JustCare

Tag: ACA

  • Coronavirus: Second-quarter profits double for big health insurers

    Coronavirus: Second-quarter profits double for big health insurers

    Reed Abelson reports for The New York Times that second-quarter profits doubled for big health insurers from the same period in 2019. The Affordable Care Act imposes a limit on the profit that health insurers can keep.  But, people with health insurance are not likely to see money back any time soon.

    Because few people sought medical care for anything other than COVID-19 between April and June, insurers paid few claims. But, they collected the same premiums they always collect. So, the pandemic has served them very well so far.

    The Trump administration has suggested that the health insurers with outsize profits, such as UnitedHealth Group, Anthem and Humana, speed up rebates. But, it has no authority to require them to do so. It also suggested that they lower premiums. Again, it has no authority to require them to lower premiums.

    Because insurers are not legally allowed to change their premiums during the year, the Centers for Medicare and Medicaid Services is giving them the right to do so. Big whoopee. Insurers are not going to lower premiums, even if they can, since that would work against the interest of their shareholders.

    The Affordable Care Act (ACA) allows health insurers to keep 15-20 cents on the premium dollar, depending upon the type of insurance they are selling, individual, small group or large group. They must pay out the other 80-85 cents for medical care. Still, holding on to extra premium money for as long as possible benefits them financially. And, the ACA gives them three years to hold on to the money.

    The ACA effectively protects insurers that charge excessive premiums from having to return the excess money quickly on the theory that health care costs fluctuate and premiums might be inadequate to meet insurer expenses later on. For example, if people start going to the hospital and doctor at twice the rate they have been, insurers would have a cushion to pay those claims. Of course, the laws on premium-setting also protect insurers. They can relatively easily raise their rates next year.

    CVS Health, which owns Aetna, saw its net income increase in the second quarter by $1 billion. Last year, its second quarter net income was $2 billion. Anthem saw its net income increase $1.2 billion in the second quarter. UnitedHealth, the largest health insurer in the US, saw its net income rise by $3.3 billion.

    Taxpayer money for Medicare and Medicaid private health plans–Medicare Advantage and Medicaid managed care–has likely been paid to private health insurers in exchange for providing far less care than projected. If Medicare Advantage plans are able to keep the payments that they received for the first half of the year, they would be making out like bandits. The same is true for Medicaid managed care plans.

    The pandemic is hurting most hospitals and doctors. Many hospitals and doctors are struggling to generate the revenue to stay in business. And, private health insurers owe them nothing. Proponents of a single government health insurance system–one without private health insurers designing insurance policies–explain that in such a system hospitals and doctors would be on a global budget with guaranteed revenue in good times and bad.

    One as of yet unanswered question is whether employees at companies that are self-insured are seeing reductions in their insurance premiums. And, if not, why not? Their employers should be paying out less in claims.

    The marketplace is clearly not able to ensure that Americans are getting the health care they need at a fair price. “We’re looking at the fact that health care can’t be regulated by the marketplace,” said Representative Pramila Jayapal. It’s time for Medicare for all.

    As of now, Vice-President Biden is opposed to Medicare for all. It would be great if these enormous insurer profits led him to rethink his position.

    Here’s more from Just Care:

  • Coronavirus: Trump wants to kill the ACA

    Coronavirus: Trump wants to kill the ACA

    In the midst of the coronavirus pandemic, President Trump just confirmed that he wants to kill the ACA and, with it, health care coverage for about 30 million Americans. The Washington Post reports that the Trump administration is supporting a lawsuit brought by several Republican governors against the ACA that is now in the Supreme Court.

    For sure, the Affordable Care Act (ACA) does not offer the guaranteed universal coverage we all need. Rather, it delivers health insurance that is too often unaffordable and generally also comes with very restricted networks of doctors. People with coverage through state health insurance exchanges also cannot count on the insurance they buy through the state exchanges being there for them from one year to the next.

    That all said, the ACA offers some excellent protections. If the Trump Administration kills the ACA, it will end federal protections that ensure people with preexisting health conditions can get health insurance. It will also end a mandate on health insurers to cover dependent children up to age 26 on their parents’ policies. And, it will end Medicaid coverage for people with incomes up to 135 percent of the federal poverty level.

    Moreover, if 30 million people lose health care coverage, premiums would likely rise significantly for everyone else and Medicare costs would rise. The more people with health insurance, the lower the cost of health care coverage. People who are uninsured drive up costs for everyone with insurance. Put differently, the more people with health care coverage before they go on Medicare, the lower the costs to Medicare when they enroll. In addition, everyone benefits when everyone is insured. Universal coverage promotes the public health.

    Several Republican states brought the lawsuit against the Affordable Care Act. A group of Democratic states is defending the ACA. The Supreme Court has already upheld the ACA twice. But, this time around, it is not clear it will. It will hear arguments in this case next month. But, it might not issue a decision until 2021.

    Here’s more from Just Care:
  • Biden’s policy agenda benefits older adults far less than Sanders’

    Biden’s policy agenda benefits older adults far less than Sanders’

    Mark Weisbrodt writes for MarketWatch about the divide between Vice President Joe Biden and Senator Bernie Sanders on Social Security and Medicare. Sanders commands more support from younger voters than Biden by a margin of 47 percent to 13 percent. Curiously, older adults lean Biden over Sanders by a margin of 25 percent to 11%, even though Sanders’ Social Security and Medicare reform proposals are far more beneficial to older adults than Biden’s.

    Today, 27 million Americans live above the poverty line because of Social Security. Sanders has advocated to strengthen Social Security since he became a Senator in 1991. Biden has argued for cuts to Social Security since 1984 and as recently as 2013. Biden supported the chained CPI, which would have reduced Social Security benefits.

    Only now, with a large cohort of Democrats behind raising Social Security benefits, does Biden support increasing Social Security benefits. But, Biden has historically failed to accept that Social Security can be strengthened easily. Sanders, in sharp contrast, has argued that Social Security can close a longterm and relatively small funding gap.

    Older adults also may not realize how much Medicare for All would help them, expanding their benefits and lowering their out-of-pocket costs. Sanders’ Medicare for All bill would be a huge improvement over Medicare today, covering 100 percent of the cost of dental, hearing and vision care as well as long-term services and supports. The typical person with Medicare pays nearly $6,000 a year out-of-pocket for health care, almost 25 percent of average income. With Medicare for All, older adults and people with disabilities would have that money to spend on other things.

    Vice President Biden does not plan on improving Medicare benefits at all. His health care plan focuses almost exclusively on helping people who get coverage through the state health exchanges under the Affordable Care Act (ACA). And, his health reform agenda does little to ensure people can afford the deductibles and coinsurance imposed by ACA plans, let alone to rein in costs.

    Here’s more from Just Care:

  • Can building on the ACA bring down health care costs?

    Can building on the ACA bring down health care costs?

    The Kaiser Family Foundation (KFF) released a new report looking at trends in public opinion on health care reform. Its findings suggest that most Americans don’s know that building on the ACA will neither provide them with access to the care they need nor bring down their health care costs. Among other things, building on the ACA keeps our current system with $600 billion in administrative waste in tact.

    KFF finds that voters who lean Democratic are more inclined to want to build on the ACA than replace the ACA with Medicare for All. Voters appear to be looking for incremental change. They favor an expansion of Medicare. They don’t appear to understand that if you leave private health insurers in place, you do not achieve the savings needed to expand benefits and reduce health care spending.

    Americans also appear to lack a good understanding of how different reform proposals would affect their out-of-pocket health care costs. They do not appreciate that Medicare for All would save middle-income households about 10 percent of their income. A public option would save them far less, if anything; it would continue to impose high premiums, deductibles and co-insurance costs.

    That said support for Medicare for All has grown appreciably over time, according to Kaiser. It was not until February 2016 that a majority of Americans supported national health insurance. Today, more Americans favor Medicare for All than oppose it. Not surprisingly, three in four Democrats support Medicare for All and seven in ten Republicans oppose it.

    Here’s more from Just Care:

  • Vice-President Biden calls for expanding Social Security, while opposing Medicare for All

    Vice-President Biden calls for expanding Social Security, while opposing Medicare for All

    At an AARP Iowa forum, Vice-President Joe Biden unequivocally called for expanding Social Security benefits. Regrettably, Biden still opposes Medicare for All.

    In Biden’s words: ‘We should be increasing, not decreasing, Social Security. It’s within our capacity to do so.’ Biden joins Barack Obama, Hillary Clinton, and the rest of the Democratic Party in support of expanding – never cutting – Social Security’s modest benefits. Congressman Larson has a plan in Congress, the Social Security 2100 Act, to expand Social Security.

    At the same time, Biden wisely supports prescription drug price negotiation. But, he mistakenly limits federal drug price negotiation to people with Medicare. For everyone else, rather than having the federal government step in to regulate drug prices, he proposes allowing drug importation. That’s a fine band-aid but hardly a long-term plan.

    Biden says he does not support Medicare for All. He may not understand that his health care reform proposal–to expand the Affordable Care Act and offer people a public option on the state health insurance exchanges–will only ensure that high health care costs rise higher.

    The ACA’s state health insurance exchanges add a layer of bureaucracy and administrative costs to our health care system that only drive up health care spending. Moreover, because no individual state has the power of the federal government to rein in provider rates, the ACA also keeps irrational and excessive rates for doctors and hospitals.

    Larry Levitt of the Kaiser Family Foundation explains to Politico: Biden’s plan leaves “an inefficient and costly health care system in place.” It preserves high prices for working Americans. Only Medicare for All eliminates administrative waste and rationalizes provider rates.

    Medicare for All, in sharp contrast to Biden’s plan, improves on traditional Medicare. It offers richer benefits, including vision, hearing, dental and long term services and supports at less cost and it drives down health care spending by as much as $5.1 trillion over ten years.
    Here’s more from Just Care:
  • Poll shows most Americans want more than incremental health reforms

    Poll shows most Americans want more than incremental health reforms

    A new Kaiser Health Tracking poll looks at how Americans are feeling about Medicare for All as well as other health care reforms. A solid majority support Medicare for All. They want more than incremental health reforms.

    Support for Medicare for All is particularly high, 71 percent, when people understand it would guarantee health care as a right for all Americans. And, it is nearly as high, 67 percent, when people understand it would eliminate insurance premiums and lower out-of-pocket health care costs. Without these explanations, support is still at 56 percent.

    That said, a majority of Americans also say they favor reform that offers Medicare as an option and still leaves commercial insurers in the mix. But, for Congress to enact Medicare for All, commercial health insurance cannot remain. It adds no value. It drives up costs and, too often, keeps people from getting the care they want and need. Restricted access to doctors and hospitals, arbitrary delays and denials of care, and high premiums, deductibles and coinsurance are not the solution for fixing our unsustainable health care system.

    Moreover, as we know from the commercial Medicare Advantage plans, commercial insurers market to the healthy and steer people in poor health to traditional Medicare. As a result, they make traditional Medicare more costly. Medicare for All is the only way to rein in health care costs and guarantee everyone coverage for care from the doctors and hospitals they want to use.

    A lot of Americans, including half of Democrats in Congress, say they support improvements to the Affordable Care Act rather than Medicare for All. But, in many states, the health insurance exchanges work poorly. Premiums are high. The health plans offer poor choices. And, the states lack the will, if not also the skill and the resources to oversee the commercial insurers and ensure they are doing right by their members.

    To guarantee everyone in America good affordable coverage, we must transition from the ACA, with its state-based coverage through for-profit commercial insurers. We need one federal plan, that takes the profits out of the system and marshals the negotiating leverage of all 330 million Americans to rein in costs. We must eliminate the endless layers of bureaucracy in our health care system with its attendant costs. And, we must broadly pool and distribute costs across everyone.

    Here’s more from Just Care:

  • Guaranteeing coverage to people with pre-existing conditions critical to most voters

    Guaranteeing coverage to people with pre-existing conditions critical to most voters

    According to a new Kaiser survey, a majority of voters say that a federal candidate’s position on pre-existing conditions is an important factor in their 2018 vote. Voters care more about this than they care about repealing the Affordable Care Act or passing legislation to bring down drug prices and a range of other issues. Another recent study showed that candidates’ position on health care costs is also important to voters.

    It’s not clear that there is a single Republican running for Congress who supports the provision in the Affordable Care Act that requires health insurance companies to enroll people with pre-existing conditions and to charge them the same premium as everyone else. Indeed, the vast majority of Republicans want to repeal the ACA, including this provision. (N.B. A majority of voters also believe that President Trump is trying to make the ACA fail; it protects people with pre-existing conditions.)

    Before the ACA was enacted, health insurers had the power under federal law to deny coverage to anyone with a pre-existing condition. Or, they could offer coverage but refuse to cover services related to the pre-existing condition. And, if they enrolled people with pre-existing conditions, they could raise their premiums.

    In this survey, Kaiser did not ask about the importance to voters of federal candidates’ positions on reining in health care costs, which has been a top priority, along with reining in drug costs, for several years now.

    If you agree that health insurers should be required to enroll anyone who applies to enroll regardless of their health status, make sure you vote for candidates who support protecting people with pre-existing conditions. And, if you want Congress to improve and expand Medicare, so that everyone in America is guaranteed health coverage throughout their lives, without the burden of premiums, deductibles and copays, let your members of Congress know. Sign this petition. Today, 63 percent of the public supports improved Medicare for All. 

    Here’s more from Just Care:

  • Center for American Progress proposes plan to improve and expand Medicare

    Center for American Progress proposes plan to improve and expand Medicare

    In a sign that the Clinton-Obama wing of the Democratic party has moved left, last week the Center for American Progress proposed Medicare Extra, universal national health insurance for everyone without health insurance and everyone else who would prefer it to the coverage they have. Unlike the Sanders plan, CAP proposes a multi-payer plan that allows everyone with insurance to keep what they have if they like it. The plan has many advantages over more modest Medicare for all proposals, but it allows commercial for-profit health plans to remain in the mix, driving up costs and threatening the traditional Medicare-like plan it proposes.

    Medicare Extra is an enhanced version of Medicare, filling most of its gaps and providing significantly more coverage. Much like Sanders’ Medicare for All plan, in addition to the standard Medicare benefits, this government plan would cover vision, hearing and dental care as well as long term care supports and services. The coverage would be automatic for anyone without health insurance, everyone turning 65, and everyone at birth; and, it is available to everyone else who chooses it over the coverage they currently have.

    To its credit, CAP recognizes that we cannot rely on commercial health insurers to guarantee good affordable coverage in America. It further appreciates that we cannot rely on states to ensure access to care for their residents. And, it relies on the federal government to regulate prices for its Medicare Extra plan because “competition” cannot and has not reined prices in. These are all important lessons learned from the Affordable Care Act.

    Like the Sanders plan, Medicare Extra (essentially traditional Medicare with expanded benefits) is administered by the federal government. But, CAP does not go as far as Sanders to eliminate commercial insurance. Rather, CAP attempts to do a better job of leveling the playing field between commercial insurance and the government plan, a Sisyphisian task. And, likely, the CAP plan’s Achilles heel.

    As we have seen over the decades and most recently with the ACA, if given any latitude, commercial health insurers will always design their health plans to avoid enrolling people with costly conditions, keeping their networks free of centers of excellence and top specialists. They will never reveal the value of their coverage for people who develop complex conditions, such as heart disease, cancer, stroke or diabetes. Moreover, government has never been able to oversee them effectively or prevent them from committing fraud, wrongly denying care and otherwise keeping the public in the dark about what they offer their members. CAP envisions reining the commercial health plans in significantly more than Medicare Advantage plans, but it is hard to understand how it will be enough.

    Unlike Sanders, CAP also allows people with employer coverage and Medicare to keep the coverage they currently have if they so choose. People with Medicaid would be enrolled in Medicare Extra. And, everyone enrolled in Medicare Extra has the choice of this government-administered traditional-Medicare-like plan or Medicare Choice, essentially a commercial Medicare Advantage plan with expanded benefits. It goes without saying that the added administrative costs of all these options are considerable, especially if there is appropriate oversight of the commercial plans.

    CAP has yet to model the financing for its proposal, which relies on wealthier Americans to pay more and provides free coverage to people under 150 percent of the federal poverty level. But, CAP expects that Americans earning more than 500 percent of the federal poverty level, just over $60,000 a year for an individual ($104,000 for a couple), would spend 10 percent of their after-tax income for their health insurance, as well as about 20 percent coinsurance, which is likely to make it unaffordable to many.

    If you want Congress to improve and expand Medicare for all, please sign this petition.

    Here’s more from Just Care:

  • There may soon be a female Democratic doctor in the House

    There may soon be a female Democratic doctor in the House

    Erin Mershon of StatNews reports that, over the last almost 60 years, there have been 49 physicians who have become members of Congress. Of that group, only a few have been Democrats and only two have been women. None has been a Democrat and a woman. A grassroots organization is working to change history and put some female Democratic doctors in the House and Senate.

    A group of 8,000 Democratic doctors who are women, led by Dr. Ramsey Ellis, is supporting eight female Democratic physician candidates for Congress this year. Dr. Ellis was a grassroots organizer for Hillary Clinton. Now, she is heading Physician Women for Democratic Principles in order to help ensure there are more women and more physicians governing our country and leading the public debate on health issues.

    Imagine how Democratic physician women policymakers might have shaped and improved on Medicare, Medicaid and the Affordable Care Act had they been our representatives in Congress when these major pieces of legislation were being debated. Only two Republican female physicians have ever served in Congress, Reps. Nan Hayworth of New York and Shelley Sekula-Gibbs of Texas. Today, there are 15 physicians in Congress, all are men and 13 of them Republicans.

    With one third of the physicians in the US female, it seems reasonable that five physicians in Congress would be female. Similarly, about half of physicians are Democrats. If the physicians in Congress reflected the national pool of physicians, seven or eight of them would be Democrats, not just two of them.

    Stat interviewed several Congressional candidates who are physicians to understand why they were running for office. Their primary reason: To solve the health care problems presented by the Affordable Care Act. Candidates who are members of Physician Women for Democratic Principles want to strengthen the ACA and Medicaid. Not surprisingly, Republican physician candidates want to repeal the ACA and slash Medicaid funding.

    Here’s more from Just Care:

  • Higher drug prices for rural hospitals keep them from providing critical care

    Higher drug prices for rural hospitals keep them from providing critical care

    Sarah Tribble reports for Kaiser Health News that particularly high drug prices for rural hospitals can keep them from providing critical care. For no clear reason, the ACA prevents rural hospitals from negotiating prescription drug discounts for many expensive drugs, as larger hospitals can do. Instead, rural hospitals must pay full price for “orphan drugs” that treat rare diseases and also may treat many common conditions.

    The ACA prevents rural hospitals from participating in a federal drug discount program–the 340B program–intended to ensure that low-income patients receive needed hospital care. Instead, rural hospitals are often forced to pay many times more for a costly medication than other hospitals.

    Many blockbuster drugs can be designated as orphan drugs, under the Orphan Drug Act, so long as they also treat rare diseases. So, rural hospitals are struggling to pay for the high-cost drugs that treat patients with rare diseases as well as patients with their common conditions. There are literally thousands of drugs designated as orphan drugs.

    Without the benefit of a discount, rural hospitals are hard-pressed to stock orphan drugs, leaving patients with urgent and emergency stroke, cancer and other needs without needed care. For example, a single dose of the stroke medication, Activase, cost one rural hospital $8,010 and the larger hospital $1,600. 340B program discounts are often significant, according to a GAO report.

    In fact, having to pay high prices for orphan drugs is forcing some rural hospitals to close entire hospital units. Consequently, patients needing these drugs must travel far from home to get needed care that their local hospital should be able to provide.

    No one is taking responsibility for the ACA exclusion of orphan drugs from the 340B program for rural hospitals. The provision was never even discussed in Congress but somehow slipped into the legislation. That said, Pharma invested heavily in ensuring that rural hospitals were denied drug discounts for rare disease drugs after the ACA was passed.

    Here’s more from Just Care: