Category Archives: Insurance

Medicaid, Public Health and Chronic Disease Management

UVa Hospital

by James C. Sherlock

From the CDC:

Chronic diseases have significant health and economic costs in the United States. Preventing chronic diseases, or managing symptoms when prevention is not possible, can reduce these costs.

Virginia pays a great deal of money every year to contractors who manage the care of its Medicaid population.

It is a hard job, but even though the challenges are tough, it has appeared to me for a long time that we are not getting our money’s worth from $18 billion annually in Medicaid payments for the populations managed by these contractors.

A white paper, “Prevent Costly Chronic Disease Through Member Engagement” caught my eye as the basis for a follow up to my earlier report on public health and Medicaid managed care in Petersburg.

This is that update. Continue reading

Hey, Buddy, What’s Your Friggin’ Problem?

by James A. Bacon

Based on anecdotal evidence, I have long thought that the rudest, most aggressive drivers in the United States resided in the Northeastern states. It turns out, based on insurance data, that Virginia has some of the worst drivers in the country. So much for our self-image as courteous ladies and gentlemen.

Insurify, a website that helps consumers find automobile insurance, collects a massive volume of data on driver history, including accidents and tickets. Virginians stand out in several regards. Ranked by driving offenses including failure to yield or stop, improper backing, passing where prohibited, tailgating, street racing, and hit-and-run, Virginia is the No. 1 state for drivers with a “rude” driving violation on record. The percentage of rude drivers (3.58%) is more than twice that of the national average (1.68%).

Likewise, Virginia ranks No. 1 in the country for the percentage of drivers with a reckless driving offense (0.56%). That is more than five times the national rate (.09%) Continue reading

Things Are Not Always As Intuitive As They May Seem

Photo credit: CNBC

by Dick Hall-Sizemore

Sometimes, public policy proposals can be counterintuitive.

Virginia law authorizes health insurance companies to charge smokers up to 50% greater than the premium that would otherwise be effective. The 2022 General Assembly passed legislation that would have repealed this authorization. The bills, HB 675 (Hope, D-Arlington) and SB 422 (Edwards, D-Roanoke), passed both houses with strong bipartisan majorities.

The Governor vetoed them.  His explanation for the vetoes was:

Smoking and tobacco use are among the leading causes of chronic health problems that result in higher healthcare costs. This legislation would force insurance companies to recover costs associated with tobacco users by raising premiums on non-tobacco users. The ability to reduce premiums by quitting smoking is also a valuable incentive to encourage healthier habits.

Requiring non-tobacco users to cover the increased healthcare costs associated with tobacco use is not a policy I can support.

On its face, this explanation sounds reasonable. After all, society should discourage smoking and no one wants to subsidize unhealthful habits. Continue reading

Feds Require Changes to Virginia Health Insurance Law

by James C. Sherlock

There are a couple of new issues between Virginia’s Bureau of Insurance (BOI) and the federal Centers for Medicare/Medicaid Services (CMS).

The problems were briefed today by a Board of Insurance representative to the Health Insurance Reform Committee.

CMS has told the BOI that the 2020 General Assembly passed a law (possibly without knowing the implications) that violated a federal statute. The Virginia law attempted to protect the state from having to spend money to fund a new health insurance mandate for Qualified Health Plan (QHP) holders. QHPs are small group and individual policies sold on the ACA exchange.

The feds are not amused. Virginia law apparently will need to be changed. Continue reading

Will Liability Insurers Drive School Mask Policies?

by James C. Sherlock

California has imposed a school mask mandate for the fall.  Virginia has not — yet.

California shows us some of the implications. In that state, the mandate has produced varying reactions.  Reporting in Education Week has illuminated some of those. Continue reading

Another Bit of Nonsense in the Cost of Health Care

Colonoscopy
Image credit: Johns Hopkins University

by Dick Hall-Sizemore

I just had an experience that illustrates the bewildering complexity of the finances of the American health care system.

Yesterday, I had a colonoscopy. I’m a veteran of this procedure, having had several because there is a history of colon cancer in my family. (No polyps this time, by the way.)

The protocol for the dreaded “prep” time has changed. No longer does the patient have to consume a gallon or two of sickening sweet liquid (others who have had this procedure know what I am talking about). Now, one has to take 24 pills in two stages between 6 p.m. the night before and 6 a.m. the day of the procedure, along with a lot of water. Continue reading

Is DOJ’s Focus on Healthcare Monopolies Coming to Virginia?

by James C. Sherlock

The Acting head of the Justice Department’s Antitrust Division, Richard A. Powers, yesterday delivered a speech that described the Justice Department’s new goals, strategies and resources for criminal antitrust enforcement.

The clouds have darkened over Virginia’s healthcare monopolies.

The Commonwealth. Virginia has failed in its duty to oversee its healthcare industry.  The full extent of that failure has been detailed in previous columns.

It has failed in two major ways:

  1. The Virginia Department of Health (VDH) has been captured by the healthcare provider industry that it regulates. Indeed VDH has been actively complicit in industry evasion of antitrust statutes through its administration of Certificate of Public Need (COPN) law.
  2. The Commonwealth’s regulatory structure has a strategic vulnerability. Neither the VDH that regulates providers nor the State Corporation Commission that regulates insurers can adequately oversee integrated health care delivery and insurance companies to prevent or detect what amount to internal conspiracies in restraint of trade. In the wrong hands, integrated provider monopolies and regionally powerful insurers can serve as weapons against competitors to both.

Continue reading

An Agenda for High Quality Primary Care

by James C. Sherlock

The Business of Healthcare

I have written columns here and in various newspapers across the state for a number of years supporting health enterprise zones (HEZ’s) in underserved areas of Virginia.

I drafted and Republican Attorney General candidate Jason Miyares sponsored legislation of that title in the General Assembly.

It lost. Like night follows day, Democrats killed it. Fast forward.

The National Academy of Sciences, Engineering and Medicine released an implementation plan May 4 for the U.S. government, recommending it provide high-quality primary care to all Americans. The program proposed is simply too large in my view to be run effectively in 50 states by the federal government and its one-size fits all regulations.

But it contains good ideas — action items that Virginia can and should legislate without waiting for federal legislation that may never see the light of day. Continue reading

The Business and Politics of Senior Care in Virginia

by James C. Sherlock

We write here often about senior care, the companies that provide it and the politics around that business.

It is useful to understand the continuum of care to make sure we also understand the different financial situations which companies in different parts of that industry find themselves and the way they are overseen and paid in Virginia.

The larger corporations that offer these services often offer both facility and in-home care.

The basic descriptions below are offered for considering the business interests and therefore the lobbying efforts of the companies that provide the services. They are not meant for personal counseling. Continue reading

What Texas’s Crisis Means for Virginia

by Peter Galuszka

The Texas freeze and ensuing energy disaster has clear lessons for Virginia as it sorts out its energy future.

Yet much of the media coverage in Virginia and certainly on Bacon’s Rebellion conveniently leaves out pertinent observations.

The statewide freeze in Texas completely fouled up the entire energy infrastructure as natural gas pipelines and oil wells stopped working, coal at generating plants iced over and wind turbines stopped working.

Making matters much worse, Texas opted not to have power links with other states. Its “free market” system of purchasing power meant utilities skimped on maintenance and adding weather-relative preventive measures such as making sure key generation components were weatherproof.

The result? Scores dead and millions without electricity. Here are more points worth considering in Virginia:

Climate Change is For Real

It is a shame that so much comment in Bacon’s Rebellion is propaganda from people who are or were paid, either directly or indirectly, by the fossil fuel industry. Thus, the blog diminishes the importance of dealing with climate change in a progressive way.  Continue reading

Virginia Hospitals Demand More Transparency — for Healthcare Insurers

by James A. Bacon

Annual health care spending per person in Virginia is slightly below the national average — about $10,800 per person compared to $11,600 for the nation as a whole, but most of that advantage is eaten up by higher insurance costs, finds a new study by the Altarum Institute that was underwritten by the Virginia Hospital & Healthcare Association (VHHA).

Among the major components of healthcare expenditures, spending on hospital services is 12% less per capita in Virginia than the national average, 18% less for nursing homes, and 3% less for physicians and clinical services. But Virginians spend 7% more per capita on prescription drugs, says the study, based on 2019 numbers. Overall, per capita health spending on providers is 7% lower in Virginia than it is nationally. Continue reading

If You Pay Full Price for Flood Insurance, Ask our City/County Manager Why

Roanoke flooding in 1985

by James C. Sherlock

There were lots of comments in my last post about government programs to mitigate flooding damage in flood plains, specifically about buying and tearing down houses that repeatedly flood.

One of the carrots to do so is Community Rating System (CRS) discounts to flood insurance in communities that take an active role in flood plain risk mitigation.

CRS is a part of the National Flood Insurance Program (NFIP).  It is an incentive program that recognizes and encourages community floodplain management activities that exceed the minimum program requirements.

When that happens, not only is the risk of flooding diminished, but flood insurance premium rates for all citizens of a community that accomplishes the goals are appropriately discounted to reflect the reduced flood risk.

To quote the program web page,

“For National Flood Insurance Program Community Rating System participating communities, flood insurance premium rates are discounted in increments of 5 percent.

Continue reading

Sorry, We Can’t Pay Your Insurance Claim. It Would Cost Us Too Much.

By Dick Hall-Sizemore

For the past 17 years, my wife and I have rented a house at Sandbridge in Virginia Beach for a week in late May. My daughter and her family, including the three grandkids, come down for the week. It is the highlight of our year.

This year was no exception. A year ago, we reserved the week of May 16-23. Then, of course, the coronavirus intervened. The Governor issued an executive order telling everyone to stay at home unless it was absolutely necessary to go out. Stores and restaurants were closed. Would we be able to go to the beach? What about all that money I had already paid (the entire balance due)? Continue reading

Wise King Ralph Rules: Less Choice for the Self-Employed

Wise King Ralph

by James A. Bacon

According to Governor Ralph Northam, the way to ensure access to quality, affordable medical insurance for Virginians is to reject bills that would… expand access to health insurance for Virginians.

Yesterday Northam vetoed two bills passed with broad bipartisan support that would have allowed self-employed people to buy insurance through professional groups such as Realtors’ associations. He also vetoed a third, which would have permitted small businesses to band together to buy group health insurance for employees.

Northam’s logic was that the legislation could undermine the Affordable Care Act by providing an alternative to buying coverage on the state exchange, reports the Washington Post.

“Governor Northam’s administration has worked to expand access to affordable quality care for all Virginians,” said a statement released by the Governor’s Office. “The vetoed bills would address health insurance cost concerns for targeted segments of the population, but in doing so, could increase the cost of insurance for sicker Virginians in the marketplace.” Continue reading

WTJU Podcast: COVID-19 and the Economy

By Peter Galuszka

Here’s is the twice-monthly podcast produced by WTJU, the official radio station of the University of Virginia. With me on this podcast  are Nathan Moore, the station general manager, and Sarah Vogelsong, who covers, labor, energy and environmental issues across the state for the Virginia Mercury, a fairly new and highly regarded non-profit news outlet. Our topic is how Virginia is handling the economic fallout from the COVID-19 pandemic.