Category Archives: Insurance

What Missouri, Oklahoma teach us about state efforts to expand Medicaid eligibility

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.

Projected costs

Source: Analysis of the Fiscal Impact of Medicaid Expansion in Missouri, Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, 2019. Reprinted with permission.

Missouri voters in August approved a ballot measure that would expand Medicaid eligibility to include healthy adults, beginning July 1, 2021.

According to reporting at NPR by Alex Smith, 53.25% of 1.2 million voters approved the measure, meaning Missouri joins 36 other states and the District of Columbia in expanding Medicaid under the Affordable Care Act. The approval came despite strong opposition from Republicans and rural voters, Smith wrote. Continue reading

Employers and insurers paid hospitals 247% more than Medicare rates, new study shows

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.

Photo: stevenharman via Flickr

Research released today shows that from 2016 through 2018, self-insured employers and commercial health insurers in 49 states and the District of Columbia paid 247% more, on average, than what the Medicare program would have paid for the same inpatient and outpatient hospital services.

Researchers from RAND analyzed hospital claims data from 3,112 hospitals in every state except Maryland, which was excluded because the state has an all-payer rate setting model in which hospitals charge prices that are equal to what Medicare and private insurers pay, the report explained. The claims totaled $33.8 billion and came from self-insured employers, six state all-payer claims databases and health plans from 2016 to 2018. Continue reading

Report card shows erosion of health insurance coverage in the states

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.

Chart: Commonwealth Fund

In four of the states that have not expanded Medicaid eligibility have among the highest rates of uninsured residents, according to a Commonwealth Fund report.Source: “2020 Scorecard on State Health System Performance,” The Commonwealth Fund, September 2020.

The coronavirus has certainly pushed the health care system into a crisis. Still, even before the pandemic began earlier this year, health insurance coverage in the states already was being eroded and health care costs were rising sharply along with the number of preventable deaths, according to a new report by the Commonwealth Fund.

In addition to those sad statistics, the fund’s researchers show in the 2020 Scorecard on State Health System Performance that racial and ethnic disparities were getting worse as well. Continue reading

Wide variations in health care providers’ charges raise questions about the right rate

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.

Source: Analysis of Spending on Shoppable Services in Massachusetts, the Pioneer Institute, Boston, August 2020.

Source: Analysis of Spending on Shoppable Services in Massachusetts, the Pioneer Institute, Boston, August 2020.

Early last month, a report from the Pioneer Institute in Boston showed that Massachusetts consumers could have saved $22 million in 2015 if they got health care from lower-cost providers instead of from the highest-priced health care providers.

In “Analysis of Spending on Shoppable Services in Massachusetts,” researchers wrote that consumers could have saved $116.6 million if the savings were adjusted for inflation over four years.

The researchers analyzed what providers charged in 2015 for 16 shoppable services, such as elective or non-emergent surgery. Continue reading

Report shows wide variation in what insurers pay providers versus what Medicare would have paid

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.

Researchers from the Health Care Cost Institute reviewed 210 million claims from individuals with health insurance through their employers in 2017 and compared what insurers paid physicians and other providers for those services against what Medicare would have paid for the same services in 271 metropolitan areas.

Graphic: Health Care Cost InstituteResearchers from the Health Care Cost Institute reviewed 210 million claims from individuals with health insurance through their employers in 2017 and compared what insurers paid physicians and other providers for those services against what Medicare would have paid for the same services in 271 metropolitan areas. (Click to enlarge graphic.)

During the coronavirus pandemic, any number of good news stories seem to get little or no coverage because most health care journalists are busy covering COVID-19.

One such case in point was a report earlier this month from the Health Care Cost Institute. In Comparing Commercial and Medicare Professional Service Prices, HCCI researchers compared what health insurers paid to physicians and other providers with what Medicare pays for those services.

This report should not be overlooked for at least three reasons. Continue reading

N.C. journalist goes to Europe for lessons about opioid crisis

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.

NC Health News reporter Taylor Knopf interviews Thilo Beck, head of psychiatry at Arud Centre for Addiction Medicine inside a heroin-assisted treatment facility in Zurich, Switzerland.

Photo: Andy SpechtNC Health News reporter Taylor Knopf interviews Thilo Beck, head of psychiatry at Arud Centre for Addiction Medicine inside a heroin-assisted treatment facility in Zurich, Switzerland.

Last year, Taylor Knopf, a health care journalist at North Carolina Health News, spent more than a week out of a vacation to report on how France and Switzerland have been able to do what the health care system in the United States has so far failed to do: stem the tide of opioid-related deaths.

Knopf earned first place in AHCJ’s Awards for Excellence in Health Care Journalism Public Health (small) category for her six-part NCHN series, “Lessons from Abroad.” Continue reading