Last summer, just shy of its 65th birthday, East Texas Medical Center filed a lawsuit in state district court in Smith County alleging that Aetna Health, Cigna Healthcare and, especially, Blue Cross and Blue Shield of Texas have plunged the hospital into financial jeopardy by repeatedly shutting it out of the most common and popular group health insurance networks. Hospital executives say it makes no sense and feels oddly personal.The 502-bed main hospital in Tyler, which serves as the mother ship in a system of rural hospitals and clinics, is the only full-service, nonprofit hospital in all of Texas that has been involuntarily shut out of statewide preferred provider networks, the hospital contends. The exclusion carries a big toll to the entire region, its executives say.
The Affordable Care Act's health insurance co-ops absorbed deep financial losses last year, and 2016 is shaping up to be a make-or-break year for these nonprofit alternatives to traditional insurers. But it's too late for the Knoxville-based Community Health Alliance, which shut down at the end of 2015 after state officials said its "financial success could not be guaranteed." "Ultimately, the risk of CHA's potential failure in 2016 was too great and would have caused substantial detrimental effects on the market as a whole if it were to collapse," TDCI Commissioner Julie Mix McPeak said in October when announcing the co-op would "wind down."
Rejecting critics and community concern, voting members of Seattle’s Group Health Cooperative have overwhelmingly agreed to join with the California health-care giant Kaiser Permanente. Voting 8,824 to 1,586 in mailed-in ballots, the members approved the move that essentially dissolves the iconic, home-grown cooperative, founded nearly 70 years ago with the mission of providing integrated health care and health coverage to Northwest residents. The results of the vote were announced Saturday at a meeting at Seattle’s Smith Cove Cruise Terminal that was attended by about 300 co-op members out of an expected 1,000.
UnitedHealthcare is facing competition this year in Atlanta and Chicago from a new name in health insurance — a carrier that’s actually one of its subsidiaries. For the first time, individual shoppers are buying coverage from Harken Health, a company with about 100 employees based at an office on the UnitedHealthcare corporate campus in Minnetonka. Harken is being run as an independent entity, executives said, with a distinct approach to selling coverage. Subscribers receive unlimited access to primary care, without copays, if they visit a health center owned by Harken Health.
A year after UF Health Jacksonville warned it might have to close its doors — a fear amplified by nightmare scenarios of MASH tents erected at other hospitals — UF Health is on the mend. It’s building a new $85 million hospital on the Northside. The metal girders and beams show the outlines of the five-story hospital that is being constructed next to UF Health Jacksonville’s medical office building. Its financial numbers are trending in the right direction. It’s in the midst of its biggest year ever for revenue.
A top ObamaCare official acknowledged Thursday that a troubled nonprofit "co-op" insurer set up under the health law should have been shut down sooner. The co-op, called CoOportunity, operated in Iowa and Nebraska and was shut down by regulators in January 2015 because of financial problems. Andy Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services (CMS), said at a Senate hearing Thursday that the insurer should have been shut down before beginning the 2015 coverage year. That could have helped prevent customers from being inconvenienced in the middle of their coverage year.