About health insurance/insurers
Walmart workers sue over higher premiums from 'unfair' tobacco surcharge “The workers said the surcharge raises premiums for certain employees, violating anti-discrimination provisions in the Employee Retirement Income Security Act (ERISA) based on tobacco use.
Walmart charged employees that used tobacco $30 to $195 per biweekly pay period. Households with more tobacco users and health plan type were factors that determined how much extra individuals paid.
These funds were withheld from paychecks and deposited in the health plan’s trust account. On average, this totaled $1,150 annually per plaintiff in the lawsuit.”
Comment: The ACA exchange plans allow for companies to charge smokers more for their insurance.
An Examination of Medicaid Renewal Outcomes and Enrollment Changes at the End of the Unwinding “Key Takeaways
During the unwinding of the Medicaid continuous enrollment provision, over 25 million people were disenrolled and over 56 million had their coverage renewed. Overall, 31% of people whose coverage was redetermined during the unwinding were disenrolled, but that share ranged widely across states. For example, five states—Montana, Utah, Idaho, Oklahoma, and Texas—have disenrollment rates over 50%, while five states—North Carolina, Maine, Oregon, California, and Connecticut—have disenrollment rates under 20%.
Despite millions of disenrollments during the unwinding, nationally, nearly 10 million more people are currently enrolled in Medicaid/CHIP than at the start of the pandemic. While enrollment among adults is over 20% higher than in February 2020, child enrollment has nearly returned to pre-pandemic levels and is only 5% higher.
Several factors likely explain the net growth in Medicaid enrollment. The pandemic may have encouraged some people who were previously eligible for Medicaid but not enrolled to newly enroll, and during the unwinding, many states took steps to improve their renewal processes to reduce the number of people who were disenrolled despite remaining eligible. In addition, several states expanded eligibility for certain groups, including five states that adopted Medicaid expansion since the onset of the pandemic.
Similar to the national trend, Medicaid/CHIP enrollment in most states is higher than it was in February 2020; however, total Medicaid/CHIP enrollment has fallen below pre-pandemic enrollment in three states, Montana, Colorado, and Arkansas, and child enrollment is lower in 12 states.”
Indiana insurers, hospitals accused of Medicaid fraud in giant whistleblower lawsuit “Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower lawsuit.
Implicated in the lawsuit is Anthem, the largest managed care company in Blue Cross Blue Shield Association; CareSource, one of the country’s largest managed health plans; and Coordinated Care, a subsidiary of Centene; and MDwise.
Health systems named are Indiana University Health, Ascension Health, Lutheran Health Network and other regional hospitals…
The insurers are accused of misusing Medicaid funds by violating standard hospital billing rules, paying for services after patients already died, improperly paying chiropractic office visits and improperly bundling dental and opioid treatment claims. Insurers knew reporting higher expenditures in the encounter data would result in greater capitated payments in the future, the lawsuit said.”
About pharma
FTC formally sues PBMs over insulin prices and warns manufacturers “The Federal Trade Commission is suing the titans of the pharmacy benefit manager industry for anticompetitive practices and artificially raising the price of insulin drug prices, the agency announced Friday.
The complaint alleges that Optum Rx, Express Scripts and Caremark — all vertically integrated with UnitedHealth Group, Cigna and CVS Health, respectively — caused patients to pay more for life-saving drugs and engaging in ‘rigging pharmaceutical supply chain competition in their favor.’”
About healthcare IT
Tech Trends 2025 An interesting monograph covering:
AI Avatars
Quantum Advantage
Expert Models
Deepfake Defense
Post-Quantum Cryptography
AI Sovereignty
Digital Humans
Pre-Quantum Foundations
Exponential AI
‑About healthcare personnel
Examining Physician, Resident and Student Wellbeing and Impact of the Current Healthcare Landscape “Highlights of the key findings identified this year include:
—Six in 10 physicians and residents, and seven in 10 medical students reported often experiencing burnout
—More than half of physicians know of a physician who has ever considered, attempted or died by suicide
—Seven in 10 physicians and medical students, and at least six in 10 residents agree that consolidation is having a negative impact on patient access to high-quality, cost-efficient care
—According to physicians, negative impacts of mergers/acquisitions include job satisfaction (50%), quality of patient care (36%), independent medical judgment (35%) and patient healthcare costs (30%)
About healthcare finance
PRIVATE EQUITY’S REVENUE CYCLE:CREATING AND COLLECTING U.S. MEDICAL DEBT “KEY POINTS
—Medical debt has become a significant burden on U.S. patients in recent years, impacting 14 million people and totaling at least $220 billion
—Debt collection falls within a healthcare subsector called revenue cycle management (RCM), which includes identifying, managing, and collecting medical claims and patient payments
—In recent years private equity investment in revenue cycle management companies has been elevated despite a downturn in private equity investment more generally
—Private equity firms have consolidated debt collectors, medical payments, and other revenue cycle management functions into “end-to-end” service providers, coordinated from the point of initial patient contact to aggressive follow-up on payments for services
—Some private equity-owned debt collectors have suggested that they are more aggressive than other debt collection companies
—Private equity-owned revenue cycle management companies have increasingly helped facilitate loans – through medical credit cards, installment plans, and strategic partnerships with financial service providers – to indebt patients who cannot afford to pay a full medical bill at one time
—A number of private equity-owned debt collectors have received complaints in the CFPB consumer complaint database – which includes data going back to late 2011 – primarily around attempts to collect debts that are not owed or collecting wrong amounts
—There are measures lawmakers can take to address potential harms from private equity’s ownership of companies creating the debt crisis, including limitations on medical debt, restrictions on medical debt collectors, and increased ownership transparency.”