N.Y. Law Offers Model For Helping Consumers Avoid Surprise Out-Of-Network Charges

by Michelle Andrews
Kaiser Health News, July 14, 2015

It’s a situation that occurs all too often: Someone goes to the emergency room and doesn’t learn until he gets a hefty bill that one of the doctors who treated him wasn’t in his insurance network. Or a diligent consumer checks before scheduling surgery to make sure that the hospital she plans to use and the doctors that will perform it are all in network. Then she learns later that an assistant surgeon who she didn’t know and who wasn’t in her network scrubbed in on her operation.

“If we’re mandating that people buy insurance coverage it seems we should also protect them from surprise medical bills,” says Mark Rukavina, from Community Health Advisors in Chestnut Hill, Mass.

If an out-of-network doctor or other provider doesn’t have a contract with a health plan that determines how much they get paid for services, they may bill the patient for any charges not covered by insurance. In those instances, the consumer could be on the hook for the rest of the bill, a practice known as “balance billing.” Although there’s no federal protection, about a quarter of states have laws on the books against balance billing by out-of-network hospitals, doctors or other providers in at least certain circumstances such as emergency care




To: Executive Council Members
DATE: June 26, 2015
RE: July 30 th National Day of Action

We need to mount a vigorous defense of Medicare and ensure that President Obama will veto any privatization of Medicare. As the AFL-CIO statement on healthcare reform says, adopting “Improved Medicare for All” is the only solution to the increasing cost and access problems of our current healthcare system.

AFL-CIO President Richard Trumka


From the Care Act to the Able Act, A Rundown of the 2015 Health Bills that Passed

The Oregon Legislature passed five dozen new laws affecting healthcare policy that were covered in The Lund Report, making significant gains in public health, consumer protection, workers’ health benefits and mental health policy.

by Chris Gray, for The Lund Report
July 15, 2015

You win some, and you lose some, as the story goes, and Oregon’s 2015 legislative session was no different.

The Oregon Association of Hospitals and Health Systems walked away as one of the biggest winners, crushing a price transparency bill that would have exposed its members to competition, while the Legislature limited its efforts to increase transparency to a $250,000 tax-funded website that will publish historic statewide averages of hospital price information from the all-payer, all-claims database.

But the hospitals, in turn, lost a battle to the Oregon Nurses Association, and will no longer be able to turn a blind eye to their nurse staffing committees, whose recommendations will now have the force of law. The ONA couldn’t pass a bill to require nurses at blood drives -- after a big win in the House, the Red Cross lobbied to send that bill to a quiet defeat in the Senate. A bill to give nurse practitioners the privilege of performing vasectomies was similarly snipped.

The decision to cut the vasectomy bill was also a rare setback for Planned Parenthood, which had a highly productive session, winning passage of bills that increase patient privacy around health insurance information and make a woman’s access to birth control nearly unfettered.

Here’s a rundown of the many bills covered in The Lund Report in this year’s session, with a comprehensive compilation of the significant healthcare legislation that went the distance in the 2015 session. A separate article will look at the bills that fell short:


Celebrating 50 years of Medicare and Medicaid

Santa Monica Daily Press, July 11, 2015
by David Sayen

It’s easy to forget that before 1966, roughly half of all American seniors were uninsured, living in fear that the high cost of health care could plunge not only them, but their families, into poverty.  Few of us remember that not long ago, far too many disabled people, families with children, pregnant women, and low-income working Americans were unable to afford the medical care they needed to stay healthy and productive.

Fifty years ago, on July 30, 1965, the landscape of health care in America changed forever when President Lyndon B. Johnson signed the landmark amendment to the Social Security Act that gave life to the Medicare and Medicaid programs.

Medicare and Medicaid save lives, help people live longer, and provide the peace of mind that comes with affordable health care that’s there when you need it. Chances are, you or someone in your family either has Medicare or Medicaid or you know someone who does. In fact, Medicare and Medicaid cover nearly 1 out of every 3 Americans — that’s well over 100 million people.

Marking the 50th anniversary of these lifesaving programs this summer gives us an important opportunity to recognize and remember the ways these programs transformed the delivery of health care in the United States.


The Choice Ahead: A Private Health-Insurance Monopoly or a Single Payer

Robert Reich. (photo: Robert Reich)

Robert Reich. (photo: Robert Reich)

by Robert Reich, Robert Reich's Blog
RSN 06 July 15

The Supreme Court’s recent blessing of Obamacare has precipitated a rush among the nation’s biggest health insurers to consolidate into two or three behemoths.

The result will be good for their shareholders and executives, but bad for the rest of us – who will pay through the nose for the health insurance we need.

We have another choice, but before I get to it let me give you some background.

Last week, Aetna announced it would spend $35 billion to buy rival Humana in a deal that will create the second-largest health insurer in the nation, with 33 million members.

The combination will claim a large share of the insurance market in many states – 88 percent in Kansas and 58 percent in Iowa, for example.

A week before Aetna’s announcement, Anthem disclosed its $47 billion offer for giant insurer Cigna. If the deal goes through, the combined firm will become the largest health insurer in America.

Meanwhile, middle-sized and small insurers are being gobbled up. Centene just announced a $6.3 billion deal to acquire Health Net. Earlier this year Anthem bought Simply Healthcare Holdings for $800 million.

Executives say these combinations will make their companies more efficient, allowing them to gain economies of scale and squeeze waste out of the system.

This is what big companies always say when they acquire rivals.

Their real purpose is to give the giant health insurers more bargaining leverage over employees, consumers, state regulators, and healthcare providers (which have also been consolidating).

The big health insurers have money to make these acquisitions because their Medicare businesses have been growing and Obamacare is bringing in hundreds of thousands of new customers. They’ve also been cutting payrolls and squeezing more work out of their employees.


Dembrow Resurrects Healthcare Study Bill after Failed Vote on Friday

With “two broken arms,” Sen. Alan Bates changes his mind again about studying the financing of universal healthcare in Oregon, even as he complained the state would be studying something -- a single-payer system -- that he did not believe would ever happen. Sen. Michael Dembrow said studying the issue could still strengthen the CCO system.

The Lund Report, July 7, 2015
by Chris Gray

Sen. Michael Dembrow’s bill to study healthcare financing in Oregon died on Friday, but it rose again on Sine Die Monday, as Sen. Alan Bates, D-Ashland, reaffirmed his support in a 16-14 vote on the final day of the 2015 legislative session.

Near the start of the Monday morning Senate floor session, Bates said he was changing his vote “with two broken arms,” and while he’d offer his begrudging support, he highlighted the single-payer aspect of the study and described it as a lost cause.

“I think we’re going to spend $300,000 in this state on something that’s not going to happen,” said Bates, an osteopathic family physician. “I don’t want to spend money on this [study] ever again. Our present healthcare system is barely sustainable and I don’t want to put any more load on it.”

Bates had been a sponsor of House Bill 2828, but in a moment of fatigue and frustration on Friday, his nay vote sank the bill, as its supporters looked on, stunned. His opposition led a Republican supporter, Sen. Jackie Winters of Salem, to switch her vote, and Democratic Sens. Mark Hass of Beaverton and Chuck Riley of Hillsboro also voted it down.

My View: Oregon needs to get a better attitude

     Sanuel Metz, MD

     Sanuel Metz, MD

The Portland Tribune, Tuesday, 07 July 2015
by Samuel Metz

The Federal Aviation Agency reports that not all airline accidents are caused by bad weather. Some pilots, in a crisis, succumb to “hazardous attitudes,” making a bad situation worse. By teaching pilots to overcome these attitudes, flying becomes safer.

And so it is with health care. Oregonian voters have our own “hazardous attitudes” that worsen the impending health care crisis. Overcoming these attitudes means health care becomes less expensive, more accessible, and, like aviation, safer. But before correcting these attitudes, we must identify them.

The FAA’s hazardous attitudes are simple: Antiauthority, impulsivity, invulnerability, “machoness,” and resignation. Voter attitudes toward health care are far more complex.

First hazardous attitude: “Other people should only get the health care they can pay for.” This is certainly true today. And without action, it will be true indefinitely. Other industrialized nations, all of which provide better care to more people for less money, adopt a different attitude: Everyone needs health care, so let’s find the best method to achieve it.

Second attitude: “Restricting access to health care reduces costs.” Gov. Nathan Deal of Georgia advocates closing emergency rooms to people who can’t pay, thus saving money for taxpayers. This radical proposition certainly benefits wealthy taxpayers without emergent needs. But for the rest of us, helping wealthy taxpayers by denying emergency care to our families could mean dying on the doorsteps of an emergency room.