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Editorials

Medicaid expansion means a richer QHP buyer pool on exchanges

Andrew Sprung

In my close look at silver plan selection in 2015 among HealthCare.gov customers who were eligible for Cost Sharing Reduction (available only with silver plans). I expressed some disappointment that CSR takeup had apparently dipped a bit on the federal exchange from 2014 to 2015. Disappointment on that particular point may have been misplaced.

The ACA reminded us how little we know about long-run Medicare spending

Louise Sheiner

Official projections of long-term Medicare spending were lowered sharply in response to the ACA. It seemed like the ACA had made a major dent in addressing our long-term fiscal challenges. But had it?

Sovaldi: Near-perfect example of price discrimination

David Williams

This isn’t just theoretical. I was approached by a consultant representing large U.S. employers who were exploring pharmacy tourism that would send patients abroad for their drugs.

Are antipsychotics overprescribed for kids?

David Rettew, MD, University of Vermont

It turns out that most providers who prescribe antipsychotic medications are not psychiatrists.

Big organizations don't always lead to lower costs or better care

Tim Vogus, Vanderbilt

In his new book, America's Bitter Pill, Steven Brill dives deep into the history of the Affordable Care Act (ACA) and how it was passed. He concludes that, although providing more Americans with health insurance is worthy of praise, the ACA does far too little to address the costs of health care.

The real cost of the payment integrity challenge

Paul Vosters, Discovery Health Partners

Clearly healthcare is the most interesting and dynamic sector in the U.S. today. We are witness to an unprecedented transformation as healthcare stakeholders embrace new delivery entities and new reimbursement models, shift attention to building relationships with members and explore new markets. There will be winners and losers in this game, and everyone is placing their bets.

Three observations from 2015 open enrollment

Paul Houchens, Milliman

Exchange market leaders in 2014 may have had a large portion of their membership renew coverage, but a material portion may have higher monthly costs in 2015, which could change persistency rates.

Screening charade: Hospital discount program misses evidence

Vik Khanna and Al Lewis

For many Americans, $179 for $2,000 worth of cardiovascular disease screenings might be better spent on a good pair of shoes.

Consumers have skin in the game, so now what?

Jim Lee, Altarum Institute

If consumers can not make more informed healthcare decisions, they may just end up being skinned alive.

Money Grab: CMS to rerun risk scores for recovery

Daniel Weinrieb

If you read the memo and muttered, "uh-oh" under your breath, you might be thinking that your plan/organization owes CMS some money, and soon. If you haven't read this memo, "uh-oh" would be an understatement.

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