Arkansas's attorney general on Wednesday accused drugmakers and pharmacy benefit managers of colluding to drive up the price of insulin drugs, the latest in a series of lawsuits to take aim at skyrocketing costs for the life-sustaining medicine, reports Reuters. The lawsuit targets three drugmakers who produce the vast majority of the insulin drugs sold in the U.S. and three of the leading pharmacy benefit managers. Arkansas’ Attorney General stated that 50,000 Arkansans with diabetes were uninsured and that many had been forced to ration insulin because of the high cost.
California passed legislation limiting cost-sharing for abortion care services, according to the Office of Governor Gavin Newsom. Senate Bill 245 prohibits state-regulated health plans from charging separate deductible, coinsurance, copayment or any other cost-sharing requirement on coverage for all abortion-related services. However, patients with high-deductible health plans still must meet their deducible before the protection goes into effect.
California will become the first state to remove immigration status as a barrier to healthcare, making all low-income undocumented residents eligible for state-subsidized insurance regardless of age, according to the Sacramento Bee. The governor announced a budget deal he struck with the legislature that included a new Medi-Cal expansion covering more undocumented adults. The program’s launch, starting no later than Jan. 1, 2024, is expected to provide full coverage for approximately 700,000 undocumented residents ages 26-49 that were not included in previous coverage expansions and will lead to the largest drop in the rate of uninsured Californians in a decade.
A recent survey found that roughly one in four California respondents enrolled in individual market plans experienced difficulty affording premiums, out-of-pocket costs and delaying or avoiding care due to cost, according to California Health Care Foundation. Notably, enrollees with poor health status and chronic conditions more frequently reported difficulty affording plans and delaying/going without care. The survey also found that 28 percent of respondents cut necessities or borrowed money due to healthcare costs.
The Centers for Medicare and Medicaid (CMS) granted Colorado’s Section 1332 state innovation waiver to create its own state-specific public option next year, reports Fierce Healthcare. The public option plan will be sold on the state’s marketplace and is expected to lower premiums by an average of 22 percent. Under state law, the public option plan also must lower premiums by five percent in 2023, 10 percent in 2024 and 15 percent in the third year. The state’s public option plan will operate within Colorado’s reinsurance program, which is authorized to continue under the waiver through 2027. CMS will pass through any savings that the federal government receives to the state, which will in turn use that money to offer subsidies to further lower the cost of healthcare.
In Connecticut, two health systems are on the brink of owning more than half of the 27 hospitals in the state, reports the CT Mirror. In 2000, the state had 23 independent hospitals, but now it just has 6. Residents of Windham say that when their hospital was acquired by Hartford HealthCare, they were told they would get new services and highly trained specialists. But soon after, the critical care unit was converted to progressive care, which can’t handle the same complexity of care. Now, the health system is moving forward with plans to close the hospital’s labor and delivery unit, which is directly contradictory to promises made to the community. Cuts such as these have devastating impact on the state’s rural labor and delivery landscape.
A report from the Office of Health Strategy and the Office of the State Comptroller focuses on the Connecticut Healthcare Affordability Index (CHAI), which measures the impact of policy models on Connecticut families’ ability to make ends meet. The findings measured the impacts of the cost of basic needs, income inadequacy rates and affordable healthcare rates by using the following policy models: American Rescue Plan (ARPA) Premium Tax Credit, Covered Connecticut and the Cost Growth Benchmark. The model estimates that if the temporary ARPA provision was available in 2019, nearly 31,000 additional households would have had affordable healthcare. It also estimates that expanding eligibility of the Covered Connecticut Program helped more than 17,000 additional households attain affordable coverage. Finally, by tying the rate of hospital spending growth to the cost growth benchmark, the model estimates that 14,000 additional households would attain affordable healthcare.
Georgia has passed legislation requiring insurance plans that cover diagnostic examinations for breast cancer to treat cost-sharing requirements the same as annual mammograms, according to AllOnGeorgia. The law is intended to increase access to life-savings health exams and increase the likelihood of early detection of breast cancer. In the same session, Georgia also passed HB 1041, which raises the cap on income tax credits for contributions to rural hospitals to $75 million per year in order to improve the financial solvency of the rural hospitals.
Illinois lawmakers passed legislation that extends continuous coverage for individuals without a source of income and lowers the eligibility age for undocumented immigrants from 55 to 42, reports mystateline.com. The new laws authorize the state to seek federal approval to allow individuals without a source of income at the time of their medical benefits redetermination to be considered for renewal. The package also expands coverage for midwifery services by adding certified professional midwives to the program.
Indiana hosted a National Hospital Price Transparency Conference discussing the state’s high hospital costs, where researchers discussed the impacts of consolidation and monopolies’ ability to increase prices, according to Wane 15. During the conference, the Employers’ Forum of Indiana unveiled a new dashboard to score healthcare systems on price and quality, which showed that Indiana has the seventh highest costs in the nation, relative to Medicare, without necessarily providing higher quality care. These tools are intended to help healthcare purchasers, such as private insurers, more aggressively negotiate rates with hospitals.
Kansas policies leave patients vulnerable to high medical bills, according to KCUR. Based on the Medical Debt Policy Scorecard, Kansas has limited policies reducing how often people incur medical debts and zero policies increasing patients’ ability to resolve debt out of court. The researchers suggest that Kansas can improve protections by requiring hospitals to tell patients about charity care and preventing hospitals from sending bills to collection agencies while patients are still negotiating amounts or making incremental payments, among many other strategies.
The Kentucky governor announced the state’s efforts to establish counties as “Recovery Ready Communities,” to provide high-quality recovery programs across Kentucky, reports Spectrum News 1. Cities and counties can apply for certification upon offering transportation, support groups and employment services at no cost for people seeking treatment for drug or alcohol addiction. Kentucky’s Office of Drug Control Policy and other community partners, including Volunteers of America, is launching the certification program.
Maryland passed the Healthy Babies Equity Act, which expands Medicaid to cover prenatal and postpartum care for pregnant people regardless of immigration status, reports Maryland Matters. Previously, Medicaid coverage was provided just for emergency medical services (including labor and delivery) to low-income undocumented residents. It is expected that a higher federal reimbursement for labor and delivery will offset costs of expanded prenatal and postpartum care, while additional savings could appear if prenatal care reduces pregnancy complications and early childhood health issues.
In a report focused on health insurance coverage and care by geographic regions in Massachusetts, the Center for Health Information and Analysis (CHIA), provides a baseline assessment of gaps in coverage, access, utilization and affordability across eight health service regions leading into the COVID-19 pandemic. The report notes that most Massachusetts residents (93.3%) were insured all year, with some variation by region – the Southcoast and Cape and Islands regions had the lowest rates of continuous coverage (89.4% and 89.9%, respectively). Rates of unmet healthcare needs due to cost ranged from 21 percent in the Cape and Islands to 31.3 percent in Southcoast, while rates of medical debt and problems paying medical bills in the family ranged from 18.3 percent in Metro Boston to 27.7 percent in Southcoast.
The Massachusetts Health Policy Commission (HPC) has blocked the state's largest and most expensive hospital system—Mass General Brigham—from expanding into the Boston suburbs, reports Fortune. The HPC examines hospital-specific data and recommends to the state Department of Public Health whether to approve mergers and expansions. This marks the first time in decades that the state health department used its authority to block a hospital expansion because it undercut the state’s goals to control health costs.
Michigan passed a bill increasing transparency surrounding healthcare costs and coverage, according to Senate Bill 447 requires insurers to provide large employer group customers with specific information about the costs of its insurance plan upon request. Specific data to be made available includes expenditures for inpatient and outpatient claims, claims for equipment, devices and services and amounts paid for prescription drugs.
Missouri policies leave patients vulnerable to high medical bills, according to KCUR. Based on the Medical Debt Policy Scorecard, Missouri has zero policies increasing patients’ ability to resolve debt out of court. The researchers suggest that Missouri can improve protections by requiring hospitals to tell patients about charity care and preventing hospitals from sending bills to collection agencies while patients are still negotiating amounts or making incremental payments, among other strategies.
The Federal Trade Commission (FTC) has blocked the proposed integration of Saint Peter’s Healthcare into RWJBarnabas Health, reports ROI NJ. The FTC released a statement saying the acquisition would harm competition for inpatient general acute care services, citing “overwhelming evidence” that the acquisition would be bad for patients, because the parties would no longer have to compete for the lowest prices and best quality of service. The FTC also blocked a proposed merger in Bergen County in Winter 2021 for similar reasons.
Two of New Hampshire’s largest healthcare providers abandoned plans to merge following objections from the attorney general, which said a partnership between Dartmouth Health and GraniteOne Health would limit competition without providing protections for consumers, according to the New Hampshire Bulletin. The AG issued the statement after three years of review, stating that New Hampshire had experienced significant consolidation in recent years, and that the transaction as proposed would ultimately violate state and federal laws without remedies to address the anticompetitive harm.
New Mexico’s governor created a Prescription Drug Task Force intended to work on reducing the cost of prescription drugs, according to the Office of the Governor. Members are tasked with analyzing and reporting solutions to manage and minimize the cost of prescriptions and advising the governor in addressing excessive prescription drug prices and the financial burdens they place on New Mexicans.
A new state board set up to address high prescription drug costs in Oregon met for the first time, according to The Lund Report. Legislation passed in 2021 to establish the Prescription Drug Affordability Board, with the aim of protecting residents and entities that provide healthcare coverage from high prescription drug prices. Under the law, the five-member board will identify and report on nine drugs annually that pose potential affordability challenges. The board will send reports and recommendations to the Legislature.
Hundreds of millions of dollars have been taken from South Carolinians’ paychecks and tax refunds by hospitals collecting on unpaid medical bills, reports WBTV. This investigation reveals that just a fraction of patients are filing protests against these garnishments. Previous reporting revealed that more than $390 million were garnished by hospitals, medical facilities and drug rehabilitation centers from 2018-2021. Advocates say that many South Carolinians aren’t receiving the required notification forms telling them they can file a protest against this garnishment, though the law requires hospitals that use the state program to garnish tax refunds to notify patients of their ability to file a protest. The General Assembly last updated the Setoff Debt Collection Act in 2003, but advocates feel more oversight of these state programs is needed to protect consumers.
Vermont passed a bill authorizing the Green Mountain Care Board to develop a patient-focused, community-inclusive plan for setting hospital budgets, according to VTDigger. S 285 also directs the Agency of Human Services and the Care Board to collaborate on a new proposal that may include budget-setting authority for the Board. This move is intended to begin addressing Vermont’s high and rising healthcare costs through hospital budgets.
Washington has passed legislation taking significant steps toward expanding health and dental insurance coverage to all residents regardless of immigration status, according to The Seattle Times. These steps include submitting a waiver that, if approved, would allow the state to offer plans available to undocumented immigrant adults on the state’s marketplace. The waiver would also leverage state-funded affordability programs that help lower premiums for consumers.
Washington’s Health Care Cost Transparency Board passed a motion authorizing the Board to seek additional data to inform its work, such as data available from Medicare hospital cost reports, according to the Washington State Hospital Association. The additional data is intended to help the board better understand hospital costs and prices in the state following insights from a Colorado report which raised issues with prices and profit margins in Colorado hospitals.
The governor’s Health Equity Council (GHEC) voted on final recommendations and released the executive summary, reports the Wisconsin Department of Health Services. The Council was charged with creating a comprehensive plan to achieve long-lasting and equitable health outcomes for all Wisconsinites. The Council’s primary focus is targeting social determinants of health, such as economic status, educational attainment or location. In total, the Council adopted 20 recommendations representing a variety of policy and implementation approaches aimed at addressing issues such as access and quality of care, reinforcing existing and creating new pathways for economic opportunity, building critical infrastructure to close gaps in assessing technology and strengthening its ability to proactively respond to threats to our collective wellbeing due to climate change.
The health systems in Hawaii and Maine have performed best of all the states during the COVID-19 pandemic, according to new rankings compiled by the Commonwealth Fund, according to Pew Charitable Trusts. The rankings weighed factors including vaccination rates, capacity in hospital and intensive care units and death rates. The Commonwealth Fund rankings added categories specific to how state healthcare systems performed during COVID-19 from February 2020 to the end of March 2022.
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