Topic: Brain Food

It’s silly season again, so let’s sue the President

William MacBain

The Speaker of the United States House of Representatives, one of the most senior elected officials in the US government, has announced that the House is going to sue the President because he has delayed enforcement of a provision of the 2010 health care law; a provision that a majority of that same House has vociferously criticized as unfair to business and a “job killer.” In 2014 Washington, this makes perfect sense.

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Tuesday Night’s Primary Elections Were Huge. Here’s What They Mean for Our Industry.

John Gorman

House Majority Leader, Eric Cantor (R-VA) is toast.  Trounced in his Richmond district by a nobody Tea Bagger Tuesday night. Cantor gave up his leadership position yesterday. Depending on where you sit politically, either the unthinkable or the inevitable happened.  In fact, a Majority Leader hasn’t lost incumbency since the office was created in 1899.   “The defeat of the second-ranking Republican in the House by an ill-funded, little-known tea party-backed candidate ranks as the biggest congressional upset in modern memory and will immediately generate a series of political and policy-related shock waves in Washington,” wrote Chris Cilizza of WaPo.

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Follow the Leader: United Health Group’s Outlook on Government Health Programs

John Gorman

Ralph Giacobbe at Credit Suisse is a leading health industry analyst and is doing the best work of his career.  Today he produced a fantastic recap of his discussion with United Health Group CEO Steve Hemsley and several of his top executives.  It included some fascinating insights into the market leader’s strategy for government health programs:

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Lighting the Path in the Golden Age of Government-Sponsored Health Programs: Join Us for the GHG Client Forum

John Gorman

More than 300 guests will convene on May 1-2 at the Red Rock Casino in Las Vegas for the 2014 Gorman Health Group Forum, our annual strategic retreat for leaders in government-sponsored health programs. This year’s gathering promises to be the most actionable, content-packed conference you could attend on how to succeed in this new Golden Age of government business. And when the learning and planning is done for the day, we will celebrate this unique moment in health care history as only GHG can in Vegas.  Here’s what’s happening this year and why you’ve got to join us: Read more

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Innovation and Quality must go hand-in-hand

Regan Pennypacker

Plan sponsors are waiting with anticipation for their 2014 Medicare Star Ratings to be released. Just yesterday, Tufts Health Plan in Watertown, Massachusetts released the news that their Medicare Preferred HMO plan was awarded 4.5 out of a possible five stars. It reminds me of the old Ford commercial jingle where they said “Quality is Job 1″. No truer words apply when it comes to maintaining high quality plan options for our nation’s Medicare beneficiaries.

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Sea Change at CMS

Jean LeMasurier

Administrator Marilyn Tavenner officially named Paul Spitalnic as the CMS chief actuary. I worked with Paul when he first came to CMS to implement the Part D program. He then served as the Director of the Part C and D actuarial group. Paul is very smart and will ably fill the shoes of other distinguished CMS chief actuaries that I have worked with including Guy King and Rick Foster.  Both Guy and Rick were outstanding public officials who came to CMS from the Social Security Administration and from a tradition of government run social insurance programs. I guess experience with the managed care side of Medicare is no longer considered a handicap.  To me this shows how much has changed at CMS. Part C is almost 30 percent of the Medicare program and Part D is administered through contracts with private plans.  These programs are no longer step children.  Congratulations Paul.

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Health Insurance Premium Guessing Game

William MacBain

Health insurance issuers are generating enough fodder for a good guessing game. Will Obamacare increase rates for individual insurance or not? And if so, will the increase be modest or catastrophic. Writing in the April 25 edition of the Washington Post, Ezra Klein reports that the Blues plan that serves the national capital area is warning of big increases in individual premiums. The cause? More sick people are going to get health insurance, now that the pre-existing condition limitations have been removed by the Affordable Care Act. But is that the whole story? Klein also reports that insurance companies in Vermont and Rhode Island are projecting a more modest impact in announcing their proposed 2014 rates. But in Massachusetts, where “Obamneycare” has been in place since 2006, individual premiums are the highest in the nation.

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