A new law that makes employers extend health benefits to about a million uninsured Californians will be watched carefully. Opponents of the law, signed by Gov. Gray Davis two days before the recall vote that ousted him, vow to challenge it in the courts.

"The California Chamber [of Commerce] agrees that uninsured Californians need help, but the multibillion-dollar health care tax ... is the wrong approach," says Allan Zaremberg, the chamber's president. "It is a job killer that will force new expenses on employers already struggling with rising workers' compensation costs and a looming unemployment insurance tax increase. Rather than swelling the ranks of the insured, [it] will swell the ranks of the unemployed."

The law requires that some employers either provide insurance to employees or pay into a state fund that will provide coverage. Businesses with 200 or more employees will have to cover workers and dependents by 2006 to avoid paying into the fund.

Businesses that employ 50 to 199 workers must offer health insurance to employees (not dependents) by 2007. Employers with fewer than 20 workers are exempt, and those with 20 to 49 workers are exempt unless the state acts to provide tax credits to offset the cost of health benefits.

The chamber is weighing a challenge on the grounds that the fee employers must pay if they choose not to provide health insurance is an unlawful tax. It argues that a new tax on business requires a two-thirds legislative majority. This law was enacted by simple majority.

The chamber also is looking into whether the law violates federal ERISA provisions.

The ramifications might be wide if the law weathers these challenges. It "could be a model for the rest of the nation," says the Wall Street Journal. The San Francisco Chronicle predicts that the law will "put California at the forefront of the push to broaden insurance coverage through employer mandates."

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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.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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.