AHIP Presses Congress, White House To Ramp Up Scrutiny Of Private Equity Provider Deals

AHIP presses Congress, White House to ramp up scrutiny of private equity  provider deals | Fierce Healthcare

Source: Fierce Healthcare, by Robert King

Health insurance trade group AHIP is calling for the White House and Congress to increase scrutiny of private equity control of providers, which the group worries could impact quality and costs.


The group earlier this week released letters sent to the White House and congressional leaders outlining parts of a new policy road map and priorities (PDF). Chief among them was more transparency surrounding private equity deals, which has grown in popularity across certain parts of the provider industry.

“While improving transparency of health care prices at the federal level has been a major focus, only the recent executive order related to nursing home care has applied to the activities of private equity entities of the health care marketplace, which have vastly different business models than other health care organizations,” the letter to President Joe Biden said.

AHIP wrote that there needs to be more transparency on private equity control of physician specialty groups and how the deals can impact quality and costs for patients.

The group noted in a white paper that back in 2018 private equity made up 45% of all health mergers and acquisitions. While initial deals applied to certain specialties like orthopedics and urology, AHIP said targets have expanded.

AHIP wants Congress to pass legislation that requires the public reporting of all private equity and hedge fund purchases of specialty groups and other providers such as emergency room physicians or ambulance providers. They also want the federal government to study any anticompetitive impact on the acquisition of providers by private equity firms.


Other key priorities in AHIP’s road map include:

  • * Advance use of site-neutral payments to ensure payments are the same no matter the site of care. The Centers for Medicare & Medicaid Services has cut Medicare payments in recent years to off-campus hospital clinics to bring the payments in line with those paid to physician clinics. But the effort led to a legal fight with the hospital industry.
  • * Support the expansion of home-based advance care via “value-based care and payment models,” the road map said.
  • * Remove barriers to telehealth access, which exploded in use since the onset of the pandemic; but, now, regulators are figuring out what to make permanent. AHIP wants the federal government to have network adequacy regulations to account for the availability of telehealth and to ban billing of “distant site facility fees for telehealth services.”

AHIP’s push to scrutinize private equity deals comes as the federal government has delivered more scrutiny of hospital merger deals. The Federal Trade Commission also launched a probe into physician practice acquisitions back in January 2021 to examine their impact on market competition.

White House Warns Of COVID Surges In The Winter

White House warns of Covid surges in the winter - POLITICO

Source: Politico, by Hannah Farrow

Covid cases surged during the last two winters and are likely to again this year — unless the country can prepare and act, White House Covid-19 response coordinator Ashish Jha said Sunday morning.

“If we don’t get ahead of this thing, we’ll have a lot of waning immunity, this virus continues to evolve and we may see a pretty sizable wave of infections, hospitalizations and deaths this fall and winter,” Jha said on ABC’s “This Week.”

Congress needs to provide resources, Jha said, specifically $22.5 billion, a number that will help with a vaccine supply that’s dwindling. In March, White House Coronavirus Response Coordinator Jeff Zients said: “If the science shows that fourth doses are needed for the general population later this year, we will not have the supply necessary to ensure shots are available.”

The money, once allocated, would go toward Covid vaccine supply and coronavirus testing.

“If Congress doesn’t step up and fund these, I think, urgent and emergent priorities … they can’t wait until the fall, it will be too late,” Jha said.

And the proof is in the jab. With cases increasing in the Northeast, deaths remain low because of high vaccination rates.

“That’s not true for the whole country,” Jha said.

With enough resources to get more people vaccinated and more therapeutics in place, he said, “I do think we can get through this winter without a lot of suffering and death.”

Is it a Myth that Health Care Costs Are Spiking Under the ACA?

Former White House spokesman Robert Weiner and analyst Daniel Khan argue that the Affordable Care Act has not caused massive spikes in healthcare premium. In a recent article in the Tallahassee Democrat, Weiner and Khan say that one of the biggest issues in the presidential election is a recurring Republican critique of the Affordable Care Act: the supposedly massive healthcare price spikes. Frontrunner Donald Trump said, “I don’t know if you have been watching lately — people’s premiums are going up 35, 45, 55%. Their deductibles are so high nobody’s ever going to get to use it. Obamacare is turning out to be a bigger disaster than anybody thought.” Weiner and Khan say the results speak otherwise.

The following are highlights of their arguments: It is true that employer-based insurance premiums increased 26% from 2009 to 2014, but before the passage of the ACA, they went up 34% from 2004 to 2009 and 72% from 1999 to 2004. So we are talking about half the increases compared to before the law. Twenty million more Americans now have health insurance through the Affordable Care Act, including nearly 8 million new Medicaid enrollees under Obamacare’s expansion, according to Obamcarefacts.com.

In addition, people will be living longer. According to a Harvard School of Public Health study of Massachusetts, “In each of the first four years of the state law, 320 fewer Massachusetts men and women died than would have been expected. That’s one life extended for every 830 newly insured residents.” Another study, by the American Journal of Public Health, shows that nearly 45,000 people die every year due to a lack of health insurance.

Yet the literally sickening (potentially to millions) refrain persists, “Repeal and replace Obamacare.” The House has now voted to repeal it 63 time (but never with the replace part, since they’d actually use Obamacare provisions).Even in Kentucky, with uninsured down to an all-time low 7.5% there, U.S. Senate Leader Mitch McConnell, Republican from Kentucky, takes credit for the insurance expansion by his state, but refuses to publicly acknowledge it’s because of and under Obamacare. It’s as though it came from the sky.

Florida’s great former congressman and senator, Claude Pepper, fought for national health insurance his whole life. He would be incensed at the opponents of Obamacare for trying to block the coverage for millions who now have it. Pepper, whose library and museum are at Florida State University in Tallahassee, said back in 1987, “What I’m talking about is a principle of insurance applied to health care. We insure our homes. We insure our businesses. Why can’t we insure something that’s even more important to us, our lives and our health?”

In 2013, Gov. Rick Scott, who knows health costs as a former hospital group administrator, was for Obamacare Medicaid expansion before he was against it. He said, “While the federal government is committed to pay 100% of the cost, I cannot, in good conscience, deny Floridians the needed access to health care.” Then he lost that “good conscience” to politics. He reversed after his Republican legislature refused to allow it for fear of giving Obama credit for anything.”

According to HHS.gov, if Florida were to expand Medicaid, an additional 848,000 uninsured people would gain coverage.” Even without, under Obamacare’s marketplace, a Gallup poll confirmed that the uninsured rate in Florida in 2014 was 18.3%, down from 22.1% in 2013.

Through healthcare.gov, customers can search for an array of plans based on their financial and health priorities. Customers are able to switch plans, which enables them to save a lot of money. According to the HHS, those who switched plans within the same metal tier (platinum, gold, silver, bronze) saved an average of nearly $400 on their 2015 annualized premiums after tax credits as compared to those who stayed in their same plans.

According to HHS, about 8 out of 10 returning consumers will be able to buy a plan with premiums less than $100 dollars a month after tax credits; and about 7 out of 10 will have a plan available for less than $75 a month.

A smart consumer can both achieve health care coverage and save money, without succumbing to the naysayers who either have not done their homework comparing plans or, for political purposes, do not want to credit the President for a major achievement.

Robert Weiner is a former spokesman for the Clinton White House and was Chief of Staff of Cong. Claude Pepper’s (D-FL) House Aging Committee and Subcommittee on Health. Daniel Khan is senior policy analyst at Robert Weiner Associates and Solutions for Change. Here is a link to article:http://www.tallahassee.com/story/opinion/2016/03/25/spiking-health-care-costs-aca-myth/82267170/

Gingrich Sees Potential for Bitter, Brutal Fight between GOP and White House

Republicans are weighing whether to get into the death grip of Obamacare or wait out President Obama’s term seeking specific, practical, doable reforms, according to Former House Speaker Newt Gingrich who spoke at a recent Academy of Managed Care Pharmacy forum in Washington, D.C, Gingrich says that Congressional Republicans will vote to repeal the ACA as a part of the budget reconciliation process.

Rather than starting a bitter, brutal fight over the Affordable Care Act (ACA), the GOP is likely to pursue specific, practical reforms that could gain large bipartisan support. However, he said, “If the U.S. Supreme Court strikes down federal subsidies for individuals living in states with federal exchanges, you will have chaos.” Faced with the growing cost of new, expensive medicines, the American people will eventually decide not to pay for marginally better ones, while continuing to pay for life-saving or life-changing medicines. The Republican capture of the Senate and multiple governors’ mansions continues to reverberate, not only on Capitol Hill and in state capitals, but also in executive suites of health care companies around the nation, said AMCP CEO Edith A. Rosato, RPh, IOM.

White House plans ACA good news campaign

The Obama administration and Affordable Care Act supporters are planning a campaign to highlight success stories related to the insurance exchange rollout, such as stories of people who have access to a health care provider after many years without care. Politico (Washington, D.C.) (12/29)

People with canceled coverage to get ACA exemption under White House plan

A senior official said Thursday that the White House will allow a hardship exemption for people whose health insurance has been canceled under the Affordable Care Act. These individuals will be allowed to purchase a catastrophic insurance policy in place of a more comprehensive plan. The announcement was made in a letter from HHS Secretary Kathleen Sebelius clarifying who would be eligible for the exemption. The New York Times (tiered subscription model) (12/19), Politico (Washington, D.C.) (12/19), Reuters (12/19

White House clarifies tax-penalty time frame under ACA

People who enroll in an insurance plan by March 31 will not be subject to the Affordable Care Act’s tax penalty for 2014, the Obama administration said. Tax experts had said that people would have to enroll by mid-February in order for insurance to take effect in time to avoid the penalty. Forthcoming guidance “will ensure that if you sign up for insurance by the end of March, you will not face a penalty,” an HHS official said. The New York Times (tiered subscription model)/In Practice blog (10/23), Kaiser Health News (10/23)

Last Updated 05/25/2022

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