Stories by Caitlin Owens

How to crack down on surprise medical bills

A new Brookings Institution paper outlines ways to prevent patients from receiving surprise medical bills — particularly the patients who are unlikely to know their doctor is out-of-network.

The big picture: The paper argues that any solution must take into account that health care settings often are not normal markets.

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Patients either aren't in a position to make choices (like in an emergency room), or don't have a choice of doctor (like anesthesiologists or radiologists in a hospital).

Data: Brookings; Chart: Harry Stevens/Axios

Details: The paper recommends 2 fixes:

States could cap out-of-network provider rates in these situations, limiting patients' cost-sharing to what they'd normally pay for in-network services.
Separate billing would be banned for out-of-network doctors at in-network facilities. Insurers would instead pay the hospital a certain amount and then that facility would pay providers for their services.

Go deeper: Why ending surprise medical bills is harder than it looks

surprise medical bills

Caitlin OwensFeb 20

Study: FDA, drugmakers let opioid misuse slide

Oxycodone pain pills. Photo: John Moore/Getty Images

Federal regulators and fentanyl manufacturers didn't take action when it became clear that highly potent fentanyl products were being inappropriately prescribed to as many as half of the patients taking them, according to a new study in the Journal of the American Medical Association.

How it works: The type of fentanyl in question is approved by the Food and Drug Administration only for adult cancer patents who have already built up a tolerance to less potent opioids.

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An FDA monitoring program requires that all doctors, pharmacists and patients involved in prescribing, dispensing and using these drugs certify that they understand their proper use.
The FDA also requires manufacturers to demonstrate that they are in compliance with the rules.
In surveys by drugmakers, most doctors, pharmacists and patients indicated that they understood how these fentanyl drugs were supposed to be used, but some providers were prescribing them for off-label use anyways.

The bottom line: In 2016, drugmakers found that between 34.6% and 55.4% of patients receiving this kind of fentanyl did not have opioid tolerance, meaning the drug was being misused.

Despite this information, neither the FDA nor drugmakers took action to end the inappropriate prescribing.

Go deeper: Opioids app aims to lower response times for overdose victims

Opioid epidemic

Caitlin OwensFeb 19

Judges say U.S. owes ACA insurers billions

The Affordable Care Act's cost-sharing reduction payments saga continues: The Trump administration ended the payments in 2017, Congress failed to fund them, and now 3 judges have said the government is still on the hook for the payments.

The big picture: "If their decisions stand, insurers could recover roughly $12 billion a year, every year, until Congress intervenes to stop the bleeding," Nicholas Bagley writes in the Incidental Economist.

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While Congress never appropriated the funds, which was the basis of a different lawsuit, the ACA still required the U.S. government to pay the subsidies to insurers.
When the payments stopped, insurers sued, and the cases are ongoing in the Court of Federal Claims.

The bottom line: It's looking unlikely that any final decision, if insurers win, will take into account that insurers have made up for the lost subsidy money by raising premiums and, thus, premium subsidies — the ACA's other form of government assistance.

The 3 judges have either said or suggested that this won't impact their decision.
That means that the possibility of insurers participating on exchanges getting a multi-billion dollar windfall has increased.

Go deeper: Health insurer loses $73 million after Trump halts ACA subsidies

Affordable Care Act