Given that national health reform was more or less modeled on Massachusetts' program, it's always tempting to look at how reform has unfolded in the Commonwealth to try and predict what will happen nationally. The latest news from Massachusetts is that the new federal reforms, layered on top of the existing state reforms, has resulted in the number of the uninsured falling to near zero. Problems with the state website have complicated the issue, however -- most of the new enrollees are in a temporary coverage plan because it hasn't been determined yet if they qualify for subsidized coverage (and if they don't, they may not be willing to pay a premium). Part of the new wave of enrollees in 2014 were low-income workers. Under the previous Massachusetts health care law, individuals weren't allowed to sign up for state-subsidized insurance if they had access to insurance through work, and the affordability rule in the federal law lifts that restriction in part. While no one expects universal coverage in the US as a whole any time soon, if ever, it is interesting that enrollment has continued to grow over time in Massachusetts.
If you live in New York, the days of dropping off paper prescriptions at the pharmacy are over. The New York Times reports that electronic prescriptions will now be required by a 2012 state law meant to combat the rise of prescription drug abuse (Minnesota has a similar law, but New York will be the first to back it up with penalties, including fines and imprisonment, for doctors who fail to comply). Although many doctors have already made the transition to electronic prescriptions, this will create some extra work for those who have yet to do so. That being said, advocates of the law say that it will result in reduced fraud, improved legibility, and better coordination of care. In addition to preventing intentionally fraudulent behavior, the law will also reduce the number of good-faith errors that can occur when a pharmacist misreads a doctor’s chicken-scratch handwriting.
Interestingly, one doctor notes in this article that another side-effect of the law might be the inclination of physicians to prescribe more common treatment regimens – that is, drugs that most pharmacies have in stock – than in the past, because they’d rather not go through the hassle of re-sending a prescription. And then there are patients who don’t fill their prescriptions, for one reason or another – in the old system, pharmacies wouldn’t have known the difference, but now that doctors have to send scripts ahead of their patients, we wonder how it will affect drug compliance. Will people be more inclined to follow the doctor’s orders, if the prescription has already been called in? And if not, what about the extra work this creates for pharmacists, filling prescriptions that are never claimed? Employers with New York-based employees should keep an eye on this transition and its implications for health care consumers – especially if other states start to follow suit.
ERISA pre-empts Vermont's all-payer claims database (APCD) reporting law, the US Supreme Court has ruled. The court held the state statute imposes duties that are inconsistent with ERISA's central design of providing a uniform national scheme for plan administration without interference from multiple state laws. Vermont's law requires all health plan payers to report to state regulators an array of claims and other data about their plans. APCD laws have taken effect or are planned in at least 18 states and several other states have considered such a program. The ruling limits state databases' potential to improve health care transparency but relieves ERISA plan sponsors of complying with multiple APCD laws.