The Obama administration has given the go-ahead for insurers and employers to use a new cost-control strategy that puts a hard dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements. Some experts worry that such a move would surprise patients who pick more expensive hospitals. The cost difference would leave them with big medical bills that they'd have to pay themselves. That could undercut key financial protections in President Barack Obama's health care law that apply not just to the new health insurance exchanges, but to most job-based coverage as well.
If you live in Jackson, Miss., Obamacare is giving you a raw deal. A 27-year-old in Jackson pays $336 a month for the second-cheapest silver health plan on Mississippi's s federally run insurance marketplace. That is more than twice as much as the $154 a 27-year-old in Nashville would pay for the same type of policy, and the $138 for a similar person in Tucson. Across all 34 insurance marketplaces run by the federal government, the average is $287, about 25 percent cheaper. The reason for the higher prices in some markets? Paltry competition, say Leemore Dafny and Christopher Ody from Northwestern University, and Jonathan Gruber of the Massachusetts Institute of Technology. Jackson has only two insurers on the marketplace: Humana and Centene.
Recently released data about Medicare payments to doctors is missing large amounts of information, badly undercutting its usefulness for analyzing Medicare spending and making reforms to the government-funded system, the American Medical Association (AMA) charged Thursday. The AMA said that up to 40 percent of medical provider billing codes that should have been included in the huge data dump were missing "entirely," presenting a potentially skewed picture of Medicare spending in different areas of the country and misleading the general public. One example was the fact that the data dump identified zero Medicare claims for cases in 2012 of "closed treatment of shoulder dislocation, with manipulation; without anesthesia," according to the AMA.
The phone calls were part Big Brother, part benevolent parent. When a rare ice storm threatened New Orleans in January, some residents heard from a city official who had gained access to their private medical information. Kidney dialysis patients were advised to seek early treatment because clinics would be closing. Others who rely on breathing machines at home were told how to find help if the power went out. Those warnings resulted from vast volumes of government data. For the first time, federal officials scoured Medicare health insurance claims to identify potentially vulnerable people and share their names with local public health authorities for outreach during emergencies and disaster drills.
The Index Patient: His name, two years later, is guarded within the privacy of medical files and a family compound of bereaved relatives, his wives, and his children. He was 60 years old. He was a businessman. He lived in Bishah, a small city southeast of the great Saudi port metropolis of Jeddah, and when he became too sick for the Bishah doctors to care for him properly, he was transported to Jeddah, feverish and coughing. There he lay, inside one of the tall white buildings of the Dr. Soliman Fakeeh Hospital, where a diagnostic physician called onto his case happened to be a virology specialist, an Egyptian physician named Ali Mohamed Zaki, who liked to pay close attention to the latest reports of pernicious infectious disease.
Pennsylvania's ambitious alternative to expanding Medicaid -- a private-market initiative that Gov. Tom Corbett says is designed to save money -- would require 723 new state workers, about one percent of the current workforce. The projected number of hires, detailed by state officials, is far higher than most states have needed and surprised some public-policy experts. Many states are adding employees to review applications and confirm eligibility, and to implement all the changes required by federal law. Those new hires typically are in the dozens. New Jersey, for example, said the contractor that coordinates its health benefits hired 38 permanent employees and 62 temps.