Affordable Care Act

Obamacare Health Industry News Recap: 3/14-3/18: What we learned this week

Published on April 27, 2016



  • Report: 2015 US Drug Spending Up 5 Percent, Half 2014’s Rise

Express Scripts Holding Co., the largest U.S. prescription benefit manager, found that the average price of brand-name drugs already on the market increased by 16.2 percent in 2015 and has jumped 98.2 percent since 2011. The report also says one-third of brand-name prescription drugs had price increases exceeding 20 percent last year.
Express Scripts forecasts drug spending will rise 6 to 8 percent annually from 2016 through 2018. As many insurers and government health programs try to hold down medication costs, the data shows that changes can’t be made any time soon.
The data are based on prescription claims processed by Express Scripts. The St. Louis Company handles pharmacy benefits for about 85 million Americans with insurance, provided by employers, local and state governments, unions and Affordable Care Act insurance exchanges.
Dr. Glen Stettin, chief innovation officer at Express Scripts, said its clients were dealing with “significant challenges to affordable care in 2015 — including a record number of newly approved, high-cost therapies.” Last year, the Food and Drug Administration approved 33 specialty drugs, many of them for cancer.
Read more: (New York Times)

  • Obama Health Law Missed 2015 Enrollment Target

The government reported Friday that last year’s final enrollment numbers under President Barack Obama’s health care law fell just short of a target the administration had set. The Health and Human Services Department said about 8.8 million consumers were still signed up and paying premiums at the end of last year, which just missed Sylvia M. Burwell’s goal of having 9.1 million customers enrolled.
However, the 2015 coverage year had started with 11.7 million people signed up, so why did so many consumers drop off?
People drop coverage for many reasons. Some find a job that provides health care benefits. Others aren’t able to keep up their monthly premiums, despite generous taxpayer subsidies.
Advocates also say many consumers could get worried by paperwork requirements for verifying U.S. citizenship, legal immigration and income. The law’s subsidies are based on income, and people without legal permission to be in the country cannot buy coverage even if they pay the full premium themselves.
About 12.7 million people have signed up for coverage through the insurance markets this year. Burwell’s goal is to have 10 million still enrolled at the end of the year.
Read more: (abc News)

  • Three Changes Consumers Can Expect In Next Year’s Obamacare Coverage

New rules revealed in late February and published in the Federal Register hope to make health insurance a bit more straightforward for consumers. Below are the three new finalized changes by the Department of Health and Human Services that affect consumers who buy their own health insurance in one of the 38 states using the online federal insurance exchange.

  1. Consumers could have access to more information about the size of the insurers’ network of doctors and hospitals.
  2. Consumers could be given slightly more warning about “surprise” medical bills form out-of-network providers.
  3. Consumers’ out-of pocket costs could be more standardized.

HHS also finalized its annual increase in the cap on how much consumers can be charged out of pocket annually for such things as deductibles and copayments. The rule applies to those who buy their own coverage and many employers plans. Next year the cap will be $7,150 for an individual or $14,300 for family coverage.
Read more: (Kaiser Health News)

  • A court case that could hurt Obamacare’s health

A pending federal lawsuit threatens to end the billions of dollars in reimbursement that insurers get from the government annually to lower out-of-pocket health expenses for up to 7 million Obamacare customers. According to a new Commonwealth Fund analysis released Thursday, that program can dramatically cut the medical costs that many customers pay under their Obamacare health plans.
The House’s suit claims the administration acted illegally in giving insurers billions of dollars in reimbursement for Obamacare customer’s out-of-pocket costs because Congress had not specifically authorized such spending.
The administration, in turn, argues that the cost-sharing reimbursements to insurers are legal because they are “inextricably intertwined” with federal spending on subsidies to help pay for qualified Obamacare customers’ monthly premiums, which Congress did authorize. These same subsidies survived in the King V Burwell case last year.
The House prevails in the newest case, insurers would still be obligated under the Affordable Care Act to reduce the out-of-pocket costs for Obamacare customers who earn 250 percent or less of the federal poverty level — but would get no compensation for their expenses in doing so from the government.
Read more: (CNBC)

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