This Week in Healthcare Reform: July 16th, 2021

Hospitals charge uninsured patients the highest prices; a new analysis highlights dramatic generic drug price variations; an insurer coalition vaccinates 2 million older adults; and, stakeholders throw their support behind a health-related social needs bill.

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Week in Review

Hospitals & The Uninsured: A new report shows that hospitals routinely charge uninsured patients the highest rates.  According to the analysis published by The Wall Street Journal, among the hospitals sampled, 21 percent billed these patients at the highest rates for the majority of healthcare services included in the analysis.  Further, in the Medicare Advantage space, uninsured patients’ fees were 3.6 times higher than the average paid by these plans.  The authors went on to note that these types of practices were especially common among the hospitals of major nonprofit health systems – which is all the more alarming given the results released in a separate report detailing nonprofit hospitals’ community investments.  That analysis focused on comparing how much these health systems spent on charity care relative to the tax exemptions they benefit from.  According to that analysis, 72 percent of private nonprofit hospitals spent less on this type of care than they received in tax breaks. 

Generic Rx: The rising cost of prescription drugs continues to rank near the top of the list when it comes to health policy areas of public interest and concern.  And, it’s no surprise, given how much of the average healthcare premium dollar goes towards paying for prescription drugs.  A new study only serves to draw further attention to the issue, as the price variations for generic drugs threatens to further drive up healthcare costs.  According to the analysis, costs for common generic drugs can vary by more than $50 a pill among hospitals.  Drilling further into the data, some hospitals actually charged a nearly 6,000 percent markup on average compared with the pharmacy price for the exact same drug.  For instance, researchers found that one medicine (used to treat anxiety and depression), which cost patients 50 cents per pill at a hospital in Tennessee, was coming in at $57 per pill in Las Vegas.

Vaccine Milestone: A broad coalition of health insurers reached an important milestone earlier this month in the effort to contain the coronavirus pandemic.  The Vaccine Community Connectors (VCC) program announced it had helped vaccinate more than 2 million seniors against COVID-19 in under 100 days.  The VCC, a public-private partnership, was launched in March of this year by AHIP and the Blue Cross Blue Shield Association.  The program was initially pulled together to encourage people over the age of 65 in socially vulnerable communities to get vaccinated.  It has since expanded to encompass outreach to Medicaid enrollees and other underserved populations.  Organizers are quick to say that the work of the collaborative effort continues beyond this milestone, with insurers focused on breaking down long-standing barriers to access for other vaccines and to help people from these distressed communities better manage their chronic conditions.

Health-Related Social Needs Support: Stakeholders continue to invest in addressing how non-medical social drivers of health impact patient outcomes.  This focus on health-related social needs (also referred to as social drivers of health) has seen health systems and insurance providers expand benefits to include food security, transportation, and housing.  Now, a new bipartisan House bill seeks to strengthen efforts to coordinate these health and social services, in part by offering targeted technical assistance to communities.  That bill, the “Social Determinants Accelerator Act of 2021”, would establish an interagency council to coordinate health-related social needs services, among other provisions.  Hundreds of healthcare and social service organizations have already thrown their support behind the proposed legislation, urging lawmakers to pass the bill.