RFK Jr. weighs major changes to how Medicare pays physicians
by Dan Diamond - Washington Post - November 22, 2024
Robert F. Kennedy Jr. and his advisers are considering an overhaul of Medicare’s decades-old payment formula, a bid to shift the health system’s incentives toward primary care and prevention, said four people who spoke on the condition of anonymity to discuss private deliberations.
The discussions are in their early stages, the people said, and have involved a plan to review the thousands of billing codes that determine how much physicians get paid for performing procedures and services.
The coding system tends to reward health-care providers for surgeries and other costly procedures. It has been accused of steering physicians to become specialists because they will be paid more, while financial incentives are different in other countries, where more physicians go into primary care — and health outcomes are better.
Although policymakers have spent years warning about Medicare’s billing codes and their skewed incentives, the matter has received little national attention given the challenge of explaining the complex issues to the public, the technicalities of billing codes and the financial interests for industry groups accustomed to how payments are set.
“It’s a very low-salience issue,” said Miriam Laugesen, a Columbia University professor who has written a book, “Fixing Medical Prices,” about Medicare’s physician payments. “The prominent stakeholders in this area would probably prefer to keep it that way.”
Kennedy was selected this month by President-elect Donald Trump to lead the Department of Health and Human Services and has been drawing up plans to roll out his “Make America Healthy Again” agenda, a set of ideas to reduce the causes of chronic disease and childhood illness. The position requires Senate confirmation.
A spokesperson for Kennedy did not respond to a request for comment.
Medicare’s billing codes are shaped by the American Medical Association, which represents more than 250,000 physicians. The lobbying group oversees a panel of several dozen physicians — known as the AMA/Specialty Society RVS Update Committee, more commonly referred to as the RUC — who study the resources needed for each medical service and issue recommendations to the federal government. While those recommendations are not binding, federal officials overwhelmingly accept them and use them to set reimbursement for doctors’ duties.
The panel’s recommendations have historically been skewed by misleading estimates of how physicians spend their time, according to a 2013 Washington Post investigation. For instance, The Post found that the RUC repeatedly inflated the amount of time a doctor needed to perform a procedure.
The AMA also collects millions of dollars in revenue from its work to develop and recommend billing codes, with the lobbying group conducting trainings, selling books and charging royalties.
The AMA declined to comment.
Lawmakers have spent decades questioning why physicians play a role in setting their own federal payments. Trent Lott, the Mississippi Republican who served as Senate minority leader, in 2001 took aim at the lobbying group’s influence, calling to strip the AMA’s copyright for the codes.
Senators say those concerns have persisted.
“I’ve long been concerned with this secretive AMA committee setting their own payment rates from Medicare,” Sen. Elizabeth Warren (D-Massachusetts) said in a statement to The Post on Wednesday. “It’s just plain unethical — these recommendations should be made in the best interest of patients and taxpayers, not a handful of well-connected insiders.”
Sens. Sheldon Whitehouse (D-Rhode Island) and Bill Cassidy (R-Louisiana) also have launched an effort to overhaul physician payments, asking for feedback this year on creating a federal committee — separate from the RUC — to advise on billing codes. Cassidy is the incoming chairman of the Senate health committee.
Kennedy and his aides are looking to work with the AMA on changes to the billing codes, said one of the people familiar with the discussions.
The medical association has said that some criticisms of its process are outdated and that hospitals, health insurers and other industry representatives provide input as well to Medicare that shapes payment rates for those organizations.
STAT News first reported that Kennedy and his aides were discussing changes to Medicare payments. Any federal attempt to overhaul billions of dollars in annual payments to health-care providers appears destined to spark an intense lobbying effort to stymie the changes or shift them to reward certain procedures, experts said.
The billing codes are implemented by the Centers for Medicare and Medicaid Services, commonly known as CMS. Trump on Tuesday selected Mehmet Oz, a cardiothoracic surgeon and longtime TV personality, to lead CMS.
“Our CMS codes embed a system that waits for Americans to get sick and profits,” Calley Means, a Kennedy adviser, posted Wednesday on X, commenting on Oz’s selection. If Kennedy and Oz are confirmed, they would play significant roles in reshaping the Medicare coding system.
Many public health officials and experts have been alarmed by Trump’s selection of Kennedy to lead HHS, saying his longtime vaccine skepticism makes him an unacceptable choice to oversee agencies responsible for the nation’s vaccine supply. Kennedy has repeated debunked claims about a link between vaccines and autism, written that coronavirus vaccines were a “crime against humanity” and made other statements that experts say undermine confidence in shots credited with eliminating diseases such as polio in the United States and saving millions of lives globally.
“I think the most dangerous thing about the nominee for secretary is his view on vaccines,” Kathleen Sebelius, who served as HHS secretary during the Obama administration, told CNN this week. “That is enormously dangerous and life-threatening for people in this country and across the globe.”
Kennedy, who founded a prominent anti-vaccine group, has said he is not anti-vaccine and would focus federal vaccine efforts on conducting additional research.
He and his allies have said the former Democrat is trying to shake up incentives that produce poor health outcomes in the U.S. health system, citing elevated rates of chronic disease and other public health problems that outpace other high-income countries. Kennedy and his aides have pinned some of the blame on entrenched industry groups, including the pharmaceutical industry, and criticized conflicts of interest between drugmakers and physicians.
“There is a culture of looking at all levers of our healthcare system with fresh eyes to deliver wins for the American people,” a person with knowledge of the discussions wrote in a text message to The Post.
A variety of groups and observers have long called for changes in how Medicare pays physicians.
The Government Accountability Office, a nonpartisan watchdog, in 2015 called for more transparency around how physician payment rates are set and warned of potential conflicts of interest among the AMA physicians who make recommendations.
“It is clear that the RUC process is broken and that the AMA has no interest in even minor changes,” the Center for American Progress, a left-leaning think tank, wrote in 2018.
“This cabal wields its influence to favor costly specialty care over primary care, and the prices of physician services skyrocket, year after year,” Joe Lonsdale, a Silicon Valley entrepreneur and Republican donor, wrote in 2019.
https://www.washingtonpost.com/health/2024/11/21/rfk-physician-payments/
How to Handle Kennedy as America’s Top Health Official
Dr. Bedard is a physician and writes about medicine and criminal justice.
President-elect Donald Trump has named Robert F. Kennedy Jr. as his pick for secretary of health and human services. This was not my desired outcome. Like many liberals and health care providers, I’ve been alarmed at Mr. Kennedy’s dubious claims about public health and science.
In the spirit of wanting the best for the country, however, I believe there’s a health care agenda that finds common ground between people like myself — medical researchers and clinicians — and Mr. Kennedy. There are seeds of truth to some of what Mr. Kennedy says. We can’t spend four years simply fighting his agenda; noncooperation won't protect the integrity of American public health or advance its interests. Rather, there’s opportunity to leverage Mr. Kennedy’s skepticism and relative political independence for good — to turn his most valid criticisms of the American health care system into constructive reforms.
One place to start: Americans’ concerns about management of the Covid-19 pandemic. Mr. Kennedy’s rise to power was fueled by the anxieties of anti-vaxxers, and though the pandemic was rarely discussed during the election, its aftermath loomed large and may have contributed to Democrats’ defeat.
There’s been no meaningful, public reckoning from the federal government on the successes and failures of the nation’s pandemic response. Americans dealt with a patchwork of measures — school closings, mask requirements, limits on gatherings, travel bans — with variable successes and trade-offs. Many felt pressured into accepting recently developed, rapidly tested vaccines that were often required to attend school, keep one’s job or spend time in public spaces.
The lack of effort to build consensus about what the country did well and what to avoid next time is a missed opportunity to bring closure to a difficult era while preparing for the next pandemic.
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Restoring people’s willingness to take vaccines is urgent, and Mr. Kennedy’s skepticism on this topic may counterintuitively be an advantage. His statements on vaccinations are more complex than they’re often caricatured to be. He’s said he was not categorically opposed to them or, as an official in the new Trump administration, planning to pull them from the market: “I’m not going to take away anybody’s vaccines. I’ve never been anti-vaccine,” he said recently in an interview with NBC News. But he consistently raises largely unsupported safety concerns and positions vaccine refusal as a matter of personal freedom.
Still, Mr. Kennedy is right that vaccine mandates are a place where community safety and individual liberties collide, and that official communication about vaccine safety can be more alienating to skeptics than reassuring. His approach, he said in the same interview, would be respectful, rather than scolding: “I’m going to make sure the scientific safety studies and efficacies are out there, and people can make individual assessments.”
The trick with vaccination, of course, is that it works reliably only if most people get the jab. To encourage vaccine uptake, experts need to communicate differently with the public about vaccination, which is why Mr. Kennedy should create a nonpartisan and independent vaccine commission. A commission made up of good-faith scientists, clinicians, patients, regulators and civil rights advocates with divergent viewpoints could examine available data and reach conclusions on which circumstances justify vaccine mandates, how to prioritize who is vaccinated first in a crisis, how vaccine refusals should be handled and how to address people’s concerns.
Treating Mr. Kennedy’s supporters as fools has not brought them into the pro-vaccine tent, and the country risks outbreaks of dangerous diseases such as measles if vaccination refusals continue to rise. If Mr. Kennedy approaches his role with the same us-versus-them spirit that powered his failed independent campaign for the presidency, he will sow division and put lives at risk. But if he de-escalates conspiracist rhetoric and leads a sincere national conversation about vaccination, he just might save them.
Mr. Kennedy has promised to expose how the relationship between the medical establishment and corporate interests distorts American health care. He argues that the country underinvests in interventions that prevent chronic disease in favor of over-treating patients with drugs once they’ve fallen ill. This critique has significant merit and is not especially controversial among health care providers.
The nefarious influence of the pharmaceutical industry on health care is well established. There are many examples of drug makers funding advocacy groups and influencing regulators into approving ineffective or potentially harmful drugs, and then wining and dining doctors into prescribing those therapies to patients.
This raises serious questions: Have we become too reliant on treating every matter of discomfort with a pill instead of tackling questions about environment, culture and behavior? Are we over-diagnosing and over-treating mental illness with prescription drugs while failing to prevent rising self-harm?
Mr. Kennedy has vowed to take on these questions by firing health agency leaders and personnel, withholding funds and dismantling current regulatory practices. There are better ways to achieve his goals. He can, as he’s promised, divert research and policy efforts toward disease prevention, diet and exercise. He can apply more rigor and skepticism to the drug approval process. He can use the federal government’s robust scientific apparatus to investigate how environment and lifestyle contribute to poor health, and to change what treatments are incentivized for reimbursement.
Mr. Kennedy often speaks about chronic disease as a problem caused by the government in cahoots with industry for corporate gain. For me, this oversimplifies and overpoliticizes the roots of disease. But he’s right that the public is owed more transparency about how scientific knowledge is produced.
Lastly, Mr. Kennedy should prove his independence and seriousness by prioritizing a concern traditionally promoted by Democrats and opposed by Republicans: protecting and expanding health care access. Mr. Kennedy has weakly endorsed a public option for health care. And so far his emphasis on lifestyle and disease prevention hasn’t been in conflict with seeking traditional medical care.
Expanded subsidies for health insurance premiums are set to expire at the end of 2025. Mr. Kennedy could play an important role in preventing this rollback of federal support and be an important advocate for universal health care. If Mr. Kennedy has concerns about how Obamacare is structured and what it covers, he could make changes there, too. It could be rearranged to subsidize more lifestyle and dietary interventions, and disincentivize redundant, expensive tertiary care.
Adopting a spirit of resistance against all practices and policies of the incoming administration, or dismissing a man with a growing movement behind him, won’t help those working in medicine and public healthOne of Mr. Kennedy’s repeated talking points is that he is not anti-science, but he’s against the perversion of scientific credibility for greed and power. He should, accordingly, use his newfound power and responsibility to strengthen science and public health for the good of us all. Rather than fight him every step of the way, I want to find a middle ground we might stand on together.
https://www.nytimes.com/2024/11/15/opinion/rfk-jr-trump-health-agenda.html
I thought the following message from Alexandra Rojas, Executive Director of Justice Democrats, would resonate with many of you:
- SPC -
The 2024 election is over, and Donald Trump has officially won the presidential election.
Trump’s victory is a devastating outcome for our country and the innumerous marginalized communities he has targeted for the last decade.
There are millions of people living in the U.S. who are scared right now for what the future holds and we stand ready to protect and defend each other. We face threats of mass deportations, a national abortion ban, and an all-out assault on our democracy and civil rights. Our political leadership – those who have had the power and privilege to govern over us for decades – owes it to each of them to take responsibility for how a second Donald Trump presidency became possible again under their watch.
The leadership of the Democratic Party has repeatedly chosen to let Trump, the GOP, and corporations dictate our policy positions rather than our own base or the people who will inherit the future we are fighting for.
Our leadership cannot say they stand for peace and the sanctity and prosperity of all lives if we continue to let families get forced out of their homes because they can’t make ends meet in this economy; throw away our asylum policies because of Trump’s demonizing of immigrants; or refuse to stop funding bombs we know are wiping out entire generations of families in Palestine.
The Democratic Party is rapidly losing its legitimacy amongst the everyday people and marginalized communities continuously used as stepping stones to win elections. For as long as our Party has cozied up with corporate CEOs, right-wing billionaires, and big money Super PACs, everyday people in this country have seen Democrats’ populist platitudes as hypocrisy at best, and outright deceitful at worst.
The reality is that the leadership of both parties is bought and paid for by billionaires and corporations that are dividing our communities, undermining our fundamental freedoms, exploiting our workers, and destroying our planet. These monied interests are on the frontlines of destroying our democracy, taking away the power of voters through their unprecedented spending in elections — while those in power refuse to stand up and fight back. For eight years, the Democratic Party has been the Party against Trump instead of the Party for the people.
With the victory of Donald Trump, there are no easy answers for where we as a country and movement go from here. But what is clear to us is that politically courageous leaders at the federal level are needed now more than ever – the Democratic Party must usher in a new era, led by new leaders, not beholden to corporations and billionaires. Leaders in Congress like the Squad have shown us another way of doing politics is possible and represent the promise of uniting our fractured nation into a multiracial democracy where everyone thrives and no one is left behind.
It’s time to end the era of career politicians and the corrupt campaign finance laws that keep them in power. Either they can choose to step down and welcome a new generation of teachers, nurses, union workers, and everyday people to the halls of power or they can be forced out at the ballot box. Their time is up.
In solidarity,
Alexandra Rojas
Executive Director
How Taxpayers Are Helping Health Insurers Make Even Bigger Profits
by Chris Hamby - NYT - October 31, 2024
Health insurers have made an enticing pitch to local governments across the country: When your workers see doctors outside your health plan’s network, costs can balloon, but we offer a program to protect against outrageous bills.
Cities, counties and school districts have signed up, hoping to control the costs of their medical benefits.
Then come the fees.
In Shelby County, Tenn., the insurer’s charges for administering the program climbed last year to $1.3 million — more than the county budgeted this year for long-term disability insurance for all of its roughly 6,000 employees.
In Hoboken, N.J., the charges sometimes exceeded the amount paid to doctors for providing treatment. And in a stretch of California’s Central Valley where two counties share a health plan, the fees unexpectedly quintupled in one year to more than a quarter-million dollars, contributing to a plan deficit.
From southern Florida to the Pacific Northwest, local governments have paid similar fees, often with little awareness that their taxpayer dollars have become a lucrative revenue stream for some of the nation’s largest insurers, according to a review of documents obtained in two dozen public records requests and interviews with city and county officials and benefits consultants.
“We don’t like it,” said Hollis Magill, a human resources official for the Central Valley counties’ plan, “but there’s not much we can do.”
Behind the fees is a little-known partnership between major insurers — including UnitedHealthcare, Cigna, Aetna and Elevance Health — and a data analytics firm called MultiPlan.
An investigation by The New York Times in April found that together the insurers and MultiPlan cut payments to medical providers, then take a share of the purported savings for themselves, sometimes leaving patients with larger-than-expected bills to make up the difference.
Most contracts between insurers and private employers are confidential, coming to light only when there is litigation. But cities, counties and school districts have to open their books to the public. The Times identified two dozen government entities through publicly available documents, offering a window into a broader trend affecting public-sector employers struggling to provide affordable medical coverage.
The fees, the review found, are a volatile expense for stewards of the public purse that can complicate even the best laid spending plans. “With a set budget, any increase in the cost of health insurance has to be taken from something else,” said Heather Britton, who oversees the health plan covering city and county employees in Denver.
In some instances, the fees are costlier than the medical treatment itself. The records show that Hoboken paid an obstetrician gynecologist $292.88, less than half the $629.14 the city paid in fees to the UnitedHealthcare subsidiary UMR to handle the claims. Kitsap County, Wash., paid Aetna roughly $7,000 for handling a $16,000 bill that the insurer reduced to $2,000.
In statements, UnitedHealthcare, Cigna and Aetna defended their cost-containment programs and said they helped protect local governments and their workers from big bills. Elevance declined to comment.
Low Payments, High Fees
Like their private-sector counterparts, many cities and counties have tried to control costs with an arrangement known as self-funding: They pay their workers’ medical bills from their own budgets and hire an insurer to run the plan. When workers see doctors in the plan’s network, most charges have been negotiated in advance; when they go out of network, the bills can vary widely.
In recent years, big insurers have found ways to profit from this arrangement by supplementing their standard charges with add-on fees. UnitedHealthcare acknowledged that it had come to depend on the “significant revenue” generated by fees from its out-of-network program, which totaled $1.1 billion a year, according to an internal document recently made public by an Oklahoma judge after requests from The Times. And the insurer sketched out plans to goose this income stream, even as it worried about the bad “optics” of the fees.
When a patient sees an out-of-network medical provider, the insurer often sends the claim to MultiPlan, a New York-based analytics firm that recommends what it determines is a fair payment. The difference between the original bill and the amount ultimately paid is what the insurer says it saved the employer. The insurer and MultiPlan each collect a percentage of that savings as a fee. Lower payments mean greater savings, which can yield higher fees — a particular sore point for critics of the arrangement.
“This is just direct revenue for the insurance company,” said Ms. Britton of Denver.
Insurers and MultiPlan insist they are beating back rampant overbilling by some doctors and other providers, a well-known problem in health care. In a statement, a MultiPlan spokesperson said the company “plays an important role in our health care system by helping lower out-of-pocket costs, reducing or eliminating balance bills for millions of patients and helping generate millions of dollars in health care cost savings.”
The insurers also say employers knowingly choose the programs and find them valuable. “The fact that we retain over 95 percent of our government clients every year is a testament to the value we deliver,” a Cigna spokesperson said. But interviews with government officials suggest that the value is not always evident.
While a few of the respondents to The Times’s records requests characterized the fees as minor, more expressed frustration at how they were calculated and suspected that insurers were charging too much.
A third of the respondents said they had no documentation of the fees and acknowledged that they didn’t know what they were paying. Several declined to be interviewed or answer further questions.
Ms. Magill, who is the director of human resources for Fresno County, Calif., and helps manage the county’s joint plan with neighboring Tulare County, discovered how the cost-containment program can play out. After learning of the fivefold spike in fees in 2022, she pressed for an explanation from the counties’ insurer, Anthem, an Elevance subsidiary.
In part because of an increase in employees seeking substance abuse treatment from out-of-network providers, she was told, the counties had racked up $1.3 million in out-of-network medical bills.
Anthem had sent the claims to MultiPlan and ultimately decided that fair payment was $287,667.30, less than a quarter of the billed amount. The insurer then charged the counties nearly that much in so-called savings fees: $259,089.74.
“What they’re trying to say is, ‘Look how much it saved you,’ but that’s really not a savings,” Ms. Magill said. She noted that out-of-network providers often set high list prices that they know are rarely paid in full.
Little Choice but to Pay
The cost of providing health coverage for workers continues to accelerate, and such costs represent an even larger share of total compensation for state and local governments, which often pay less but offer richer benefits than the private sector.
When insurers pay medical claims for companies without self-funded plans, they charge premiums that can include a hefty profit. When they administer self-funded plans, the insurers usually receive a lower base payment but often add fees for related services, such as recouping overpaid claims or using a prescription-benefits administrator other than the insurer’s preferred company.
Monitoring these costs — even identifying them in contracts that often exceed 100 pages — can be onerous.
The public records reviewed by The Times came from urban centers with health plans covering more than 10,000 employees and family members, and more rural areas with closer to 1,000 enrollees. Their boards and commissions had reviewed and approved the contracts during public meetings that had agendas crowded with a range of issues, including reappointing notaries, renovating fairgrounds and funding travel for the court clerk.
Some governments chose newer versions of cost-containment programs, which insurers said would save them even more money in part by using algorithms that typically yield even lower payment recommendations.
UMR, for example, has offered one such program that it pitched as its “lead solution,” records from local government meetings show. It was part of the company’s strategy to “force clients to move to more aggressive programs” that usually result in lower payments to providers, and potentially higher fees for employers and larger bills for patients, according to the internal company documents recently made public in Oklahoma.
Phase 2: Strategy for 2021 is force clients to move to more aggressive programs
Source: Read the PDF
Insurers told The Times they made a point of offering employers multiple options.
“We offer these products in response to our self-insured customers’ requests to help them manage rising health care costs,” a UnitedHealthcare spokesperson said in a statement.
An Aetna spokesperson said the company offers employers “various options and strategies to help lower costs and minimize balance billing.”
But information from insurers about the fees ranged widely. Some governments received detailed entries for each medical claim, while others got monthly charges that fluctuated wildly with little explanation. Shelby County, for example, had to pay Cigna $60,000 in fees one month and $127,000 the next.
In its statement, Cigna said it was proud of its work with Shelby County, adding that “it would be misleading” to focus on the $1.3 million in fees without mentioning what it considered to be a $4 million savings in payments to providers.
Still others said they received no fee data at all from their insurers. A spokeswoman for Roanoke County in Virginia said officials didn’t know what they had been charged, adding, “We do, however, utilize a professional vendor that vets our fees, and we would be made aware if there were any issues.” The vendor, USI Insurance Services, declined to comment.
A spokeswoman for the Sunnyside Unified School District near Tucson, Ariz., said it “has not paid any fees” for its cost-savings program “that we are aware of.” After The Times pointed out that the district’s insurer, UMR, had projected charging about $34,000 a year in fees when it pitched the program in 2020, the spokeswoman stopped responding to requests for comment.
A few local officials said their employees rarely saw out-of-network doctors so they had not encountered problems with big fees. “We’ve not had to ask our employees for a premium increase in years,” said Nathan Cahall, acting city manager of Middletown, Ohio.
More common, however, was a mix of wariness and grudging acceptance: human resources managers doing their best to monitor their insurers, worried that they were missing something. Several pushed their insurers for more information after receiving the records requests and additional inquiries from The Times.
“I don’t like it morally, conceptually,” said one benefits manager for a small Midwestern town who feared that speaking publicly would sour the town’s relationship with the insurer. She said that a broker hired to help manage the town’s plan had told her the cost-containment program was “not something you can opt out of.”
Avoiding the fees is indeed difficult, consultants and lawyers who advise employers said. While some government entities “have no idea what’s going on,” said Julie Selesnick, a lawyer, others “are becoming aware of these fees.” But in most cases, she said, they have little choice but to pay.
UMR advised Columbia Public Schools in Missouri that if the district chose not to use its cost-containment program, the insurer would increase its overall base rate. Internal UnitedHealthcare emails made public in a legal dispute over fees with a private trucking company in New Jersey showed a similar calculation. If the company opted out of the cost-savings programs, an executive wrote, “We would increase their admin fees for the lost fee revenue.”
A Push for Transparency
Some local governments have been able to install guardrails. Through a broker, Denver got UnitedHealthcare to limit its fees. Michael Faughnan, a senior vice president for the broker, Lockton, said he began negotiating fee caps for clients a few years ago after identifying large charges buried among their medical claims payments.
Other consultants and data analysts who work with employers also said they had found out-of-network fees interspersed with records of payments to medical providers, obscuring that the money was going to insurers and MultiPlan and not toward employees’ care.
“I’m sure many employers are out there paying this and not even aware that they’re paying it,” Mr. Faughnan said.
The push for more information about the fees reflects growing concerns about insurer transparency. A few employers have sued their insurers, accusing them of improperly paying claims and concealing excessive fees. And in two instances, workers have sued employers, alleging that the companies’ lax oversight allowed their pharmacy benefit managers to fleece the plans.
Legislation enacted in 2020 required that employers have greater access to their workers’ claims data, and a bill introduced last year by a bipartisan group of senators would strengthen those requirements.
MultiPlan is also under scrutiny. Lawmakers on the House committee overseeing employer-based insurance wrote to the Labor Department to express concern about the firm’s practices, and the department has previously said that it had “a number of open investigations” into the type of pricing services MultiPlan provides. Senators have also pressed MultiPlan for information, raising concerns that the firm’s business model could present a conflict of interest.
At the same time, Senator Amy Klobuchar has asked top antitrust regulators to investigate whether MultiPlan colluded with insurers to drive down payments to providers and leave patients with big bills. And the American Medical Association and dozens of providers have made similar accusations in lawsuits that were recently consolidated into a single case akin to those brought against companies accused of improperly hiking rents or peddling dangerous products. The firm is also under financial pressure because of a missed revenue target and a plunging stock price.
The MultiPlan spokesperson said that the lawsuits were “without merit” and that without its services, costs would increase for patients and employers.
Despite all of this, some local government officials said, it is not any easier to negotiate better terms with insurers.
“It just feels like it’s Whac-a-Mole — there’s one more revenue stream that the insurance company wants and they create,” said Ms. Britton, the Denver benefits manager. “And so, OK, what else is out there that we’re missing?”
Julie Tate and Emily Cochrane contributed reporting.
Biodiversity loss: a health crisis
More than 1,500 Mainers will get relief from $1.8 million in medical debts
More than 1,500 Maine residents will have a total of $1.8 million in medical debts canceled through a partnership between a local nonprofit and a national charity.
Mainers For Working Families, a progressive advocacy group, said it worked with the Boston-based organization Undue Medical Debt to erase some or all of the residents’ unpaid bills – an average of $1,200 in debt relief per person.
While $1.8 million is believed to be just a fraction of the overall debt burden on Maine patients – an estimated 40% of Maine residents carry some medical debt – the news could have a big impact for some.
“I live on $26,200 a year. I’m trying to fight, but I don’t have a lot of fight left in me,” said Kim Earley, an Old Town resident chosen to receive debt relief and featured in a video posted by Mainers For Working Families.
Earley said she became sick after the loss of her husband and 6-month-old son in a car accident 22 years ago and it took a long time for her to be diagnosed with Addison’s disease, a rare and chronic endocrine disorder.
“I owe probably $2 million now and it’s continuing to grow,” she said. “I am really hoping that someone sees what is actually happening out there. God, I hope so.”
Evan LeBrun, executive director of Mainers for Working Families, said his organization started looking into medical debt as an issue last year and created a project to shine a light on the human impact. Earley was one of the people featured.
“But we encountered so many people with serious, crippling medical debt and no way out,” he said.
LeBrun said the initial plan was to use some of his own organization’s funds to help pay debts, but when they started to look into the idea further, they found Undue Medical Debt. Since its founding in 2014, the organization has erased $10 billion in debts across the country, including $100 million in New Jersey this summer.
“We’re thankful for both this impactful donation – which will relieve an undue burden on over 1,000 Mainers – and for the storytelling and advocacy work being carried about by Mainers for Working Families,” President and CEO Allison Sesso said in a statement. “Medical debt is an issue that affects families financially and emotionally, and debt relief is only one tool in combating this national crisis.”
In recent years, as health care costs have ballooned, many individuals and families have crowdfunded on sites like GoFundMe to help pay for their care. In other cases, LeBrun said, people have paid off medical debt with high-interest credit cards, which only compounds their financial problems.
Undue Medical Debt leverages its donations to purchase bundled medical debt at steep discounts from hospitals and other providers. Among its major donors is Mackenzie Scott, ex-wife of Amazon founder Jeff Bezos, who gave $30 million in 2022.
Those who were chosen to have their debts paid in Maine couldn’t have income above four times the federal poverty line, which is about $60,000 for an individual, or must have debt of at least 5% of their annual salary.
Letters have been sent to individuals across the state. No action is required by recipients.
LeBrun said the $1.8 million in debt that was purchased by Undue Medical Debt in Maine represents “a drop in the bucket,” but he doesn’t know how much is out there.
“It’s a number we’ve tried to get,” he said.
A recent survey by Consumers For Affordable Healthcare, another local advocacy group, found four out of 10 Mainers have medical debt in their household, and nearly all of them who’ve accrued that debt within the past two years still have it.
“Too many Mainers struggle to pay for basic necessities, have used savings, have incurred credit card debt, or have been contacted by a collection agency, most often due to a bill from a hospital,” said Ann Woloson, executive director of Consumers for Affordable Health Care. “Too many have experienced discomfort or pain for longer than needed or delayed or skipped going to the doctor when sick. More needs to be done to constrain health care costs and prevent medical debt in Maine.”
Sometimes, patients face huge expenses because of so-called “facility fees” that are tacked onto bills. This spring, lawmakers passed a bill that makes medical bills more transparent by disclosing such fees.
LeBrun said his organization, which has advocated for other progressive policies, including paid family leave, tax fairness and creating a public power company, hopes to persuade Maine lawmakers to consider paying off more medical debts.
FIRST PARTNERSHIP IN MAINE
This is the first time Undue Medical Debt has partnered directly with a Maine organization to buy debts here.
However, Maine was among nine states where $45 million in debt was purchased this year with funds raised by Casey McIntyre Memorial & Debt Jubilee, a viral campaign started by the family of a 38-year-old woman who died of ovarian cancer.
Undue Medical Debt has worked with several other states and larger cities as well in recent years.
In New Jersey, it worked with the administration of Gov. Phil Murphy, who leveraged $550,000 in American Rescue Plan funds to help eliminate debt for nearly 50,000 residents there.
“Medical debt accumulates very quickly and can follow a person for decades,” Murphy said this summer. “With this strategic investment and our partnership with Undue, we are wiping the slate clean for thousands of New Jersey families, eliminating their debt, and making a real, tangible impact on their lives.”
Other organizations have raised money to help pay medical debts, too. In 2020, more than 100 United Church of Christ congregations across New England raised enough money to erase a total of $26.2 million in medical debt for thousands of families across the Northeast, including Maine.
Letter: It’s OK to vote with others in mind
I will be fine. Since Trump was elected, my investments have already received a boost. I will no longer have to pay tax on my Social Security wages, so it’s said.
I’m fortunate to have a stable financial picture. But I voted against my own interests and security because I wanted other things for people I care about. Health care for all, worker protections, child tax credits and assistance for new home owners, this is what I want for family and friends, and it was my motivation.
Ultimately, it was not a political or financial decision, but a personal one, even when people we love vote differently.
Daniel Bergeron
Portland
