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What We're Reading: MA Plans Denying Claims; Poor Skipping Care; GOP Candidates Endorse Last-Minute Measures

AJMC Staff
Medicare Advantage (MA) plans have been improperly denying many medical claims to both patients and physicians; low-income people in states that haven't expanded Medicaid are much more likely to forgo needed medical care, citing costs, than those in other states; dozens of vulnerable House Republicans have recently signed on to bills or resolutions in support of protecting pre-existing conditions.

MA Plans Improperly Deny Payments, Report Finds

Medicare Advantage (MA) plans have been improperly denying many medical claims to both patients and physicians, according to a report from the HHS inspector general. The New York Times reported that the report cited an incentive to deny claims in an effort to increase profits at the private insurers, which now cover more than one-third of all Medicare beneficiaries. The findings come as administration officials are creating new incentives to enroll in MA plans. Some experts predict that the share of Medicare patients in the private plans could grow to one-half in a few years.

 

Nonexpansion States See More Low-Income Patients Skipping Care

Low-income people in states that haven't expanded Medicaid are much more likely to forgo needed medical care, citing costs, than those in other states, according to the Associated Press. The nonpartisan Government Accountability Office worked with the National Center for Health Statistics to analyze federal survey data from 2016. Nearly 20% of low-income people in nonexpansion states said they passed up needed care in the past 12 months, compared with 9.4% in states that expanded the program. Other findings noted that more people in nonexpansion states skipped prescribed medication or did not seek out specialist care compared with those in expansion states.

 

House GOP Members in Tight Races Attempt to Show Support For Pre-Existing Protections

Dozens of vulnerable House Republicans have recently signed on to bills or resolutions in support of protecting pre-existing conditions. The Hill reported that the measures are more of an eleventh-hour political statement. They aren’t expected to pass or even get a markup at the committee level. Thirty-two of the 49 GOP incumbents in races deemed competitive by the nonpartisan Cook Political Report have backed congressional measures on pre-existing conditions in the past 6 weeks.

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