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Wednesday, Nov 25 2015

Full Issue

Early Effort By Rubio To Limit Federal Payments To Insurers Is At Heart Of Current Turmoil

Some of the co-op failures and the threat from UnitedHealthcare about a possible pull-out in 2017 are prompted by low levels of federal payments to help shield insurers from losses in the exchanges. Rubio helped lead an effort to stop those payments. Meanwhile, HHS Secretary Sylvia Burwell says she is trying to get more information about costs to consumers.

Sen. Marco Rubio may have dealt the biggest blow in the GOP鈥檚 five-year war against ObamaCare. A 2014 budget measure inspired by the Florida senator and presidential hopeful is pushing some insurers to drop out of the ObamaCare exchanges, experts say. ... This fall, more than a dozen health insurers representing 800,000 people have dropped out of the ObamaCare exchanges, many out of fear that the administration no longer has the cash to cushion their losses in the costly early years of the marketplace. ... The angst in the industry centers on an obscure program in the healthcare law known as 鈥渞isk corridors鈥 that was designed to shield insurers against losses. Rubio in 2013 went on the warpath against the program, decrying it as a 鈥渢axpayer bailout.鈥 (Ferris, 11/24)

To reduce turbulence in Obamacare鈥檚 fledgling insurance markets, the Obama administration鈥檚 top health official is pushing to get more information to consumers about what they鈥檒l actually pay for health care, which can include out-of-pocket costs as well as premiums. The changes are meant to help people choose coverage that fits their needs when up-front premiums and out-of-pocket costs are added together, Health and Human Services Secretary Sylvia Mathews Burwell said during an interview at Bloomberg News鈥檚 Washington bureau. Cases of patients signing up, paying for a time, and then dropping out of Obamacare have plagued insurers like UnitedHealth Group Inc., which is debating whether to exit the government-run market to avoid more financial losses. (Tracer and Winkler, 11/24)

Consumers seeking health policies with the most freedom in choosing doctors and hospitals are finding far fewer of those plans offered on the insurance marketplaces next year. And the premiums are rising faster than for other types of coverage. The plans, usually known as preferred provider organizations or PPOs, pay for a portion of the costs of out-of-network hospitals and physicians. They are the most common type offered by employers, and some consumers in the individual marketplaces find them more appealing than health maintenance organizations and other policies that pay only for medical facilities and doctors with whom they have contracts. (Appleby and Jordan, 11/25)

News outlets also report on state developments -

The sudden collapse of the largest nonprofit insurance cooperative created by President Barack Obama's health care law is causing headaches in New York, especially for medical providers owed millions of dollars for treating the failed plan's patients. More than 200,000 people insured through Health Republic Insurance of New York have until Monday to sign up with another company if they want to maintain coverage in December. State regulators ordered the insurer to shut down at the end of the month because of severe financial problems. They are also investigating what they say were inaccurate financial filings by the company. (Caruso, 11/24)

Executives with Arizona's nonprofit health insurance co-op said Tuesday that they have failed to come up with additional financial backing and the insurer plans to shut down all operations Dec. 31. The announcement by Meritus Health Partners means 59,000 Arizonans it now covers need to find a new insurer by Dec. 15 if they want coverage on Jan. 1. The decision comes nearly a month after the state Department of Insurance suspended its right to sell new policies or renew current ones and placed it under formal supervision. Federal officials also pulled its policies from the health insurance marketplace website late last month. (Christie, 11/24)

More Minnesota residents are qualifying for financial help this year to buy coverage on the state's health insurance exchange. MNsure announced Monday that more than 70 percent of the customers buying private insurance so far this month have received federal subsidies. That's up from roughly 50 percent last year. (11/23)

For a third straight year, Tampa is opening its recreation centers to health care navigators so residents can get advice about signing up for coverage under the Affordable Care Act. This year, Tampa is competing with 20 other cities in a White House-sponsored Healthy Communities Challenge competition to see which can sign up the highest percentage of people who lack coverage. The winning community will get a visit from President Barack Obama to highlight its success. (Danielson, 11/24)

Oregon's court battle with Oracle America is not going to get cheaper anytime soon. In August 2014, the state and the California software giant each filed lawsuits blaming the other for the $300-million collapse of the much-touted Cover Oregon health insurance website project. (Budnick, 11/24)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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