Comments on: Can Employer-sponsored Insurance Be Saved? A Review of Policy Options: Price Regulation https://chirblog.org/can-esi-be-saved-review-of-policy-options-price-regulation/ Blogging about health insurance coverage, insurance markets, and how people are affected by insurance reform Fri, 10 Mar 2023 17:43:20 +0000 hourly 1 https://wordpress.org/?v=6.4.4 By: February Research Roundup: What We’re Reading - Center on Health Insurance Reforms https://chirblog.org/can-esi-be-saved-review-of-policy-options-price-regulation/#comment-95561 Fri, 10 Mar 2023 17:43:20 +0000 http://chirblog.org/?p=7080#comment-95561 […] have a lower Medicaid share of revenue. As policymakers evaluate cost containment strategies like price regulation, data illustrating how payer mix relates to health system profitability will help guide their […]

]]> By: Rachel Schwab https://chirblog.org/can-esi-be-saved-review-of-policy-options-price-regulation/#comment-95429 Wed, 25 Jan 2023 20:05:36 +0000 http://chirblog.org/?p=7080#comment-95429 In reply to Jon Gabel.

Thank you for your comment. One of the most straightforward and easily implementable approaches to rate caps of this type is to build off of the Medicare system, for example setting caps at a percentage above Medicare’s rates. Since Medicare pays hospitals using the DRG (Diagnosis Related Group) system, this would require any insurers not already paying hospitals based on DRGs to move to that system. Alternatively, an insurer/hospital could demonstrate that the system being used and the rates paid under it satisfy the limits delineated by the caps.

]]> By: ERISA 101: The United States’ Hands-Off Approach to Regulating Employer Health Plans - Center on Health Insurance Reforms https://chirblog.org/can-esi-be-saved-review-of-policy-options-price-regulation/#comment-95421 Tue, 24 Jan 2023 20:44:13 +0000 http://chirblog.org/?p=7080#comment-95421 […] This financial threat is catalyzing a growing focus on the role employer-sponsored plans can play in health care cost containment. But under the current legal framework—the Employee Retirement […]

]]> By: Robert Messman https://chirblog.org/can-esi-be-saved-review-of-policy-options-price-regulation/#comment-95418 Mon, 23 Jan 2023 20:34:26 +0000 http://chirblog.org/?p=7080#comment-95418 Having studied health care costs as a finance professional and director and treasurer of Health Care for All Colorado Foundation with a team of doctors and managed my own care for multiple myeloma, I have concluded that our politicians have allowed health care to become a racket with wanton price gouging throughout. My private oncologist was bought out by a hospital and raised the price of my monthly chemo infusions from $12K to $30K, fortunately discounted and covered by Medicare/Medigap. Recognizing that most of the major insurers have engaged with Medicare fraud through their Advantage Plans, my conclusion is that the country’s only solution is to expand coverage by the only honest, efficient and effective insurer, Medicare, to the nation through a fair and sustainable financing that includes personal taxes in place of premiums, employer payroll taxes and a small national sales tax.

]]> By: Jon Gabel https://chirblog.org/can-esi-be-saved-review-of-policy-options-price-regulation/#comment-95417 Mon, 23 Jan 2023 19:20:19 +0000 http://chirblog.org/?p=7080#comment-95417 Nice Summary.
To regulate prices, insurers would need to pay hospitals on a per case difference. With fee-for service payment, it would seem impossible to monitor each service.

Do we know what percent of private hospital care is on a per case payment method?

In the ESI market, the vast majority of employees and retirees work for employers that self-insure, and therefore are not subject to state regulation.

]]> By: John Greene https://chirblog.org/can-esi-be-saved-review-of-policy-options-price-regulation/#comment-95416 Mon, 23 Jan 2023 18:42:25 +0000 http://chirblog.org/?p=7080#comment-95416 I somewhat disagree with the assertion that Medicaid payments help. This varies greatly by state and because of the lower reimbursement, there is a significant cost shift to private pay to make up the difference.

I share you concern with private equity and think we need to push for site neutral payment policies to combat the coding distortions towards hospital rates.

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