Articles Posted in Insurance

debtmedicalnytjuly2021-300x250A scandal of the U.S. health system may be far worse than imagined, with the medical debt sold to collection agencies alone amounting to a staggering $140 billion.

The $140 billion estimate came from researchers who published in a medical journal and found that such unpaid sums had increased significantly from an $84 billion calculation in a similar 2016 study, the New York Times reported (see excellent chart, courtesy of the newspaper).

The newspaper noted the debt estimate is an ugly number hanging over the finances of tens of millions of patients who are too often poor and uninsured — debtors who could benefit significantly, if politicians in their states had expanded Medicaid coverage for them as allowed under the Affordable Care Act:

aidpoor-300x200Cash is king. That truism may hold for thrifty savers and businesses and individuals buffeted by economic uncertainty. But this realistic view also may be turned on its head for poorer, uninsured patients trying to cope with bankrupting medical bills.

That’s because hospitals — a leading driver of health care costs — gouge with their premium prices those who pay with cash, the Wall Street Journal reported.

The newspaper, working with previously secret pricing data that institutions across the country must disclose now, has given consumers yet another eye-popping view of the elasticity of hospital charges and how they punish the poor:

fentanylillustration-300x99Just as attorneys generals for more than a dozen states inch toward a multibillion-dollar settlement with a drug maker faulted for its big role in the start of the opioid abuse and drug overdose crisis, that health menace is taking a new, deadly turn in the region around the nation’s capital.

In Washington, D.C., Maryland, and Virginia, officials report they are grappling with spiking overdose deaths, numbering in the hundreds, and blamed on the rise of fentanyl. It is a synthetic, prescription painkiller developed to assist late-stage cancer patients. It packs a wallop. And Big Pharma companies pushed for its wider use with aggressive marketing and sales campaign that landed some drug executives in jail.

The excessive promotion of fentanyl also led to its illegal manufacture, notably in chemical factories in China. Its increasing abuse, along with other opioids, also opened the door to big problems with illicit drugs.

aduhelm-300x250The  Food and Drug Administration has back-tracked on a major part of its  accelerated approval of Aduhelm, a prescription medication targeted at Alzheimer’s patients.

The  FDA green light for the drug also has created such consternation among medical specialists, insurers, policy experts, and politicians — including with news reports of hidden, cozy dealings between a top regulator and the medication’s maker —  that the acting agency chief has asked the independent inspector general to investigate what happened.

The fury over Aduhelm is occurring even as another drug maker is pushing legal action that authorities argue also could saddle taxpayers with other soaring costs for other expensive drugs.

billsmedical1-300x200Federal regulators have taken a welcome initial step to bar insurers and health care providers from holding patients hostage in their all-too-common fee fights, with draft rules out now to crush “surprise” medical bills.

The politically riven, do-nothing Congress shocked critics by ending 2020 with an actual new law, included in legislation dealing with the coronavirus pandemic, that gave patients new protection from nightmares created when insurers and big corporation sought to reduce their health care costs with so-called narrow networks of pre-approved health care providers.

This scheme allowed insurers and companies to negotiate with doctors, labs, hospitals, and others for preferential prices, and, effectively, guarantees of patient business, in exchange. Patients began howling when their long-time caregivers were excluded from insurer networks, which also often also excluded big-name practitioners as well as well-known academic medical centers and big hospitals.

axioshospitaldebtsuitchart-300x261While medical debt menaces far too many patients, especially those who already struggle because they are poor, sick, and injured, big hospitals are too willing to exploit the legal system with aggressive collection efforts that generate little revenue but lots of grief for patients.

Those are some of the takeaways from a raft of articles and deeper digs into medical debt from the likes of the news site Axios (see here, here, here, and here), the Pulitzer Prize-winning investigative site ProPublica, and the news columns of the Wall Street Journal.

Axios and ProPublica have built their reports around commendable work by researchers at Johns Hopkins medical school, who followed up their important 2019 published study on Virginia hospitals suing their patients.

scotusbldg-300x193It’s three strikes now from the U.S. Supreme Court: Have Republicans finally gotten themselves thrown out of their game to strip tens of millions of Americans of their health insurance?

The conservative-packed high court, in a 7-2 vote, rejected the latest and third GOP attempt to overturn the Affordable Care Act, which Republicans in Congress also have failed to kill in more than five dozen votes over more than a decade.

The case decided by the justices — supported by the Trump Administration and brought by attorneys general in Republican-controlled states like Texas and opposed by their counterparts in Democratic-controlled states — proved to be the legal equivalent of a belly flop.

aduhelm-150x150The federal Food and Drug Administration has created an instant medical and regulatory morass by giving an accelerated approval to Biogen’s costly prescription medication targeted at patients with Alzheimer’s disease.

This is the first drug to win the precious official nod from the FDA in almost two decades.

But the agency’s OK to market aducanumab (pronounced “add-yoo-CAN-yoo-mab”), which will go by the brand name Aduhelm, may go in the books as one of the sketchiest and most ferociously contested in recent times. The drug somehow overcame Everest-sized reasons why, at best, it needed further study — which it is supposed to get. And it faces Himalayan-sized criticisms that it will raise false hopes for those afflicted with a condition that is spiking in a fast-graying nation, and for which no effective medical remedy has been found.

fatcats-300x245While too many of us get overdosed with clownish depictions — from doctors, hospitals, insurers, and corporations, especially Big Pharma firms — of how the civil justice system operates, it’s always worth a reminder of the tremendous fortitude ordinary folks show in pursuing malpractice and other personal injury or liability claims.

Yes, the cases, on rare occasions, can result in sizable favorable rulings for plaintiffs, as the public might be reminded by the U.S. Supreme Court’s new refusal to overturn a $2.1 billion judgment against Johnson & Johnson.

Twenty women sued J&J, asserting its iconic baby powder played a key role in their suffering ovarian cancers.

brooks-lasureandbecerra-300x240Chiquita Brooks-LaSure has won U.S. Senate confirmation and will become the first black woman to lead the federal Centers for Medicare and Medicaid Services or CMS.

The longtime government official, who was an adviser to President Obama and has served in multiple other top federal roles (shown right, with her boss, Health and Human Services head Xavier Becerra), jumps into a role with gigantic challenges. These include:

  • The administration by her agency of federal health insurance programs, including for children and those covered under the Affordable Care Act. The Biden Administration and Democrats, as part of coronavirus pandemic rescue efforts, bolstered Obamacare and opened enrollment in it, with subsidies, to millions of Americans slammed by the coronavirus pandemic. But those efforts, which have boosted ACA enrollment, also will need renewed legislative support — which may occur right as the midterm elections are under way. CMS also may be a key part of some Democrats’ plans to improve health care coverage in this country by lowering the qualifying age for Medicare for 60-something Americans who often must pay staggering premiums and who lose jobs and employer-related coverage at scary rates. This is an idea that Republicans reject.
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