Bich Nguyen1d ago

"Unlike plans sold on the exchanges, these options — some sold by major insurers, others by small companies or nonprofits — can deny claims with few or no legal rights for consumers to appeal. The plans are not required to cover 'essential health benefits,' such as preventive care, and can impose annual or lifetime caps on benefits."

https://kffhealthnews.org/health-industry/alternative-health-plans-growth-sharing-ministries-short-term-aca-premiums/

#healthcare #ACA #obamacare #insurance #CostsOfCare #RuralHealth #USpol

Cheaper, Alternative Health Plans Are Having a Moment, but Critics Urge Caution - KFF Health News

Congress' decision not to extend enhanced marketplace tax credits has boosted the appeal of alternative health coverage with lower monthly premiums. Consumer advocates dismiss the plans as "junk insurance,” while proponents say patients need alternatives to pricey marketplace options.

KFF Health News
Bich Nguyen6d ago

"The dueling narratives are taking place ahead of the fall midterms as Democrats attempt to persuade voters that President Donald Trump and his policies are to blame for rising costs across the economy — with health care at the top of the list. Republicans are countering that they are saving Americans money by going after fraud that Democrats have long overlooked — and showing results."

https://www.politico.com/news/2026/05/25/obamacare-affordability-premiums-fraud-midterms-looming-00930051

#healthcare #ACA #obamacare #medicaid #insurance #CostsOfCare #USpol

RFK Jr., states at odds over cause of Obamacare’s enrollment declines

Trump administration officials point to their work on fraud as the reason for dropoffs while states and insurers blame higher premiums.

Politico
Bich NguyenMay 19

"Drugmakers and insurers are aiming to take advantage of lawmakers’ worries about affordability to convince them it’s the hospitals they should regulate, and not them, if they want to bring down Americans’ bills. Some of the changes the drugmakers and insurers are pursuing would pad their own profits."

https://www.politico.com/news/2026/05/17/hospitals-affordability-drugs-insurers-health-care-00924303

#healthcare #hospitals #PhRMA #PrescriptionDrugs #insurance #insurers #medicaid #medicare #CostsOfCare #DrugPrices

Hospitals are taking the fall for high health care costs

On right and left and among industry rivals, everyone is pointing the finger at the caregivers.

Politico
Brian Pierce MDJan 4, 2024

New case study from the center left think tank #thirdway about #maine #hospital consolidation and how it's "ripping off patients"

As a Maine doc, the only omission I see is that they fail to discuss Maine's #certificateofneed law which allows hospitals here to block lower cost competitors. That's part of why we send some patients out of state for lower cost tests and surgeries.

https://www.thirdway.org/report/fixing-maines-broken-hospitals-a-case-study

#costsofcare #healthreform

Third Way

Show threadBrian Pierce MDNov 22, 2023
@FrankPasquale
#costsofcare #healthreform #healthinsurance
Brian Pierce MDNov 19, 2023

#Capitation involves a lot more than paying #primarycare a monthly fee. It creates perverse incentives for #familymedicine docs and other PCPs to ration care.

#directprimarycare #costsofcare #healthreform

https://kffhealthnews.org/news/article/compensation-pay-primary-care-shortage-solution/

Compensation Is Key to Fixing Primary Care Shortage - KFF Health News

Many proposals have been floated about how to address the nation’s primary care problem. They range from training slots to medical school debt forgiveness but often sidestep comprehensive payment reform.

KFF Health News
Show threadBrian Pierce MDOct 19, 2023
@pluralistic Pertinent to #healthreform #costsofcare #MedMastodon
Show threadBrian Pierce MDSep 15, 2023

@petersuber

Much of this is due to #feeforservice billing paradigm and prepaying for routine care via #healthinsurance

For #primarycare, it's simpler to dump both. That makes primary care efficient enough that we can provide it (and free phone calls and messages) for $44 to $99/month when the hospital clinic down the street is charging $173 to $351 per visit.

Save the insurance for big , expensive problems.

#costsofcare #directprimarycare #dpc #healthreform

Show threadBrian Pierce MDSep 10, 2023

@jeffjarvis

All those false positives ("indidentalomas") from full body #MRI will get expensive workups and then follow up studies that will be paid by the rest of us via higher insurance premiums and taxes.

Get some data first please. Failing that, add a special tax on these to cover the extra workups upfront instead of socializing their false positive costs to everyone.

#medmastodon #costsofcare #radiology #evidencebasedmedicine #ebm #sbm #sciencebasedmedicine

Show threadBrian Pierce MDAug 22, 2023

@brittanytrang @STAT

4. #maine is one of many states that still have Certificate of Need laws that had the goal of reducing oversupply/use of services but now protect hospital networks (mostly regional monopolies) from lower priced competitors.
It's not rare for me to send patients out of state for cheaper studies, procedures, etc. The price savings are often big enough to make the trips worthwhile for them. The shorter wait for consults are a bonus.

#costsofcare

https://www.pressherald.com/2021/04/07/board-wont-recommend-central-maine-healthcares-proposed-topsham-surgical-center/

Board won’t recommend Central Maine Healthcare’s proposed Topsham surgical center

The Lewiston-based organization has suspended its application for a certificate of need.

Press Herald