A quick roundup of the issues driving the healthcare reform conversation.
Week in Review
A FEDERAL BARRIER TO IMPROVING HEALTHCARE
Quick takeaway: A federal requirement limiting how much health plans can spend on non-medical services is a major barrier to improving the health of many low-income Americans, according to Martha Roherty, executive director of Advancing States
Digging Deeper: The Medical Loss Ratio (MLR), which caps spending on non-medical services at 15%, discourages Medicaid Managed Care Organizations from investing in benefits aimed at addressing social drivers of health, which can impact as much as 80% of health outcomes.
What it means: Services like a ride to a doctor’s appointment, or a home-cooked meal after returning home from a hospital stay, are critical in helping patients get well. By amending the MLR to allow expanded spending on non-medical services, Congress could dramatically improve health outcomes for millions of Americans.
UNCHECKED HOSPITAL MERGERS INCREASED HEALTH COSTS
Quick takeaway: A new study highlights how a critical gap in antitrust enforcement for hospital mergers within the Federal Trade Commission (FTC) lead to increased healthcare costs of at least 5%.
By the numbers:
- Between 2002 and 2020, the FTC took action against only 13 of 1,164 acute-care hospital mergers.
- The study showed the FTC could have flagged 20% of the mergers, compared to the 1% they actually challenged.
- 90% of hospital markets are now considered highly concentrated.
Yale economist Zach Cooper, author of the study, shared that:
“Since 2000, hospital prices have grown faster than prices in any other sector of the economy. The average price of an inpatient admission is now nearly $25,000. We need to be doing more to preserve competition in U.S. hospital markets.”
What it means: The researchers highlight a lack of resources within the FTC as the primary factor in a lack of enforcement.
CONGRESS SHOULD ADOPT SITE-NEUTRAL PAYMENTS FOR HEALTHCARE
Quick takeaway: Two former secretaries for the Department of Health and Human Services (HHS) have come together across the political aisle to advocate for hospital billing reform.
Digging Deeper: Healthcare within a hospital setting is billed at a higher rate than at other locations for care. As hospitals acquire physician offices, they increasingly charge higher rates outside, billing for those services as if they were delivered in a hospital setting driving up healthcare costs.
What it means: Former HHS Secretaries Alex Azar and Kathleen Sebelius highlight how critical hospital billing reform would be for patients, saying “People should pay for the care they receive, not for the sign on the door.”
END OF INTERNET SUBSIDY THREATENS TELEHEALTH ACCESS
Quick takeaway: Millions of low-income Americans are at risk of losing the ability to see their doctors virtually unless Congress extends of the Affordable Connectivity Program.
Digging Deeper: Around 23 million households receiving financial help to afford their internet received healthcare through online appointments, according to a federal survey. That includes 5 million seniors and over 3 million families with a K-12 student receiving free or reduced-price lunch.
What it means: The program has been critical in expanding healthcare access for underserved communities and people with disabilities. A bipartisan bill to further fund the program has been introduced in the Senate.
Spotlight
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