JustCare

Category: Health insurance

  • High deductible health plans are a barrier to care for working people

    High deductible health plans are a barrier to care for working people

    Corporate health insurers can use a range of tactics to make it seem that they are offering you more at less cost. One such tactic relies on high deductibles to keep premiums down so that the health plan looks more affordable. A recent EBRI report on employers who offer high deductible plans to their workers confirms that high deductibles can be a huge barrier to care.

    EBRI looked at the effect on access to care for people with mental health disorders of a switch from a preferred provider organization to a high deductible health plan.  EBRI observed that people with major depressive disorders and anxiety were less likely to get care in high deductible health plans.

    EBRI further found that working people with mental health disorders in high deductible health plans used fewer health services of many types. They used fewer office visits, they filled their prescriptions less frequently, they spent fewer days in the hospital and they used emergency rooms less often. Moreover, working people in high deductible health plans also used fewer preventive services, including fewer cancer screenings and vaccinations.

    In sum, working people in high deductible health plans saved their employers a lot of money on health care. Workers made the choice to forgo health care services and spend less on health care in a variety of instances. It would therefore stand to reason that the higher the deductible, the greater the barrier to care for people with Medicare, who tend to live on far lower incomes than working people.

    EBRI’s findings are in sync with a range of other findings showing that, overall, cost is a barrier to care for people with health insurance. Tens of millions of Americans with insurance are underinsured and live on small fixed incomes. Once out-of-pocket health care costs come into play, they are forced to decide between their health and their rent or mortgage or heat or supper. These are choices that no one should have to make.

    A recent NBER study found that more than 20 percent of people with Medicare drop all their  prescriptions–including life-saving medicines–when they face a copay increase of as little as $10.40. As a result, thousands die. So, it’s not surprising that high-deductible health plans, with deductibles in the thousands of dollars, lead lots of people to forgo care. Some of these people likely die needlessly as a result.

    Congress continues to sit back and let people opt against getting needed health care because of the cost rather than regulating health care prices and guaranteeing access to health care to anyone and everyone who needs it, regardless of ability to pay. Talk about a Darwinian approach that will lead to countless needless deaths and disabilities.

    Here’s more from Just Care:

  • Medical debt on the rise

    Medical debt on the rise

    New research from the Peterson Center on Health Care and the Kaiser Family Foundation finds that Americans are now holding at least $195 billion in medical debt. Nine in ten of them have health insurance. Emergency care, COVID-19 care and mental health care are the three biggest causes.

    Three million Americans owe more than $10,000 in medical debt, and 16 million Americans owe more than $1,000. Not surprisingly, the most vulnerable Americans face the greatest debt. Researchers say that “Medical debt can happen to almost anyone in the United States, but this debt is most pronounced among people who are already struggling with poor health, financial insecurity, or both,”

    In a separate survey of 1,250 people, researchers found that more than half (55 percent) say they have some medical debt. And, almost half of these people report not being able to purchase a home or put money aside for retirement as a result.

    Nearly seven in 10 people (69 percent) who purchase their own health insurance have medical debt and just over six in ten (61 percent) who have employer coverage have medical debt. Just under six in ten (59 percent) without health insurance report having medical debt.

    People with health insurance appear to have the same rate of medical debt as people without health insurance. But having health insurance limits the amount of debt people have. Health insurance deductibles have sky-rocketed over the last several years, presenting a barrier to care for many Americans. They are also a driver of medical debt.

    Employer plan deductibles average $1,669 in 2022 for people who work for large employers. People working in companies with fewer than 200 workers face even higher average deductibles, $2,379. And, individuals with state health insurance exchange plans and no subsidies faced average deductibles of $4,364 in 2020.

    Total average out-of-pocket costs for health care are now $12,530. That includes premiums, deductibles and copays. And, it represents about 20 percent of the typical person’s annual income, $67,521 in 2020.

    People not yet eligible for Medicare, with incomes between 100 and 400 percent of the federal poverty level, are entitled to subsidies on health insurance through the state health insurance exchanges, which can bring down their health care costs significantly. People with Medicare with low incomes are also eligible for government assistance paying premiums, deductibles and coinsurance, through Medicaid and Medicare Savings Programs.

    To minimize your costs, plan ahead. If you have Medicare, to save money, make sure you have the number of the local ambulance that takes Medicare on your phone and your refrigerator. If you’re in a Medicare Advantage plan, have the number of an in-network ambulance.

    Here’s more from Just Care:

  • UnitedHealth could force nearly 3,000 patients to forgo care or find new physicians

    UnitedHealth could force nearly 3,000 patients to forgo care or find new physicians

    Because the US Congress leaves it to corporate health insurers to negotiate health care provider rates and agreements, our health care costs are far higher than they should be. In addition, access to health care is often far more difficult than it should be. In Vermont, Valley News reports that UnitedHealth’s negotiations with doctors at the University of Vermont Medical Center might fail and UnitedHealth would then cut ties with physicians for nearly 3,000 patients, forcing them to forgo care or find new physicians.

    Corporate health insurers are legally obligated to think first and foremost about their own profits. The effects of their administrative, financial and other activities on patient care do not seem top of mind. So, it’s no surprise that UnitedHealth’s failure to reach agreement with physicians providing in-network care at UVM Medical Center could leave its members without a treating physician. If fewer members are getting in-network care, it would increase profits further for UnitedHealth.

    UnitedHealth’s members will all have to find new network physicians if United does not reach agreement with the providers at UVM. But, that means that some members in the midst of cancer treatment could be without treatment as of April 1. Notably, people in Medicare Advantage are not affected by these negotiations, likely because the government negotiates provider rates for people with Medicare, and Medicare Advantage plans can piggyback off those rates for their Medicare members.

    UnitedHealth claims UVM provider rates are rising too much. UVM, in turn, says that it is facing rising staffing and other costs and needs higher rates to survive. It adds that administrative and other operational barriers UnitedHealth imposes keeps patients from getting the care they need in a timely fashion. “Despite our best efforts to resolve these issues, patients continue to experience unnecessary delays in and restrictions on approvals for common tests, imaging, treatments and medications, among other challenges, due to United’s own policies and reimbursement practices.”

    UnitedHealth told one cancer patient currently getting treatment at UVM Medical Center to get her chemotherapy from a hospital 95 miles away. Really? If Congress does not yet deem it appropriate to step in and guarantee everyone access to care, it’s hard to imagine what it will take to move policymakers.

    Here’s more from Just Care:

  • How to pay less for your hospital care

    How to pay less for your hospital care

    If your income is low, you might be able to pay less for your hospital care. Among the many elements of the Affordable Care Act is a requirement that nonprofit hospitals provide financial assistance to patients with limited means. Kaiser Health News reports that most people do not know about this law that can keep them from medical debt.

    Most hospitals in the US are nonprofit. Under federal law, these hospitals must forgive your hospital bills if you make less than a certain income. But, there are a lot of people who qualify for “charity care,”–full or partial help paying for their treatment–who do not know they are eligible.

    Jared Walker founded an organization, Dollar For, that helps people get the charity care to which they are entitled and avoid medical debt.

    What should you do to apply for charity care? Find out what your hospital’s policy is. It likely won’t be on the hospital website’s home page or easily searchable on its website. To find the hospital’s policy online, try googling the name of the hospital and “charity care” or “financial assistance.”

    Once you find the policy, you should also have an application. If you can’t find the policy through a simple google search, call the hospital and ask for a copy of it, along with an application.

    Are you eligible for charity care? Hospitals all have different policies. For example, one hospital might charge you nothing if your income is below 200 percent of the federal poverty level. It might lower your out-of-pocket costs if your income is between 200 and 300 percent of the federal poverty level.  You probably will need to show proof of income.

    What if you’re not eligible? You should still apply if your income is low and you can’t afford the cost of care. For example, if the hospital’s policy only covers uninsured people but your costs with insurance are super high, it’s still worth applying. It’s also worth applying if your income is higher than the cut-off, but you can’t afford your hospital costs. In these and all cases, write a letter to accompany the application that explains your financial situation.

    How long do you have to apply? Under federal law, you have about eight months (240 days) from the date of your hospital bill to apply for financial assistance, and your hospital might give you much longer.  Unfortunately, that could be after the hospital has sent your bill to collection. (A hospital can hire a collection agency to try to collect the money you owe as soon as six months after it first bills you.)

    What if a collection agency is going after money from you for your hospital care? Let the agency know that you have applied to the hospital for charity care. And, ask the hospital to call off activity by the collection agency.

    What’s the best way to send my application and letter? Hand-deliver or fax them in order to be sure the hospital receives your letter and application and that they do not get lost in the mail. If you opt to fax them, see if your public library will fax them for you.  You can also fax them through an online app.

    To be sure, getting charity care is not the easiest undertaking. But, it’s worth the effort. You could save yourself thousands of dollars and avoid medical debt.

    Here’s more from Just Care:

  • The myths health insurers want you to believe

    The myths health insurers want you to believe

    When I was a health insurance communications exec, I was a big part of an ongoing effort–funded by your premium dollars–to get you to believe big myths about the U.S. healthcare system.

    Even a minute or two of Googling would have disproved our claims, but we succeeded because we knew most people wouldn’t bother. For the most part, health reform advocates have also not been up to the task of challenging the misinformation and setting the record straight.

    Why do my former colleagues keep this deception going? For a single reason: to protect what has become an extraordinarily profitable status for health insurers. As long as you (and the people you vote for) keep believing the myths, you will be parting with far more of your hard-earned dollars than you should to keep insurers’ shareholders happy.

    Let’s look at three of those myths.

    Myth 1: The U.S. has the best health care system in the world. 

    While there is no doubt we have some of the very best hospitals, technology, physicians and other caregivers, we are nowhere close to having the best system. My former colleagues and I perpetuated that myth because we wanted you to think that any kind of significant reform is unnecessary, especially if the reform might reduce insurance revenues and profits. We didn’t even want you to think that the millions of Americans without insurance is a big deal because, well, those are just people shirking their individual responsibility by remaining uninsured. In other words, it is their fault, not the system.

    In 2004, long before the Affordable Care Act was passed, the Commonwealth Fund launched a major project to assess the performance and fairness of several developed countries’ health systems. Of the 11 systems assessed, ours came in dead last. They have updated the assessments every couple of years, and the top-performing systems have varied over time, but one thing has remained constant: the U.S. continues to bring up the rear–despite the ACA.

    The Commonwealth Fund’s most recent assessment, published just this month, found that once again, the United States “trails far behind” other high-income countries on measures of health care affordability, access, administrative efficiency, equity, and outcomes. This is despite the fact that we spend far, far more of our GDP on health care than any other country on the planet.

    So yes, we do indeed have some of the world’s best health care providers, but they are off limits to millions of us, because of the fragmented nature of how we pay for care and the administrative burden and costs associated with world-leading inefficiencies on the payer side.

    Myth 2: Our employer-based system of health coverage works beautifully, and we can count on it to be there when we need it. 

    That myth was busted big time last year when we witnessed millions of Americans losing their coverage along with their jobs during the pandemic. The truth is that most people who have employer-sponsored insurance (ESI) are just a layoff or plant closing away from being plunged into the ranks of the uninsured.

    The insurance industry and its allies, including the U.S. Chamber of Commerce, which just published a commentary on its website extolling the virtues of ESI, have persuaded politicians on both sides of the aisle to remind us that more than 150 million Americans get their coverage through the workplace. What they don’t tell us is that that number hasn’t increased much at all over the past 20 years while the U.S. population has grown by more than 50 million.

    One big reason: fewer than a third of small U.S. businesses now offer coverage to their workers, compared to around half two decades ago. The average family policy through an employer has increased to more than $21,000 a year, according to the Kaiser Family Foundation, and the cost of insurance has gotten so high that more and more small employers are throwing in the towel.

    Even our biggest employers are now realizing that the cost of providing coverage to their workers is out of control. An astonishing 87% of the top executives of America’s largest companies say the cost of providing health insurance will become unsustainable for them in the next five to ten years, according to a survey conducted earlier this year by the Kaiser Family Foundation and the Purchaser Business Group on Health.

    Myth 3: Health insurers are appropriate and efficient gatekeepers to healthcare.

    Under the pretense of reducing unnecessary and inappropriate care, insurers began making providers get approval from them in advance before treating people enrolled in their health plans. But by putting increasingly aggressive prior authorization requirements in place, these policies also reduce access to care that is both necessary and appropriate, and insurers avoid paying an untold number of claims.

    Insurers have become so aggressive that one in four doctors say prior authorizations requirements have caused “serious adverse events” for their patients and in more than a few instances have contributed to premature patient deaths (according to the American Medical Association).

    Insurers have succeeded in persuading employers and policymakers that these prior authorization requirements save money, but there is little evidence to support that. In fact, prior authorization demands add considerably to the high administrative expenses the Commonwealth Fund and other researchers note are unique to the U.S. healthcare system.

    Ultimately, these myths serve to preserve the status quo. Insurers continue to bring in record profits, by making care harder to access. Perpetuating these myths are central to deflecting criticism and avoiding reform.

    This post was originally published on Un-covered.

    Here’s more from Just Care:

  • Confirmed: Private insurance is full of ugly surprises

    Confirmed: Private insurance is full of ugly surprises

    Thank god that Medicare regulates provider rates for older and disabled Americans and gives people a meaningful choice of public insurance–traditional Medicare–that covers virtually all medically reasonable and necessary care from the doctors and hospitals you want to use. Private health insurers have tremendous freedom to decide when care is needed and what you’ll pay and no obligation to disclose their policies. That’s why private health insurance is usually full of ugly surprises.

    Sarah Kliff reports for the New York Times on the highly varying prices hospitals charge health insurers for the same service. Kliff’s story underscores two huge issues with health care coverage in the US for working people: People cannot choose a corporate health plan that’s right for them, since they cannot predict their out-of-pocket costs. The high and highly varying rates that health insurers negotiate with providers presumably benefit them, but add no value for their members.

    Kliff’s piece, which examines the different prices different insurers pay for different services reveals once again that, in many cases, corporate health insurers are either unwilling or unable to rein in provider rates. She shows that, for example, at the University of Mississippi Medical Center, people without insurance pay $782 for a colonoscopy, about 35 percent of what someone with coverage through Aetna pays, $2,144, and almost 50 percent of what someone with coverage through Cigna pays, $1,463.

    Kliff is only able to report this story now because the Trump administration mandated the disclosure of hospital negotiated provider rates. Many hospitals are not yet complying with the requirement or are burying the information so that it is extremely difficult to find. The Biden administration is threatening to penalize hospitals who are not open and transparent about their rates.

    Kliff also uncovers that some people in PPOs pay higher rates for the same services than their counterparts in HMOs offered by the same insurer. The same insurer offering a PPO and an HMO product might negotiate far higher rates for the same services offered through the PPO than through the HMO. Why would that be?

    People living in different states, with the same insurer, receiving the same service at the same hospital also might pay wildly different rates. At the Hospital at the University of Pennsylvania, a pregnancy test for New Jersey patients in the Blue Cross PPO  is $93, while the test is $58 for New Jersey patients in the Blue Cross HMO. For the same test, patients who live in Pennsylvania pay $18. And, the hospital charges uninsured patients $10.

    People with United Healthcare’s PPO pay $4,029 for an MRI at Aurora St. Luke’s in Milwaukee. People with United Healthcare’s HMO pay $1,093 for the same service. This craziness hurts patients and prevents them from being able to protect themselves financially.

    If this story tells us anything is that the health care market is broken. Congress must step in to protect Americans from a totally irrational health care pricing system. The simplest way to do so is to do what every other country does, all-payer rate-setting–setting rates for all providers.

    Here’s more from Just Care:

  • Coronavirus: What will your COVID-19 test cost you?

    Coronavirus: What will your COVID-19 test cost you?

    If you’re under 65, you can face surprise bills for COVID-19 testing if you’re not careful; you should understand how to avoid these bills. If you have Medicare, you should not pay anything for a COVID-19 test; getting the test should be a walk in the park. Medicare covers the full cost of the test whether you are enrolled in traditional Medicare or a private Medicare Advantage plan.

    Medicare has waived the Part B deductible for the COVID test as well as the 20 percent coinsurance charged for most Part B services. Medicare also covers the COVID-19 serology test in full.

    The Families First Coronavirus Response Act also waives cost-sharing for COVID-19 testing-related services, including doctors’ visits and other outpatient services, such as hospital observation and emergency department care. People in Medicare Advantage also face no cost sharing for either the COVID-19 test or testing-related services. Medicare Advantage plans also are not allowed to require prior authorization or other administrative barriers for these services.

    Sarah Kliff reports for the New York Times that Congress tried to protect working people from coronavirus testing bills as well. But, it did not wholly succeed.  For example, insurers are not required to cover routine tests now required by many employers and schools. And, doctors and hospitals have found workarounds to the law designed to protect people from coronavirus testing costs, charging unexpected fees for their services.

    Data from Castlight suggests that more than two in 100 people receive bills for COVID-19 testing. To avoid surprise bills, go to a federally qualified health center, there are thousands of them across the country, or another public testing site when getting a test. You can find these locations on your state health department’s website.

    Kliff reports that you might want to avoid hospitals and free-standing emergency rooms. They can charge big bills. They tack on a “facility fee.” One Texas hospital emergency room charged a $1,684 facility fee for its drive-through coronavirus test. A New York patient received a bill for a $1,394 facility fee and more, for her test conducted in a tent outside a hospital. According to Pro Publica, these fees are sometimes ten times more than the cost of the COVID-19 test.

    Some patients are finding that providers are requesting multiple tests when they come in for a COVID-19 test. Make sure that you are clear that you only want the COVID-19 test and that the doctor won’t be charging you for other tests.

    If you are uninsured, see whether your doctor is willing to bill the federal government for your test instead of you. The government has a provider relief fund to cover the cost of COVID-19 tests for the uninsured. But, doctors can choose whether to bill that fund or not. Also, in some states, Medicaid will pick up the cost of the COVID-19 test for the uninsured.

    Here’s more from Just Care:

  • UnitedHealth Group profits by restricting people’s coverage

    UnitedHealth Group profits by restricting people’s coverage

    This post was originally published in the Health Justice Monitor.

    UnitedHealth Group Earnings: What They Suggest about Patient Access to Care
    American Hospital Association
    July 15, 2021
    By Rick Pollack, AHA President and CEO

    Today UnitedHealth Group announced a jaw-dropping $6 billion in earnings in a single quarter. But not enough has been said about a big contributor to these profits: not paying for health care services. During the same quarter last year the company noted its $9.2 billion in profit was due in part to “broad-based deferral of care.” What that means in real-life: profit was earned off missed childhood vaccinations, reduced access to opioid misuse treatment and avoided emergency care for cardiac arrest. But even this isn’t the full story.

    Throughout the course of the pandemic, United pursued a number of changes to its policies to further restrict patients’ coverage. United didn’t just profit from avoided care, it actively sought to scale back what care it would pay for at the same time.

    *  Specialty Pharmacy Services: In many parts of the country, United has been rolling out coverage restrictions that no longer permit patients to access specialty pharmacy therapies in a hospital outpatient department even if that is where their doctors practice.

    *  Surgeries: United will no longer cover a large number of surgical procedures performed in hospital outpatient departments.

    *  Lab and Radiology Services: United has announced plans to restrict coverage for many lab and radiology services provided by hospitals and outpatient departments.

    *  Primary Care and Specialty Services:  United, the nation’s largest employer of physicians, says it will begin restricting coverage for most physician evaluation and management services provided in hospital outpatient departments, including provider-based clinics.

    United routinely rolls out these coverage restrictions throughout the year, meaning that enrollees purchase their health plans under one set of rules only to later learn that their providers and cost-sharing responsibilities have changed.

    Our top private health insurer is rolling in cash. And it’s reducing coverage
    Los Angeles Times
    July 20, 2021
    By David Lazarus, Business Correspondent

    UnitedHealth Group, parent of UnitedHealthcare, the country’s largest private health insurer, earned $15.4 billion in profit last year. It took in more than $9 billion in profit during the first half of this year.

    So what does a well-heeled insurer do amid such a windfall? It seeks to reduce people’s coverage, of course.
    …

    The insurer won’t cover nonemergency treatment at non-network facilities outside a policyholder’s service area, which is defined as your state of residence and adjoining states.

    This change mainly affects UnitedHealthcare members who want to travel to residential treatment facilities, rehabilitation clinics and other nonhospital healthcare providers.

    Which is to say, if you’re a UnitedHealthcare member and you need rehab for any reason, you’d better stay in network and you’d better stick close to home. Otherwise, you’ll be footing the bill yourself.
    …

    Coverage networks might save insurers a few bucks, but they’re not in the best interest of patients, who should be free to seek the best possible care from the best-qualified doctor or hospital.

    Nor, for that matter, should people’s coverage be tethered to their jobs. Lose your job, lose your health insurance — what the hell kind of system is that?

    We know from the experience of other developed countries that [insurance risk management] is done most effectively by creating a single risk pool comprising the entire population, and then having a single government program handle all claims consistently, fairly and transparently.

    Studies have shown that the taxes paid into such a single-payer system — Medicare for all, say — would be less than the premiums, copays and deductibles that now constitute most out-of-pocket medical expenses for Americans.

    Comment by Don McCanne

    UnitedHealth Group has demonstrated that it has mastered its ability to increase profits by not paying for health care services. They are serving their corporate shareholders at a cost to their customers, aka patients.

    Contrast this private insurer function to what the role of a publicly financed and publicly administered insurer would be. Passive insurer shareholders and profits would play no role. The goal would be to pay for necessary health care services, not avoid them.

    Even David Lazarus – the Business Correspondent for the LA Times – sees what UnitedHealth Group does and in response sings the praises of single payer.

    Based on Rick Pollack’s comments, the American Hospital Association should be a valuable team member in our efforts to achieve health care justice for all.

  • How should we pay physicians?

    How should we pay physicians?

    There is not, and there will never be, a perfect system for paying health care providers. Capitated payments, which are upfront, regardless of the number and cost of services physicians deliver, creates an incentive for providers to avoid treating people with costly conditions. Fee-for-service, which pays physicians for services they deliver, creates an incentive for them to deliver more care than necessary. Paying physicians a salary can lead them to be lazy, since they will get paid anyway, or not.

    Medicare Advantage, Medicare benefits offered through private health insurers, was an experiment to see whether paying insurers a capitated fee offered any value. To date, it has cost taxpayers and people with Medicare more and there is no evidence that the for-profit health plans deliver as good care as traditional Medicare. In fact, the evidence, to the extent it is available, should elicit grave concern. How can we think a health insurance model like Medicare Advantage for older and disabled Americans, which does not compete to attract members with complex and costly conditions, has any worth?

    The federal government also has been testing ways in traditional Medicare to  incentivize physicians and hospitals to deliver better care at lower cost and move away from fee-for-service payments. Some of its experiments reward providers financially. To date, there is little evidence that these financial incentives lead to improved quality or lower costs. New research shows that they might be harming some patients. The post below is reprinted from the Health Justice Monitor.

    Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System: A Qualitative Study, JAMA Health Forum, May 14, 2021, By Dhruv Khullar, Amelia M. Bond, Eloise May O’Donnell, Yuting Qian, David N. Gans, and Lawrence P. Casalino

    “Participating in the MIPS program results in substantial financial and time costs for physician practices. We found that, on average, it cost practices $12 811 per physician to participate in MIPS in 2019. We found that physicians themselves spent a considerable amount of time to participate in MIPS. In 2019, physicians spent more than 53 hours per year on MIPS-related activities, which translates to nearly $7000 per physician. If physicians see an average of 4 patients per hour, then these 53 hours could be used to provide care for an additional 212 patients a year—equal to more than a full week’s work for a physician.”

    ***
    Comment by Adam Gaffney

    Pay-for-performance (P4P) is an increasingly central part of the American healthcare landscape. The Affordable Care Act added a multitude of new P4P programs to Medicare, including the Hospital Readmissions Reductions Program (HRRP) and the Hospital Value-Based Purchasing Program (HVBP). Then, the Medicare Access and CHIP Reauthorization of 2015 gave us the Merit-based Incentive Payment System (MIPS), a new P4P program that imposes financial sticks and carrots on individual clinicians across the country based on a slew of complicated performance metrics.

    Much research suggests that these programs have little effect on patient outcomes. The HRRP was much lauded for apparently reducing readmissions, but later research attributed much (or all) of this apparent reduction to changes in diagnostic coding. There is also some evidenceHRRP may have harmed some cardiac patients. Meanwhile, studies of the HVBP have found virtually no impact. Fewer studies, however, have examined the costs of such programs.

    That’s what makes this study, led by Dr. Dhruv Khullar at the Weill Cornell Medical College, so valuable. The researchers interviewed the leaders of 30 physician practices across the nation who participated in the MIPS, and quantified the costs of participation in the program. Overall, they found that we spend more than $12,000 per physician annually to cover the administrative costs of participation in MIPS. Additionally, “MIPS-related activities” suck up over 200 hours of labor per year from practice staff, including 53.6 hours from frontline clinicians. And this is merely for a single P4P program.

    There is little evidence, in other words, that P4P programs substantively improve care — and growing evidence that they further inflate our already enormous administrative costs while sapping the time and energy of practicing doctors. For these reasons, P4P should not be included in a Medicare for All reform. Notably, the House Medicare for All Bill excludes this payment mechanism. The underlying political idea of P4P is a fundamentally neoliberal one: the idea that we are all motivated only by pursuit of the dollar. Instead, doctors want to provide the best care they can. That it is not to say that there isn’t room for quality improvement in our healthcare system — far from it — but a paucity of profit incentives is not the culprit. Further, an increasing number of studies show that P4P is redistributive — shifting funds from providers that care for poorer patients (who tend to have worse outcomes) to the providers of the wealthy.

    Here’s more from Just Care:

  • 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: