As President Obama prepares to push for an overhaul of the medical system, providers of U.S.-backed health plans for the elderly are raising prices. Humana Inc., Health Net Inc., and nearly 200 other providers increased 2009 premiums by 13% on average, or more than five times as much as last year, for people who use Medicare Advantage, according to consulting company Avalere Health.
Recent legal settlements with big health insurers may allow some managed-care plan participants to begin recovering some of the money they may have overpaid for using out-of-network doctors and hospitals. So far, insurers UnitedHealth Group Inc., Aetna Inc., and Health Net Inc. have agreed to make millions of dollars in funds available to patients and, in some cases, physicians for possibly having shortchanged them in the past. A number of other legal actions are pending that seek redress for patients and healthcare providers who claim they were underpaid by insurers for out-of-network services.
Congress convened last month with 16 medical doctors, including three newly elected members of the House of Representatives as well as a freshman senator, according to the latest tally by the Chicago-based American Medical Association. "The number of physicians in Congress continues to grow, with 16 physicians in the 111th Congress, demonstrating intense physician interest in making a difference in people's health and their lives," said Nancy Nielsen, MD, president of the AMA. Often, doctors are known to push an agenda that would increase access to medical care by boosting payments to programs that pay doctors and other medical-care providers.
On his last day in office, Rod Blagojevich moved to increase payments to Illinois doctors' caring for sick children, which is the subject of criminal allegations against the former governor. In a memo, Illinois Department of Healthcare and Family Services Director Barry Maram, who oversees the state Medicaid insurance program for the poor, increased reimbursement to pediatric specialists who provide services that include "neonatal and pediatric critical care services," according to the memo dated Jan. 29. On that day, the Illinois Senate removed Blagojevich from office.
Kansas Gov. Kathleen Sebelius has emerged as a leading candidate for the Cabinet post of secretary of Health and Human Services. "I've got to believe she's on the short, short, short list," said Ron Pollack of the health advocacy group Families USA in Washington. "I think the likelihood is enormous."
One group that's celebrating the long-awaited bill expanding the State Children's Health Insurance Program: The Physicians Hospitals of America, which represents doctor-owned hospitals. The group was fighting a version of the bill that would have curbed expansion of these hospitals by prohibiting Medicare payments to new ones and restricting expansion of existing ones. The restrictions were the brainchild of California Rep. Pete Stark, who has criticized such facilities as cherry pickers of lucrative patients, among other things.