Understanding Healthcare

By Aditya Singh

Healthcare will only be affordable and accessible when it's understandable

Healthcare will only be affordable and accessible when it's understandable

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South Dakota is Next

Medicaid is a program that offers health insurance to low-income Americans. It is administered at the state level but paid for by a combination of the state and federal government. Because the program is administered at the state level, there are variations f…


When You Mix Military and Health Bureacracy

The Department of Defense (DoD) oversees much of the US military and operates the Tricare, the healthcare program for active duty Americans and their families. In 2013, the DoD announced the Healthcare Management System Modernization contract, which the EHR v…


All Eyes On Montana

In reference-based pricing/payment (RBP), the insurer sets reference prices for medical services. The insurer tells healthcare providers "we will not pay any more than this reference price".One document to the Montana Legislative Finance Committee in 2015 out…


If All Plans are Above Average, None of Them Are

MA plans, once again, administer benefits of the Traditional Medicare program through private insurers. Many of these MA plans have additional offerings and may even specialize in specific geographies. Because the federal government is essentially contracting…


Cigna and it’s Fraudulent Home Care Program

Medicare is the federal healthcare coverage plan intended mostly for individuals over the age of 65. It’s run by the Centers for Medicare and Medicaid Services (CMS).The Original or Traditional Medicare program operates directly with CMS. However, in Part C M…


Do Accountable Care Organizations Work?

The CMS website offers a pretty concise definition for what an ACO is, and it gives a good starting point for assessing the structure of ACOs, successes, and drawbacks.ACOs are groups of doctors, hospitals, and other health care providers, who come together v…


How are Workforce Shortages Strangling Hospitals?

Clinician burnout was an area of concern for healthcare provider organizations before the pandemic, but the pressures of COVID-19 led to record-shattering staffing shortages as clinicians dropped out of the labor market.The lower number of nurses, doctors, an…


Cheaper Medicare... Because of a Botched Drug Rollout

The drop in premiums applies to members of "Traditional Medicare", which is administered directly by the federal government via the Centers for Medicare and Medicaid Services (CMS). These changes might not be applied to Medicare Advantage (MA) plans, which ar…


Why a Lack of Grocery Stores is Trouble

A food desert is a place where people have low access to healthy and fresh foods like fruits and vegetables, influenced by factors like income levels, travel distance to stores, and transportation costs.The existence of a food desert disproportionately affect…


The Quiet Fight against Bigger Hospitals

In economics, there has been a great deal of investigation into how the size of businesses in a space can affect the products sold to consumers and wages paid to workers.Ideally, if a company is overcharging a product or underpaying workers, consumers take th…


Medicaid Needs to Pay Doctors More

Health insurance generally has three important stakeholders. There's the member of the health plan, who is also a patient to a care provider. The health insurer is the other large stakeholder.Without insurance, the cost of the services of the doctor may be to…


Health Insurers Made Billions Then Refunded Them

To minimize exposure to the virus, and to free up medical resources and staff for treating those with it, in-person visits for non-urgent care decreased significantly while some providers proceeded to cancel elective surgeries.In fact, this led to an ironic a…


Why Rural Hospitals are Struggling

The closure of a hospital means that people have to go further to get treatment, and it's a vicious cycle that disproportionately affects those with lesser means and those of older age.


What are the Medicaid Expansions?

The Medicaid expansion updates a state's Medicaid eligibility rules to cover all adults with and without children at or below 138% of the federal poverty line (FPL), a measure used to categorize income levels.Most states have adopted these expansions since th…


What are the Expanded Health Subsidies?

The Affordable Care Act (ACA, aka Obamacare) aimed to increase the number of Americans on health insurance. It did this through a variety of methods, such as expanding Medicaid coverage and mandating large employers to give health benefits.Another way it soug…


What are the Transparency Rules?

Price transparency is a topic that economists tend to like to talk about, especially in markets where everything is expensive and confusing.Generally, price transparency is the ability of participants in a market to know the cost of a good or service being so…


How an Insulin Price Cap Works

First, we must start with why the price of insulin matters, which requires understanding why it must be prescribed.Diabetes is a general term for a number of diseases that affect the way the body utilizes glucose, more commonly known as blood sugar. Glucose i…


Why Do Employers Sponsor Health Insurance

Health insurance is a relatively new concept, originating in the early 1900s. A precursor to health insurance plans focused on ensuring families did not lose out on wages when the employee earning income was sick or recovering from injury.Early attempts at a …


How are Health Plans Paid For

The premium is probably the simplest of the terms we will discuss. This is a monthly rate which you pay the health insurer.Generally, these premiums are the revenue that health plans use to help pay for the healthcare of their members. The pricing levels used…


Why do insurers make you go in-network?

Talking about provider networks requires us to first look through the lens of the health plan insurer. Regardless of your opinion of these insurers, their incentives and priorities are what drive a lot of the way we understand the need for provider networks.T…