Mitt Romney suggested Sunday that Americans who lack insurance can find the care they need in emergency rooms—a position that contradicts the rationale behind his Massachusetts healthcare law. In an interview on CBS, the former governor was asked whether the government should provide healthcare for the uninsured. The GOP presidential nominee replied by saying that "we do provide care for people who don't have insurance"—emergency care. "If someone has a heart attack," Romney said, "they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."
Seven of the top 10 Medicare prescription drug plans (PDPs) saw a double-digit increase in premiums for 2013, according to an analysis by Avalere Health. The increases mean that several of the top 10 PDPs will lose eligibility for low-income subsidy beneficiaries in some U.S. regions, the study found. The release comes not long after the Kaiser Family Foundation found that health insurance premiums rose by a modest 4 percent this year on average, down from a 9-percent increase in 2011. Analysts attributed the drop to the slow economy.
After a summer of disappointing economic news, the recent Census report on the uninsured was a rare bit of sunshine. The number of uninsured Americans declined by about 3 percent, or 1.34 million, to 48.6 million in 2011. This was the largest one-year numerical decline in twelve years. There were "only" about 1.7 million more uninsured in 2011 than there were in 2006, before the devastating recession. The search for policy fingerprints on these findings points directly to Medicaid. For all the controversy over this program, the safety net did its job.
The Obama administration on Monday began requiring health insurers to provide user-friendly guides to patients that explain their benefits, aiming to make buying insurance nearly as easy as scanning packages of food for nutrition facts. Under President Barack Obama's healthcare reform law, employers and insurers must provide a summary of benefits and coverage in a clearly worded, standardized format that allows the private insurance market's 163 million beneficiaries to make side-by-side comparisons of plan offerings. The benefit guides will also factor into the creation of new state-based health insurance markets due to begin offering subsidized, private coverage to moderate-income consumers in January 2014.
The months-long Center for Public Integrity investigation into the Medicare program has uncovered a textbook example of the expensive consequences of what's known as "regulatory capture." Doctors and hospitals are likely being overpaid billions of dollars, which is hastening the depletion of the Medicare trust fund, because lawmakers and regulators put lobbying and professional groups representing healthcare providers in charge of writing the rules that determine reimbursement. And to make matters worse, to maximize revenue and profits, some doctors and hospitals have figured out how to game the system to their financial advantage by abusing what has been held out as a means to improve care and reduce administrative costs—electronic health records.
It's hard to imagine a successful accountable care organization (ACO) that doesn't rely heavily on IT. ACOs require that clinicians meet a long list of quality measures to prove that they're acting in an accountable way to reduce costs without reducing the quality of medical services. And most of those metrics are best tracked with software. But the very foundation upon which ACOs are built could be shaky, making software tools only so effective. If genuine accountability is your goal, technology gets you only halfway there. Providers need a proven structural model to make an ACO cost effective, and at least one prominent thought leader questions whether the current approach will do the trick.