This is yet another part of the squeeze on the private insurance industry. (Link via Dr. Art Fougner.)
In the Annals of Emergency Medicine, Wiler, et al ask, "Episodes of Care: Is Emergency Medicine Ready?"
Their conclusion: Despite the push for payment "reforms" in the form of "episodes of care", this will hurt ER departments and ER patients. Instead, they advocate retaining the current fee-for-service model. This is, of course, a very politically incorrect conclusion.
Robert Book describes, "Unreasonable Rate Review for Health Insurance". In particular:
So, the Exchange cannot exclude a plan because its premiums are too high, but it can take high premiums into account in decided whether or not to exclude it.Just another reminder that government-run health insurance exchanges will not be any sort of a "free market", but rather a pseudo-market where the government determines if the prices are "reasonable".
This is a recipe for arbitrary decisions by state and federal bureaucrats as to which health plans will be permitted.
