A Robert Wood Johnson study estimates that 21 million people would lose health insurance coverage if the U.S. Supreme Court overturns the ACA.
A U.S. Supreme Court ruling nullifying the Affordable Care Act would result in the uninsurance rate for nonelderly people climbing nearly 70%, with 21 million Americans losing coverage, according to a new study commissioned by the Robert Wood Johnson Foundation.
"Invalidating the ACA would be devastating to millions, especially people who gained access to affordable health coverage in the past decade," said Avenel Joseph, vice president for policy at the Robert Wood Johnson Foundation.
"Nearly overnight, America's health care system could become more expensive and less accessible and perpetuate health and financial insecurity. Unfortunately, those who have the least stand to lose the most," Joseph said.
The Supreme Court has scheduled oral arguments for November 10 on the constitutionality of the ACA in the consolidated California v. Azar and Texas v. Azar lawsuits, but a ruling is not expected until mid-2021 at the earliest.
The plaintiffs in both cases are asking the justices to rule on the constitutionality of the individual mandate without a tax mandate, and whether the mandate is severable, and the rest of the law can remain in place.
The study suggested that if the high court nullifies the ACA, the lost coverage would disproportionately hurt "certain racial and ethnic groups" For both non-Hispanic Black and white people, the uninsurance rate is expected to increase nearly 85% (to 20% of Blacks and 15% of whites). Among Hispanics, the increase would be nearly 40% (to 30%).
Poor people in states that expanded Medicaid access would also be disproportionately affected, with Maine, Kentucky, and West Virginia seeing their uninsurance rates nearly triple.
If the ACA is overturned, the study also estimated that federal health care spending would fall $152 billion annually and the amount of uncompensated care sought by the uninsured would rise 74%.
To get their estimates, the researchers tapped the Urban Institute's Health Insurance Policy Simulation Model, a microsimulation model of the health insurance system that allows researchers to estimate cost and coverage implications of health policy decisions.
The analysis takes into account projections that the United States will have partially recovered from the COVID recession as of 2022.
Utah-based MSSI for more than six years allegedly paid millions of dollars in kickbacks to healthcare providers in the form of free advertising, practice development, practice support, and purported unrestricted "educational" grants.
Medical device maker Merit Medical Systems Inc. will pay $18 million to settle whistleblower allegations that it paid kickbacks to hospitals and physicians to use their products, the Department of Justice said.
According to federal prosecutors in New Jersey, South Jordan, Utah-based MSSI used a scheme known as the Local Advertising Program that for more than six years paid millions of dollars in kickbacks to healthcare providers in the form of free advertising, practice development, practice support, and purported unrestricted "educational" grants to induce them to purchase MMSI products, which the providers used on procedures for Medicare, Medicaid and TRICARE beneficiaries.
"Paying kickbacks to doctors in exchange for referrals undermines the integrity of federal healthcare programs," said Acting Assistant Attorney General Jeffrey Bossert Clark of DOJ's Civil Division.
"When medical devices are used in surgical procedures, patients deserve to know that their device was selected based on quality of care considerations and not because of improper payments from manufacturers," Clark said.
MMSI issued a statement saying it agreed to the settlement "in order to avoid distraction from its core mission, and the cost of litigating the matter to success."
"The settlement agreement does not constitute a finding of wrongdoing by Merit or its management, and it expressly recognizes that Merit denies the allegations," the company said in a media release.
The products included MMSI's EmboSphere devices, used for uterine fibroid embolization procedures, and its QuadraSphere devices, used for other types of embolization procedures.
MSSI claimed that its financial assistance was designed to "increase the awareness" of medical treatments, but DOJ alleged that the device maker provided the aid only to some healthcare providers to reward past sales, induce future sales, and steer business to MMSI and away from MMSI's competitors.
DOJ also alleged that MMSI ignored numerous warnings that its conduct violated the Anti-Kickback Statute, including warnings from MMSI's own chief compliance officer.
Under the settlement, MMSI will pay $15.21 million to the federal government, and $2.79 million to states that funded Medicaid claims involving MMSI devices.
The whistleblower, Charles J. Wolf MD, the former chief compliance officer of MMSI, will receive $2.65 million from the federal share of the settlement.
Along with the civil settlement, MMSI entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services-Office of Inspector General.
Medicaid and CHIP have seen the number of services delivered via telehealth increased by more than 2,600%.
The Centers for Medicare & Medicaid Services on Wednesday added 11 new telehealth services that Medicare fee-for-service will pay for during the coronavirus pandemic Public Health Emergency.
The new telehealth services include some neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. Medicare will begin paying for the new telehealth services immediately and for the duration of the PHE.
Since the beginning of the PHE last spring, CMS has used an expedited process to add 144 services to the Medicare telehealth services list – such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services.
Between mid-March and mid-August more than 12 million Medicare beneficiaries – representing 36% of people with Medicare FFS – have used telemedicine services.
The data shows that there have been more than 34.5 million services delivered via telehealth to Medicaid and Children's Health Insurance Program beneficiaries between March and June, an increase of more than 2,600% when compared to the same time last year.
"Medicaid patients should not be forgotten, and today's announcement promotes telehealth for them as well," CMS Administrator Seema Verma said. "This revolutionary method of improving access to care is transforming healthcare delivery in America."
The data also shows that adults ages 19-64 received the most services delivered via telehealth, although there was substantial variance across both age groups and states, CMS said.
The share of markets between 2014 and 2019 that were highly concentrated increased from 71% to 74%, the analysis found, with more than half (52%) of the markets that were highly concentrated in 2014 even more concentrated by 2019.
"For many of the 70 million Americans who live in highly concentrated health insurance markets, a lack of competition is a problem that keeps getting worse as consumers have more limited health insurance options to choose," AMA President Susan R. Bailey, MD, said in a media release.
"The AMA strongly encourages a dialogue among regulators, policymakers, lawmakers, and others about the need for a better, more open and competitive marketplace to benefit patients and the physicians who care for them," Bailey said.
The 2020 Competition in Health Insurance: A Comprehensive Study of U.S. Markets examined 384 metropolitan statistical areas across the nation using the Herfindahl-Hirschman Index. Markets with an HHI of 2500 points or higher are "highly concentrated."
AMA singled out Elizabethtown-Fort Knox, Kentucky as a glaring example. In 2014, this MSA-level market had an HHI of 3534 – exceeding the federal threshold for a highly concentrated market by more than 1000 points. In 2019, the HHI rose to 5159.
Anthem, the dominant provider in that region, saw its market share grow from 45% in 2014 to 70% in 2019.
Across the nation, AMA said, the average MSA-level market had an HHI of 3473 – exceeding the federal threshold for a highly concentrated market by nearly 1000 points. Market concentration levels increased on net between 2014 and 2019 with the average market HHI rising by 151 points. More than half (56%) of markets experienced an increase in the HHI, and in 17% of markets the HHI increased by at least 500 points. In markets with a rise in the HHI, the average increase was 481 points.
The HHI scores illustrate that 92% of MSA-level markets had a single insurer with a market share of 30% or greater, while 48% of MSA-level markets had a single insurer with a market share of 50% or greater, AMA said.
The study found that:
The 10 states with the least competitive commercial health insurance markets were: 1. Alabama, 2. Hawaii, 3. Michigan, 4. Delaware, 5. South Carolina, 6. Kentucky, 7. Alaska, 8. Louisiana, 9. Illinois, 10. North Carolina. See the 10 states with the least competitive PPO, or exchange markets.
Fifteen states had a single health insurer with a state-wide market share of 50% or greater: 1. Alabama (86%), 2. Michigan (67%), 3. Hawaii (66%), 4. South Carolina (64%), 5. Delaware (64%), 6. Kentucky (64%), 7. Louisiana (62%), 8. Illinois (59%), 9. Indiana (56%), 10. Mississippi (55%), 11. North Carolina (55%), 12. Oklahoma (55%), 13. North Dakota (54%), 14. Vermont (53%), and 15. Alaska (51%).
The five health insurers with the highest market share in the most MSA-level markets were: 1. Anthem (75 MSAs), 2. Health Care Service Corp. (43 MSAs), 3. UnitedHealth Group (28 MSAs), 4. Florida Blue (22 MSAs), and 5. Highmark (21 MSAs).
AHIP Responds
David Allen, an AHIP spokesperson, responded on Thursday to HealthLeaders' request for comment on the AMA report.
"The key to negotiating lower prices is competition among doctors and hospitals – not health insurance providers," Allen said in an email. "That means hospital market consolidation is a key concern. Unfortunately, the AMA study failed to include this major factor in its analysis (in fact, the word "hospital" is only used once in the study’s 67 pages). But facts matter.
"The fact is highly concentrated hospital markets result in health care costs above and beyond what Medicare pays for the same services. This leads to higher health care costs and increased premiums for patients and communities.
"What's more, hospital market consolidation continues to trend upward. According to the Health Care Cost Institute's Healthy Marketplace Index, almost 75% of U.S. hospital markets are now designated as 'highly concentrated.' And it's not just hospital mergers and acquisitions that drive up prices; hospitals are also purchasing physician practices too.
"We agree doctors and hospitals should be fairly compensated for the value of care they offer. But we all have a role to play in reducing healthcare prices and improving quality of care for America's patients. And as the facts show, provider consolidation drives up prices and fails to address healthcare costs."
No direct patient care positions will be eliminated. The job cuts represent 0.6% of the health system's 41,000 employees.
Intermountain Healthcare announced Tuesday that it will trim 250 administrative positions from its 41,000-member work force in three states to lower overhead and reduce patients' medical bills.
"Intermountain is implementing these changes and some internal reorganization to help keep healthcare more affordable now and in the future," the Salt Lake City-based health system said in a media release. "Reducing overhead costs and improving efficiencies with administrative and business functions allows the system to preserve patient care positions."
When contacted, Intermountain officials declined to specify how much money the job cuts were projected to save, or how much of those overhead reductions were expected to reduce patients' costs. The 250 job cuts represent 0.6% of Intermountain's 41,000-member workforce in Utah, Idaho, and Nevada.
To get the 250 voluntary buyouts, Intermountain is offering voluntary buyouts for 750 employees in its "centralized business functions," ages 55 or older with 10 years or more at the health system. The buyouts will include additional pay and health benefits depending on length of service. Employees will have two weeks to choose whether to accept the buyout.
In addition to the buyouts, Intermountain is replacing only open positions that are critical for care delivery. There are now 50 open administrative positions that will not be filled.
"If the combination of voluntary separation and ongoing attrition does not reach the goal of reducing 250 business positions, Intermountain will use involuntary reductions," Intermountain said.
More than half (57%) people age 18-34 who were hospitalized for COVID-19 were Black or Hispanic.
Younger people hospitalized with COVID-19 have a one-in-five chance (21%) of ending up in the intensive care unit, according to a research letter published in JAMA Internal Medicine.
In addition, 10% of patients age 18-34 required mechanical ventilation and 2.7% died. By comparison, the death rate of those in the same age group hospitalized with heart attacks is half of that figure. The researchers also found that 57% of young people hospitalized for COVID-19 were Black or Hispanic.
"There was a significant rate of adverse outcomes," said study first author Jonathan Cunningham, MD, a Cardiovascular Medicine fellow at the Brigham. "Even though a 2.7% death rate is lower than for older patients, it's high for young people who typically do well even when hospitalized for other conditions."
The Brigham and Women's Hospital researchers used the Premier Healthcare Database to look at clinical records from 419 hospitals that treated 3,222 hospitalized COVID-19 patients aged 18-34.
Patients with cardiovascular risk factors represented 37% of the young people hospitalized, while 24.5% of patients had obesity and morbid obesity, 18.2% had diabetes and 16% had hypertension.
Patients with these comorbidities were also more likely to suffer adverse outcomes. For example, patients with morbid obesity comprised 41% of the hospitalized young adults who died or required mechanical ventilation.
For individuals with more than one of these conditions, risks for adverse outcomes were comparable to the risks faced by middle-aged adults, aged 35-64, who had none of these conditions, as observed in a study of 8,862 members of this population, the letter said.
The researchers stress that the dataset, which relies on hospital administrative claims, only lends insight into the adverse outcomes of hospitalized young people.
"We know nothing about the total denominator of patients who got an infection," said corresponding author Scott Solomon, MD, director of noninvasive cardiology in the Division of Cardiovascular Medicine at the Brigham.
"We think the vast majority of people in this age range have self-limited disease and don't require hospitalization. But if you do, the risks are really substantial," he said.
When the deal is finalized, Paladina will operate 350 clinics as the nation's second-largest direct primary care provider.
Direct primary care provider Paladina Health announced on Monday that it will acquire Healthstat, a provider for employer-sponsored health centers.
Financial terms of the acquisition were not disclosed.
Denver-based Paladina operates 120 clinics in the Midwest and Western U.S. Heathstat, based in Charlott, N.C., will add more than 230 clinics in 13 additional states, including in the Southeast where Paladina does not have a presence.
When the deal is finalized, Paladina will operate 350 clinics as the nation's second-largest direct primary care provider.
"Paladina Health and Healthstat share a common mission and vision to transform healthcare in America, and this integration expands our reach, scale and expertise to pursue our commitment on a truly national level," Paladina CEO Chris Miller said in a media release.
"Both organizations have innovative, data-driven, patient-centric care models that are proven to reduce employer costs while improving health outcomes and employee satisfaction. Combining our companies makes both of us stronger and represents a huge step forward in fixing America's broken healthcare delivery model," Miller said.
The venture capital firm New Enterprise Associates is the primary backer for Paladina, and NEA General Partner Mohamad Makhzoumi said the "strategic acquisition enables Paladina Health to accelerate growth into new markets and further scale its operations across the country."
"With the added expertise, services and partnerships that Healthstat brings to the table, Paladina Health will be able to meaningfully amplify its impact with members and employers alike," Makhzoumi said.
The pay hike is projected to cost the health system $6 million a year, as part of a multi-phase 2020-2021 compensation plan for all employees.
More than 3,000 frontline, fulltime, parttime and contingent workers at Henry Ford Health System will get a "living wage" pay raise of $15 an hour starting on Monday, the Detroit-based health system announced Friday.
"There is a strong association between financial health and security and overall health, a reality that has been driven home over the last eight months for our team members who are on the front lines of the fight against COVID-19,'" Wright Lassiter, III, President and CEO, Henry Ford Health System, said in a media release.
"We are passionate about the need to do this and are thrilled to be able to make it happen, especially now," he said.
The minimum wage in Michigan is $9.65 an hour but will increase to $9.87 an hour in 2021.
For a 40-hour work week, $15 an hour amounts to more than $31,000 annually, which represents a 55% increase over the $20,000 annual earnings of minimum wage employees in Michigan.
The pay hike is projected to cost the six-hospital health system about $6 million a year. It's part of a multi-phase 2020-2021 compensation plan for all employees, including a general increase in the fourth quarter of 2020, and market adjustments for other positions.
Henry Ford had planned to provide the pay raises earlier this year until the coronavirus pandemic shut down much of the health system's elective and nonurgent services, resulting in layoffs for more than 2,800 employees in April, most of whom have since been brought back.
Employees in more than 100 job descriptions will get the raise, including janitors, maids, nurse assistants, food service workers, health screeners and clinic services reps, about 400 of whom are unionized.
Wake Forest Baptist Health and Wake Forest School of Medicine will become the academic core of Atrium Health.
Atrium Health on Friday finalized its acquisition of Wake Forest Baptist Health, creating an expanded 42-hospital health system with a footprint in four states.
Under the acquisition, first announced in April 2019, Wake Forest Baptist Health and Wake Forest School of Medicine will become the academic core of Atrium Health, which will build a medicine school in Charlotte, now the largest city in the nation without a 4-year medical school.
"As the healthcare field goes through the most transformative period in our lifetime, in addition to a new medical school, our vision is to build a 'Silicon Valley' for healthcare innovation spanning from Winston-Salem to Charlotte," said Eugene A. Woods, president and CEO of Atrium Health.
"Everything we do will be focused on life changing care, for all, in urban and rural communities alike. And we will create jobs that provide inclusive opportunities to enhance the economic vitality of our entire region," he said.
The merger comes just days after rival Novant Health gained approval from county commissioners in Wilmington, N.C., for the $1.5 billion acquisition of county-owned New Hanover Regional Medical Center.
Providers will begin repaying the $106 billion in advanced Medicare payments next spring.
Medicare providers will be given more time to pay back theAccelerated and Advance Payment Program funds they received during the coronavirus Public Health Emergency, the Centers for Medicare & Medicaid Services announced Thursday.
Under the original terms of the loans, providers were required to make payments starting in August. Now, the repayment will be delayed until one year after the AAP was received, CMS said.
Under thenew repayment terms, after the first year, Medicare will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the 11 months, recoupment will increase to 50% for six months.
If a provider of medical supplier is unable to repay the total amount of the loan during the 29-month timeframe, CMS will slap a 4% interest penalty on outstanding balances.
The new repayment terms were authorized by the Continuing Appropriations Act, 2021 and Other Extensions Act, which was passed last week by Congress and funds the federal government through December 11.
CMS is also offering guidance on how to request an Extended Repayment Schedule (ERS) that allows providers or suppliers to pay debts over to five years in the case of extreme hardship.
CMS Administrator Seema Verma called the $106 billion in advance payments the federal government made to providers during the pandemic "a lifeline to help keep them afloat" as patient volumes, and non-urgent and elective procedures tanked and revenues dried up.
"CMS' advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors," Verma said. "While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal."
CMS expanded the AAP on March 28 and paid more than 22,000 Part A providers, totaling more than $98 billion in accelerated payments. This included payments to Part A providers for Part B items and services they furnished.
In addition, more than 28,000 Part B suppliers, including doctors, non-physician practitioners, and Durable Medical Equipment suppliers, received advance payments totaling more than $8.5 billion.
