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What happened while we were focused on important stuff

Happy December.  While we were doing all things Thanksgivukkah, the world continued.  Here are the “high”-lights. Such as they are.

The deadline to “fix” the federal health care exchange passed; with White House officials declaring:

  1. it never really was a guaranteed drop-dead date; 
  2. it’s fixed for most some about 50,000-at-a-time users; and
  3. the small employer enrollment deadline has been extended for a year.

What is NOT fixed is the back end; insurers are not getting accurate information about who enrolled; the plans they enrolled in; or the amount, if any, of their subsidy.  It appears the Administration has decided that somehow the insurers will figure it out and if they don’t that’s the insurer’s issue.

That’s unfair, wrong-headed, and blithely ignorant, not to mention irresponsible.  Health insurers have spent hundreds of millions of dollars preparing for January 1, and now they’re being told “we screwed up and it’s your problem if you don’t know who your members are, don’t get paid for those members, and can’t tell doctors if someone is covered.”

On the state exchanges, there’s a mixed bag with states enrolling lots of folks, while others (MD, OR) having their own issues. Those states signing up folks may find the problems with the interface with the feds spill over. Here’s a sampling of the latest figures:

  • New York – 76,177
  • California – 385,556
  • Kentucky – 60,000+
  • Colorado – 6001

The Feds get much more oversight authority over compounding pharmacies; a bill addressing the issue was just signed into law that gives the FDA a significant role in monitoring compounders.  Recall one Massachusetts compounder was implicated in illnesses and least five deaths associated with contaminated drugs used for back injections.

In the much smaller work comp world, there’s been a shake-up at Coventry Workers Comp, with Art Lynch taking over the top spot from suddenly-departed David Young. Some may see this as a sign that owner Aetna isn’t interested in comp; I don’t.

On the even-smaller work comp doc dispensing issue, Pennsylvania is the latest battleground, with legislation just introduced to cap reimbursement for physician dispensed repackaged drugs at 110%, with a five day limit on scripts.   Legislation is herePlease please please forward the link and get your government affairs folks involved, and thanks to WorkCompCentral’s Mike Whitely for the heads’ up.

Finally, as far as I know, there weren’t any more acquisitions in the work comp world over the weekend…



Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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