Over the years our firm has periodically sent out a newsletter to advise our clients and friends about recent changes, trends and happenings in the healthcare field.  We are pleased to share the August issue of our newsletter with you.  Periodically, we will do our best to share with you "insight" that we find helpful in our practice and that should be helpful for you in yours. 

August 4, 2017

St. Louis Post-Dispatch

A few health care industry executives have sent a letter to Missouri's insurance director, asking her to take a "hard and earnest look" at Anthem's emergency room policy and whether it is legal.

This summer, Anthem began warning members that if they were to go to the ER for a minor ailment, then the patients would be stuck with the entire bill. Anthem said it would no longer cover emergency visits for such ailments as the common cold amid what Anthem said is an increasing trend of unnecessary ER visits by its members.

"We think this policy is unfair to policyholders, and downright dangerous for patients," according to a letter dated July 27 and addressed to Insurance Director Chlora Lindley-Myers.

The letter was signed by Herb Kuhn, CEO of the Missouri Hospital Association; Dr. Jonathan Heidt, president of the Missouri College of Emergency Physicians; Brian Bowles, executive director of the Missouri Association of Osteopathic Physicians and Surgeons; and Thomas Holloway, executive vice president of the Missouri State Medical Association.

The signers allege that Anthem's policy violates the "prudent layperson" standard. In other words, there are legal protections for people with limited medical knowledge who need what they believe is immediate care.

That standard is "critically important," the letter said. "Is that chest pain just unwelcome indigestion, or is it a life-threatening cardiac event?"

The letter calls the policy by Anthem a way to shift costs from the insurer to the patient and says it will have a "chilling effect" on patients who will forgo care, worried they may be on the hook for the entire bill.

Editorial: Looking Beyond the Obamacare Debate to Improve Health Care

By The Editorial Board, New York Times

August 26, 2017 

Now that Republicans in Congress appear to have at least temporarily abandoned their crusade against the Affordable Care Act, it seems like a good time for lawmakers to come up with plans to fulfill their promises to increase access to health care and to lower costs.

Let's stipulate up front that congressional leaders and President Trump are unlikely to lead that effort, given that they narrowly failed to take health insurance away from millions of people. This conversation would need to be led by senators who have committed to a bipartisan approach, and by state governments, some of which have already begun to take action.

Change might not come soon enough for the 29 million people without health insurance or the many millions who struggle to afford high premiums, deductibles and other health costs. But even the A.C.A., the 2010 health law also known as Obamacare, was the product of many years of spadework and was based on a Massachusetts health reform bill signed into law by Gov. Mitt Romney in 2006.

Obamacare has helped 20 million people gain access to insurance, and it appears to have helped slow the growth in health care costs. But even former President Barack Obama has said that there is still work to be done. The United States spends much more on medical care than other rich countries, like Britain, Australia and the Netherlands, according to a recent Commonwealth Fund report, yet its citizens live shorter lives and suffer from more illnesses and injuries than people in other industrialized nations.

One option that appears to have gained support among the public is a single-payer system, which proponents like Senators Bernie Sanders and Elizabeth Warren call "Medicare for All." A Kaiser Family Foundation poll found in June that 53 percent of Americans favor such a system. This was up from 46 percent, according to an average of seven polls conducted in 2008 and 2009. But moving to a single-payer system from one dominated by employer-paid health coverage would be a big leap, and in any case the political climate is clearly not ready for it. Many Democratic voters as well as party leaders like Representative Nancy Pelosi and Senator Chuck Schumer have been reluctant to embrace the idea, and, no surprise, most Republican voters and lawmakers oppose it.

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