Seniors in progressive U.S. states are choosing private Medicare Advantage plans more so than the national average even as the politicians who want to represent them talk about getting rid of the insurer’s role in health coverage.
New data from the Kaiser Family Foundation shows more than 40% of new Medicare beneficiaries in Oregon and Minnesota chose Medicare Advantage plans in 2016. And more than 36% of new Medicare beneficiaries in New York and California chose Medicare Advantage plans in 2016.
Scott Kohan woke up in an Austin, Texas, emergency room after an attack that broke his jaw. The hospital was within his insurance network. But the oral surgeon who set his jaw wasn’t. Mr. Kohan’s insurer refused to pay the surgeon’s $8,000 bill.
He’s not alone. An estimated 51% of ambulance rides, 22% of emergency-department trips, and 9% of elective cases, in which patients have time for due diligence, lead to surprise bills. These typically come from providers who refuse to join insurance networks so they can charge astronomical fees.
Congress could eliminate the Part D “protected classes” rule which forces insurers to pay for any drugs in six arbitrary categories, regardless of their price or value. (The Trump administration had proposed just such a reform, but withdrew it in a sop to the drug lobby.)
More substantially, Congress should require that drug companies selling drugs into Part D rebate any price increases above consumer inflation to Medicare, to offset the program’s taxpayer-funded subsidies.
Without reforms of this type, it’s highly likely that restructuring Part D would drive costs upward.
Consolidation in the health system and health insurance industries has been a focus for years. But a new report sheds light on how the “bigger is better” mantra has taken hold in companies that make syringes, X-ray machines or other healthcare products
The report, prepared by the Open Markets Institute using data from IBISWorld, shows a small handful of companies dominate their respective markets in certain healthcare sectors that tend to get less of a spotlight than their payer and provider counterparts.
Instead of debating how to expand Medicare coverage, politicians should focus on fixing the fatal financial flaws in the existing program that threaten to bankrupt the nation.
Medicare spent 3.6% of gross domestic product in 2016, more than six times the share it consumed in 1967, the first full year it was implemented. The forecasts I have analyzed show that the share of GDP will rise to at least 9% within 75 years—and that’s the good-news scenario. Other plausible forecasts show that Medicare could spend more than twice that.
Citing the need to reduce rising health care costs, Gov. Ron DeSantis signed a bill Tuesday that would allow Florida to pursue importing prescription drugs from abroad — though components of the bill will still require federal approval to take effect.
HB 19 will open up three pathways for bringing medication in from different countries, including Canada, through a 2003 federal law that tasks federal officials with authorizing state plans to import prescription drugs. No state has received such approval in the 16 years since the bill was passed, but DeSantis, surrounded by a half-dozen lawmakers in the Villages, said he is confident Florida will clear those hurdles when the state asks for the approval likely next year.
California will become the first state to pay for some adults living in the country illegally to have full health benefits as the solidly liberal bastion continues to distance itself from President Donald Trump’s administration.
Democrats in the state Legislature reached an agreement Sunday afternoon as part of a broader plan to spend $213 billion of state and federal tax money over the next year. The legislature is expected to approve the deal this week. The agreement means low-income adults between the ages of 19 and 25 living in California illegally would be eligible for California’s Medicaid program, the joint state and federal health insurance program for the poor and disabled.
In one case, an insurer prevented a woman from getting a CT scan her doctor ordered. In another, a mother couldn’t afford the full regimen of special bags needed to clear her cancer-stricken daughter’s lungs. In a third case, a woman lost her health insurance and could not afford end-of-life chemotherapy.
These examples come from National Nurses United, the country’s largest nurses’ union. To prevent further incidents like these, the union favors a universal, government-run health care system. A lead editorial in the New York Times last week appeared to endorse their thinking.
If any state can serve as the poster child for the problems associated with ObamaCare’s Medicaid expansion, it’s Louisiana, which joined the expansion in 2016, after Democrat John Bel Edwards became governor. An audit released last year exposed ineligible Medicaid beneficiaries, including at least 1,672 people who made more than $100,000. But Louisiana’s Medicaid expansion has revealed another waste of taxpayer funds, both in the Pelican State and nationwide: the money spent providing coverage to people who already had health insurance.
People new to Medicare can receive their Medicare benefits through either traditional Medicare or private plans, such as HMOs or PPOs, known as Medicare Advantage plans. Older adults and younger beneficiaries with disabilities have said that they make this choice based on premiums and out-of-pocket costs, access to desired providers, the reputation of the company offering the plan, ads and other marketing materials, and the advice of brokers, family members and friends.