LOSERS

Modern Healthcare - - NEWS -

Pres­i­dent Barack Obama had to veto a bill passed by con­gres­sional Repub­li­cans to re­peal most of the Af­ford­able Care Act, whose new in­sur­ance mar­kets also faced ques­tions about sus­tain­abil­ity.

As of Dec. 17, 12 of 23 not-for-profit co-op health plans es­tab­lished through ACA loans to pro­vide more in­sur­ance com­pe­ti­tion have been shut down for fi­nan­cial rea­sons.

Michael Can­non of the Cato In­sti­tute and Jonathan Adler of Case Western Re­serve Univer­sity were re­buffed by the U.S. Supreme Court when the jus­tices re­jected the law­suit they spear­headed to crip­ple the ACA’s pre­mium sub­sidy pro­gram.

Dr. Prem Reddy, CEO of Prime Health­care Ser­vices, with­drew Prime from a deal to ac­quire the six-hos­pi­tal Daugh­ters of Char­ity Health Sys­tem, its big­gest deal to date, af­ter the Cal­i­for­nia at­tor­ney gen­eral set tough con­di­tions for ap­proval.

Martin Shkreli, CEO of Tur­ing Phar­ma­ceu­ti­cals, was vil­i­fied even by drug in­dus­try lead­ers for “prof­i­teer­ing” af­ter his com­pany bought the rights to the drug Dara­prim and im­me­di­ately raised the price by more than 5,000%.

Unit­edHealth Group CEO Stephen Hem­s­ley an­nounced his com­pany lost $425 mil­lion on its ACA ex­change plans in 2015 and blamed him­self for a bad de­ci­sion in mov­ing his com­pany into the ex­changes.

Health­care providers and low-in­come res­i­dents in Florida, Ten­nessee, Utah and Vir­ginia saw ma­jor po­lit­i­cal ef­forts fall short to ex­pand Med­i­caid un­der the ACA.

Ten­nessee Repub­li­can Gov. Bill Haslam failed to get his GOP-con­trolled Leg­is­la­ture to ap­prove his con­ser­va­tive version of Med­i­caid ex­pan­sion.

Many health plan mem­bers re­ceived care at an in-net­work fa­cil­ity and later got a sur­prise out-of-net­work bill from an out-of-net­work provider from whom they un­know­ingly re­ceived care.

Health­care providers’ right to sue state Med­i­caid agen­cies over low pay­ment rates was sharply lim­ited by the U.S. Supreme Court’s Arm­strong de­ci­sion, which could re­duce low-in­come Amer­i­cans’ ac­cess to care.

Florida Repub­li­can Gov. Rick Scott had to set­tle for about half the fed­eral fund­ing his state had been re­ceiv­ing to sub­si­dize hos­pi­tal care for low-in­come pa­tients af­ter Scott an­gered the Obama ad­min­is­tra­tion by re­fus­ing to ex­pand Med­i­caid un­der the ACA.

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