Overnight Health Care: States fight Trump on non-ObamaCare plans | Analysis looks into surprise medical bills | Left hits industry group working against single payer

Overnight Health Care: States fight Trump on non-ObamaCare plans | Analysis looks into surprise medical bills | Left hits industry group working against single payer

Happy Monday, and welcome to Overnight Health Care. The Senate returns from recess Wednesday night, but the House is out for the rest of the month. There is plenty of health news though to keep us busy.

Here are today's health care headlines:


States are fighting back against the administration's efforts to expand "short-term" insurance.

The Trump administration's new policy of expanding the sale of "short-term" insurance plans as a cheaper alternative to ObamaCare is quickly running into opposition from state regulators. The head of the Department of Health and Human Services has urged states to cooperate with the federal government. But instead, insurance commissioners are panning the new plans as "junk" insurance and state legislatures are putting restrictions on their sales.

The pitch from the White House: During a speech to conservative state legislators, HHS Secretary Alex Azar last week argued short-term plans can provide a viable, cheaper option for people priced out of ObamaCare plans-- but only as long as states don't restrict them.


"This affordable option will only be as available as state legislators and insurance commissioners allow it to be," Azar said.

The state view: State insurance officials argue that, despite being less expensive than ObamaCare plans, the short-term plans are bad for consumers and aren't an adequate substitute for comprehensive insurance.

"These policies are substandard, don't cover essential health benefits, and consumers at a minimum don't understand [what they're buying], and at worse are misled," said California Insurance Commissioner Dave Jones (D).

Why the plans are so controversial: The short-term plans don’t need to meet ObamaCare’s consumer protections. Administration officials say that means they will be as much as 50 to 80 percent cheaper than ObamaCare plans.

But the tradeoff is that people with pre-existing conditions can be charged more. In addition, the plans don't have to comply with ObamaCare mandates for covering certain services, such as mental health treatment, maternity care or prescription drugs.

More on the fight here.


A new analysis looks into why patients often end up with expensive medical bills, even when they go to in-network facilities.

About 1 in 6 hospital stays for patients enrolled in large employer health plans results in out-of-network bills, which tend to be costly and not fully covered by insurance, according to an analysis released Monday.

The Kaiser Family Foundation (KFF) study of medical bills from large employer plans found that 18 percent of inpatient admissions result in out-of-network claims.

Even when enrollees choose in-network facilities, KFF found, 15 percent of admissions include a bill from an out-of-network provider.

The catch: The bills arise when a patient goes to an in-network hospital, but receives care from a medical professional who is out-of-network.

Why it matters: Your chances of getting a bill from an out-of-network provider shoot up if you go to an emergency room, regardless of whether you're seeking inpatient or outpatient services, the study found. The same is true for patients who seek inpatient or outpatient mental health and substance abuse treatment.

We break down the numbers here.


Liberals attack health care companies for new group opposing single payer

The Hill reported that some of the biggest players in the health-care industry, from insurers, to drug companies, to doctors, have formed a new group to fight rising Democratic calls for single-payer health care. The group, called Partnership for America’s Health Care Future, comes as industry groups worry that single-payer is becoming the default option for Democrats.

Our story riled up Democrats and supporters of single-payer, who vowed not to be deterred by the opposition. Here are some of the reactions:

Ari Rabin-Havt, senior adviser to Sen. Bernie SandersBernard (Bernie) Sanders2020 Democrats barnstorm the country for MLK weekend Bill Maher defends Bernie Sanders campaign over sexual harassment allegations Americans need an economy that supports more than the 1 percent MORE (I-Vt.):  "They are unanimous in their hate for Medicare for All -- and we welcome their hatred."

Andy Slavitt, former CMS administrator for President Obama: "This group 'Partnership for America's Health Care Future' represents what people hate the most about Washington, politics and using people's lives as political footballs."

Amirah Sequeira, legislative advocate at National Nurses United: "You know you're winning when the health insurers, Pharma, hospitals get together to stop #singlepayer All of these companies are on the wrong side of history - we will guarantee healthcare for everyone in the USA despite their objections #MedicareForAll"


From the other side, a GOP expert on the case against single payer:

Brian Riedl, a senior fellow at the Manhattan Institute, writes that supporters are wrong to claim that single payer saves money.

  • He argues that unless there are deep cuts of 40 percent in payments to hospitals and doctors, single payer would raise total national health spending, not cut it.
  • He argues that it is almost impossible to put together $32 trillion in new taxes to cover the cost, even if people would be saving money by no longer having to pay premiums and other health-care costs.

Key quote: "Produce an actual proposal. And this time, include both the specific tax increases that would be required, and a blueprint for how providers will survive such deep payment reductions. Until then, "affordable single-payer health care" will remain just an empty talking point."

Read the piece here.


What we're reading

Obama administration gave out $434 million in improper ObamaCare payments: Watchdog (Washington Examiner)

The Trump administration has another pretty good, pretty modest plan to lower drug costs (Vox.com)


State by state

Putnam, DeSantis campaign against ObamaCare in Florida governor's race (News 4 Jax)

Tennessee ObamaCare rates drop even lower after Trump backs off funding cuts (Nashville Public Radio)

UnitedHealthcare loses New York risk-adjustment battle (Modern Healthcare)


From The Hill's opinion pages

Medicare's new Step Therapy program is a step in the right direction