[Article Highlight] Why the Biden Administration Should Help States Develop Capitated Public Options
Amy Y. Gu, Managing Editor December 9, 2020
A new article published in the Milbank Quarterly Opinion proposes the new Biden administration should help states develop capitated public options as part of its health policy agenda, which could lay the groundwork for a federal public option. Authored by Source Advisory Board Member Richard Scheffler and Thomas Rice, the article examines the recent efforts of Washington and Colorado in developing quasi-public options in their states. The authors identify specific states, including California, Massachusetts, and Rhode Island, as being most ready for such a risk-based capitation program. Finally, they call …
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The Source Roundup: December 2020 Edition
Amy Y. Gu, Managing Editor December 1, 2020
In the final monthly roundup of this tumultuous year, we highlight articles and reports that examine 1) rising and varying healthcare costs and their pronounced impact on Americans during the pandemic; 2) antitrust enforcement challenges of private equity partial ownership and joint ventures; 3) continued success of the Affordable Care Act in both marketplace participation and coverage protections for Americans amidst the pandemic; and 4) value-based pricing for COVID-19 treatment and vaccines. Rising and Varying Healthcare Costs Increase Burden to Americans In the Kaiser Family Foundation report How costly …
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[Case Brief] Atrium Health Settlement Encourages Enforcement of Anti-tiering/Anti-steering Clauses in Healthcare Contracts
Amy Y. Gu, Managing Editor November 16, 2020
Editor’s Note: An abbreviated summary of this case appears in the research report “Preventing Anticompetitive Contracting Practices in Healthcare Markets”, which provides a detailed analysis of anti-tiering/anti-steering clauses, including economic justification and procompetitive use and states that have restricted its use in healthcare contracts. The antitrust case against Sutter Health in California has drawn the attention of state regulators and policymakers across the country, spawning legislative reform efforts to curb dominant hospitals’ market power. Prior to this, an enforcement action against Atrium Health, a large health system on the …
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The Source Convenes Interdisciplinary Panel of Experts and Stakeholders to Inform Policies to Promote Competition in Health Care
Amy Y. Gu, Managing Editor November 16, 2020
On November 13, The Source on Healthcare Price & Competition and the UC Berkeley Petris Center jointly hosted a virtual convening of some of the leading experts in law and economics in a workshop to review and evaluate current findings of our collaborative research series “The Role of States in Promoting Competition in Healthcare: A Legal and Economic Analysis.” Our research analyzes how state merger review authority and regulation of contracts between providers and insurers affect the price of healthcare services and insurance premiums. The interactive workshop, supported by Arnold …
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Spotlight on State: District of Columbia
Kendall Kohlmeyer, Student Fellow November 13, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See District of Columbia page. The District of Columbia established its own health insurance exchange under the Affordable Care Act, whereas most states maintain exchanges facilitated by the federal government. In provider market oversight, the District of Columbia requires the State Health and Planning Development Agency (SHPDA) to issue a certificate of need for …
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Spotlight on State: Illinois
Kendall Kohlmeyer, Student Fellow November 6, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Illinois state page. Illinois was one of the first states to protect patients from surprise bills for services they receive unintentionally from out-of-network providers with the Fair Patient Billing Act. More recently, the legislature considered a proposal to create the Right to Shop Act, which would require health insurance carriers to develop a benefit plan …
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The Source Roundup: November 2020 Edition
Alex Montague, Health Policy Researcher November 2, 2020
This month’s roundup arrives in the wake of the confirmation of a new Supreme Court justice, the final days of the 2020 presidential election, and record-breaking numbers of COVID-19 cases. In light of this historic time, we highlight articles and reports about the implications of the Supreme Court’s new dynamics for healthcare policy, health insurance coverage and affordability as discussed during the 2020 election, and the COVID-19 pandemic’s continuing impact on healthcare costs and coverage. We also look at the continuing effect of increasing consolidation in both the insurer and …
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Spotlight on State: Maryland
Kendall Kohlmeyer, Student Fellow October 30, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Maryland state page. Maryland has been a pioneer in state healthcare system reform. Maryland is the only state in the country that regulates rates for hospital services under the Maryland All-Payer Model. Launched in 1971, the all-payer system requires all third-party payers to reimburse hospitals at the same rate. The program was revised in 2014 …
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Rate Regulation in California: AB 2118 Makes Strides, But Falls Short of Comprehensive Rate Review
Katie Gudiksen, Senior Health Policy Researcher October 26, 2020
In the 2020 legislative session, the California legislature enacted AB 2118 to require insurance companies selling insurance plans in the individual or small group market in California to file additional information, including premiums, cost sharing, benefits, enrollment, and trend factors, with the state Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).[1] This new law reflects an effort to give state agencies better oversight of state healthcare markets by patching small holes in the rate review process of state regulators. However, the time may be ripe …
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Blue Cross/Blue Shield Reaches Settlement Agreement with Class Plaintiffs in Private Antitrust Suit
Amy Y. Gu, Managing Editor October 15, 2020
The private antitrust case against Blue Shield/Blue Cross (BCBS) reached a preliminary partial settlement last month after eight years of litigation. A driving force for this settlement may have been the April 2018 district court ruling that was seen as a serious blow to the defendants. In two antitrust suits that have been consolidated in Alabama federal court (put into Multi-District Litigation),[1] healthcare providers and employer subscribers sued BCBS companies across the country, alleging horizontal market allocation in violation of Section 1 of the Sherman Antitrust Act. The plaintiffs claim …
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