The White House takes action on three major consumer issues: surprise medical bills, inaccurate provider directories, and the enforcement of free birth control coverage.  1) As we reported last week, about 1/3 of those with private health insurance received surprise medical bills over the last two years.  2) According to New Mexico’s Superintendent of Insurance, inaccurate provider directories are the number one consumer complaint his office receives.  3) And a National Women’s Law Center study found that hundreds of insurance plans fail to fully cover FDA-approved contraceptives, despite the federal requirement to do so. 

The White House is working to address each of these issues administratively.  1) Next year, healthcare.gov will likely come with an out-of-pocket cost calculator that gives consumers a better idea of the overall value of their plan than, say, a premium.  The administration hopes that this will reduce unexpected costs for consumers.  2) Insurers must now update their provider directories each month, and will face a fine if they don’t.  3) New regulations clarify that insurers must cover every type of birth control without any out-of-pocket costs.

Health Action NM has been reporting on these issues to our national partners for the past year.  We are pleased to see that they are being addressed.  While progress is being made on all three of these issues, there is much more work to be done on each of them.  Health Action NM will continue to follow them closely.

- Barbara Webber, Executive Director

 

NM Medicaid expansion enrollments reach 214,000 by the end of April and are expected to grow to 241,000 by June of 2016.  The Human Services Department (HSD) announced another positive month of enrollment growth in the state’s Medicaid program.  The Medicaid expansion has been a huge success story in New Mexico.  While original estimates suggested that about 170,000 people were eligible for expanded Medicaid, we’re now expecting closer to 250,000 - the need was much greater than we anticipated.

Since the expansion began in 2014, the federal government has paid for it in full.  In 2017, the state must pick up 5% of the cost of expansion. HSD estimates that the state will need to devote about $43 million to cover these costs during fiscal year 2017.  Now is the time to start talking about how best to pay for NM’s portion of the incredibly successful Medicaid expansion.

- Joe Martinez, Outreach Coordinator

 

Employers take a new approach to reducing health costs: set your own price.  Hospitals have come under scrutiny in the past for charging exorbitant and unreasonable medical bills, driving up costs for everyone.  After one employer was charged $600,000 for a an employee’s three day stay in a local hospital, they hired a consulting firm to look in to what had happened.  The firm assessed the services and found that they cost a small fraction of what the hospital was charging.  They added a modest profit for the hospital to their calculation and sent the payment back. “We wrote a check to the hospital for $28,900 and we never heard from them again,” said the business owner.

Prices in US health care are notoriously high.  And, as this story shows, they are also extremely unreasonable.  How could a hospital get away with charging $600,000 for a procedure that they wound up accepting $28,900 for in the end?  This is why many advocates continue to push for a system where prices are transparent and set based on how much the services cost rather than backdoor deals between hospitals and insurance companies.  There is little consumers can do to stand up against this type of pricing scheme.   Isn’t it time to formally address the problem of arbitrary pricing?

- Colin Baillio, Communications and Outreach

 

Maryland implements pilot programs that may be the next big step in controlling costs for consumers.  The state is experimenting with how it pays hospitals to reduce readmissions.  It provides a lump sum of money to a hospital for any admission and doesn’t pay anything for readmissions within the next 30 days.  The hope is that hospitals will provide the best possible treatment for the patient during the first admission without providing costly and unnecessary care and will reduce the likelihood of a readmission.  Health Action NM will continue to keep an eye on this model and its impact on costs and the quality of care.

- DeAnza Sapien, JD, Health Advocacy Coordinator

Health Action