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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Spotlight on State: New York
Kendall Kohlmeyer, Student Fellow October 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 New York state page. New York is a leader in healthcare price transparency initiatives. The state passed legislation in 2011 that enables the creation of an all-payer claims database and has operated its all-payer database (APD) since 2016. The APD collects data from public and private insurance carriers, health plans, third-party administrators, and pharmacy benefit managers, …
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[Sutter Case Watch] Court Officially Rejects Sutter’s Proposed Settlement Due to Inadequate Compliance Monitor Selection
Amy Y. Gu, Managing Editor October 6, 2020
See case page: UFCW & Employers Benefit Trust v. Sutter Health In August, The Source reported on the preliminary approval hearing for the proposed settlement of California’s high-profile antitrust suit against Sutter Health. Among other issues, Judge Anne-Christine Massullo of the Superior Court of San Francisco was particularly troubled by the selection process of the independent compliance monitor and required supplemental filings from the parties regarding the selection and outreach process employed in the selection of Jesse Caplan of Affiliated Monitors, whom the parties jointly requested to appoint (see The Source …
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Pharmacy Benefit Managers Under Legal Scrutiny – U.S. Supreme Court to Decide if States Can Regulate PBM Reimbursement to Pharmacies
Katie Gudiksen, Senior Health Policy Researcher and Sammy Chang October 5, 2020
On October 6, the Supreme Court will hear oral arguments in the case Rutledge v. Pharmaceutical Care Management Association (PCMA). A decision in this case will resolve whether an Arkansas law to regulate pharmacy benefit managers (PBMs), Act 900, is preempted by federal law and may affect the enforceability of similar laws passed by at least thirty-five other states.[1] Arkansas passed Act 900 to protect pharmacies from dispensing drugs at a loss. Specifically, the law requires PBMs, when challenged by a pharmacy, to raise the reimbursement rate for a drug …
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How the United States Can Use Telehealth Expansion to Achieve Market Savings
Kendall Kohlmeyer, Student Fellow October 2, 2020
The COVID-19 pandemic necessitated the rapid expansion of telehealth services. This has led the federal government and many states to expand insurance coverage for telehealth services through emergency waivers of certain requirements. Implemented ideally, widespread telehealth use could lower the overall cost of health care in commercial markets by lowering per-patient and per-visit costs for specialty and primary care providers, while increasing patient satisfaction and quality of care. However, if done poorly, telehealth expansion could increase healthcare costs by providing easy access to care that is unlikely to improve health …
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The Source Roundup: October 2020 Edition
Alex Montague, Health Policy Researcher October 1, 2020
With the passing of Justice Ruth Bader Ginsburg and nomination of Amy Coney Barret to the Supreme Court just weeks before the presidential election, many are turning their attention to health care and the fate of the Affordable Care Act (ACA). With this backdrop, this month’s Source Roundup looks at 1) what is at stake as the ACA faces the Supreme Court again in California v. Texas, 2) new information about rising healthcare prices, 3) anticompetitive contract practices between providers and insurers, and 4) the potential of a public option …
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Spotlight on State: Kansas
Amy Y. Gu, Managing Editor September 28, 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 Kansas state page. Kansas was one of the first states to mandate an all-payer claims database (APCD). In operation since 2010, the Data Analytic Interface (DAI) is maintained by the Kansas Department of Health and Environment (KDHE) and the Division of Health Care Finance (DHCF) and collects medical, dental, and pharmacy claims, eligibility files and …
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The Source Cited in Report on What States Can Learn About Provider Consolidation from the Sutter Health Settlement
Amy Y. Gu, Managing Editor September 23, 2020
Two papers published by The Source were cited in the latest Milbank Memorial Fund report “California’s Sutter Health Settlement: What States Can Learn About Protecting Residents from the Effects of Health Care Provider Consolidation”. The first, “Addressing Health Care Market Consolidation and High Prices”, is co-authored by The Source’s Jaime S. King and Katherine L. Gudiksen, with Robert A. Berenson et al. for the Urban Institute. The second paper is “Preventing Anticompetitive Healthcare Consolidation: Lessons From Five States”, written by Jaime S. King, Samuel M. Chang, et al. and jointly published …
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Spotlight on State: Michigan
Kendall Kohlmeyer, Student Fellow September 21, 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 Michigan state page. Michigan is one of the few states that bans Most Favored Nation (MFN) clauses in healthcare contracts between providers and health care corporations. The ban resulted from a landmark antitrust enforcement case against Blue Cross Blue Shield of Michigan that settled in 2013. In provider consolidation, the state has a …
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