Today's Datapoint

13.6% more prescriptions were filled in 2014 by enrollees in public exchanges than patients with commercial insurance, according to a new report from Prime Therapeutics LLC.

Quote of the Day

"The underlying [health insurance] market isn't so broken that employers are crying out for a solution. What they want is dramatically lower premiums, and that's not what [the Small Business Health Options Program] offers. I think SHOP is a tough sell."



— Rosemarie Day, president of Day Health Strategies and former chief operating officer of the Massachusetts exchange, told AIS's Inside Health Insurance Exchanges.

Americans Are Retiring Early - Too Early Maybe?

65% of pre-retirees plan to work in retirement, yet only 27% actually do. Only 44% of workers have actually calculated how much they might need to have a comfortable retirement. Though there are times when it makes sense to take Social Security early, those who retire earlier than their full retirement age (according to Social Security) may be leaving thousands of dollars on the table.

Source: Employee Benefit Research Institute

According to the Bureau of Labor Statistics, in March 2015:

• Health care added a net 22,000 jobs
•  Ambulatory health care services added 19,000 jobs
• Hospitals added 8,000 jobs
• Nursing care facilities lost 6,000 jobs

:Source: "Early Release of Selected Estimates Based on Data From the National Health Interview Survey, January–September 2014," Centers for Disease Prevention and Control/National Center for Health Statistics, March 24, 2015, http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201503_11.pdf

Percent of Enrollees Paying Part D Medicare's Income-Related Premiums

According to an issue brief by the Kaiser Family Foundation, an estimated 5% of the 42.2 million Medicare beneficiaries enrolled in Part D plans pay higher income-related amounts in addition to their specific Part D plan monthly premium amounts. Below is the data:

Of the 2.1 million Part D enrollees who pay the Part D income-related premium:

• 0.8 million (2%) pay 35% of Part D program costs.
• 0.7 million (2%) pay 50% of Part D program costs.
• 0.2 million (1%) pay 65% of Part D program costs.
• 0.4 million (1%) pay 80% of Part D program costs.

Note: Data is from 2015.
Source: Kaiser Family Foundation

According to a recent government report for January through September 2014,

survey respondents assessed their own health as follows:

• 36.5% - excellent
•  30.1% - very good
• 23.6% - good
• 7.6% - fair
• 2.2$ - poor

The percentage of persons who reported "excellent" or "very good" health decreased with age:

• 84.7% of those under age 18
• 64.7% of those aged 18–64
• 45.2% of those aged 65 and over

Source: "Early Release of Selected Estimates Based on Data From the National Health Interview Survey, January–September 2014," Centers for Disease Prevention and Control/National Center for Health Statistics, March 24, 2015, http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201503_11.pdf

Lawmaker wants to address medical billing surprises

Bill would allow patients to take all balance billing cases to mediation

By Chris Tomlinson

March 25, 2015

The Texas Legislature may be on its way to helping millions of Texans who get unexpected medical bills every year due to confusion over which facilities and which doctors are part of their insurance network.

A tip of the hat goes to state Sen. Kelly Hancock who has introduced Senate Bill 481, which got a hearing Tuesday in the Business and Commerce Committee. The Republican from North Richland Hills wants to expand a mediation program that helps settle the bills when a doctor working at a hospital doesn't accept the same insurance plans as that hospital.

Millions of Texans every year experience this disconnect. The insurance company tells them a hospital is part of the insurance network, but then they see a doctor there who is out-of-network. The insurance company refuses to pay the doctor's full-fee, so the patient gets an unexpected bill.

A few months ago I wrote about this scenario and readers flooded me with mail about their experiences with what is known as balance billing. These patients developed elaborate plans to make sure all of the doctors involved were in-network, only to discover the hospital made a last-minute substitution that cost the patient thousands of dollars. The practice was also the subject of several New York Times stories.

Surprise medical bills are the No. 1 cause of bankruptcy and bad credit ratings. Since doctors focus on treating patients rather than who will pay them, patients frequently don't know that their insurance won't pay for the doctor until weeks after treatment.

Hancock wants to expand a state law that allows patients to take some of those bills to mediation so that patients can appeal EVERY bill they receive from out-of-network doctors working at in-network hospitals. The bill would also help with emergency room visits that the patient could not have predicted.

In addition to my endorsement, the Texas Association of Business, the Center for Public Policy Priorities and AARP all think this is a great bill.

"It is our hope that the Legislature will recognize this serious problem and quickly pass this bill to address it," the TAB's Bill Hammond said. "The practice is not fair for consumers and is not fair for businesses, who struggle to provide health insurance for their employees."

Hancock heard the complaints, and while his bill will not end the practice, it does expand the current law to cover more cases. If he can rally his fellow lawmakers to pass it, it will be a step in the right direction.

http://www.houstonchronicle.com/business/outside-the-boardroom/article/Lawmaker-wants-to-address-medical-billing-6156338.php?t=00c05fdf41