State Care Network

The State Care Network monitors, investigates, and provides recommendations on healthcare issues in states nationwide. A special project of @A4Horg.

[State Care Network @statecarenet]

For the 3rd year running, New York's legislators have rightfully rejected stripping away an important protection that ensures Medicaid patients can get the emergency and specialty care they need.

🚨 Now as final budget negotiations close, it's time for them to stand firm!

[State Care Network @statecarenet]

NYS lawmakers pass 13th budget extender as negotiations continue https://t.co/JrRPb4Z401

[State Care Network @statecarenet]

#NewYork #fairIDR #Medicaid #budget #Albany #patients #healthcare #medtwitter

@AndreaSCousins
@SolagesNY
@NYSenatorRivera
@AmyPaulin
@JayJacobs28
@JCColtin
@NYSA_Majority
@AMBichotte
@JeffreyDinowitz
@JonRivera149
@JoshJensen134
@EmilyAssembly
@Bobby4Brooklyn

[State Care Network @statecarenet]

For the 3rd year running, New York's legislators have rightfully rejected stripping away an important protection that ensures Medicaid patients can get the emergency and specialty care they need.

🚨 Now as final budget negotiations close, it's time for them to stand firm!

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Is that why you tried to put doctors out of business and were sued by the AMA?

[State Care Network @statecarenet]

Fantastic piece in @Newsday from @MedSocietyNYS President @davidjakubowicz. A must read regarding #NewYork’s #IDR process.

https://t.co/bDF0wEKJpv

#fairIDR #NY #budget #Albany @AmyPaulin @SolagesNY @AndreaSCousins

[State Care Network @statecarenet]

RT @DrBruggeman: OK…. Promise it’s my last response. I think it will be eye opening for many of you and expose the hypocrisy of the @FAHhos…

[Action for Health @A4Horg]

"The data is clear" = only the data you pay for, and literally nothing else.

We'll await patiently for something more, if you have it.

In the meantime, there's a lot of actual research, data, and survey results from @bmj_latest, @econliberties, @JAMA_current, @Healthgrades, @ndpanalytics, @mercatus, and @AEI that say the exact opposite.

Your charade is coming to an end. And lawmakers, regulators, patients—even employers and brokers—are now realizing it, 16 years after your attempted #ACA coup de grâce.

Seriously, thank you for your attention to this matter.

[DrOzCMS @DrOzCMS]

🚨 It is time for New York to come clean about its Medicaid program.

Today, I sent a letter to Governor Hochul demanding answers and detailed documentation about the state’s fraud detection, program integrity infrastructure, managed care oversight, and corrective actions. Protecting beneficiaries and ensuring proper stewardship of Medicaid funds remain central to the federal-state partnership, and we at CMS stand ready to eradicate the fraud, waste, and abuse happening in New York.

Governor Hochul and her team have 30 days to respond to our request. If we’re not satisfied with their response, we will take corrective action.

[State Care Network @statecarenet]

...It is the law’s safeguard. Weakening it risks reducing access to life-saving care."

@BKRBusinessMin @SolagesNY @AmyPaulin @NYSenatorRivera @drdanchoi @MedSocietyNYS @QCCommission @HANYScomm @DrAlexUrology

#medtwitter #healthcare #fairIDR #budget #medicine #Albany #NYC

[State Care Network @statecarenet]

💥 A must read in @BeckersSpine from @LIBrainandSpine's Dr. Brian McHugh.

https://t.co/ygJGJBLhCX

"#NewYork’s No Surprises law works because it balances #patient protections with fair dispute resolution. Independent dispute resolution is not a loophole...

(1/2)

[IndeMed @IndeMedAction]

🚨Arizona H.B. 2211 would gut the No Surprises Act's protections by imposing arbitrary caps on physician arbitration offers — and penalize physicians who exercise their federally authorized rights.

The NSA is working: $567/yr in patient savings, 10M+ surprise bills prevented, and growing provider networks.

‼️Don't let insurers rewrite a bipartisan law.

🔎See IndeMed's statement from @DrBruggeman on H.B. 2211:
https://t.co/lPoVgZe21D

[Adam Bruggeman, MD @DrBruggeman]

BCBS Arizona is sneaking in a new Arizona bill (H.B. 2211) after losing a significant number of federal IDR arbitrations under the No Surprises Act.

The bill would make it “unprofessional conduct” (and subject to licensing board discipline) for a physician to offer more than 3X the Qualifying Payment Amount (QPA) or 3X Medicare in federal arbitration.

Think about that for a minute…

Congress deliberately rejected fixed payment caps when drafting the bipartisan No Surprises Act. Instead, lawmakers created independent arbitration so neutral decision-makers could weigh all relevant factors and determine fair payment case by case.

H.B. 2211 attempts to override that framework at the state level by capping arbitration offers and threatening physicians’ licenses for fully participating in a federally established process.

The QPA itself has repeatedly been shown to understate true median in-network rates. Capping offers at 3X a benchmark that may already be significantly depressed effectively allows insurers to dictate rates while penalizing physicians who challenge them.

Tomorrow, @IndeMedAction will submit formal opposition ahead of the House Appropriations hearing.

As of tonight’s registration, there are 2 in favor — both BCBS representatives — and 137 opposed — including frontline physicians, nurses, CRNAs, and major Arizona physician organizations

This doesn’t fix a broken system. It undermines one that is working for patients.

Stay tuned for our full statement tomorrow.

[IndeMed @IndeMedAction]

https://t.co/ayqzfNqrhy

[PHA @physicianhosp]

‼️Unanimous support at today's @HouseCommerce hearing: Major health insurance CEOs voiced zero objections to physician-led hospitals when questioned by @RepMGriffith.

Patients, physicians and payers agree: physician-led deliver value and strengthen competition in healthcare.

[Action for Health @A4Horg]

Anthem’s policy punishes hospitals for staffing care with available specialists. Medicare physician payment is down 26% in real terms since 2001, and reimbursement for hospital-based specialists is increasingly compressed toward Medicare levels. Rural hospitals are at risk, families pay more, and Anthem profits.

[Action for Health @A4Horg]

Over at @anthem_watch today, we've published our latest blog post dissecting a new "study" co-authored by @ElevanceHealth's Public Policy Institute.

The study argues that payments decided through the #NoSurprisesAct's arbitration process—which #Congress created to resolve disputes between #insurers and #doctors—are wildly “inflationary,” often several times higher than what insurers say is the market rate.

It sounds alarming—it is also deeply misleading. 🤨

Here's the problem: the study relies on a benchmark called the qualifying payment amount, or #QPA.

❌ The QPA often is not what insurers say it is.

❌ Additionally, the QPA is calculated by insurers, reported by insurers, and—critically—rarely audited.

And even in this #Elevance-promoted study, the QPA often does not match real in-network prices.

Read more. 👇

https://t.co/ENLvlUVYyg

#AnthemWatch #insurance #medtwitter #healthcare #NSA #fairIDR #health #policy

[Action for Health @A4Horg]

Anthem is hitting hospitals with a 10% penalty for using out-of-network specialists, even when they’re the only ones available. Hospitals struggle, families pay more, and Anthem reports billions in profit.

Learn more: https://t.co/TbytwGc3e9

#AnthemWatch #healthcare #patients #insurance #medtwitter

[Rep. Chip Roy Press Office @RepChipRoy]

Rep. Roy in @RulesReps: “Now we're sitting here, and we're listening to nonsense about health care, where my colleagues on the other side of the aisle sit here saying, 'Well, you guys aren't doing anything about the massive, expensive cost of health care.' Why do you think it's expensive? Because you literally cut a deal with insurance companies to run health care...

And yet, Republicans will complain about it, and then they'll offer milquetoast garbage like we're offering this week, and then go home at Christmas and say, 'Look at what we're doing, we’re campaigning on reducing health care.'

Well, congratulations. At some point people will look at this body and say, 'Maybe we should get rid of all 435 members of the House and all 100 members of the Senate, and start over, because Congress is literally failing the American people.'”

[PHA @physicianhosp]

"PHA Applauds Congressional Efforts to Lift Anti-Competitive Restrictions on Provider-Owned Hospitals to Unleash Affordability and Access to Patients Nationwide"

More:
https://t.co/CydmPmZJpp

[Adam Bruggeman, MD @DrBruggeman]

URGENT:

The Republican healthcare plan includes “provider owned hospitals”! Today is a massive breakthrough for everyone who has been fighting to reverse the injustice. As quickly as I am typing this, members of the AHA and FAH will be working to protect their monopoly on hospitals ownership.

Remember that this policy will reduce costs and improve quality. Call your Congressman today and let them know that the “provider owned hospitals” cannot be stripped out of the plan. They cannot back down to pressure from hospitals. We have let large corporations put in their monopoly granting regulations for far too long. Let’s take back our healthcare system!