All San Diego hospitals do a great job discounting rates for low income patients. Some have a standard policy based on FPL, some do it on a case-by-case basis.
AB 731 will require large group health insurance(100+ employee) renewals to be released 120 days prior to renewal date, up from the current 60 days requirement.
Certainly good from a strategic planning standpoint. Opponents argue that the rate review procedures included will increase costs for the entire market by adding a layer of bureaucracy to achieve a result best served by a competitive marketplace, while proponents say the added layer of regulatory scrutiny will reduce costs for Californians.
Official ruling released yesterday from the CA Department of Managed Health Care: Association Health Plans(trust plans) to be completely phased out by July 1, 2021.
Official release here:
Recommended Rx dosages are often the same for a 110lb woman and a 250lb man. As medical professionals work to improve and customize recommended Rx dosages, this is a good fact for consumers to be aware of:
Seismic mandate upgrades will cost California hospitals between $34 billion and $143 billion by 2030 when the next round of requirements go into effect. This is both an important infrastructure investment and a key driver of healthcare cost increases.
Reminder to employers with CA residents, The State of California has instituted an individual mandate for all citizens to have health coverage starting Jan. 1, 2020 to counteract the repeal of the PPACA individual mandate. Great time to start a group benefits plan if your company does not have one in place.
Regional medical system consolidation can cause both system-wide efficiencies that drive down costs and market monopolies which drive up costs. NorCal's Sutter Health is facing a jury trial for utilizing alleged anti-competitive tactics. The result could set a legal precedent for more cases like this through the country:
A good % of Californians are from somewhere else. If you're looking to find a quality hospital in your area, CalHospitalCompare is a great comparison tool:
In addition to making the user look really uncool, clinical data is mounting that e-cigarettes are not a safe alternative to smoking:
Industry-specific Association Health Plans(AHP) are probably on their way out in California due to new State regulations.
The "Cadillac Tax", a tax on high cost health plans originally enacted to fund components of the 2010 healthcare reforms has already been delayed until 2022. Now, it may be formally repealed. With the US annual deficit approaching $1T and historically low interest rates, why not?
Interesting report from the WSJ on the economics behind why wage growth is stagnating in the face of a booming economy and tight labor market. Workplace culture and an effective employee benefits plan are as important as ever to reduce employee turnover.
HHS has introduced a plan to allow states to implement programs to import prescription drugs from Canada. Within a few years, this could have a HUGE impact at equalizing Rx price disparities between the USA and the rest of the world. Great first step for American healthcare consumers!
Ever had a medical claim denied? Always a good idea to appeal it. According to advocacy group Families USA: “About half of appeals go in favor of the consumer”:
Almost all other countries utilize GOVERNMENT-SET PRICING which results in substantially lower Rx costs for their citizens, leaving American consumers to heavily subsidize R&D innovation for new life saving prescription drugs for the entire world through higher costs. Here's a quick breakdown of the two ideas currently being considered by US government officials:
1. GOVERNMENT-SET PRICING: https://khn.org/news/pelosi-aims-for-feds-to-negotiate-drug-prices-even-for-private-insurers/
PROS: Could have an immediate impact at reducing Rx prices for consumers.
CONS: Will allow big government bureaucracy to play favorites. This approach will substantially stifle future Rx R&D investment and innovation. The life-saving Rx therapies of the future may never be developed. Government-set pricing in counties like the UK and Canada means some Rx therapies are simply not available since the government panel has concluded that they are too costly. Short-term economic backlash could be substantial. Example: if the government panel decides to arbitrarily reduce a blockbuster Rx price by 40%, the pharma company who makes the drug could be forced to layoff 1,000 workers to adjust for immediate loss of income.
2. FREE MARKET SOLUTION: https://khn.org/news/states-proposals-import-cheaper-drugs-trump-support-experiment/
PROS: Could have an immediate impact at reducing Rx prices for consumers. Eventually drug manufacturers will raise prices on other countries where the USA is importing Rx from. This will force other countries to pay their fair share of the R&D costs for life saving Rx therapies. If done correctly, this approach could create a fair global free market where costs are reduced for US consumers and Rx R&D investment is not substantially reduced.
CONS: Potential safety issues from counterfeiting. Differences in patent protection duration will need to be regulated. Drug costs for consumers outside of the USA will increase.
New pricing transparency executive order could have monumental impact are reducing healthcare costs over the next 5-10 years.
Ever have a trip to the emergency room and wonder why fees are so astronomical? In 1986 the EMTALA was signed into law. This increased access to to basic medical care for the uninsured, but also put tremendous cost pressure on hospitals. Since around 55% of emergency room care goes uncompensated, these costs are spread out to insured members of the population in the form of really high costs.
With presidential debates kicking off soon, lowering health care costs to consumers continues to be a lead concern for voters.
In 2018, 71% of IVF patients treated paid for most or all of their IVF treatment out-of-pocket with average amount paid over $22,000 per cycle. Due to the high cost and selective nature of the benefit, most employers are still reluctant to provide this as an employee benefit.
With record low unemployment, many companies are turning to emerging benefits to attract and retain employees:
Wellness program ROI can be difficult to measure, as shown in this recent study of employer BJ's Wholesale Club.
Crossing the border to buy expensive prescriptions is a tempting strategy, especially for San Diegans. There are substantial safety and legality concerns. Income-based Rx prescription assistance programs offered by pharma companies and non-profits should be evaluated and exhausted first. Google: "prescription assistance programs".
Amazon now accepts HSA/FSA cards for over-the-counter medical supplies:
The Affordable Care Act made great improvements to insurance market standardization, transparency, and access. Recent proposed initiatives from the Department of Health and Human Services will help increase transparency for Rx and hospital costs at the consumer level. These are great initiatives for reducing healthcare costs!