Healthcare Roundup: Pandemic Insurance Expenses, Healthcare Cost Transparency, Pfizer Vaccine and More

States Shifting Burden of Doctors’, Dentists’ Pandemic Expenses onto Insurers:

A bill in committee in the California Senate (SB 242) would require state-regulated private health insurance plans to reimburse doctors and dentists for “medically necessary” expenses related to the pandemic, including personal protective equipment and staff to screen patients for COVID-19 symptoms before their appointments.

Judee Tippett-Whyte, DDS, president of the California Dental Association, who also has a dental practice in Stockton, said a box of 100 gloves that cost $2.39 at the start of the year now costs $30, and the N95 masks her practice now uses cost over 12 times more than the 20-cent surgical masks it used before the pandemic began.

“We’ve sustained a lot of financial costs,” she said. “We shouldn’t have to bear the cost of this for ourselves.”

California’s medical and dental lobbies also say insurers have cash to spare, having continued to collect premiums during the pandemic while paying out less in claims. UnitedHealth Group, the country’s biggest health insurer, recently reported that it earned 44 percent more in the first quarter of 2021 than in the same period last year.

Mary Ellen Grant, spokesperson for the California Association of Health Plans, however, said insurers don’t typically cover the cost of nonmedical supplies.

“Here we are with treatment and office levels back at pre-pandemic levels,” she said. “Now they want additional payment from plans to pay for nonmedical expenses.”

California doctors have also received nearly $10 billion from the U.S. Department of Health and Human Services for PPE and other pandemic expenses via the Provider Relief Fund, and medical and dental practices have obtained loans through the Small Business Administration’s Paycheck Protection Program.

“They’ve gotten plenty of help from the feds to cover these costs,” Grant said.

But Allison Hoffman, a professor at the University of Pennsylvania’s Carey Law School who specializes in health insurance policy and regulation, said, “We’re starting to see a kind of broader definition of what health insurance might pay for in order to keep people healthy.”

“There’s nothing like a public health emergency to shine a light on the fact that sometimes it’s not a prescription drug or surgical procedure that’s going to improve health.”

Washington enacted legislation last month (SB 5169) allowing healthcare providers to add $6.57 to the amount they bill insurers for each patient they see to help cover their pandemic costs. Sen. David Frockt (D), who introduced the bill, said it was surprisingly uncontentious, given that it pit the state’s medical association against its insurance association.

Deliberations over California SB 642 appear unlikely to be as rancor-free.

As Anthony York, spokesperson for the California Medical Association, said of the state’s health insurers, “We’re not surprised plans don’t want to pay more, but ultimately this is a fight we’ll have in the Legislature.” (KAISER HEALTH NEWS, STATE NET)

Blue Cross Blue Shield Association Drops Rule Limiting Competition among Members:

The Blue Cross Blue Shield Association has lifted a cap on the share of its 35 member insurers’ revenues that must come from business under the Blue Cross Blue Shield brand. Formerly, the licensees had been required to derive two-thirds of their revenues from such business.

The rule change was prompted by an antitrust settlement the insurers reached with their customers last year, which has yet to receive final judicial approval.

By allowing the member insurers to vie more with each other for non-Blue-branded business, the change “certainly should increase competition,” said University of California Hastings Law Professor Tim Greaney, although he added that it was unclear how long it would take to have an impact. (WALL STREET JOURNAL)

OK Law Requires Healthcare Cost Transparency:

Oklahoma has enacted legislation (HB 1006) requiring healthcare providers to post the cost for cash-paying patients of their 20 most common procedures and services. The price lists don’t have to include charges for complications or rates for procedures and services negotiated with insurers. (TULSA WORLD, STATE NET)

CA Healthcare Workers Demand Better Working Conditions:

Workers from three Southern California facilities owned by Tenet Healthcare planned to protest against low wages, understaffing and unsafe working conditions at the for-profit healthcare system’s annual shareholders meeting last week. The demonstration was backed by the National Union of Healthcare Workers, which represents about 600 respiratory therapists, medical technicians and other employees of Fountain Valley Regional Hospital. (FIERCE HEALTHCARE)

Pfizer COVID-19 Vaccine on Pace to Be World’s Top-Selling Drug:

Pfizer expects global sales of its COVID-19 vaccine to reach $26 billion this year. That would far exceed the $20 billion in annual sales of the world’s current top-selling drug, AbbVie’s rheumatoid arthritis medication Humira. (WASHINGTON POST)

Weekly Testing No Longer Required for Vaccinated OH Nursing Staff:

Ohio Gov. Mike DeWine (R) announced last week that fully vaccinated staff at nursing homes and assisted-living facilities no longer have to be tested each week for COVID-19. Coronavirus cases at the state’s 960 nursing homes have plummeted from 3,785 on Jan. 6 to 214 on April 21. (PLAIN DEALER [CLEVELAND])

-- Compiled by KOREY CLARK