Bob Herman
@bobjherman
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Health care business reporter for @statnews and its Health Care Inc. newsletter. Contact: bob.herman @statnews .com or DM.
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JUST IN: Ohio Dept of Insurance says CareSource will sell ACA health plans in Ohio's Paulding County. No more empty ACA counties.
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Truly damning excerpts about Aetna's execs. They bailed on Obamacare markets b/c of the Humana merger litigation—not for business reasons.
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UnitedHealth Group posted $6.6 billion of profit in its "COVID quarter." That obliterated Wall Street's projections and was by far the health care giant's most profitable quarter ever.
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The top 7 executives at UnitedHealth Group made $169.2 million in 2019.
That's pretty close to what the entire CDC got to study and prepare for "emerging infectious diseases" in 2019.
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Parents are in tears as states weigh shutting down CHIP coverage for kids. Unbelievable it's gotten to this point.
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Sinema is carrying water for basically every part of the health care industry.
As all of D.C. tries to figure out exactly what Sen. Kyrsten Sinema is thinking as President Biden's entire domestic legislative agenda hangs in the balance, her office is circulating a letter... opposing cuts to Medicare Advantage pay rates
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Just thought I'd check in on this tweet from May.
Trump says “you’re going to have some big news” in two weeks when big drug companies are “going to announce voluntary, massive drops in prices.”
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.
@PeterHotez
, who helped create COVID vaccine Corbevax, on licensing the vaccine tech for free: "You know, very much, we are a believer in this concept of decolonization. There's too many colonial trappings around trying to own technology."
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Millions of Americans lose or switch their job-based health insurance every month because they quit, get laid off, are fired, or retire.
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Wow: North Carolina hospitals torpedoed the state's effort to expand Medicaid because ... it also would have loosened the state's certificate of need law (i.e., would have opened the door for more lower-cost surgery centers and facilities to open).
New: Rs & Ds say a driving force behind Medicaid expansion’s failure in NC last month is a group that represents the state's hospitals.
That the group is at the center shows the sweeping influence it has over lawmakers & the legislative process.
#ncpol
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The median household income in 2015 was $56,515, which the average health care CEO made in less than a day.
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The employer-based health insurance system that many politicians don't want to touch is a large reason why workers' income has stagnated over the past 20 years.
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Moderna's CEO: "Our biggest problem is that we cannot produce enough vaccine to meet the high demand."
Generic drug companies are offering to help them and the other vaccine makers. "None of their offers have been met positively."
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Surprise billing has been studied to death. This isn’t nuclear fission. Meanwhile, somewhere, another person is getting saddled with medical debt from a surprise bill. But sure, let’s pause and reflect more.
Rep. Richard Neal says they need to “pause” on surprise billing:
“I’d rather pause and make it happen. I think there’s some need for reflection...Its pretty interesting that Kevin and I reached an agreement. It tells you how deep-seated some of the qualms are on this.”
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Johnson & Johnson is known for selling Band-Aids and baby powder. But J&J also used to grow raw narcotics, boasting that one of its opium poppies "enabled the growth of oxycodone."
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Wow: West Virginia county is suing a bunch of drug distributors, alleging they helped fuel the opioid crisis.
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CBO distilling decades of health care payment battles, policies, and research into one slide.
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Cigna CEO David Cordani made $79 million in the 2020 pandemic year. That was roughly 6x as much as the year before. Cigna’s profit shot up 66% from 2019 to 2020.
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In which two Nobel Prize-winning economists torch the U.S. health care system.
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Absolutely crazy: Delaware is raising the health insurance premiums of state employees by *27%* next year, and state leaders are admitting here that this single hike will wipe away *seven years* of their salary increases. A gargantuan pay cut.
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This
@sarahkliff
project takes aim at a crucial component of our health care system: high hospital & doctor prices.
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Maybe you've noticed the American Medical Association hasn't said a peep about the 10 drugs Medicare put on its first negotiation list. This from 2017 is why:
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A former manager at Eli Lilly explains how a now-failed sepsis drug was priced in 2001.
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This is now two straight years surprise medical bills won’t get solved at year end, largely because of Neal, who happens to get campaign cash from a private equity firm that owns providers who specialize in surprise medical bills.
New: PELOSI spoke to NEAL over the weekend to try to get him to compromise on surprise billing, but Neal is not budging.
Surprise billing is on life support, if not dead.
“Ways and Means gets to own consumers’ surprise bills," says
@repgregwalden
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Hospitals: Wow, UnitedHealth's pandemic profits are jaw-dropping.
OK, but it looks like big hospital systems are ~3x more profitable.
Hospitals: Wow, cannot believe you're attacking us.
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2030 headline: "Inside a regular hotel room in the Maldives."
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What a wild year. I’m beyond honored to be named a Pulitzer finalist with the one and only
@caseymross
. More than anything, we hope this shines light on the Medicare Advantage enrollees, and their families, who have been harmed by the use of this AI.
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@sarahkliff
You know it's a big deal when the major hospital lobbying group tells its members to rev up their PR engines.
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Employers pay consulting firms to make sure pharmacy benefit managers aren’t ripping them off with unfair prescription drug contracts. But a hidden flow of money between consulting conglomerates & PBMs compromises that relationship. Read our investigation:
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JUST IN: UnitedHealth Group, NaviHealth face class-action lawsuit over the use of algorithmic care denials in Medicare Advantage plans. Lawsuit extensively cites STAT's reporting. $UNH
@caseymross
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There is no better chart showing the distribution of U.S. health insurance than this by
@charles_gaba
.
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Jesus, famously known for his love of medical debt collection
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Amar Desai, CEO of Optum Health (UnitedHealth Group's provider division), discloses the company now employs *90,000 physicians.* That's up from 70,000 in last year's update. United/Optum acquired 20,000 doctors, and basically disclosed none of those transactions. $UNH
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The AHA releases another report claiming hospital mergers are great. Big part of the report is non-random interviews with hospital execs.
Relatedly, I commissioned a report about whether I'm loved. I interviewed my wife and 3-year-old son.
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Person: Yes, hello, I heard there is a new hospital price transparency law. I'm trying to be a Good Consumer, so I was wondering if you could share the machine readable fi-
Hospital: lol, here you go, enjoy.
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More than half of unvaccinated Americans live in households that make less than $50,000 annually. Most low-income workers still want to get vaccinated. It's just not always easy.
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An updated, and truly damning, MedPAC slide: Medicare Advantage plans are being overpaid by tens of billions of taxpayer dollars *every year* by both attracting healthier, lower-cost people and coding the hell out of everyone who enrolls.
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The health care corner of Wall St. is drooling over a Biden presidency and split Congress. Assumes that divide would lead to no substantial changes, not even a public option. Health insurers, pharma stocks up big.
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The doctor was an employee of TeamHealth, the private equity ER staffing group known for surprise billing. And this is the mission of PeaceHealth: “We carry on the healing mission of Jesus Christ by ... treating each person in a loving and caring way.”
NEW: An ER physician who publicly decried what he called a lack of protective measures against the novel coronavirus at his workplace, PeaceHealth St. Joseph Medical Center, has been fired.
Follow our live coronavirus updates:
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A hospital CEO kicked off
#JPM20
by saying, “The number one cause of personal bankruptcy is our industry.” And yet, hospitals then went on to explain how they are focused on growing revenue, with no real details about how that would save patients money.
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NEW: All year,
@caseymross
and I have explored how UnitedHealth and NaviHealth have cut off rehab care for Medicare Advantage members. Turns out, there also were secret rules to deny people from getting rehab care in the first place. Our latest:
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UCSF’s hospital charged the equivalent of a Volkswagen Jetta for a COVID-19 test that Medicare would pay, at most, $100 for.
And Cigna (or the employer) agreed to pay *$9,300*.
A tale of price-gouging and awful negotiating. Perfectly emblematic of the U.S. health care system.
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Health insurance stock prices are soaring right now following Biden's Super Tuesday.
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New analysis of health care executive pay is out: 179 CEOs made $2.5 billion in 2019, similar to cash-outs in 2018.
That's four times the CDC's 2019 budget for all "emerging and zoonotic infectious diseases."
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Shout-out to
@bjdickmayhew
who raised red flags when Aetna pulled out of profitable Pennsylvania Obamacare market.
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More Americans have gotten COVID shots since Omicron was detected.
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EEOC says employers can legally require workers to get a COVID vaccine. Agency also says employers can offer incentives for workers to get vaccinated. Appears there is no limit on the incentive size as long as the employer isn’t administering it.
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Nobody has profit margins in health care like pharmaceutical companies. It's not even that close.
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Within $HCA's $1.1 billion net profit, $590 million is post-tax bailout dollars. That's right: Taxpayers directly subsidized 55% of HCA's "COVID quarter" profits.
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People hate shopping for health insurance, and switching barely happens in Medicare, Medicaid and employer plans. "It's just too hard."
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People in every U.S. county will have at least one ACA health insurance option for 2018.
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Novartis won't raise prices on its drugs for the rest of 2018. In other news, the annual price of its cancer drug Gleevec has gone from $26,000 in 2001 to $146,000 in 2017.
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This matters in the context of "Medicare for All" because M4A skeptics say people are satisfied with their employer health plan. But people change their coverage all the time.
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Tonight, right now, I will detail some of the largest changes in the Medicare inpatient prospective payment system rule from the past five years. 1/277
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@JohnJHarwood
This
@CitizenCohn
tweet probably should be pinned somewhere.
Paul Ryan says insurance can't work if healthy must pay more to subsidize the sick. But this is exactly what happens in every employer plan.
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The gall of the health care industry to say it can’t provide advanced estimates of costs to patients because it doesn’t have the technology, and that taxpayers should cover their costs to do so.
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This interview shows why
@ashishkjha
has been among the most knowledgable, rational expert voices during the coronavirus pandemic.
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Medicare is paying $35.92 for the CDC's coronavirus test and $51.33 for commercial ones. Keep these numbers in mind in case you get billed.
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New York wants to blacklist health insurers from Medicaid if they withdraw from the Obamacare exchange.
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A win for pharma companies, especially those that make insulin and would’ve seen noticeably lower profits. Also gives industry extra time to kill this Medicaid reform completely.
Senate Dems delay by one year the elimination of the inflation cap on Medicaid drug rebates.
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The goal of the COVID-19 vaccines was always to *reduce death and severe illness*. Even with the Delta variant, the vaccines are still doing that. But that message is getting lost.
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Many Blue Cross Blue Shield insurers are making money this year. The ACA is not crippling them.
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Keep in mind: When it comes to this coronavirus vaccine, Moderna admitted taxpayer dollars make up "100% funding of the program."
For context, the $32-$37/dose Moderna cites for smaller volume agreements of
#COVID19
vaccine is 60% more (on low end) than Pfizer price of $19.95/dose agreement with U.S. govt.
Moderna notes price would be lower for larger volume agreements.
Price would go up after pandemic.
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Coincidentally, Bernie Sanders made this point last night in his Fox News town hall, as well as the fact that employers frequently change health plans or carriers every fall.
Also notable: How the audience largely applauds the idea of a government-run health system and how Sanders wrests the conversation back to tout Medicare for All.
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Medicare Advantage insurers are using unregulated predictive algorithms to pinpoint the precise moment when they can plausibly cut off payment — even if patients still desperately need more intensive care. New investigation w/
@caseymross
:
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If Lilly had raised the price of Humalog over time by general inflation, it would be $34/vial today. Instead, it is $275/vial, and its authorized generic will be $137/vial.
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This chart explains a lot about how UnitedHealth has become the most powerful entity in health care. What it means: UnitedHealth is funneling more of the insurance premiums it collects from workers and taxpayers toward itself.
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2023 Medicare Advantage rule is out. Can't understate just how friendly things are for health insurers. One of the largest-ever base payment hikes. Nothing changing with the bloat around risk adjustment. Just a bonanza of taxpayer cash.
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In the stimulus package: Hospitals and diagnostic testing companies can essentially name their price on COVID-19 tests, and employers and insurers will be *required* to pay it.
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Congress is ready to fully repeal the ACA's taxes on medical devices, health insurers and employer health plans. Cannot understate how giant of a gift this is for the health care industry.
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37.5 million Americans have got a booster dose of a COVID-19 vaccine.
30.3 million people in the eight African countries where the U.S. imposed a travel ban have gotten *one* dose of a vaccine.
Here's the overall vax status of those countries, too.
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Pretty powerful quote that gets at a hard truth of our health care system right now.
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Wow: Tenet Healthcare, a large, for-profit hospital chain, blasted email to employees urging opposition to GOP bill.
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Large hospital chain $HCA has received $700 million from the first tranche of bailout money that does not have to be repaid, CFO says.
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New CBO report: Health care prices are outrageous for all the obvious reasons (hospital & doctor oligopolies, insurers don't really care, etc.). Also, for the millionth time, "cost-shifting" isn't a thing.
Yep, checks out:
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How Humira has drained patients and society, in three grafs. Read more from
@RebeccaDRobbins
:
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NEW with
@caseymross
: All year, we’ve been probing how Medicare Advantage plans have denied care based on predictions generated by an algorithm. New documents show the problem goes deeper at UnitedHealth Group and NaviHealth.
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The recent fight over “Medicare cuts” and Medicare Advantage is such a major deflection from how health insurance companies have taken over Medicare — a shift that has been embraced and enabled by all politicians.
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NEWS:
@AdvocateAurora
, a large hospital system in Illinois and Wisconsin, is temporarily refraining from sending any patient bills related to coronavirus care.
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Hospital chain $HCA absolutely obliterated Q2 profit expectations. Almost $1.1 billion net profit in a quarter where elective procedures were essentially halted for several weeks.
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Come along and dive inside an Express Scripts PBM contract. It’s pretty wild.
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A pernicious example of a surprise medical bill from a "surgical assistant" led to this gem of a letter.
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HHS released its 2018 budget then took it down? Don't worry, gang. I saved a PDF in time. Enjoy:
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The amazing thing about these stories: So many hospitals are already swimming in cash, yet they decide to sue their patients anyway.
A mom took her 4-year-old daughter to the Children's hospital in Wisconsin.
She ended up with a bill for $2,242. She couldn't afford it.
The hospital took her to court, garnished her paycheck, and she fell behind on her mortgage.
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🚨 DOJ just sued Anthem, alleging fraudulent coding practices in Medicare Advantage. Link to full lawsuit in our story.
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Notable exceptions from today's stock market beating: Domino's (up 2%) and Teladoc (up 4%). Coronavirus apparently means staying indoors and video chatting with doctors about why we don't feel so hot from our new all-pizza diets.
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Hospitals, like
@ClevelandClinic
here, are arguing negotiated payments with insurers should not be aired publicly because, ya know what, the system is just too damn complex.
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The concept of job-based health insurance churn also has been highlighted often by
@MattBruenig
.
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