State News

A group of retired Illinois educators is suing the state over what they say is a diminishment of promised benefits, reports the Center Square. The state is reducing what taxpayers pay for retired teachers’ healthcare by around $100 million per year, starting in July 2022. The group believes that reduced state contribution would mean increased costs for retired teachers and claims that their actuary has said that the fund would be depleted in anywhere from one to four years. 

Patients who take re-exposure prophylaxis (PrEP), a medication that prevents HIV, should not be paying anything out of pocket for the drug or any of the associated costs, yet that is not the case for many, reports Axios. Peter Sacco described copays he received for clinic visits and lab work associated with monitoring his health for his PrEP prescription. Federal officials told insurers there should be no copays for baseline and monitoring services for PrEP, yet when Sacco appealed his $130 bill for such services, his insurer denied the appeals.

New legislation in New Jersey will require insurers to reimburse healthcare providers for telehealth and telemedicine services at the same rate as in-person services—originally enacted at the outset of the COVID-19 pandemic— with limited exceptions for the next two years, reports the Governor’s Office. The legislation also charges the state’s Department of Health with conducting an in-depth study of the use of telehealth and telemedicine and the effects on patient outcomes, quality and satisfaction and access to care in order to inform future decisions on payment structure for these services. The extension includes a requirement that audio-only behavioral healthcare services are reimbursed at the same rate as in-person services and prohibits insurance carriers from imposing geographic or technological restrictions on the provision of telehealth services, as long as they meet the same standard of care as if they were delivered in-person.

The Healthcare Value Hub’s Healthcare Affordability State Policy Scorecard ranked Arkansas 30^th out of 47 states, plus DC, in healthcare affordability, reports the Arkansas Center for Health Improvement. The scorecard gave Arkansas 29.9 out of 80 possible points and provided several recommendations to improve affordability, such as: enacting stronger price transparency requirements; pursuing coverage options for residents earning too much to qualify for Medicaid; and enacting protections against short-term, limited-duration health plans.

Chandak Ghosh rushed to the Mt. Sinai West emergency room in New York City in 2010 with severe back and stomach pains, according to We The Patients. He was diagnosed with kidney stones, given pain medication, and discharged. In the following days, Mr. Ghosh began to receive separate bills from numerous providers he had seen during his visit. Though he was fully insured, he was told he was responsible for payment until his insurance company paid, and that if he didn't pay by a certain date, the bills would be sent to collections agencies and could hurt his credit. By the time his insurance had fully paid (months later), Mr. Ghosh has received 27 different billing statements. 

After Wellstar Health System and UnitedHealthcare insurance did not agree on a new contract, Georgia resident Shelly Azzopardi was left without clear coverage for newly out-of-network follow-up services, according to Georgia Health News. Health care consultants and industry officials say an increasing number of contracts end without a deal, and even when they are resolved, they pressure thousands of patients to choose between higher out-of-pocket costs or leaving a trusted physician or hospital network. A similar dispute is looming involving Anthem Blue Cross and Blue Shield. This trend becomes more pressing as healthcare systems acquire additional hospitals and physician practices, effectively increasing the stakes of negotiation, and with it, the potential for patients to be left out of network if deals collapse.

Saint Francis Hospital and Medical Center has sued Hartford HealthCare and its subsidiaries, reports the CT Mirror, claiming that it is trying to create a monopoly on hospital services by acquiring physician networks, particularly cardiologists, and demanding that they refer their patients only to Hartford HealthCare. The lawsuit alleges "a campaign of exclusion, acquisition and intimidation," and claims that Hartford HealthCare executives have stated in meetings that their plan was to "crush" or "bury" Saint Francis. The lawsuit also claims that as Hartford HealthCare acquired physician practices, it threatened and intimidated physicians who don't comply with its dictates. Hartford HealthCare has been cornering the market on lucrative operations such as cardiac and orthopedic surgeries by forcng doctors to send their patients only to Hartford HealthCare hospitals or by obtaining exclusive rights to robotic equipment. 

Saint Francis Hospital and Medical Center has sued Hartford HealthCare and its subsidiaries, including Hartford Hospital, reports CT Mirror. Saint Francis claims that Hartford HealthCare is trying to create a monopoly on hospital services by acquiring physician networks, particularly cardiologists, and demanding that they refer patients only to Hartford HealthCare. The lawsuit claims that as Hartford HealthCare acquired physician practices, they threatened and intimidated physicians who don’t comply with its “dictates.” The lawsuit also claims that other hospitals in the region suffer due to Hartford HealthCare’s “anticompetitive conduct.” 

Medicaid expansion in Louisiana was associated with decreased travel distance to healthcare providers, according to a study in Health Affairs. The authors studied this relationship among continuously enrolled Medicaid beneficiaries from 2015-2017, with Medicaid expansion occurring in July 2016. Distance traveled decreased across eight different types of services, ranging from −3.46 miles for general practices to −0.70 miles for specialty care. Black enrollees living in nonmetropolitan areas experienced the greatest decline in travel distance, with more than nine fewer miles traveled for primary care services. The authors argue that Medicaid expansion can be a tool to address racial and geographic disparities in healthcare access.