Articles Posted in Insurance

richmondcommtyhospital-300x153Big hospitals and hospital chains that enjoy the financial and reputational benefits of nonprofit or charitable status have taken major fire for maximizing profits while piling on patients’ crushing medical debt and exploiting the poorest and most vulnerable of the injured and sick.

Medical economists, in recent times, have zeroed in on hospitals and their opaque pricing schemes and sky-high costs as important contributors to the ever-rising, nosebleed U.S. spending on health care. Americans pay more on average than any consumers on the planet, while seeing some of the worst outcomes among peers in advanced nations. And with a third of U.S. health care spending flowing into hospitals — more than $1 trillion annually — shouldn’t the suits running institutions and big chains have expected greater scrutiny of their business practices?

Kudos to the nonpartisan Kaiser Health News service and NPR for showing how hospitals in the Dallas-Fort Worth area are thriving — by saddling patients in that metropolis with some of the heaviest per capita medical debt to be found anywhere in the country.

cfpbchartnursinghomecost-300x226Two federal regulatory agencies have rebuked nursing homes and their debt collectors, warning them that they may be breaking the law with sketchy efforts to make loved ones and friends pay for the care of sick, injured, and debilitated residents in long-term facilities.

Bottom line: A lot of the forms that you may sign for a loved one as they are admitted to a nursing home are straight-up illegal if they purport to make you responsible for paying the facility’s bills.

The Consumer Financial Protection Bureau (CFPB) has conducted hearings and issued a report as well as putting out a joint letter with the Centers for Medicare and Medicaid Services (CMS), the agency with oversight of nursing homes and other long-term care facilities.

coronavax-150x150As summer ends, millions of Americans should pop around the corner for a healthy double — that is, a pair of vaccinations, one targeted against the latest, widely circulating coronavirus Omicron variants and the other shot to fight the seasonal flu, federal health officials say.

The newest booster for the BA.4 and BA.5 Omicron variants should be available at drug stores, clinics, and doctors’ offices this coming week, regulators at the federal Food and Drug Administration and the Centers for Disease Control and Infection have decided.

The coronavirus shots, as occurs with annual flu vaccines, will be based on existing products that have been given to huge populations globally — safely, with great effectiveness, but now without extensive clinical trials that were conducted of previous formulas of the vaccines.

IRAapproval-300x174President Biden and congressional Democrats have embarked on a major political experiment, testing the public’s willingness to delay gratification on seeing big benefits of a landmark measure with important elements to improve their health and wellbeing.

Is it more persuasive to regular folks that one political party is trying to tackle huge problems, or will relentless naysayers reap rewards for doing little or nothing?

As a little more than four score days remain before important midterm elections, Democrats will be seeking to convince voters of the significance of the giant Inflation Reduction Act — aka the much-reduced Build Back Better legislative package originally proposed by President Biden.

charity2-150x150Play this one out in your mind: a guy you know at church — he’ll be the first to let you know he makes $200,000 a year — tells you about how he gave to charity a junker car worth not more than $4,600 (2% of his income). Now what’s your reaction if you learn this guy got thousands of dollars in tax breaks for that giving?

Is this savvy business conduct? Or does it make you sputter even while sitting in the pews on Sunday?

Now multiply the sums involved, exponentially, and it should be cause for questions anew about the nation’s hospitals and their charitable care. As the Wall Street Journal reported of its dive into the institutions’ required federal disclosures:

charges-150x150Consumers should brace themselves for increasing costs of yet another key component of most families’ budgets: the price of health insurance premiums. Even if Congress can’t get its act together to extend coronavirus pandemic-related subsidies for millions of Americans covered under Obamacare, insurers in individual marketplaces across 13 states and Washington, D.C., are looking to raise rates an average of 10% next year.

Those are the annual findings of the Kaiser Family Foundation, which scrutinized preliminary rate submissions for Affordable Care Act policies sold on public marketplaces in the District of Columbia, Georgia, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, New York, Oregon, Rhode Island, Texas, Vermont, and Washington state, the AP reported.

The foundation offered a key footnote to its early warning about spikes in the cost of health coverage, which for several years now had remained low:

billpaying-150x150While Congress seems paralyzed or, at best, willing to shrink significantly its efforts to help Americans deal with the punishing costs of care in the U.S. medical system, could federal lawmakers be confronted at the same time with more compelling evidence about the need for aggressive, not timid, action?

Do beleaguered constituents need to barrage members of the House and Senate with copies of an excellent, painful series from NPR and the nonpartisan Kaiser Health News service on the crushing effects of medical debt on regular folks, especially cancer patients? Must voters write, call, and email  representatives to ensure they see the research findings of the Kaiser Family Foundation or the Commonwealth Fund about how nightmarish the U.S. medical system has become?

In detailing the “financial toxicity” that cancer patients experience with bankrupting treatment, KHN reporter Noam Levey mixes poignant human stories with scary economic data to detail how care for a leading killer of Americans may have improved medically but has become a calamity of a different sort. He makes these points among others (quoted liberally but without their sourcing, not fully included in these bullets for brevity’s sake):

dive-180x300Even as Congress lumbers into creating the next crisis for millions of Americans and whether they can access and afford health insurance, the giant, built-in flaws in the current coverage system keep sending far too many patients and their loved ones into a financial morass with which politicians and policymakers refuse to reckon.

Successive Democratic and Republican administrations have clashed over health insurance, notably the coverage extended to poor, working poor, and middle-class folks under Obamacare. But the people in charge have erred, big time, by blindly accepting a health care fallacy that plagues the U.S. system, according to Aaron E. Carroll,  the chief health officer for and a distinguished professor of pediatrics at Indiana University. He said this in a New York Times Opinion article:

“The Affordable Care Act was supposed to improve access to health insurance, and it did. It reduced the number of Americans who were uninsured through the Medicaid expansion and the creation of the health insurance marketplaces. Unfortunately, it has not done enough to protect people from rising out-of-pocket expenses in the form of deductibles, co-pays, and co-insurance. Out-of-pocket expenses exist for a reason; people are less likely to spend their own money than an insurance company’s money, and these expenses are supposed to make patients stop and think before they get needless care. But this moral-hazard argument assumes that patients are rational consumers, and it assumes that cost-sharing in the form of deductibles and co-pays makes them better shoppers. Research shows this is not the case. Instead, extra costs result in patients not seeking any care, even if they need it.

bag-150x150If patients can benefit from price transparency by hospitals, shouldn’t employers and health insurers post online what they are paying for medical services? Yes, say federal regulators, who started requiring this effective July 1.

The federal Centers for Medicare and Medicaid Services (CMS) has ordered parties that act as health payers to make public a wealth of economic information that previously had been closely held, NPR and the Kaiser Health News service reported:

“[H]ealth insurers and self-insured employers must post on websites just about every price they’ve negotiated with providers for health care services, item by item. About the only exclusion is the prices paid for prescription drugs, except those administered in hospitals or doctors’ offices. The federally required data release could affect future prices or even how employers contract for health care. Many will see for the first time how well their insurers are doing compared with others. The new rules are far broader than those that went into effect last year requiring hospitals to post their negotiated rates for the public to see. Now insurers must post the amounts paid for ‘every physician in network, every hospital, every surgery center, every nursing facility,’ said Jeffrey Leibach, a partner at the consulting firm Guidehouse.

cubanmark-150x150While some individuals with jaw-dropping wealth have pushed into showy extremes of shooting themselves and their pals into outer space or dropping hundreds of millions of dollars on yachts or Manhattan penthouses, a tech mogul and pro basketball franchise-owning billionaire is winning attention by attempting something different, challenging, and potentially beneficial to regular folks in great need: He is trying to make skyrocketing prescription drug prices affordable.

The Cost Plus Drug startup by entrepreneur Mark Cuban (shown above) could not only benefit individuals but also the federal government, providing Medicare an estimated $4 billion in 2020 savings on the cost of generic meds.

Those aren’t figures hyped by the imagination of the Texas billionaire’s publicists. They were published in the Annals of Internal Medicine, based on research by three MD-Ph. D.s in part of the medicine department at Brigham and Women’s Hospital. and Harvard Medical School. Dr. Hussain Saleem Lalani, the lead author of the study, told NBC News this of the research findings:

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