September 25, 2018 

Volume 5, Number 13

In This Issue

Drug Spending vs. Medicaid

Behind Your Rising HC Bills

If Doctors Got Paid Only Medicare Rates

Senate Passes Broad Spending Bill

Easing Costs on Drug Companies

Protection Against Surprise Medical Bills

Life Insurance Incentives

Merger Cleared By Justice Dept.

Step Therapy for Medicare Adv. Patients

Lawsuit Seeks to Block Health Insurance Efforts

Apple Watch EKG App

Aetna CEO: Yoga, Meditation, & Therapy

TJG On Facebook

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This newsletter is provided for informational purposes only. It is not intended for legal or tax advice, nor does it create an attorney/client relationship between The James Group, LLC and any readers or recipients. Readers should consult counsel of his or her own choosing to discuss how these matters relate to their individual circumstances. Reproduction of any kind is prohibited without the express written consent of The James Group, LLC.

Kaiser Health News: As States Try To Rein In Drug Spending, Feds Slap Down One Bold Medicaid Move
States serve as “laboratories of democracy,” as U.S. Supreme Court Justice Louis Brandeis famously said. And states are also labs for health policy, launching all kinds of experiments lately to temper spending on pharmaceuticals. No wonder. Drugs are among the fastest-rising health care costs for many consumers and are a key reason health care spending dominates many state budgets — crowding out roads, schools and other priorities. (Bebinger, 9/21)

Source: Kaiser Health News

Wall Street Journal: Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition
Last year, Cigna Corp. and the New York hospital system Northwell Health discussed developing an insurance plan that would offer low-cost coverage by excluding some other health-care providers, according to people with knowledge of the matter. It never happened. (Mathews, 9/18)

Source: Wall Street Journal

Doctors For America: What If Doctors Got Paid Only Medicare Rates?
One of the biggest problems with our health care system is the unchecked growth of health care costs. We know that Medicare does a better job of controlling health care costs than private insurers. Along with this comes lower reimbursement rates for doctors which leads to the oft reported phenomenon of doctors not accepting new Medicare patients or dropping out of Medicare altogether. (Kalyanaraman, 8/31)

Source: Doctors For America

The Wall Street Journal: Senate Passes Broad Spending Bill
To combat the opioid epidemic, the bill appropriates $3.8 billion, an increase of $2.7 billion over 2017. Of that, $1.5 billion will go to states for grants. The Senate on Monday passed broad, bipartisan legislation aimed at combating the opioid epidemic through new research, treatment and help for families affected by addiction. (Andrews, 9/18)

Source: The Wall Street Journal

The Hill: Lawmakers Consider Easing Costs On Drug Companies As Part Of Opioids Deal
Lawmakers are considering adding a provision easing costs on drug companies to an opioid package currently being negotiated. The powerful pharmaceutical industry has been pushing for months to roll back a provision from February’s budget deal that shifted more costs onto drug companies, and they sense they have a chance to attach the change to the bipartisan opioid package currently moving through Congress. (Sullivan, 9/20)

Source: The Hill

Kaiser Health News: Senators Unveil Legislation To Protect Patients Against Surprise Medical Bills
With frustration growing among Americans who are being charged exorbitant prices for medical treatment, a bipartisan group of senators Tuesday unveiled a plan to protect patients from surprise bills and high charges from hospitals or doctors who are not in their insurance networks. The draft legislation, which sponsors said is designed to prevent medical bankruptcies, targets three key consumer concerns. (Bluth, 9/19)

Source: Kaiser Health News

The New York Times: Life Insurance Offering More Incentive To Live Longer
Brian and Carla Restid, a couple in their mid-60s, bought life insurance four years ago to protect their lifestyle in retirement. A year later, they upgraded to a pilot program offered by the insurer to get fitter, healthier and more energized. In exchange for working to improve their well-being and providing details about the process, they have saved $700 so far in premiums. (Sullivan, 9/19)

Source: The NY Times

The Wall Street Journal: Cigna, Express Scripts Say Merger Cleared By Justice Department
The companies said, to date, that they had obtained clearances from departments of insurance in 16 states, and are working with regulators in the remaining jurisdictions to obtain clearances for the merger. Cigna and Express Scripts said they expect the deal will close by year-end 2018, subject to the satisfaction of all closing conditions. (Nakrosis, 9/17)

Source: The Wall Street Journal

Kaiser Health News: 'Step Therapy' Cost-Cutting Tool Could Limit Drug Choices For Medicare Advantage Patients
Starting next year, Medicare Advantage plans will be able to add restrictions on expensive, injectable drugs administered by doctors to treat cancer, rheumatoid arthritis, macular degeneration and other serious diseases. Under the new rules, these private Medicare insurance plans could require patients to try cheaper drugs first. If those are not effective, then the patients could receive the more expensive medication prescribed by their doctors. (Jaffe, 9/17)

Source: Kaiser Health News

The Wall Street Journal: Lawsuit Seeks To Block Trump Health-Insurance Effort
The suit, filed in U.S. District Court for the District of Columbia, takes aim at one of the central planks of the administration’s plan to roll back the Obama-era health law, after Congress failed to repeal it last year. It sets the stage for a legal standoff that could affect coverage and premiums for millions of Americans in 2019. The Trump administration rule finalized in August loosens restrictions on a type of coverage known as short-term medical insurance—low-cost plans that cover a limited period with less-expansive benefit offerings, which are subject to fewer consumer protection regulations. The plans don’t have to cover people with pre-existing conditions, and insurers can charge higher premiums based on a consumer’s health status. (Armour, 9/14)

Source: The Wall Street Journal

Stat: Here’s The Data Behind The New Apple Watch EKG App 
When the new Apple Watch heart monitoring app can get a reading, it can accurately detect that a person has an irregular heart rhythm known as atrial fibrillation 99 percent of the time, according to a study of the new device that Apple submitted to the Food and Drug Administration. ...In one study, Apple tested the watch in more than 580 people, half of whom had atrial fibrillation. The app couldn’t read about 10 percent of the heart rhythm recordings in the study. When it looked at the rest, though, the app was very accurate: It caught more than 98 percent of people with atrial fibrillation, and correctly told people that they didn’t have the condition 99.6 percent of the time. (Sheridan, 9/13)

Source: Stat

The New York Times: Mark Bertolini Of Aetna On Yoga, Meditation And Darth Vader
Not long after joining Aetna, the health insurance giant, Mark Bertolini almost died. A skiing accident in 2004 left his body broken and his prospects dimmed. He was in his late 40s and considered early retirement. When conventional Western medicine didn’t help him recover, Mr. Bertolini turned to Craniosacral therapy, yoga and meditation. Soon he was back at work, and was made chief executive of the company in 2010. (Gelles, 9/21)

Source: The NY Times

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