Re-underwriting would be prohibited under a bill introduced in the House and Senate on Oct. 16. Under the legislation, insurers would not be allowed to increase or reclassify premiums "based on a health-status-related factor," says Sen. Bob Graham, one of the sponsors.... Health benefits for part-time workers were the focus of a labor dispute between a union representing janitors and 30 cleaning companies in Boston. Under a tentative deal ending a three-week strike, about 1,000 part-time employees who work in the largest buildings and who are members of Boston Local 254 of the Service Employees International Union will get health insurance through employers. About 75 percent of the union's 11,000 members are part-time workers.... Meanwhile, a former editor of the New England Journal of Medicine says that the only way to help the working poor and all other segments of society is to switch to a single-payer health care system. In a New York Times opinion piece, Marcia Angell says that the fatal flaw in today's system is that medical care is treated "as a commodity." She adds that "the criterion for receiving it is ability to pay, not medical need."
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.