Fewer children are falling through society's safety net, recent government statistics show, but that might change as states face the daunting challenge of trying to insure more youngsters with less money.

A report from the Centers for Disease Control and Prevention shows that the percent of children without health insurance declined from 13.9 percent in 1997 to 9.8 percent in the first half of 2002. However, while public insurance coverage such as that provided by the Children's Health Insurance Program remained fairly constant until 2000, it has increased steeply in the last two years. Meanwhile, the percent of children covered by private plans dropped.

Tommy Thompson, secretary of health and human services, says the data indicate that giving governors wide latitude regarding how to spend federal CHIP dollars has helped to cover more youngsters. The federal financial contribution to CHIP is substantial, ranging from 65 percent to 84 percent of total program dollars, depending on the state.

However, even this relatively small share may become too burdensome for states, many of which face deficits of 13 percent to 18 percent, according to a survey by the Center on Budget and Policy Priorities. The survey adds that 11 states have proposed reducing Medicaid and CHIP benefits, and about 1 million people would lose coverage as a result.

Percent of persons under 65 with public health coverage (1997-2002)

Percent of persons under 65 with private health coverage (1997-2002)

Percent of persons without health insurance by age group (1997-2002)

SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION, EARLY RELEASE OF SELECTED ESTIMATES BASED ON DATA FROM THE JANUARY-JUNE 2002 NATIONAL HEALTH INTERVIEW SURVEY

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.