Payer Roundup—Hospitals create monopolies via contracts; 24,000 Texans could soon lose coverage

Hospitals manipulate contracts to rake in profits 

Hospital systems are driving up healthcare costs by designing restrictive contracts with insurers, the Wall Street Journal reported Tuesday.

Large hospital groups, such as NewYork-Presbyterian, Johns Hopkins Medicine, OhioHealth and Aurora Health Care, force insurers to include them in every plan while restricting the insurers from covering other, often less-expensive providers. The contracts also allow them to avoid disclosing prices, limit claim audits and tack on additional fees. 

Services like echocardiograms, endoscopies and ultrasounds cost considerably more when performed in an outpatient facility rather than a physician’s office. Nerve and muscle tests cost 343% more. But in areas where only one hospital system exists, or one hospital system is the dominant provider, insurers feel they have no choice but to include them in their networks. 

This problem could get worse as hospitals continue to consolidate. (Wall Street Journal article

A public insurance program in one of Texas’s most populous counties could soon close

Commissioners in Travis County, Texas, which includes Austin, are weighing whether to shut down their public, nonprofit insurance company Sendero. 

Central Health, the county-run healthcare provider, established Sendero in 2012 to provide coverage to uninsured individuals who couldn’t afford ACA plans. About 24,000 Texans receive coverage through Sendero, and some have called it life-saving. 

Central Health officials voted to close Sendero last week, citing market instability and financial difficulties. However, the county must approve the decision, and they said they want to hold a public hearing. (KUT article

Former pro football players demand health insurance 

Several NFL Hall of Famers recently said they will boycott future Hall of Fame induction ceremonies until the league provides them health insurance coverage. 

“It would be reasonable if [people] thought life was good for us. But on balance, it’s not. As a group we are struggling with severe health and financial problems,” the group wrote in a letter to the NFL’s commissioner, the Players Association executive director and the Hall of Fame president. 

Former professional football players suffer from a variety of health problems that leave them unable to walk, sleep or understand who they are, the letter says. It would cost less than one 30-second Super Bowl ad to cover every Hall of Fame member. 

The athletes are also demanding a pension. (Letter—PDF)