Princess Health and Hard-fought bill to protect independent pharmacies passes Senate committee; would regulate pharmacy benefit managers. Princessiccia

Princess Health and Hard-fought bill to protect independent pharmacies passes Senate committee; would regulate pharmacy benefit managers. Princessiccia

business General Assembly insurance legislation legislature managed care Medicaid pharmacies state government

Gusty 08:32 Add Comment

By Melissa Patrick
Kentucky Health News

Update March 28: SB 117 passed the Senate March 14 with a 38-0 vote and passed the House March 25 with a 97-0 vote. It now awaits the signature of the governor.

Approval of Senate Bill 117 by the Senate Appropriations and Revenue Committee March 11 brought Kentucky's independent pharmacies one step closer to getting better price transparency from the companies that negotiate with pharmaceutical manufacturers, insurance companies and their beneficiaries. The bill would subject pharmacy benefit managers to regulation by the state Department of Insurance.

Republican Sen. Max Wise

"We are talking about independent pharmacies that have had family histories for years," Sen. Max Wise, sponsor of the bill, said in an interview. "They are trying to compete just to stay alive and . . . are suffering right now. This is a fight for the little guy and I am happy to stand up with the independent pharmacies."

Wise, a freshman Republican from Campbellsville, told the committee that while pharmacy benefit managers still don't support his bill, they did come to the table over the last week with independent-pharmacy representatives and the state Cabinet for Health and Family Services to reach a compromise that the committee approved unanimously.

The legislation would allow the Insurance Department to regulate PBMs much like insurance companies are regulated. It would also provide an appeal mechanism to resolve pricing disputes between pharmacies and PBMs.

The bill would not require PBMs to change how they work with fee-for-service Medicaid, nor does it require them to release their pricing methodology unless absolutely necessary, and any releases would not be subject to the state open-records law.

The bill was intensely debated for weeks, first in the Senate Health and Welfare Committee and then heard twice in the A&R Committee. Last week's A&R meeting involved "several hours of testimony from a local pharmacist, PBM representatives, and members of the Cabinet for Health and Family Services," the Kentucky Independent Pharmacist Alliance said in a news release.

Wise, a former FBI agent who was elected in 2014, told the committee, "This has been a very tough and complicated bill to work on."

The legislature passed a "maximum allowable cost" law in 2013 to require increased transparency in reimbursement practices. "Kentucky is one of only a handful of states to regulate the actions of PBMs," said the independent pharmacists' release. It said the state has more than 500 independent pharmacists.

Princess Health and Merger mania: Aetna bids for Humana; Cigna may want it too; Anthem has bid for Cigna; UnitedHealth makes a play for Aetna.Princessiccia

Princess Health and Merger mania: Aetna bids for Humana; Cigna may want it too; Anthem has bid for Cigna; UnitedHealth makes a play for Aetna.Princessiccia

business health insurance mergers

Gusty 17:13 Add Comment

Aetna Inc. has made a bid to buy Louisville-based Humana Inc.,"one of a number of recent moves by big health insurers to find merger partners," Dana Mattioli and Liz Hoffman report for The Wall Street Journal.

The proposal was made in "the last few days," the Journal reports. "It isn�t clear how much Aetna indicated it would pay. Humana has a market value of $30 billion. The company hired Goldman Sachs Group Inc. to help it field takeover interest, people familiar with the matter have said."

Meanwhile, Aetna has been approached by another big insurer, UnitedHealth Group. "It isn�t clear what, if any, Aetna�s response was," the Journal reports. "News of the Aetna proposal comes the same day Anthem Inc., another of the five big managed-care companies, said it boosted its takeover offer for Cigna Corp.,"offering $47.5 billion. "Anthem went public with the bid after the two sides failed to reach agreement, and is seeking to put pressure on Cigna through Cigna shareholders."

"Cigna itself is eyeing Humana, people familiar with the matter have said. The five big managed-care companies are jockeying for deals that will enable them to get more efficient and better respond to changes in the health care landscape in the U.S.," the Journal reports.

"Humana, which has an estimated 12,000 employees and roughly 2,000 contractors in Louisville and the immediate region, has been seen as an attractive target in the health-insurance industry because of its well-run business running Medicare Advantage programs," Grace Schneider reports for The Courier-Journal. The company is valued at $30 billion.

"The company's membership rolls have surged to more than 3 million in the last year," Schneider writes. "That growth comes when health care reform has forced providers � hospitals, doctors, pharmacies, among them � to consolidate to increase their leverage and clout in an increasingly competitive health care segment. For the same reason, health insurers are now looking to consolidate."

Princess Health andFate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion.Princessiccia

Princess Health andFate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion.Princessiccia

business health health care access hospitals newspapers rural health rural hospitals rural-urban disparities

Gusty 13:22 Add Comment

Just like country grocery stores in rural areas often have to close because community members drive past them to chain stores to save a few cents, rural hospitals will also suffer and eventually disappear if citizens do not use them, Publisher Chris Evans writes for The Crittenden Press in Marion.

When Evans was growing up in northwest Tennessee, his grandparents had to close their grocery store, which had been the center of the community, because too many people chose to purchase their food and other items from the new Walmart eight miles down the road. "Our rural hospitals are headed down the same path of extinction unless we recognize and reverse the trend," Evans writes.

Charlie Hunt, volunteer chairman of Crittenden Health Systems, which owns the local hospital, told Evans, "The only way for rural hospitals to survive is through community support."

In Kentucky, one-quarter of the 66 rural hospitals are in danger of closing, according to state Auditor Adam Edelen. In general, "Country hospitals do not have a good record for making money or breaking even, for that matter," Evans writes in a front-page column for the weekly he and his wife own.

Based on the results of Obamacare, Evans opines, it appears that America is moving toward a single-payer health care system like Canada's. Then instead of the government paying for 85 percent of Crittenden Hospital's services, it will pay for 100 percent. "When that happens, hospitals will have to play solely by government rules or get completely out of the game," Evans writes. Most of the 50 rural hospitals that have been shuttered in the past few years have been in the rural South.

"Hunt, who chairs the board, said that approximately 10 percent of the future of this hospital rests in the hands of its leaders. The other 90 percent falls squarely on the shoulders of this community," Evans writes. The column is not online, but PDFs of the pages on which it appears are posted here.

Princess Health and Princess Health andMcConnell presses Democratic foe Grimes to say how she feels about Obamacare, but won't bite on questions about Kynect.Princessiccia

Princess Health and Princess Health andMcConnell presses Democratic foe Grimes to say how she feels about Obamacare, but won't bite on questions about Kynect.Princessiccia

business elections health insurance health reform insurance exchange malpractice obamacare politics poll

Gusty 17:23 Add Comment

By Al Cross
Kentucky Health News

At his first press conference after winning the Republican nomination for a sixth term, U.S. Sen. Mitch McConnell pressed Democratic nominee Alison Lundergan Grimes to clarify her position on the federal health-care reform law but wouldn't say whether his plan to "start over" on the issue would include shutting down the state's successful health-insurance exchange.

"She's been dodging it for a year," McConnell said Friday. "She's been in this race for a year. It's time for her to answer the question, "How do you feel about it?" Grimes, Kentucky's secretary of state, twice refused Wednesday to say how she would have voted on the 2010 law if she had been a senator.

McConnell speaks at half-hour press conference.
(Associated Press photo by Timothy D. Easley)

The topic arose when McConnell was asked to reply to Democratic assertions that his pledge to "pull it out root and branch" would end the law's insurance coverage for 415,000 Kentuckians through the state exchange.

The senator didn't answer directly. "This is another good reason why the two of us ought to have a real debate," he said, recalling his post-primary proposal for three Lincoln-Douglas-style debates by the middle of September.

Asked if he would dismantle the state exchanges created under the law, McConnell said he would have created a national market -- "tear down the walls, the 50 separate silos in which health insurance is sold" -- passed medical-malpractice reform, and allowed small businesses to "band together in this international [sic] market."

Asked again, specifically, if he would shut down Kentucky's exchange, which is branded as Kynect, he said "I think that's unconnected to my comments about the overall question here."

While polls have shown the law to be unpopular in Kentucky, a small plurality of voters in a recent poll had a favorable opinion of Kynect. Last fall, the Kentucky Health Issues Poll found that people who weren't sure how the law would affect them and their families had an unfavorable opinion of it, while those who said they did know how it would affect them had a favorable opinion.

In his overall comments about the law, McConnell said a Congressional Budget Office study has predicted that full implementation of the law would still leave 30 million Americans uninsured, covering only 10 million. "What is the cost-benefit ratio of this kind of destruction, this kind of impact, on 16 percent of the economy?" he asked. "The people of this state are entitled to know the answer to the question, 'How do you feel about it?' and I think my opponent has tried to dodge that question."

UPDATE: Joe Sonka of LEO Weekly writes, "According to the CBO, by 2024 the number of uninsured will, in fact, be 31 million people, but without the ACA there would have been 56 million people uninsured. This number takes into account the undocumented immigrants who can�t get insurance because of the lack of immigration reform, and the people who can�t get Medicaid in states that opted out of the Medicaid expansion. That means that when the ACA 'kicks in fully' . . . 26 million will have gained access to health-care coverage because of it."

Asked if repealing the law would be his top priority as majority leader if Republicans take control of the Senate, he said he wasn't ready to say because he's not in the majority yet, "but I think it's reasonable to assume that would be a high priority for us." He noted that Obama will be president until January 2017, an implicit acknowledgement that Obama would veto any repeal and two-thirds votes of the House and Senate would be required to override him.

Jason Millman of The Washington Post writes that the issue could be pivotal in the race. "Kentucky is about as big of an Obamacare paradox that you could find: the state's exchange is working well, but Obamacare remains unpopular in the state," he writes. "It�s also home to one of the more successful Obamacare health insurance exchanges." He concludes, "Grimes may want to have a better answer the next time she's asked whether she would have voted for the health-care law." She has refused to say.

Princess Health and Half-day seminars on health reform's impact on business Wed. and Thur.; journalists invited.Princessiccia

Princess Health and Half-day seminars on health reform's impact on business Wed. and Thur.; journalists invited.Princessiccia

Affordable Care Act business health insurance health journalism health reform Patient Protection and Affordable Care Act

Gusty 18:53 Add Comment

Experts on the impact of federal health-care reform on business will give advice to Kentucky companies at half-day seminars in Lexington and Louisville on Wednesday and Thursday of this week. Presentations about the Patient Protection and Affordable Care Act will include discussions of expected cost increases and tax implications for businesses.

The Kentucky Health Care Reform Seminar will be presented by The Iasis Group, The Lane Report and the Kentucky Chamber of Commerce. The seminar is part of a statewide partnership that includes Commerce Lexington, Greater Louisville Inc., the Kentucky Society for Human Resource Management and the Northern Kentucky Chamber of Commerce.

The Lexington seminar will be held Wednesday, May 8, at the Griffin Gate Marriott Resort, with registration starting at 12:30 p.m. The Louisville seminar will be held Thursday, May 9, at the Louisville Marriott Downtown, with registration beginning at 8 a.m.

Members of the news media are invited to attend the seminars at no cost. For more information or details about covering the event, contact the Kentucky Chamber's Jessica Fletcher at 502-848-8731.

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

Affordable Care Act business federal government governor health care access health care costs health insurance Medicaid Patient Protection and Affordable Care Act state government

Gusty 13:32 Add Comment

By Molly Burchett
Kentucky Health News

Some Kentucky business leaders are discussing a possible endorsement of expanding Medicaid through private insurance, in a plan similar to one the federal government approved for Arkansas.

The Health Policy Council of the Kentucky Chamber of Commerce discussed the idea last Friday. A talking paper for the meeting highlighted presumed benefits of the approach, in which people newly eligible for Medicaid could use federal funds to buy private insurance through the insurance exchange that the state is constructing.

The health council has yet to decide the chamber's position on Medicaid expansion, but the council's talking paper said expanding Medicaid privately might be a better option than expansion of traditional Medicaid, considering the state's tight budget and already problematic managed care system.

The paper says a private plan would be beneficial to Kentucky because it would allow market forces to control costs and ultimately result in better health care. Private expansion would also prevent a flood of newly eligible people from entering the managed care system. "If Kentucky accepts the traditional Medicaid expansion, everyone that qualifies would be put into the already struggling managed care system, which until changes are made, cannot support the influx," the paper asserted.

The Obama administration has encouraged states to consider the Arkansas approach, the paper says.  To do so, states need to apply for a waiver, and the administration has provided information on how a state would apply. "Florida, Ohio, Louisiana, Maine and Pennsylvania are all looking into this option," the paper said.

An estimated 181,000 uninsured adults would become eligible for Medicaid in 2014, if Kentucky decides to accept the funds offered by the health law to provide coverage to those earning up to 138 percent of the federal poverty level.

Gov. Steve Beshear has said he will make his decision about Medicaid expansion no later than July 1. His office has declined to say whether the privatized option is under consideration, saying, "The governor is considering multiple issues as he determines whether Kentucky will expand Medicaid eligibility.  Along with affordability for the state, he is also looking at potential economic impact through jobs and investment created by possible expansion, as well anticipated changes in health outcomes for newly-eligible Kentuckians."