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Medicaid

You’re on A (Medicaid) Roll, Whether You Know It or Not

A new Health Affairs piece by Dong Ding, Benjamin Sommers, and Sherry Glied found that 30 percent of Medicaid enrollees in 2022—26.4 million of 88 million enrollees — did not know they had Medicaid coverage. By March 2023, Medicaid enrollment reached 94 million, likely increasing the number of people unaware they had Medicaid to nearly 30 million. The main reason for the explosion in Medicaid and unaware program enrollees: states did not conduct eligibility reviews for more than three years. This boosted insurers’ bottom lines, but it wasted real resources that could have gone to those who need Medicaid while inflating federal deficits.

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Medicaid

Nursing Bad Policy

On April 22, the Biden administration finalized a rule mandating minimum staffing levels for nursing homes. The controversial new rule is expected to cost the industry, federal and state governments, and patients more than $43 billion over 10 years. Key questions include: Who is paying for all this, and where are facilities going to find staff? Let’s explore the rule and the questions it raises.

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Private Health

Competing Complications

On April 23, the Federal Trade Commission (FTC) voted to approve a new final rule banning noncompete agreements (NCAs) across the entire economy with very limited exceptions. This is as big a deal in health care as anywhere else: According to the American Medical Association (AMA), NCAs affect between 37-45 percent of physicians, and the FTC argues in the rule that anywhere from 35-75 percent of hospitals are under its jurisdiction. The FTC also claims a potential $194 billion in spending reductions in the health care sector over the next decade. Let’s explore the details – and complications – of this final rule below.

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Private Health

Don’t Act Surprised

Imagine this: One day, you find yourself in a bad car accident that requires emergency surgery. The ambulance takes you to the hospital, which is fortunately in your network, as is the surgeon operating, but the anesthesiologist on call is not. Good news though – Congress passed the No Surprises Act (NSA), implemented in 2022, so you don’t have to pay any more than you normally would if the anesthesiologist was in-network. All that’s left is for your insurance company and hospital to fight over the difference. The bad news: The provider/payer fights are likely to cause your premiums to go up and make the provider market more concentrated, raising prices for everyone. How did this happen? Let’s explore below.

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