WellPoint Inc., the parent of Anthem Blue Cross and Blue Shield in Missouri, took a huge gamble when it dove headfirst into many of the new health insurance marketplaces around the country. Aetna Inc. hedged its bets by entering a patchwork of federal- and state-run health exchanges, but skipped California and New York, two of the most populous markets. UnitedHealth Group Inc., the nation's largest health insurer, decided to participate in only a dozen or fewer exchanges in 2013. Given the current disarray on the federal-operated website, its strategy may prove wise — or overly cautious.
The primary aim of the Affordable Care Act is to reduce the number of uninsured Americans. Even if the new federal health law accomplishes that goal, states still must grapple with the relatively high cost and low quality of U.S. health care. Per person, the U.S. spends far more than any other country on health care—and yet it gets relatively poor results for its money. It lags behind other countries on many health measures, and according to a recent report by the U.S. Institute of Medicine, about one-third of the $2.6 trillion Americans spent on health care last year paid for unnecessary procedures and avoidable hospital admissions.
Last week, the nation's leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs. The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.
Medicare is wasting hundreds of millions of dollars a year by failing to rein in doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available. ProPublica analyzed the prescribing habits of 1.6 million practitioners nationwide and found that a tiny fraction of them are having an outsized impact on spending in Medicare's massive drug program. Just 913 internists, family medicine and general practice physicians cost taxpayers an extra $300 million in 2011 alone by disproportionately choosing name-brand drugs. These doctors each wrote at least 5,000 prescriptions that year, including refills, and ranked among the program's most prolific prescribers.
Democratic lawmakers downplayed the support some members of their party gave to a Republican bill that would let insurers sell for another year health policies that don't meet the requirements of the Affordable Care Act. House Democratic leader Nancy Pelosi of California, speaking yesterday on NBC's "Meet the Press," said the 39 House Democrats who supported the Nov. 15 measure were basically those who had already opposed an insurance mandate for individuals and businesses. "Democrats stand tall in support of the Affordable Care Act," Pelosi said. "The rollout of the website, that's terrible. But the fact is that will be fixed."
Massachusetts' top insurance official said Monday that the state won't allow consumers to keep health insurance policies that fall below the minimum requirements of the federal health care law. State Insurance Commissioner Joseph Murphy said in a letter sent Monday to the Obama administration that substandard insurance policies are "virtually non-existent" in Massachusetts because of its first-in-the-nation health care law that took effect in 2007. In a reversal of policy, Obama announced last week that millions of Americans would be allowed to renew individual coverage plans that otherwise would be cancelled under the federal law in 2014.