Medicare is evolving into a program that looks more like a marketplace of private plans with a public plan as a backup option!

A fundamental change in the architecture of Medicare is rapidly happening into something different to what people think the Medicare program is. Medicare Advantage (MA) continued to grow during the pandemic, and most Medicare enrollees will be in private plans in a couple of years despite MA’s deep-rooted problems. Spending on MA is rising precipitously…

Compact Nursing States List 2022

Everything you need to know about the changes being made to multi-state licensure. How many states are in the eNLC? What states have pending legislature for eNLC? What is the nursing compact licensure? Including new states joining and NLC states not joining. Indiana is the most recent state to join eNLC as of July 2020.…

Surprise medical bills are now illegal

Today a new federal law bans many types of out-of-network medical bills and puts the onus on doctors and health insurance companies to resolve their payment disputes. Patients should no longer face unexpected charges from doctors who are not in their insurance networks. What is on the law: patients still have to pay in-network copays,…

Why Public Health Is in Crisis!

State and local public health departments across the country have endured not only the public’s fury, but widespread staff defections, burnout, firings, unpredictable funding and a significant erosion in their authority to impose the health orders that were critical to America’s early response to the pandemic. While the coronavirus has killed more than 700,000 in…

The U.S. is the drug industry’s gold mine!

Americans pay pharma more than the rest of the world combined for the top 20 blockbuster drugs (see: financial filings by Public Citizen). The U.S. is pharma golden goose! and the analysis shows how much the industry has at stake as it fights Democrats’ plan to allow Medicare to negotiate drug prices and let employers piggyback off…

Wild forecast for hospitals for the end of 2021

Hospitals’ forecast for the second half of 2021 is full of uncertainties, thanks to the unvaccinated and the fast spreading Delta variant. The unvaccinated impact stretches across all areas of a hospitals’ balance sheets and will likely hurt margins in the near- and medium-term. The expectation for the year was that vaccines were going to…

Continue to keep Americans in the dark: The U.S. Chamber of Commerce and the Pharmaceutical Care Management Association are suing the federal government to halt a regulation that would force health insurers and employers to reveal the prices of services and drugs!

The healthcare industry claims it is in favor of price transparency, but in reality, the industry has fought hard any attempts to unlock the black box of prices. The regulation in question, finalized last November, requires plans and companies that are self-insured to make prices and out-of-pocket costs available for 500 items by Jan. 1, 2023. That…

DOJ joins lawsuits against Kaiser Permanente affiliates for submitting inaccurate diagnosis codes to the Medicare Advantage Program

Going after Kaiser Permanente, a company that many view as the gold standard for Medicare Advantage, indicates the problem may touch almost every corner of the industry. The lawsuit alleges Kaiser Permanente knowingly made its Medicare Advantage patients look sicker than they were, to obtain more money from the federal government. These allegations, which come…