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Who's At Risk For Big Premium Hikes - Health Care Edge

Who's At Risk For Big Premium Hikes

By Sam Baker, Sophie Novack and Clara Ritger

 

LOOK OUT, WEST VIRGINIA: With the 2014 open enrollment period behind us and 2015 rate filings creeping up soon, the biggest and most immediate Obamacare question is about next year's premiums -- and where, based on this year's experience, they're likely to increase the most. Interviews with health care experts revealed a couple of consensus trouble spots: Among the most likely are West Virginia and Hawaii, followed, with lower confidence, by Ohio, Arizona, Iowa, New Mexico, Mississippi and South Dakota. If large insurance carriers decide to jump into some of those states' markets, things might not be as bad. But based on those states' enrollment experiences this year and the competitiveness in their marketplaces now, they're the ones to keep an eye on.

Top Health Care News

OBAMACARE'S TROUBLE SPOTS: More details on the several states in danger of big premium increases. (Sam Baker, National Journal)

VIRGINIA FILINGS GIVE FIRST LOOK AT 2015 RATE INCREASES: All health plans have raised premiums more than the rate of inflation, but less than some had predicted. Carriers say the new rates are the result of a sicker population signing up this year and pent up demand for health services. (Louise Radnofsky, Wall Street Journal)

 

FOUR FAILED STATE EXCHANGES COST TOTAL OF $474 MILLION: "Each of the states — Massachusetts, Oregon, Nevada and Maryland — embraced Obamacare, and each underperformed. All have come under scathing criticism and now face months of uncertainty as they rush to rebuild their systems or transition to the federal exchange. (Jennifer Haberkorn and Kyle Cheney, Politico)

Implementation

PRIMARY CARE SYSTEM HANDLING CONSUMER SURGE UNDER ACA: Despite dire predictions of a doctor shortage with expanded coverage under the health law, there have been limited reports of patients facing major delays getting care, according to reports from insurers, physician practices, and community health centers. (Phil Galewitz, Kaiser Health News/USA Today)

STUDY: DROPPING ACA EMPLOYER MANDATE WILL HAVE LITTLE IMPACT ON COVERAGE: A report from the Urban Institute and Robert Wood Johnson Foundation argues for the elimination of the employer mandate, saying it would only reduce the number of people covered by 200,000, but would lessen opposition from the business community and get rid of some of the changes to hiring and labor market practices that could harm employees, such as cutting hours. (Sarah Kliff, Vox Media)

STUDY: REJECTING MEDICAID EXPANSION A LOSS FOR HEALTH CENTERS AND PATIENTS: "In the states that expanded Medicaid this year, the government and private insurance payments will generate potential revenues of $2.1 billion in 2014 for the centers. That's money the centers can use to pay for physicians, nurses and to expand services. But in the states that opted against expanding Medicaid, the centers will lose about $569 million in extra Medicaid funding, the study found." (Phil Galewitz, Kaiser Health News)

 

POLL: 61 PERCENT THINK ACA SHOULD BE KEPT AS IS OR CHANGED TO WORK BETTER: Yet only 12% of Americans consider the law a success, almost half say it's too soon to tell, and just under four in 10 think it is a failure, according to a new CNN/ORC International poll. (Paul Steinhauser, CNN)

Enrollment

INSURANCE AGENTS PLAYED MAJOR ROLE IN CALIFORNIA'S ACA ENROLLMENT: "They personally signed up 525,000 Californians — nearly 40% of the state's total, new data show. About the same number signed up on their own using the Covered California website." (Chad Terhune, Los Angeles Times)

INSURANCE CEO SAYS SHUT DOWN HAWAII HEALTH EXCHANGE: The CEO of Hawaii Medical Services Association, Hawaii's largest insurance company, said the state should not continue spending money on its struggling exchange, and instead seek a federal waiver to pursue alternate options. (Cathy Bussewitz, Associated Press)

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Hospitals

RURAL HOSPITALS FEEL PINCH: Fewer patients, the shift of more lucrative procedures and treatments to major medical centers, and the overall rising cost of health care have hurt rural hospitals' budgets. Financially strapped facilities are being squeezed further by Medicare changes and dwindling government subsidies. (Valerie Bauerlein, Wall Street Journal)

Drugs and Medicine

ALABAMA PAIN CLINIC AN OUTLIER AMONG MEDICARE DRUG PAYMENT DATA: "Nationwide, about $4 out of the $299 in total drug treatments by doctors per Medicare beneficiary is spent on unclassified drug injections. In Huntsville, the amount spent is $152 per enrollee — 38 times the national average — out of $766 in total drug treatments." (Amy Brittain, David S. Fallis and Dan Keating, Washington Post)

THAT PRESCRIPTION MIGHT NOT HAVE BEEN TESTED FOR YOUR AILMENT: "One study found that 1 in 5 prescriptions written in doctors' offices have not been approved by the Food and Drug Administration to treat the condition they are being used for." (Patti Neighmond, National Public Radio)

ADDICT. INFORMANT. MOTHER.One Pennsylvanian woman, addicted to heroin and husband in jail, begins helping drug enforcement officers catch dealers to keep herself from behind bars. (Susan Dominus, New York Times)

WHEN PARENTS SMOKE MORE, SO DO THEIR KIDS: Smoking addiction can be inherited, but habits of how much parents smoke can also be passed onto children. (Maggie Fox, NBC News)

Medicare

CMS MOVES TO IMPROVE MEDICARE QUALITY OF CARE: The agency announced that it hired two contractors to oversee the Quality Improvement Organization (QIO) program: Maryland-based Livanta and Ohio-based KePRO. (Ferdous Al-Faruque, The Hill)

Obesity and Nutrition

HAGSTROM: DOCUMENTARY ON OBESITY LACKS POLICY MUSCLE: "Fed Up" focuses on the food industry's failure to dish up nutritious options. (Jerry Hagstrom, National Journal)

Happening This Week

Monday

STATE MEDICAID EXPANSION: THE THIRD WAY: The Alliance for Health Reform holds a 12:15 p.m. briefing in G-50 Dirksen with state health officials and health policy experts.

Tuesday

HOW WELL ARE SENIORS MAKING CHOICES AMONG MEDICARE'S PRIVATE PLANS AND DOES IT MATTER? The Kaiser Family Foundation hosts a briefing with policy experts on Medicare Advantage at 9:30 a.m. to look at whether Medicare Advantage beneficiaries are satisfied with their coverage and informed about their options.

SENATE VOTE ON OBAMACARE EMPLOYER MANDATE TWEAK: Senate Majority Leader Harry Reid has set up a procedural vote on a House bill to tweak the Affordable Care Act employer mandate for veteran employees. The "Hire More Heroes Act of 2014" would allow employers to leave veterans out of the 50-count threshold to qualify for the employer mandate, as long as they have health insurance through TRICARE, the federal veterans health program. The bill passed the House in March, and the Senate is expected to hold a procedural vote Tuesday or Wednesday.

Wednesday

HEALTH INSURANCE EXCHANGE SUMMIT: Global Health Care, LLC hosts the Health Insurance Exchange Summit from Wednesday, May 14- Friday, May 16 at the Capital Hilton. The conference agenda includes sessions on states' experiences and insurers' experiences with the first year of Affordable Care Act enrollment.

AMERICA'S ADDICTION TO OPIOIDS HEARING: The Senate Caucus on International Narcotics Control holds a hearing on the federal government's role in combatting heroin and prescription drug abuse at 2:30 p.m. in 192 Dirksen. Representatives from the Office of National Drug Control Policy, the National Institute on Drug Abuse and the Drug Enforcement Administration are among those scheduled to testify.

Thursday

HEALTH INSURANCE EXCHANGE SUMMIT: Global Health Care, LLC hosts the Health Insurance Exchange Summit from Wednesday, May 14- Friday, May 16 at the Capital Hilton. The conference agenda includes sessions on states' experiences and insurers' experiences with the first year of Affordable Care Act enrollment.

A CLEARER VIEW - CAN PRICE TRANSPARENCY SAVE $100 BILLION IN HEALTH CARE? The West Health Institute unveils a new analysis that estimates that increased information about health care pricing can save $100 billion in health care spending over the next ten years, followed by a discussion on how public policies can generate further savings. The event begins at 7:30 a.m. at the Newseum.

AN EARLY LOOK AT THE AFFORDABLE CARE ACT AND WOMEN: The Kaiser Family Foundation hosts a briefing with administration officials and women's health advocates at 9:30 a.m. to look at a new report on women's early experiences with their new coverage and benefits under the Affordable Care Act.

THE STATE OF VA HEALTH CARE: The Senate Veterans' Affairs Committee is scheduled to hold a full committee hearing 10 a.m. in Dirksen 106. The VA department has been plagued with scandal recently, as investigations have found that delays in care at VA hospitals have led to a wave of veteran deaths.

THE STATE OF TOBACCO USE AND REGULATION IN THE U.S.: The Senate Health, Education, Labor, and Pensions Committee is scheduled to hold a hearing at 2:30 p.m. in 430 Dirksen on the issue of tobacco regulations, which has been getting significant attention recently, given the Food and Drug Administration's recent release of long-awaited proposed guidelines for regulation of e-cigarettes.

Friday

HEALTH INSURANCE EXCHANGE SUMMIT: Global Health Care, LLC hosts the Health Insurance Exchange Summit from Wednesday, May 14- Friday, May 16 at the Capital Hilton. The conference agenda includes sessions on states' experiences and insurers' experiences with the first year of Affordable Care Act enrollment.

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Don't Miss Today's Top Stories

Health Care Edge is one of my top resources."

Meghan, Associate Specialist

Great news in short form along with much needed humor."

Patrick, President of private healthcare consulting firm

Informative and help[s] me stay on track. "

Director of Scientific Affairs, Non-profit medicial society

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