Health Care

Now insurers and employers have to reveal health care prices

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Good morning — today we’re thinking of Highland Park, Ill., where a July Fourth celebration turned into a tragedy.

Today’s edition: A dive into how House GOP women are discussing abortion. A look at the patchwork countermeasures Democrats are pitching in response to the new post-Roe era. But first …

Will the next wave of price transparency requirements actually help patients? Unclear.

Insurers and some employers are now required to publicly disclose what they pay hospitals, doctors and other medical providers — an unprecedented look at data that has long been kept secret.

It’s the next phase of a nascent effort to infuse more transparency into the health system’s opaque pricing schemes. Last year, hospitals were forced to start posting certain prices online, though recent reports suggest spotty compliance.

But the Trump-era mandate for insurance companies and self-insured employers first went into effect Friday. There are key questions around whether the industry will do a better job of complying initially than hospitals — particularly since they’ll be slapped with heftier fines for flouting the rules. 

The overarching goal of the effort is lofty. Force the health industry to open up its books, and thus make it easier for consumers to compare prices and shop around for medical care. But it’ll take time before any such information is useful for patients.

Friday was basically a massive data dump. 

The first phase of the rule requires insurers and employers to post online the rates they negotiate with hospitals, as well as billed charges and allowed amounts paid to out-of-network providers. That information must be posted in machine-readable files — and the large files are meant to be parsed by third parties, such as researchers and app developers. 

That means the information isn’t helpful for patients — yet. While experts create tools to sift through the data, looming requirements could better help patients understand the cost of care. 

  • Beginning January 2023, cost estimates must be available online for about 500 items and services, such as X-rays and colonoscopies.
  • By January 2024, this mandate will extend to all items and services.

But still, it’s unclear whether consumer behavior will change — and if these efforts will actually arm patients with the information they need to shop around for care.

  • Niall Brennan, the chief analytics and privacy officer at Clarify Health, believes the information will instead serve two main functions: Shining a light on “egregious billing practices” for certain services and helping employers know when they’re getting a “raw deal” from insurers.

So, how well are insurers complying? It’s too early to know for sure. 

But the requirement was delayed by six months, giving the industry more time to gear up for the rules. Some major insurers have posted the files to their websites. The fines for not doing so could potentially be much bigger than the penalties for hospitals, amounting to $100 per day for each beneficiary affected by the violation.

AHIP, the major insurer lobby, says it has worked to help members understand the new requirements and clarify technical questions with federal regulators. But according to spokesman David Allen, a few issues arose as plans began to implement the requirements, such as the massive size of the machine-readable files.

For the hospital industry … the rules have been in effect since January 2021, and the Centers for Medicare and Medicaid Services recently fined two facilities for disobeying the price transparency rules. Some advocates are urging the agency to take an aggressive approach.

In February, a report by patient advocates determined that only 14 percent of the 1,000 hospitals the group reviewed were in line with the requirements. The group, PatientsRightsAdvocate.org, recently sent a letter to the agency asking it to penalize several hospitals the group thinks aren’t complying with the rules.

But CMS and the hospital industry contend their efforts to get hospitals in line with the rules are working. The agency performed an initial audit of 235 hospitals back in early 2021 — a quick check to get an initial portrait of how well hospitals were abiding by the rules. 

About 30 percent of facilities had no major compliance issues, and the rest were referred for a comprehensive compliance review and potential enforcement action, according to a CMS spokesperson who said most have since come into compliance or are “actively working” to do so. The results of the initial audit have not been previously reported.

  • “[Hospitals] ultimately do want to be able to provide this information, and they know how serious we are about having this transparency,” Meena Seshamani, the agency’s head of the Medicare program, told The Health 202 last month.

House GOP women are a crucial piece of party’s next move on abortion

Republican leaders quickly called for a nationwide ban on abortion after the Supreme Court overturned Roe v. Wade‘s decades-old protections. But if the GOP retakes the House next year, they’ll need the support of one key voting bloc: the women in the House Republican conference, The Post’s Marianna Sotomayor writes. 

There are 32 women in the conference this year — and that number is likely to grow. 

Of the roughly dozen House Republican women who spoke to Marianna about current plans, few wanted to discuss the possible legislative implications of the recent Supreme Court decision. But most were united in their belief that it should be up to states to determine subtle nuances in abortion laws.

Several women in the conference have said publicly that they support antiabortion legislation if it includes certain exceptions.

  • “I can imagine that in a Republican-controlled Congress you’ll see some guardrails put in, but I don’t think it would be an extremity. I think it would just be guardrails, making sure we have exceptions in there,” Rep. Nancy Mace (R-S.C.) said.

With Roe overturned, Democrats present a patchwork of countermeasures

Democrats at the local, state and federal level are cobbling together a patchwork of countermeasures in an attempt to protect abortion access, The Post’s Annie Linskey, Mike DeBonis, Marianna Sotomayor and Tyler Pager report. 

The ruling created a new rallying cry for the party, which has been bracing for a difficult election season. But it also revealed some divergencies in the path forward that will be tested in the coming months.

On Capitol Hill, House Democratic leaders are discussing ways to force Republicans into uncomfortable positions on abortion. They’re currently plotting potential votes designed to expose GOP opposition to some popular protections and underscore their own commitment to them. 

But in the Senate, some senior Democratic aides have privately expressed concerns that the tactic could open a path for centrist Republicans to break with their party and claim they acted to uphold women’s rights. 

  • A likelier strategy in the Senate, our colleagues write, is to attempt over the summer to pass bills on the floor by unanimous consent — a maneuver that would publicly demonstrate GOP opposition to popular measures but would not require all senators to cast votes on them.

Beyond Congress, Democrats say they’re planning to draw attention to state-by-state developments and shift their focus to legislative races that could serve as a pathway to enacting more abortion protections. 

Meanwhile, President Biden has directed federal health agencies to ensure medications including contraception and the abortion pill remain available. But the administration has tamped down some novel ideas being debated in the party, instead stressing the importance of Democrats’ success in the midterms.

Women searching for abortions online must wade through misinformation

False and misleading information about abortion is spreading online, and researchers fear it will only get worse in the aftermath of the Supreme Court decision, our colleague Rachel Lerman reports. 

They’re warning that what abortion-seekers find online could increasingly leave them even more confused and point them toward options that may be misleading — or even dangerous. 

Here’s a snapshot of how the issue is playing out online: 

  • On TikTok, videos suggesting herbal remedies to self-induce a miscarriage have racked up thousands of views, which experts warn aren’t safe or effective.
  • On Twitter, antiabortion activists have shared false information about the supposed dangers of the procedure.
  • On Google, some women seeking abortions are being rerouted to “crisis pregnancy centers,” which try to dissuade individuals from obtaining the procedure.

Social media companies have struggled for years to reliably and completely remove harmful information from their sites, and many tech companies have faced significant backlash about their lack of action to combat misleading abortion posts in the days following the court’s ruling. 

But experts say moderating those posts will likely get more difficult in a post-Roe world as the internet continues to be inundated with misinformation about the procedure from both sides of the abortion debate, a reality they say could wind up harming patients.

  • Republicans in nearly two dozen states have ratcheted up efforts to tap dollars from a covid relief package to pay for tax cuts, our colleague Tony Romm reports.
  • Sens. Michael Bennet (D-Colo.) and Catherine Cortez Masto (D-Nev.) are pressing the Biden administration to update the Health Insurance Portability and Accountability Act (HIPAA) to further prevent information on abortions from being shared with law enforcement agencies.
  • Abortions once again have been banned in Texas after the state’s Supreme Court on Friday blocked a lower court order that had temporarily allowed the procedure to resume, our colleague Adela Suliman reports.
  • As the world struggles to respond to multiple crises at once, global aid officials are warning that wealthy Western countries shifting away from the coronavirus pandemic could further drive health disparities around the world as low-income nations continue to grapple with the virus, Politico’s Erin Banco reports.

A Clunky Mask May Be the Answer to Airborne Disease and N95 Waste (By Andrew Jacobs | The New York Times)

Texts, web searches about abortion have been used to prosecute women (By Cat Zakrzewski, Pranshu Verma and Claire Parker | The Washington Post)

Barriers to abortion in Canada make it an unlikely haven for Americans (By Amanda Coletta | The Washington Post)

Thanks for reading! See y’all tomorrow.

Topics #Alternative #Beauty #Health Care #Medicine #Popular Diets