The repeal of the 80th percentile rule in Alaska, as argued by Jim Grazko, is a vital step towards reducing health care costs in the state. According to Grazko, insurers such as Premera should bring them into the network and control how much they will pay. However, Grazko emphasizes that price and cost are two different things. While insurers focus on the price they pay, health care providers are more concerned with the cost of providing care.
Grazko compares Premera Alaska’s health care costs to those in Washington but fails to mention other commercial insurers currently paying for healthcare services. He also mentions Medicaid and Medicare but does not provide specific comparisons with commercial insurance products.
Grazko argues that it would be challenging for Premera to compare payment amounts across multiple payers since Alaska lacks a structure to collect or analyze this data. He suggests an all-payer claims database like those in other states would help better understand who is paying for what.
On the other hand, Sandra Heffern believes that repealing the 80th percentile rule will not be an easy solution to reducing high health care costs in Alaska. She points out that pricing and costs of healthcare are complex, and providers aim to provide high-quality care for patients in the state.
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In summary, while Grazko’s argument is valid regarding controlling health care payments through insurers, Heffern highlights that pricing and costs of healthcare are intricate and require more comprehensive solutions beyond just repealing one rule.