JustCare

Tag: Medical debt

  • How much profit should shareholders reap from health care?

    How much profit should shareholders reap from health care?

    A group of Yale researchers looked at where all the profits from the health care industrial complex flow. They found that the vast majority of money earned by pharmaceutical corporations, for-profit hospitals, health insurers and other publicly traded companies went to corporate shareholders, reports Sujata Srinavasan for Connecticut Public Radio.

    In the 21 years between 2001 and 2022, the researchers found that $2.6 trillion went to shareholders. Their study is published in JAMA Internal Medicine. The number is shocking for at least three reasons. First, the $2.6 trillion represents 95 percent of the profits. Second, only five percent of the money went to medical research and development, improved hospitals or pharmaceutical research. Third, the returns to shareholders more than tripled over that period.

    Given how much Americans pay for health care and the burden of medical debt on millions of us, it’s time for the government to rein in the prices we are being charged or, at the very least, limit corporate profits with the goal of lowering costs. Today, about 12 percent of adults in the US owe more than $10,000 in medical debt. Should there be a limit on corporate profits to reduce health care costs?

    With increasing vertical integration in health care, e.g. UnitedHealth owning providers, a pharmacy benefit manager, claims processing centers, insurance companies and more, unless there is a limit on corporate profits, it’s more than likely that health care costs will continue to mount. Health care corporations are not putting patients first.

    Corporate shareholder returns are not the only funds being stripped out of our health care system and driving up costs. The researchers did not look at the $1 trillion that private equity firms invested in health care over the last decade. These companies have destabilized a large number of hospitals, taking out profits and leaving them in major debt. They have also profited wildly from investments in home care agencies at the expense of older adults.

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

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

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

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

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

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

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

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

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

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

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

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  • More than 4 in 10 Americans face cost barriers to care

    More than 4 in 10 Americans face cost barriers to care

    At any given time, about 10 percent of Americans are responsible for 70 percent of health care spending. Since anyone can be hit by a car or diagnosed with cancer tomorrow, you could be among that ten percent facing very high health care costs, even with health insurance. Unfortunately, health insurers today too often do not provide people adequate coverage, leaving nearly a quarter of their enrollees underinsured, according to a new report by the Commonwealth Fund.

    In addition to underinsurance presenting a barrier to care for a large cohort of Americans, the Commonwealth Fund found that 12 percent of Americans went without health insurance during some point in the year. An additional nine percent of Americans surveyed were uninsured throughout the year.

    The Commonwealth Fund defines underinsurance as the plight of people with insurance who face high deductibles and copays relative to their income. As a result, these people are often inclined to forego or postpone care.

    All in, the Commonwealth Fund survey results show that almost half of Americans (44 percent) did not have insurance throughout the year and/or could not access affordable care even with insurance. Slightly more than half of Americans had insurance throughout the year with access to care they could afford.

    Some underinsured and uninsured Americans don’t need care or need little care and can manage. But nearly six in ten people (57 percent) who are underinsured and seven in ten who are uninsured reported going without needed care, including prescription medicines, medical tests, and medical procedures. The consequences of foregoing care can be dire, including preventable death and serious health conditions.

    Equally concerning, millions of uninsured and underinsured Americans face medical debt.

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  • US health care system ranks dead last among 10 of the world’s richest countries

    US health care system ranks dead last among 10 of the world’s richest countries

    The Commonwealth Fund this week released its biennial ranking of the health systems of 10 of the world’s richest countries, and once again the United States comes in dead last – as it has for the past 20 years – not just overall but on most performance measures, especially access and affordability.

    Throughout the report, it’s clear that one of the reasons the U.S. always brings up the rear internationally is the fact that far too many Americans – including those of us with health insurance – can’t afford to get the care we need. And tragically, so many of us who do seek care – with or without insurance – wind up deep in debt. As the Commonwealth Fund reports over the years have shown, that is a uniquely American tragedy.

    As KFF News has reported, more than 100 million Americans – 41% of adults – are mired in medical debt, and the vast majority of those people have both jobs and health insurance. The problem is that their “coverage” is just not nearly sufficient because of the ever-increasing out-of-pocket demands big insurance conglomerates (and the employers that hire them to administer health care benefits) saddle us with to boost their profits. (We’re the only country that allows for-profit insurance companies to run its health care system.)

    As the Commonwealth Fund’s report shows, we spend around twice as much for health care as the average of the other nine countries and almost twice as much as a percentage of GDP, yet we are the only one of the bunch that has not achieved universal coverage.

    Despite the big gains in coverage we’ve made since the enactment of the Affordable Care Act, more than 26 million of us remain uninsured. But just as unacceptable is the fact that far more than that – one of every four working adults in this country – are underinsured because of the uniquely American high-deductible plans that our employers and insurers have forced us into. For many of us they are not just high, they are sky-high. Forbes magazine has called people in such plans functionally uninsured.

    The Commonwealth Fund’s researchers note that unaffordable cost-sharing requirements – deductibles, copays and coinsurance obligations – “render many patients unable to visit a doctor when medical issues arise, causing them to skip medical tests, treatments, or follow-up visits, and avoid filling prescriptions or skip doses of their medications.” And when they do get the tests, treatments and medications they need, they all too often find themselves buried in debt.

    It has become such a problem that the Biden-Harris administration has made alleviating medical debt a priority. The White House is expected to lay out at least some of the steps the federal government can take to do that in the coming weeks.

    One important thing the administration already has done is ask Congress to pass legislation that would cap out-of-pocket costs for prescription drugs at $2,000 a year – and make sure that cap applies to all of us – not just Medicare beneficiaries. A $2,000 cap for people enrolled in Medicare Part D (and the private replacement plans marketed as Medicare Advantage) will go into effect in January.

    [This post was originally published in HEALTH CARE un-covered.]

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  • Vice President Harris wants to forgive medical debt

    Vice President Harris wants to forgive medical debt

    Vice President Kamala Harris’s economic plan calls for forgiving medical debt for as many as 15 million Americans, reports Annie Nova for CNBC. Americans should not go bankrupt because they need medical care, says Harris. She wants to erase much of the more than $220 billion in medical debt.

    Harris’ campaign has not laid out any of the details for how she would cancel medical debt. For sure, the government would need to be involved. Today, about 14 million Americans owe at least $1,000 in medical debt. The American Rescue Plan, which became law during the Covid pandemic, provides local governments with the ability to buy and cancel nearly $7 billion in medical debt by December 2026 for about three million Americans.

    A majority of Americans (51 percent) believe it is very important for our government to forgive medical debt. Medical debt drives inequities in society and creates impediments to prosperity. It also can deter people from getting further medical care. Older adults alone owe more than $54 billion in medical debt.

    Donald Trump has never suggested that he would cancel medical debt. He simply has called for more health care price transparency. And, he has called for repeal of the Affordable Care Act, which has reduced the number of uninsured Americans by more than 20 million and prevents insurers from denying health insurance coverage to people with pre-existing conditions. The Congressional Budget Office found that repealing the Affordable Care Act would quickly lead to 27 million Americans losing their insurance coverage and those with insurance coverage seeing their premiums doubled.

    The Biden Administration has been working to eliminate medical debt from people’s credit reports. And, medical debt under $500 is no longer appearing on people’s credit reports. Vice President Harris wants to eliminate all medical debt from people’s credit reports.

    In an interview with Ady Barkan about health care, Harris says “Access to health care should be a human right.” She describes the lunch at which her mom told her that she had been diagnosed with colon cancer and the inhumanity of our health care system, which is so expensive and challenging to navigate.

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  • Mental health care is unaffordable for one in four Americans with anxiety and depression

    Mental health care is unaffordable for one in four Americans with anxiety and depression

    Researchers at Johns Hopkins found that 25 percent of adults with anxiety and depression in the US cannot afford to pay their mental health care bills, keeping them from receiving psychiatric care. Medical debt doubled the likelihood that people would either go without treatment or delay treatment for mental conditions, according to the research findings published in the JAMA Network. Mental health parity continues to be a dream.

    Nearly one in five households in the US carry medical debt, making it hard to get treatment for mental conditions when needed. Medical debt is prevalent among Americans with anxiety and depression.

    More than eight percent of Americans have not paid their medical bills of $250 or more. Overall, Americans in debt often face poor health outcomes and struggle to pay for their daily needs, including food and housing. Having health insurance does not help them.

    Sadly, not even half of adults with a mental disorder get treatment for it in the US. It’s expensive, even with insurance. And, psychiatrists tend not to accept insurance. So, out-of-pocket costs for mental health treatment can be exceptionally high.

    The researchers surveyed nearly 28,000 adults. Insured Americans with high deductible health plans were most likely to forego or delay mental health treatment.

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  • Why can’t people know their health care costs before receiving care?

    Why can’t people know their health care costs before receiving care?

    Health care should not be a commodity; it should be a right. But, so long as our country treats health care like a commodity, people should be able to know what they’ll be charged before receiving health care. Instead, it feels as if hospitals and physicians can make up their charges and insurers can make up what they cover; patients have little choice but to pay what they are billed or end up in medical debt.

    At a recent Senate hearing, policy experts explained why the current health care system isn’t working. Hospitals are supposed to post their prices, but many still don’t and, honestly, it probably would be of no help to patients if they did. The issue is not simply the costs of different services, but which services are delivered, over both of which patients have little control.

    The only solution for protecting people against high health care costs is an all-payer rate-setting system with regulated prices and public health insurance that covers them. Medicare for all. Once corporate insurers are in the mix and hospitals and physicians can charge what they please, as we know, your health care costs can be through the roof.

    The Senate Special Committee on Aging heard from witnesses about how impossible it is for patients to shop for health care effectively. Senator Mike Braun called provider behavior monopolistic. But, his solution, explained in a report, is simply for more price transparency, which will never address the problem of high prices.

    Hospitals also now get away with charging “facility fees,” which can be super high and are always unpredictable. Moreover, consolidation in the health care space is driving up prices, without any evidence of improved quality of care. But, Congress remains unwilling to address health care costs in a meaningful way.

    Congress did cap prescription drug costs for people with Medicare Part D at $2,000 a year beginning in 2025. But, that legislation continues to allow pharmaceutical companies to charge what they will for their prescription drugs. That’s not a meaningful solution. It will drive up Part D premiums further.

    For their part, hospitals argue that they need to increase prices because insurers too often refuse to pay them for the services they deliver. In addition, many patients can’t afford to pay their hospital bills, so hospitals are forced to absorb the cost of the services they deliver.

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  • New bill in Congress would cancel medical debt

    New bill in Congress would cancel medical debt

    Senator Bernie Sanders and Congressman Ro Khanna just released a bill designed to cancel medical debt, reports Joan Greve for The Guardian. Senator Jeff Merkley and Congresswoman Rashida Tlaib are co-sponsoring the bill. While medical debt is more of a problem among working Americans than among people with Medicare, older adults face significant medical debt and people in Medicare Advantage are more likely to face medical debt than people in Traditional Medicare. Imagine if everyone in the US were medical-debt free.

    Through a federal grant program, under the bill, all patient debt today would be cancelled. The Fair Debt Collection Practices Act would be reformed so that creditors could not collect unpaid medical bills.

    The legislation also would change the way physicians, hospitals and other providers can bill. It would change the Consumer Credit Reporting Act so that credit agencies could not report the fact that people have unpaid medical bills. As a result, people’s unpaid medical bills would not ruin their credit ratings.

    The bill is designed to help ensure people’s financial security when they get sick. They should not go bankrupt because they are diagnosed with cancer, suffer a stroke or have another medical emergency. One hundred million people in the US today are faced with medical debt. Unpaid medical bills total more than $22o billion according to the Kaiser Family Foundation.

    Medical debt is a particularly serious burden for people with low incomes, people with disabilities, Hispanic and Black Americans. It is also common among cancer survivors, 33 percent of whom have been forced into debt.

    Will Congress pass a bill that cancels medical debt? It’s unlikely. The Republican-controlled House of Representatives has little interest, even though such a bill draws bi-partisan support. Two years ago, a YouGov survey found that two-thirds of Americans, including a majority of Republicans, believe Congress should step in to address medical debt.

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  • Hospital billing practices frequently leave people without medical care or in court

    Hospital billing practices frequently leave people without medical care or in court

    The Lown Institute reports that if you aren’t able to pay your hospital bills, you have a one in three chance of being sued. On top of that, some hospitals are refusing to allow you to schedule new appointments.

    Almost half of adults in the US find affording the cost of healthcare challenging. Forty percent of them have medical debt. And, many of those people in debt end up choosing to go without medical care or to leave the hospital against medical advice. Medical debt now totals somewhere between $81 to $140 billion.

    The Lown Institute is collecting information on each hospital’s billing and collection practices. People should know which hospitals to avoid. That said, many hospitals are struggling to survive. There’s no excuse for hospitals filing lawsuits against patients, but the hospital system is broken. And, there’s also no excuse for the government standing back and watching hospitals go bankrupt because insurers are not paying them, to the detriment of their constituents.

    The Leapfrog Group, Northwestern University Feinberg School of Medicine, and Johns Hopkins University School of Medicine published a recent analysis of some hospital billing and collection data in JAMA. Of the more than 2,000 hospitals studied, a third said that they bring lawsuits against patients for delayed or inadequate payment of their bills. Rural hospitals sue patients more frequently than urban and suburban ones.

    What’s equally appalling is that hospitals often do not provide patients with itemized bills within a month of services. And more than one in 20 hospitals surveyed had no representatives to help patients with billing questions or to look into billing errors or to set up a payment plan.

    What is to be done? Lown does not propose national health insurance, likely because it’s not on the table at the moment. It should be. That’s the only way to ensure health equity and end medical debt. It’s also a far better way to ensure hospital solvency than allowing hospitals to sue patients for money they don’t have.

    Lown is focused on better hospital billing practices. Insanity. Who could step in to ensure that hospitals did a better job of billing patients? The JAMA authors say that if we standardized hospital billing practices, there would be greater accountability. Good luck! At the very least, we should be standardizing hospital prices.

    We should not leave it to the states to fix this problem. They do not have the will, the skill, the money or the power to take this on. Yes, a couple of states have done a little on credit reporting of medical debt. That’s something, but not wildly enough. How many millions more people will suffer the indignity of not being able to get medical care or of not being able to afford medical care or of being sued for not being able to pay medical bills before Congress acts?

    Lown Institute suggests that documenting the problem could help promote health care affordability and hospital accountability. By the time they have the data they need and anyone’s attention, tens of millions of Americans will have been harmed by our travesty of a healthcare system.

    Here’s more from Just Care:

  • Older adults owe $54 billion in medical debt

    Older adults owe $54 billion in medical debt

    The Consumer Financial Protection Bureau, an arm of the federal government, reports that almost four million older adults owe as much as $54 billion in medical debt. Of those, 98 percent have either Traditional Medicare or Medicare Advantage. What’s truly shocking is that a lot of that debt is money they should not be paying.

    Virtually all older adults have Medicare, and seven in 10 report having additional insurance, either Medicaid, retiree coverage from a former employer or supplemental insurance such as Medigap. Yet, between 2019 and 2020, there was a 20 percent increase in the amount of unpaid medical bills of older adults, from $44.8 billion to $53.8 billion. That’s about 25 percent of all medical debt among adults at that time.

    The average amount older adults owed in 2020 was $13,800, although half of them owed less than $1,500. In 2019, they owed an average of $11,700, with half owing less than $1,200. The jump is confounding since fewer people got medical care in 2020 than in 2019 as a result of Covid-19. The jump is also greater than the increase in Medicare premiums and overall health spending.

    The Consumer Financial Protection Bureau found that a smaller percentage of people in Traditional Medicare with supplemental coverage, either Medigap or retiree coverage from a former employer, had unpaid medical bills than people in Medicare Advantage.

    There is a substantial chance that a lot of these medical bills are erroneous. Physicians and other health care providers sometimes wrongly bill Medicare patients extra. You should never pay an unexpected bill from a physician without first checking with your local State Health Insurance Program (SHIP).

    If you have both Medicare and Medicaid, you should have no or virtually no out-of-pocket costs for all Medicare-covered services. And, physicians and other health care providers are prohibited from charging you directly, except for a small copay in some states. Do not pay those bills. Call the doctors office and assert your rights; you might also want to file a complaint with Medicare.

    If your health care provider sends an erroneous bill to a bill collector or credit reporting company, it could harm your credit. Call your local member of Congress and seek help correcting your credit report. If you are not able to get additional care because of your medical debt, let your member of Congress know.

    Congress allows bill collectors to go after people with Medicare with near impunity. The bill collectors should be penalized for going after people with Medicare without taking appropriate steps to ensure that bills are accurate. Meanwhile, people with Medicare, including people in Medicare Advantage plans, often pay these erroneous bills, deplete their savings and then struggle to afford the care they need.

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