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What We're Reading: Ramifications of DOJ Stance in ACA Case; Nursing Home Patients at Risk; Insurers Eye ED Bills

AJMC Staff
The Department of Justice (DOJ)’s legal brief in the Texas case against the Affordable Care Act (ACA) could have far-reaching ramifications besides ending protections for people with pre-existing conditions; 1 in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions; Anthem, Blue Cross Blue Shield of Texas, and UnitedHealth Group are among insurers scrutinizing the cost of emergency department (ED) visits.

DOJ Action in ACA Lawsuit Highlights Insurance Protections at Stake

The Department of Justice (DOJ)’s legal brief in the Texas case against the Affordable Care Act (ACA) could have far-reaching ramifications besides ending protections for people with pre-existing conditions, The New York Times reported. The changes, if successful, could change guaranteed issue and community rating provisions, which in turn would make insurance harder to get for individuals who buy their own insurance or get it through a small employer, as well as potentially making it unaffordable for many middle-income people who receive financial assistance with their premiums.

 

Nursing Home Patients at Risk for Boomerang Hospitalizations

One in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions, such as dehydration, infections, and medication errors, Kaiser Health News reported. Citing federal records, the article noted that such rehospitalizations occur 27% more frequently than for the Medicare population at large, as nursing homes have been unintentionally rewarded by colliding government payment policies, which financially incentivized the transfers.

 

Insurers Increasingly Looking at ED Bills 

Anthem, Blue Cross Blue Shield of Texas, and UnitedHealth Group are among the insurers scrutinizing the cost of emergency department (ED) visits, Politico reported. ED care has rarely been subject to denials, but care is being billed at more expensive codes. ED spending doubled between 2009 and 2016, even though the number of patients treated remained flat, according to an analysis of insurer claims data recently published by the Health Care Cost Institute.

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