health law

The IRS has recently released rules to address aggressive debt collection from poor patients by nonprofit hospitals, ProPublica reports. The rules, required by the Affordable Care Act, will require nonprofit hospitals to "post their financial assistance policies on their websites and offer a written, 'plain language summary' of them to patients when they're in the hospital. If patients don't apply for assistance or pay their bills, then the hospitals are required to send at least one more summary of the policy, along with mentioning it on billing statements. And if hospitals plan to sue patients over unpaid bills, they must attempt to verbally tell the patients about their policies, as well as send notices that they are planning to sue and that the patients may qualify for financial assistance."

Reuters' Lawrence Hurley reports that the U.S. Supreme Court rejected an appeal brought by the Association of American Physicians and Surgeons and the Alliance for Natural Health USA, challenging "various aspects of the law known as Obamacare including the so-called individual mandate that requires people to obtain health insurance or pay a tax."

Gallup's Jenna Levy reports that "the uninsured rate has dropped 4.2 percentage points since the Affordable Care Act's requirement for Americans to have health insurance went into effect one year ago." Levy also reports that the uninsured rate among "blacks dropped seven points over the past year, while the rate among Americans earning less than $36,000 in annual household income dropped 6.9 points." Overall, Gallup's surveys shows the Affordable Care Act has met one of its goals to increase the number of Americans with health insurance coverage. 

Ruth Reader, writing for VentureBeat, reports that, in 2014, healthcare providers made up nearly one-third of all data breaches: "Hot medical identities can sell for as little as $50, according to a report issued earlier this year by the FBI. With more and more hospitals moving to electronic health records and healthcare breaches on the rise, its hard to see how this problem won’t become more widespread in the coming year." Reader also points out that, unlike for financial breaches, it is much harder to prove that a consumer didn't receive medical services on their records.

The Republican governor of North Carolina, Pat McCrory, has expressed interest in expanding Medicaid in that state, the Associated Press reports. While North Carolina was one of 24 Republican-helmed states that initially resisted expanding healthcare coverage for the poor under President Barack Obama's signature law, "McCrory said he is open to expanding Medicaid coverage after he and the General Assembly revamp the program to control costs," according to the AP. Medicaid expansion in North Carolina would benefit 320,000 low-income workers.

 

Maine Governor Paul LePage spent close to $53,000 on private lawyers to try to remove low-income young adults from the state's Medicaid program, even though Attorney General Janet Mills rejected pursing the case and told the governor he couldn't win, the Associated Press reports.  The U.S. Court of Appeals for the First Circuit ruled that the Affordable Care Act requires the state of Maine to keep providing Medicaid coverage to 19- and 20-year-olds from low-income families. The Patient Protection and Affordable Care Act requires states accepting federal Medicaid funds to freeze their Medicaid eligibility standards for children until 2019.

Legislators in Montana have proposed a limited expansion of Medicaid that would cover 15,000 to 18,000 people earning less than 100 percent of the federal poverty level, the Independent Record reports, but the plan would not allow Montana to take a federal subsidy that would expand coverage to 70,000 more people. Democratic Governor Steve Bullock wants to accept the money. The federal government would pay the entire cost in 2016 and 95 percent of the cost in 2017,  but the state would have to pick up 10 percent of the expansion cost by 2020, the newspaper further reports.

The New York Times' Robert Pear reports that, even as the rolls of people getting healthcare coverage through Medicaid are swelling, Medicaid reimbursements for primary care will be cut by 43 percent, on average. Why? Some healthcare providers will not take Medicaid patients at the lower rates. Moreover, the extension of higher Medicaid payments faces long odds in the Republican-controlled Congress. 

Separately, there is a case pending in the U.S. Supreme Court in which the Obama administration has taken the position that healthcare providers have no right to enforce a requirement that Medicaid rates must be sufficient to "'enlist enough providers' so that beneficiaries have at least as much access to care as the general population in their geographic area," Pear further reports.

 

The waiting time for appeals over Medicare coverage has been cut in half, Kaiser Health News reports: "The Office of Medicare Hearings and Appeals (OMHA) has decided most of the 5,162 cases filed by beneficiaries in the fiscal year ended Sept. 30, plus 1,535 older cases, according to statistics provided to Kaiser Health News. That’s a dramatic change from the year before, when a third of beneficiary cases (1,493) were not decided and nearly half (1,705) of the 2012 cases also were unresolved."

The office is still a long way from meeting the federal requirement that an appeal be decided within 90 days after a request for a hearing.

The progress in addressing the Medicare-coverage backlog has been at the expense of appeals filed by healthcare providers like hospitals, nursing homes and medical-device suppliers. There are 900,000 appeals from healthcare providers, and the wait times for their appeals have doubled because appeals from beneficiaries have been prioritized.

Legislators in Utah have rejected Governor Gary Herbert's alternative plan to providing Medicaid expansion to low-income Utah residents in favor of two even more limited proposals, The Salt Lake Tribune's Kristen Moulton reports. The Legislature’s Health Reform Task Force "proposed recommending options that would cover between 12.5 percent and 20 percent of those below the federal poverty line — but only those who are mentally ill, addicted, disabled or too sick to work," Moulton reports. The governor's plan would cover 46,000 people.

David Patton, executive director of the Utah Department of Health, told Moulton he is still hopeful that the full Legislature will pass Medicaid expansion.