JustCare

Author: Wendell Potter

  • Death and debt by deductibles

    Death and debt by deductibles

    Note: This post was originally published on The Potter Report.

    Congrats, America! Earlier this month you passed an annual milestone: Two days after Tax Day, you made it to… Deductible Relief Day!

    What’s that? It’s the day where the average person with employer-based health insurance has spent enough on health expenses to finally meet their deductible.

    Health insurance deductibles have been rising so rapidly (year after year after year) that the Kaiser Family Foundation decided to track the trend to show how severely Americans are getting ripped off (and sick). And it’s bad.

    As you might guess, the Deductible Relief Day is being pushed further each year. In 2005, you had to wait until February 28. By 2009, you wouldn’t be popping champagne until March 18. In 2019, you waited two months more than that.

    As the Kaiser Family Foundation noted, in 2009, the average deductible was $533 for a single person. In 2018, it was $1350. How? The insurance industry strategy of moving all of us into high-deductible plans (one of the many gross abuses I saw first-hand at Cigna) has paid off well for my former employers.

    In 2018, about 85% of covered workers were enrolled in a high-deductible plan, up from just 50% ten years earlier. Another way of looking at this: Average enrollee spending on deductibles more than tripled between 2007 and 2017.

    And Kaiser didn’t look at people who buy their coverage on their own through the ACA exchanges. They’re in even *worse* shape. The Commonwealth Fund found that 40% of people in ACA plans are underinsured because of high out-of-pocket charges – and many likely never meet their deductibles.

    As a result, millions of Americans are not going to the doctor or picking up prescriptions. Insurers LOVE that. It’s far fewer claims to pay! It’s why, when many other businesses went belly up during COVID-19, insurers made record profits: medical treatment was less accessible!

    President Biden, are you paying attention to this? You must.

    Millions of people WITH insurance who voted for you, including folks on Obamacare, CAN’T USE IT because of deductibles! Insurers can charge families up to $7,200 before they’ll pay a dime. It keeps going up. Every. Single. Year.

    No wonder more and more Americans with insurance are turning to GoFundMe or bankruptcy court. It’s not just the premiums you gotta worry about, Joe. Deductibles are eating us alive. You and Congress need to pay attention before NO Americans can meet their deductibles.

    Here’s more from Just Care:

  • Coronavirus: Health insurers celebrate their most profitable year

    Coronavirus: Health insurers celebrate their most profitable year

    As millions of Americans celebrated President Biden’s inauguration, some of my former colleagues in the health insurance industry were quietly celebrating some news of their own: their most profitable year ever.

    That’s right: insurance companies made a fortune during a pandemic.

    Just hours before President Biden took the oath of office, UnitedHealthcare quietly released the news that it had blown away Wall Street’s most optimistic profit expectations for 2020, the year of the worst public health crisis in our lifetime that’s seen more than 400,000 Americans die.

    The company reported that although it insured fewer people in the United States in 2020 than in 2019, it took in $15 billion more in revenues. One of the ways it was able to pull that off? By paying far fewer claims last year than the year before. Again, this was during a pandemic.

    Had it not been for membership gains in its Medicare Advantage and Medicaid plans, UnitedHealth would’ve hemorrhaged even more health plan enrollees. In fact, it covered 1.5 million fewer in individual and employer-sponsored/group plans than in 2019 but made BILLIONS more in profits.

    One reason for the drop in health plan enrollment: millions lost health insurance with their jobs during COVID-19. That isn’t a problem for Big Insurance. I hope President Biden pays close attention to how UnitedHealth and others have made huge profits since the Affordable Care Act was passed.

    Mr. President, you called it a “big f*cking deal” when President Obama signed the ACA into law. It brought insurance to 20 million of the 50 million Americans uninsured at the time and made it illegal for insurers to deny coverage to people with preexisting conditions. But …

    Insurance lobbyists rigged the bill in ways that guaranteed huge profits for years to come. Consider this: when you were sworn in as Vice President in 2009 you could’ve bought a share of UnitedHealth stock for $21.55. When you became president yesterday, that share would cost $350.84.

    No wonder Wall Street loves UnitedHealth and other big health insurers so much. UnitedHealth’s shares alone have increased 1,650% over the past 12 years. How much have American wages increased in that time? Not much. How much have their premiums increased? A lot.

    Meanwhile, tens of millions are still uninsured. Even more are “underinsured” because of absurdly high deductibles insurers charge us before they’ll pay a dime. That’s why so many of us with insurance go bankrupt or turn to GoFundMe to beg for money to pay medical bills.

    Get this: UnitedHealth now makes more than two times as much from government programs like Medicare Advantage and Medicaid, than from its “commercial” customers. Most of its revenue by far is coming from taxpayers than their corporate & individual customers.

    Mr. President, to help people get the care their doctors say they need, investigate this industry and take action to put an end to this outrageous profiteering. We taxpayers are being taken to the cleaners by these companies. I know because I worked for them. Let’s talk.

    This post was originally published on Tarbell.org.

    Here’s more from Just Care:

  • Aetna, for-profit insurers do not serve public good

    Aetna, for-profit insurers do not serve public good

    The U.S. Department of Justice is trying to block Aetna’s merger with Humana. And, Aetna, along with other for-profit insurers, are pulling out of most of the Obamacare state exchanges, claiming that they are losing too much money. We must recognize and address the reality that for-profit insurers are not in the business of serving the public good.

    Let’s be clear. Obamacare has served the for-profit insurers extraordinarily well. Aetna alone has made nearly $7 billion in profits since the launch of Obamacare in 2014, and its stock price has soared. Aetna’s stock price is more than six times higher than it was when debate began over the Affordable Care Act in 2009.

    Aetna’s contention that it’s not viable for it to continue offering coverage in the exchanges, that they are getting too many enrollees with high health care costs, rings hollow. The non-profit insurers, such as Kaiser and Blue Cross, are managing to balance risk in the state health exchanges.

    It is indeed true that the majority of people enrolling in the state exchanges are poor and in poor health and that there are not as many young, healthy people to enroll as the insurance industry would like in order to balance risk. But, it is also true that for-profit insurers feel obligated to exceed Wall Street’s expectations every quarter in order to drive up their stock prices. Any business unit that is not doing well jeopardizes their ability to do so. That motivates Aetna’s CEO to close down its line of business in the state health insurance exchanges.

    What’s disturbing and makes the case for a public health insurance option in the state exchanges is that Aetna has no obligation to the public, no obligation to continue serving sicker poorer people in the state exchanges, even when its operating earnings are growing and the federal government’s Medicare and Medicaid programs are major growth areas. Indeed, its thanks to Obamacare that Aetna has so many more Medicaid enrollees.

    The non-profit insurers are remaining in the state exchanges because they can take a long-term view. They do not need to please Wall Street every quarter. But, they alone cannot meet the needs of people in the state exchanges. In order to give people the choice of a health plan they can rely on, we need a public health insurance option like Medicare or an expansion of Medicare for people under 65.

    Here’s more from Just Care:

  • What to do about big money in politics

    What to do about big money in politics

    What can be done to reduce the outsized influence of special interests and a handful of billionaires on our political system? My new book with Nick Penniman, Nation on the Take: How Big Money Corrupts Democracy and What We Can Do About It, outlines several legislative proposals that would go a long way toward ensuring that average Americans can once again exercise their right of self government.

    While it’s true that reversing the Supreme Court’s Citizens United decision will likely take years, there are actions that our lawmakers—the people who work for us—can take to restore our democracy. Yes, the Citizens United decision has enabled the rich and powerful to have greater influence than ever before over public policy and our political system. There are groups that are working for a Constitutional amendment to overturn that decision (it could also be overturned when the composition of the Court changes in the coming months or years). There are also many other things that our elected officials—at municipal, state and federal levels—can and must do now.

    So, what are the legislative fixes that we can accomplish right now, regardless of the Supreme Court? Broadly speaking, they fall into four categories that embody the principles of a high-functioning democracy: (1) everyone participates, (2) everyone knows, (3) everyone plays by the same commonsense rules, and (4) everyone is held accountable.

    1. Everyone Participates: Citizen funding of elections: This is the “game changer” category. Unless we create better ways of financing politics in this country, we’re never going to be able to rebalance the power dynamic in Washington and the state capitals. There are several types of citizen funding programs, dozens of which are already in place at the state and local levels, including:

    • Clean elections, in which candidates receive a set amount of money to operate their campaigns;
    • Matching funds, in which a government fund matches every dollar raised from citizens, by some multiple, up to a certain amount;
    • Tax incentives, in which people get a tax credit or deduction for political contributions, up to a certain amount;
    • Vouchers, in which the government provides each citizen with a certificate for $50 or $100, which he or she can then contribute to a candidate or party; and
    • Hybrids, or some combination of the above approaches.

    2. Everyone Knows: Transparency: The one thing we know is that darkness encourages bad behavior. That’s why it’s critical that voters know exactly where the money is coming from. And the information should be available online immediately, presented in an intuitive and easy-to-navigate format to give the public the true transparency people need to make informed decisions.

    3. Everyone Plays by the Same Commonsense Rules: Reform lobbying: Beyond campaign financing and transparency lies a realm of ideas that is too often overlooked; ethics and lobbying reforms. Many of these involve changing the way lobbyists interact with politicians and government officials. One such fix: Let’s enact at the federal level what many states have in place—bans on campaign contributions from lobbyists.

    4. Everybody is Held Accountable: Change the way the elections’ cop works: All the laws on the books are utterly irrelevant without a strong enforcement mechanism ensuring that everyone is held accountable to the laws. Our system of self-government relies, in part, on a citizen’s belief that someone is enforcing the rules of politics, keeping the game clean.  That someone is the Federal Election Commission, which, unfortunately, has been dysfunctional for years. We need to fix the FEC.

    Nation on the Take provides much more information about these proposals as well as how average Americans can get involved in the fight to restore democracy. For an excerpt from the book, click here.

  • Fixing democracy: Addressing big money in politics

    Fixing democracy: Addressing big money in politics

    What can we do to fix our democracy? We need to be out there advocating for reform.  Among other things, we need to get big money out of politics and health care. It’s corrosive.

    In Deadly Spin, my first book, I described having an epiphany a few years ago when I witnessed thousands of people—people who could have been relatives or former neighbors—standing in long lines, in the rain, waiting to get medical care in barns and animal stalls at a county fairgrounds near where I grew up in Tennessee. I was head of corporate communications for one of the country’s biggest health insurers at the time. I realized that what I did for a living was helping to perpetuate a status quo in American health care that benefited a few at the expense of millions of others.

    I was so shaken by what I saw that day in 2007 that I left my job a few months later and became a vocal critic of my former industry and an advocate for reform.

    I had a second epiphany two years later when it became abundantly clear to me that we would never achieve the reforms we need until we address an even more fundamental problem: the corrosive effect of big money in politics.  My fellow reform advocates and I were disheartened time and again when rich special interests, the insurance and pharmaceutical industries in particular, were able to kill important consumer protections in the reform legislation that they thought might adversely affect profits. (Read here about how members of Congress have a stake in pharmaceutical and device companies they regulate; and here about how federal policy promotes high drug prices.)

    That’s why I teamed up with Nick Penniman, a fellow former journalist, to write a new book: Nation on the Take; How Big Money Corrupts Our Democracy and What We Can Do About It. In it we describe how American democracy has become coin operated. How special interest groups increasingly control every level of government. We also link this legalized corruption to the kitchen-table issues all of us face every day. And we chart a way forward, toward the recovery of America’s original promise.

    As we wrote in the book: “Democracy requires reinvention and constant vigilance. Like the Founders and the abolitionists, the suffragists and the civil rights activists, when we see a fundamental problem in our system, we fix it. That’s the American way. Now we need to fix democracy—before we can fix the other problems we all face.” You can now order the book online.

    Other posts that might be of interest:

  • To maximize profit, health insurers dropping small businesses

    To maximize profit, health insurers dropping small businesses

    Arguably, the people who have benefited most from the health care law—at least financially—are the top executives and shareholders of the country’s health insurance companies. And to maximize profit, health insurers are dumping small businesses or raising their rates substantially. Many small business owners who would like to keep offering their employees health coverage can no longer afford it.

    Insurer rates are rising steadily, and small business owners cannot afford to keep offering coverage as much as they would like to.  At the same time, the insurers’ share prices have doubled, and some have more than tripled, since the Affordable Care Act was signed.

    About two thirds of the country’s small businesses offered coverage to their workers in the 1990s. Now, it’s down to 50-55 percent. One reason is that insurers are “dumping” unprofitable accounts, especially small business customers.

    Insurers can lose money if a single employee of a small business gets sick or needs costly care. So, it’s in their interest to stop serving those businesses. Unfortunately, Obamacare does little to keep them from doing so.

    For more information on what’s happening in the health insurance market, visit the Center for Public Integrity, where I write about this in greater detail.

    For information about how health insurer mergers are driving up premiums, click here. To learn more about health insurance options and how fewer health insurers are offering out-of-network coverage, click here.