The nation's largest health insurer is imposing tighter controls on its coverage for hysterectomies after more than a year of debate over a medical device that was found to spread hidden cancer in some women undergoing the procedure. As of April, UnitedHealth Group Inc. will require doctors to obtain authorization from the insurer before performing most types of hysterectomies, according to a bulletin sent to physicians and hospitals. The decision marks another blow to the tool known as a laparoscopic power morcellator, which cuts up and removes tissue through small incisions in the abdomen. Until recently, morcellators were being used in thousands of laparoscopic hysterectomies every year to remove benign growths known as fibroids. [Subscription Required]
There is still a week until the latest Supreme Court showdown on the Affordable Care Act—and likely months away from a ruling on King v. Burwell—but pundits already are polishing their crystal balls. From MedPage Today.
For example, if the Supremes throw out subsidies, will that mean a trip in the way-back machine to a pre-Obamacare world?
That was just one of the questions put forward by Robert Wah, MD, president of the American Medical Association, during a panel discussion at the AMA's National Advocacy Conference on Wednesday. (Read MedPage Today'sexclusive interview with Wah here.)
King v. Burwellis yet another opportunity for the Supreme Court to weigh the legality of the ACA.
This time around, the justices will weigh the intent of the ACA language to determine if the federal government will subsidize healthcare for beneficiaries who aren't receiving employer-sponsored health insurance in every state, or only in those states with their own exchanges. A plaintiff victory would make subsidies in the 34 states with federally-run exchanges illegal and could reverse the employer mandate in these states.
Charles "Chip" Kahn III,president of the Federation of American Hospitals (FAH) said that after meeting with a senator who is "chairman of a major committee" this week he heard an earful about how the government was going to lose the case.
"You would have thought that health reform was literally still being debated and had not been passed by the Congress many, many years ago." Kahn said the case is a metaphor for all of the differences separating Republicans and Democrats.
"When you talk to anyone in Washington about the case, how they feel about the outcome really is determined by where they fall on the great political divide that the Affordable Care Act has become," he said.
Kahn is a Republican, but said he cannot see a way to offer true insurance reform and coverage without the "bells and whistles" provided in the exchanges
Kahn, by the way, has a lot of experience with the politics of healthcare -- back in the Clinton administration he was the EVP at the Health Insurance Association of American, and architect of the "Harry and Louise" commercials that sank Hillary Clinton's healthcare reform plan.
"I think it's a Republican illusion that they can undo this thing," he said. But, if the courts should decide in favor of the plaintiff, Kahn predicts " a real meltdown" in several states, as they try to keep reforms in place without a stable exchange structure.
According to a joint analysis from the Robert Wood Johnson Foundation and the Urban Institute, if the plaintiff wins, the number of uninsured Americans would jump by 8.2 million.
Regarding an ACA reversal, John Rother, JD, president and CEO of the National Coalition on Health Care said, flatly, "We're not going back." Even considering the possibility was silly, he said.
The case, however, is admittedly a stumbling block. "As long as we have a debate about repeal, it's very hard to move toward more constructive dialogue about what modification we could agree to."
To that end, Wah also asked panelists what improvements they envisioned for the Affordable Care Act. "What areas need to be resolved in order for the health system reform to be a success?" Rother said the ACA had delivered on access and on insurance reform but fallen short on affordability. In particular, he said the Coalition hadn't predicted the rise of high-cost deductible plans.
"We need a better, higher value health system, one that people can afford not only when they pay premiums, but also when they need care," he said.
Rother, like Kahn, spent years in the healthcare reform trenches, although he was usually on the other said as the chief lobbyist for the AARP.
Alissa Fox, senior vice president at the Office of Policy and Representation for Blue Cross, Blue Shield Associations (BCBSA), said she's concerned about a health insurance tax that affects even the lowest cost plans. Employers who "self-fund" would be excluded but "[i]t actually increases the burden on individuals and small business."
Fox argued that the tax could cost affected families on average $400 per year and increase health costs by 2% to 2.5%, according to estimates from the Joint Committee on Taxation.
"Repealing that would be something we very much support," she said.
Fox acknowledged that removing the tax would create a hole in the funding but emphasized that "[the healthcare tax] is raising the cost of insurance as we're trying to address affordability."
Kahn said repealing any of the ACA taxes would be difficult. "[A]t the end of the day there's no free lunch and it's better to have explicit taxation and then have everybody covered," than to have a "Byzantine hydraulic system"of hospital financing with levels for every payer -- private, Medicare, and Medicaid -- he said.
Rother agreed. "It seems we are kidding ourselves if we think we can
Making health insurance available and affordable to millions of people who buy their own coverage was a key goal for backers of the federal health law known as Obamacare. But if the Supreme Court strikes down the insurance subsidies of millions of Americans who rely on the federal insurance marketplace, it could leave many worse off than they were before the law took effect, say experts. "The doomsday scenario could materialize and it does impact everyone" — those getting subsidies, as well as those paying the full cost of their plans on the individual market in states using the federal exchange, said Christopher Condeluci, an attorney who worked for Iowa Republican Sen. Charles Grassley on the Senate Finance Committee staff during the drafting of the law.
The United States fumbled its response to the Ebola epidemic before it even began, neglecting experiments to make vaccines and drugs against the virus, and cutting funding to key public health agencies, a presidential commission said Thursday. Americans focused on their own almost nonexistent risk of catching Ebola from travelers instead of pressing to help the truly affected nations, the scathing report from the Presidential Commission for the Study of Bioethical Issues says. They've been acting against their own best interest, the commission said in its report. Ebola started spreading in Guinea just about a year ago, but the response was slow.
A national veterans task force is advocating radical changes in the medical system for America's former military personnel, including a choice to receive subsidized private care and conversion of the Veterans Health Administration into a non-profit corporation rather than a government agency. The reform measures, if enacted into law, would affect America's roughly 22 million veterans dramatically, especially the 8.5 million enrolled for care through the Department of Veterans Affairs. Repercussions would be even more profound for future veterans. Concerned Veterans for America, a conservative non-profit, sponsored the study called "Fixing Veterans Health Care" amid a crisis in VA health-care services.
For most customers returning to the Obamacare marketplaces this year, it really paid to shop around. New data shows that a large number of them did. That bodes well for those shoppers and the future offerings of the insurance marketplaces. More than half of people who bought insurance on HealthCare.gov last year explored their options before choosing a 2015 plan, according to a report from the Department of Health and Human Services. Of those 2.2 million who shopped, more than half switched to a new health plan. Those high rates of shopping and switching are unusual in public health insurance marketplaces.