Health Care Round-Up: SCOTUS and ACA, Hospital Price Transparency, Medicaid Overcharges

ACA Survives Third Supreme Court Challenge:

For the third time since being enacted in 2010, the Affordable Care Act has survived a major challenge in the U.S. Supreme Court. By a wider margin than in the previous challenges in 2012 and 2015, with seven of the nine justices in the majority, the court ruled that the plaintiffs in the case - two individuals and 18 states - hadn’t suffered direct injury from the law giving them legal standing to challenge it.

The decision allowed the justices to sidestep the broader legal questions at the heart of the case: whether the ACA’s “individual mandate” requiring Americans to obtain health insurance or pay a financial penalty was constitutional and whether the rest of the law could stand without it.

A federal judge in Texas had declared the entire law invalid in 2018. The following year the U.S. Court of Appeals for the Fifth Circuit agreed that the individual mandate was unconstitutional, but it declined to rule on the validity of the rest of the law.

Those rulings, however, were nullified by the Supreme Court’s decision that the plaintiffs “failed to show that the challenged minimum essential coverage provision, without any prospect of penalty, will harm them by leading more individuals to enroll in these programs.” (NEW YORK TIMES, REUTERS, SUPREMECOURT.GOV)

Hospitals Not Complying with Federal Price Transparency Rule:

A federal rule that went into effect in January requires hospitals to publicly disclose the prices they charge for their services, including the rates they’ve negotiated with insurers and the discounted cash prices they offer to uninsured patients, as well as the prices for “shoppable services” that can be planned in advance, like lab tests and surgical procedures.

The Trump administration adopted the rule in 2019 with the aim of allowing consumers to shop around for the best deal and thereby driving down prices.

But according to a new study in JAMA Internal Medicine, most hospitals aren’t complying with the federal rule. Only 17 percent of the randomly selected hospitals in the study - and 25 percent of the 100 highest-revenue hospitals - were in full compliance with the rule. Hospitals have been more willing to provide shoppable services tools than to disclose their negotiated rates or cash prices.

The study’s authors offered a simple explanation for the hospitals’ lack of compliance.

“Compliance could be limited because the penalties for noncompliance are minimal (maximum $300 per day) and the costs of disclosure potentially great,” they wrote. (AXIOS)

Hospital Provider Cashing in on Trauma Centers:

Trauma team activation fees charged by HCA Healthcare, the nation’s largest hospital operator along with the U.S. Department of Veterans Affairs, can be as much as $50,000 per patient and 10 times more than what other hospitals charge. Such fees have made trauma centers a key element of HCA’s business model, helping the company double its stock price in three years. It has now opened such centers in over half of its 179 hospitals, and those centers now comprise 1 of every 20 nationwide. (KAISER HEALTH NEWS)

Conscience Clause Inserted into OH State Budget:

An amendment added to the Ohio state budget last week would let doctors, hospitals and health insurers refuse to provide or pay for medical services that violate their moral beliefs. The amendment, from Sen. Terry Johnson (R), would also grant medical providers immunity from lawsuits for refusing to provide services on such grounds.

With Republican supermajorities in both chambers of the Ohio Legislature, Mike Gonidakis, president of Ohio Right to Life, said he thinks the conscience clause will be part of the final budget, an outcome his organization fully supports.

“We are delighted that Sen. Johnson independently put the amendment in the legislation,” he said. “We think it's fantastic.”

But even if the conscience clause does become law, health insurers in the state may not take advantage of it.

“We believe the policy could prohibit individuals from getting the care they receive when they need it,” said Dan Williamson, spokesman for the Ohio Association of Health Plans. “It’s their business model to ensure people who are enrolled in plans get access to care.” (COLUMBUS DISPATCH)

Centene to Pay MS $55.5M for Medicaid Overcharges:

Centene Corp., the nation’s largest Medicaid managed care organization, has agreed to pay Mississippi $55.5 million to settle a lawsuit alleging that one of its subsidiaries overcharged the state’s Medicaid program for pharmacy benefits management. The settlement is one of the largest following an investigation by the state auditor’s office in the state’s history. (INSURANCE JOURNAL)

Federal Bill Would Permanently Expand Telehealth:

Legislation has been introduced in Congress that would permanently expand telehealth services under Medicare.

“It should not have taken a pandemic for Medicare to finally unlock the potential of telehealth services — and now we need to make sure that these vital telehealth services continue to be available to patients long after the COVID-19 pandemic is over,” said a statement from U.S. Sen. Jeanne Shaheen (D-NH), who introduced the Protecting Rural Telehealth Access Act with fellow Democratic U.S. Sen. Joe Manchin of West Virginia and Republican U.S. Sens. Joni Ernst of Iowa and Jerry Moran of Kansas. (ASSOCIATED PRESS)

MS Accuses Drug Companies, PBMs of Manipulating Insulin Prices:

Last week Mississippi became the first state in the nation to sue drug makers and pharmacy benefit managers for allegedly conspiring to inflate insulin prices. The state’s lawsuit claims drug companies benefited from an arrangement that “artificially” inflated insulin prices to secure placement on insurance formularies, and PBMs benefited from “secret” rebates from the drug makers. (STAT+)

Federal Judge Dismisses TX Hospital Workers’ Suit over COVID-19 Vaccination Mandate:

U.S. District Judge Lynn Hughes dismissed a lawsuit brought by 117 workers at Houston Methodist Hospital over its mandate that workers be vaccinated against COVID-19. Hughes found no merit in the workers’ claims that firing them for refusing to be vaccinated constituted wrongful termination and that the vaccines were experimental and dangerous. (INSURANCE JOURNAL)

— Compiled by KOREY CLARK