JustCare

Tag: Premiums

  • Medicare for All lowers taxes for most Americans

    Medicare for All lowers taxes for most Americans

    Emanuel Saez and Gabriel Zucman, economics professors at UC Berkeley, report in The Guardian that Medicare for All–a public health insurance program, which Senators Bernie Sanders and Elizabeth Warren both support–would lower taxes for most Americans and lead to a big pay raise for many Americans as well. (Note: Warren’s financing plan imposes no taxes on middle class Americans; it puts their share of insurance premiums back in their pockets.)

    Saez and Zucman explain that no matter how you do the financing around Medicare for All, because it saves so much money, it does not raise taxes. They argue that in order to talk about health care in America, you need to start with its huge cost, 20 percent of GDP. With Medicare for All, the cost of health care for the vast majority of Americans comes down.

    Health insurance premiums are equivalent to taxes, only they are paid to corporate health insurers instead of the federal government. People or their employers must pay these premiums. Unlike choice of restaurants or clothing, where you can pick lower cost options or forgo it, you cannot (or should not) do so with health care or health insurance. Health care is like education. Everyone needs it, and for that reason other countries pay for it through taxation.

    In the US, working people are charged a fixed rate for their health care–based on a variety of factors including age and geography–which Saez and Emanuel call a poll tax. Health insurance costs are not based on ability to pay as they are in other wealthy nations.  Rather, they are regressive. In fact, once you add in the cost of health care, the US tax system overall is “highly regressive.” It’s about 30 percent for the lower-income earners, 40 percent for the middle-income earners and 23 percent for billionaires. CEOs pay the same amount for their health insurance as their secretaries.

    The health care system in the US is unsustainable. Medicare for All would end the poll tax and establish a progressive tax. Consequently, workers would benefit substantially through increased income. For example, if you earned $50,000 a year and had employer coverage, the $15,000 or so your employer pays for your health insurance would increase your income to $65,000. Your health insurance tax, based on ability to pay, would be $4,000, leaving you with $61,000 in come, ahead by $11,000 a year.

    You can visit TaxJusticeNow.org, a web site with a tax calculator that Saez and Zucman developed, to see how you would fare financially with Medicare for All. You could see how different Democratic presidential candidates’ tax plans would affect low-, middle- and high-income people’s tax rates. With Sanders’ Medicare for All plan, only the bottom 90-plus percent of income earners would benefit financially.

    If you support Medicare for all, please let Congress know. Please sign this petition.

    Here’s more from Just Care:

  • Congresswoman Jayapal introduces Medicare for All bill

    Congresswoman Jayapal introduces Medicare for All bill

    Today, Congresswoman Jayapal and 105 co-sponsors introduced the Medicare for All Act in the U.S. House of Representatives. Unlike most other health reform bills in the House and the Senate, the Medicare for All Act offers comprehensive health care for everyone in the US, including long-term care, and takes hundreds of billions of dollars of waste out of the system.

    The Medicare for All Act would fix our broken health insurance system. We have 30 million uninsured and tens of millions more people who have inadequate coverage, which keeps them from getting needed care. We ration health care even for people with insurance, based on their ability to pay deductibles, coinsurance and out-of-network bills.

    Commercial health insurers add as much as $500 billion in administrative waste to the cost of health care. Moreover, they have no ability to rein in doctor, hospital and prescription drug costs to fair levels. Not surprisingly, we spend about twice as much per person on health care as other wealthy countries, which have far better health outcomes.

    Because health care costs are so high in the US, approximately one in three adults are not getting care their doctors recommend or are not going to the doctor or filling a prescription. 33 percent of U.S. adults go without recommended care, do not see a doctor when sick, or fail to fill a prescription. In wealthy European countries such as Germany and the Netherlands, only about one in 12-14 adults go without recommended care.

    The Medicare for All Act ensures that our health care system puts patients first, giving everyone equal access to good care. A large majority of the public support it, including 86 percent of Democrats and 52 percent of Republicans. And, support is growing as people learn more about how it works and why it works.

    Not only would people be able to use the doctors and hospitals they want, all necessary services would be covered in full, including long-term care, mental health, reproductive health, dental, vision, medical supplies, and prescription drugs.

    The Medicare for All Act would create 2.6 million new jobs. It would help small businesses, as they no longer would need to pay for commercial health insurance for their workers. No longer would insurers come between patients and their doctors to decide what care was needed.

    Moreover, the cost of covering everyone and eliminating premiums, deductibles and copayments would be entirely offset by the savings achieved from the elimination of waste and health insurance industry profits as well as lower provider rates and prescription drug prices. The law would be phased in over two years.

    If you support Medicare for all, please sign this petition.

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  • Hospital upcharges for prescription drugs provides further justification for federal government drug price negotiation

    Hospital upcharges for prescription drugs provides further justification for federal government drug price negotiation

    A new report by Pharma, the trade association for drug manufacturers, looks at hospital upcharges for prescription drugs and provides further justification for federal government drug price regulation. The report suggests that hospitals are making a bundle off of prescription drugs.

    According to Pharma, which analyzed the prices hospitals charge for all hospital-administered drugs, on average, hospitals charge almost five times (479 percent) the price they pay for these drugs.  Just over half of hospitals (53 percent) charge between two and five times the cost of these drugs. One in six hospitals, 17 percent, are charging at least seven times their cost.  And one in twelve hospitals (8 percent) are charging more than ten times the price they pay for them.

    Uninsured patients may get hit with these exorbitant drug charges in full. Insurers generally pay a negotiated rate for the drugs their enrollees receive in hospital. That negotiated rate is typically more than twice the price that hospitals pay for the drugs, and less than what hospitals charge the uninsured. It’s no wonder the public wants Congress to address health care costs.

    These excessive hospital charges mean ever higher health insurance premiums for Americans.  They also drive people into medical bankruptcy or force them to forego necessary medicines.

    Congress should not permit hospitals to hike up the price of drugs beyond a small administrative fee.  And, health insurers, along with Pharma and the general public, should be calling on Congress to pass legislation that forbids this behavior.

    Unfortunately, our commercial health care system permits pharmaceutical companies, Pharmacy Benefit Managers (PBMs) and the insurance industry, in addition to hospitals, to make out like bandits when it comes to what they charge for drugs. Pharmaceutical companies like to shift blame to hospitals and PBMs for their markups. And, insurers and PBMs tend to keep quiet about the high price of prescription drugs, enjoying the riches they reap from the failure of Congress to negotiate one fair price for everyone.

    It’s time Congress stepped in to negotiate fair drug prices for everyone in this country. If Germany and Japan can do it, so can the US.

    If you want Congress to rein in drug prices, please sign this petition.

    Here’s more from Just Care:

  • Medicare Part D in 2018

    Medicare Part D in 2018

    The Kaiser Family Foundation has a new issue brief  on Medicare Part D enrollment, premiums, and cost-sharing in 2018. The biggest takeaway is that if you are among the 43 million people with Medicare who have prescription drug coverage through Medicare Part D,  you should choose your Medicare Part D drug plan carefully. Costs differ considerably among them.

    More than seven in 10 people enrolled in both traditional Medicare (the government-administered plan that covers your care from virtually all doctors and hospitals anywhere in the US) and in Medicare Advantage plans (commercial health plans that contract with the government to offer Medicare benefits) get their prescription drug coverage through Medicare Part D. Almost six in 10 Part D plan enrollees are in traditional Medicare and just over four in 10 are enrolled in Medicare Advantage.

    The average monthly Part D premium is $41, up 2 percent from 2017. Some premiums are as low as $20 and some are as high as $84. Deductibles, the amount you pay out of pocket before coverage kicks in, can be non-existent in some Medicare Part D drug plans. Four in 10 people are in Part D plans without deductibles. More people are enrolled in plans with a standard $405 deductible.

    Coinsurance and copays, the amount you pay out of pocket when you get a covered drug, varies considerably, with generic drugs having far smaller out-of-pocket costs than brand-name drugs, though those costs have risen considerably over the last few years. Drugs that are considered “specialty,” which cost a minimum of $670, often have cost-sharing as high as one-third of the drugs’ price. Forty percent of people with Medicare are enrolled in Part D drug plans that charge coinsurance this high.

    You can check out your Part D drug options on the Medicare Plan Finder, which includes information on premiums, deductibles and the costs of drugs in different Part D drug plans. Unfortunately, the Medicare Plan Finder can be misleading and difficult to use. You can get free help navigating it from your State Health Insurance Assistance Program or SHIP. Or, you might consider other options for keeping your drug costs down.

    Most people with a Medicare Part D plan are enrolled in either UnitedHealth, Humana or CVSHealth.

    Medicare’s Extra Help program helps pay the Medicare Part D premium for about 30 percent of people enrolled in these plans. One million people getting Extra Help pay a $26 monthly premium, on average, for their coverage, though they are eligible for Part D plans for which they do not need to pay a premium.

    If you want Congress to rein in drug prices, please sign this petition.

    Here’s more from Just Care:

  • Budget deal lowers drug costs for people with Medicare

    Budget deal lowers drug costs for people with Medicare

    Congress’ budget deal lowers prescription drug costs for people with Medicare. Under the budget agreement, pharmaceutical companies must absorb more of the cost of prescription drugs for people in the Medicare Part D “donut hole,” a gap in drug coverage for people with substantial drug costs. The budget deal also ends the donut hole in 2019, one year earlier than planned.

    The donut hole is triggered when your total drug costs hit $3,750. At that point, in 2018, you pay 35 percent of your drug costs until you spend $5,000 out of pocket on covered drugs. The budget deal means that you will pay 25 percent of your drug costs while you are in the donut hole, beginning in 2019. Pharmaceutical companies will absorb 70 percent of drug costs, up from 50 percent.

    These drug discounts for people with Medicare in the donut hole are often off of drugs that pharmaceutical companies are able to price preposterously high. So, out-of-pocket costs for people in the donut hole needing one high-priced drug can still be as much as $5,000. But, until Congress steps in to negotiate drug prices, as every other developed country does, the discounts are better than nothing. The change in the law could save people with high drug costs thousands of dollars.

    With the budget deal, not only are drug costs lower for many people with Medicare, but people with Medicare should see lower Part D premiums because of lower drug spending.

    In other good news, the budget deal ends the limit on physical, speech and occupational therapy. Historically, Medicare has capped coverage for therapy services. The budget deal also permits Medicare to cover a much greater array of telehealth services.

    That all said, the budget deal did not include the CREATES Act, which is intended to speed drugs to market once they are off patent. CREATES would have made it harder for pharmaceutical companies, which lose their drug patents, from keeping generics off the market. They often do not share samples of these drugs, needed to manufacture the generics, with generic manufacturers. Right now, generic manufacturers do not have the right to sue pharmaceutical companies to get the samples of drugs going off patent.

    Furthermore, the budget deal repeals the Independent Payment Advisory Board established through the Affordable Care Act to help Medicare control costs.

    And, the one million people with Medicare with the greatest yearly incomes–individuals who earn at least $500,000 and couples who earn at least $750,000–will see an increase in their Part B and Part D Medicare premiums.

    Here’s more from Just Care:

  • People with Medicare spend an average of $5,500 on health care annually

    People with Medicare spend an average of $5,500 on health care annually

    Medicare works to ensure people access to quality affordable health care, but average out-of-pocket health care costs are still considerable. A new report from the Kaiser Family Foundation finds that individuals typically spend more than $3,200 a year just on Medicare premiums, deductibles and coinsurance. When you add in costs for services Medicare does not pay for, people spend an average of $5,500 a year out of pocket on health care or, put differently, more than 40 percent of their Social Security benefits.

    Juliet Cubanski and Tricia Neuman analyzed data from 2013 to determine the amount people with Medicare spend on health care. All in, they found that spending on health care eats up about 41 percent of the average monthly Social Security check, $1,115. Average annual Social Security benefits were $13,375 in 2013 and average total income for a person with Medicare was $35,317.  Their report establishes that people with Medicare have far higher annual average out-of-pocket health care costs than the Center for Retirement Research found based on 2014 data, 41 percent of their Social Security benefits as compared to 33 percent.

    To be sure, the percentage of income spent on health care is far higher for people who rely exclusively or almost exclusively on Social Security for their retirement income. And, a notable portion of the 62 million people receiving Social Security benefits rely almost exclusively on Social Security for their income. More than one in five married couples and more than four in ten individuals rely on Social Security for more than 90 percent of their income, according to the Social Security Administration.

    When the Kaiser Family Foundation researchers dug deeper, they found that people over 85 and women typically spent an even higher share of their Social Security income on health care than men and people under 85. People 85 and older spent on average 74 percent of their Social Security benefits on health care costs Medicare does not cover. Women over 85 spent more than men, 83 percent of their Social Security benefits as compared to 58 percent. Because Medicare does not pay for custodial nursing home care or most other long-term care services and supports, the oldest cohort of people with Medicare have especially high out-of-pocket costs.

    Out-of-pocket costs for people in poor health and people with lower incomes were also higher than other people. People in fair or poor health spent an average of $6,128 on health care as compared to $5,246 for people in excellent, very good or good health. Put differently, people who could perform all the activities of daily living–bathing, feeding, toiletting, dressing and transferring–spent on average $4,673 out of pocket a year on health care, whereas people who needed help with activities of daily living spent on average $6,946.

    The researchers found that one in four people with traditional Medicare spent almost 30 percent of their total income on health care costs Medicare does not cover. And, one in ten people spent just under 60 percent of their total income.

    We need to increase Social Security benefits if we want to ensure retirees can make ends meet and keep older adults from falling into poverty. Their situation is projected to get even worse as health care costs continue to grow.

    If you want Congress to expand Social Security benefits, please sign this petition.

    Here’s more from Just Care:

  • GOP tax bill cuts $400 billion from Medicare

    GOP tax bill cuts $400 billion from Medicare

    On Friday December 1, 51 Senate Republicans voted to slash Medicare as much as $400 billion  over the  the next ten years in order to pay for tax cuts to millionaires and billionaires. The tax bill undermines Medicare as we know it and threatens to increase costs to the nearly 60 million older adults and people with disabilities who depend on Medicare for their health security. It also destabilizes the health insurance exchanges, jeopardizes the health care of millions of younger Americans and is certain to increase the number of people who face medical bankruptcy.

    How does the tax bill threaten Medicare? The Senate tax bill would add $1.5 trillion to the deficit over ten years. A “pay-as-you-go” rule currently in place requires Congress to pay for those deficits. It triggers automatic cuts to Medicare and other mandatory spending programs, including affordable housing, nutrition programs and student loans. The pay as you go rule allows Medicare cuts to be as much as 4 percent, $25 billion, beginning this fiscal year.  Medicaid, Social Security and food stamps are exempt from the pay as you go rule.

    With a cut to Medicare this large, doctor and hospital rates would likely decrease, reducing the number of doctors willing to treat older adults and people with disabilities. The cut cannot affect either Medicare benefits or premiums and out-of-pocket costs. Congress could waive the pay as you go provision, but it would require 60 votes and, it seems unlikely it would.

    Before Congress takes its final vote on the tax bill, the Senate bill needs to be reconciled with the House bill. Americans need to pressure their members of Congress to oppose this bill.  Here are the key differences between the two bills.

    1. The House bill eliminates the tax deduction for large medical expenses, which benefits many older adults, who use a lot of health care, and 8.8 million Americans in total. The Senate bill retains this deduction.
    2. The House bill retains the individual mandate in the Affordable Care Act. Everyone would continue to need to have health insurance coverage or pay a penalty. The Senate bill repeals the mandate, which the CBO projects would leave 4 million more people uninsured in 2018 and 13 million people uninsured by 2025. It would drive up premiums and out-of-pocket costs for everyone in the state health insurance exchanges and put Obamacare at serious risk. Many people who opted out of health insurance in the exchanges, would buy skimpy, limited coverage, which might not cover their basic medical needs or pre-existing conditions.

    These dangerous threats to the nation’s health come with a multi-billion dollar cost to middle income Americans and a multi-billion dollar gain to millionaires and billionaires. A November 26, CBO report finds that people earning between $40,000 and $50,000 will pay $5.3 billion more in taxes than they currently would, while people earning $1 million or more would pay $5.8 billion less.

    Here’s more from Just Care:

  • Unlike Canadians, Americans pay a huge financial and emotional price for health care

    Unlike Canadians, Americans pay a huge financial and emotional price for health care

    Catherine Gordon reports for the UC Observer on cancer care in Canada and the US, profiling her own experience in Canada and that of her sister Karen, in the US.  The sisters were diagnosed with breast cancer within one year of each other. They both received first-rate treatment; but, unlike Catherine, Karen paid a huge financial and emotional price for her health care.

    Both sisters had six chemotherapy treatments and 25 rounds of radiation treatment. Catherine’s medical bills were minimal, $750 in out-of-pocket costs and $1,200 for her wig. The Ontario Health Insurance Plan paid for the rest of her care. Ontario’s Assistive Devices Program paid for most of the cost of her $400 breast prosthetic.

    Karen, in sharp contrast, paid more than $23,000 out of pocket–about $7,500 in health insurance premiums and $16,000 to meet her deductibles over her two years of care. In addition, she suffered through the emotional and financial hassles of deductibles and copays, as well as accessing needed care. Karen was asked to write a check for her care minutes before she was about to get surgery. “Just as I was getting ready to head to the operating room, a tall man in a nice suit came in and told us he had to have a cheque before they would go ahead. ‘It’s our new policy because people aren’t paying their bills.’  We paid him, of course, but it seemed absolutely outrageous — especially when you’re frightened and sick.”

    Catherine reports that Karen’s file folder of  medical bills was three inches thick. She had nearly 50 bills from a range of health care providers, including pathologists, imaging centers, radiologists, plastic surgeons, anesthesia services, blood labs. She had no clue who many of these providers were or what services they had provided. Karen had to navigate this sea of bills, while “in crisis mode and trying to deal with getting well.”

    Watch this video put together by Bernie Sanders to learn more about Catherine and Karen’s experiences getting cancer care in Canada and the US, respectively.

    Here’s more from Just Care:

  • One third of Social Security benefits spent on Medicare costs

    One third of Social Security benefits spent on Medicare costs

    An October 2017 Center for Retirement Research paper looks at the amount retirees spend on health care out of pocket as compared with income. It finds that Medicare out-of-pocket costs are so high that retirement income for many is inadequate, threatening people’s retirement security. Typically retirees spend one third of their Social Security benefits on Medicare out-of-pocket costs.

    Based on 2014 data, researchers found that, on average, retirees spend $4,274 a year out of pocket on medical and hospital care. Almost $3,000 is spent on premiums. Costs for long-term care are in addition to these costs. But, Michelle Andrews of Kaiser Health News reports that the researchers did not find a significant increase in average out-of-pocket spending when long-term care is factored in.

    Researchers further found that about 20 percent of a typical retiree’s income goes to Medicare out-of-pocket costs. And, almost one in five of retirees (18 percent) were left with less than half of their Social Security checks after paying for Medicare costs. Six percent of them were left with less than half of their total income, including Social Security benefits.

    That said, the researchers also found a $426 reduction in out-of-pocket spending in 2014 from 2004. In 2004, it averaged, $4,700. This drop is most likely attributable to the introduction of the Medicare Part D prescription drug benefit.

    In short, we need to expand Social Security if we want to ensure retirees can make ends meet and keep them from falling into poverty. Their situation could get even worse by 2020, when Medicare spending is projected to increase.

    If you want Congress to expand Social Security benefits, please sign this petition.

    Here’s more from Just Care:

  • President Trump blows up ACA adding $200 billion to deficit

    President Trump blows up ACA adding $200 billion to deficit

    President Trump has been saying for a long time that the ACA was going to implode. He was counting on Republicans in Congress to make sure that happened. Without their assistance, he just issued an Executive Order that blows up the ACA and  adds nearly $200 billion to the deficit.

    On October 12, 2017, Trump signed an Executive Order that ends subsidies to help people with modest incomes enrolled in state health insurance exchanges pay their deductibles and copays. These “cost-sharing reductions” cost the federal government about $7 billion a year and save the seven million people who benefit from this help about $1,000 each in out-of-pocket costs. Vox’s Sarah Kliff reports that this provision in Trump’s Executive Order means:

    • Insurers could increase premiums by 20 percent in 2018 in order to cover their increased costs. Premiums could increase by 25 percent by 2020.
    • The federal deficit will increase because the government will have to spend $194 billion more to subsidize the increased premiums of 10 million people in the health care exchanges, according to the Congressional Budget Office.
    • One million more people will be uninsured in 2018.
    • Some health insurers will lose a lot of money on 2018 premiums set before the Executive Order was signed.
    • More health insurers may decide to leave the health insurance exchanges.

    Congress could fix this problem by passing a law that specifically approves these cost-sharing reduction payments. Some believe that this is possible as part of a bi-partisan fix to avoid driving up the deficit.

    In addition, the Trump Executive Order allows insurers to sell skimpy policies that do not cover the essential benefits mandated in the ACA. Some healthy people might leave the state exchanges and buy these skimpy policies because they cost less. But, these people will put their own health at risk if they get sick, because they are likely not to have the coverage they need. And, they will drive up premiums for people in the state exchanges.

    Attorneys general from 18 states and the District of Columbia, including New York and California, filed a lawsuit on October 13 challenging Trump’s Executive Order, the Hill reports.

    Here’s more from Just Care: