About health insurance/insurers
The US Medicaid ProgramCoverage, Financing, Reforms, and Implications for Health Equity A really good summary of the Medicaid system. Highlights: In 2022, Medicaid insured approximately 80.6 million individuals (56.4% from racial and ethnic minority groups in 2019). In 2020, estimated Medicaid spending was $671.2 billion (16.3% of total US health spending). The proportion of beneficiaries enrolled in Medicaid managed care was 69.5% in 2019, 45 states have pursued 139 Medicaid delivery system reforms from 2003 to 2019, and 38 states and Washington, DC, have expanded Medicaid under the Affordable Care Act. Racial and ethnic health disparities are common within Medicaid, and evidence on the association of Medicaid policies and reforms with achieving racial health equity remains limited.”
The Medicare Financing Conundrum An excellent analysis of the Medicare funding problem from the Urban Institute. Some conclusions:
”Although creating a new dedicated financing source could close a given Medicare financing shortfall, it is hard to match future growth in Medicare spending needs exactly with growth in a particular financing source.
It is easier to enact reforms consistent with the goals of tax or budget policy through general revenue financing than through dedicated financing.
Dedicated financing via a trust fund can work when it covers all costs and imposes budgetary rigor on matching spending and receipts, but the HI trust fund is not set up to work that way.
Broadening the base of an existing dedicated tax, such as subjecting employer-sponsored health insurance to the HI payroll tax, would follow the tax policy principle of horizontal equity without necessarily adding to the complex array of Medicare financing sources.
Addressing HI and SMI financing issues together would help confront longer-term Medicare financial challenges and allow fairer and more efficient financing and spending trade-offs to be made within HI, SMI, and the broader tax system.”
Centene to Pay $166 Million to Texas in Medicaid Drug Pricing Settlement “Health insurance giant Centene Corp. has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services.
It’s the biggest known payout by the nation’s largest Medicaid insurer over its drug pricing practices. The deal was signed July 11 but hadn’t been publicly announced until Monday after KHN obtained a copy of the settlement through a Texas public records request and began asking questions.
The agreement makes Texas at least the 12th state to settle pharmacy billing claims with St. Louis-based Centene.”
About hospitals and healthcare systems
Ascension Health closes 2022 with $1.8B loss, -3.1% operating margin “Ascension Health closed its 2022 fiscal year with an $879.1 million operating loss and net loss of more than $1.8 billion, according to investor disclosures for the period ended June 30.
A nearly $2.1 billion rise in operating expenses and $1.2 billion in net losses from investments drove the 144-hospital system’s poor performance, according to the financial documents.
The losses are a turnaround from the previous year’s $676 million operating income and almost $5.7 billion net gain.”
About pharma
A $3M gene therapy: Bluebird bio breaks its own pricing record with FDA approval of Skysona “On the heels of an FDA go-ahead for gene therapy Zynteglo, bluebird bio has won an FDA accelerated approval for Skysona, or eli-cel, for the rare neurological disorder cerebral adrenoleukodystrophy (CALD), the company said Friday. The company is charging $3 million per treatment with Skysona, higher than Zynteglo’s $2.8 million, making it the priciest therapy in the world.”
About the public’s health
Association of improved air quality with lower dementia risk in older women “In this study on a geographically diverse cohort of US community-dwelling older women, we found that long-term improvement in ambient air quality in late life was associated with reduced dementia risk. The associations did not significantly differ by age, education, geographic region, Apolipoprotein E e4 genotypes, or cardiovascular risk factors. These findings strengthen the causal association between late-life exposure to air pollution and dementia risk.”
In a first, health panel calls for routine anxiety screening in adults “In a nod to the nation’s pressing mental health crisis, an influential group of medical experts for the first time is recommending that adults under age 65 get screened for anxiety.
The draft recommendations, from the U.S. Preventive Services Task Force, are designed to help primary care clinicians identify early signs of anxiety during routine care, using questionnaires and other screening tools.”