Author Archives: Joseph Burns

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Lawsuit may indicate change in government’s pursuit of insurance fraud

Photo: Urban Bohemian via Flickr

Photo: Urban Bohemian via Flickr

A 2011 lawsuit unsealed last week reveals the inner workings of the nation’s largest health insurer, UnitedHealth Group. In the lawsuit, lawyers for the plaintiff allege that UnitedHealth evaluated certain employees on how well they raised risk adjustment scores.

The lawyers contend the practice was part of a scheme to increase payments from the federal Centers for Medicare & Medicaid Services by submitting false statements about the level of illness among Medicare Advantage patients. Continue reading

New reports show uninsured rate continued to drop in 2016

Source: NCHS, National Health Interview Survey, 2010-2016, Family Care component, released February 2017.Data from the National Center for Health Statistics shows the rate of growth of high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs) since 2010. A CDHP is an HDHP with a tax-advantaged health savings account.

Source: NCHS, National Health Interview Survey, 2010-2016, Family Care component, released February 2017.Data from the National Center for Health Statistics shows the rate of growth of high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs) since 2010. A CDHP is an HDHP with a tax-advantaged health savings account. (Click to enlarge.)

A report released today by the National Center for Health Statistics indicates that the uninsured rate among Americans of all ages was 8.8 percent in the third quarter of 2016.

The report shows that in the first nine months of last year, 28.2 million Americans remained uninsured, and this number was 20.4 million fewer than those uninsured in 2010, the year Congress passed the Affordable Care Act (ACA). Continue reading

Judge cites anti-competitive concerns in blocking Anthem-Cigna merger

By AgnosticPreachersKid (Own work) (CC BY-SA 3.0 or GFDL), via Wikimedia Commons

By AgnosticPreachersKid (Own work) (CC BY-SA 3.0 or GFDL), via Wikimedia Commons

U.S. District Judge Amy Berman Jackson has blocked the merger of Anthem and Cigna, the second court ruling this year against megamergers in the health insurance industry.

On Thursday, Anthem said it would appeal the Feb. 8 ruling promptly and request an expedited hearing. Cigna said it would review the decision and evaluate its options. Anthem has a financial incentive to appeal given that under the terms of the merger proposal, Anthem agreed to pay Cigna $1.85 billion if the deal fell apart. Continue reading

Resources for covering insurance and its role in addiction treatment

Photo: Debora Cartagena/CDC

Health care journalists covering addiction, overdoses, and the heroin epidemic are likely to learn that the health insurance system appears to be part of the problem. That’s what Terry DeMio found on her beat in southern Ohio and northern Kentucky. Since January 2016, DeMio has been the Cincinnati Enquirer’s heroin epidemic reporter.

Rather than paying for the best medications for drug addicts in need, health insurers often require patients to start with the lowest-cost drugs. Then if the lowest-cost prescription fails, insurers then pay for the next highest-cost drug. Called fail-first or step therapy, this process repeats until the patient finds one that works. Meanwhile, the patient suffers or could die, DeMio said. Continue reading

Federal judge sides with DOJ, blocking Aetna-Humana merger

Medicare Advantage 2016 Spotlight: Enrollment Market Update, by Gretchen Jacobson, Giselle Casillas, Anthony Damico, Tricia Neuman and Marsha Gold for the Kaiser Family Foundation, May 11, 2016.

Medicare Advantage 2016 Spotlight: Enrollment Market Update, by Gretchen Jacobson, Giselle Casillas, Anthony Damico, Tricia Neuman and Marsha Gold for the Kaiser Family Foundation, May 11, 2016.

U.S. District Judge John D. Bates on Monday sided with the Department of Justice to block the merger of Aetna and Humana. The ruling is being called a victory for members of Medicare Advantage (MA) plans, since Aetna and Humana — two of the nation’s largest health insurers would, as a combined company, have owned the biggest share of the Medicare Advantage market, The Wall Street Journal reported.

For journalists covering health insurance in their cities and states, there’s a story on how the merger would have affected competition in states where the two companies compete. Continue reading