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KFF Health News reported on the state of New York's recent efforts to encourage the disclosure of medical costs to patients. Many practices require patients to agree in writing to pay for all charges not covered by insurance (requiring patients to sign "blank checks"), and a state law was recently passed to prohibit such practices (especially given that patients often are not presented with actual cost estimates when they are asked to sign those forms). Implementation of the law was delayed indefinitely. However, "Doctors and other providers would still be obligated to have the cost discussion with patients before the patient is asked to sign the form agreeing to pay for the service."

KFF Health News reported on the state of New York's recent efforts to encourage the disclosure of medical costs to patients. Many practices require patients to agree in writing to pay for all charges not covered by insurance (requiring patients to sign "blank checks"), and a state law was recently passed to prohibit such practices (especially given that patients often are not presented with actual cost estimates when they are asked to sign those forms). Implementation of the law was delayed indefinitely. However, "Doctors and other providers would still be obligated to have the cost discussion with patients before the patient is asked to sign the form agreeing to pay for the service."

Even though details still need to be worked out, it does seem that there is growing dissatisfaction with the status quo. Very few other industries (if any) have a standard practice of requiring their customers to agree to pay before the customers know the costs of the product or service. While it is true that complications can arise and that can make it difficult for providers to accurately estimate total costs, patients should not be expected to bear all of the challenges of that uncertainty.

Despite many efforts to curb growth in healthcare costs, KFF Health News reports that health insurance premiums continue to rise faster than inflation. Focusing on California, the article reports that "Average monthly premiums for families with employer-provided health coverage in California's private sector nearly doubled over the last 15 years, from just over $1,000 in 2008 to almost $2,000 in 2023 ... That's more than twice the rate of inflation. ... Average premiums for families with employer-provided health coverage grew as fast nationwide as they did in California from 2008 through 2023." A practical effect of this is that "During the last two decades, the cost of health insurance premiums and deductibles in California rose from about 4% of median household income to about 12%."

Despite many efforts to curb growth in healthcare costs, KFF Health News reports that health insurance premiums continue to rise faster than inflation. Focusing on California, the article reports that "Average monthly premiums for families with employer-provided health coverage in California's private sector nearly doubled over the last 15 years, from just over $1,000 in 2008 to almost $2,000 in 2023 ... That's more than twice the rate of inflation. ... Average premiums for families with employer-provided health coverage grew as fast nationwide as they did in California from 2008 through 2023." A practical effect of this is that "During the last two decades, the cost of health insurance premiums and deductibles in California rose from about 4% of median household income to about 12%."

The article does mention that "California is trying to lower health care costs by setting statewide spending growth caps, which state officials hope will curb premium increases. ... Other states that imposed similar caps saw health care costs rise more slowly than states that did not." The central enforcement mechanism appears to be fining healthcare organizations whose growth in spending exceeds a 3.5% target. While these efforts may seem promising, previous efforts to slow the growth in costs have also appeared promising at different points in time. Mandating limits to growth will likely cause organizations to look for exemptions of some sort or potentially trim quality of care.

KFF Health News reports that to address a looming shortage of physicians, some states have made it easier for physicians trained in other countries to practice in the US. The previous requirements seem wasteful: "Until recently, every state required physicians who completed a residency or similar training abroad to repeat the process in the U.S. before obtaining a full medical license." The article reports that "at least nine states have dropped this requirement for some doctors with international training" with over "a dozen other states are considering similar legislation." Nevertheless, foreign-trained doctors sill need to "pass the standard three-part exam that all physicians take to become licensed in the U.S."

KFF Health News reports that to address a looming shortage of physicians, some states have made it easier for physicians trained in other countries to practice in the US. The previous requirements seem wasteful: "Until recently, every state required physicians who completed a residency or similar training abroad to repeat the process in the U.S. before obtaining a full medical license." The article reports that "at least nine states have dropped this requirement for some doctors with international training" with over "a dozen other states are considering similar legislation." Nevertheless, foreign-trained doctors sill need to "pass the standard three-part exam that all physicians take to become licensed in the U.S."

Some supporters see this relaxing of requirements as a way of addressing physician shortages, particularly in certain areas, since a number of laws "require the [foreign-trained] doctors to work for several years in a rural or underserved area." Requirements such as those can benefit some rural hospitals that experience difficulties when trying to hire qualified physicians.

Some opponents seem to believe that the way to address the physician shortage is to instead better compensate physicians and to accelerate training "for nurse practitioners and physician assistants who want to become doctors." In a landscape in which health insurance premiums have generally outpaced inflation for decades and where many are uninsured due to the cost of health insurance, simply raising physician compensation seems to be an difficult solution. Other solutions, such as the suggested expansion of loan repayments, might help.

KFF Health News reported on some efforts underway in California to rein in drug prices. For context, "state data shows California health plan drug costs have grown by more than 50% since 2017. California insurers spent 11% more on pharmaceuticals in 2023 than in 2022, with specialty and brand-name drugs driving the increase."

KFF Health News reported on some efforts underway in California to rein in drug prices. For context, "state data shows California health plan drug costs have grown by more than 50% since 2017. California insurers spent 11% more on pharmaceuticals in 2023 than in 2022, with specialty and brand-name drugs driving the increase."

The legislature proposed a bill to subject pharmacy benefit managers (PBMs) to licensing requirements and to "require them to pass along 100% of the rebates they get from drug companies to the health plans and insurers that hire them to oversee prescription drug benefits." The governor appears to oppose that bill, in favor of the state manufacturing its own generic drugs, along with requiring more transparency. Regardless of which approach (or perhaps another) ultimately changes the landscape, the proposals signal an ongoing concern with high prescription drug costs.

The article also raised some potential anti-competitive practices, where PBMs "appeared to steer the most profitable prescriptions away from competitors and to their affiliated pharmacies, which they reimbursed at markups exceeding 1,000% for some drugs." This practice apparently causes reimbursement from some insurers to some pharmacies to be less than what it costs the pharmacy to buy certain medications.

There has been much frustration with insurers denying claims, and KFF Health News published a piece about legislation that California is considering to curb that practice. The article opens with a child with "a grapefruit-sized tumor" being denied treatments recommended by doctors. Denials can be appealed through a process known as independent medical review (IMR). Surprisingly, the majority of appeals in one year resulted in overturned initial denials in a solid majority of the cases: "In 2023, state data show, about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer's initial denial being reversed."

There has been much frustration with insurers denying claims, and KFF Health News published a piece about legislation that California is considering to curb that practice. The article opens with a child with "a grapefruit-sized tumor" being denied treatments recommended by doctors. Denials can be appealed through a process known as independent medical review (IMR). Surprisingly, the majority of appeals in one year resulted in overturned initial denials in a solid majority of the cases: "In 2023, state data show, about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer's initial denial being reversed."

The proposed legislation would levy fines on "insurers whose denials are overturned more than half the time." That would certainly be a better system than the status quo, but it seems to impose a large penalty only at a specific threshold. Another design would be to award patients a more modest amount to compensate them for their time and potentially delayed care -- that change would help recognize the costs imposed on patients by the current system. Designing the incentives to be too patient-friendly, however, will result in higher costs, which in turn will cause premiums to rise.