Rice University's Baker Institute for Public Policy has issued a new report on hospital finances. The report, entitled Prices Versus Costs: Unpacking Rising US Hospital Profits, compares "the commercial operating costs, net patient revenue from commercial patients, and commercial operating profits of hospitals with different price levels to examine if higher prices are charged to cover higher costs, or instead to generate higher profits."They concluded:"We find that belonging to the highest inpatient price quartile is associated with 17% higher costs per adjusted discharge and 36% higher commercial revenue per adjusted discharge. These differences result in a 69% higher commercial operating…
Healthcare in the US Becoming Less Affordable
July 23, 2024 The ability of Americans to access affordable healthcare has declined in recent years, according to a new report by Gallup and the nonprofit West Health.According to the report, entitled Tracking Healthcare Affordability and Value: The West Health-Gallup Healthcare Affordability Index and Healthcare Value Index:"Cost security among U.S. adults has dipped to its lowest level in 2024, down six points since 2022 to just 55%. This decline is driven primarily by adults aged 50 to 64 (down eight points to 55%) and 65 and older (down eight points to 71%). Younger adults under the age of 50, after…
NY Times Investigative Series on Pharmacy Benefit Managers and High Prescription Drug Costs
June 21, 2024 The New York Times has begun a new series about how pharmacy benefit managers prioritize their own interests at the expense of patients, employers, and the public. Part one, entitled "The Opaque Industry Secretly Inflating Prices for Prescription Drugs," was published June 21, 2024. According to the Times:"The three largest pharmacy benefit managers, or P.B.M.s, act as middlemen overseeing prescriptions for more than 200 million Americans. They are owned by huge health care conglomerates — CVS Health, Cigna and UnitedHealth Group — and are hired by employers and governments."The job of the P.B.M.s is to reduce drug…
Journalism Organizations Plan Webinar Series on Business of Healthcare
February 14, 2024 The Association of Health Care Journalists and Investigative Reporters & Editors, with the support of the NIHCM Foundation, are hosting a series of free webinars for journalists on the business of healthcare.The series is entitled "Follow the Money: The Business of Health Care." The first webinar, “Using HospitalFinances.org and other tools to tell money stories,” will be 1-2 pm eastern on Wednesday, March 27. Here's the rest of the schedule:April 24, 1-2 pm eastern: “Digging into pricing: What does health care cost?”June 26, 1-2 pm eastern: “Coverage 101: Understanding private health insurance and Medicare/Medicaid plus a new tool for…
US Healthcare Spending in 2022: $4.5 Trillion
January 2, 2024 According to the federal Centers for Medicare and Medicaid Service (accessed January 2, 2024): "US health care spending grew 4.1 percent to reach $4.5 trillion in 2022, faster than the increase of 3.2 percent in 2021 but much slower than the rate of 10.6 percent in 2020. The growth in 2022 reflected strong growth in Medicaid and private health insurance spending that was somewhat offset by continued declines in supplemental funding by the federal government associated with the COVID-19 pandemic."In a related article published in the journal Health Affairs ("National Health Expenditure Accounts Team. National Health Care…
Baker Institute: More Texans Insured Thanks To The ACA
November 23, 2023 Rice University's Baker Institute for Public Policy reports that more Texans have health insurance coverage now thanks to the Affordable Care Act. According to the Institute's November 14 issue brief, entitled Looking at the Numbers: 10 Years of Data on the Affordable Care Act Reveal Benefits for Texans:"When the ACA was enacted in 2010, Texas had the highest uninsured rate (23.7%) in the country — 5.6 million people. The Texas Health and Human Services Commission estimated that full implementation of the ACA could cut the uninsured rate in half, with 36% or 2 million people gaining subsidized…
Update: Medicare Drug Price Negotiations Moving Forward
Negotiations between the federal government and the manufacturers of ten prescription drugs over prices for the Medicare program are moving forward. The American Hospital Association reported on Oct. 3, 2023 ("CMS: Makers of selected drugs agree to participate in Medicare price negotiation"):"The companies that make the first 10 Medicare Part D drugs selected to participate in the Medicare Drug Price Negotiation Program have agreed to participate in the program’s price negotiations, the Centers for Medicare & Medicaid Services announced. CMS in August selected 10 high-cost drugs for the first negotiation cycle, which will run until next August for prices effective in…
Medicare and Medicare Advantage
Medicare is a complicated system that mixes public and private insurance providers. As reported by the Scripps News Service on Oct. 21, 2022 ("Why Is Medicare So Complicated?"):"By the government's last count in 2021, 64 million adults were enrolled in Medicare. But that doesn't mean it's simple to navigate. The Medicare maze is growing more entangled over the years, as Congress adds new benefits, exceptions, and penalties."As KFF explains in its Sept. 18, 2023 issue brief, What to Know about the Medicare Open Enrollment Period and Medicare Coverage Options:"People with Medicare may choose to receive their Medicare benefits through traditional…
Medicare Open Enrollment Season Runs October 15 – December 7
Open enrollment season for Medicare is October 15 through December 7. According to the federal Centers for Medicare and Medicaid Services (last accessed Oct. 15, 2023):"Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs."As KFF explains in its brief on Medicare open enrollment and plan options including Medicare Advantage plans, What to Know about the Medicare Open…
List of Drugs For Which Medicare Will Negotiate Prices Announced
September 1, 2023 On August 30, 2023, Kaiser Health News reported ("5 Things to Know About the New Drug Pricing Negotiations"):"The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ever-rising drug prices for seniors and, eventually, other Americans."Under the 2022 Inflation Reduction Act, Congress gave the federal government the power to negotiate prices for certain high-cost drugs under Medicare. The list of drugs selected by the Centers for Medicare & Medicaid Services will…