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Medicare, Medicaid, Health Reform

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Monthly Archives: June 2013

Health Insurance Exchanges: Progress in Iowa, Minnesota, Nevada, New York, Oregon, Rhode Island, and DC

Much about the Health Insurance Exchanges is uncertain, even as the October 1 deadline to make them operational approaches. Many states running their own or partnership exchanges have yet to decide on key elements of plan management, consumer outreach, and other important functions. Exchanges are a genuine game changer for the health insurance marketplace and highly complex to implement.  The...

Medicare Special Needs Plans: MedPAC Recommendations on Future of Special Needs Plans

Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare beneficiaries that meet specific criteria. Institutional SNPs (I-SNP) serve beneficiaries who, for 90 days or longer, need institutional provider services, such as long term...

Compounded Drugs: Congress Takes an Interest in Growing Compound Drug Industry

Compounded drugs are a new hot issue in the pharmaceuticals industry and in Congress. There are little data about compounding pharmacies, but a new Congressional Research Service brief gives a comprehensive overview. Compounded Drugs Personalize Drug Treatments: Compounded drugs are created when a physician or pharmacist mixes or changes pharmaceuticals to meet an individual patient’s needs. For example, a patient who...

Medicaid Federal Match Rates: Reforming the FMAP Formula

The Government Accountability Office (GAO) says it has found a more fair way to set federal matching rates for state spending on social programs such as Medicaid and the Children's Health Insurance Program (CHIP). Match rates that take into account differences among states in health costs, demand for services, and tax bases would ensure taxpayers in different states bear...

Multi-State Health Plans in Health Insurance Exchanges: OPM Final Rules

The federal Office of Personnel Management (OPM) had a tricky job in setting rules for multi-state health plans (MSP), which eventually will be offered in all states through Health Insurance Exchanges (HIX). The OPM had to take decide how to allow for disparate state and federal requirements for exchange-based plans, while promoting fair competition and consumer choice. The final rule...

Federal Prescription Drug Pricing: Price Differences Between the VA and DoD

The prices of generic drugs vs. brand-name drugs has gathered a lot of attention lately. But buying in bulk and purchasing practices can have as much of an effect on prices as drug patents do.  That’s what the Government Accountability Office (GAO) found when it compared Rx prices paid in prescription drug benefit programs in the Department of Defense (DoD) and...

Health Insurance Exchange Premiums: Adverse Selection Possibly Mitigated with Taxpayer Subsidies

Fears abound that health insurance premium increases because of the Affordable Care Act (ACA) will discourage young, healthy people from participating in the Health Insurance Exchanges. But most young people are likely to be eligible for exchange subsidies, softening the sting of so-called premium shock and attracting healthier people to the exchanges.  Conservatives and actuaries predict that Obamacare will increase...

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