Monday, March 31, 2014

Health Care Reform Articles - March 31, 2014

Start-Up Health Insurer Finds Foothold in New York

Friday, March 28, 2014

Health Care Reform Articles - March 28, 2014

Of Patients and Prices

By A.W. Gaffney, M.D.
Truthout, March 26, 2014
There are many good reasons to impatiently anticipate the end of one's medical training, which not infrequently lasts upwards of five years following medical school. But counterpoised to the oft-cited benefits -- greater autonomy, reliably increased remuneration, less reliably improved hours, and so forth -- there is also, unfortunately, an almost entirely unrecognized drawback: a largely unavoidable entanglement in the business of health care.
Now for some, such an entanglement might make the transition from training seem all the more attractive. But clearly, one need only hear about patients (or their surviving family members) being chased by collections agencies for medical bills, or about the growing problem of "medical bankruptcies" among the insured, or even about the bizarre unaffordability of asthma inhalers to see that something is seriously askew with the way the price of health care can adversely impact the circumstances of the ill. As my own clinical training now winds down, I frequently reflect on how to navigate today's highly problematic health care terrain - in which patients are increasingly exposed to the cost of care provided.
I think it's only fair to begin, however, by recognizing that unlike ethical issues revolving around artificial hearts or organ transplants, the problem of the cost of health care isn't entirely new. Hippocrates (or whoever it was that wrote the Precepts) generally saw nothing wrong in doctors looking after their pecuniary interests, though he also opined that they mustn't "extort money from those who are at death's door." The problem of US national health spending has likewise been recognized for some time: in 1971, as health care expenditures rapidly outstripped inflation, Richard Nixon proclaimed that the nation faced a "deepening crisis," which has been more or less the conventional wisdom ever since (if not without reason).
However, an awareness that something might be awry with what prices patients were being charged by hospitals, physicians, pharmaceutical companies, ambulance companies and more or less everyone in the health care industry seems to have surged into the spotlight in more recent years. The journalist Steven Brill, for instance, in an important issue-length article "Bitter Pill" in Time last year, investigated the stories of patients who received massive itemized bills for health care, which, in several instances, might very well be termed "money from those who are at death's door."
He discussed one person, for instance, who between diagnosis with metastatic lung cancer and death a mere 11 months later had accumulated some $900,000 in medical bills, debt that was then dumped onto his devastated wife. Additionally jarring, however, was Brill's exploration of the extremely high prices being charged for individual services or items to such patients (e.g. $77 for each tiny square of cotton gauze), which originated from a confidential list of hospital prices dubbed the "chargemaster."
Elizabeth Rosenthal of the New York Times has explored the issue further in an ongoing and highly revealing series. Like Brill, she finds instances of absurd prices (e.g. $3,355.96 for five stitches in the ER), though in most cases, these prices are frequently several times higher than what insurance companies - which directly negotiate reimbursements with hospitals and providers - actually pay. However, for the uninsured, the "underinsured" (i.e. those who have insurance, but with high deductibles, coinsurance or copays), those who are out-of-network, or those who have limits on coverage, the "chargemaster" is real enough. For these individuals and families, massive and arbitrary medical bills - for conditions ranging from the trivial to the deadly - can be tantamount to financial ruin.
Why is this issue coming to the spotlight now? Partially, it's a reflection of ongoing trends in the health care system that predated Obamacare but that are also not ended by it. Insured patients increasingly have more financial liability, or as the saying goes, "skin in the game," when they receive health care. High-deductible employer plans are more and more common, "four-tier" prescription drug plans are the norm, and themost commonly purchased "silver" plans on the Obamacare exchanges have an actuarial value of only 70%. All of this equates to increased "cost sharing," or out-of-pocket money paid for health care, on top of annual premiums (which are also rising). Between uninsurance and underinsurance, it's not all that surprising that unpaid medical bills apparently constitute half of accounts reported to collection agencies, compromising the credit scores and the financial opportunities of those affected. Along similar lines, 62% of US bankruptcies, according to one study, are caused by medical illnesses - even though most of these bankrupt individuals actually had health insurance at the time of their illness.

Most states fail on health price transparency, but not Maine

Maine doctors, here’s what your patients think of you

Survey: Mainers struggle to pay medical bills — even those with insurance

Posted March 26, 2014, at 5:12 p.m.
Many Maine residents, even those with health insurance, struggle to afford their medical bills, a new statewide survey has found.
While the poorest Mainers reported the most difficulty affording health services, more than a quarter of residents with health coverage ran into trouble paying medical bills, according to the survey released Wednesday by the Maine Health Access Foundation.
Designed to track the impact of the Affordable Care Act in Maine, the survey polled nearly 1,000 residents in December 2013, just before new private policies purchased on took effect on Jan. 1, 2014. The research will provide a snapshot of the burden of health costs in Maine to serve as a benchmark in future years, said Dr. Wendy Wolf, president and CEO of the private nonprofit foundation.
“One of the most important questions that policymakers are going to want to know is what is happening in the wake of the Affordable Care Act with actually lowering the rate of uninsurance, and also helping people with the issue of both affordability and the types of benefits that are offered in insurance plans,” she said.
The foundation, which is leading the effort to sign Mainers up for health insurance under the ACA, partnered with market research firm GfK to conduct the survey. The poll piggybacked on a national health reform survey developed by the Urban Institute and funded by the Robert Wood Johnson Foundation and the Ford Foundation.
Bucking the national trend, Maine adults in the middle income range actually struggled more than their low-income counterparts to pay medical bills. About 35 percent of mid-range earners — with incomes between about $33,000 and $93,000 a year for a family of four — faced problems or were unable to afford their bills during the prior year, compared to 32 percent of those earning less. Many middle-income Mainers receive no government aid and don’t earn enough to buy a health policy with sufficient coverage, the survey results noted.
The Maine survey polled 992 adults between the ages of 18 and 64 across a range of incomes. Included were the uninsured; people who buy their own coverage in the individual market; those who get coverage through work; and Mainers with government-sponsored insurance, with the exception of Medicare.
The growth of bare bones, high-deductible health plans in the individual market likely contributed to many Mainers’ difficulty affording medical bills, Wolf said. Those plans will be phased out under the Affordable Care Act, except for those under age 30.
A chief goal of the law, also known as Obamacare, is to expand access to more robust and affordable health insurance, with free preventive care and a cap on out-of-pocket costs., the federal government’s gateway for insurance marketplaces in Maine and 35 other states, targets private policies for individuals and small businesses, but also allows users to determine if they’re eligible for Medicaid.

Anti-Anxiety Drugs Tied to Higher Mortality