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One week after Apple's new mobile payment system, Apple Pay, debuted in CVS stores, CVS has backtracked and barred its use. Rite Aid took the same step, leading many observers to note that the two companies are part of a group of retailers that's developing its own payment system, called CurrentC. Partners include Wal-Mart, Best Buy and 7-Eleven.

The two pharmacy chains stopped using Apple Pay and other "swipeless" payment systems, including Google Wallet. Previously, CVS and Rite Aid had joined other large retailers to create their own mobile wallet, with two key goals: cutting major credit card companies out of their transactions and building more consumer loyalty (and data tracking) through points programs and store credit cards.

Another test of the new system could present itself in the case of Target. Apple mentioned the retail giant at its event announcing Apple Pay, but Target is also a member of the Merchant Customer Exchange, the group that's working on CurrentC.

Further illustrating how delicate and complicated the mobile payment issue promises to be, the MCX website's photo of the CurrentC app shows it running on an Apple iPhone.

Here's a rundown of angles on the story:

"Apple is partnering with Visa, MasterCard and American Express as well as the biggest banks, which together cover more than 80 percent of credit card purchases in the U.S. And Apple is opening up a new revenue stream because it'll get a small cut from the transactions." — NPR's Aarti Shahani.

"Some merchants are finding themselves tied to the Merchant Customer Exchange, known as MCX, while Apple Pay is being rolled out. 'Merchants are contractually obligated to MCX, so they really don't have a choice,' Nathalie Reinelt, an analyst with Aite Group, said in an e-mail." — Bloomberg News

"Please note that we do not accept Apple Pay at this time," says a Rite Aid memo quoted by NFC World. "However we are currently working with a group of large retailers to develop a mobile wallet that allows for mobile payments attached to credit cards and bank accounts directly from a smart phone. We expect to have this feature available in the first half of 2015."

"The only thing that's clear is that sooner or later, consumers are bound to become confused. Which phone can I use (Apple does not support Google Wallet)? Which payment type do you accept? And who the heck can I trust with my data? There goes the convenience factor." — Forbes

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To clamp down on health care costs, a growing number of employers and insurers are putting limits on how much they'll pay for certain medical services such as knee replacements, lab tests and complex imaging.

A recent study found that savings from such moves may be modest, however, and some analysts question whether "reference pricing," as it's called, is good for consumers.

The California Public Employees' Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems.

More than three years ago, CalPERS began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, who helps set benefits policies at CalPERS.

Shots - Health News

Opting Out Of Your Insurance Plan's Network Can Be Costly

Working with Anthem Blue Cross, the CalPERS set $30,000 as the reference price for those two surgeries in its preferred provider organization plan.

Members who get surgery at one of the 52 hospitals that charge $30,000 or less pay only their plan's regular cost-sharing. If member choose to use an in-network hospital that charges more than the reference price, however, they're on the hook for the entire amount over $30,000, and the extra spending doesn't count toward their annual maximum out-of-pocket limit, Boynton says.

"We're not worried about people not getting the care they need," says Boynton. "They have access to good hospitals; they're just getting it at a reasonable price."

In two years, CalPERS saved nearly $6 million on those two procedures, and members saved $600,000 in lower cost sharing, according to research published last year by James C. Robinson, a professor of health economics at the University of California, Berkeley, and director of the Berkeley Center for Health Technology. Most of the savings came from price reductions at expensive hospitals.

The agency recently set caps on how much it would spend for cataract surgery, colonoscopies and arthroscopic surgery, Boynton says.

Those who have studied reference pricing say it is most appropriate for common, non-emergency procedures or tests that vary widely in price but are generally comparable in quality. Research has generally shown that higher prices for medical services don't mean their quality is higher. Setting a reference price steers consumers to high-quality doctors, hospitals, labs and imaging centers that perform well for the price, proponents say.

Others point out that reference pricing doesn't necessarily save employers a lot of money, however. A study released earlier this month by the National Institute for Health Care Reform examined the 2011 claims data for 528,000 autoworkers and their dependents, both active and retired. It analyzed roughly 350 high-volume and/or high-priced inpatient and ambulatory medical services that reference pricing might reasonably be applied to.

The overall potential savings was 5 percent, the study found.

"It was surprising that even with all that pricing variation, reference pricing doesn't have a more dramatic impact on spending," says Chapin White, a senior policy researcher at RAND and lead author of the study.

Even though the results may be modest, a growing number of very large companies are incorporating reference pricing, according to benefits consultant Mercer's annual employer health insurance survey. The percentage of employers with 10,000 or more employees that used reference pricing grew from 10 percent in 2012 to 15 percent in 2013, the survey found. Thirty percent said they were considering adding reference pricing, the survey found. Among employers with 500 or fewer workers, adoption was flat at 10 percent in 2013, compared with 11 percent in 2012.

This spring, the Obama administration said that large group and self-insured health plans could use reference pricing.

The health law sets limits on how much consumers have to pay out of pocket annually for in-network care before insurance picks up the whole tab — in 2015, it's $6,600 for an individual and $13,200 for a family plan. But if consumers choose providers whose prices are higher than a plan's reference price, those amounts don't count toward the out-of-pocket maximum, the administration guidance said.

Leaving consumers on the hook for amounts over the reference price needlessly drags them into the battle between providers and health plans over prices, says White.

"You expect the health plan to do a few things: negotiate reasonable prices with providers, and not to enter into network contracts with providers who provide bad quality care," White says. "Reference pricing is kind of an admission that health plans have failed on one or both of those fronts."

health care costs

Affordable Care Act

Health Insurance

When Don Sage of Concord, N.H., learned his electric bill could rise by as much as $40 a month he got flustered. He and his wife make do on a bit less than $30,000 a year in Social Security payments, and they pay close attention to their electric bills.

"When the invoice comes in the mail to get paid, I have a target amount that we can fluctuate up or down, based on our fixed budget," Sage says. "They don't need my permission to hike up their rates, but the fact is we're the ones that are paying these increases."

Utilities in New England have announced electricity rates hikes on the order of 30 percent to 50 percent, making prices some of the highest in the history of the continental United States.

For Sage and other consumers, these changes seem to have come out of nowhere, but in reality, they have been a long time coming. Between the years of 2000 and 2013, New England went from getting 15 percent of its energy from natural gas to 46 percent. That's dozens of power plants getting built.

But the pipelines to supply those power plants? Not so much.

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Falling Oil Prices Make Fracking Less Lucrative

At the same time, with the fracking boom just a few hundred miles west driving down gas prices, more and more homeowners were switching to natural gas for heating.

So now when it gets cold and everyone turns on their heat, the pipelines connecting New England to the Marcellus Shale are maxed out.

Power plant operators are left to bid on the little bit of gas that's left over for them, and the prices can get out of hand.

"In New England, this winter, based on what's been recently trading, is likely to have the highest natural gas prices on planet Earth," says Taff Tschamler, chief operating officer of energy supplier North American Power.

Gas for January delivery is trading at nearly $19 per million BTUs. Gas in Japan, which relies entirely on imported gas and often has the world's highest prices, is forecast to cost less than $18 this winter.

Big pipelines in New England are on the drawing board, but they won't be built until 2018 at the earliest — and that's only if they don't get swamped by local opposition.

i i

One proposed solution for New England's energy price spike problem: Importing more liquefied natural gas and feeding it into the pipeline network on the other side of the region's bottleneck. Sam Evans-Brown/New Hampshire Public Radio hide caption

itoggle caption Sam Evans-Brown/New Hampshire Public Radio

One proposed solution for New England's energy price spike problem: Importing more liquefied natural gas and feeding it into the pipeline network on the other side of the region's bottleneck.

Sam Evans-Brown/New Hampshire Public Radio

How To Cope

So what's a region to do? For one, if you import gas and plug it into the pipeline network at a different spot, you can avoid the bottleneck.

Distrigas, New England's only liquefied natural gas import terminal, is just north of Boston. Tony Scaraggi, the company's vice president of operations, says even with last year's frigid winter, New England only hit its maximum pipeline capacity for 40 days.

"That's equivalent to like, two and a half to three LNG tankers coming in. So you gotta compare that to the cost of a $2 to $3 billion pipeline," Scaraggi says.

He says burning more expensive foreign natural gas for those 40 days is still cheaper than building an oversized pipeline.

The environmental community is weighing in on the question, too.

Peter Shattuck with Environment Northeast put out a paper arguing the region could save money by using less power.

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New York Says It's Time To Flip The Switch On Its Power Grid

"If demand for gas remains low, because of things like energy efficiency, distributed generation, renewable heating technologies like heat pumps and biomass, we may not need any infrastructure overall," Shattuck says.

So while it's certain that some pipelines will get built, the big question is how much additional capacity, and who will pay.

A plan from the six New England governors to subsidize bigger pipes was tabled recently when Massachusetts announced it wanted to study the question further before committing.

Ultimately, whether electricity prices continue to rise in New England next winter and the winter after that will come down to weather.

"At any rate, what I think we're hoping for is that the good Lord who protects drunks and the United States will also protect New England," says Peter Brown, an energy attorney with the law firm Preti Flaherty.

In other words, pray for a warm winter.

To clamp down on health care costs, a growing number of employers and insurers are putting limits on how much they'll pay for certain medical services such as knee replacements, lab tests and complex imaging.

A recent study found that savings from such moves may be modest, however, and some analysts question whether "reference pricing," as it's called, is good for consumers.

The California Public Employees' Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems.

More than three years ago, CalPERS began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, who helps set benefits policies at CalPERS.

Shots - Health News

Opting Out Of Your Insurance Plan's Network Can Be Costly

Working with Anthem Blue Cross, the CalPERS set $30,000 as the reference price for those two surgeries in its preferred provider organization plan.

Members who get surgery at one of the 52 hospitals that charge $30,000 or less pay only their plan's regular cost-sharing. If member choose to use an in-network hospital that charges more than the reference price, however, they're on the hook for the entire amount over $30,000, and the extra spending doesn't count toward their annual maximum out-of-pocket limit, Boynton says.

"We're not worried about people not getting the care they need," says Boynton. "They have access to good hospitals; they're just getting it at a reasonable price."

In two years, CalPERS saved nearly $6 million on those two procedures, and members saved $600,000 in lower cost sharing, according to research published last year by James C. Robinson, a professor of health economics at the University of California, Berkeley, and director of the Berkeley Center for Health Technology. Most of the savings came from price reductions at expensive hospitals.

The agency recently set caps on how much it would spend for cataract surgery, colonoscopies and arthroscopic surgery, Boynton says.

Those who have studied reference pricing say it is most appropriate for common, non-emergency procedures or tests that vary widely in price but are generally comparable in quality. Research has generally shown that higher prices for medical services don't mean their quality is higher. Setting a reference price steers consumers to high-quality doctors, hospitals, labs and imaging centers that perform well for the price, proponents say.

Others point out that reference pricing doesn't necessarily save employers a lot of money, however. A study released earlier this month by the National Institute for Health Care Reform examined the 2011 claims data for 528,000 autoworkers and their dependents, both active and retired. It analyzed roughly 350 high-volume and/or high-priced inpatient and ambulatory medical services that reference pricing might reasonably be applied to.

The overall potential savings was 5 percent, the study found.

"It was surprising that even with all that pricing variation, reference pricing doesn't have a more dramatic impact on spending," says Chapin White, a senior policy researcher at RAND and lead author of the study.

Even though the results may be modest, a growing number of very large companies are incorporating reference pricing, according to benefits consultant Mercer's annual employer health insurance survey. The percentage of employers with 10,000 or more employees that used reference pricing grew from 10 percent in 2012 to 15 percent in 2013, the survey found. Thirty percent said they were considering adding reference pricing, the survey found. Among employers with 500 or fewer workers, adoption was flat at 10 percent in 2013, compared with 11 percent in 2012.

This spring, the Obama administration said that large group and self-insured health plans could use reference pricing.

The health law sets limits on how much consumers have to pay out of pocket annually for in-network care before insurance picks up the whole tab — in 2015, it's $6,600 for an individual and $13,200 for a family plan. But if consumers choose providers whose prices are higher than a plan's reference price, those amounts don't count toward the out-of-pocket maximum, the administration guidance said.

Leaving consumers on the hook for amounts over the reference price needlessly drags them into the battle between providers and health plans over prices, says White.

"You expect the health plan to do a few things: negotiate reasonable prices with providers, and not to enter into network contracts with providers who provide bad quality care," White says. "Reference pricing is kind of an admission that health plans have failed on one or both of those fronts."

health care costs

Affordable Care Act

Health Insurance