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What We're Reading: Senate Dems Urge ACA Action; Doctor Shortage in Puerto Rico; Anthem Reverses Denial Policy

AJMC Staff
Senate Democrats are urging Republicans to agree to a resolution that would allow the Senate to intervene in a lawsuit challenging the legality of the Affordable Care Act; the after effects of Hurricane Maria are helping to fuel an exodus of physicians from Puerto Rico; a new congressional report suggests Anthem has effectively reversed a policy denying emergency department claims after the fact. 

Senate Democrats Urge Republicans to Agree to Resolution About the ACA

Senate Democrats are urging Republicans to agree to a resolution that would allow the Senate to intervene in a lawsuit challenging the legality of the Affordable Care Act (ACA), The Hill reported. The resolution would allow the Office of Senate Legal Counsel to intervene in a case brought by Republican attorneys general that argues the ACA is now unconstitutional since Congress repealed the 2010 law's individual mandate last year. Although Republicans criticized the Justice Department decision not to intervene, it is unlikely that Republicans will agree to the request.

 

Existing Phyisician Shortage in Puerto Rico Worsened By Hurricane Maria

The after effects of Hurricane Maria are helping to fuel an exodus of physicians from Puerto Rico, Kaiser Health News and PBS NewsHour reported. From 2006 to 2016, the number of doctors on the island declined from 14,000 to 9000, according the College of Physicians and Surgeons of Puerto Rico. The situation is worsened by an ongoing financial crisis and low payments from health insurers. Nearly 2 in 3 children—and half of all Puerto Ricans—rely on Medicaid, and the poverty-stricken territory receives far less money from Congress to pay doctors than do low-income states. Pediatricians can double their salary by moving to the United States. 

 

Anthem Reverses Most of Its Emergency Department Claim Denials, Report Finds

A new congressional report suggests Anthem has effectively reversed a policy denying emergency department claims after the fact, The New York Times reported. The insurer initially rolled out the policy in 3 states, warning members that if it determined claims were for minor ailments, the bills might not be paid. In 2017, Anthem denied more than 12,000 claims on the grounds that the visits were “avoidable,” but when patients challenged their denials, Anthem reversed itself most of the time, according to data the insurer provided to Senator Claire McCaskill, D-Missouri.

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