Home Care Keeps Me Alive. It Should Be Fully Funded.
Barkan is a co-founder of Be a Hero, a political advocacy organization fighting for health care justice. He was diagnosed with A.L.S. in 2016.
Five years ago, I went to sleep each night thinking I was the luckiest and happiest person I knew. I was 32 and had a brilliant wife, an adorable infant son and a fulfilling career organizing for social justice. We owned a house in paradisiacal Santa Barbara, Calif. Then I was given a death sentence.
I was told I had amyotrophic lateral sclerosis, or A.L.S., a mysterious neurological illness. I asked my doctor how long I could expect to live. He said three to four years.
Today I am nearly completely paralyzed and am typing these words using technology that follows the movement of my eyes, which are the one body part that I am still able to control well. I have a breathing tube implanted in my windpipe, and to compensate for my failing diaphragm, I’m hooked up to a ventilator 24 hours a day. I am fed through a small hole in my belly.
Living with A.L.S. can be horrendous. But I have a beautiful life. I laugh every day, and I am never depressed. I am still organizing for social justice. My life is good because I live at home with my wife, Rachael, and our two young kids. Most nights before dinner, my toddler, Willow, sits on my lap, and we watch “Sesame Street.” Although I’m not the father I had hoped to be, I’m grateful for each moment with my children. And it’s all possible because I have 24-hour home care.
I can afford this care only because I forced my health insurance company to pay for most of it and we have some very wealthy friends who cover the rest. Private health insurance rarely covers home care. Neither does Medicare. My team of seven caregivers is skilled, reliable and very stable. And that is possible only because we pay them well above the low market rates. Without home care, I would have to be in a nursing home to stay alive. And to be honest, I don’t know if that would be a quality of life that I would be willing to tolerate.
In Japan, where health care is guaranteed, one study found that people with A.L.S. were much more likely to choose to go on a ventilator to extend their life as people with the disease in the United States. This means more Americans with A.L.S. opt to die. I argue it’s because home care is prohibitively expensive and life in a nursing home is so miserable. My doctor’s initial prognosis was based on the assumption that I would not undergo a tracheotomy and receive the home care necessary to survive with a ventilator.
Home care is literally keeping me alive. But across the country, almost a million children, adults and seniors with disabilities sit on waiting lists for Medicaid’s home- and community-based care, in danger of being removed from their homes and sent to live in institutions.
In his jobs and infrastructure plan introduced this year, President Biden proposed $400 billion for home- and community-based care. That’s what’s needed to clear the 820,000-person waiting list and provide professional caregivers — the majority of whom are women of color — with better wages. Funding for home care would also give new choices to the one-tenth of caregivers — most of whom are women — who were forced to leave their paid jobs or retire early to take care of a loved one.
The significantly scaled-back bipartisan version of this plan eliminated the president’s proposal for in-home care funding. Republicans did not support the president’s original proposal, and even some conservative Democrats said we cannot afford it. The fate of the funding now depends on how hard the president, Senate majority leader Chuck Schumer and Speaker Nancy Pelosi fight for that commitment.
Most people want to stay in their homes and communities as they age, so fully funding home care is a matter of ensuring everyone has the choice to live at home. During the Covid-19 pandemic, about 134,000 nursing home residents have died from the disease.
The pandemic has shown the urgent need to transform America’s social contract. We are the richest nation in the history of the world. We have money for endless wars, a Space Force and tax cuts for billionaires. But when it comes to ensuring everyone has basic health care, we can’t seem to scrape together the money.
Our time on this earth is the most precious resource we have. And yet America’s misplaced national choices are depriving millions of disabled people and our loved ones of invaluable years and priceless days.
Recently, with the help of my wonderful home caregiver Izzy, I took my son, Carl, to basketball practice for the first time. When we got home and continued shooting hoops in the driveway, I wept tears of joy. After I was diagnosed, when Carl was only 4 months old, I didn’t think that I would ever get to watch him learn to dribble. But thanks to my caregivers, I can tolerate my paralysis, and I was able to do just that.
It’s now been five years since I was diagnosed, and Carl is old enough to form memories that will last the rest of his life. He will remember me even after I’m gone. But I am not gone yet. And every day, thanks to my home care, I experience the deep love of my children and family. Everyone deserves as much.
https://www.nytimes.com/2021/09/08/opinion/als-home-health-care.html
CVS Health Quietly Made Massive Donation to Dark-Money Group Fighting Access to Care
The pharmacy and health insurance giant gave $5 million to Partnership for America’s Health Care Future.
by Lee Fang - The Intercept - April 21, 2021
In a year marked by a coronavirus pandemic that has killed millions, CVS Health financed a wave of political advocacy against measures to control health care costs and increase access.
The health care giant, which owns Aetna health insurance and operates thousands of pharmacies and walk-in clinics around the country, provided $5 million to the Partnership for America’s Health Care Future, or PAHCF.
The seven-figure donation from CVS is the largest known contribution to PAHCF, which was formed in 2018 to lobby and advocate against proposals such as Medicare for All, the public option, and similar reforms that have gained growing support in recent years. PAHCF is a 501(c)(4) and is not required to disclose donor information.
Last year, PAHCF swamped voters in Democratic primary states such as South Carolina with ads urging voters to oppose Medicare for All. In states considering the public option, the group hired local lobbyists and aired advertisements designed to discourage state legislators from voting for the plan. And just before the general election, the group again aired ads attacking the public option.
Neither CVS Health nor PAHCF responded to a request for comment. Despite CVS Health’s donation, the company is not listed as a coalition member of PAHCF on the group’s website.
In recent weeks, PAHCF appears to be reprising its role. The group has launched ads that have warned lawmakers against supporting President Joe Biden’s national public option proposal and funneled resources into states to attack state-based proposals for public insurance plans.
Last week, CVS Health chief executive officer Karen S. Lynch co-signed a letter to Connecticut Gov. Ned Lamont, warning that the drive to enact a public health insurance option would drive health insurance businesses out of the state.
The letter, also signed by the chief executives of Anthem, Cigna, Harvard Pilgrim Health Care, and UnitedHealth Group, charged that the effort to lower premiums and expand coverage through a public option “will only further deteriorate the state’s fragile economy.”
The disclosure of the $5 million donation comes as PAHCF has embarked on another round of advertising in the Colorado, Maine, Montana, Connecticut, and the Washington, D.C., markets. The organization also launched an offshoot in Nevada, another state in which legislators are considering a public option proposal.
Last year, PAHCF successfully lobbied to defeat a previous attempt to pass a so-called public option insurance plan in Colorado.
The Colorado program was designed to provide residents with an alternative health insurance plan with premiums that would cost an average of 20 percent less than private insurers. The proposal also contained a number of cost-saving measures, including a requirement that drug companies pass rebates directly to consumers, rather than third-party health care providers or insurers.
The PAHCF ads railed against the proposal, claiming that it would introduce “government-controlled health care” that would insert politicians into decisions that should be left to patients and doctors.
The group, working in concert with the Federation of American Hospitals and the Healthcare Leadership Council, has also lobbied lawmakers directly. Internal documents from the group, previously reported by The Intercept, show that PAHCF and its affiliates directly engaged ghostwriters to author opinion columns, briefed Democratic Party officials on the dangers of embracing health reform, and worked to pressure candidates in the presidential primaries.
But watchdogs such as the Center for Health and Democracy say the group is merely a lobbying front to preserve the profits and market share of private health providers and insurers.
“The story of healthcare in America is about profit-driven corporations versus Americans who need care,” said Wendell Potter, the president of the Center for Health and Democracy.
While the pandemic ravaged the economy and claimed the employer-sponsored health coverage of some 15 million Americans, much of the health care industry thrived. CVS Health collected nearly $13.9 billion in operating income last year. HCA Healthcare, the for-profit hospital chain that also funds PAHCF, paid its chief executive Samuel Hazen $30.4 million last year.
CVS devotes large sums of money on political influence. Last year, the company spent $10.3 million on federal lobbying efforts. The voluntary disclosure that shows the $5 million donation to PAHCF also revealed other donations to political influence groups that do not reveal donor information.
The company donated $1,750,000 to Majority Forward, a group affiliated with Sen. Chuck Schumer, D-N.Y., that supports Senate Democrats and $1,750,000 to One Nation, a group affiliated with Sen. Mitch McConnell, R-Ky., that supports Senate Republicans. CVS also made donations to a variety of political organizations, including Third Way, the Congressional Black Caucus Foundation, the Congressional Hispanic Caucus Institute, the American Enterprise Institute, Center Forward, and the American Action Forum.
“Make no mistake: As long as their billions in profits are threatened, the front group for the health insurance industry will spend whatever it takes to keep the status quo exactly the way it is,” added Potter.
Back on the Trail, Sanders Campaigns for a Legislative Legacy
Senator Bernie Sanders is barnstorming the country again, but not for
the presidency. Instead, he’s making the case for a $3.5 trillion bill
that would be a once-in-a-generation achievement.
by Emily Cochrane - NYT - September 5, 2021
CEDAR RAPIDS, Iowa — With a khaki-clad leg propped up on a bench, hand on his hip, Senator Bernie Sanders was regaling the post-church Sunday brunch crowd outside a bar with enticing details about Democrats’ emerging $3.5 trillion budget bill.
As Meatloaf’s “Paradise by the Dashboard Light” blared in the background, Mr. Sanders, an independent from Vermont, fielded questions from curious diners about plans to provide two years of free community college education and reduce prescription drug prices, interjecting an occasional apology for letting the food grow cold as he gathered feedback about the package.
Before sitting down with his family to finish eating, one man wondered aloud about something else entirely: Less than a year after the end of the 2020 presidential campaign season and with the midterm elections looming, what was Mr. Sanders doing in Iowa?
“I am chairman of the Senate Budget Committee,” replied Mr. Sanders, a veteran of two unsuccessful bids for the presidency. “And I am here to explain what the hell is in the budget for the American people.”
Just a few days shy of his 80th birthday, Mr. Sanders was back on the campaign trail last week, trekking across Republican-leaning districts in the Midwest to cap off a blitz of local television interviews and opinion essays placed in traditionally conservative news outlets.
But this time, instead of pursuing a higher political office, he was campaigning for a legislative legacy: a $3.5 trillion package that, if passed, would amount to the most significant expansion of the social safety net since the Great Society of the 1960s.
Speaker Nancy Pelosi of California and Senator Chuck Schumer of New York, the majority leader, rallied every Democrat in Congress last month behind the budget blueprint, which sets the stage for them to push through ambitious initiatives to address climate change, provide funding for paid family leave, child care and education benefits, and increase taxes on the wealthy — all on a party-line vote.
But it is Mr. Sanders who will oversee the drafting of the legislation in the Senate, which Democrats plan to steer through Congress using fast-track budget reconciliation rules, which shield it from a filibuster but will require the support of every Democrat in the Senate and nearly every Democrat in the House. Committee leaders hope to finish their work on the enormous bill by Sept. 15. The process will not be easy, given the need for party unity and the strict rules that limit what can be included in reconciliation bills.
Among the steepest challenges will be persuading conservative-leaning Democrats, such as Senators Joe Manchin III of West Virginia and Kyrsten Sinema of Arizona, to drop their reservations about the plan’s cost and support it.
“Pelosi and Schumer have enormously difficult jobs — they really do — and it’s easy to disparage them, to criticize them, but they have no margins with which to deal with,” Mr. Sanders said in an interview. “It’s not a job that I envy, a job that I could do for three minutes.”
Mr. Sanders has decided the best way to make the case for his vision is through outreach to Republican voters, including in-person conversations in Republican-leaning districts in Indiana and Iowa. Having relished his past interactions with voters on the campaign trail, he was back in his element, far from the staid corridors of Capitol Hill.
“This is way outside of what normal budget committees do, but on the other hand, I feel very fortunate to be in this position at this moment,” Mr. Sanders said, drinking iced tea on the patio of Midtown Station, a restaurant near the fire station, after his question-and-answer session. “In fact, if I weren’t so preoccupied with the reconciliation package and having to deal with members of Congress, etc., etc., I would probably take the Budget Committee on the road all over this country.”
“That’s what we should be doing,” he added. “We’ve got to explain to the American people what we’re doing here for them, and it can’t simply be an inside-the-Beltway process.”
But whether in Washington or in Iowa, Mr. Sanders has little patience for discussing the procedural details of the reconciliation package, focusing instead on the policy ideas he jots down in sprawling cursive. In opening remarks at a nearby park before a crowd of hundreds fanned out in lawn chairs and on picnic blankets, Mr. Sanders offered a brief warning that Senate rules could “put you to sleep in about three seconds.”
“It’s complicated, it’s boring, etc.,” he told them.
Yet those mind-numbing details will be crucial. The need for Democrats to be virtually unanimous in their support will drive the process, determining which policies can be included and which will have to be jettisoned. And the Senate parliamentarian, as the arbiter of the chamber’s rules, will potentially advise dropping certain provisions because they do not directly affect taxes and spending, a requirement for items included in reconciliation bills.
Glossing over those specifics, Mr. Sanders reassured the crowd — largely a gathering of his acolytes from across the state — that his vision would become law despite the opposition of people like Mr. Manchin and Ms. Sinema.
“After a lot of negotiations and pain — and I’m going to be on the phone all week — what we are going to do is pass the most comprehensive bill for working families that this country has seen,” he said in response to questions about the two moderates. Asked whether he would compromise on the overall price tag, Mr. Sanders, who initially wanted a $6 trillion package, replied: “I think we are going to get a $3.5 trillion bill. I’ve already made a compromise.”
Days later, Mr. Manchin called for a “strategic pause” on the budget package, writing in the opinion section of The Wall Street Journal, “I can’t explain why my Democratic colleagues are rushing to spend $3.5 trillion.”
In Cedar Rapids, Mr. Sanders readily acknowledged how aggressive his timeline was, but argued that there was no time to spare.
“You can’t slow it down,” he said. “Within a little while, everything is going to become political. The only way you get things done historically in Congress is in the first year of a session, where you can escape a little bit from the partisan politics.”
The array of “Bernie” campaign attire in the crowd last Sunday indicated that few present took issue with the transformative policy ideas that Mr. Sanders laid out: free community college and prekindergarten, federal funding for paid family leave and child care, the establishment of a civilian corps to help create jobs while combating climate change, and an expansion of Medicare to include dental, vision and hearing benefits — all paid for with tax increases on wealthy people and corporations.
“I did not vote for Bernie before, but I’m interested in the whole process and the political pull that he has had,” said Frank Nidey, 70, a Democrat from Cedar Rapids who brought his two grandchildren to the rally. “I know that this legislative process is very messy, and I don’t know for sure what’s going to come out of it.”
Republicans took advantage of Mr. Sanders’s foray into their states to assail the plan, with conservative activists staging their own small rallies to stoke opposition. Senator Mike Braun of Indiana posed next to a large pig with “Pull the Pork” written in big black letters across it. Representative Ashley Hinson of Iowa scoffed on Twitter that Mr. Sanders would have “a tough time” selling his “far left policies outside the main stream” in her state.
At Midtown Station, Tim Barcz, 41, initially joined the discussion with Mr. Sanders because he wondered what the senator was doing in his town, but the back-and-forth piqued his interest when it turned to free college, an issue newly relevant with his oldest son just entering high school.
Normally, visits from politicians are “just shaking hands and kissing babies, but when you hear Bernie talking about policy, that’s important,” said Mr. Barcz, an independent who said he had reluctantly voted for Donald J. Trump. “But will you change hearts and minds this way? That’s what I don’t know.”
https://www.nytimes.com/2021/09/05/us/politics/bernie-sanders-budget-bill.html
House Dems Introduce Bill to Lower Medicare Age to 60
"Congress and President Biden should
immediately deliver for the people by prioritizing the expansion and
improvement of Medicare in the upcoming Build Back Better package."
—Rep. Pramila Jayapal
The bill (pdf)—which is led by Democratic Reps. Pramila Jayapal (Wash.), Conor Lamb (Pa.), Joe Neguse (Colo.), Susan Wild (Pa.), Haley Stevens (Mich.), and Debbie Dingell (Mich.)—would bring 23 million more Americans into the government-run program. The policy is supported by President Joe Biden, who—thought he continues to oppose Medicare for All—promised to lower the Medicare eligibility age during his 2020 presidential campaign.
Sponsors of the new proposal hope it will be included in the $3.5 trillion Build Back Better budget reconciliation bill supported by Biden and progressive lawmakers—as well as a majority of U.S. voters. While both houses of Congress have passed the budget blueprint for the landmark package, congressional Democrats are facing an aggressive push by corporate lobbyists and right-wing colleagues from both sides of the aisle to eliminate or weaken crucial provisions.
Proponents of the Medicare expansion bill said it would save many lives.
"Lowering the Medicare eligibility age will not only be life-changing for at least 23 million people, it will also be lifesaving for so many across America who will finally be able to get the care they need and deserve," Jayapal said in a statement announcing the new bill.
Researchers have found that there is a massive increase in the diagnosis of cancer among Americans who reach the age of 65 that could have been detected much earlier if they had access to Medicare.
Medicare eligibility expansion is also popular policy—and seen by many Americans, especially progressives, as a gateway to more ambitious healthcare reform. According to a Data for Progress survey in June, 60% of likely U.S. voters support lowering the Medicare eligibility age to 60, while a March poll from Morning Consult found that 55% of respondents favor Medicare for All.
Many of the lawmakers who support the new bill are also co-sponsors of the Medicare for All Act of 2021, which was introduced by Jayapal and Dingell in March.
"We are the only industrialized nation that does not have guaranteed access to healthcare for all its citizens—this needs to change now," Dingell said on Friday. "We're working on ensuring universal healthcare, and this includes lowering the Medicare eligibility age to 60 so that more adults can get the critical access to the quality, affordable healthcare they need."
Healthcare advocacy groups welcomed the new bill.
"The creation of Medicare transformed the lives of seniors by guaranteeing them access to healthcare and eliminating healthcare bills that threw many into poverty," Public Citizen president Robert Weissman said in a statement.
Weissman added that, if passed, the new bill "can have a similarly transformative effect on the lives of tens of millions of Americans, guaranteeing care, keeping people out of medical bankruptcy, and opening up life choices."
Jayapal said that "expanding and improving" Medicare "is not only the right thing to do from a policy perspective, it is also what the majority of Americans across party lines support."
"Congress and President Biden," she added, "should immediately deliver for the people by prioritizing the expansion and improvement of Medicare in the upcoming Build Back Better package."
https://www.commondreams.org/news/2021/09/03/house-dems-introduce-bill-lower-medicare-age-60
Only one major hospital network and one free-standing hospital in Maine are in compliance with a new federal law that requires hospitals to publish detailed prices of medical procedures.
And the published data is on hospital websites that are difficult to navigate, confusing and, in some cases, require consumers to enter extensive insurance information to obtain cost estimates.
Nine months after the Jan. 1 compliance deadline, the MaineHealth network of nine hospitals and MaineGeneral Medical Center in Augusta have published charges for a range of services and procedures. The remaining 26 hospitals in Maine have not met the requirements of the law, but several say they will be posting the full database of price comparisons soon to come into compliance.
A national consumer advocacy group, patientrightsadvocate.org, estimated that less than 6 percent of hospitals had fully complied with the law by July.
But based on what has so far been published in Maine, prices for medical procedures vary widely.
Knee replacement surgery can cost $13,000, $55,000 or prices in between. Colonoscopy prices range from $1,000 to $2,000. The cost of the same medical procedure can vary widely depending on the hospital, insurance carrier and what plan the consumer chooses.
For instance, a colonoscopy at Maine Medical Center can cost about $1,000 to $2,000, depending on what insurance plan a patient has. And that’s not factoring in co-pays, deductibles and cost-sharing components that are part of the byzantine way that the United States pays for its health care.
Maine’s 36 hospitals are working to comply with the new federal law, but the state also publishes its own price transparency tool, the comparemaine.org tool that gives average prices by hospital for hundreds of medical procedures.
MaineHealth, the parent company of Maine Medical Center in Portland, seven other hospitals in the state and one in New Hampshire, including Mid Coast Hospital in Brunswick and Pen Bay Medical Center in Rockport, is publishing the detailed data required under federal law, but the website is difficult to navigate.
Others, such as Northern Light Health in Bangor and Central Maine Healthcare in Lewiston, have not yet complied with the new law, but do provide some of the prices and are working on standing up websites that will be in compliance.
“It’s definitely on every hospital’s work plan,” said Jeff Austin, vice president of the Maine Hospital Association. “Even the regulators understand it is complicated and there is a lot of data to upload. They’re not going to go from 0-60 immediately.”
The U.S. Centers for Medicare and Medicaid Services began sending out warning letters in May to hospitals that hadn’t complied, giving them 90 days to publish the data. Since then, CMS has indicated it would give hospitals at least an additional 90 days – totaling 180 days or about six months – to comply. If hospitals fail to comply they could eventually incur penalties from hundreds of dollars per day to thousands daily, depending on the size of the hospital.
Suzanne Spruce, spokeswoman for Northern Light Health, the parent company of Eastern Maine Medical Center in Bangor and Mercy Hospital in Portland, said they are working on “full compliance” in the next two months.
“We are diligently working to comply with price transparency requirements and have been adding information as it has been completed, including a recently added shoppable services price estimator tool for most of our (hospital system),” Spruce said. Central Maine Healthcare, the parent company of Central Maine Medical Center in Lewiston and MaineGeneral Medical Center in Augusta have similar “price estimator” tools as those used by Northern Light Health.
John Porter, spokesman for MaineHealth, acknowledged that its price transparency website is not user-friendly. The database can list several very similar procedures that cost different amounts. But he said there’s a financial helpline that patients can call to walk through the process.
The state website – comparemaine.org – is much easier to navigate, and it also can give prices based on a patient’s insurance company. But those prices are an average and not the actual sticker price that’s required in the federal law. The state website has been running since 2018.
Mitchell Stein, a Maine-based health policy advocate, said price transparency is an important step forward, but it doesn’t address the underlying problems with the way Americans pay for health care. Prices for the medical procedures are negotiated between insurance companies and health care networks.
“So much of health care is not shoppable,” Stein said. “How useful is this going to be for consumers? You are not stopping to check the database on the way to the ER or the urgent care. You are focused on getting care as soon as possible.”
A poll this summer conducted by the Kaiser Family Foundation, a national health policy think tank, found that 85 percent of patients do not shop for medical services.
But Ann Woloson, executive director of Maine’s Consumers for Affordable Health Care, said she’s encouraged by the new price transparency law, and it will be a boon to Maine patients once it’s fully implemented.
“Any step that provides pricing information to consumers is a good thing in general,” Woloson said. “It increases transparency, which is important. It could lead to improved competition and lower prices overall.”
Woloson said the information could be best used for planned procedures, such as colonoscopies, elective surgeries and imaging tests. The data can also be used for research and advocacy purposes.
“There is at times a real difference in what you pay, for instance, for a knee replacement,” Woloson said. “Depending on what coverage you have, the costs you see on the website could play a role on where you have a procedure done.”
Woloson said despite what’s published on public databases, patients should always double check with their insurance company to make sure what they are choosing is indeed the most affordable. A procedure that looks more affordable on the website may incur some unforeseen costs, such as if it’s out-of-network or how close the patient is to meeting an annual deductible.
At comparemaine.org, for example, the cost of a knee replacement varies from $13,237 at Central Maine Orthopedics in Auburn to $55,575 at Northern Light Maine Coast Hospital in Ellsworth, with most prices in the $30,000 to $40,000 range. Woloson said even the MaineHealth site, which has the actual sticker price, may be deceiving, because the customer may be choosing a plan on the website that is not the same as the plan that they have through their employer or through the Affordable Care Act marketplaces. So Woloson said it’s best to always call your insurance company after shopping for prices.
Heather Bouffard, director of marketing and communications for Community Health Options, a Lewiston-based insurance company, said that although the price transparency tools are helpful, “there are still details to work out.”
“The source data is quite complicated, and service definition inconsistencies among hospitals could lead to consumer confusion. The ease of use and the reliability of digital tools are paramount as people try to make sense of the data,” Bouffard said.
Austin, with the hospital association, said complying with the law is going to take time because of the large amount of data that has to be sorted and the complexity of making it available in a way that patients can search for it. But Austin said a companion regulation that will be implemented over the next few years will require insurance companies to make the same information available.
Patients will be able to search on their insurance company’s website, type in their plan and see how much they will pay for a medical procedure, but specific to their plan, such as deductibles, co-pays and cost-sharing.
“The one thing we can’t give you right now, but a lot of people want, is ‘OK, but what am I going to have to pay for this?'” Austin said.
Trevor Putnoky, membership and communications director for the Healthcare Purchaser Alliance of Maine, which represents employers in purchasing health care plans, said that the law is an important step toward creating a “functional market.”
“Transparency is a critically important component of a functional market, and traditionally health care has lacked insight into cost and quality, so this is a big step forward,” Putnoky said. “Where there is transparency in markets, unwarranted price variation diminishes, and numerous studies have shown that the price variation in health care has no correlation to quality or outcomes.”
But Putnoky also said that while the data is “critically important, it will only have an impact if it gets used, and there isn’t a lot of awareness of it right now.”
Putnoky said he doesn’t believe that the data will impact negotiations between employers purchasing health plans for their workers and insurance companies.
“Studies show that rates paid to hospitals vary significantly for individual procedures from (insurance) carrier to carrier, but in aggregate the carriers are all in the same ballpark when it comes to spending within a given network,” Putnoky said. “It would also be extremely difficult to tease out how price variation at the procedure level – especially when there’s only reporting on a subset of services – translates into total premium paid.”
There are other quirks as well. For instance, MaineHealth’s official cost for the uninsured is often higher than for people covered by insurance plans. But Porter said that the cost to the uninsured is not likely to be what people actually pay.
Porter said when an uninsured patient sees the high prices, it could spur them to get insurance. Now that Maine has expanded Medicaid, people living near or below the poverty line will either qualify for Medicaid or a very low-cost plan through the ACA.
“The price for an uninsured patient is meant to be the beginning of a conversation,” Porter said.
But Stein said that’s the major problem with the underpinnings of how health care is financed in the United States. Prices are almost “random.”
Stein said one reform that would make costs more predictable is to establish an independent “all-payer rate setting board” where prices for medical procedures would be the same throughout the state. Maryland is the only U.S. state that has set up a rate setting board.
“At that point, insurance companies would be competing with each other on a level playing field,” Stein said. “Currently, there seems to be not much rhyme or reason to how prices are related to one another.”
https://www.pressherald.com/2021/09/05/few-maine-hospitals-comply-with-federal-price-disclosure-law/
The Potter Report: $140 Billion
by Wendell Potter - The Potter Report - September 9, 2021
The $140 billion the New York Times says Americans owe in medical debt is just the tip of the iceberg.
The number doesn’t even include the billions we are putting on our
credit cards to pay for health care because of insurance deductibles we
can’t possibly meet.
The New York Times is reporting that the amount Americans owe in
medical debt is much bigger than previously thought. Citing research
published in JAMA, Sarah Kliff and Margot Sanger-Katz wrote that
collection agencies held $140 billion in unpaid medical bills in 2020 — far more than the $81 million researchers estimated in 2016.
Another crucially important fact the Times story does not
mention is that much of Americans’ medical debt–maybe more than half of
it–is owed not by the uninsured but by people who have health insurance.
To meet Wall Street’s profit expectations, insurance companies like
the ones I used to work for keep jacking up the amount Americans have to
pay out of their own pockets before their coverage kicks in. It is not
at all uncommon for patients in this country to have to pay thousands of
dollars in deductibles, copayments and coinsurance every year. That’s
in addition to the premiums they have to pay to get the coverage in the
first place.
Sarah Gantz of The Philadelphia Inquirer is one of the relatively few reporters covering this growing crisis. In late 2019, she told the story of Sharon Kelly,
a breast cancer survivor who had stopped going to the doctor–even
though she had insurance–for fear of adding to her debt she already
owes.
“It kind of paralyzes you,” said Gantz, who paid nearly $7,000 a year
in premiums alone in 2019. ”I started thinking, ‘What if I just don’t
have insurance.”
She added: “Medical debt is a very quiet and insidious kind of debt.
It just starts coming from all different places. … It doesn’t hit you
until you’re at the height of it.”
Kelly is like millions of other Americans with health insurance who
give little thought to the actual value and usefulness of their
policies. As Gantz wrote, Kelly had always been healthy and rarely used
her health insurance plan–and didn’t give much thought to the
deductibles she’d have to pay if she got sick.
That’s the way it is with high-deductible plans. People in these
plans, which are now prevalent in the US, mistakenly think their
coverage is adequate and will protect them from financial ruin. That can
be an incredibly costly and even deadly mistake.
Gantz reported that in Pennsylvania, even people with coverage
through their employers paid for about 14% of their health costs out of
pocket in 2019. It’s even worse for people who have to buy coverage on
their own, including from the health insurance marketplace established
by the Affordable Care Act as Kelly did. People enrolled in those plans
paid 22% of their medical costs out of their own pockets, according to
the Health Care Cost Institute.
That is consistent with the findings of the Commonwealth Fund,
which has been tracking the rapid growth of Americans who are
underinsured because of high out-of-pocket requirements. The
Commonwealth Fund’s most recent research found that more than 40% of
people with individual plans and more than a quarter of people with
employer-sponsored coverage are now underinsured and consequently
unprepared for a serious diagnosis or accident. An alarming 43.4% of
adults between the ages of 19-64 are now inadequately insured.
“It’s almost like you’re sitting on a time bomb,” Gantz quoted Sara
Collins of the Commonwealth Fund as saying. “You have this
high-deductible plan you may not use much, but if you do get sick, you
can end up with a lot of out-of-pocket costs.”
In Kelly’s case, she learned from a routine mammogram that she had
cancer when she was halfway through the calendar year. She had no choice
but to pay her deductible over the remainder of the year. And then, as
Gantz reported, “January came, and her deductible bounced back up to
$7,000. Her treatment continued, as did the bills.”
Because of those bills, Kelly decided not to undergo chemotherapy as
her doctors advised. She also has put off going back to the doctor.
She’s far from being alone. An untold number of Americans are
gambling with their lives because of their high-deductible plans, not
going to the doctor when they should and, increasingly, not even picking
up their prescriptions. The ACA established a ceiling for
out-of-pockets, but that ceiling is ridiculously high and increases
every year. In 2021, many Americans with insurance will have to pay
$8,550 before their coverage kicks in. If they have a family policy, the
out-of-pocket maximum is now $17,100.
It can be just as bad if not worse for Medicare beneficiaries. People
in Medicare Advantage plans, operated by private insurers, can also be
on the hook for thousands of dollars in out-of-pockets. And, incredibly,
there is no cap on out-of-pockets for people enrolled in the
traditional Medicare program.
Addressing this growing problem must become a priority of the Biden
White House and Congress. The president is understandably proud and
protective of the ACA, but just getting more people enrolled in health
plans and increasing premium subsidies are not nearly enough and will
not be helpful to the millions of middle-class Americans in
high-deductible plans.
Ezekiel Emanuel, who helped write the ACA, told the Times on the 10th
anniversary of the law last year that not anticipating the growth and
consequences of ever-rising out-of-pocket requirements was “a huge mistake.”
It is time for Congress and the Biden administration to fix that huge mistake. Several patient advocacy, business and provider organizations are coming together to put pressure on them to do that. Stay tuned for details.
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