Where we’re going

As 2019 draws to a close, and despite a flurry of activity throughout the year, the House and Senate have been unable to reach agreement with respect to balance billing. Members of the House and Senate introduced a myriad of bills all targeting “surprise medical billing.” They held hearings and negotiations. They spoke repeatedly about … Continued

One thing is certain as we head into 2020, health care costs continue to rise. Here are some of the key statistics reported in 2019: $3.8 trillion is the predicted health care spend in 2019[1] 4.8% is the predicted increase in health care spend in 2019[2] 5.7% is the average rate national health spending is … Continued

A fascinating article entitled, “The employer-health insurance connection an ‘accident of history’” by David Balat appeared in the November 9, 2019 edition of The Hill. The article briefly traces the history of healthcare in the United States and how it evolved into an employer-sponsored benefit. “Most early prepaid medical care programs in this country began … Continued

Kaiser State Health Facts has issued a report of 2017 adjusted expenses per inpatient day for all 50 states.[1] “These figures, which are based on information from the 2017 American Hospital Association Annual Survey, include all operating and nonoperating expenses for registered U.S. community hospitals, defined as public, nonfederal, short-term general and other hospitals. The … Continued

The Affordable Care Act (“ACA”) requires health insurance companies to disclose how much they spend on health care and how much they spend on administrative costs, such as salaries and marketing. If an insurance company spends less than 80% (85% in the large group market) of premiums on medical care and efforts to improve the … Continued

In February 2018, 20 Republican state attorney generals and governors filed suit to have the ACA declared unconstitutional in the U.S. District Court for the Northern District of Texas in a case captioned, Texas, et al. v. United States of America, et al., 4:18-cv-00167. The plaintiffs were successful and the case is now on appeal … Continued

In a September 3, 2019 article in Health Affairs, Michael E. Chernew, Maximillian J. Pany, and Richard G. Frank make the argument for market-based price caps to address soaring health costs. “The gap between prices in the US and other countries, the large price-cost margins in the commercial sector, and the wide variation in prices … Continued

Today the Kaiser Family Foundation released its annual Employer Health Benefits Survey. The annual survey of employers “provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2019 survey included 2,012 interviews with nonfederal public and private firms.” Here are just … Continued

On June 20, 2019, Peterson-Kaiser published “An examination of surprise medical bills and proposals to protect consumers from them.” The study used “claims data from large employer plans to estimate the incidence of out-of-network charges associated with hospital stays and emergency visits that could result in a surprise bill.” It also surveyed state and federal … Continued

Ground ambulance bills are the largest source of unexpected out-of-network medical bills according to research by Christopher Garmon, a health economist at the University of Missouri-Kansas City. His research showed that “[i]n more than half of cases involving ambulance transportation, the ambulance services were out of network […].”[1] Over 50% of ground ambulance rides end … Continued