A quick roundup of the issues driving the healthcare reform conversation.
Item of the Week
MA VALUE In defense of Medicare Advantage.
What it means: With more than 30 million seniors and individuals with disabilities now enrolled in Medicare Advantage (MA) plans, the program has distinguished itself from traditional Fee-for-Service (FFS) Medicare by focusing on coordinated care that not only saves beneficiaries and taxpayers money, but leads to better health outcomes, as well.
Which is why so many stakeholders – including, lawmakers, providers, and patient groups – have rushed to defend the program from proposed cuts and other policy changes that would result in higher out-of-pocket costs and fewer benefits for beneficiaries.
Take Action: Already, thousands of Health Action Network advocates have taken action, urging lawmakers to protect the millions of Americans enrolled in MA plans from the increased premiums, higher out-of-pockets costs, loss of benefits, and limited access that would all result from these proposed cuts. If you haven’t already, take action today!
NONPROFIT HOSPITALS The estimated value of nonprofit hospitals’ tax exemptions hits nearly $28 billion.
Quick takeaway: According to a new study, nonprofit hospitals – which account for 58 percent of all community hospitals – saw the collective value of their tax exemptions jump from $23.7 billion in 2019 to $27.6 billion in 2020. In fact, that value has grown 41 percent since 2011.
What it means: Tax exemptions are extended to nonprofit hospitals from federal, state, and local governments in exchange for the charity care these facilities provide. However, the analysis goes on to show that these systems only provided about $16 billion of charity care.
MEDICAL CLAIMS Doctors’ visits have grown increasingly complex and more costly over time.
Further context: A recently released report shows a worrying trend in how providers are billing at higher and higher levels. According to the data:
- The total number of claims billed at the highest two levels of complexity in outpatient settings grew from 22 percent in 2004 to 43 percent in 2021.
- Those same claims saw a similar spike for emergency departments, jumping from 33 percent in 2004 to 60 percent in 2021.
These more expensive services impact both out-of-pocket costs for consumers and the health system overall.
What it means: The data only serves to increase lawmakers’ focus on provider billing, specifically, the bipartisan scrutiny surrounding how hospitals charge more for outpatient services that can be done in less expensive settings.
Rx PRICES Stakeholders point to competition to lower rising prescription drug prices.
Quick takeaway: At a recent event, lawmakers, advocates, and economists spoke to the importance of cracking down on the pharmaceutical industry’s abuse of the patent system to increase competition and lower drug prices for consumers.
Further context: More and more attention is being paid to how drugmakers have exploited the system to undermine competition in order to keep more affordable alternatives from coming to market.
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The Health Action Network includes everyday Americans—families, workers, businesses, patients, providers, neighbors, and friends. We are working together because we support market-based solutions that offer better healthcare choices and help build a stronger economy. The Health Action Network is an Elevance Health, Inc., initiative.