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Articles by Galen Institute

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SPOTLIGHT: Grace-Marie Turner, Founder, President and Trustee, Galen Institute, Inc. May 21, 2015

U.S. Domestic Medical Travel, May 20, 2015

U.S. Domestic Medical Travel (USDMT): What are your thoughts on patients traveling for care to Centers of Excellence (COEs) – domestic or international?

Grace-Marie Turner (GM): Today, health plans, employers and individuals are looking for ways to maximize the value of their spending on healthcare and coverage. With the rising cost of medical treatment, some individuals and companies are looking beyond traditional boundaries of local hospitals and providers to send employees to Centers of Excellence (COE) domestically and abroad for high-quality, cost-effective care.

USDMT: Are COEs reserved for high-profile hospitals such as Cleveland Clinic, or can other facilities compete in this arena?

GM: COEs do not necessarily have to be “mega-systems.” It is important to evaluate hospital networks and individual facilities on their competitive advantages.

Two examples: physician-owned hospitals that focus on delivering high-quality, efficient care for specific medical procedures in which they have particular expertise; and smaller entities that focus on procedures in which they have skills and expertise. Both can have a major market advantage.

USDMT: Are physician-owned hospitals and surgi-centers able to excel because they aren’t burdened by Medicaid and the uninsured?

GM: Some physician-owned hospitals and surgi-centers are able to offer urgent care, but most don’t have the capacity to provide the full range of services required of an emergency room. Nevertheless, they do try hard to be responsive to the needs of their communities without going beyond their skills and resources. Community hospitals that have large Medicaid and uninsured populations resent these practical limitations and have successfully lobbied to curtail the growth of these specialty hospitals. But the mega-hospitals should see them as part of the mosaic of providers serving communities up to the limits of their capacity and expertise.

USDMT: Is bundled pricing the wave of the future?

GM: As consumers become increasingly involved in making personal healthcare decisions, they are going to seek both more and better information, as well as greater transparency and simplicity.

Bundled rates appeal to consumers because they offer certainty, and in turn, shift the financial responsibility to the facility in case something goes wrong.

There will continue to be providers and medical facilities that operate on the traditional fee-for-service service model. The more that consumers are involved, however, the greater the appeal of bundled rates.

USDMT: How is the issue of pricing and quality transparency unfolding?

GM: Our health sector has been opaque to consumers for many decades, and we still have a long way to go to figure out how to bring consumer transparency into this industry. Of course, there are many people and businesses offering services based upon a plethora of transparency concepts because they know there is a high demand for valuable information.

Oddly enough, one of the major pushes for transparency stems from the healthcare law. Today, there are consumers who have $10,000 deductibles before their insurance policy will even pay a penny, and these individuals want to know, “If I need a procedure, how much is it going to cost me?”

At this point, I don’t see a single model for providing accessible data rising above the others, but I think that this industry will evolve as more and more players enter this space, and as we begin to see which ones offer information that connects with consumers.

Continued on U.S. Domestic Medial Travel

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Guy Benson: Obamacare Updates: Tale of Fail from Coast to Coast May 21, 2015

By Guy Benson

Town Hall, May 21, 2015

It’s time now for your monthly reminder that Obamacare neither “working in the real world,” “proving its critics wrong,” nor “blowing away expectations:”

Colorado (higher taxes): “The Connect for Health Colorado board of directors voted unanimously Thursday to raise the fees it charges on health insurance policies to bolster its finances as federal grants run out later this year. The state health insurance exchange raised the fee on 2016 plans purchased through its marketplace from the current 1.4 percent of premiums to 3.5 percent, the same rate charged on the federal exchange…Although insurance carriers pay the fees to the exchange, they acknowledge fees are passed on to consumers in one form or another…The fee increases are projected to help bring revenues to about $40 million in fiscal year 2015-16. It would cover operational expenses, but not capital costs, such as improving the computer system…”

Kentucky (hurting hospitals):  “While Kentucky has gained national prominence as the only Southern state to fully embrace Obamacare, its hospitals say the law has left them facing billions of dollars in cuts and forced them to lay off staff, shut down services and worry for their financial health and, in some cases, survival. The Kentucky Hospital Association outlined its concerns in a report released Friday called ‘Code Blue,’ saying payment cuts to hospitals are expected to reach nearly $7 billion through 2024. ‘Kentucky hospitals will lose more money under the Affordable Care Act than they gain in revenue from expanded coverage,’ it said, experiencing a net loss of $1 billion by 2020…Hospitals are suffering a net loss, officials said, partly because about three-quarters of newly-insured Kentuckians signed up for Medicaid, which reimburses hospitals less than it costs to treat patients.”

Continued on Town Hall

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Doug Badger: Let States Exchange Obamacare For Something Better May 4, 2015

By Doug Badger

A Brief Case, May 5, 2015

In the 34 states that did not establish Obamacare exchanges, Governors nervously await a Supreme Court ruling that could throw their health insurance markets into chaos. Meanwhile, many of the Governors who did establish exchanges are regretting their decision.

More than five years after its enactment, Obamacare has proven a bitter brew for many states.  Nowhere is this more evident than in health care exchanges. 

Exchanges began as a figment of Washington’s imagination.  The fertile minds of health policy analysts had conjured a bewildering system of cross-subsidies that involved charging young people unfairly high premiums to reduce premiums for older workers, overcharging healthy people to subsidize unhealthy ones, taxing middle income people to subsidize lower-income people (what the President likes to call “middle class economics”), cutting Medicare to enlarge Medicaid, taxing the uninsured for being uninsured, taxing employer-sponsored health plans and taxing employers for not sponsoring health plans, all garnished with tens of billions in new taxes on medicines, medical “devices” (everything from tongue depressors to defibrillators) and, of course, on health insurance itself.

Continued on A Brief Case

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Fraser Institute: More than 52,000 Canadians left the country for medical care in 2014 May 1, 2015

Fraser Institute, March 17, 2015

VANCOUVER—Large numbers of Canadians continue to venture abroad to seek medical care, according to a new study released today by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

The study, Leaving Canada for Medical Care, 2015, estimates 52,513 Canadians left the country to receive non-emergency medical treatment in 2014, an increase of 26 per cent compared to the previous year.

“These figures are not insubstantial. They point to an increasing number of Canadians who feel their medical needs aren’t being met in Canada,” said Bacchus Barua, Fraser Institute senior economist and the study’s co-author.

The study draws upon data from the Fraser Institute’s annual Waiting Your Turn study – a national survey of physicians across Canada in 12 major medical specialties. In the 2014 survey, physicians specializing in internal medicine procedures — such as colonoscopies, gastroscopies and angiographies — reported the highest number of patients leaving Canada for treatment (6,559). Meanwhile, neurosurgeons reported the highest proportion of patients (2.6 per cent) who travelled abroad for medical care.

While there is no definite data on why Canadians go elsewhere for medical attention, there are several possible reasons: Some patients may have been sent abroad because of a lack of available medical resources; some may have chosen to leave Canada in response to concerns about medical quality; while others might have left because of lengthy wait times.

Continued on the Fraser Institute

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Tom Howell: No free ride: Two-thirds of Obamacare recipients had to repay subsidies to IRS April 28, 2015

By Tom Howell Jr.

The Washington Times, April 28, 2015

Most filers who received government subsidies to buy Obamacare plans had to pay money back to the IRS this year, according to an H&R Block analysis released Monday that looks at the health law’s first full tax season.

The tax-prep giant studied its own massive customer base and concluded that two-thirds of its filers who got subsidies from Obamacare were overpaid during the course of the year, and owed money back to the IRS on the April 15 deadline.

They repaid $729 on average, cutting the average refund by about a third.

Under the original terms of the Affordable Care Act they would have been capped at repayments of just $250, but Congress went back and lifted those caps, ensuring that the government could “claw back” most of the overpayments, and saving billions of dollars that have gone to other government priorities.

This tax season marked the first time the IRS has had to enforce its part of Obamacare — the tax penalties levied on those who lacked insurance, and the tax subsidies paid to Americans who qualified for help in buying plans.

Continued at The Washington Times