Twitxy Saved

Loren Adler

@LorenAdler

Fellow & Associate Director, Brookings Institution Center on Health Policy | Associate Editor, Health Affairs Scholar | health policy, budgets, Knicks
Washington D.C. brookings.edu/people/loren-a… Joined July 2011
1.1K Following 10K Followers 23K Posts

Latest posts 5

Loren Adler @LorenAdler
With Centene and Molina among the big gainers, I’d read this more as a shift in expectations about Medicaid and ACA cuts than about the prospects for hospital payment or Medicare Advantage reforms.
Jason Furman Verified account @jasonfurman 6d
Stock markets up after election results. But what is most interesting is the composition. Health and solar up, data centers and Musk-related down. Crypto up may be the one I wouldn't have expected.

And note, markets presumably had already been pricing in large Democratic gains.
View quoted post on X
1 replies 3 reposts 5 likes 4.8K views View on X
Loren Adler @LorenAdler
1/ Both letters raise legitimate concerns about insurers not paying arbitration awards.

But neither grapples with how much higher average awards are than pre-law commercial prices. Higher expected arbitration payments feed into future premiums.
Ed Gaines Verified account @EdGainesIII Oct 23
These letters to the WaPo Editors are well stated:

"The No Surprises Act is supposed to protect patients. Here’s how it hurts providers.
Reforming the No Surprise Act and AI standards, in readers' eyes.
October 22, 2026 at 4:29 p.m. EDT Yesterday at 4:29 p.m. EDT

Jackson Hammond and Brian Blase’s Oct. 18 op-ed, “A $17 billion surprise bill for Americans,” argued the No Surprises Act’s arbitration system is driving up health care costs, but they missed the root cause driving disputes.

I am a practicing emergency physician, and I’ve never met a colleague who said they view arbitration as a business model. But it becomes necessary when insurers terminate network contracts to make lowball payment offers to physicians who treat patients in emergencies, regardless of their ability to pay.

The op-ed, which detailed the new Paragon Health Institute analysis, argued that independent arbitrators side with providers in roughly 85 percent of disputes. But that statistic deserves context. In one study, which was backed by the Americans for Fair Health Care coalition, insurers’ qualifying payment amounts were set at $0 in more than 20,000 disputes, and in almost 1,000 others, they were set at less than $1.

Meanwhile, more than 20 percent of the time, insurers delayed paying arbitration awards or failed to participate, leaving physicians waiting to be paid for care they had already provided.

Paragon argues that physicians use arbitration to demand higher rates. My organization, TeamHealth, has seen awards below what insurers paid for the same services in 2019.

Health care systems would rather work under fair, stable in-network agreements, but persistent underpayments make it harder to recruit and retain clinicians and negotiate sustainable contracts, contributing to narrower networks and reduced access to emergency care.

Congress should preserve the No Surprises Act’s patient protections, require insurers to comply with arbitration decisions and address the payment practices that make arbitration necessary.

Jody Crane, Richmond
The writer is the chief medical officer for TeamHealth."

Letter #2:

"Every single day in America, someone experiences a life-threatening event that requires an air ambulance to keep them alive and get them to a hospital that can provide the appropriate level of care. Teams of dedicated medics, nurses and pilots are on duty 24/7 to respond to emergencies. But these services are critically undervalued by health insurance companies.

As important as the No Surprises Act is for protecting patients, it lacks the enforcement mechanisms needed to ensure emergency care providers are reimbursed.

Unfortunately, a growing number of payers are refusing to pay the outstanding claims that independent arbitrators have determined they owe — decisions which are legally binding and must be paid within 30 days. To date, insurers owe my company, PHI Health, more than $50 million in unpaid independent dispute resolution awards for emergency care already delivered.

This enormous burden has forced us to suspend operations at one base in rural California and threatens the future of air ambulance services. Insurers’ failure to respect the law could eventually leave many communities without air medical services, a situation Congress hardly intended.

The No Surprises Act needs more teeth to ensure that insurance companies follow the law and that claims owed are paid promptly.

Paul Julander, Tempe
The writer is co-president of PHI Health."
View quoted post on X
5 replies 5 reposts 13 likes 8.6K views View on X
Loren Adler @LorenAdler
New from across Brookings: what the midterms could mean for public policy.

@MattAFiedler & I discuss how the next Congress’s health care bills could lay the groundwork for future reforms, even if they don’t become law.

brookings.edu/articles/the-m…
www.brookings.edu The midterm effect: What the 2026 election could mean for public policy | Brookings Brookings experts examine the implications of the upcoming 2026 midterms on the most consequential issues facing the nation.
0 replies 0 reposts 1 likes 1.2K views View on X
Loren Adler @LorenAdler
1/ Not the way I would've chosen to spend our premium dollars & taxpayer subsidies
Tara Bannow @TaraBannow Oct 19
I dug into the finances of the three nonprofit arbitrators resolving No Surprises Act disputes. For every dollar they made in '25, ~half was pure profit.

Read more about these 'mini-gods' and how they're getting rich off their new jobs.

tinyurl.com/5ye2csun via @statnews
View quoted post on X
4 replies 1 reposts 10 likes 3.1K views View on X