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Morning Briefing

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Monday, Mar 30 2015

Full Issue

State Highlights: More States Advance 'Right-To-Try' Laws; N.Y.'s Out-Of-Network Protections Start

A selection of health policy stories from Indiana, California, South Carolina, New York, Connecticut, Missouri and Washington.

A divisive measure called 鈥渞ight to try鈥 is getting a tryout in Indiana. ... Earlier in the week, [Indiana Gov. Mike Pence] signed a bill allowing people who are battling life-threatening conditions to gain access to experimental medicines. Known as a 鈥渞ight to try鈥 law, the idea is to leapfrog a drug-development process that takes years before new treatments become available. The move reflects rising frustration with an FDA program called expanded access, in which people who are seriously ill can obtain a drug under development, even though they aren鈥檛 enrolled in a clinical trial. (Silverman, 3/27)

New protections against big surprise medical bills are starting in New York. They require insurance payments for out-of-network medical treatment in emergencies, when similar services or specialists are unavailable within the insurer's network or when care is provided without the patient's knowledge. (3/30)

Narrow-network plans have gained members because of their lower premiums, but experts say there is significant dissatisfaction with access, surprise bills and provider directory information. But there is significant consumer and provider dissatisfaction with how many of these plans are organized, including concern about inadequate access and information. Critics say insurers have made many missteps in building adequate networks and maintaining accurate, up-to-date provider directories. In some rural areas, there are too few in-network providers, forcing plan members to travel long distances to see one. Some patients find out that a hospital or doctor was out-of-network only after they receive a shockingly high bill. So far, federal and state regulations on narrow networks are vague and inconsistent, experts say. (Herman, 3/28)

With billions of dollars in reserve, nonprofit insurer Blue Shield of California is facing new pressure to offer better prices for its policies. Despite its nonprofit status, the health insurance giant is usually on par or priced slightly above its for-profit rivals, according to a review of rates and interviews with insurance agents and industry officials. ... The San Francisco insurer's premiums are drawing renewed scrutiny since the California Franchise Tax Board stripped Blue Shield of its longtime exemption for state income taxes after an audit. (Terhune, 3/27)

Sacramento-based Sutter Health said Friday that it had net income of $402 million in 2014, up 34 percent from $300 million in 2013. The health system said operating revenue last year totaled $10.2 billion, up from $9.6 billion in 2013. (Glover, 3/27)

While some current and former Beaufort County employees may want to shell out more money to stay on their health insurance plans, they won't be allowed to, county officials said Thursday. The county had already researched that and other options before Beaufort County Council voted Monday to eliminate health coverage to 95 retirees and 590 current workers eligible to receive it upon their retirement, deputy county administrator Josh Gruber said. (Lurye, 3/27)

When New York State鈥檚 lawmakers were mulling legalizing the medical use of marijuana last summer, some proponents feared that the proposed law was so restrictive that it would prevent many patients from receiving the drug. Now, with the state鈥檚 Health Department close to issuing final regulations about the new program, the law鈥檚 supporters say their fears may soon be realized. (McKinley and Saint Louis, 3/29)

The majority of teenagers with mental health issues don't get help. But maybe if help were just a text message away 鈥 they wouldn't be so hesitant to reach out. That's the thinking behind NYC Teen Text, a pilot program at 10 New York public high schools that allows teens to get help with mental health issues by text. (Singh, 3/27)

Connecticut veterans are escaping the notice of a state program aimed at combating prescription drug abuse, an epidemic among those veterans; and the federal government's Department of Veterans Affairs is to blame, a state official says. (Radelat, 3/30)

St. Louis area pediatricians will soon have help managing asthma care for their patients. The American Lung Association is implementing a program here to improve the system that primary care clinics use to identify and treat the disease. The Enhancing Asthma Care for Children program has measurably reduced asthma symptoms for patients in other cities where it has been introduced, said Jill Heins, director of respiratory health for the American Lung Association of the Upper Midwest. (Phillips, 3/29)

Mental health advocates say police and Milwaukee County officials still have a long way to go to catch up with the best practices from other cities. While the city is moving to train every officer in crisis intervention skills, that won't be completed until the end of 2017. In the meantime, advocates say police and county mental health administrators have not been aggressive enough in working together 鈥 despite early success in pairing police officers with mental health professionals. (Kissinger, 3/28)

Some St. Louis area residents face the prospect of getting stuck with hefty medical bills because of a recent change by the nation鈥檚 largest health insurer. Minnetonka, Minn.-based UnitedHealthcare, which covers approximately one-fourth of Missourians, has changed the way it handles something known as 鈥渂alance billing鈥 鈥 the difference between the provider鈥檚 charge and the amount allowed by the insurer. (Shapiro, 3/29)

Premera Blue Cross failed to adequately protect its customers' personal information and notify them of a recent data breach in a timely manner, according to the latest class-action lawsuit filed Thursday against the insurer in federal court in Seattle. The suit is one of at least five class-action suits filed over the breach, said James Bilsborrow, an attorney representing the plaintiffs with law firm Weitz & Luxenberg. Premera announced earlier this month that a May 2014 cyberattack breached a system that contained records for 11 million of its customers. (Schencker, 3/27)

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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