Congress is back in town this week. On Thursday morning, the Oversight subcommittee of the House Energy and Commerce Committee will hold a hearing on the Health and Human Services Department’s role in healthcare cybersecurity.
In a bit of good news, Modern Healthcare reports
As hospitals begin to control costs more consciously in a value-based environment, they are asking staffers to be more frugal. “There’s a paradigm shift that’s happening across the country in terms of cost of care,” said Dr. Jay Bhatt, chief medical officer for the American Hospital Association, adding that clinicians are taking an increasingly active role in fiscal responsibility—mostly as a result of uncertainties in the industry.
Uncertainty is a common sense reason for cost control. In contrast, Business Insider discusses the case of patient who costs his ACA health exchange plan $1 million per month. The article which interviews a Kaiser Health Foundation leader explains
The community rating, a provision of Obamacare, obligates insurers to price premiums the same for people of the same age in the same area. This prevented people with preexisting conditions from being charged more than healthy people and getting priced out of the market.
Without that provision, an insurance company could raise premiums for a sick patient substantially to offset some of their costs, but the price could be so high that it would be financially crippling for the patient’s family.
Additionally, the ACA eliminated lifetime limits for insurance plans. Before the ACA, insurers could set a cap on how much they would pay out to a patient over the course of their life.
The FEHBlog does wonder if the cost of care significantly increased because of the certainty of third party payment. In any event, these types of consumer protections have existed in the FEHBP since well before ACA enactment in 2010. The article does note that the proposed American Health Care Act would include an invisible risk pool that would help individual health insurers with these outliers cases.
AHIP writes about health insurer efforts to integrate mental health and other medical care. That’s encouraging.