The Clinton Herald, Clinton, Iowa

National News

May 16, 2014

New health cost controls get go-ahead from feds

WASHINGTON (AP) — The Obama administration has given the go-ahead for insurers and employers to use a new cost-control strategy that puts a hard dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements.

Some experts worry that such a move would surprise patients who pick more expensive hospitals. The cost difference would leave them with big medical bills that they'd have to pay themselves.

That could undercut key financial protections in President Barack Obama's health care law that apply not just to the new health insurance exchanges, but to most job-based coverage as well.

Others say it's a valuable tool to reduce costs and help check premiums.

Some federal regulators appear to be concerned. A recent administration policy ruling went to unusual lengths, acknowledging that the cost-control strategy "may be a subterfuge" for "otherwise prohibited limitations on coverage."

Nonetheless, the departments of Labor and Health and Human Services said the practice — known as reference pricing — could continue. Plans must use a "reasonable method" to ensure "adequate access to quality providers." Regulators asked for public comment, saying they may publish additional guidance in the future.

HHS spokeswoman Erin Shields Britt said in a statement that the administration is monitoring the effects of reference pricing on access to quality services and will work to ensure that financial protections for consumers are not undermined.

One way the new approach is different is that it sets a dollar limit on what the health plan will pay for a given procedure. Most insurance now pays a percentage of costs, and those costs themselves can vary from hospital to hospital. Now if you pick a more expensive hospital, the insurance still pays the same percentage.

The new strategy works like this:

Your health insurance plan slaps a hard limit on what it will pay for certain procedures, for example, hospital charges associated with knee and hip replacement operations. That's called the reference price.

Text Only
National News
  • 20140727-AMX-GUNS271.jpg Beretta, other gun makers heading to friendlier states

    In moving south and taking 160 jobs with it, Beretta joins several other prominent gunmakers abandoning liberal states that passed tough gun laws after the Newtown shooting.

    July 29, 2014 1 Photo

  • Fast food comes to standstill in China

    The shortage of meat is the result of China's latest food scandal, in which a Shanghai supplier allegedly tackled the problem of expired meat by putting it in new packaging and shipping it to fast-food restaurants around the country

    July 29, 2014

  • Medicare hospital fund to last 4 years longer

    Medicare's finances are looking brighter, the government said Monday. The program's giant hospital trust fund won't be exhausted until 2030 — four years later than last year's estimate.

    July 28, 2014

  • After 6 weeks, finally a deal on VA health care

    After more than six weeks of sometimes testy talks, House and Senate negotiators have agreed on a compromise plan to fix a veterans health program scandalized by long patient wait times and falsified records covering up delays.

    July 28, 2014

  • Brother sues W.Va. senator over business loan

    U.S. Sen. Joe Manchin III faces a $1.7 million civil suit filed by a brother over a lifeline to save a family carpet business.

    July 25, 2014

  • Official: Hospital gunman intended to kill others

    A psychiatric patient ranted about a hospital gun ban before opening fire at the suburban medical complex, killing his caseworker and grazing his psychiatrist before the doctor pulled out his own weapon and fired back, authorities said Friday.

    July 25, 2014

  • 10 things to know for today

    Your daily look at late-breaking news, upcoming events and the stories that will be talked about today:

     

    July 25, 2014

  • Illinois woman, 47, dies rescuing boy in Wisc. lake ARLINGTON HEIGHTS, Ill. (AP) — Friends and family are mourning the death of an Illinois woman who drowned while rescuing a 9-year-old boy in a Wisconsin lake.The (Arlington Heights) Daily Herald reports 47-year-old Karen Wessel of Arlington Heights d

    July 25, 2014

  • Taiwan plane crash photo Air travel a leap of faith for passengers WASHINGTON (AP) — Airline travel requires passengers to make a leap of faith, entrusting their lives to pilots, airlines, air traffic controllers and others who regulate air travel.Even after a week of multiple tragedies in worldwide aviation, “There

    July 25, 2014 1 Photo

  • Arizona's prolonged lethal injection is fourth in U.S. this year

    Arizona's execution of double-murderer Joseph Wood marked the fourth time this year that a state failed to dispatch a convict efficiently, according to the Constitution Project, a bipartisan legal group.3

    July 24, 2014

AP Video
Facebook