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Health care purchasing made easier by “Simple Choice” plans
The Obama administration is introducing standardized health care plans to the exchanges to simplify comparison purchasing. All the “Simple Choice” plans feature similar benefits and cover basic health care services including primary care visits and prescription drugs without requiring individuals to first meet their deductible. Premiums are not regulated and individuals will still have to cover the co-pay for any medical treatment they receive, writes Robert Pear of The New York Times.
Risk-adjustment accused of unfairly favoring large insurers
Some insurers are calling for changes to a risk-adjustment program under which insurance companies compensate each other for covering high-risk patients. Critics assert the current structure unfairly favors plans with higher premiums and excessive administrative costs, undermining efficiency in the marketplace. Defenders, including the Blue Cross Blue Shield Association, attest larger insurers tend to receive higher payouts because they cover more patients. Chad Terhune of California Healthline reports federal regulators plan to make minor adjustments, but say the program is currently working as intended.
Penn State, Pinnacle abandon merger plans
In the wake of continued opposition from the Federal Trade Commission (FTC), PinnacleHealth System and Penn State Hershey Medical Center will not merge. The U.S. Court of Appeals renewed an antitrust challenge from the FTC last month, which would have led to a trial to determine anti-competitive effects of the merger. PinnacleHealth and Penn State decided to terminate the deal rather than take part in a potentially long and expensive regulatory battle. In a statement the two health systems expressed a commitment to collaborate in the future. Erica Teichert at Modern Healthcare has the story.
Medicare premiums could rise for those with greater earnings
Medicare beneficiaries with higher incomes may see a spike in premiums next year. About 70 percent of beneficiaries qualify for hold-harmless treatment, a Medicare provision that prevents Part B premiums from rising beyond the increase in Social Security payments. Anne Tergesen at The Wall Street Journal explains costs will increase for high earners as Medicare must distribute its increase in expenses among the 30 percent of beneficiaries who are not eligible for hold harmless (subscriber’s content).
Limited mental health care means more ER visits
More people, especially children in need of psychiatric help, are relying on the emergency department. Shefali Luthra of Kaiser Health News reports there are fewer than 8,500 mental health specialists in the country, and more than 15 million young patients need services.