Few are paying attention to the cost curve and the potential for state to enact their own reform measures
IT'S NOT THE SAME
At the same time, private sector companies must bear all of these costs, yet somehow compete in the marketplace with the public option exempted from the costs and from any need to return a profit.
Other aspects of the structure, while not immediately identifiable as having a potential to increase private-sector costs, could have a significant effect on the way the private sector conducts the business of insurance. For instance, policies currently being debated might drastically alter provisions in antitrust regulation.
Currently, the private sector health plans and the business of insurance are regulated on a state-by-state basis, with the insurance industry benefitting from an antitrust exemption via the McCarran-Ferguson Act.
All of that may change, however. For instance, as of presstime, President Obama had indicated that Congress should revisit the McCarran-Ferguson Act and, specifically, provisions in that act exempting insurance companies from antitrust exposure.
There have also been discussions that a federal charter should be drawn up under which the federal government, not the individual states, should regulate insurance.
Finally, one aspect of the healthcare debate that has received less national attention, but is of great interest to the private sector, is the extent to which states may enact their own healthcare reforms.
Some states, for instance, have recently entertained vigorous debates related to regulation of minimum payments to doctors and hospitals and reforms to the small group and individual markets. And with all this activity, there is very little attention to the factors driving healthcare costs and almost nothing to address that in the proposed legislation.
Most proposals involve a provision prohibiting exclusions for enrollees' pre-existing conditions, which would essentially provide guaranteed issue insurance coverage. This too has the potential to increase costs.
This column is written for informational purposes only and should not be construed as legal advice.
Barry Senterfitt is a partner in the insurance industry practice of Akin Gump Strauss Hauer & Feld LLP in the firm's Austin, Texas, office.
Janet Farrer is an associate at Greenberg Traurig LLP, Austin, Texas.
AstraZeneca, Daiichi Sankyo Submit New BLA for Datopotamab in Lung Cancer
November 12th 2024After feedback from the FDA, the companies have voluntarily withdrawn the previous biologics licensing application for datopotamab deruxtecan for patients with advanced or metastatic nonsquamous non-small cell lung cancer.
Read More
In this latest episode of Tuning In to the C-Suite podcast, Briana Contreras, an editor with MHE had the pleasure of meeting Loren McCaghy, director of consulting, health and consumer engagement and product insight at Accenture, to discuss the organization's latest report on U.S. consumers switching healthcare providers and insurance payers.
Listen
Breast Cancer Patients Desire Early, Frequent Financial Screening
November 11th 2024Current financial screening procedures in the United States may need to change, according to recent research done by Laila Gharzai, M.D., LLM, from the Department of Radiation Oncology at Northwestern University.
Read More
In our latest "Meet the Board" podcast episode, Managed Healthcare Executive Editors caught up with editorial advisory board member, Eric Hunter, CEO of CareOregon, to discuss a number of topics, one including the merger that never closed with SCAN Health Plan due to local opposition from Oregonians.
Listen
The Takeaway From Study of Midlife MS Patients: Don't Stop Disease-Modifying Therapy
Published: November 11th 2024 | Updated: November 11th 2024People with multiple sclerosis (MS) often stop taking disease-modifying therapy as they transition from relapsing-remitting MS to secondary progressive MS. This study shows that people who stop stop disease-modifying therapy have higher hospitalization rates and more visits to the emergency room.
Read More