JustCare

Tag: Health care

  • President Biden drafts a package of health care reforms for his second term

    President Biden drafts a package of health care reforms for his second term

    President Joe Biden is assembling a package of health care reform proposals for his second term, including a proposal to bring down the price of prescription drugs, reports CNN. It’s a smart move given that health care affordability is the second most important issue for Americans, after inflation.

    At the same time as President Biden looks to enhance people’s health care benefits, former President Donald Trump is calling to repeal the Affordable Care Act (ACA). President Biden wants to keep federal subsidies for people receiving care through the ACA and do more to reduce drug prices for people with Medicare and all other Americans. Biden’s goals are modest given the state of health care in the US and we need to push him to call for affordable health care for all, but his goals are far better than Trump’s.

    The ACA not only gives 10 million more Americans health insurance through the state health insurance exchanges, it expanded Medicaid to cover more Americans. People with incomes up to 135 percent of the federal poverty level are Medicaid-eligible. President Biden is looking into ways to ensure that the three and a half million people in the 10 states that opted against expanding Medicaid have Medicaid coverage.

    President Biden is again calling for a public health insurance option. In theory, such an option could remove the private insurer middlemen and all the waste and increased costs they bring. But, it’s not at all clear, based on Medicare Advantage and traditional Medicare (the public option) that a public health insurance option would bring down costs. The devil is in the design.

    Right now, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, is focused on bringing down the price of ten drugs that cost the Medicare program the most, as required by the Inflation Reduction Act. That’s both the camel’s nose under the tent for lower drug prices and small potatoes. The swiftest and easiest way to bring down drug prices is to allow people to import drugs from abroad and require insurers to cover those far less costly drugs.

    The Inflation Reduction Act also penalizes drug companies for raising drug prices more than the rate of inflation. This measure should keep drug prices from going up at obscene rates. But, it is also small potatoes, given how high drug prices are in the US–often four times higher than in France.

    Here’s more from Just Care:

  • Private equity buying up specialists and driving up health care costs

    Private equity buying up specialists and driving up health care costs

    Reed Abelson and Margot Sanger-Katz report for The New York Times on private equity’s growing role in health care. The New York Times story is based on a new report from the Antitrust Institute finding that private equity is buying up specialist practices and driving up health care prices and expenses in the process.

    Private equity sees big dollars in health care and is paying big money to own physician practices all over the country, at a rapid rate. In 13 percent of the country, private equity owns more than 50 percent of physician practices, which means higher costs for everyone. In markets with the highest private equity penetration, health care costs are rising most dramatically. In cases where private equity controlled more than 30 percent of the market, gastroenterology, dermatology, and obstetrics and gynecology costs rose by double digits.

    Private equity firms appear to see value in owning many, if not all, physician specialists as well as primary care practices. Private equity firms have focused on urology, ophthalmology, cardiology, oncology, radiology and orthopedics. Once they have a solid share of the specialty market they demand higher prices from insurance companies.

    Insurance companies, in turn, must pay these private-equity owned practices higher prices in order to have enough specialists in their networks. And, if insurance companies are paying more, you better believe that your health insurance premiums are rising, along with deductibles and copays.

    Thankfully, Traditional Medicare has fixed provider rates. But, if Medicare Advantage takes over Medicare, (as it will likely do if Congress does not act soon,) Medicare Advantage plans will not have the leverage to negotiate Medicare rates and costs will rise dramatically in Medicare Advantage.

    Alternatively, the federal government could require Medicare Advantage plans to pay Medicare rates. The private equity-owned practices would likely have to honor those rates to ensure they have enough patients. The Medicare population tends to make up a significant portion of specialists’ patients.

    Here’s more from Just Care:

  • Medicare Advantage could be the death of Medicare

    Medicare Advantage could be the death of Medicare

    In an op-ed for The Nation, Ady Barkan, co-director of Be a Hero, makes the compelling case that Medicare Advantage, the part of Medicare administered by private health insurers, could be the death of Medicare. It could also be the death of guaranteed affordable health care for all in the US. Senator Bernie Sanders, Representative Pramila Jayapal, and Representative Debbie Dingell are trying to prevent that and breathing continued life into Medicare through their recent introduction of the Medicare for All Act in Congress, legislation that would keep corporate health insurers out of Medicare.

    Several times in the last 70 or so years, progressive policymakers have tried to ensure everyone in the US has guaranteed access to affordable health care. And, several times, their efforts failed. Most recently, advocates on the ground and in the Congress pushed for a public health insurance option, like Medicare, for all Americans. Instead, we got the Affordable Care Act, health insurance through corporate health insurers.

    During his campaign for the presidency, Senator Bernie Sanders brought to national attention the value of Medicare for All, guaranteed, government-administered, affordable health insurance. He called for an improved and expanded version of traditional Medicare that the US guaranteed everyone, with dental, vision and hearing benefits, and without premiums, deductibles and copays.

    Ady Barkan testified in the US House of Representatives on the value of Medicare for All. He understood its value full well. At 35, he was diagnosed with ALS. He explained how everyone will need health care at some point.

    “Our time on this earth is the most precious resource we have,” were his words. “A Medicare for All system will save all of us tremendous time. For doctors and nurses and providers, it will mean more time giving high quality care. And for patients and our families, it will mean less time dealing with a broken health care system and more time doing the things we love, together.”

    Barkan interviewed all the presidential candidates on Medicare for All and then sat down with President Biden to discuss health care. At the time, Barkan supported Medicare for All but did not appreciate that corporate health insurers had sunk their teeth into Medicare through the Medicare Advantage program. Now, he recognizes that if corporate health insurers take full hold of Medicare, it is not likely we will get government-administered Medicare back.

    The argument for Medicare Advantage when Congress debated it in the early 2000’s was that it would improve quality and save money through “managed care.” But, 20 years later, Medicare Advantage has always cost more per enrollee than traditional Medicare. And, several analyses show that quality of care, particularly for people with costly and complex conditions tends to be worse in Medicare Advantage than in traditional Medicare.

    Because the federal government pays corporate health insurers upfront for the care they provide, regardless of the amount they spend on care, the insurers do what they can to spend as little of that money on people’s care as possible. The less they spend, the more they profit. The consequence for enrollees can be deadly–delayed and denied care, lack of access to top quality specialists and specialty hospitals and unaffordable out-of-pocket costs.

    Medicare Advantage has become big business. Every business wants in and wants more. The insurance companies offering Medicare Advantage are buying up primary care providers in order to help control the care that people receive. To be sure, in the best of hands, this could be great. But, in the hands of corporate executives who are looking to return as much money to shareholders as possible, you can imagine the danger.

    The corporate health insurer execs are likely dreaming of a time when Congress passes Medicare Advantage for All, a time when they control the full Medicare market and the hundreds of billions of dollars that come with it. Americans should be extremely concerned.

    Without traditional Medicare in the mix, putting competitive pressure on the Medicare Advantage plans, without the tens of billions in excess payments to the Medicare Advantage plans, and without any freedom for enrollees to disenroll from Medicare Advantage, all bets are off on health care costs and coverage for older adults and people with disabilities, all bets are off on their health and well-being.

    Fortunately, members of Congress are beginning to understand the fundamental differences between traditional Medicare and Medicare Advantage. They are holding hearings focused on abuses in Medicare Advantage–overpayments, inappropriate delays and denials, misleading marketing and ghost networks, among others. And, the Biden administration is passing regulations in an attempt to rein in the bad actor Medicare Advantage plans.

    Unfortunately, the regulations are only as good as the government’s ability to enforce them. And, enforcement has been lax, to put it mildly. As of now, the Medicare Advantage plans that are engaged in keeping their enrollees from getting costly care can continue to do so, with impunity.

    If we are going to guarantee Medicare for All, free or low-cost access to good care in the US, we must keep the corporate health insurers from taking over Medicare.

    Here’s more from Just Care:

  • US continues to spend more for poorer quality care than other developed countries

    US continues to spend more for poorer quality care than other developed countries

    Once again, The Commonwealth Fund is out with a report showing that we spend way more than other developed countries for our health care and yet get far less for our money. We spend more per person on health care than every other country and more as a percentage of our gross domestic product. And, unlike every other country, we don’t have guaranteed health care for everyone. 

    We live shorter lives, with average life expectancy of  77 , the lowest life expectancy at birth by three years than other wealthy nations. Black Americans live shorter lives than white Americans, averaging 74.8, as compared to 78.8. And Native Americans still shorter, averaging 71.8. Hispanic Americans have higher life expectancies at birth, 81.9. And Asian American life expectancies are higher still, 85.6.

    Our people have multiple chronic conditions at the highest rate of all nations. We also have higher death rates for conditions that are preventable or can be treated. We have the third highest suicide rates. We have the highest infant and maternal mortality rates. We have 5.4 deaths per 1,000 births and 24 maternal deaths for every 100,000 births. And, we have the highest obesity rates.

    Not surprisingly, more people in the U.S. die from assaults, including gun violence.

    While our government’s focus is on overtreatment, we have far fewer physician visits than people in other countries. We also have proportionately fewer physicians and hospital beds than other developed countries. 

    As a percentage of GDP, we spend about twice as much as the average of other developed countries on health care, at nearly 18 percent. That percentage is growing as prices continue to rise, our population ages, and new technologies for treating patients are developed. 

    On a per person basis, we spend twice as much on total healthcare costs as Germany, the next highest-spending country. And, we spend close to four times as much as most other developed countries.

    Though other developed countries guarantee health care for all, through public health insurance, they generally also offer their residents the right to buy private health insurance. In the US, more than 26 million people—8.6 percent have no insurance at all, and tens of millions more are underinsured, often unable to afford care even though they have insurance. 

    Affordable care for everyone is critical to reining in costs and addressing these terrible quality of care US rankings. Right now, even with insurance, almost half of US residents skipped or delayed getting needed care because of the cost. In addition to reining in health care costs, we must ensure well-coordinated care, including primary care, starting with investing in more primary care providers. 

    Here’s more from Just Care:

  • Poll: Many more older adults delayed care because of cost in 2022

    Poll: Many more older adults delayed care because of cost in 2022

    Nearly four in ten Americans reported that they or a family member delayed health care last year because of the cost. That’s an all-time high and a huge increase from the year before. Even with Medicare, many more older adults also report delaying care.

    The Gallup poll shows a 12 percent increase in Americans skipping health care in 2022 from 2021. There was no change in people’s response to the question of whether they or a family skipped care between 2020 and 2021. But, 2022 was  a year of tremendous inflation, which has made life even more difficulty for most adults.

    Even more troubling is that Americans reported that they or their family members often delayed treatment for serious conditions in 2022. Of the 38 percent who reported delays in care, 27 percent said that the delays were for very serious or somewhat serious treatments.

    Not surprisingly, people with annual incomes under $40,000 were more likely to say that they or a family member had delayed care for a serious health condition (34 percent) than people with incomes above $100,000 (18 percent). And, 12 percent more people with lower incomes delayed care for serious conditions in 2022 than in 2021. People with incomes between $40,000 and $100,000 delayed care almost as much as people with incomes under $40,000 (29 percent).

    Women and younger adults also were more likely to report delays in getting medical treatments for serious conditions for themselves and family members. Almost one in three women (32 percent) reported delaying care in sharp contrast to one in five men. That’s an increase of 12 percentage points for women in just one year.

    About one in eight (13 percent) people with Medicare reported delaying care in 2022. That’s nearly double– a six percent increase–those reporting delays in care just a year earlier. Still, people with Medicare were less likely to report delaying care because of cost than working people and young adults.

    Here’s more from Just Care:

  • Sen. Bernie Sanders will focus on high health care costs as head of the HELP committee

    Sen. Bernie Sanders will focus on high health care costs as head of the HELP committee

    Next month, Senator Bernie Sanders will become chair of the Senate Health Education Labor and Pensions (HELP) committee. HealthcareDive reports that, in that role, among other things, Sanders will focus on high health care and prescription drug costs as well as elder care.

    In a recent video, Senator Sanders spoke of the huge profits in the pharmaceutical industry at the same time that Americans are going without critical drugs because they are unaffordable; many are dying. The Inflation Reduction Act is a first step towards reining in high drug costs for people with Medicare. It gives the government some power to negotiate drug prices for the 60 most expensive drugs over the next several years, beginning in 2026.

    But, Senator Sanders points out that the government’s prescription drug negotiating power is quite weak and explains that Congress has a lot more to do to rein in drug prices. As I see it, Congress should immediately open its borders to drug importation from verified pharmacies around the world and require insurers to cover imported drugs prescribed by treating physicians.  That is not a long-term solution to high drug prices, but it is a likely way to put downward pressure on drug prices quickly and help ensure that Americans can afford their medicines. Americans usually pay many times what residents of other wealthy countries pay for prescription medicines.

    The Inflation Reduction Act also caps annual out-of-pocket drug costs for people with Medicare at $2,000 beginning in 2025.

    Senator Sanders said the HELP committee would hold many hearings with health care and pharmaceutical company executives. Senator Wyden, as chair of the Finance Committee, has focused on the pharmaceutical industries’ failure to pay corporate taxes through international tax law shenanigans.

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  • How to ensure your hospital bill is correct

    How to ensure your hospital bill is correct

    Most of us do not check our health care bills too carefully. We do as we are told by the doctors and hospitals and pay our insurance deductibles and copays largely without questioning the bills. It can be difficult to make sense of the bills, let alone to figure out if a health care bill is correct.

    Bram Sable-Smith reports for Kaiser Health News on a billing expert who saved her family a lot of money by questioning her husband, Dr. Bhavin Shah’s, medical bill. The hospital charged Shah more than $3,000 out of pocket. It took more than a year for the hospital to recognize that the procedure it claimed to have performed had never been performed and correct its bill. It could afford to delay as it pays no penalty for billing errors. During the hospital’s extended bill review time, Shah’s bill was sent to debt collections.

    Here’s what you can do to ensure you are not overpaying for your medical care in hospital 

    1. When you receive a bill, immediately call the hospital and ask for an explanation of all the charges. Make sure that the bill is itemized, with standardized billing codes.
    2. Focus on the services with the biggest charges and compare the charges for those billing codes with charges for the same billing codes at other hospitals in your area. All hospitals are required to disclose this information. You can visit fairhealthconsumer.org for information on typical hospital charges in your area. You can also check Medicare’s online tool. You should be able to see whether your bill is comparable to bills at other hospitals or completely out of line.
    3. If your hospital charges a lot more than other hospitals, contact the hospital and challenge its charges. Also, complain to your health insurer. Or, if that doesn’t work, complain to your state attorney general’s office.
    4. Ask for your medical records. You might find that the medical records do not show evidence of services for which you were billed.
    5. To protect your credit score and avoid more hassle, ask the hospital to hold off sending the bill to a debt collector while it is being disputed.

    And, if your income is low, keep in mind that non-profit hospitals are required to offer some charity care.

    Here’s more from Just Care:

  • Americans want health care system overhaul

    Americans want health care system overhaul

    A new survey of Americans finds utter and complete dissatisfaction with our health care system, reports Amanda Seitz for AP News. Nearly nine in ten Americans say that health care is not handled well or extremely well, including health care for older adults. Most Americans want Congress to overhaul our health care system and think Medicare and Medicaid should be expanded to cover long-term care. They want guaranteed access to care.

    The Associated Press/NORC poll finds that more than half of Americans think the US is not handling health care too well or well at all. Just slightly more than three in ten Americans, 32 percent, think the US handles health care somewhat well. Only 11 percent believe that the US is handling health care for older adults very well or extremely well.

    On top of the dissatisfaction with our health care system writ large, almost 80 percent of Americans worry to some degree about being able to get the care they need when they need it. As it is, tens of millions of Americans are forced to choose between health care and other basic necessities, forcing many of them to forego critical health care.

    As for the cost of prescription drugs, more than nine in ten Americans believe our government is not handling this issue appropriately. How could they? Drug companies are raking in mega profits as millions of Americans die because they can’t afford their medicines. And, though millions of Americans import low-cost drugs from abroad, they are technically forbidden from doing so, even when it could save their lives. Prices abroad can be 90 percent less than in the US.

    What’s the solution? Most Americans–two-thirds–want the federal government to step in and ensure access to care for all Americans. Support for the federal government to step in has grown significantly in the last five years. In 2019, 57 percent thought guaranteeing health care was a government responsibility. In 2017, 52 percent thought so.

    Of course, the simple most cost-effective solution would be for the federal government to negotiate fair prices for health care services, as every other country does, and expand traditional Medicare to everyone. But, only four in ten people polled in this survey supported this solution.

    A majority of people like the idea of a “public option,” allowing people to choose to buy health insurance administered through the government. I once liked it as well…until I came to appreciate how powerful and influential the corporate health insurers are in undermining the public option. We see it today with Medicare Advantage, which is corporate health insurance that has been killing traditional Medicare. Corporate health insurers market and design health plans to attract the healthy, make it difficult for many people to get costly and complex care, and encourage the people with the greatest health care needs to use the public option.

    People too often don’t appreciate that they could get diagnosed with a costly and complex disease or to suffer a major accident in the unforeseeable future. Anything short of comprehensive coverage–one policy that will meet whatever needs you have from whichever physicians you need to see–is a gamble.

    One study, published in June in the Proceedings of the National Academy of Science, found that Medicare for all would have likely saved 338,000 lives lost to Covid-19.

    As Congresswoman Pramila Jayapal tweeted last week, “In the richest country in the world, no one should die or go into debt just because they don’t have access to healthcare.” “We need Medicare for All now.”

    Here’s more from Just Care:

  • Nearly 100 million Americans are now struggling to afford healthcare

    Nearly 100 million Americans are now struggling to afford healthcare

    Dan Witter reports for Gallup on the horrifying situation facing nearly 100 million Americans forced to choose between their health care and other basic needs.  The latest Gallup poll from June 2022 shows that almost four in 10 Americans had to skip or postpone health care, forgo other basic needs, or borrow money to pay for their health care. 

    The poll data indicate that more than one in four (26 percent) Americans are skipping care or delaying care because of the cost. We already know from prior research that thousands of older adults with Medicare end up dying because they cannot afford the out-of-pocket costs of their heart and other critical medicines. Just a $10.40 copay increase leads them to stop filling their prescriptions. 

    People with low incomes struggle most to pay for their care. More than half of households with annual incomes below $48,000 had to forgo some basic necessities in order to afford their care. And, 43 percent of adults with annual incomes under $24,000 skipped a medical procedure or did not fill a prescription because of the cost, in the six months preceding the poll.

    Wealthy Americans are far from immune from the burden of high health care costs. Nearly one in five households with annual incomes of $180,000 or higher are having to forgo spending on other basic needs to pay for their health care.

    Women fare worse than men paying for health care. About 30 percent of women have had to skip or delay health care because of the cost. But, many men are not prepared for these costs either. About 22 percent report struggling with health care costs.

    Women, particularly those younger than 50, are disproportionately being compelled to cut back on health care due to its rising costs. Three in 10 women overall (30%) report having done so, compared with 22% of men — and this percentage swells to 36% among women under 50.

    Skipping health care often comes in conjunction with people spending less on utilities and food. And 60 percent of people who borrowed money to cover necessities also skipped or delayed health care. 

    As difficult as it is for people to pay for needed health care, the poll data shows that, right now, people are most worried about the cost of gasoline (43 percent) and food (34 percent). Only 3 percent of respondents put health care at the top of the list. 

    Of note, Democrats (33 percent) are less concerned than Republicans and Independents (43 percent) about rising health care costs. People of color are more concerned than white adults. 

    Lastly, people hold little hope that either the federal government or their state government will keep costs down. Nearly six in ten Americans are “not at all confident” their representatives in Congress will help them.  

    Most Americans are aware that health care costs continue to increase at a rapid rate. At the moment, increases are not as fast as other sectors. But, that is likely based on pre-negotiated rates established for 2023, pre-inflation, and is likely to change.

    JAMA reported that drug launch prices are up 20 percent a year in the 13 years between 2008 and 2021. In effect, they are ten times higher!!!

    Here’s more from Just Care:

  • 2022: Health care costs remain a top policy priority

    2022: Health care costs remain a top policy priority

    A new Kaiser Family Foundation poll finds that Americans continue to see their health care costs as a top policy priority for Congress. Health care prices and unexpected medical bills are a major concern. Slightly more than half of Americans polled say they have delayed or gone without health care in the last 12 months because of the cost.

    When it comes to household expenses, one in four Americans are very worried about facing unexpected health care bills. Health care costs are their top household expense worry after gasoline and transportation costs, which 40 percent of Americans are very worried about. Nearly six in ten Americans (58 percent) are very worried or somewhat worried about facing unexpected medical bills.

    What types of health care have people foregone? More than a third of Americans (35 percent) went without dental care in the last 12 months because of the cost. One in four went without eye care (25 percent) or a visit to the doctor (24 percent). About one in six (18 percent) went without mental health care and about one in seven (14 percent) went without hospital care.

    How do Americans want Congress to address these issues? Most of the poll answers focused on people’s out-of-pocket costs and not on health care prices. Americans seem to be more focused on having Congress limit what they pay for their care than on regulating prices. What they might not appreciate is that the money to cover limits on their costs is going to have to come from somewhere. Would they want the money to come from higher taxes, or do they also support price regulation?

    The public wants Congress to prioritize a limit on prescription drug price increases to the rate of inflation (61 percent) over regulation of drug prices (48 percent) for working people. Do Americans understand that a limit on drug price increases does not preclude the introductory price of a drug from being through the roof?

    The public overwhelmingly supports drug price negotiation for people with Medicare; 98 percent of Democrats and 84 percent of Republicans see it as a top priority.

    The public also supports out-of-pocket drug caps and caps on insulin costs as a top priority for lawmakers. But, at what cost to them? Those caps are likely to drive up overall health insurance premiums considerably if they are not combined with drug price regulation.

    The public feels less strongly that policymakers continue to fund COVID-related health care costs. Only about one in four Americans believe Congressional investments in COVID health care should be a top priority.

    Views of the Affordable Care Act are split along party lines. Nearly nine in ten (87 percent) Democrats see the ACA favorably, with more than four in ten of them (43 percent) saying the ACA helped them and their families. In sharp contrast, nearly eight in ten (79 percent) Republicans view the ACA unfavorably, with four in ten saying it hurt them and their families.

    Overall, Americans have a negative view of long-term care facilities’ staffing levels, fees and care quality. The 25 percent of Americans with some direct familiarity with long-term care facilities have even stronger negative views of them.

    Here’s more from Just Care: