A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Private Market

The HPC wants bold and meaningful change

  The Health Policy Commission (HPC) met on Thursday, May 22 to cover a range of HPC activities including updates on the patient-centered medical home certification program, the registration of provider organization program, and the CHART Phase 2 investments. Slides from the meeting (pdf) have lots of details on the discussion. Keep reading for our detailed summary of the agenda points and discussion. Read more »

HPC Looks At Hospital Grants & Possible Lahey/Winchester Hospital Merger

The Health Policy Commission (HPC) board met on Wednesday, April 16 to cover a wide range of issues that included an update on patient-centered medical home standards, planning around behavioral health integration, cost and market impact reviews, and Phase 2 for the Community Hospital Acceleration, Revitalization, & Transformation (CHART) Investment Program. Slides from the meeting can be found here. Keep reading for all the details. Read more »

Is The Price Right? Now You Can Check. Massachusetts Issues Consumer-Friendly Transparency Guidelines for Health Insurers

Economist Uwe Reinhardt has an apt description of how the complete lack of information around health insurance prices feels to consumers: “Imagine a department store whose customers are blindfolded before entering. A shopper might enter the store seeking to buy an affordable dress shirt and a tie, but exit it with a pair of boxer shorts and a scarf. Sometime later, he would receive an invoice, whose details would be incomprehensible to him, save for one item: a dollar amount in a framed box with the words: “Pay this amount.” Read more »

HPC Committee Hears Testimony on Consumer Appeals Regulation

The Health Policy Commission’s (HPC) Quality Improvement and Patient Protection Committee held a hearing Monday on proposed amendments to 958 CMR 3.000, the Office of Patient Protection (OPP) regulation governing health plan internal and external appeals procedures.  The proposed amendments follow a listening session that OPP convened over the summer, and include consumer-friendly changes required by the Affordable Care Act (ACA) and Massachusetts state laws, as well as changes to provide additional clarifications and protections for consumers. Read more »

HCFA Urges Massachusetts To Reject Extending Non-Compliant Plans (UPDATE: Admin agrees with us)

The Obama administration's decision to permit insurers to continue to offer plans they otherwise would have cancelled (here's some good place-it-in-context background from The New Republic's Jon Cohn) is still subject to state insurance market rules. Already a number of states, including Washington, Arkansas, Vermont and Rhode Island, have ruled that they will continue to insist that all new plans offered in the state comply with the consumer protections in the ACA. Note that "grandfathered" plans, in existence before the ACA was signed in 2010, were always still allowed to be offered to... Read more »

All Your Base Rates Are Belong To Us: Springfield Republican Reports on Premiums Under Obamacare

Yesterday, a story by Shira Schoenberg in the Springfield Republican  covered the just-approved health insurance rates for next year: Read more »

Remember That Dire ACA Forecast? Never Mind.

Remember that dire report commissioned by the Mass Association of Health Plans from July (it's here (pdf))? Never mind. The report was an attempt to forecast the impact of the ACA on small group and individual premiums in Massachusetts. The ominous Globe headline was "National health care overhaul apt to push up costs." The story said: The analysis, by Wakely Consulting Group, projects President Obama’s health care law — supported by the Patrick administration — will tack an average of 3.7 percent on to premiums. Read more »

Interview: Liz Is Happy To Gets Her "Medical Loss Ratio" Rebate From Her Insurer

Under both Massachusetts law and the ACA, insurers must spend a minimum percentage of health care premium revenue on medical benefits for the people they cover. This is called the "Medical Loss Ratio" (MLR) in insurance argot. If insurers don't spend enough of their revenue on medical care, and too much on administrative and other costs, they must pay a rebate of the excess to their customers.  The Massachusetts requirement for last year was that at least 90% of all premiums for individuals and small groups must go for medical care, and no more than 10% can be used for administrative,... Read more »

Consumer Appeal Rights Comments Wanted

The Health Policy Commission’s (HPC) Quality Improvement and Patient Protection Committee convened yesterday. The meeting focused on a discussion of the Office of Patient Protection’s (OPP) internal and external review procedures, and culminated in a lively listening session advising OPP on how to make these processes more accessible to patients and consumers. Read more »

Brouhaha Good News Update: De-Merger Averted; Tobacco Surcharge Rejected

Several weeks ago we posted on the controversy over implementing ACA rules on insurance regulations. It can get complex, but the short summary is that when Chapter 58 merged the individual and small group health insurance markets, Massachusetts allowed insurers to offer discounts to the larger small groups. The discounts are matched by surcharges added to premiums paid by individuals and smaller small groups. So larger small groups (typically companies with 35-50 workers) pay less than they should, and individuals and small firms pay more than they should. The spread resulted in the winners... Read more »


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