JustCare

Tag: Uninsured

  • 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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  • 2022: Health care costs threaten the well-being of many Americans

    2022: Health care costs threaten the well-being of many Americans

    Fewer Americans are uninsured than ever–almost half the number before the Affordable Care Act took effect. But, rates of underinsurance are high, with millions of people having gaps in their coverage, millions skipping care and millions falling into medical debt because they cannot pay their health care bills. The Commonwealth Fund surveyed Americans and found that, too often, health care costs threaten their well-being.

    The big takeaways:

    • More than four in ten adults under 65 (43 percent) did not have adequate health insurance. People without insurance, people with gaps in insurance coverage during the year, and people who could not afford their care are included in this group.
    • Nearly three in ten people with employer coverage (29 percent) and more than four in ten people with coverage they bought in the individual market (44 percent) were underinsured.
    • Close to half of all people (46 percent) said that they had not gotten care or delayed getting care because of the cost. More than four in ten (42 percent) struggled to pay medical bills or were in medical debt.
    • Half of people surveyed (49 percent) said they could not afford to pay an unexpected medical bill of $1, 000 within 30 days, primarily people with low incomes (68 percent), Black adults (69 percent), and Latin/Hispanic adults (63 percent).

    Large numbers believe health care costs should be a top priority for the Biden administration and Congress. Democrats (68 percent), Independents (55 percent), and Republicans (46 percent).

    “Underinsured” is defined for people living above twice the federal poverty level as out-of-pocket health care costs over 12 months, excluding premiums, representing at least 10 percent of household income and for people living under twice the federal poverty level, representing at least 5 percent of household income ($27,180 for an individual and $55,500 for a family of four in 2022). Or, people whose health care deductible represented at least five percent of household income.

    People who lacked health insurance for at least a year tended to be young, poor, with one or more chronic conditions, living in the South, Latin/Hispanic. Undocumented individuals are not able to get affordable coverage.

    Because the US lacks a national health insurance program or even a national health insurance enrollment program, a lot of people who might be eligible for coverage based on their age, income and needs, go without coverage. More than half the people surveyed (56 percent) who had employer coverage but had been uninsured at some point during the year did not know that they were eligible to enroll in their state health insurance exchange plans because they lost their coverage.

    Americans likely would pay a lot less for their health care if the government set rates for all health care providers, as it does for people with Medicare. Because the US does not set provider rates–as all other wealthy countries do–these high rates drive high cost-sharing. Physician and hospital prices in the US are higher than anywhere else in the world.

    Close to one in four people with chronic conditions, such as diabetes, are not filling their prescriptions regularly because of the out-of-pocket cost.

    Of note, nearly one in four people with bills in collection said the bills stemmed from a mistake in billing. More than half of people with medical debt (56 percent) owed at least $2,000.

    Medical bills from out-of-network doctors at in-network hospitals represented almost half of all cost issues. These surprise bills are no longer permissible under the No Surprises Act, which took effect January 2022. But, the survey included a timeframe before then.

    When the public health emergency is declared over, likely in 2023, states will lose their improved federal matching funds. Inevitably, with less money, they will reconsider Medicaid eligibility and restrict coverage.

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  • Budget reconciliation: What’s happening with drug prices?

    Budget reconciliation: What’s happening with drug prices?

    As the Democrats in Congress work on the budget reconciliation bill, a lot is happening with drug prices. And, it is still unclear where Congress will end up. Here’s what we know as of now:

    Uninsured Americans will continue to be burdened by high drug prices: Unless something changes soon–and it’s hard to imagine what it would be–uninsured Americans will continue to face unconscionably high drug prices even if Congress lowers drug prices for everyone else. How could this be, you might wonder? It appears that lawmakers do not have a way to lower drug prices for the uninsured through a budget reconciliation bill. What the uninsured pay for drugs does not affect the budget in any evident way. Also, it appears that lawmakers do not see a way to regulate drug prices for the uninsured, short of Medicare or health care for all, which is not on the table.

    The US Department of Health and Human Services has a plan to negotiate drug prices for people with Medicare: With White House backing, Secretary Xavier Becerra is looking to negotiate Medicare drug prices and to limit price increases to the rate of inflation. Becerra’s plan mirrors the plan working its way through Congress. One unanswered question is the number of drugs that will have their prices negotiated. Another is whether private insurers will be willing and able to take advantage of Medicare’s negotiated prices.

    It is unlikely that a drug’s negotiated price will relate to the value that drug offers: Some countries, such as Germany and Australia, do value-based pricing–price prescription drugs based on their value to patients, in terms of the drug’s efficacy and the quality of life it offers. Currently, writes Thomas Waldrop for the Center for American Progress, drug prices in other wealthy nations are easily half the prices we pay and sometimes as little as 25 percent of the cost. Right now, we all bear the burden of exorbitant drug prices, as taxpayers and as patients. Medicare and Medicaid alone in 2019 spent $290 billion on prescription drugs.

    We have little understanding of the value of FDA-approved drugs so insurers must cover drugs of little or no value with unreasonably high price tags: We do not have the information to assess a drug’s value. We do not have detailed or centralized information on drug usage rates, let alone health care usage rates.  And, the FDA does not do comparative effectiveness reviews of drugs. It simply determines whether a new drug is more effective than a placebo.

    Regulating drug prices will not affect critical innovation: The federal government has funded research for every new drug on the market. Pharmaceutical companies are not innovating in the ways we need–to find treatments for conditions that are rare and therefore less profitable to them. Rather, they are focused on maximizing profits by targeting research on drugs that are most used or for which they can generate the most money.

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  • Coronavirus: Health insurers celebrate their most profitable year

    Coronavirus: Health insurers celebrate their most profitable year

    As millions of Americans celebrated President Biden’s inauguration, some of my former colleagues in the health insurance industry were quietly celebrating some news of their own: their most profitable year ever.

    That’s right: insurance companies made a fortune during a pandemic.

    Just hours before President Biden took the oath of office, UnitedHealthcare quietly released the news that it had blown away Wall Street’s most optimistic profit expectations for 2020, the year of the worst public health crisis in our lifetime that’s seen more than 400,000 Americans die.

    The company reported that although it insured fewer people in the United States in 2020 than in 2019, it took in $15 billion more in revenues. One of the ways it was able to pull that off? By paying far fewer claims last year than the year before. Again, this was during a pandemic.

    Had it not been for membership gains in its Medicare Advantage and Medicaid plans, UnitedHealth would’ve hemorrhaged even more health plan enrollees. In fact, it covered 1.5 million fewer in individual and employer-sponsored/group plans than in 2019 but made BILLIONS more in profits.

    One reason for the drop in health plan enrollment: millions lost health insurance with their jobs during COVID-19. That isn’t a problem for Big Insurance. I hope President Biden pays close attention to how UnitedHealth and others have made huge profits since the Affordable Care Act was passed.

    Mr. President, you called it a “big f*cking deal” when President Obama signed the ACA into law. It brought insurance to 20 million of the 50 million Americans uninsured at the time and made it illegal for insurers to deny coverage to people with preexisting conditions. But …

    Insurance lobbyists rigged the bill in ways that guaranteed huge profits for years to come. Consider this: when you were sworn in as Vice President in 2009 you could’ve bought a share of UnitedHealth stock for $21.55. When you became president yesterday, that share would cost $350.84.

    No wonder Wall Street loves UnitedHealth and other big health insurers so much. UnitedHealth’s shares alone have increased 1,650% over the past 12 years. How much have American wages increased in that time? Not much. How much have their premiums increased? A lot.

    Meanwhile, tens of millions are still uninsured. Even more are “underinsured” because of absurdly high deductibles insurers charge us before they’ll pay a dime. That’s why so many of us with insurance go bankrupt or turn to GoFundMe to beg for money to pay medical bills.

    Get this: UnitedHealth now makes more than two times as much from government programs like Medicare Advantage and Medicaid, than from its “commercial” customers. Most of its revenue by far is coming from taxpayers than their corporate & individual customers.

    Mr. President, to help people get the care their doctors say they need, investigate this industry and take action to put an end to this outrageous profiteering. We taxpayers are being taken to the cleaners by these companies. I know because I worked for them. Let’s talk.

    This post was originally published on Tarbell.org.

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  • Coronavirus: Blame corporate health insurers for our failure to contain it

    Coronavirus: Blame corporate health insurers for our failure to contain it

    Wendell Potter, a former health insurance executive at Cigna, knows first-hand how poorly corporate health insurers ensure that Americans get the care they need. They create all kinds of obstacles to care and coverage. In an interview with Philadelphia Magazine, Potter explains why corporate health insurers are to blame for our failure to contain the spread of the novel coronavirus; we need guaranteed universal health care to contain it.

    In the US, we have more than 30 million people who are uninsured. We also have nearly 50 million people who are underinsured; they have health insurance, but it is inadequate to enable them to get the care they need. Understandably, millions of Americans are not willing to take the risk that they will be able to afford the care they receive when they go to the hospital or the doctor’s office. As a result, many Americans are not seeking treatment for COVID-19.

    Canada has a government-administered universal health care system and a lower death rate from Covid-19 than the US. In Canada, there are no out-of-pocket costs for this care. Having universal coverage is critical to contain the spread of the coronavirus.

    In addition to universal coverage, you need a strong public health infrastructure and smart leadership. The UK has a system of government-administered universal care, but it has a higher COVID-19 death rate than the US. Prime Minister Boris Johnson was too slow in locking down the country, too slow in providing personal protective gear to health care workers and too slow in ensuring mass testing.

    Health care should be free at the point of service. Other wealthy countries do not charge their residents for care at the point of service. They simply tax their residents on a sliding scale for their coverage. In the US, the average out-of-pocket cost of COVID-19 treatment is somewhere between $9,000 and $20,000 for people with insurance. We ration care based on the ability to pay.

    The US also ties health insurance to employment. As a result, most of the 43 million people who have lost their jobs as a result of the pandemic were forced to find new coverage. We now know that at least 5.4 million of them could not. Many older adults are skipping needed care for fear of contracting the virus if they go to the doctor or the hospital. Some are dying. Their deaths are preventable.

    Federal law has no teeth when it comes to ensuring that people get needed care because we rely so heavily on private health insurers for people’s care. The recently passed CARES Act requires that COVID-19 testing be free in most instances. But, the federal government is hard-pressed to enforce the law and there are lots of grey areas. Some people who have negative test results are getting big bills. And, out-of-pocket costs for COVID-19 tests are all over the map.

    Meanwhile, health insurers are profiting nicely. United Healthcare earned $5 billion in profits in the first quarter of 2020, up 3 percent. Insurers are collecting premiums, but not paying out as many claims as usual because people are not going to the doctor or hospital for checkups and elective procedures.

    Congress is not likely to pass legislation that guarantees government-administered health care for all any time soon, even if a Democratic president is elected and we have a Democratic Congress. That said, Democratic voters favor Medicare for All.  The tide is turning. Potter says that it is becoming more difficult for health insurers to stop federal reforms that diminish their power.

    Here’s more from Just Care:

  • Medicare for All would lead to a better performing labor market

    Medicare for All would lead to a better performing labor market

    A new paper by Josh Bivens at the Economic Policy Institute makes the case that there is no reason that Medicare for All would reduce the number of jobs in the US. To the contrary, he finds that Medicare for All could increase people’s wages and create better jobs, helping families. An important by-product of enacting Medicare for All would be a far better performing labor market.

    How could Medicare for All increase wages? If employers gave the money they currently spend on their workers’ health insurance premiums back to their employees. Today health insurance premiums account for 8.4 percent of a typical worker’s total compensation. Economists like Emanuel Saez and Gabriel Zucman are proposing that Medicare for All require employers to return  all (or most) of the money they currently spend on their workers’ health insurance premiums to their workers in increased wages. Even if they gave all that money to their employees, employers would save money as they would not have the administrative expenses associated with providing health insurance, although they would have higher payroll contributions for Medicare and Social Security.

    Why would jobs be better? Everyone would have good affordable health care and would not have to worry about taking a job that they didn’t want because Medicare for All allows them to get the care they need when they need it. People would also experience less anxiety when they lost their jobs or were between jobs because they would still have health care coverage. Also, they would not feel locked into their jobs, if they wanted to leave, because they would always have health insurance.

    With Medicare for All, people would be more inclined to create their own jobs. Small businesses could grow and flourish, as people at these businesses would not have to worry about health care costs. Right now, the US ranks at the bottom of OECD countries in terms of people who are self-employed, at 6.3 percent. Small businesses are extremely risky because of the cost of health insurance and health care. Countries with universal health care, such as France, Spain and Germany, have between 9.9 percent and 16.0 percent self-employment.

    Why would there be more jobs? No question, Medicare for All would cause a shakeup in the job market as 1.8 million people working for insurers and in medical billing are projected to lose their jobs. But, the federal government would be paying for more health care, including dental, vision, hearing and long-term supports and services, creating more demand for health care and more jobs in the health care delivery space. 

    In addition, Medicare for All legislation should include support to help people who had been working for insurers and in medical billing to find new jobs. It’s not as big a lift as some believe. The number of people who would lose their jobs if Medicare for All were to be enacted is relatively small. It is about one-twelfth the number of people who lost jobs in 2018, 21.5 million.

    Today, about 87 million Americans are uninsured (23 million) or underinsured (64 million).  And, the cost of ensuring that people get the health care they need continues to grow. Health insurance premiums rose 20 percent in 2019. Prescription drug costs grew 9 percent. Prices keep going up far faster than in any other developed nation. For that to end, the federal government must step in to set prices for health care, as it would with Medicare for All.

    Here’s more from Just Care:

  • Medicare for All addresses racial injustice

    Medicare for All addresses racial injustice

    Our health care system disproportionately hurts people of color. African Americans and Latinx, in particular, struggle to get access to affordable health care. Corporate health insurers can’t provide good affordable coverage. Medicare for All would address this racial injustice.

    Our market-based health care system has helped foster racial inequities in the US. Latinx and African Americans are more likely to be uninsured than white people. Today, nearly one in five Latinx (19 percent) are uninsured and more than one in ten African Americans (11.1 percent) are uninsured. About 7.3 percent of white people are uninsured.

    Not surprisingly, almost a third of African American adults under 65 are in medical debt. They also struggle to afford needed health care, often delaying treatment.

    Co-sponsors of Medicare for All legislation in Congress and policy experts spoke on Capitol Hill last week about how Medicare for All is critical for addressing racial biases in our health care system and promoting racial equality.

    “We have a burden of our health care system that does disproportionately affect black and brown folks … and poor communities,” U.S. Rep. Pramila Jayapal (D-Wash.) said at the event. For example, today, African-Americans are three times more likely than whites to die in childbirth.

    Back in July, the NAACP, League of United Latin American Citizens (LULAC), United We Dream and seven other national organizations representing people of color sent a letter to Congress supporting Medicare for All. Medicare for All guarantees health care as a right. And, universal healthcare is “a racial justice necessity because communities of color, in particular, suffer from a lack of access to affordable health insurance.” Today, “racial bias mars the entirety of American healthcare.”

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  • Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    In a recent report published by the National Committee to Preserve Social Security and Medicare Foundation based on research by the Actuarial Research Corporation, we demonstrate that Speaker Paul Ryan’s proposal to raise the age of Medicare eligibility from 65 to 67 would harm the health of 65- and 66-year old adults as well as the financial health of the institutions that care for them.

    If Congress raises the Medicare eligibility age to 67, between two and four million people 65 and 66 years old would be left uninsured, depending on whether or not the ACA is repealed. Currently, Medicare covers almost everyone 65 and over, with only 1.1 percent of people over 65 uninsured. But if the eligibility age for Medicare increases by two years, even if the ACA is not repealed, the percentage of uninsured would increase seventeen-fold to 18.7 percent or 1.9 million people 65 and 66. If the ACA is repealed, the percentage of uninsured would increase to 37 percent or 3.8 million people, more than one in three people 65 and 66.

    These uninsured older Americans will be hard-pressed to get needed care, particularly if the ACA is repealed. To the extent they have chronic conditions, insurers may no longer agree to cover them and, even if coverage is available, it is unlikely to be affordable for most people; if it’s affordable, it is likely to cover only limited benefits, with annual and lifetime caps. They will, therefore, end up using emergency services at far greater cost to our health care system and the institutions that provide them care.

    Doctors and hospitals in particular will find themselves covering the cost of care for most of these newly uninsured Americans (without reimbursement), putting these health care providers at financial risk. To the extent they raise their rates to absorb these costs, insurance premiums will rise further, escalating health care costs for insured Americans.

    Medicare is far better than commercial insurance at guaranteeing coverage, containing costs, and giving people with costly conditions access to the care they need. We should be expanding Medicare to everyone in the U.S., not driving up health care costs and the number of uninsured by raising the eligibility age.

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  • Beware of high doctor charges

    Beware of high doctor charges

    Gerard Anderson, Johns Hopkins Bloomberg School of Health, and Ge Bai, Johns Hopkins Carey Business School, conducted a national study to determine the extent to which doctors charge patients in excess of Medicare’s approved rates. They found a very wide charge variation among doctors, with doctors charging on average two and a half times the rate they accept from Medicare. If you have commercial insurance–including a private Medicare Advantage plan–and get out-of-network care, beware of high doctor charges.

    Specialties in which patients have little or no choice of physician had some of the highest excess charges. Anderson and Bai found that the median charge to uninsured and out-of-network patients for anesthesiologists was 5.8 times Medicare’s approved charge. Emergency doctors, radiologists and pathologists on average charged four or more times Medicare’s approved rates to these patients.

    These findings underscore the plight of some patients in the health care marketplace, particularly the uninsured and people hospitalized, receiving out-of-network care unexpectedly. Many of these people lack choice of physicians or lack knowledge that their physician is out of network. And, they generally have no recourse. Just like drug companies with patented drugs, physicians treating the uninsured and out-of-network patients can charge whatever they please.

    To be clear, because the physician marketplace, for the most part, is not competitive, physicians generally command rates well in excess of Medicare’s rates from insurers. Insurers are largely unable to drive down provider charges to Medicare levels, which drives up premiums and deductibles for the insured patients. To rein in health care spending, we need to address this issue as well.

    Medicare Advantage plans come closest to negotiating rates akin to Medicare’s because of the competitive pressure the traditional Medicare program exerts on the market.

    Without a national database reflecting the amount physicians actually charge patients and how much patients pay, it’s impossible to know exactly what patients receiving out-of-network care and uninsured patients are paying for their care. But, the bigger issue is that even if we knew, it would not keep doctors from charging high rates whenever they can. The simplest way to drive these rates down is to expand Medicare, making it available to everyone without employer coverage and creating some competitive pressure in the marketplace.

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  • CBO projects premiums could double after ACA repeal

    CBO projects premiums could double after ACA repeal

    A new report from the Congressional Budget Office (CBO) projects that premiums could double by 2026 for people buying coverage in the individual market after key parts of the Affordable Care Act are repealed. Moreover, 18 million people could lose their health insurance within a year. The New York Times reports that these CBO findings could lead the Republican leadership to delay dismantling of the ACA until they have a replacement plan.

    Without a replacement plan for the ACA, the CBO estimates that 32 million will lose health insurance in the next nine years. These 32 million are in addition to the 26 million who are uninsured today. By 2026, we would more than double the number of uninsured in the U.S. from 26 million today to 59 million.

    Republicans plan to eliminate funding for Medicaid expansion, which means 19 million people with Medicaid would lose insurance. Republicans also plan to end subsidies that have helped people with moderate incomes afford their insurance, leaving another 23 million without coverage. The CBO believes that employer-based coverage will increase some.

    Republicans also plan to do away with the insurance mandate and penalty imposed on people who do not have health insurance. As a result, many insurers will leave the state health insurance exchanges. Insurers depend upon healthy people to join their health plans to keep premiums down.

    Without the insurance mandate, many of the young and healthy will not sign up. Without these healthy people in the exchanges, the CBO projects that premiums will rise by as much as 25 percent in the non-group market during the first full year after a replacement plan goes into effect. And premiums will be about 50 percent higher once the premium subsidies are no more.

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