Editor's Note -
The following link is to a radio program about healthcare reform that aired on WERU-FM (Community Radio) in Blue Hill, Maine on September 6, 2022. Dr. Philip Caper and Dr. Geoff Gratwick were interviewed about health care reform in Maine by Jim Campbell and Amy Browne of the WERU staff. Both Drs. Caper and Gratwick were instrumental in founding Maine AllCare, a non-profit organization advocating universal health care in Maine.
https://weru.s3.amazonaws.com/archives/2022/mtwlcb_20220906.mp3
- SPC
New insurer in Maine’s ACA marketplace to offer hybrid health insurance
Taro Health will offer direct primary care packaged with conventional health insurance in Cumberland County beginning in 2023, and says it could go statewide in a few years.
by Joe Lawlor - Portland Press Herald - September 1, 2022
Starting this fall, Cumberland County residents will have the option of purchasing a new type of health insurance on the Affordable Care Act marketplace that blends traditional insurance and direct primary care.
Taro Health – a new insurer based in Maine – is offering a potentially first-in-the-nation insurance model that consumers will be able to purchase starting in November, with coverage beginning in 2023.
The insurer is targeting about 5,000 people who choose to pay their doctors directly and forgo traditional insurance, a model called direct primary care. Under direct primary care, patients pay out of pocket for routine doctor visits and the type of care that can be done in a doctor’s office, such as diagnosing and treating mild illnesses, some screenings, blood tests and annual physicals.
People who want to switch to a direct primary care doctor in 2023 are also eligible for Taro Health plans.
By eliminating insurance paperwork for routine care, direct primary care advocates say, doctors can focus more time on patients and pass on cost savings from not having to process insurance claims.
But that model flounders when patients need specialized care, such as for broken bones, cancer or rare diseases. If they hadn’t purchased insurance in addition to paying direct primary care fees, they would be on the hook for the cost of expensive hospital visits and specialty care. The Taro Health plan is a hybrid of conventional insurance and direct primary care. Members pay a monthly premium for traditional health insurance options and a network of 12 physicians who participate as direct primary care providers.
A COMBINING OF CONCEPTS
“There’s a combining of concepts,” Jeff Yuan, a co-founder of Taro Health, said in an interview Wednesday. “We are insurance. We are not just direct primary care.”
Yuan, of New York City, said his company chose Maine to launch the hybrid insurance model because the state has one of the highest per capita rates of direct primary care physicians in the country. Yuan said he expects Taro Health will expand to the rest of Maine and other markets in the coming years. MaineHealth’s network will be in-network for Taro Health.
Taro Health plans will be available at CoverME.gov starting on Nov. 1. Comparison shopping for the new Taro Health plan and the rest of the ACA marketplace plans were not available on the Maine Bureau of Insurance website Wednesday, but they are expected to be released soon.
Direct primary care has traditionally attracted people who want to have more time with their doctors and have the financial means to pay a monthly membership fee, the cost of routine care and a premium for a conventional health plan to cover major illnesses and injuries.
Dr. Lisa Lucas, a direct primary care doctor in Freeport, said about half of her patients have insurance, and have to pay for her care above and beyond their monthly insurance premiums. Those customers are buying conventional health insurance plans and paying for direct primary care, making it cost prohibitive for some families.
“For a lot of my patients, if they’re paying for insurance, to see me, I’m an extra cost,” Lucas said on Wednesday. “But with a Taro plan, I am no longer an extra cost. It’s included in the plan.”
Starting in 2023, Taro will have a network of 12 direct primary care physicians in Cumberland County that patients can choose from, and Taro Health’s monthly premium will cover the monthly DPC membership fee, which is typically about $75, Yuan said. Out-of-pocket costs would be capped at $9,100, and like other insurance there would be a series of co-pays and caps on drug costs.
Yuan said the emphasis will be on no or low costs for all primary care services to keep patients healthy and thus less likely to need more expensive specialty care.
“The plan is really designed for people who want a different primary care experience,” Yuan said.
Taro Health will also be offering traditional plans on the ACA marketplace, alongside Anthem, Community Health Options, United Healthcare, Harvard Pilgrim and Aetna.
COMPETITIVE PRICING
Yuan said the average silver plan premium for Taro is about $600 per month without subsidies. ACA subsidies typically pay the bulk of the cost of monthly premiums.
“When we developed rates and priced our plans, we worked to ensure we were affordable to Mainers. Our premiums are price-competitive with all the other insurers, with us being a few dollars more or less than the incumbents depending on the metal tier,” Yuan said.
ACA plans are broken into bronze, silver and gold plans, with bronze plans having lower premiums but less generous benefits, and gold offering extensive benefits but higher premiums, with silver a middle-of-the-road plan.
Lucas, the Freeport doctor, said she used to practice medicine outside of the direct primary care model, and found she was spending a few minutes with each patient, and not getting to know them or their needs. Part of that is the traditional model jams as many patients as possible into the system, while direct primary care caters to fewer patients. The other reason she switched to direct primary care is that the insurance paperwork was taking too much time.
“You are filling out forms for the insurance company to get reimbursement rather than focusing on what the patient needs,” Lucas said.
Peter Hayes, CEO of Healthcare Purchaser Alliance of Maine, which advocates for improvements in the health care system in Maine, said that trying different models is welcome as a way to potentially address some of the shortcomings in the health care system.
“We’re excited that there’s a new product in the marketplace that consumers can look at. We like the focus on primary care,” Hayes said. “Time will tell whether their new construct works or not.”
Hayes said one potential pitfall is there might not be enough doctors to care for the volume of patients if direct primary care becomes popular since each doctor sees fewer patients.
Amazon's latest health care obsession
My thoughts on one of the bigger stories that happened over the summer
by Merrill Goozner - Washington Monthly - September 8, 2022
Concierge care for the well-off will not save the American health care system, but it could prove lucrative for Amazon.
The world’s second-largest retailer stunned health care observers late last month when it folded its start-up primary care practice just three years after it was unveiled as “the future of medicine.” It was Amazon’s second failed health care experiment, the first being a joint venture with JPMorgan Chase and Berkshire Hathaway that aimed to provide “employees and their families with simplified, high-quality, and transparent health care at a reasonable cost.”
Amazon’s latest retreat from direct involvement in health care came less than two months after it announced plans to acquire San Francisco–based One Medical, a subscription primary care service now in 25 major markets across the U.S. The main clients for One Medical’s suite of digital and in-office primary care visits are the well-off and the well-insured.
Amazon Executive Chairman Jeff Bezos has run this playbook before. Should the Federal Trade Commission approve the acquisition, we might start seeing One Medical clinics popping up inside Whole Foods stores, his high-end acquisition in the grocery store space.
A recent analysis of One Medical’s 182 medical offices showed that they are located in the top 10 percent of America’s most fortunate communities. Its clientele, which stood at 736,000 individuals at the end of 2021, is overwhelmingly urban, wealthy, non-Hispanic white, and college educated.
The firm charges $199 a year to already-insured individuals or their employers in exchange for what the firm bills as “seamless digital health and inviting in-office care, convenient to where people work, shop, live, and click.” It bills insurers or self-insured firms for its services. More than half its $255 million in revenue in the most recent quarter came from Medicare, largely through contracts with Medicare Advantage insurers, many of which also cater to younger and healthier elderly beneficiaries.
The one thing One Medical doesn’t do much is take on full risk for treating its patients. The rapidly expanding firm absorbs all the health care expenses, including paying for costly specialty care and hospitals, for less than 5 percent of its patients.
The nation’s ailing primary care system desperately needs a shot in the arm. Bezos launched Amazon Care three years ago with claims that the start-up medical service would provide that boost. Now it’s gone, and One Medical isn’t the answer.
The well-insured members of the upper middle class attracted to concierge providers like One Medical are not the main reason U.S. health care spending is the highest in the world. However, those patients’ overuse of certain procedures (think lower back, cardiac stent, and minor skin lesion operations, for instance) are certainly contributors. About 5 percent of patients account for half of all health care spending. These health care frequent flyers are disproportionately poor and less educated, and suffer from multiple chronic conditions that require intensive specialist treatment and lead to frequent hospitalizations.
A recent National Academies of Sciences, Engineering and Medicine report identified a well-functioning primary care system as key to getting better outcomes and lowering costs for these seriously ill people. Empowering primary care physicians to coordinate their care, and giving their practices expanded staff options for dealing with those patients’ most serious social problems, like poor or no housing and food insecurity, will reduce hospitalizations, improve their overall health, and in the long run lower the overall cost of care.
It is significant that Amazon dropped its Amazon Care venture, because its 1.6 million employees should have been an instant clientele. Its workforce has a disproportionate need for intensive primary care advice.
Amazon, which aggressively fights every attempt by its workforce to unionize, pays its workers significantly less than workers earn at competitor firms like FedEx and UPS. Their employees are subjected to more stress on the job and suffer workplace injuries at twice the rate of other firms. Just ahead of last year’s holiday season, more than 200 public health experts sent an open letter to Amazon CEO Andy Jassy begging the firm to improve conditions for warehouse workers and drivers because “injuries among Amazon workers increased dramatically during ‘peak times’ like the holiday season and Amazon’s Prime Day.”
“This decision by Amazon to throw in the towel must come as vindication to those who believed that the healthcare business is just too complex, even for a company like Amazon,” Paddy Padmanabhan, CEO of Damo Consulting, told The Washington Post. “This raises the question of whether anyone can ever be successful as a stand-alone primary care provider in healthcare or whether you need to be part of an integrated health system to make it work.”
The consultant speculated that Amazon might withdraw its bid for One Medical. But, while it’s still losing money in its expansion phase, the firm claims that intensive primary care saves money for its business clients.
A JAMA-published study of its in-house health clinic at Elon Musk’s SpaceX venture in Hawthorne, California, showed that company workers (average age 27, 62 percent male, and highly educated) who used the clinic reduced their use of emergency rooms by 33 percent and hospital admissions by 16 percent compared to employees who did not. Savings from those reductions more than offset the increased spending on primary care, the study, whose authors included One Medical clinicians, claimed.
That should encourage Bezos and his expansion-minded staff to stay the course. Rather than focusing on the hard-to-treat, like his own employees, One Medical will likely become another offering in Amazon’s growing portfolio of business services for high-end technology companies, like its own Amazon Web Services.
There’s one other reason One Medical may continue to appeal to Bezos. Publicly traded since January 2020, it has been fighting off a unionization drive by its 500 support personnel. “The minute we went IPO, we pivoted away from patient care to membership volume,” an administrative staffer told a National Public Radio reporter. “Ever since we went public as a company, profit matters over employees and patients.”
Amazon Really Believed It Could Sell You a Health Care Fantasy
By Libby Watson - NYT - September 2, 2022
What if you could get health care as quickly and easily as you order socks and cat litter? It sounds fanciful in a country where people die waiting to see a doctor, but Amazon believed it could do for health care what it had done for shopping. Hailed as “the future of medicine,” the Amazon Care telehealth and house-call service was pitched to employers as “high-quality care, convenience and peace of mind.”
Last week, though, the company announced it would shut down Amazon Care at the end of this year. For the second time in two years, Amazon has had to concede failure in an effort to take on the American health care system. It might be possible to deliver a spatula to someone’s apartment in 24 hours, but applying the same approach to health care seems a taller order.
Yet Amazon is not giving up: It plans to purchase One Medical, a membership-based primary care provider with in-person and telehealth services in 19 cities. One Medical could prove a better business bet, but there’s no grand fix for the health care system to be achieved here.
Any company claiming its innovation will revolutionize American health care by itself is selling a fantasy. There is no technological miracle waiting around the corner that will solve problems caused by decades of neglectful policy decisions and rampant fraud. And a fix aimed at just the upper crust of employer-sponsored health coverage has no hope of making health care more accessible to those who are truly being left behind.
Amazon Care and One Medical saw the same market opportunity within the crisis-ridden American health care system: a paid escape hatch for the better-off. Not the really wealthy — they have always had concierge care on demand — but the middle- to upper-middle-class worker who has a job and insurance, yet who can’t believe how hard it is just to see a doctor.
One Medical, pitching itself as “no ordinary doctor’s office,” lets people with means leapfrog some of the hassles and waits of American health care, while promising longer appointments and friendlier doctors. Its offices are concentrated in wealthier areas and do not accept Medicaid, which reimburses providers far less than private insurance and tends to cover sicker patients who require more costly care.
Amazon will have a big task on its hands to make One Medical work: The company, which charges $199 a year for membership, has not been profitable, losing $91 million in the first quarter of 2022.
Amazon Care hoped businesses would pay for their employees to have on-demand telehealth and in-home care, allowing them to skip the process of finding a provider in their insurance network, making an appointment that may be weeks away and taking time off work to go to it. Amazon would send a nurse to you, to “give people back valuable time in their day,” its website promised.
But those promises outstripped reality. Shortly before the announcement of Amazon Care’s closing, The Washington Post reported that former clinical employees alleged that the service had “prioritized pleasing patients over providing the best standard of care,” trying to scale up too quickly to establish good practices. The telehealth providers struggled with regulations and the logistics of caring for patients in many states, unsure if they could prescribe antibiotics or where to refer patients for X-rays.
The Post also reported that Amazon asked nurses to “store and dispose of medical supplies at home and stabilize patient blood samples using centrifuges in their personal cars.” (Amazon told The Post that mobile nurses were provided with disposal equipment. The company said it prioritized patient and employee safety).
The venture’s approach to labor was characteristic of Amazon. One nurse formerly at Care Medical, the independent company founded and essentially controlled by Amazon that provided the actual health care for Amazon Care, told The Post that the contract nurses used were “essentially gig workers, and their training was really subpar.” She also said that an Amazon staff member told her that nurses were considered “the warehouse workers of Amazon Care.”
That is chilling to hear, given the years of complaints from Amazon warehouse workers about oppressive, even dangerous working conditions. Amazon’s entire brand is speed and convenience — for the customer. The price for that speed is relentless toil and sometimes impossible-to-meet standards for workers, leading to extremely high turnover. Such a model is harder to maintain for a health care company, with workers who typically require years of training, and in the middle of a nursing shortage.
One Medical has faced accusations of putting profits ahead of patient care, too, with staff members complaining that executives have cut appointment lengths and placed unrealistic expectations on call center employees since the company went public in 2020. (One Medical has denied those accusations.)
Replacing the easy parts of primary care is, well, easy. But part of why Amazon Care had difficulties is that not all aspects of primary care are so simple that they can be performed in your home or through a video consultation (which is nevertheless a valuable service that is no doubt here to stay). For anything more complicated, patients would still have to visit a traditional clinic, meaning they would have to contend with all the things that are most tiresome about American health care: insurance, phone calls and drug prices — if they can get the time off to visit the doctor at all.
At the same time, Amazon Care struggled to offer enough services to compete with other telehealth and in-person providers, including One Medical, which has about 200 physical locations and partnerships with over 8,000 companies.
Amazon is right about one thing: American primary care is troubled. Reams of evidence show that good primary care improves health and lowers costs, yet primary care is one of the worst-paying fields in medicine. Independent practices are increasingly being absorbed by larger hospital systems, which can more easily make money on referrals to their specialists; this process further drives up health care costs. America spends more than twice what other wealthy countries spend on health care, while also having worse health outcomes. We have it all backward.
This imbalance results from a thicket of incomprehensible financing systems. Hospitals say they lose money on treating Medicaid and Medicare patients, and therefore must charge private insurance more to make up the shortfall. Prices are negotiated with insurers for thousands of individual procedures and services, but even the hospitals themselves might not know how those numbers relate to any real costs incurred. Insurance companies make an increasing portion of their huge profits running Medicare Advantage plans, which have received billions in inflated payments for claiming their patients are sicker than they are. Wealthy hospitals abound in rich areas while rural hospitals close.
Amazon might think it can fix anything with enough money, technology and logistics, but Amazon Care didn’t have a hope of untangling this mess. Against most companies that sell products in America, Amazon is a Goliath. Put it up against the problems of the American health care system, and it looks like David with a slingshot made of wet spaghetti.
https://www.nytimes.com/2022/09/02/opinion/amazon-health-care.html
CVS Makes $8 Billion Bet on the Return of the House Call
The deal for Signify Health, which has a network of doctors who make home visits, would cement the drugstore chain’s move away from its traditional roots.
The drugstore giant CVS Health said on Monday that it would acquire Signify Health, which runs a network of doctors making house calls, for roughly $8 billion in a deal that cements the pharmacy chain’s move away from its retail roots.
The deal, if approved by shareholders and regulators, would give CVS, which has nearly 10,000 stores nationwide, a new avenue to reach its customers: at home.
Pharmacies like CVS have been searching for new ways to strengthen ties with their large customer base, particularly as consumers increasingly head online for the everyday items that used to draw them into stores. In Signify, CVS is acquiring a company that offers analytics and technology to help a network of 10,000 doctors provide in-home health care to 2.5 million patients across the United States. Signify has a focus on those on Medicare and in underserved communities.
“Their interest is to take over the home,” said Dr. Eric Topol, a professor of molecular medicine at Scripps Research in San Diego, who noted that any care provided to patients at home, rather than in the hospital, lightens the financial load on insurance companies, including Aetna, the insurance business that CVS owns. Signify contracts with insurance providers, including Aetna.
“If you’re looking at it from Aetna’s standpoint, this is a way to save big, big expenditures for their people they cover,” Dr. Topol said.
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CVS has been whittling down its store base as it has pushed further into health care. The retailer said last year that it would close roughly 900 stores over three years. Its executives told analysts last month that the chain was looking at deals as a way to tack on new health services and ways to deliver those services‚ including in the home.
Karen S. Lynch, the chief executive of CVS, reiterated that strategy in a statement on Monday. “Signify Health will play a critical role in advancing our health care services strategy and gives us a platform to accelerate our growth in value-based care,” she said.
CVS has roughly 40,000 physicians, pharmacists, nurses and nurse practitioners, as well as 1,100 MinuteClinic locations, which offer care ranging from vaccinations to physicals.
The pharmacy giant will pay Signify $30.50 per share in cash. Signify’s shares jumped almost 7 percent in after-hours trading; CVS’s stock rose less than 1 percent. The two companies said they expected the deal to close in the second half of 2023, pending regulatory and shareholder approval.
“We are both building an integrated experience that supports a more proactive, preventive and holistic approach to patient care, and I look forward to executing on our shared vision for the future of care delivery,” the chief executive of Signify, Kyle Armbrester, said in a statement on Monday.
CVS’s move toward health care began in earnest nearly a decade ago, with its $21 billion acquisition of pharmacy benefits manager Caremark Rx. It acquired more than 1,000 of Target’s pharmacies in 2015 and the health insurer Aetna for $69 billion in 2018.
The Centers for Medicare and Medicaid Services said in 2019 that it expected national health spending to reach $6 trillion by 2027, consuming a larger share of gross domestic spending, as baby boomers aged and the price of services rose. But many Americans still do not get care, in part because of the costs and inconvenience.
The pandemic changed the way people seek medical attention and how companies think about providing it, as many patients sought new alternatives to traditional hospital care. CVS and other retailers like Walmart played a key role in the Biden administration’s coronavirus vaccination campaign, and the White House also started a “test to treat” program to allow patients to test for the virus and obtain a prescription for antiviral pills at the same retail location if they tested positive.
Change across health care has led to deal-making in the industry. Amazon announced in July that it planned to acquire One Medical, a chain of primary care clinics around the country, for $3.9 billion. Walgreens has announced a string of deals, including most recently an acquisition of Carecentrix, another company that provides services in the home.
And CVS is looking to carve out its own position as the deal-making heats up.
“CVS doesn’t want to sell us just prescriptions and toothpaste; it wants to be our primary care provider,” said Erik Gordon, a professor at the University of Michigan’s Ross School of Business. “With stores that are convenient to many of us, it is going to be a big player.”
How This Rural Wisconsin County Put Publicly Funded, Non-Profit, National Health Care on the Ballot
Citizens of Dunn County, Wisconsin, have a plan to place national, publicly-funded health care for everyone on their November 8th county ballot. In June and July at meetings of the County Board of Supervisors, many spoke of a broken health care system and their proposal to fix it. After the third meeting, the Board voted unanimously to put the following question on the ballot:
“Shall Congress and the President of the United States enact into law the creation of a publicly financed, non-profit, national health insurance program that would fully cover medical care costs for all Americans?”
Located in central west Wisconsin and blessed with lakes and farmland, Dunn County is far from bustling cities. About 16,000 of its 45,000 residents live in Menomonie, the county seat, named by the Smithsonian as “One of the Best Small Towns in the USA.”
“Nobody in my family is going to retire sitting pretty and most of the reason for that can be laid at having to pay off medical expenses, even though we were insured, for months and months and months, and that is money we did not spend on all the things that you can spend money on right here in beautiful Dunn County.”
By focusing on the health care crisis in America’s heartland, the people of Dunn County hope to propel the issue onto the nation’s agenda. They believe that rural concern for neighbors just may outweigh the rancorous partisan divide, and with the idea spreading, influence a Congress that has, so far, refused to consider Medicare for All.
On July 27, 2022, between the pledge of allegiance and the story of how the county fair proceeded despite the windstorm that took out the electric milking machines, they stepped to the microphone at the Board of Supervisors’ meeting to insist that those who represent them allow their voices to be heard in a ballot referendum.
Margie Hagerman of Menomonie spoke first. “The health care of the majority of Americans has been declining in recent years with lower life expectancy than other developed countries. Other… countries have found ways to cover everyone through a national, non-profit, health insurance system. Why can’t the United States?”
“If you put a referendum out you're giving a voice to the people--you need to do that because we exist only by the consent of the people,” said Michel Brandt.
John Hoff said, “currently the drug pharmaceutical system is totally stacked against the individual—yes, they're working on something in congress but that's only for 20 drugs.”
Tom Walsh told of his son, a small business owner, who, since the Affordable Care Act, has paid $750 a month for insurance with a $5,000 deductible. “He can get one physical exam a year—that will be free…but the rest of it he pays out of his pocket. We need Medicare for All basically to save small business owners, save people that are susceptible to bankruptcy because they can't afford to pay for their insurance and if they do have it the deductible is so high it really doesn't help that much…so we really need a national health insurance program.”
Steve Hogseth called attention to the top 23 countries ranked for their democracy and asserted that, of them, the United States was the only one without universal health care of some form.
Lenore Mercer spoke of working in a clinic when the former governor suspended Badger Care. “I'll always remember a clean-cut, hard-working, full-time employed father breaking down and saying I’m not worried about myself, but for my kids, how will they get to see a doctor? I thought this is so wrong.”
“Our for-profit driven system balloons profits for insurance companies and drug manufacturers and now millions of Americans can't afford health care,” Mercer concluded.
Retired physician Lorene Vedder ended her comments by asking those in the audience who supported putting this measure on the November 8th ballot to please stand. All rose.
Monica Berrier, Dunn County Supervisor for District 13, weighed in at the Legislative Committee Meeting. “I want to make the argument that it really is in the county's interest to be advocating for a better health care system… I'll do this through the perspective of our budget and whether the current system is a responsible use of taxpayer dollars.”
She said that the county spends about $500,000 each month on health insurance and that in the 2022 budget, $10 million out of a $90 million budget has been set aside for health insurance. The $90 million is not just for personnel but includes all county operations.
“So we’re spending a lot but when we compare that to what the employees are actually getting it’s a pretty bad deal. They’re part of a system where delays and even outright denials of care are routine. I believe that as elected officials and stewards of taxpayer dollars we have a responsibility to demand better of the federal government that serves us.”
Berrier laid it out. “I want to close by thinking about what we could do with this money instead. We all know that the budget process comes down to higgling over fifty dollars here a hundred dollars there. A couple months ago we had a good discussion about the wheel tax and many of us including myself are worried about the potential impact that this might have on people who can't afford it. For comparison, the wheel tax brings in just $700,000 every year and that's peanuts compared to the 10 million dollars we are budgeted to spend on health insurance this year…instead of wringing our hands over the wheel tax we could be just fixing the roads instead. I think that we as elected officials really have a responsibility to advocate for a more efficient health care system”
Dr. Vedder had spoken earlier to the Dunn County Executive Committee. “My chief concern is a decreasing life expectancy that we have in this country. If you compare Canada to the United States, they live 4.5 years longer than we do. Back in 1970 we lived the same life expectancy so why are we seeing this difference?
“People are afraid here in our country to access health care because of the excess cost of medical care--30 million people in this country don't have health care insurance, 44 % don't have the funds to obtain medical care even if they have insurance.
“We access health care a lot less than any developed country in the world. By avoiding health care we have our people…coming to emergency rooms when it's too late to treat them, their disease is too advanced. We bankrupt people over medical bills—nowhere else in the developed world are people bankrupted by their health.”
Someone announced that the issue would be placed on the agenda for the Legislative Committee.
The health care advocates came prepared to speak at the Legislative Committee Meeting on July 20. At a couple of minutes per person, they filled the first 35 minutes of the meeting. Dr. Steve Brown told of his wife using health care services in Portugal, receiving x-ray, lab services and IV antibiotics. She was diagnosed with Legionnaires disease and received good care. He said that even though they did not have travel insurance, the bill was reasonable—about $160.
Steve Carlson of Trego spoke of a precedent in Wisconsin for a health care ballot question fourteen years ago when county voters agreed that everyone in the state should have health care coverage equal to state officials. He said that people in Washburn, Douglas, and Portage counties are working on placing referenda, like the current one proposed in Dunn County, on the ballot for the Spring election.
Louisa Gerasimo told of medical bills that depleted retirement savings. “Nobody in my family is going to retire sitting pretty and most of the reason for that can be laid at having to pay off medical expenses, even though we were insured, for months and months and months, and that is money we did not spend on all the things that you can spend money on right here in beautiful Dunn County.”
Commission Hager commented that this issue had roused the most public interest and comment since the ATV county road expansion. The supervisors voted unanimously to place the issue on the ballot. Chair Kelly McCullough said, “Looks like we will be having the referendum all right…that also answers the question of pressuring your legislators—does it work—it looks like it all right.”
Rural health care is in deep crisis. Over 800 rural hospitals are under threat of closing. Rural physicians struggle to survive on the meager payments of Medicaid. Mergers and acquisitions accelerate the pain as hospitals are bought up by those whose only concern is profit. Delayed care causes untold suffering and death. Is it possible that the people of these rural communities, under the stress of a broken health care system, can spark a movement to fix health care for the nation?
Some people in Dunn County think so and are working to make it happen.
Judge invalidates parts of the ACA that mandate health coverage of many preventive services and drugs
by Bob Herman - STAT - September 7, 2022
A federal judge in Texas has ruled that parts of the Affordable Care Act mandating health insurance companies cover many preventive services and drugs for free are unconstitutional.
Judge Reed O’Connor also said the ACA’s requirement that health plans cover HIV pre-exposure prophylaxis, or PrEP, at no cost violates religious freedom law.
The decision, released Wednesday, is a temporary win for the plaintiffs, which include Steven Hotze, a physician and conservative activist who has campaigned against the ACA and previously called same-sex marriage a “wicked, evil movement.” The Department of Health and Human Services did not immediately say if it would appeal the decision, although an appeal is considered likely.
Under the ACA, health insurers are required to cover an array of preventive health services — like cancer screenings and vaccines — at no cost. In particular, any service or drug that gets an “A” or “B” rating from the U.S. Preventive Services Task Force must automatically be added to that list of free services.
However, the plaintiffs in this case argued they should not be compelled, as individuals or as business owners, to buy and offer coverage that includes “PrEP drugs, contraception, the HPV vaccine, and the screenings and behavioral counseling for [sexually transmitted diseases] and drug use.”
O’Connor specifically agreed that any services recommended by members of the USPSTF are invalid because those members “are unconstitutionally appointed.” Instead of being appointed by those within HHS, “they must be appointed by the President and confirmed by the Senate,” O’Connor wrote.
The specific requirement that health insurers cover PrEP drugs violates religious freedom, O’Connor said in his ruling. The plaintiff had previously argued that covering PrEP — which reduces the risk of getting the deadly infectious disease HIV, and which is widely prescribed to men who have sex with men and people who inject drugs — “would make him complicit in those behaviors.” O’Connor agreed.
The list price of brand-name PrEP drugs also is more than $22,000 annually. But O’Connor argued the government does “not show a compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions.”
The requirements that insurers cover some kids’ services, reproductive services, and vaccines still stand for now.
This is not O’Connor’s first attempt at dismantling the ACA. Most recently, in 2018, he ruled the ACA was unconstitutional after Congress zeroed out the law’s individual mandate to purchase health insurance. The Supreme Court overturned O’Connor’s ruling in 2021.
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