HMOs and PPOs have more negotiating power than other nongovernment payers
While they don't have the weight of Medicare and Medicaid, HMO and PPOs do have significant negotiating power when compared with other private insurers. Other payers, such as automobile, workers compensation and travel insurer's, had even less ability to negotiate prices, according to a recent study published in Health Affairs.
Over the examined six years, median prices paid by HMO/PPO insurers in Florida increased from 1.9 times the Medicare price to 2.5 times the Medicare price. In contrast, other private insurers saw their median prices increase from 2.8 times the Medicare price to 3.8 times the Medicare price. (Health Affairs article)
Democrats preparing array of healthcare investigations if blue wave takes the House
House Democrats are preparing a range of investigations into the Trump administration in the case they take the House back in the 2018 elections. Many of those investigations surround actions taken in regards to the Affordable Care Act, Politico learned.
Those actions include the cancellation of CSR payments, removing the individual mandate and urging courts to gut protections for pre-existing conditions. Outside groups are also urging the Democrats to look into the approval of work requirements. (Politico article)
Senators seek transparency from CBO on health insurance simulation
Twelve senators are asking the CBO to release more details about its new health insurance simulation model (HISIM2).
"In addition to soliciting feedback from the agency's technical review panel, we recommend CBO establish a process for broader external validation of HISIM2 by the public prior to putting the model to use next spring," senators wrote in the letter.
In particular, senators signaled they would like more information to know whether CBO should re-estimate federal spending and coverage under the Affordable Care Act. (Letter [PDF])
Republican lobbying group behind launch of Alliance to Protect Medical Innovation
A shadowy drug pricing organization, Alliance to Protect Medical Innovation, emerged this week, but it's hardly a new, independent player. While the exact source of the organization's funding is still unclear, the group admitted to Stat Thursday that it relied on Republican lobbying firm CGCN group and "seed money from people inside the [drug] industry."
“We are helping them with the rollout of the organization," Ken Spain, partner at CGCN Group, told Stat. (Stat article)