expertise, among other things, in the administration of… [Read More]

Zombie Apocalypse: Health Insurer’s Tax

Zombie Apocalypse Health Insurers Tax

In 2014, fully-insured employer plans were greeted with a nasty surprise – the Health Insurance Providers Fee. The insured’s already massive healthcare costs were being further inflated 1.5–2% due to the new tax congress levied on insurers, which was based upon each carrier’s market share in the health insurance market. Of course that $8 billion… [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]