LOUISVILLE, Ky. — In many ways, Kentucky, a poor state with a starkly unhealthy populace, has become a symbol of the Affordable Care Act’s potential.
Largely because the state chose to expand Medicaid, the drop in the uninsured rate has been among the sharpest in the nation. Hospital revenues are up, health care jobs are multiplying and far more Kentuckians are getting preventive checkups and screenings, according to state officials.
Amanda Mayhew is one of the beneficiaries. She earns little enough to qualify for Medicaid under the new guidelines, and she enrolled in August. She has been to the dentist five times to begin salvaging her neglected teeth, has had a dermatologist remove a mole and has gotten medication for her depression, all free.
“I am very, very thankful that Medicaid does cover what I need done right now,” said Ms. Mayhew, 38. “They ended up having to pull three teeth in the last three weeks, and I would have been in a lot of pain without it.”
But as the first year of coverage ends, potential obstacles to the law’s success are also coming into sharp relief here. Relatively few people have signed up for private health plans offered through the state’s new online marketplace, Kynect. People earning between 138 and 400 percent of the poverty level — between about $16,000 and $47,000 for a single person — can get subsidies to help with the cost.
Even with that incentive, only about 76,000 Kentuckians signed up for these plans in 2014 and have renewed the coverage for next year. Since the enrollment period for 2015 began on Nov. 15, an additional 9,000 people have selected exchange plans. Before the new coverage options took effect, state officials estimated that some 340,000 uninsured Kentuckians could get private insurance through the exchange.
David Elson signed up for private health insurance in February, but then decided he could not afford the $350 monthly premium for a plan that included his doctors. He never paid his bill and lost his coverage. His poor health got worse, and in October, he landed in the hospital with end-stage kidney disease.
“The president gets up there and says, ‘We’ve got to get affordable health care for our people,’ ” said Mr. Elson, 61. “It’s not.”
For Members of Health Ministries in Texas, Caring Means Sharing the Bills
By EDGAR WALTERS
DALLAS — Erica and Lance Beiler have found an alternative to federally mandated insurance, but it required a leap of faith.
The Beilers are part of a small but fast-growing number of residents who have joined health-care sharing ministries, religious alternatives to enrolling in the federal insurance program in which members pool monthly payments to help cover one another’s medical expenses. So, unlike most uninsured Americans, the Beilers did not have to buy health insurance or risk a fine under the Affordable Care Act.
When Ms. Beiler, 30, gave birth to a girl last month, the roughly $10,000 bill was “all taken care of,” she said. The networks, which have been around for more than two decades, are seeing a jump in membership, particularly among people, like the Beilers, who object to some requirements of the health care law.
The purpose of the ministries is for Christians to come together and support each other when needed most, said Anthony Hopp, director of membership development for Samaritan Ministries, a network that includes members in Texas.
The influx of for-profit companies into the hospice field has benefited patients, advocates say, because the commercial companies made big investments in technology, focused on efficiency and made care more accessible.
But a Washington Post analysis of hundreds of thousands of U.S. hospice records indicates that, as those companies transformed a movement once dominated by community and religious organizations into a $17 billion industry, patient care suffered along the way.
On several key measures, for-profit hospices as a group fall short of those run by nonprofit organizations.
The typical for-profit hospice:
●Spends less on nursing per patient.
●Is less likely to have sent a nurse to a patient’s home in the last days of life.
●Is less likely to provide more intense levels of care for patients undergoing a crisis in their symptoms.
●Has a higher percentage of patients who drop out of hospice care before dying. High rates of dropout are often viewed as a sign that patients were pushed out of hospice when their care grew expensive, left dissatisfied or were enrolled for hospice even though they were not close to death.
The quality of individual hospices varies widely. In some cases, for-profit hospices provide service at levels comparable to nonprofits, according to the review. But the data analysis, based on hundreds of thousands of Medicare patient and hospice records from 2013, shows that the gap between the for-profits as a whole and nonprofits is striking and consistent, regardless of hospice size.
“Unfortunately, a lot of people have come into the business for the wrong reasons,” said Michael Girard, who with his wife Deb owns the Circle of Life for-profit hospice in Reno, Nev. “A lot of the problems we have in hospice today have happened with the entry of what I call the ‘vulture capitalists.’ ”
The federal government has been trying — for years — to develop a way to measure and report hospice quality, but the effort has lagged behind other health-care industries. The Washington Post has published an online hospice guide that provides detailed information on more than 3,000 hospices.
The findings on for-profit hospices come amid repeated complaints within the industry that pressure to cut costs, combined with sparse government oversight, has led some companies to focus on the bottom line to the detriment of patients.
Hospice operators have an economic incentive to provide less care because they get paid a flat daily fee from Medicare for each of their patients. That means that the fewer services they provide, the wider their profit margin.
WASHINGTON — Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.
The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.
The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average.
Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states.
In his budget request in March, President Obama proposed a one-year extension of the higher Medicaid payments. Several Democratic members of Congress backed the idea, but the proposals languished, and such legislation would appear to face long odds in the new Congress, with Republicans controlling both houses.
How can Americans get better health care for less money? There's a quiet experiment going on among primary-care physicians, and the results are intriguing
Nowhere outside the pages of dickens is there a more aptly named fellow than Garrison Bliss. A trim, gray man, he has twinkling eyes and a face lit by a smile of such authenticity that it makes you think of Shaker furniture. But he’s a doctor, not a mystic. And he’s smiling because he believes he and his cousin have found the answer to one of the toughest questions in health care.
The idea is deceptively simple: Pay frontline doctors a fixed monthly fee directly instead of through the byzantine insurance bureaucracy. Make the patient, rather than the paperwork, the focus of the doctor’s day. The result will be happier doctors, healthier patients and a striking reduction in wasted expense.
In one of the more intriguing experiments in the medical industry, Qliance Health, the company Bliss co-founded with his cousin Dr. Erika Bliss, 47, is applying this idea to managing the health of roughly 35,000 patients–about half of them on Medicaid. If it can work for them in Seattle, they say, maybe it could work for everyone.
How the Bliss cousins arrived at this notion is a more complicated story. But it’s one worth telling, because it says a lot about how the U.S.–normally adept at hooking up the buyers and sellers of goods and services–managed to make such a mess of its medical economy. The story starts with the fact that Garrison Bliss, 69, wasn’t always so happy.
Shumlin said on Wednesday that it was "not the right time" to enact single-payer health care, three years after he signed Act 48, a bill aimed at establishing universal insurance coverage by 2017. At the time, Shumlin said that a new single-payer system, to be called Green Mountain Care, would help control health care costs. The governor now says that he could not justify the projected tax increases associated with the plan and that the federal government hadn't provided enough funding to make the transition feasible.
To demonstrate their anger over his decision, activists burned medical bills they said they could not pay and delivered a plate of burnt toast to Shumlin's office, suggesting that his political career had been irreparably tarnished.
The prospect of single-payer health care in Vermont is no more, at least for now.
Gov. Peter Shumlin announced Wednesday that he is backing away from his signature policy push that would have made Vermont the first state in the nation with a publicly financed health care system overseen by state government. The governor now says that the taxes required to pay for such a system would simply be too much for Vermont to bear.
Gov. Shumlin came to the VPR studios to talk with host Alex Keefe about his decision and what comes next.
Alex Keefe: You said yesterday that your decision not to continue with single-payer right now, as you put it, was “difficult and disappointing.” Help Vermonters understand exactly why you made it.
"My dream has been to move to a more sensible health care system where health care is a right, not a privilege, where you have it because you are a resident of Vermont, not because of how wealthy you might be or how lucky you might be. And that's the way it should be for the country." - Gov. Peter Shumlin
From ‘hellish’ to health care: The Affordable Care Act in Maine 1 year late
by LIndsay Tice - Sun Journal
A little over a year ago, things weren’t going very well for the Affordable Care Act.
For some Mainers, “hellish” might have been the right word.
The website for the federal insurance marketplace kept failing. Phone lines jammed for the popular new health insurance co-op in Lewiston. Overall, it took people longer to sign up for health insurance than it did to fly cross-country, and the process was about as frustrating.
And those were the lucky ones. Many very poor Mainers couldn’t get insurance, period.
All from health care reform that no one completely understood.
Since then, a lot has changed. And a lot has stayed the same.
More than 40,000 Mainers have gotten insurance through the marketplace, 90 percent of them with a federal subsidy to help pay for it. But the very poorest still don’t have insurance.
Hospitals, doctors and others in health care are changing the way they do business, focusing more on cost, quality and keeping people healthy. At the same time, hospitals and clinics still are having trouble paying for growing demands on charity care.
Insurance sign-ups are quicker, easier, less frustrating (Woo!). But people are still confused (Groan.).
That’s where we come in.
Last year, the Sun Journal and the Bangor Daily News joined forces to bring you ACA 101, a big look at the big law. There were tips. There were resources. There were examples featuring the characters of “Grey’s Anatomy.” (Because that’s just how we roll, yo.)
This year we bring you ACA 201, a look at how Maine has fared in the year since health insurance became mandatory for most Americans and a gander at what Mainers can expect in Year Two and beyond.
Also, more tips. More resources. And some profiles of real Mainers dealing with real insurance issues. Sorry, “Grey’s.”
First up: What’s changed. What’s not. What’s love got to do with it.
Well, that’s new
The Patient Protection and Affordable Care Act — known as the ACA or “Obamacare” — was signed by President Barack Obama in 2010. It was controversial then and is controversial now.
The law phased in sizable changes to health care, including requiring insurers to provide some preventative care for free and prohibiting them from placing lifetime caps on insurance coverage (2010), requiring insurers to spend at least 80 percent of premium dollars on medical claims rather than overhead such as office space and the corporate jet (2011), requiring that consumers be given easy-to-understand summaries about a health plan’s benefits and coverage (2012), and creating health insurance marketplaces, also known as exchanges, where people can buy their own insurance and use federal subsidies to help pay for it (2013).
One of the biggest changes came in 2014. That’s when most Americans were required to have health insurance.
Each state, plus Washington, D.C., handled the ACA a little differently. For 2014, according to the Kaiser Family Foundation, 17 created their own marketplaces while 34 relied on the federal marketplace or a federal-state partnership.
By the end of this past August, 28 states, including D.C., had expanded Medicaid to cover very poor people who wouldn’t get a federal subsidy under the program, while two states were discussing expansion. Twenty-one states didn’t expand.
Maine went with the federal marketplace and didn’t expand Medicaid.
A year or so ago, more Mainers started buying their own insurance. A lot more. Between 2013 and 2014, the number of Mainers covered by an individual insurance plan — rather than insurance from work or through the government — doubled, from about 32,000 to about 64,000.
Despite the challenges signing up this past year — the federal marketplace website all but imploded at one point — the marketplace proved a popular way for Mainers to buy that insurance, often at the urging of health care advocacy groups. Or friends.
“I think it was the folks in either Eastport or Harrington, working with the lobstering community, they were getting a lot of push back by people that didn’t like Obamacare. They finally got one of the community lead lobstermen, convinced him to sign up. And boy, when he signed up, it was just like the tipping point,” Wendy Wolf, CEO of the Maine Health Access Foundation, said. “All of a sudden people there were willing to try it because he was a trusted voice in the community.”
More than 40,000 Mainers signed up for insurance through the marketplace. The vast majority — 90 percent — got a subsidy to help pay for it.
The average subsidy: $344 a month. Average insurance cost after that subsidy: $99 a month.
“We have heard from assisters of people literally breaking into tears when they sign up and find out they have a $20-a-month premium, because for 20 years they haven’t been able to afford insurance,” Wolf said.
Answers to frequently asked questions about the Affordable Care Act
by Lindsay Tice, Lewiston Sun-Journal
Posted Dec. 29, 2014, at 5:41 a.m.
What is this “Affordable Care Act” of which you speak? It’s a controversial, 900-plus-page federal law (officially the Patient Protection and Affordable Care Act) that was signed by President Barack Obama on March 23, 2010. It makes sweeping changes to health care, such as requiring almost all Americans to have health insurance. Some people say it goes too far. Others say it doesn’t go far enough.
Why is the ACA also known as Obamacare? Opponents came up with that name back in 2007 as a dig at Obama. It stuck.
This is universal health care, right? No. In places with universal health care (we’re looking at you, Canada), the government pays for medical care. The ACA, on the other hand, requires that people pay for their own care by buying insurance. The ACA did expand government coverage — Medicaid — to some people, but the U.S. Supreme Court ruled that states didn’t have to accept that expansion. So many states, including Maine, didn’t.
So I have to have health insurance now? Yes, that started in 2014, unless you are both very poor (under the federal poverty level) and live in a state that didn’t expand Medicaid (like Maine). You can also get an exemption to the penalty if:
— Your religion prevents you from accepting insurance benefits.
— You’re part of a health care sharing ministry.
— You are an Alaska Native shareholder or a member of a federally recognized Indian tribe.
— You lack insurance for fewer than three months in a row.
— You have suffered a certified hardship.
— You can’t afford coverage because you’d have to pay more than 8 percent of your household income for coverage.
— You’re behind bars.
— You are not a U.S. citizen, a U.S. national or an alien lawfully present in the U.S.
OK, so I’m not on that list. What if I don’t get insurance? If you didn’t have it in 2014 and you were supposed to, you’ll pay a penalty come tax time in April. The IRS is in charge of that. In 2015, the penalty gets bigger.
How much is the penalty? In 2014, it’s either 1 percent of your annual household income or $95 per adult for the year/$47.50 per child, whichever is higher. (FYI: To calculate 1 percent of your household income, the IRS uses only the amount above its tax filing threshold. So for a single person, for example, the first $10,000 or so doesn’t count.)
Note the “whichever is higher” part. If you make $35,000 a year, you’ll owe about $250 in penalty, not $95.
For 2015, the penalty is either 2 percent of your annual household income or $325 per adult/$162.50 per child, whichever is higher. Again, that 2 percent is only on the amount above the tax filing threshold.
The penalty will go up again in 2016.
But what if I only went without insurance for a month (or, um, two)? Short gaps of three months or fewer are penalty free. However, those months must be consecutive. In other words, if you have more than one gap in a year — say, you didn’t have insurance between May and July and then again between October and December — only the first one is exempt. So there’s no penalty the first time, but you’ll have to pay the second.
(FYI: Penalties are based on how many months you’re without insurance. So if your penalty was $95 for the year but you were only without insurance for half the year, you’d pay half that penalty.)
I bought my insurance this past spring. That means I don’t have to shop around again until next spring, right? Right? Wrong. All individual health insurance ends Dec. 31 no matter when or where you bought it. If you want insurance in 2015, you have until Feb. 15 to sign up.
(FYI: It takes time for paperwork to be processed, so don’t expect insurance to kick in the moment you sign up. If you’re buying from the marketplace and need your insurance to start on the 1st of next month, you must sign up by the 15th of this month. If you’re not buying through the marketplace, check with your insurance carrier. It may have a different start date.)
Can I sign up for insurance whenever I want? No. Open enrollment runs only through Feb. 15, 2015. Unless you are a tribal member or an Alaska Native shareholder, or you experience a certain life-changing event (marriage, adoption, job loss, etc.), open enrollment is the only time you can get health insurance for 2015. It doesn’t matter how or where you buy it, Feb. 15 is your deadline. If you qualify, you can sign up for Medicaid or the Children’s Health Insurance Program at any time.
Enrolling was a nightmare last year! Do I have to re-enroll all over again? No. Your insurance will automatically renew if you do nothing. However, experts strongly — Very. Strongly. — advise people to review their medical needs, financial situation and insurance options. That’s because your insurance plan might have changed. Or you might qualify for a larger subsidy. Or maybe you’re in a plan that worked well this past year but isn’t what you need now.
(FYI: Some people who signed up through the marketplace did not check the box that allowed the federal government to automatically access their tax records every year. If you’re one of them, you must go back to the marketplace now to update your financial information. If you don’t, you’ll either lose your subsidy or lose your insurance.)
But … nightmare. I just don’t want to go through that sign-up mess again! People who have used the marketplace this year say it’s working better and is easier to navigate. New sign-ups that took five or six hours to complete last year are taking an hour or so now. Renewals can take just 30 minutes since last year’s information should already be filled in and only needs to be reviewed and updated.
Hey! I just logged on to Healthcare.gov and discovered I was already re-enrolled in my marketplace plan. What gives? I wanted to pick a different plan. If you didn’t go to the marketplace and choose a new plan by Dec. 15, you were automatically renewed. (That way you’d have coverage come Jan. 1.) If you don’t like that plan, you don’t have to keep it. You have until Feb. 15 to pick something else.
Is this all going to be moot? I heard something about the U.S. Supreme Court. In March 2015, the U.S. Supreme Court is expected to decide whether federal subsidies apply only in states that set up their own insurance marketplaces or whether they also can be used in states that use the federal marketplace, as they are now. Just over half of all states, including Maine, use the federal marketplace.
The court’s decision has the potential to dramatically affect subsidies — as in, kill them in most states — but no one knows how the Supreme Court will rule. And if that happens, there are possible fixes, including a tweak to the ACA’s language or a change in states’ relationship to the federal marketplace.
You can hold off getting insurance to see how the Supreme Court rules, but it’s not expected to make a decision until summer, well after open enrollment and halfway through the year. If you gamble that the law is going to fall apart and it doesn’t, you won’t be able to get insurance and you’ll be on the hook for hundreds of dollars in penalty.
If you get a subsidy, experts say you shouldn’t worry about being forced to pay it back because the court’s decision cannot be made retroactive. However, it is possible you could lose your subsidy if the court rules against the federal marketplace — and losing your subsidy could mean losing your insurance, unless you can pay the whole cost on your own.
Wait, a subsidy? If you can’t get affordable health insurance through your job and you earn between 100 percent and 400 percent of the federal poverty level, you can get money from the feds to help pay for insurance. If you’re between 100 percent and 250 percent of the federal poverty level, you also can get a discount on your out-of-pocket health care expenses. This will all be on a sliding scale — the less you earn, the bigger your subsidy.
What’s the federal poverty level? Right now it’s $11,670 a year for one person (modified adjusted gross income). For a family of four, $23,850.
Health Law Helped Adults. Now, What About Children?
With the Affordable Care Act seemingly off to a good start in its first year, increasing access to insurance coverage for adults, attention is likely to turn to an older program for children that will come to an end in 2015 if it is not reauthorized: the Children’s Health Insurance Program, or CHIP.
This program has made a huge difference in insurance coverage for children, so much so that they are not, and did not need to be, the primary beneficiaries of the A.C.A. But that does not mean that children are not a concern. A variety of factors about our national strategy for children’s health care, or our lack of one, leaves them particularly vulnerable to challenges in access and quality in the next few years.
Children have not always fared so well. From 1980 through 1984, the rates of uninsured children and non-elderly adults were almost identical. Since that time, they have diverged significantly, so that in 2012, about 15 percentage points separated the two.
This turn of events was achieved though expansions of public coverage, specifically Medicaid, in the 1984 Deficit Reduction Act, and the Children’s Health Insurance Program, in the 1997 Balanced Budget Act. In 2013, more than 41 percent of children were insured through a government program, making them more dependent on public coverage than any group except seniors.
When the Affordable Care Act was passed, Congress also reauthorized the CHIP program. As a recent Health Affairs review reports, this was done “out of an abundance of caution.” CHIP is now funded through fiscal year 2015. If it is allowed to expire after that, in some respects it might not be a calamity: Most of the children insured through CHIP would qualify for plans offered in the health insurance exchanges.
There are still many reasons to be concerned about the end of CHIP, though. CHIP plans have an actuarial value of greater than 90 percent, making them much more generous than A.C.A. silver benchmark plans, with an actuarial value of 70 percent, meaning the plan covers 70 percent of health care costs. The increased cost-sharing families might encounter by moving to private plans might leave even more children underinsured.Deductibles, co-pays, coinsurance and even premiums are usually much lower in CHIP plans than in exchange plans.
In the documentary “Fed Up,” Katie Couric and Laurie David depict America’s sugar-saturated food system in ways that are at once startling and all too familiar. It reveals why Americans have such a hard time following the governmental advice to use sugar “sparingly.”
Over the last three decades, Americans have doubled the percent of their grocery budget directed toward sweets and processed foods (by 2012, those items represented nearly one-fourth of total household grocery expenditures). Of the 600,000 food items sold in the United States, 80 percent have added sugars (that go by more than 50 different names).
Food corporations spend millions calculating the precise “mouth feel” and “bliss point” that will entice people to return repeatedly to their brand. Recent brain research shows that the carefully mixed cocktails of sugar, fat and salt in industrial foods are highly addictive.
“Processed food is far more powerful than we ever realized,” observes former U.S. Food and Drug Administration Commissioner Dr. David Kessler in “Fed Up.” “Our brains are constantly getting hijacked.” Sugars stimulate the same pleasure responses in the brain as drugs and alcohol. A study with cocaine-addicted lab rats found that 40 out of 43 rats chose sugar water over cocaine.
Food corporations use this biochemical response to maximal advantage, exploiting our innate taste for sweet foods. Soda companies, writes Michael Moss in “Salt Sugar Fat,” refer internally to their most loyal customers as “heavy users,” suggesting that they knowingly cultivate sugar junkies.
The tactics that processed food manufacturers employ – paying for favorable research, discrediting critics, using deceitful advertising, and denying health risks – are similar to those tobacco companies used to get people hooked on cigarettes. And with good reason: Of the 10 vast corporations that control 90 percent of food produced in the United States (think Kraft, Nabisco, Coca-Cola, Pepsico, Nestle, etc.), several have been held by Philip Morris or R.J. Reynolds.
The U.S. Department of Agriculture supports processed-food manufacturers by subsidizing the production of corn (converted to high fructose corn syrup) and sugar. Repeatedly, Congress and the USDA have squelched nutritional reform efforts, opting instead to let the food and beverage industry “self-regulate.”
Thanks to corporate lobbying, sugar is the lone item on “nutrition facts” labels that has no recommended daily allowance. Similarly, soda manufacturers can call a 20-ounce bottle – typically guzzled at once – “2.5 servings,” and list a “serving” of Oreo cookies as “3.4 grams” (out of an 11.3 ounce package – good luck calculating how that translates to actual cookies!) Yet the labels don’t reveal more meaningful weights: Would people really feed their children Fruit Loops, Cap’n Crunch and Golden Crisp cereal if they knew those products were – by weight – between 40 and 52 percent sugar?
Financial problems have lead the state’s insurance commissioner to take control of the management of the not-for-profit insurance provider CoOportunity Health.
CoOportunity Health, a health co-op, was set up through federal funding under the Affordable Care Act and was licensed to do business in 2013. The two dozen co-ops created nationwide were designed to add competition into the marketplace with the hopes of bringing down prices.
It is one of two providers to offer plans on the state’s marketplace through healthcare.gov.
But the not-for-profit insurance company, which offers coverage to about 120,000 members in Iowa and Nebraska, has insufficient capital, the Insurance Division said. It only has about $17.2 million in cash and assets on hand and could not obtain additional funds from the Centers for Medicare and Medicaid Services (CMS).
This lead Insurance Commissioner Nick Gerhart to submit a petition for an Order of Rehabilitation on Tuesday, which the Polk County District Court approved. This means that the company will continue in existence but be managed by Gerhart.
Those who enrolled in a CoOportunity Health insurance plan on or before Dec. 15 will continue to receive health coverage. However, those who signed up for a plan on Dec. 16 or later will no longer have coverage with CoOportunity Health and must enroll in another plan by the end of open enrollment on Feb. 15, 2015.
CoOportunity Health did not oppose this order in recognition of the financial concerns of the Insurance Division.
According to the Iowa Insurance Division, Gerhart will attempt to correct existing problems, continue operations, maintain policyholder accounting, and develop a plan of rehabilitation or petition the court for liquidation.
SCARBOROUGH, Maine - Maine is in the midst of a boom in new urgent care centers, with several starting up in the past few years.
The Portland Press Herald reports that new centers have opened in Yarmouth, Portland, Brunswick and Saco. The newest is located in Scarborough. A state website says Maine has at least 23 urgent care centers.
The industry is also growing at the national level. Urgent care centers are a $15 billion industry that grew 8 percent from 2009 to 2014. An Arizona-based health care consulting company says 6 percent annual growth is expected over the next five years.
Maine Quality Counts Executive Director Lisa Letourneau says the quick, less expensive walk-in clinics are growing because more people have health insurance and deductibles have gotten more expensive.
As aspiring doctors, we see the racial toll of poor health insurance
By Scott Goldberg Chicago Sun-Times, December 23, 2014
On December 10, medical students at more than 70 schools across the country held “white coat die-ins” in response to the lack of indictments in the police killings of Michael Brown in Ferguson, Mo., and Eric Garner in New York.
Here in Chicago, I and more than 100 students from Rosalind Franklin University, Northwestern, Rush, the University of Chicago, and University of Illinois at Chicago lay down together in protest on the campus of UIC. It was a moving experience.
Why did we do this? Like many Americans, we are angered by the repression and injustice that affects communities of color. Yet we are not outside observers to these systematic injustices.
Every day, we see the toll inequality has on the lives and health of our African Americans, Latinos, and other nonwhite patients. If we do not speak out on behalf of our patients, then we are not living up to the standards set by our profession.
In an important journal article from 2005, former Surgeon General Dr. David Satcher and co-authors demonstrated that while overall survival for both African American and white populations has improved over the last 40 years, there has been little improvement in the mortality gap between blacks and whites. In fact, this “death gap” worsened for black infants and black men age 35 and older.
What this means is that in 2002, blacks suffered 40.5 percent more deaths — 83,570 excess deaths — than would be expected if they had experienced the mortality rate of whites. This is a shocking statistic for a country with the greatest wealth and resources ever seen in human history.
While there a number of reasons why this racial disparity exists, the lack of universal health insurance coverage is an obvious one. Importantly, it’s a fixable problem.
Every other industrialized country in the world has some form of public health insurance. Many countries, like Canada, have a single-payer system whereby the government funds the private delivery of health care. In Canada, everyone is guaranteed care, medical outcomes are as good if not better than in the U.S., and yet per capita health spending is about two-thirds what we spend.
Our own extremely popular Medicare program, whose 50th anniversary will be observed in the new year, resembles a single-payer system in many ways. For those who qualify, Medicare provides ready and equitable access to care, free choice of doctor and hospital, and a minimum of wasteful paperwork.
As long as private health insurance companies remain in our health care system, there were will be steep financial barriers to people of color and all people with lower to middle incomes getting access to medically necessary, life-saving care. A Medicare-for-All system, without co-pays or deductibles, would eliminate these barriers, save money and improve health.
Regrettably, the Affordable Care Act does not come close to removing these barriers to care. Nearly 31 million people will remain uninsured even after full implementation of the law, and millions more will have skimpy health insurance policies that will leave them vulnerable to financial distress in the event of illness.
As a medical student and future physician, I believe access to high-quality health care is a right of all people and should be provided as a public service rather than bought and sold as a commodity. Until this becomes a reality, the death gap between blacks and whites will continue to afflict us.
This state of affairs is unacceptable. As Dr. Martin Luther King Jr. once remarked, “Of all the forms of inequality, injustice in health is the most shocking and inhuman.” We shouldn’t settle for it. We need an improved Medicare for All.