Weekend update

Congress remains out of town this week.  

Reuters had an interesting story about the legal strategy that Aetna and Humana plan to use against the government’s antitrust lawsuit in an effort to block their merger.

The Justice Department lawsuit focused on a county-by-county analysis of where Aetna and Humana have what is deemed too much market share in providing Medicare Advantage for elderly people and in the individual health plans created under President Barack Obama’s healthcare reform law.
Aetna will argue in court that the Justice Department defined the market for Medicare Advantage too narrowly, which has caused it to see competition issues where they do not exist, Chief Executive Officer Mark Bertolini said in an interview. The government has failed to take into account that seniors can not only choose between Medicare Advantage plans sold by private players, but also have the government-run Medicare program as an option.
“Let a judge decide. Is Medicare Advantage competitive with Medicare fee-for-service? If that is indeed the case, then there isn’t any market we need to divest,” Bertolini said. “If we have to divest, can we provide an appropriate remedy? And we have.”

The FEHBlog believes that Mr. Bertolini’s argument finds support in President Obama’s recent American Medicare Association Journal article advocating that “Congress should revisit a public plan [for the ACA marketplaces] to compete alongside insurers in areas of the country where competition is limited. ” As previously noted, the FEHBlog is not a fan of the public option.  The Heritage Foundation expert Bob Moffitt had an article providing in-depth support for this position.

Barrons informs us about challenges facing the prescription benefit management industry.  This is an article worth reading.

Healthcare IT News reports that late last week the FBI arrested three people from Miami-Dade, Florida for a $1 billion scheme to defraud Medicare and Medicaid throught skilled nursing and assisted care facilities. That’s a lot of boxes of ziti as Tony Soprano would say.  Southern Florida with its high elderly popultion always has been a hot bed for health care fraud.

Finally the Washington Post this morning published another one of its feature articles about health care problems plaguing lower income populations in the U.S.  The unfortunate case here concerns a young women who graduated from prescription pain killers to heroin and methadone.  The principal cause of this problem — overprescription of opioids and other pain killers — has been the focus of a massive amount of public attention like this series of articles and a new federal law. Hopefully the problem will dissipate before long.

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