Individual market endangered by uncertainty over subsidies

Health insurers in most states have until June 21 or sooner to decide whether they will participate in the federally facilitated marketplace exchanges in 2018. In several states, that deadline has already passed without any certainty regarding the future of vital federal funding that helps millions of Americans shoulder the burden of deductibles and co-pays.

Billions of dollars in cost-sharing reductions (CSR) that go to an estimated 7 million patients could be affected unless Congress moves quickly to eliminate “the single most destabilizing factor causing double-digit premium increases for 2018,” according to a group of organizations representing America’s physicians, hospitals, businesses, employers and health insurers.

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Anthem-Cigna merger threatens innovation, appeals court finds

The U.S. Court of Appeals for the District of Columbia has upheld a lower-court ruling blocking a proposed $54-billion mega-merger between health insurance giants Anthem and Cigna. The appeals court agreed with the trial court’s ruling that this merger would harm patients because it would likely stifle competition and choice, eliminate the existing head-to-head competition between the two insurers, reduce the number of national carriers from four to three, raise premiums, and diminish quality and innovation.

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Flawed AHCA passes House despite outcry from physicians, patients

The U.S. House of Representatives today passed an amended version of the American Health Care Act without an official estimate of the bill’s costs or its impact on the insurance coverage that more than 20 million people have gained in recent years. The 217–213 vote came after a deal that was struck early this week to capture wavering Congressmen added $8 billion in funding over five years to provide assistance to individuals who may be subject to increased premiums because of a pre-existing condition.

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Critical treatment gap seen in effort to stem opioid epidemic

Confronted by the gravity of an opioid epidemic that contributes to the deaths of 91 Americans daily, the nation’s physicians are making much greater use of state prescription drug-monitoring programs, reducing opioid prescriptions, and increasing prescriptions for the life-saving antidote naloxone. Tens of thousands of physicians nationwide are now certified to provide office-based medication-assisted treatment for opioid-use disorders, yet there remains a treatment gap that leaves too many patients who want help unable to get it.

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New changes don’t fix AHCA shortcomings, threaten key protections

The most recent effort to broaden support for the American Health Care Act, which comes in the form of an amendment proposed by New Jersey Rep. Tom MacArthur, does not address the most serious flaws in the bill and would also undermine critical health insurance consumer protections. For these reasons, the AMA “remains opposed to passage of this legislation,” the Association’s CEO and Executive Vice President, James L. Madara, MD, said today in a letter to House Republican and Democratic leaders.

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Appeals court should uphold decision blocking Anthem-Cigna merger

Giant health insurance company Anthem is appealing a federal judge’s February ruling that blocked its proposed acquisition of fellow health insurer Cigna, arguing that the merger would result in $2.4 billion in “efficiencies” that would benefit consumers. But in an amicus brief filed with the U.S. Court of Appeals for the District of Columbia, the AMA Litigation Center strongly disputed that argument and urged a three-judge panel to uphold the lower court’s ruling to protect patients and physicians.

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Major patient groups join AMA to voice concerns on House bill

When Laurie Merges lost her corporate job in Cleveland two years ago, she enrolled her children—including one on the autism spectrum who needs treatment—in Ohio’s Medicaid plan. Told of her eligibility for Medicaid under the expanded version of the program that Ohio implemented, at first Merges thought the coverage might be superfluous, as she expected to soon regain employer-sponsored insurance when she found a new job.

“But then I thought, ‘It’s a good safety net,’” Merges said today at a news conference held by the AMA and three major organizations representing patients, the American Cancer Society Cancer Action Network, the American Diabetes Association and the American Heart Association. The availability of that expanded Medicaid safety net, under which nearly 700,000 Ohioans were enrolled as of 2015, may have saved Merges’ life. She was soon diagnosed with stage 3b breast cancer, underwent bilateral mastectomy, 33 rounds of radiation and, 15 months later, is still taking oral chemotherapy.

“Without that coverage, I never would have been able to do it,” Merges said. “Thanks to my treatment, I’m hopeful I’ll be around to watch my children grow.”

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“Medspeak” can shut down effective communication with patients

The 56-year-old inpatient is scared and worried. His physician has told him the swelling in his right calf that brought him to the hospital may be caused by an “agent” or “pathogen,” but he is confused. An “agent” sounds like a person, and a “pathogen” sounds like “psychopath.” When the physician returns with the diagnosis, cellulitis, and says it is an “inflammation of the skin and subcutaneous tissues,” the patient is further confused and flummoxed about deciding whether to stay in the hospital for antibiotic treatment or receive a prescription and rest at home.

This kind of “medspeak” can get in the way of patients’ sharing decision-making with their physicians and should be avoided. There are some evidence-based methods that help close critical communication gaps.

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