State News

OSPIRG is highlighting the experiences of many Oregonians who are spending too much on healthcare and receive too little in return in the Voices for Better Care project. Jordan R. doesn’t “want to refill [their] expired epi pen because it’s so expensive. It hurts to know it’s not as expensive in other countries, but it is here.”

The Tennessee General Assembly passed a certificate of need reform bill to reduce requirements and costs associated with opening, reopening or expanding a hospital, reports the Murfreesboro Post. The law changes the fee schedule associated with obtaining approval for a new healthcare service or facility, reduces the application process from 135 days to 60 days, exempts services in counties with populations above 175,000 people and allows rural hospitals to reopen without restarting the certificate of need application process.

Health insurers in Oregon that waived all deductibles, copayments and other costs for insured patients who fell ill with COVID-19 and needed hospital care, doctor visits, medications or other treatment are no longer waiving fees for COVID treatment, according to The Lund Report. In a study released in November, researchers found about 88 percent of people covered by insurance plans — those bought by individuals and some group plans offered by employers — had policies that waived such payments at some point during the pandemic. Waivers resulted in significant savings for COVID patients who fell seriously ill and wound up in the hospital. 

A group of Tennessee Medicaid recipients has filed a lawsuit seeking to halt a plan that would make contentious changes to the state's program designed to provide medical coverage to low-income earners in the state, according to Modern Healthcare. The Tennessee Justice Center — who is representing the recipients — claims the federal government exceeded its authority in approving the proposal. Block grant supporters argue that the current system gives states little incentive to control expenses because no state pays more than half the total cost. However, opponents and health advocates have expressed concern that spending caps might cause states to purge their rolls or reduce services.

A new Montana law aimed at reducing healthcare costs will allow healthcare providers to contract directly with patients for certain basic care, such as annual checkups, office visits, vaccines, bloodwork and stitches, reports the Flathead Beacon. Currently, eight clinics in Montana are working as direct primary care providers as allowed under a 2017 memo issued by the then-Insurance Commissioner. The new law allows dentists, chiropractors and other health providers to offer similar direct care contracts to patients. Supporters of the law argue that direct care coverage can be used in combination with lower-cost catastrophic health coverage or a healthcare sharing ministry to reduce costs. 

The Tennessee Health Care Campaign’s Rural Equity Report shows three-fourths of the state’s 25 remaining essential access rural hospitals are at high risk of closure in the next few years, reports The Rogersville Review. The report includes a toolkit for rural communities with vulnerable hospitals that offers solutions to rural health inequities, including: prioritizing infrastructure improvements in roads, broadband and emergency call centers; state oversight of hospital ownership transfers; increased financial investment in rural health; and increasing coverage for Tennesseans in rural areas. The report also includes interviews with stakeholders that share their experiences and perceptions of rural hospital closures. 

An old Massachusetts policy called “automatic retention” stopped residents from losing their health coverage, reports Tradeoffs. The results of an NBER working paper show that this unique feature protected 14% of adults per year from losing health insurance coverage due to payment lapses. Because in CommCare (Massachusetts’ pre-ACA health insurance exchange) there was always one plan option with zero premium available to people making 100-150% of the federal poverty limit, if someone missed a payment for another plan, they were switched automatically to the premium-free plan. Researchers found that the adults who benefited from this policy were often younger and healthier, keeping the market risk pool balanced. 

A new analysis found large variations in commercial health insurance payments compared to Medicare payments across Colorado hospitals, reports the Center for Improving Value in Health Care. Colorado hospitals received commercial payments for inpatient and outpatient services that were anywhere from 108% to 508% of Medicare rates for the same services at the same hospitals. In particular, outpatient services in Colorado are among the most expensive in the state and a driver of rising healthcare costs.

Omitting social determinants of health (SDOH) data from CMS’ Hospital Readmissions Reduction Program misallocated penalties attributable to SDOH to hospitals with the largest share of high-risk patients, according to a Health Affairs study. Researchers used 2012-2016 data from New York City to project the program’s penalties by augmenting CMS’ readmission model for heart attack, heart failure and pneumonia with SDOH scores created to measure geographic levels and individual-level social risk. They found that including these scores affects projected penalties for hospitals treating the highest proportion of patients with high SDOH scores. If CMS continues to omit this relevant patient and geographic data from this readmission model, penalties due to SDOH and social risk factors are misallocated to hospitals serving the largest share of these populations.