State News

NYC Care, New York City’s answer to calls for universal healthcare, is now available in Brooklyn and Staten Island, according to amNY. The city expects to enroll 15,000 new NYC Care members in both boroughs over the next six months – since the launch in the Bronx in August 2017, 13,000 residents have enrolled in the program that offers free or low-cost health services. New members will be offered a primary care provider within two weeks of enrollment, have access to patient care overseen by NYC Health + Hospitals, have access to 24/7 customer assistance and a hotline for an on-call clinician to speak about patient needs, like prescription refills.

Western Maryland Health System is now officially UPMC Western Maryland, merging into the UPMC hospital network, according to the Cumberland Times-News. UPMC has committed to make certain capital investments to enhance services and upgrade facilities in the Western Maryland region, to ensure they will continue to provide quality healthcare for residents and remain one of the largest employers in the region. The new affiliation does not affect patients’ insurance coverage, and UPMC Western Maryland has reaffirmed its commitment to work with multiple payers in the future.

Joshua Bates was rushed to an emergency room in North Carolina for what turned out to be acute apendicitis; however, the hospital turned out to be out-of-network with the insurance plan provided through his employer. In this edition of Kaiser Health News' Bill of the Month, we learn that Joshua was charged $41,212 for his surgery, one night at the hospital and the emergency room charges. After payments by both Joshua and his insurer, the hospital sent him a bill for the balance, just over $28,000. Joshua was "balance billed" because he went to an out-of-network hospital - even though this was an emergency, he fell through the limited protections in existing law. A balance bill is the difference between what insurers pay toward a bill and a provider's "list charges," what facilities set themselves and often bear little or no relationship to actual costs. Joshua would be helped by a federal law providing consumers with protection against balance billing, because his employer-sponored insurance is regulated by the federal government, meaning that state regulations for state-regulated plans do not apply to him. 

UAB Health System and Ascension St. Vincent’s have gained approval of the University of Alabama System Board of Trustees to move forward with a strategic alliance, according to AL.com. While not a merger, the move allows UABHS facilities to retain the UABHS or UAB Medicine brands, and Ascension St. Vincent’s facilities to remain Ascension St. Vincent’s. Those spearheading the alliance argue that it will allow for better care coordination of programs and increase patient access to diabetes and mental healthcare services. The alliance will not change physicians or insurance coverage for patients, organizers say, and medical records are still accessible through existing patient portals.

A new Illinois law will cap out-of-pocket insulin costs at $100 for a 30-day supply, according to WGN9. The new legislation (SB 667) is expected to impact about 1.3 million people in the state who have diabetes and is considered an important step in lowering out-of-pocket costs for Illinois families.

According to NJ Spotlight, New Jersey passed two new laws (A-5916 and A-5918) that respectively authorize the state Department of Health to notify elected officials of fiscal difficulties encountered by hospitals and make hospital reporting requirements more stringent. The goal is to ensure acute-care facilities do not suddenly halt services and leave residents without healthcare in their communities. Concern driving these bills was raised by a March 2019 State Committee of Investigation (SCI) report that spotlighted $157 million in apparently duplicative management and consulting fees paid to third-party companies by CarePoint Health, which owned three Hudson County hospitals.

High prices at hospitals are driving up the cost of healthcare more dramatically in Colorado than elsewhere in the U.S., according to CPR News. Hospital profits increased by more than 280 percent between 2009 and 2018, a state report found, and profit per patient rose to more than $1,500 a patient. The report by the Department of Health Care Policy and Financing also found that uncompensated care in Colorado is at a historic low, and hospital spending on charity care and bad debt has dropped more than $385 million a year since Medicaid expansion in the state.

Connecticut’s Governor signed two executive orders to directly address healthcare costs, primary care spending and quality of care for individuals, businesses and the state government, according to Robert Wood Johnson’s State Network. The orders direct the Office of Health Strategy to establish statewide healthcare cost growth and quality benchmarks in addition to a primary care spending target, and direct the Department of Social Services to improve public transparency of Medicaid costs and quality.

UVM Health Network’s system-wide consolidation has resulted in longer wait times for patients seeking diagnosis and treatment and could increase healthcare costs for Vermonters down the line, according to the VT Digger. This is becuse hospitals that dominate local healthcare markets have greater leverage in negotiations with insurance companies, which can ultimately lead to higher prices per procedure. These higher prices trickle down to patients in the form of higher deductibles, copays and premiums. Barriers to access have caused some Vermont residents to seek care across state lines.