Health Care Reform Articles - November 17, 2021

Good morning. A creative new poll tries to understand blue-collar swing voters.

by David Leonhardt - NYT - November 13, 2021 

‘Just a fantasy’

Political pundits often talk about swing voters as if they were upscale suburbanites, like “soccer moms” or “office-park dads.” And some are. But many are blue-collar. They are the successors to the so-called Reagan Democrats, who let Republicans win the White House in the 1980s and Democrats retake it in the 1990s.

This century, blue-collar swing voters helped elect Barack Obama twice, Donald Trump once and Joe Biden in 2020. They have also played a deciding role in congressional and state elections, including in Virginia last week.

In the current polarized political atmosphere, many college graduates follow politics obsessively — almost as if it were a sport — and identify with one of the two parties. Many working-class voters, on the other hand, vote for both parties and sit out some elections.

Figuring out what moves these swing voters is a crucial question in American politics. It has become an urgent question for the Democratic Party, which is struggling to win working-class votes in many places, including some Asianand Latino communities.

This morning, a creative new poll exploring these issues is being released. It asks working-class respondents — defined as people without a bachelor’s degree — to choose between two hypothetical candidates. The candidates are described both personally (their gender, race and job category) and politically (including a sound bite in which they talk about their views).

A central conclusion is that infrequent voters are not a huge Democratic constituency just waiting to be inspired by a sufficiently progressive economic message. “That’s just a fantasy,” Bhaskar Sunkara, the founding editor of Jacobin, a socialist magazine and one of the poll’s sponsors, told me, “and it’s a fantasy we ourselves have engaged in.” (In fairness, numerous other people — including Trump and, well, me — have believed that same misplaced idea.)

The poll instead finds that working-class swing voters hold a swirl of progressive and conservative views. “To mobilize these voters will take a lot of grass-roots organizing efforts, particularly more labor-union-centered organizing,” Sunkara said. “There is no simple programmatic solution” — for either party.

Below, I walk through themes from the poll, focusing on those respondents who said they did not lean toward either party. About 33 percent of them voted for Trump last year and 22 percent voted for Biden, with the remaining voting for a third party or not voting.

YouGov, a large nonpartisan pollster, conducted the poll, in collaboration with Jacobin and the Center for Working-Class Politics, a new progressive group.

Politics isn’t just issues

Nothing produced a more positive response from poll respondents than hearing that a candidate was a small-business owner. It offered a bigger lift than any political position or demographic feature, and it was popular across Black, Latino and white respondents.

Voters also had positive feelings about candidates who were listed as being teachers, veterans or construction workers. Lawyers fared less well, and Fortune 500 C.E.O.s did worst of all.

It’s a reminder that big business and small business have very different images — and that Trump’s victory depended on selling himself as a brash entrepreneur rather than a bland corporate manager like Mitt Romney.

Race is undeniably vexing

Many Black working-class swing voters are attracted to candidates who focus on racial justice — by promising to “end systemic racism,” for example. Many white working-class swing voters are turned off by these same positions. There is no simple answer on race for the Democratic Party, given that it must attract a multiracial coalition to win.

But the political costs of a campaign message focused on ethnic identity seem significantly larger than the benefits, Sunkara said. Among five different candidate sound bites presented to respondents, the worst-performing was one that the pollsters internally described as “woke moderate.” Its first sentence sounds like something out of a corporate mission statement:

Our unity is our strength, and our diversity is our power. But for too long, special interests have blocked critical progress in addressing systemic racism, climate change, and access to affordable health care. We need creative leaders who will fight for our values, listen to the experts, and make real change happen.

Populism is popular

The second best-performing sound bite was one that pollsters internally referred to as “Republican.” It warned that “freedom is under threat from radical socialists, arrogant liberals and dangerous foreign influences.”

Yet the most successful sound bite was the “progressive populist” one. It was as pugnacious as the Republican entry, albeit with different targets:

This country belongs to all of us, not just the superrich. But for years, politicians in Washington have turned their backs on people who work for a living. We need tough leaders who won’t give in to the millionaires and the lobbyists, but will fight for good jobs, good wages, and guaranteed health care for every single American.

Populism has its limits

Working-class swing voters tend to favor generous versions of Medicare, Social Security and other universal government benefits, polls consistently show. But they also responded positively in this poll to candidates promising vaguely to “cut goverhttps://www.nytimes.com/2021/11/09/briefing/swing-voters-us-elections.html?searchResultPosition=1nment spending.”

And while Democratic-leaning working-class voters liked a “Medicare for all” message, swing working-class voters preferred candidates who instead promise to “increase access to affordable health care.”

Americans are mostly progressive on economics, but Democrats can still run too far left on these issues.

You can read the full poll results here. (If you do, note that the beginning of the report focuses on a Democratic-leaning group of working-class voters — who are relevant to primary elections — rather than the swing voters who have been my focus.)

Related: Representative Sean Patrick Maloney of New York says Democrats need to do a better job getting the message out about their achievements, starting with the president. “Free Joe Biden,” he says. Read the Q. and A. https://www.nytimes.com/2021/11/09/briefing/swing-voters-us-elections.html?searchResultPosition=1

 

Editor's Note - 

This NYT video op-ed from April 28, 2021, is worth watching - but I doubt it will change anybody's mind. 

 It is interesting that the NYT would publish it.

 - SPC 

 -

 https://www.youtube.com/watch?v=EBklyksgbco

 

Opinion | Why Is It So Dangerous to Be Pregnant in America?

Sema K. Sgaier, Jordan Downey - NYT - November 17, 2021

Compared with its peers, the United States’ trajectory in maternal health has been shameful. Solving this worsening problem requires looking not just at the quality of care a woman receives but the entire environment around her — from her access to health care to the availability of food in her community.

The Maternal Vulnerability Index uses an array of maternal health and community data — six categories in total — giving a more comprehensive picture of what’s driving risk for poor maternal health outcomes in counties across America.

The data reveals that a woman’s chance of a healthy pregnancy varies greatly depending on where she lives, based on factors such as whether she has a high school diploma, her exposure to poverty, her access to OB-GYNs and midwives, and her access to abortion clinics.

How at risk are women in your county, and why? Search for your county to find out. (Higher scores indicate more risk.)

Overall maternal risk in New York County, N.Y. is low.

Reproductive healthcare: 1

Compared with its peers, the United States’ trajectory in maternal health has been shameful. Solving this worsening problem requires looking not just at the quality of care a woman receives but the entire environment around her — from her access to health care to the availability of food in her community.

The Maternal Vulnerability Index uses an array of maternal health and community data — six categories in total — giving a more comprehensive picture of what’s driving risk for poor maternal health outcomes in counties across America.

The data reveals that a woman’s chance of a healthy pregnancy varies greatly depending on where she lives, based on factors such as whether she has a high school diploma, her exposure to poverty, her access to OB-GYNs and midwives, and her access to abortion clinics.

How at risk are women in your county, and why? Search for your county to find out. (Higher scores indicate more risk.)

Overall maternal risk in New York County, N.Y. is low.

Reproductive healthcare: 1

Source: Surgo Ventures.·Notes: Maternal risk is on a scale from 0 to 100, with a higher score meaning higher risk. W.R.A. stands for “women of reproductive age.” Air pollution is determined by the concentration of particulate matter (PM2.5). Quality of outpatient care is based on the U.S. Department of Health and Services’s Prevention Quality Indicators.

One of the most striking findings is that a woman’s risk of poor maternal health varies largely by race, and those racial gaps vary greatly by region.

For example, there are big gaps in risk for Black versus white women in the Midwest and Northeast.

For American Indian and Alaska Native mothers, the gaps in risk compared with white mothers are largest in the West and Midwest, especially in states with American Indian reservations like Montana, South Dakota and New Mexico, suggesting that women of reproductive age living on American Indian reservations may die at higher rates and have riskier pregnancies.

What’s contributing to the large gap between white and Black women?

In almost all states, three types of factors play an outsize role. White women are more likely to live in good physical environments: communities with less pollution, less violent crime and better access to high-quality housing and transportation options. They are also more likely to be in good physical health, with access to treatment and prevention strategies for sexually transmitted infections and non-communicable diseases. And they face fewer socioeconomic barriers: They are more likely to have access to educational opportunities, financial resources and healthy food options, and are less likely to face language barriers.

But there are a few exceptions — in Wisconsin, for example, the state with the single highest risk gap between Black and white women. Mental health and substance abuse play an important role, in addition to the factors described above. This includes general stress levels, mental illness such as depression, access to mental health care and use of substances like nicotine and illicit drugs.

Over the past two decades, maternal mortality has increased almost 60 percent. The United States is the only other Group of 7 country besides Canada to experience such a drastic decline in maternal health. (Canada saw a minor increase in pregnancy-related deaths.)

President Biden has invested funding in a variety of programs to improve maternal health, like expanding Medicaid coverage to 12 months after a person gives birth, implicit bias training for health care providers and state-level maternal mortality review committees.

Passing the Black Maternal Health Momnibus Act, which includes a set of transformative policies for maternal health, is the next important step in tackling this complicated issue. It is the most comprehensive and evidence-based legislative approach to date in addressing barriers to good maternal health for women of color.

These broad federal policies can’t fix the problem on their own, though. We also need much more targeted local action, in the form of a specific bundle of solutions tailored to the issues each community faces, because the reasons for maternal risk can vary from county to county.

Consider two counties where pregnancies are especially risky: Georgetown County, S.C., and Webb County, Texas.

In Georgetown County, local leaders could focus on non-communicable diseases and increasing screenings for sexually transmitted infections, providing low-cost transportation options to help women get to medical appointments, or offering more high-quality, affordable housing where pregnant women don’t have to worry about black mold growing in their bedrooms.

But in Webb County, risks are driven by things like English proficiency, whether a woman has a high school diploma, whether she lives in poverty or food insecurity, access to OB-GYNs and midwives, and access to abortion clinics. Decision-makers there should focus on a different set of solutions, such as expanding access to nutrition programs like WIC and SNAP, and increasing access to midwives, doulas and family planning services.

While the vulnerability index demonstrates the range of problems facing lawmakers, it does not fully explain the racial disparities. This suggests that other causes are at play. Black women face implicit biases that result in worse treatment and must endure other manifestations of racism, such as residential segregation at the neighborhood level.

Solving racial disparities in maternal health outcomes is the responsibility not only of people who work in health care. Housing authorities can help lower-income women find better living arrangements; city planners can increase access to healthy food options in underserved communities; and educators and school administrators can provide flexible G.E.D. or higher-degree options for mothers, potentially including free or low-cost daycare.

The United States is long overdue in addressing the devastating racial maternal health gap. Policymakers, researchers, community health organizations and advocates from all sectors must come together to provide a better future for all people giving birth.

 https://www.nytimes.com/interactive/2021/11/17/opinion/maternal-pregnancy-health.html?

Medicare Advantage's cost to taxpayers has soared in recent years, research finds

By Fred Schulte - Kaiser Health News - November 11, 2021

Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.

Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, says his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.

Nearly $34 billion of that new spending came during 2018 and 2019, the latest payment period available, according to Kronick. The Centers for Medicare & Medicaid Services made the 2019 billing data public for the first time in late September.

"They are paying [Medicare Advantage plans] way more than they should," says Kronick, who served as deputy assistant secretary for health policy in the Department of Health and Human Services during the Obama administration.

Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies. The health plans have enrolled nearly 27 million members, or about 45% of people eligible for Medicare, according to AHIP, an industry trade group formerly known as America's Health Insurance Plans.

The industry argues that the plans generally offer extra benefits, such as eyeglasses and dental care, not available under original Medicare and that most seniors who join the health plans are happy they did so.

"Seniors and taxpayers alike have come to expect high-quality, high-value health coverage from MA [Medicare Advantage] plans," says AHIP spokesperson David Allen.

Yet critics have argued for years that Medicare Advantage costs taxpayers too much. The industry also has been the target of multiple government investigations and Department of Justice lawsuits that allege widespread billing abuse by some plans.

Some insurers see 'eye-popping' revenue gains

The payment issue has been getting a closer look as some Democrats in Congress search for ways to finance the Biden administration's social spending agenda. Medicare Advantage plans also are scrambling to attract new members by advertising widely during the fall open-enrollment period, which ends next month.

"It's hard to miss the big red flag that Medicare is grossly overpaying these plans when you see that beneficiaries have more than 30 plans available in their area and are being bombarded daily by TV, magazine and billboard ads," says Cristina Boccuti, director of health policy at West Health, a group that seeks to cut health care costs and has supported Kronick's research.

Kronick called the growth in Medicare Advantage costs a "systemic problem across the industry," which CMS has failed to rein in. He says some plans saw "eye-popping" revenue gains, while others had more modest increases. Giant insurer UnitedHealthcare, which in 2019 had about 6 million Medicare Advantage members, received excess payments of some $6 billion, according to Kronick. The company had no comment.

"This is not small change," says Joshua Gordon, director of health policy for the Committee for a Responsible Federal Budget, a nonpartisan group. "The problem is just getting worse and worse."

Responding to written questions, a CMS spokesperson says the agency "is committed to ensuring that payments to Medicare Advantage plans are appropriate. It is CMS's responsibility to make sure that Medicare Advantage plans are living up to their role, and the agency will certainly hold the plans to the standards that they should meet."

Making any cuts to Medicare Advantage payments faces stiff opposition, however.

On Oct. 15, 13 U.S. senators, including Sen. Kyrsten Sinema, D-Ariz., sent a letter to CMS opposing any payment reductions, which they said "could lead to higher costs and premiums, reduce vital benefits, and undermine advances made to improve health outcomes and health equity" for people enrolled in the plans.

The formula for higher profits: Score patients as sicker than they are

Much of the debate centers on the complex method used to pay the health plans.

In original Medicare, medical providers bill for each service they provide. By contrast, Medicare Advantage plans are paid using a coding formula called a "risk score" that pays higher rates for sicker patients and less for those in good health.

That means the more serious medical conditions the plans diagnose the more money they get — sometimes thousands of dollars more per patient over the course of a year with little monitoring by CMS to make sure the higher fees are justified. According to whistleblower complaints calling out this practice of upcoding, three of the conditions frequently given a higher risk score by Medicare Advantage plans include cases of diabetes with complications, major depression and congestive heart failure.

Congress recognized the problem in 2005 and directed CMS to set an annual "coding intensity adjustment" to reduce Medicare Advantage risk scores and keep them more in line with original Medicare.

But since 2018, CMS has set the coding adjustment at 5.9%, the minimum amount required by law. Boccuti said that adjustment is "too low," adding that health plans "are inventing new ways to increase their enrollees' risk scores, which gain them higher monthly payments from Medicare."

Some of these coding strategies have been the target of whistleblower lawsuits and government investigations that allege health plans illegally manipulated risk scores by making patients appear sicker than they were, or by billing for medical conditions patients did not have. In one recent case, the Justice Department accused Kaiser Permanente health plans of obtaining about $1 billion by inflating risk scores. In a statement, the insurer disputed the allegations. (KHN is not affiliated with Kaiser Permanente.)

"Little evidence" those higher payments are justified

Legal or not, the rise in Medicare Advantage coding means taxpayers pay much more for similar patients who join the health plans than for those in original Medicare, according to Kronick. He says there is "little evidence" that higher payments to Medicare Advantage are justified — there's no evidence their enrollees are sicker than the average senior.

Kronick, who has studied the coding issue for years, both inside government and out, says that risk scores in 2019 were 19% higher across Medicare Advantage plans than in original Medicare. The Medicare Advantage scores rose by 4 percentage points between 2017 and 2019, he says — faster than the average in past years..

Kronick says that if CMS keeps the current coding adjustment in place, spending on Medicare Advantage will increase by $600 billion from 2023 through 2031. While some of that money would provide patients with extra health benefits, Kronick estimates that as much as two-thirds of it could be going toward profits for insurance companies.

AHIP, the industry trade group, did not respond to questions about the coding controversy. But a report prepared for AHIP warned in September that payments tied to risk scores are a "key component" in how health plans calculate benefits they provide and that even a slight increase in the coding adjustment would prompt plans to cut benefits or charge patients more.

That threat sounds alarms for many lawmakers, according to Kronick. "Under pressure from Congress, CMS is not doing the job it should do," he says. "If they do what the law tells them to do, they will get yelled at loudly, and not too many people will applaud." 

https://www.mainepublic.org/npr-news/2021-11-11/medicare-advantages-cost-to-taxpayers-has-soared-in-recent-years-research-finds

Democrats Choosing Less Risky Path on Drug Prices

Experts say recent compromises could create less harm in balancing innovation with profits.

by Margot Sanger-Katz - November 6, 2021

In early budget negotiations, it looked as if the Democrats were finally going to take on Big Pharma over spiraling drug prices. Then last week, drug pricing fell out of the bill altogether and it looked as if the drug companies had won again. Now there is a compromise that looks modest but could have real bite.

The drug price regulation Congress is now considering would achieve three main goals. It would limit the amount that Medicare patients can be asked to pay for drugs out-of-pocket. It would restrict how much drugmakers can increase their prices each year. And, for the first time, it would allow Medicare to negotiate directly with drugmakers on prices for their medications.

The provision on price negotiation was the one most substantially changed in the last week: It would apply to fewer drugs, require smaller discounts, and, most critically, shield new drugs from negotiations.

And yet a wide range of health economists and advocates say those compromises may have created a less risky way of balancing innovation with profits. The policy isn’t simply smaller than the original. If enacted, it will save the federal government less money than the legislation passed by the House two years ago. But it is also less likely to hinder the development of new treatments and cures, the experts said.

“There is a lot to be said for incremental changes that allow us to learn,” said Benedic Ippolito, a health economist at the American Enterprise Institute, who studies the drug market. “Especially when we think there are meaningful trade-offs to consider.”

The bill text could, of course, change or fail to become law. The Congressional Budget Office has not yet measured its effects, and House moderates are reluctant to vote on the social spending package without a comprehensive estimate of the bill’s many parts. But the drug provisions were negotiated with key senators, including Kyrsten Sinema of Arizona, who had suggested she would have voted against the previous version.

Policymakers tackling the system of drug prices have always been balancing competing interests. The unregulated U.S. pricing system causes huge expense and poor health care outcomes for people who can’t afford their medicines. But the system also encourages major risky investments in biomedical research that benefit the world. No one has a good model of how the machine works, but nearly everyone who studies the system says taking money out of the prescription drug business is likely to have some negative effect on investment in drug development.

“There is a real trade-off we face here between costs today versus treatments tomorrow,” said Craig Garthwaite, a professor of strategy at the Kellogg School of Management at Northwestern, who studies drug development.

Decades ago, most major drugs were developed by the large pharmaceutical companies that sold them. But that system has changed. Today, most drugs originate in small biotech start-ups. Those firms are often devoted to the development of a single drug, and they are financed by venture capital firms that are willing to make risky bets in the hopes that one will pay off big. In the case of biotech, the payoff usually comes when a promising drug comes along and the company is purchased by a bigger company.

Venture firms that invest in biotech now don’t necessarily have to. Their money could just as easily go into other profitable sectors of the economy, like technology. Early stage drug companies are funded, in part, because America’s high drug prices mean that a successful drug will be worth a huge jackpot. Since the rest of the world pays less, nearly all of that investment is directed at the U.S. market.

The original House proposal to regulate drug prices would have allowed the government to lower the price of up to 250 expensive drugs, no matter how new or how innovative they were. The new approach limits that power: Drugs would be subject to price regulation only after they have been on the market for about a decade. That would mean drug companies could still charge enormous prices for new drugs, but they could do so only for so long. The law would allow price regulation after nine years for most common medications, and 13 years for more complicated drugs known as biologics.

Peter Bach, the director of the Drug Pricing Lab at Memorial Sloan Kettering, and the chief medical officer of Delfi Diagnostics, has been a longtime outspoken advocate for drug price reforms. He said a delayed approach would protect the public and the government from what he sees as the industry’s most egregious practices — the endless price hikes and patent shenanigans that often insulate expensive drugs from competition for decades. But he also says it will keep the promises of the country’s intellectual property system by giving the companies a few years to profit off their new inventions.

“It all aligns with core premises in our system,” he said. “And reining in distortions that have crept in.”

The original legislation was almost guaranteed to discourage the creation of some future drugs. The nonpartisan Congressional Budget Office said it would lead to 3 percent fewer drugs in the first decade of its life, and 10 percent fewer in the decade after, as it affected drugs earlier in the pipeline. Other scholars of the system, including Mr. Garthwaite, say the effects could be even larger.

Stephen Ubl, the C.E.O. of the industry trade group PhRMA, had described the threat of the original bill as “existential” to his industry. He sounded no less concerned in a statement this week about the new proposal: “If passed, it will upend the same innovative ecosystem that brought us lifesaving vaccines and therapies to combat Covid-19.”

Mr. Ubl’s comments ignore the ways the new proposal is kinder to his industry than its predecessor.

The industry’s messaging “doesn’t scale down, even though, in fact, the innovation incentive changes would be less,” said Rachel Sachs, a law professor at Washington University in St. Louis, who studies drug policy. She said delayed negotiation was likely to mean less harm for early stage development, and noted that many of Medicare’s most expensive drugs have been on the market for years, meaning such negotiations could still make a difference.

The current proposal won’t succeed in making drug prices in the United States similar to those in peer countries. On average, Americans pay about 250 percent of drug prices in other developed countries, according to a recent study from the RAND Corporation. Those other countries tend to negotiate aggressively for lower drug prices, often by purchasing drugs for the entire nation centrally, and often by being willing to say no to newer, effective therapies that regulators deem not worth the expense.

The current bill would allow Medicare to negotiate over the prices of no more than 20 drugs each year, and only those that have been around for a while. That is a relatively small subset of the drug universe. The Food and Drug Administration approved 53 new drugs last year alone.

Advocates backing a more aggressive approach believe there are opportunities to lower prices much more without disrupting the flow of new medicines. There are also concerns that industry could game this new system in various ways, blunting its effects.

But the bill’s moderation does not mean it is not groundbreaking: It would mean a fundamental change in the way that drugs are priced and sold in the U.S. There’s a drug called Revlimid that treats the blood cancer multiple myeloma. It has been on the market since 2005, and costs nearly $17,000 a month. It’s the second-most costly drug in Medicare. And, if the new legislation were in effect today, that price would probably be a lot lower.

https://www.nytimes.com/2021/11/06/upshot/democrats-drug-prices.html 

Employer-sponsored coverage keeps getting more expensive

By Rachel Roubein - Washington Post  - November 11, 2021

 

The cost of health insurance is – still – steadily rising for the nearly 155 million Americans who get health benefits through their job.

This year, the average annual premiums are over $22,200 for families and $7,700 for individuals — a 4 percent increase from 2020. That’s according to the Kaiser Family Foundation’s annual survey on employer benefits, which has documented a consistent uptick in the cost of health coverage. 

• For instance: The average premium for family coverage rose 22 percent over the last five years.

This trend line underscores a hard truth about American health care: The system isn’t getting any better. 

Efforts to make health care more affordable have been incremental at best, and experts worry policymakers aren’t addressing the root causes of growing costs. The 2010 Affordable Care Act made significant gains in expanding health coverage, but largely did that by expanding government subsidies rather than lowering the costs of insurance, medicines or medical services.

• “I think that this data still shows you that over the long term, the system is unsustainable,” said James Gelfand, an executive vice president of the ERISA Industry Committee, which represents large employers.
• “The biggest No. 1 driver is provider prices, hospital prices, drug prices, the prices of ambulatory services,” said Sabrina Corlette, a co-director at Georgetown University's Center on Health Insurance Reforms. “We just have what is essentially market dysfunction.”

By the numbers

Workers pay a fraction of the total amount of the premium out of their paychecks since employers bear the brunt of the cost. 

• A family will pay roughly $6,000 this year, while the employer pays for the rest (which is over $16,200).
• An individual will pay nearly $1,300, while the employer picks up $6,400.

Reality check: Health-care economists argue that it’s all essentially a hidden cost to the employee. If premiums cost less, for instance, then workers’ salaries would be higher, they say.  

• “I think we lose the fact that this is coming out of the pockets of Americans. It's not some largesse from your employer,” said Craig Garthwaite, a health economist at Northwestern University’s Kellogg School of Management.

Another cost: The vast majority of workers pay a certain amount of money before their insurance plan kicks in to pay for most medical services.

• The average deductible for single coverage is $1,669, which is similar to last year, though up 68 percent over the past 10 years.
• The deductible is much higher for those who work for small companies ($2,379) compared with large firms ($1,397).

Pandemic's impact

Insurers actually reaped financial benefits during the pandemic, doubling their profits in the midst of the first coronavirus surge in spring 2020, as people stopped going to the doctor. Yet the coronavirus didn’t appear to sway the cost of employer-based coverage, since premiums rose 4 percent between 2019 and 2020 — the same increase as this year. 

• “The pandemic made employers, maybe, more conservative than they otherwise might have been about instituting major changes in benefit design or cost structures,” said Corlette, who pointed to the fact that deductibles and employee cost-sharing didn’t dramatically increase.

Instead, some employers beefed up telemedicine and mental health services amid a pandemic that took an unprecedented toll on Americans’ livelihoods.

• Roughly 16 percent of employers developed new mental health resources, like assistance programs, and 31 percent expanded the way workers could get mental health care, such as through telemedicine.
• However, only 3 percent bolstered coverage for out-of-network mental health and addiction treatment, and just 6 percent increased the number of providers an enrollee could see.
• Roughly 19 percent of smaller companies and 35 percent of large firms expanded the services telemedicine covers. And many increased the promotion of these out-of-office visits as many Americans hit pause on seeking care.

The key question is whether employers will keep these services around — or scale them back once the pandemic fades. 

• “We're gonna want to follow up on how the telemedicine stuff plays out, whether or not there's going to be a little concern about employers about opening the floodgates,” said Gary Claxton, a KFF senior vice president.

https://www.washingtonpost.com/politics/2021/11/11/employer-sponsored-coverage-keeps-getting-more-expensive/

Why Was My Doctor Visit Suddenly So Expensive?

The facility fee may be to blame for the added costs of a doctor visit.

 by Richard Klasco - NYT - November 4, 2021

A. A facility fee is an additional charge that some medical practices can add to the cost of each doctor visit. The additional charge usually comes as a surprise because, unlike an exam or a test or treatment, the facility fee is not tied directly to hands-on care.

The purpose of the facility fee is to compensate hospitals for the expense of maintaining the physical premises. Hospital-owned, off-campus medical practices are also allowed to charge the facility fee to cover specific regulatory requirements, such as building codes, disaster preparedness, equipment redundancy and other items that are largely invisible to patients.

While the regulatory requirements are arcane, the economics of the facility fee are straightforward: the practice bills more; the hospital makes more; and the patient pays more.

How much more you might have to pay depends on the complexity of your visit and whether you are a new patient. For new patients, whose visits entail more work than those of established patients, facility fees typically range from $131 to $322 per visit; for established patients, they are slightly lower. In surgical centers and free-standing emergency rooms, the facility fee can be thousands of dollars.

It is difficult to know in advance where your visit will fall within these ranges, as cost is determined by the CPT code, the billing designation that indicates the medical, surgical and diagnostic services you receive during your visit. The CPT code is typically assigned after your visit by your doctor’s business office.

The portion of the facility fee that you have to pay depends on your insurance plan. “Gold plans” usually cover a percentage of the facility fee at in-network facilities, but “bronze plans” often do not. At out-of-network facilities, costs will be higher, and coverage will be less. With all plans, you will be responsible for the entire facility fee until your deductible has been satisfied. Thus, facility fees can easily add a thousand dollars or more to a family’s annual health care costs.

You have the right to know upfront whether a facility fee will be assessed. The insurance company Aetna, for example, advises: “Ask if there will be a facility fee. If so, find out whether the procedure can be done at another location that doesn’t charge a fee. Facility fees can be tough to fight after the fact.”

One can avoid these costs by seeing a doctor whose practice is not owned by a hospital. Whether it is worthwhile to stay with a doctor or practice that charges a facility fee is a personal decision. The decision should be based on one’s finances and medical problems.

One option might be to stay with your doctor for long-term, serious health issues, but to use lower-cost venues, such as walk-in clinics, for minor problems.

 https://www.nytimes.com/2019/11/01/well/live/why-was-my-doctor-visit-suddenly-so-expensive.html