Expiration Of Healthcare Subsidies Will Have Domino Effect, Leading To Higher Prices And Increased Medical Debt

The Burden of Medical Debt – Section 3: Consequences of Medical Bill  Problems – 8806 | KFFSource: Healthcare Dive, by Heather Korbulic

The COVID-19 pandemic forced the United States to cope with a health insurance crisis it didn’t anticipate. Congress and the Biden administration responded by enacting policies to expand access to subsidized private health plans sold through Affordable Care Act exchanges.

The results were nothing short of spectacular: Fewer than 10% of Americans are uninsured, compared to nearly 22% in 2010. In addition, a record 14.5 million consumers are enrolled in a state health insurance exchange plan.

However, unless Congress takes action, the subsidies will expire at the end of the year, and millions of Americans will experience dramatic price increases, become uninsured and likely accrue medical debt.

The American Rescue Plan (ARP) enabled consumers to enjoy lower premiums and access to premium tax credits regardless of income. This made health insurance more affordable for individuals and families, which led to a record 21% increase in public health exchange enrollment compared to prior coverage years.

State-based exchanges enrolled an additional 600,000 individuals, according to the National Academy for State Health Policy, which also reported the average premium savings ranged from 7% to 47% across the state exchanges. Further, 20% or more of enrollees are paying less than $25 per month for coverage in at least eight states. It is a significant achievement to make health insurance affordable for those who once considered coverage financially out of reach.

Returning consumers can even save, on average, 40% off of their monthly premiums because of enhanced tax credits in the ARP, according to the CMS. These changes are possible because the federal government reduced the salary ceiling for tax credits, recognizing a universe of low and middle-income people who earned too much to qualify for Medicaid but found the prices of most insurance plans out of reach.

In some cases, the credits saved individuals thousands a year. The cost, for instance, of a “silver” health plan is currently $390 a month with subsidies for individuals earning $55,000 annually, down from $560 a month.

Unfortunately, those cost savings may end, leaving individuals with the hard decision of either paying for coverage or paying for basic necessities. More often than not, the latter wins out. Securing insurance through an employer isn’t always a better (or even viable) option, since premiums in employer-sponsored plans increased 3.6% in 2021 and 3.9% in 2020, according to the Urban Institute.

California Health Care Workers To Get Bonuses Of Up To $1,500 Through Newsom’s Budget Deal

CA legislature OK's Newsom bonuses for health care workers | The Sacramento  Bee

Source: The Sacramento Bee, by Cathie Anderson

Taxypayer-funded retention bonuses are indeed coming to California’s frontline health care workers after Gov. Gavin Newsom and legislative leaders reached a budget deal Monday setting aside money to thank medical professionals who have worked through the COVID-19 pandemic.

Full-time workers stand to get the biggest potential payments, up to $1,500: up to $1,000 from the state of California and up to $500 in a match from their employers, according to the text of Assembly Bill 184.

Part-time workers will get as much as $1,250, a maximum of $750 of which comes from the state and $500 from their employers.

Physicians will receive up to $1,000 from the state. Managers and supervisors are ineligible for the payouts.

The bonuses will go not only to workers at general acute-care hospitals, government-operated hospitals, skilled nursing facilities and physician practice groups but also to employees at acute psychiatric hospitals, many nonprofit clinics, hospital outpatient clinics, and at any heath facility owned or operated by the state of California or any state department.

“The Legislature finds and declares that stability in the California health care workforce will further its efforts to manage the COVID-19 pandemic and address other public health issues that face Californians,” legislators wrote in laying out their rationale for the bonuses. “Providing California health care workers in 24-hour-care facilities with retention payments … will advance California’s effort to promote stability and retention in California’s health care workforce.”

Legislators noted that the size of the individual payments could drop, depending on how many people take part in the bonus program. They have set aside $1.3 billion for the purpose, and they also provided instructions for a dispute process if physicians or workers feel they have been shortchanged, first requiring them to appeal to their employers before seeking assistance from state agencies or the courts.

Any employer that willfully withholds bonuses is liable to the employees for the unpaid amount and interest, and they may have to pay the employees’ legal fees.

Anthony Cava, a spokesperson for the Department of Health Care Services, said the agency is still working out the operation details of this effort. He could not answer questions about when the money would be distributed.

Full-time employees must have worked at least 400 hours in person and part-time workers at least 100 hours at a facility over a 91-day period in 2022. The state department will determine that employment window after the legislation is enacted.

Employers must pay out funds within 60 days of receiving them and cannot use the funds to cover or replace other payments owed to employees or physicians.

Employers and physician organizations have to report names, addresses and other information for those receiving the payments. The measures are intended to ensure that neither employees nor doctors receive more than one retention bonus, even though they may work at more than one eligible facility.

AHA Wants Congress To Pressure CMS To Reverse Updates For Inpatient Payment Rule

CMS issues first price transparency fines to 2 Georgia hospitalsSource: Fierce Healthcare, by Robert King

The American Hospital Association (AHA) is turning to lawmakers to pressure the Biden administration to change “woefully inadequate” payment rates proposed for next year.


The AHA sent a letter Friday to congressional leaders surrounding the proposed Inpatient Prospective Payment Systems (IPPS) rule, which sets inpatient rates for next year. The hospital lobbying group charged that facilities are facing major challenges not just from the pandemic.

“Historic inflation has extended and heightened the already severe economic instability brought on by the pandemic resulting in razor-thin operating margins from massive surges in input costs, including a struggling workforce, drug costs, supplies and equipment,” the letter said.


The Centers for Medicare & Medicaid Services (CMS) had proposed a market basket update of 3.2% to Medicare payments for the 2023 federal fiscal year that begins this fall. This was on top of a 2.7% payment update for 2022. The proposed rule released in April calls for a proposed 0.4 percentage point productivity adjustment.

AHA contends that the market basket and productivity update don’t reflect the major inflation jump and growth in expenses.

“More recent data shows the market basket for [fiscal year] 2022 is trending toward 4%, well above the 2.7% CMS actually implemented last year,” the group wrote. “Additionally, the latest data also indicate decreases in productivity, not gains.”

Health Care Startups Turn to ‘Coaches’ to Help Patients Cope and Monitor Treatment

Northwestern in the News - Northwestern Now

Source: Kaiser Health News, by Darius Tahir

In 2011, Sean Duffy and Adrian James were sitting in San Francisco’s Dolores Park debating what to call some workers at the company they founded, Omada Health.

Omada, which launched that year, provides virtual treatment for chronic conditions. The company addresses the conditions through a team of employees — some traditional clinicians and others meant to give encouragement to patients as they manage the day to day of hypertension, prediabetes, and other conditions. This second group was crucial, they thought. The founders ended up asking patients what title to use.

Was this person a “concierge”? Patients thought that sounded like someone who helped with their bills. A “guide”? To what destination? The founders settled on “coach.” Patients liked the term: It suggested someone who could give support and make them “feel less alone,” Duffy said, as they dealt with their health challenges.

This decision was an early marker in an eventual tech company trend. Since then, dozens of similar startups focused on health coaching have emerged, often backed by big bucks. A review by KHN — of news releases, the industry database Crunchbase, and sites like LinkedIn — found nearly 50 companies with almost $7 billion in venture capital funding.

These startups offer people or software to provide motivation, direction, or moral support for managing what goes awry with the human body, including chronic conditions, musculoskeletal ailments, obesity — even attention-deficit/hyperactivity disorder and eczema. Business models vary. Some startups take payments directly from consumers; “anti-diet” app Wellory asks for $45 a month. Other startups get monthly per-member funding from companies to offer regular coaching for their employees. Some services tout 24/7 access and average connection times of 60 seconds. With some, coaches escalate serious issues to more highly credentialed clinicians.

The enthusiasm behind coaching is, on its face, a curious turn for an industry that likes to boast of its billion-dollar pills and spooky-sophisticated artificial intelligence.

“As these digital health startups got going, they realized technology is not enough to drive change,” explained Michael Yang, the managing partner at investors OMERS Ventures, who has invested in coaching startups. Patients might need to eat better, follow the physical therapy plan, talk through emotional turbulence, and more.

Coaches — whether they’re people or software — can support patients between formal visits to the doctor. That kind of encouragement can be important for sticking to a care plan — a critical thing in a world where good habits mean a lot for keeping healthy. Whether a patient needs a team to assist with the physical aspects of recovering from orthopedic surgery or help avoiding triggers for behavioral health conditions, these coaching companies are an app or a website away.

“The model has become extremely de rigueur,” Yang said. At many startups, coaches are “doing the lion’s share of the labor.”

Still, many people in the health care industry are ambivalent about this trend. Some think it adds a human touch to a part of the economy that can be defined by brusque doctors and incomprehensible bills. Others wonder whether it’s simply a way to leverage cheap labor.

Supporters say coaches get deeply involved, even performing tasks that would go undone otherwise. “We need alternative workforces to fill in some of these gaps,” said Omada’s Duffy. At Omada, coaches wear a lot of hats: They review glucose data while tracking patients’ lifestyle changes and can provide empathy in a way that other people in the health care system aren’t providing. Coaches are “folks who ask questions before casting judgments,” Duffy said.

Giving by-the-book care to people with diabetes — or others with chronic conditions — requires many more workers than the health care system has, Duffy said. So a coach — whose salary is typically in the tens, rather than hundreds, of thousands of dollars — looks like a solution for many startups.

“‘Coaching’ is a way to avoid having to have clinical licenses or FDA approvals,” Bob Kocher, an investor at Venrock, wrote in an email. “It allows you to start serving patients way faster.”

Coaches already play a role in established institutions.

Dr. Pushpa Raja, a psychiatrist in the Department of Veterans Affairs’ Greater Los Angeles system, said peers play a prominent role at the VA. Often, people with a given condition interact with veterans who have the same disease. “They can relate to patients in a different way,” she said. “They can cheerlead patients towards goals. They can coach patients in planning out and strategizing.”

They’re also integrated into a team with psychiatrists and primary care physicians, which means they can pass on observations — for example, if someone’s depression is getting worse over time.

Some observers of health coaching startups are concerned they don’t have the same ability. Coaches might be able to “do a lot of the minutiae that are annoying” to doctors, said Liz Chiarello, a sociologist at Saint Louis University in Missouri who studies medical organizations, but a surge in these workers could “fragment our health system even further.” A behavioral health coach at a given startup might need to elevate an issue to a psychiatrist or primary care physician — and whether the startups’ coaches have tight links with institutions that offer the next-level expertise is often unclear.

What’s more, coaches might not be trained well — and might be serving too many patients to do much good.

“I cringe when I get startups who are like, ‘We’re going to hire 100 people and train them for two weeks,’” said Yang. “You’re not going to learn anything in two weeks.” For some companies’ training, “it’s pretty scary, the lack of rigor and depth,” he said.

Coaching qualifications may not be all they appear, either.

Wellory promises to match users to a nutrition coach after they take a quiz. Those coaches, in turn, suggest healthy foods for users. But some quiz-takers — like Dr. Seth Trueger, a Northwestern Medicine emergency room doctor; and a KHN reporter — were matched with a coach who described herself as “RDE,” short for “registered dietitian eligible.” It’s a term for nutritionists who have completed most, but not all, of the requirements necessary to qualify as a registered dietitian.

But RDE is not a professional designation, according to the Commission on Dietetic Registration, and anyone using it should stop “immediately.” The commission is the credentialing agency of the Academy of Nutrition and Dietetics, the trade group for food and nutrition professionals. Wellory removed the reference after KHN contacted the company about the issue.

Yang said some startups think of coaches as almost a “call center model,” with plans to hire dozens of coaches who support tens of thousands of patients.

Some startups are indeed using small teams. Take Homethrive, a new company fresh off raising $20 million to support caregivers for older adults or other patients. The company aims to use a combination of tech tools and social workers to provide caregivers with everything from emotional support and connections to recommendations for wheelchairs and walkers.

David Grabowski, a professor at Harvard Medical School who specializes in aging and long-term care, said there’s a huge opening for these companies to fill. Caregivers may be unsure about how to complete certain daily tasks, like bathing or picking up patients. But, just as much, “it’s the loneliness, it’s the feeling you’re in this by yourself,” he said.

Still, Homethrive is relying on a small workforce. The company serves about 20,000 members, co-founder Dave Jacobs said. It currently employs 40 social workers who deliver “episodic” support during the “most intense” situations, like deciding whether to move patients into homes, Jacobs said. For everyday situations, it relies on technology to connect patients to resources.

Grabowski has questions about such models. “I definitely wonder if 40 social workers is sufficient” to handle such situations, he said.

Coaching startups are an extremely heterogeneous field. Yang said that he has seen startups that do coaching well but that he’s unsure how much benefit the public is deriving. “Are we doing the population a good service at the end of the day?”

Dialysis Reform Will Be On The California Ballot Yet Again. Does It Stand A Chance?

California 2020 vote-by-mail bill approved by Legislature | The Sacramento  Bee

Source: The Sacramento Bee, by Owen Tucker-Smith

Once again, California’s largest healthcare workers union is campaigning for dialysis reform — but they face powerful opponents.

It’s deja-vu for the California political scene, where such a battle transpires repeatedly. This time around, SEIU-United Healthcare Workers West is advocating for a ballot initiative that would require a physician assistant, physician or nurse practitioner to monitor patient dialysis treatments.

The union pushed similar policies in 2018 and 2020, but both measures failed by significant margins. On Monday, Secretary of State Shirley Weber said that the 2022 measure had collected over 685,534 valid signatures, making it eligible for the November ballot.

“There’s just so much improvement that can be made, and there’s plenty of resources in the industry to make those improvements,” SEIU-UHW research director David Miller told the Bee. “That’s the tension: there’s enormous profitability, then you meet folks of enormous need, and you realize that some of that money should be diverted to patient care.”

Historically, these measures have faced opposition from organizations like the California Medical Association and giants in the dialysis industry. Now, a coalition that includes the state’s Dialysis Council, the California Taxpayer Protection Committee, the California Chamber of Commerce and many medical societies and associations are organizing to shut down the initiative.

Dialysis reform naysayers hold that forcing clinics to hire more physicians would cost too much. A fiscal report from the state estimates that the measure could raise health care costs for state and local governments “by low tens of millions of dollars annually.” The policy, according to the report, would boost clinics’ costs by by “several hundred thousand dollars” annually.

There are an estimated 80,000 dialysis patients in California. The industry says that the rising costs would end up shutting down clinics. Miller refuted this theory, and said the massive campaign against the proposition has generated misconceptions.

“Most of the misconceptions are generated by the spending against the measure, rather than a thoughtful debate about the policy itself,” he added.

In 2018, the union spearheaded Proposition 8, which would have increased staffing and worker pay by capping revenues clinics could keep. At the time, SEIU-UHW ran a campaign on emotional stories of clinic mistreatment, and on the message that clinic workers were underpaid and overworked.

But Prop 8 failed. It was the priciest proposition on the ballot, and while the union got their hands on $18 million to support it, the campaign was outspent six-to-one by the state’s dialysis industry.

Then came Proposition 23, two years later in 2020. The measure required one physician to be present during treatment; it also would force clinics to report infection data to California — not just to the federal government. Prop 23 failed too, and only 36% of voters approved of the idea.

Now, the union is back for a third time, fighting an uphill battle against an industry that has time and time again proved to be a political powerhouse in the Golden State. In December of 2020, the LA Times reported that the national dialysis industry had poured $233 million into California campaigns in four years. According to Politico, $2.2 million has already been spent against this year’s initiative, and the coalition in opposition has released searing press releases recently.

Some have questioned the aggressive approach of the union, which has funneled significant funds into the effort with little success. In the fall, Politico called the phenomenon “the electoral version of groundhog day,” and suggested that union leaders weren’t necessarily looking for a win on election day — rather, they were looking to weaken the dialysis industry, dollar by dollar.

Regardless of the union’s intentions, the industry has snapped into the defense during each stage of the game. On Monday, the coalition didn’t hesitate to respond to Weber’s announcement with their own take.

“This November 2022 initiative shakedown is just a continuation of UHW’s broader corporate union organizing campaign against health care providers,” the coalition wrote. “Since 2012, SEIU-UHW has wasted $82 million of its members’ dues money on 60 ballot initiatives across the country either directly or through its 501c4. In California alone, UHW has filed 23 state and local initiatives at a cost of $58 million or about $600 per member in wasted dues money.”

One critique of the union, according to Miller, is that the initiative is identical to 2020’s. But it’s not — 2022’s effort expanded the supervision clause to include nurse practitioners and physician assistants. The union also heard criticism about a lack of available providers in rural clinics, Miller said, so this time around the advocates are allowing for a telehealth option.

“We moved toward the critics, both in the industry and outside the industry,” Miller said. “We actually feel better and even more confident that our solutions are closer to being right… that’s how it differs from the last attempt.”

The Protect the Lives of Dialysis Patients Act joins four ballot propositions that Weber had previously named eligible for a spot on the November ballot. The three initiatives and one referendum tackle the sports betting industry, arts funding in schools, flavored tobacco sales and single-use plastics.

Other initiatives are close to making the cut. Initiatives must have their signatures qualified by June 30 to hold their place on the ballot.

California To Become First State Offering Health Care To All Undocumented Residents

California Poised to Extend Health Care to All Undocumented Immigrants -  The New York TimesSource: The Sacramento Bee, by Mathew Miranda

California will become the first state to remove immigration status as a barrier to health care, making all low-income undocumented residents eligible for state-subsidized insurance regardless of age.

Gov. Gavin Newsom late Sunday announced a budget deal he struck with the Legislature included a new Medi-Cal expansion that would cover more undocumented adults.

The program’s launch, starting no later than Jan. 1, 2024, is expected to provide full coverage for approximately 700,000 undocumented residents ages 26-49 and lead to the largest drop in the rate of uninsured Californians in a decade.

“This historic investment speaks to California’s commitment to health care as a human right,” said Sen. María Elena Durazo, D-Los Angeles.

The state already allows many undocumented residents to join Medi-Cal. In 2015, California began allowing undocumented children to join Medi-Cal. Four years later, eligibility broadened to those younger than 26. And in May, the state started covering people aged 50 and over.

The Medi-Cal expansion is expected to cost $2.6 billion annually.

Californians generally are eligible for Medi-Cal coverage based on their income. The income cap for a family of four this year is $36,156.

California also opens Medi-Cal eligibility to people with certain medical conditions. It’s available to people who are pregnant, blind, disabled, under age 21, living in a nursing home or are a recently settled refugee.

Opening up Medi-Cal to all undocumented Californians has been a goal for health and immigration advocates for years. “This budget investment reflects California’s values of inclusion and fairness and should be a model for the rest of the nation,” said Sarah Dar, director of Health and Public Benefits Policy at the California Immigrant Policy Center. “All Californians, regardless of their age or where they were born, should have access to basic necessities like food and fair, steady wages.”

Undocumented residents remain the largest group of uninsured in California, according to a recent analysis from the the Center for Labor Research and Education at the University of California, Berkeley.

A disparity and “historic wrong” that will be fixed with the expansion, said Assemblyman Miguel Santiago, D-Los Angeles.

“This is a game changer,” said Santiago. “It’s one of the most important pieces of legislation that’s gonna go through this house because the ability to give health care means the ability to live life without pain.”

Workers’ Comp Job Killer Proposal Fails to Move

Disney Apologizes After Employee Thwarts Marriage Proposal - The New York  TimesSource: CalChamber, by Ashley Hoffman

Legislation expanding the presumption that certain diseases and injuries are caused by the workplace failed in an Assembly policy committee this week for lack of a motion.

SB 213 (Cortese; D-San Jose) was opposed as a job killer by the California Chamber of Commerce and a coalition including numerous local chambers of commerce.

It would have significantly increased workers’ compensation costs for public and private hospitals by presuming certain diseases and injuries are caused by the workplace and established an extremely concerning precedent for expanding presumptions into the private sector.

In a letter sent last week to the Assembly Insurance Committee, the CalChamber-led coalition pointed out that SB 213 would have imposed an astronomical financial burden on employers in the health care industry by creating a permanent legal presumption that the following are presumptively workplace injuries for all hospital employees that provide direct care: bloodborne infectious disease, tuberculosis, meningitis, methicillin-resistant Staphylococcus aureus (MRSA), cancer, musculoskeletal injury, post-traumatic stress disorder, or respiratory disease, including COVID-19, and asthma.

The Legislature has consistently rejected this bill in all its forms, the coalition stated.

Undermines System

Workers’ compensation insurance automatically covers injuries occurring within the course and scope of employment, regardless of fault.

SB 213 sought to require that hospital employees do not need to demonstrate work causation for specified injuries or illnesses in any circumstance. Instead, these injuries and illnesses would have been presumed under the law to be work related.

Presumptions of industrial causation for specific employees and injury types are simply not needed and create a tiered system of benefits that treats employees differently based on occupation and undermines the credibility and consistency of the workers’ compensation system.

Presumption Extension

The bill’s special standard for accepting claims would have applied to hospital workers not only while employed, but also would have continued for up to 3, 5 or 10 years (depending on the injury) after the worker left employment.

Generally, there is a one-year statute of limitations for workers’ compensation claims. By requiring claims to be filed within one year from the date of injury, existing law ensures claims will be resolved while evidence and witnesses are still available. Stale claims, faded memories, and unavailable witnesses not only impede an employer’s ability to defend against a claim, but also impede the ability of the workers’ compensation system to evaluate a claim properly.

By permitting a former employee to come back and file a claim for up to 10 years after employment had ended, SB 213 would have rendered the employer virtually powerless to question the compensability of the claim.

Troubling Precedent

Although there is a long history of legal presumptions being applied to public safety employees in the workers ‘compensation system, there has never been a presumption applied to private sector employees outside of the COVID-19 pandemic.

Legislation passed in 2020 (SB 1159; Hill; D-San Mateo) established a rebuttable presumption that certain employees who contracted COVID-19 were covered under workers’ compensation. Even in this exceptional circumstance, SB 1159 was limited in both time and scope. The bill has a sunset date of January 1, 2023, and most employees outside of a few industries can fall under the presumption only if four or four percent of other workers at the worksite also contracted COVID-19 within a short time frame.

SB 213 reached far beyond SB 1159 without justification by making a permanent presumption that can apply up to 10 years after an employee has stopped working.

Workers’ compensation is designed to apply a consistent, objective set of rules to determine eligibility, medical needs and disability payments for all injured workers in California. The Legislature should not take on the role of trying to identify likely injuries for every occupation in the state with the goal of creating special rules for those employees. This is an unrealistic expectation in an insurance system that covers thousands of types of employees and employers.

No Evidence

Supporters of SB 213 have argued that health care workers are more likely to contract the diseases listed in the bill. But analyses of prior versions of the bill by a Senate committee found no evidence to support that argument.

Moreover, no statistical evidence has been presented to indicate that workers’ compensation claims by hospital employees for exposure to the diseases listed in SB 213 are being inappropriately delayed or denied by employers or insurers. In addition, there has been no demonstration that hospital employees are uniquely affected in a negative way by the current legal standard for determining compensability of industrial injuries.

American Hospital Association Urges CMS To Extend Enforcement Discretion For No Surprises Act

CMS urged to extend enforcement discretion for No Surprises Act requirement  | AHA News

Source: Healthcare Finance, by Jeff Lagasse

The American Hospital Association has urged the Centers for Medicare and Medicaid Services to extend enforcement discretion for the No Surprises Act regulatory requirement that healthcare providers exchange certain information to create a good faith estimate for uninsured and self-pay patients – until the agency identifies, and providers can implement, a standard, automated way to exchange the information.

“In the interim final rule implementing this policy, CMS notes that it is exercising enforcement discretion until Jan. 1, 2023, as it may take time for providers and facilities to ‘develop systems and processes for receiving and providing the required information,’” AHA wrote. “We agree that developing and implementing the solution will take time and cannot be achieved efficiently without additional guidance from CMS that identifies a standard technical solution that can be implemented by all providers.”

One of the main concerns from the AHA is that there are currently no methods for unaffiliated providers to share or receive good faith estimates with a convening provider or facility in an automated manner. To share this information, billing systems would need to be able to request and transmit billing rates, discounts and other necessary information for the good faith estimates between providers/facilities.

This is not something that practice management systems can generally do, said the AHA, since billing information is traditionally sent to health insurers and clearinghouses, not other providers.

“Due to the lack of currently available automated solutions, this process would require a significant manual effort by providers, which would undoubtedly result in the convening provider being unable to meet the short statutory timeframes for delivering good faith estimates to the patients and could also lead to inadvertent errors,” the AHA wrote.

AHA requested an extension in enforcement discretion until a technical solution has been found and implemented.


Without an automated standard, the AHA said, providers would need to determine individually how to transmit the information. That in turn could lead to variance throughout the industry, especially considering differences in size and technical sophistication among co-providers and facilities. Navigating a non-standardized process, the AHA contended, would increase administrative burden on providers.

To help work toward a standard solution, The AHA said it’s partnering with the American Medical Association, the Medical Group Management Association and HL7 to create a workgroup to discuss potential technical solutions for sharing and receiving critical information among providers. The group will consist of providers and vendors with knowledge of provider systems.


In December 2021, the American Hospital Association, American Medical Association and other provider organizations sued the Department of Health and Human Services and other federal agencies over implementation of the No Surprise Act. The groups are not against the legislation, they said in the lawsuit filed in federal court but take issue with how HHS implemented a dispute resolution process in the bill.

The No Surprises Act prevented 2 million surprise bills for the commercially insured, according to a survey by AHIP and the Blue Cross Blue Shield Association released in May. The analysis further showed that, if the trend continues, more than 12 million surprise bills would be avoided in 2022.

California Lawmakers Met Their Budget Deadline. Here’s What’s Left To Negotiate In The $300 Billion Spending Plan.

California budget: Big surplus, big differences - CalMatters

Source: Cap Radio, by Nicole Nixon

California state lawmakers approved a $300 billion budget this week, but several key sticking points remain between Governor Gavin Newsom and lawmakers, which could drag out negotiations on a final spending plan.

Under California law, the Legislature must approve a budget by June 15 or forfeit their pay and per diem until they do. The governor must sign the spending plan by June 30, in time for the state’s new fiscal year to begin on July 1.

Often, many budget details are worked out and approved in the weeks following those constitutional deadlines, which are referred to as “budget trailer bills.”

That appears to be the case once again this year, as top lawmakers and Newsom continue to negotiate over exactly how to spend a historic $98 billion surplus.

The budget approved by the Legislature Monday includes a record amount of money for public schools and higher education, as well as a total of $37.8 billion for budgetary reserves — nearly double the amount in savings before the pandemic in 2019.

It also includes $40 billion for infrastructure projects and funding to make Medi-Cal available for every low-income undocumented resident.

Despite the budget’s monstrous size, there are still many details for lawmakers and the governor to work out.

Republican Assembly member Vince Fong (R—Bakersfield) said the approved budget “fails to adequately address critical and core crises facing our state from the devastating drought to catastrophic wildfires, to a potentially crippling power shortage.”

Fong, who is the top Republican on the Assembly Budget Committee, criticized Democrats for passing an incomplete spending plan to meet their deadline and planning to fill in the gaps later. The practice has become the norm in state budget-making over the past decade, though Republicans say it lacks transparency.

Other unresolved issues include rebates to address skyrocketing gas prices and inflation, as well as reimbursement rate increases for state-sponsored child care providers and disability insurance, which received a temporary boost during the pandemic. Lawmakers want to increase those rates, but the Newsom administration is reportedly hesitant.

“It’s not a big surprise that when there’s a lot of money on the table, there might be more points of contention,” said Chris Hoene, executive director of the California Budget and Policy Center. “There’s often more contention about how to spend money during the good times because you’re expanding programs or you’re creating new programs or you’re doing one-time things.”

Another sticking point between top lawmakers and Newsom is the size and eligibility for a tax relief package aimed at helping Californians cope with inflation and record-high gas prices.

In March, Newsom proposed sending $400 per vehicle — up to $800 — to car owners to offset the rising cost of fuel. Leaders in the Assembly and state Senate have insisted on targeting tax relief to lower-income residents, who spend a higher percentage of their income on necessities like housing and transportation and are hit harder by inflation. Senate pro Tem Toni Atkins (D-San Diego) and Speaker Anthony Rendon (D-Lakewood) unveiled their own plan to send $200 per person, with an additional $200 per dependent, for individuals earning up to $125,000 or families with incomes up to $250,000.

But three months later, neither side appears to have budged. In a statement after the Legislature’s budget was passed, Newsom’s office said the governor “would like to see more immediate, direct relief to help millions more families with rising gas, groceries and rent prices” and noting Newsom’s plan would spend $3.5 billion more on tax relief.

Meanwhile, Republicans continue to call on Newsom and Democrats who control the legislature to suspend the state’s gas tax, which is set to increase from 51 cents per gallon to 54 on July 1.

“At a time when we have the highest gas prices not only in the nation, but in U.S. history, we need real solutions that will ease the burden on families, not increase the load,” Assembly member Suzette Valladares (R-Santa Clarita) said at a press conference Wednesday. “My colleagues and I are here … to remind Governor Newsom that it has been nearly 100 days since he promised he would bring Californians relief from the highest gas prices in the nation.”

Valladares told stories of constituents who had to sleep in their cars or skip university classes because they couldn’t afford fuel.

Republican state lawmakers argue suspending the gas tax would provide near-immediate relief to those most impacted by high gas prices.

Democrats have refused to cut the gas tax, citing the funding it provides for infrastructure projects. They also say there’s no way to guarantee oil companies and gas stations would not keep prices high and pocket the difference. A bipartisan bill attempts to address that issue by requiring fuel stations to pass on their savings and by backfilling lost revenue from the state’s burgeoning general fund.

Hoene said as an organization focused on improving life for the state’s lower- and middle-class residents, the California Budget Center prefers the Legislature’s approach of targeting relief based on income. He also thinks the state should deliver the fund through the Franchise Tax Board, which doled out millions of Golden State Stimulus checks last year.

“The best way to get aid into the hands of people who need it most is to base it on their income level,” Hoene said, “and deliver them a check — electronically or in other forms — which is exactly what we did two times over the past year, very successfully in the state.”

Deep Dive Into FSA Behavior Finds Knowledge Gaps That May Reduce Effectiveness

Deep dive into FSA behavior finds knowledge gaps that may reduce  effectiveness | BenefitsPRO

Source: BenefitsPRO, by Alan Goforth

Flexible spending accounts can be a useful way for workers to stretch health-care spending dollars further than they otherwise could. However, little is known about how workers use — or don’t use — FSAs.

In response, the Employee Benefit Research Institute established the FSA Database to shine a light on this under-researched employee benefit. Analysis of this database revealed several things:

Contributions. In 2020, workers contributed an average of $1,265 to their FSAs. Only 7.7 percent of accountholders had the benefit of also receiving an employer contribution. Among those who did, the average employer contribution was $299.

Only 3.6 percent of workers contributed the statutory maximum, which was $2,750 for 2020. Inertia may be a powerful force in setting contribution amounts, because 10.5 percent of workers contributed the statutory maximum for 2019 ($2,700).

Distributions. The vast majority of accountholders took a distribution in 2020. Fully 89 percent did, similar to the share of accountholders taking a distribution in 2019. Of those who took a distribution, the average amount withdrawn was $1,287, nearly identical to the average of $1,279 observed in 2019.

That distributions are closely tied to contributions is not surprising. There is a strong incentive for FSA accountholders to spend the entirety of their balances. Unlike with health savings accounts, there is a limit to how much accountholders can roll over each year — if they can at all — and so accountholders generally cannot withdraw significantly more than they contribute.

Limited-purpose FSAs. Workers enrolled in an HSA are ineligible to contribute to regular health-care FSAs, but they can enroll in limited-purpose FSAs to save specifically for vision and dental expenses. Because these accounts specifically are intended for defraying dental and vision expenses, accountholders tend to use them differently than standard health- care FSAs.

Notably, the average contribution was significantly smaller than the average contribution to a standard health-care FSA — $859, compared with $1,259. This may reflect the more limited scope of qualified medical expenditures that are eligible for reimbursement compared with a regular health-care FSA.

Three different FSA types. “Use-it-or-lose-it” FSAs are self-explanatory; accountholders forfeit any money remaining at the end of the plan year to their employer. FSAs with a rollover feature, on the other hand, allow the accountholder to roll over funds to the next year, up to a statutorily defined amount.

“Grace-period” FSAs allow workers to take distributions up to two and a half months after the end of the plan year. All three types of FSAs had similar average contribution and distributions. Only about $150 separated the average contribution of a “use-it-or-lose-it” FSA and the average contribution of a rollover FSA.

Similarly, the three FSA types saw similar average distributions; about $120 separated the smallest average distribution, seen in “use-it-or-lose-it” FSAs, from the largest average distribution, seen in FSAs with a grace period.

Age and FSA attributes. FSA contributions and distributions both increase with age. Older accountholders are more likely to incur health-care expenditures than their younger counterparts and, because of higher salaries on average, may be better positioned to divert more discretionary dollars to FSAs as well.

Younger accountholders contributed relatively little to their FSAs in 2020, contributing an average of $499. Generally, as age increased, so did average contribution, with one notable exception: The 45 to 54 age group contributed the most, diverting on average of $1,430 to their FSA. The oldest workers in EBRI’s FSA Database contributed the second-highest amount, chipping in an average of $1,427.

“Developing a better understanding of accountholder behavior is critical in fostering optimal usage of FSAs and ultimately can improve workers’ financial well-being,” the report concluded.

“While it is encouraging that older workers stretched their health-care dollars further with higher average contributions and more frequent distributions, younger workers had relatively small contributions, and little more than half took a distribution from their FSA. This is perhaps indicative of a knowledge gap and may hinder a worker’s financial wellbeing.”

Last Updated 06/29/2022

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