JustCare

Category: What’s Buzzing

  • Warning: Your medical debt will likely continue to appear on your credit report 

    Warning: Your medical debt will likely continue to appear on your credit report 

    During the Biden Administration, the Consumer Financial Protection Bureau (CFPB) passed a rule banning credit agencies from including medical debt on people’s credit reports. The final rule was set to go into effect on March 17, 2025. But, Evan Weinberger reports for Bloomberg Law News that Republicans in Congress are working to repeal this consumer protection.

    Congressmen from South Dakota and South Carolina aim to ensure the CFPB rule never goes into effect. They call it “irresponsible and a clear example of regulatory overreach.” They have the power to repeal the federal rule with a simple majority vote.

    As of now, President Trump delayed the rule’s start date. Moreover, a federal judge in Texas ruled in favor of a credit reporting agency group to delay the start date until June 15 unless Congress or the CFPB repealed it before then.

    The CFPB rule improves credit scores by around 20 points. According to the CFPB, around 15 million Americans have medical debt totaling $49 billion. That’s likely a conservative estimate. Others have reported that older adults alone owe $54 billion in medical debt.

    The rule’s repeal would make it harder and more expensive for people with medical debt to get credit. The Congressmen who oppose this consumer protection argue that banks and others who make loans cannot make informed decisions about whether a person is creditworthy if this CFPB rule goes into effect.

    Here’s more from Just Care:

  • Will Trump give his supporters the lower health care costs they want?

    Will Trump give his supporters the lower health care costs they want?

    As we know, Trump supporters, like most Americans want to see lower prices on basic necessities, like gas and eggs. They also want to see lower health care costs, reports Noam Levey for NPR.

    What could Trump do? He could lower the out-of-pocket maximum on health care costs for working people. But, that would also likely drive up people’s premiums. And, the Republicans opposed the new $2,000 a year maximum on outpatient prescription drug costs for people with Medicare.

    But, the polls indicate that, unlike 10 or 15 years ago, a lot of Trump supporters now want more government involvement to rein in health care costs. People recognize that the “free market” for health care is not their friend. People no longer think that government should stay away.

    In fact, Republicans want the government to step in and limit drug prices and hospital charges. They also want the government to regulate and restrict health care providers from going after medical debt according to recent polls. More than eight in ten support a $2,300 annual cap on medical debt collection.

    Republicans still don’t support Medicare for all. In fact, that would do most to lower their health care costs and ensure they received the health care they needed. One size fits all means that it works for everyone. Other options will not work for people in some or more instances, and there’s no telling when you buy insurance whether that restriced insurance coverage will work for you over time.

    Republicans also overall support Medicaid. Medicaid is especially critical for lower and middle income older adults who need long-term nursing home care. Yet, the House Budget resolution puts in place a plan that will likely slash Medicaid spending and with it push many people off Medicaid.

    Today, Republicans more often hold corporate health insurers, pharmaceutical companies and hospitals responsible for high costs than the government. They see the greed and profiteering in our corporate health care system.

    One poll shows that 75 percent of people who voted for Trump want the government to limit hospital charges. They also want the Trump administration to do more Medicare drug price negotiation, not less.

    Right now, Republicans in Congress are not focused on any of their supporters’ cost-cutting health care priorities. They are poised to slash Medicaid and end subsidies for plans in the state health insurance exchanges, both of which will drive up health care costs for millions.

    Here’s more from Just Care:

  • Senator Grassley takes on UnitedHealth Medicare Advantage overpayments

    Senator Grassley takes on UnitedHealth Medicare Advantage overpayments

    One moderate Republican Senator is concerned about the billions of dollars in government overpayments to UnitedHealth Medicare Advantage. Senator Chuck Grassley, who chairs the Senate Judiciary Committee, sent UnitedHealth CEO Andrew Witty a letter demanding that he release information on the company’s Medicare Advantage government billing practices.

    Countless reports and analyses show that the big Medicare Advantage insurers are overbilling Medicare to the tune of as much as $140 billion a year. The Medicare Payment Advisory Commission more conservatively estimates $83 billion in overpayments last year alone. But UnitedHealth won’t acknowledge that engaging nurses to add diagnoses to their enrollees’ medical records, even when the nurses have no clue what the diagnoses mean and perform no additional tests to determine additional diagnoses, is at the very least wrong, if not outright fraud.

    Senator Grassley wants UnitedHealth to provide Congress will lots of information about their billing practices. Grassley alleged apparent fraud, waste and abuse at UnitedHealth. In 2021, UnitedHealth allegedly benefited to the tune of $8.7 billion from overbilling the government.

    “Despite these oversight efforts, [Medicare Advantage Organizations] continue to defraud the American taxpayer, costing them billions of dollars a year … The apparent fraud, waste, and abuse at issue is simply unacceptable and harms not only Medicare beneficiaries, but also the American taxpayer,” Grassley wrote. Everyone with Medicare pays higher Part B premiums as a result of the overpayments, and the overpayments are eating into the Medicare Trust Fund.

    Grassley wants Congress to examine UnitedHealth’s training manuals, guidance documents, compliance program details, audit results and other documents.

    To be clear, UnitedHealth is the largest Medicare Advantage insurer and, consequently, likely to be reaping the greatest amount in overpayments. But, Humana, CVS Health and Anthem are also beneficiaries of these overpayments. According to the Congressional Budget Office, ending these overpayments would mean $1 trillion in savings over the next ten years.

    Here’s more from Just Care:

  • 2025: Will Congress extend Medicare telehealth coverage?

    2025: Will Congress extend Medicare telehealth coverage?

    Congress will decide whether to extend Medicare Coverage of telehealth services this year. Ruth Reader and Erin Schumaker report for Politico that cost should not be an issue. The latest findings, published in JAMA Internal Medicine, show that Medicare telehealth actually results in lower Medicare spending.

    Congress first expanded Medicare coverage of telehealth services to everyone with Medicare and for a range of services during the COVID pandemic. Until then, Medicare telehealth coverage was largely restricted to people in rural communities. At the end of March of this year, expanded Medicare telehealth coverage will expire unless Congress acts.

    Many policymakers appear to believe that telehealth is driving up Medicare spending and leading to worse health outcomes. But, this new research suggests otherwise. Researchers found that patients received less low-value care or, put differently, higher quality care at lower cost.

    The researchers looked at the records of 2.3 million people with Medicare across 286 health systems. Medicare spending for those patients using telehealth was lower. Patients in health systems using telehealth visited the doctor more but received fewer low-value tests and less unneeded care.

    What were the Medicare savings? The researchers projected at least $66 million. Telehealth visits generally cost less than in-person visits. That said, the Congressional Budget Office projects that two additional years of Medicare coverage of telehealth services will cost about $4 billion.

    Another study published in Health Affairs last year found that people who receive telehealth treatment saw their physicians on an ongoing basis and were more likely to comply with their prescription drug regimens. They also were responsible for fewer emergency room visits.

    Here’s more from Just Care:

  • Congressional Budget Office finds $1 trillion in Medicare Advantage overpayments

    Congressional Budget Office finds $1 trillion in Medicare Advantage overpayments

    Merrill Goozner writes for his Gooznews Substack “if only the GOP was more like Willie Sutton.” Republicans in Congress are working to cut $880 billion from the budget to pay for tax cuts for the wealthy. If they followed the health care money, they would be looking no further than Medicare Advantage.

    The government is currently overpaying insurers in Medicare Advantage about $1 trillion over the next ten years., according to the Congressional Budget Office. This past year alone, overpayments totaled $83 billion according to the Medicare Payment Advisory Commission. Medicare Advantage is the program to target; eliminating overpayments to insurers in Medicare Advantage would help eliminate fraud and waste, strengthen the Medicare Trust Fund and bring down Medicare Part B premiums.

    Republicans want to resurrect Trump’s tax cuts from 2017, which would increase the federal deficit by more than $2 trillion in the next 10 years. Cutting Medicaid, which they are looking to do, would mean major cuts to  hospitals, nursing homes, and other health care providers as well as loss of insurance coverage for millions of low-income Americans.

    Some Republicans are pushing back against House Speaker Mike Johnson because many of their constituents depend upon Medicaid and the federal dollars it brings to their states.

    The House voted on a budget resolution that would cut health care by $880 billion over ten years. Most of that money is likely to come out of Medicaid, although the resolution does not say that. So, there’s still some opportunity to guide Republicans to Medicare Advantage as a source of money.

    Goozner notes that our national debt tends to rise more during Republican administrations than during Democratic administrations.
    Source: Statista; data through 2023

    People in Medicare Advantage are no sicker than people in traditional Medicare–the government-administered Medicare program–even though the insurers would like you to believe otherwise. A new study out of Beth Israel Deaconness Medical Center, published in the Annals of Internal Medicine, found no difference in health status between enrollees in Medicare Advantage and traditional Medicare on four key metrics–obesity, high blood pressure, high cholesterol, and chronic kidney disease. Medicare Advantage enrollees are slightly more likely to have diabetes than traditional Medicare enrollees.

    To address overpayments in Medicare Advantage, the Centers for Medicare and Medicaid Services could simply adjust the amount they pay insurers down by 20 percent or so. Medicare would save about $1 trillion.

    In an editorial accompanying the research paper, Amal Trivedi and Richard Kronick wrote “Policymakers seeking to reduce health spending would better serve taxpayers by curbing MA overpayments rather than targeting Medicaid for savings.” Indeed they would!

    Here’s more from Just Care:

  • President Trump threatens Pharma with tariffs

    President Trump threatens Pharma with tariffs

    President Trump has spent his first few weeks in office undoing much of what President Biden had put in place, but he is not (yet) prepared to undo the Medicare drug price negotiation provisions in the Inflation Reduction Act. In fact, in a meeting with pharmaceutical company executives, he threatened to impose tariffs on pharmaceutical companies if they did not relocate their manufacturing to the US, reports Tristan Manalac for Biospace.

    “Pharmaceuticals, it’ll be 25 percent and higher, and it’ll go very substantially higher over [the] course of a year,” said President Trump. These tariffs would drive up drug prices substantially for working Americans. The Inflation Reduction Act (IRA), passed under the Biden Administration, penalizes drug companies for raising Medicare and Medicaid drug prices more than the rate of inflation.

    President Trump has still not said what he will do about Medicare drug price negotiation. Among other things, the IRA calls for the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, to negotiate the price of 15 prescription drugs that drive high Medicare spending in 2025.  In 2024, CMS negotiated the price of 10 high-cost prescription drugs. Those new drug prices are set to take effect in 2026.

    Pfizer, Lilly, Merk CEOs all attended the meeting with President Trump. Their trade association, PhRMA, has been trying to undo the provisions in the Inflation Reduction Act that reduce drug company profits. The drug companies have sued the government, so far unsuccessfully, claiming that lower drug prices are effectively a taking of their property. Of course, the only reason they can charge the prices they do in the US is because our government has given them monopoly pricing power on patented drugs, unlike the governments in every other wealthy nation.

    Here’s more from Just Care:

  • Congress could end overpayments to big insurers in Medicare Advantage and save $1 trillion, without gutting Medicaid

    Congress could end overpayments to big insurers in Medicare Advantage and save $1 trillion, without gutting Medicaid

    Instead of gutting Medicaid, Congress could save $1 trillion by ending hundreds of billions of dollars in overpayments to corporate health insurers in Medicare Advantage. A new report by Arnold Ventures details how our federal government could effectively end Medicare Advantage and other health care wasteful spending, save as much as $4 trillion, and not touch Medicaid spending.

    The Arnold Venture report spells out 10 ways for Congress to spend less and 10 ways to close tax loopholes that could pay for a permanent extension of the 2017 Tax Cuts and Jobs Act (TCJA). It proposes four smart ways to spend less on health care.

    Arnold Ventures recommends fixing the broken Medicare Advantage payment system that leads to as much as $140 billion a year in overpayments to corporate health insurers. Insurers use a variety of methods to maximize government payments, including “upcoding.” Insurers add diagnosis codes to enrollees’ medical records, which allows them to bill Medicare at higher rates for these enrollees, even when the insurers provide no additional services to these enrollees. The government could adjust down the rate it pays insurers to reduce overpayments significantly. This policy could save as much as $1 trillion over 10 years.

    If Congress ended overpayments to health insurers, the health insurers would claim that the government was “cutting” people’s Medicare benefits. But, the government would still be spending as much on enrollees in Medicare Advantage as in Traditional Medicare. The government would simply be reducing fraud and waste.

    Arnold Ventures recommends “site-neutral payments,” a policy that would require Medicare to pay the same amount for care in a hospital setting as for care in a physician’s office. For reasons that make little sense other than bolstering hospital coffers, today Medicare pays hospitals as much as four times more when a service is performed in a hospital setting. Hospitals have gamed the Medicare payment system by buying physicians’ practices; they can then legally charge the hospital outpatient rate for services, even though the services are identical to what they were before the hospital owned the practices.

    A few years ago, Congress limited the ability of hospitals to continue to game the Medicare payment system through purchases of physician practices. But, Congress grandfathered in the higher rates for hospital outpatient clinics established before the law passed. Ending this grandfathering provision alone would save $30 to $40 billion over ten years.

    Shockingly, the current Medicare payment system still creates an incentive for hospitals to steer patients to get care in a hospital setting, even when the service can be provided at far lower cost in a physicians’ office. Site-neutral payments could save as much as $157 billion over ten years. It would also lower out-of-pocket costs for people with Medicare.

    Arnold Ventures recommends penalizing pharmaceutical companies if they raise the price of their drugs above the rate of inflation for people in the commercial marketplace. The Inflation Reduction Act enacted this policy for Medicare and Medicaid but not for working people. This policy could save the federal government as much as $40 billion over 10 years.

    Arnold Ventures supports requiring Medicaid managed care plans to pay hospitals and nursing homes no more than the Medicare rate.

    Today, states can direct Medicaid managed care plans to pay hospitals and nursing homes at “average commercial rates.” Those rates are far higher than the Medicaid fee-for-service rates. They also incentivize hospitals with monopoly power to increase their rates, which are already twice Medicare rates. Medicaid managed care plans should not be allowed to pay hospitals and nursing homes more than the Medicare rates. This policy would save as much as $120 billion over 10 years.

    Here’s more from Just Care:

  • Why do Americans die younger than people in other wealthy nations?

    Why do Americans die younger than people in other wealthy nations?

    Americans have shorter life expectancies than people in other wealthy nations, even though we spend more on health care than other nations. The Peterson-KFF Health System Tracker looks at why it is that Americans die younger than people outside the US.

    KFF studied mortality rates in the US as well as Austria, Belgium, Canada, France, Germany, Japan, Netherlands, Sweden, Switzerland and the United Kingdom. Americans have a premature death rate of 408 deaths for 100,000 people under 70. The other countries had 228 premature deaths, close to half as many as people in the US.

    Unlike other wealthy nations, which have seen a reduction in the number of their premature deaths, the US has faced an uptick since 2010. Americans had a similar life expectancy as people in peer nations 45 years ago. We saw some increase in life expectancy with scientific advancements, but other countries saw greater increases in life expectancy by 1990. Moreover, peer countries did not see as great a reduction in life expectancy from COVID-19 as the US.

    Heart disease and cancer are the two leading causes of death in each of the countries studied, particularly for older adults. New medicines have reduced the number of premature deaths from heart disease. But, since 2010, Americans have seen an increase in premature deaths from heart disease, while other countries have seen a decrease.

    Americans suffer more from heart disease, chronic respiratory diseases, and chronic kidney diseases, which are collectively responsible for about 105 of the 408 premature deaths. COVID-19 was responsible for 64 of the 408 premature deaths in the US, and substance abuse was responsible for 29 of the premature deaths.

    Today twice as many Americans die of heart disease before the age of 70 than people in peer countries, likely because of more substance abuse and obesity in the US. Moreover, people with chronic heart conditions need ongoing medical care to remain healthy. But, Americans face much larger barriers to care than people in other countries.

    Cancer death rates declined by 40 percent in the US since 1988 for people under 70. And, the US cancer death rates remain comparable to those in peer countries over the last 40 years. Older Americans are less likely to die of cancer than people in peer nations. Some believe that’s because more Americans have died prematurely of other conditions than people in peer nations.

    Younger Americans suffer more from chronic conditions, substance abuse, injuries and communicable diseases than people in peer nations. Fifteen to 49 year olds in the US suffer two and half times more premature deaths than 15-49 year olds in peer nations. The premature death rate for this population in the US has not changed much in the last 45 years. In peer nations, it has dropped by half!

    The US has also seen higher numbers of childhood deaths than other wealthy nations. Over the last 45 years, the number of deaths of 0 to 14 year olds in the US has declined some, but it’s still higher than peer nations, 20 more deaths per 100,000 American kids. Some attribute this difference to racial disparities leading to worse health of babies at birth, more of whom are born premature or with congenital birth defects. In addition, three to four times more American kids died from killings, travel fatalities (we drive bigger cars and have less public transportation) and choking.

    Thankfully, medical advances have reduced death rates a lot. Many fewer people die of neonatal conditions, birth defects and HIV/AIDS. Deaths resulting from heart conditions also have dropped considerably. And, because fewer people smoke, fewer people are dying of cancer and heart disease. But, we are the richest country in the world, and there’s no excuse for our continuing to have shorter life expectancies than people in ever other wealthy country.

    Here’s more from Just Care:

  • Trump signs executive order creating “MAHA” commission

    Trump signs executive order creating “MAHA” commission

    President Trump signed an executive order creating a Make America Health Again (“MAHA”) Commission to be chaired by Robert F. Kennedy Jr., the newly confirmed head of the US Department of Health and Human Services, reports Noah Tong for Fierce Healthcare. The Commission will look into the “root causes of America’s escalating health crisis.”

    RFK Jr.’s priority is the childhood chronic disease epidemic.  The Commission will focus on health research, our diet, toxins and other environmental factors, health care coverage and corporate influence.  The Commission will release its “Make Our Children Healthy Again Assessment” to President Trump in 100 days.

    The Commission has 180 days to recommend a strategy for addressing childhood chromic conditions. RFK has long blamed vaccines for some childhood chronic conditions, and he has not wavered from that position, even though the evidence weighs heavily against his thinking.

    RFK Jr. has explicit authority to hold hearings and meetings and other public events, to the extent he chooses, and he can solicit expert advice from public health leaders. He says that he wants to remove dangerous chemicals from our environment and food.

    In addition to Chairman RFK Jr., Commission members include the Director of the National Institutes of Health, the Director of the Centers for Disease Control, the Commissioner of the Food and Drug Administration, the Education Department Secretary and the Housing and Urban Development Secretary.

    Meanwhile, it remains unclear how or whether President Trump will address high drug prices. The pharmaceutical industry is hoping he will end Medicare drug price negotiations required under the Inflation Reduction Act. New tariffs Trump imposed on China are projected to drive up drug prices, as many pharmaceutical ingredients are imported from China.

    Here’s more from Just Care:

  • 2025: What will become of Medicaid?

    2025: What will become of Medicaid?

    At the moment, Republicans in Congress are eyeing major cuts to Medicaid–a program that provides critical health care to more than 70 million low-income Americans–as part of their push to cut government spending significantly. In January, President Trump had said he would not cut Medicaid, except to address fraud and abuse, report Ben Leonard for Politico and Ryan Levi for NPR. What will become of Medicaid?

    Proposed Medicaid cuts are not simply about fraud and abuse. Many Republicans also want to include work requirements as part of Medicaid eligibility. To be clear, lots of people with Medicaid are over 65 or have a disability and are unable to work.

    As a result of the Affordable Care Act, 21 million more people have been able to enroll in Medicaid. Their incomes were under $45,000 for a family of four. The federal government covers up to 90 percent of that cost.

    What’s on the chopping block in Congress? As much as $230 billion a year in Medicaid cuts over the next ten years to help cover the cost of enormous tax cuts. If it happens, a significant number of the 70 million Americans with Medicaid would lose Medicaid coverage. Some would die needlessly.

    Medicaid saves lives. The research shows a nine percent reduction in adult mortality in the four years after passage of  Medicaid expansion with the Affordable Care Act.

    Some Republicans, including Robert F. Kennedy Jr., claim that Medicaid does not improve people’s health. Those not supporting Medicaid point to one experiment in Oregon, which showed that people with Medicaid had a higher chance of receiving preventive services than people without it. They were less depressed and received fewer medical bills. But, their cholesterol and blood pressure levels were no different from those who did not get Medicaid. [This seems hardly a basis for denying Medicaid’s value.]

    Republicans also claim that Medicaid dollars flow too easily to the states. The federal government covers between 50 to 90 percent of Medicaid costs. Republicans say that states game the system to get extra money from the feds.

    Could people with Medicaid afford to buy insurance in the private market, as some conservatives claim? It’s hard to imagine, given the high cost of private insurance, including premiums, deductibles and copays. Most Medicaid dollars are spent on older adults and people with disabilities for nursing home care, which Medicare does not cover.

    How are the states reacting? Some Republican states are already moving to end Medicaid expansion, reports Anna Claire Vollers for Stateline. Idaho, Montana and South Dakota are leading the way to end Medicaid expansion. If Idaho ends expansion, close to 90,000 people would lose their Medicaid coverage.

    Nine states have “trigger” laws that require them to reduce Medicaid spending if the federal government reduces its contribution to Medicaid.

    Will big cuts to Medicaid happen this year? It’s possible. If so, it would happen soon, in the reconciliation package. Hospitals and Democrats are pushing back. About 20 percent of hospital revenue comes from Medicaid.

    What happens to the cost of individual health insurance if Medicaid is cut significantly? Many states would likely end Medicaid expansion, millions of Americans would be uninsured, and individual health insurance premiums would likely rise a lot. A new report finds that if Montana stopped its Medicaid expansion, as many as 74,000 Montanans would lose coverage and the uninsured could represent as much as half of Montanans. In addition, health insurance premiums would increase as much as eight percent or $767 a year because the people signing up who had had Medicaid are a sicker cohort than the group with private insurance currently. Rural health care would be at risk.

    Here’s more from Just Care: