Two Women Prioritize Helping the Public over Protecting the Rich – McCanne Health Justice Monitor

Two Women Prioritize Helping the Public over Protecting the Rich – McCanne Health Justice Monitor

What you need to know about Medicare Advantage Article from PNHP

From UpNorthNews First-of-Its-Kind Universal Health Care Referendum on the Ballot in Rural, Red Wisconsin County Voters in Dunn County, which includes the town of Menomonie in western Wisconsin, will have a chance to weigh in on a very important, albeit unusually progressive, question this November: Should the United States provide universal health care? Earlier this summer, the Dunn County board unanimously approved the advisory referendum. Like other referendum questions about abortion rights or marijuana legalization, it won’t change any laws. But advocates say it could eventually lead to change. Why You Should Care This is the first time a referendum like this is on the ballot in Wisconsin, and Dunn County, in many ways, is an unlikely place to have taken up the question. Fifty-six percent of voters in the rural, western Wisconsin county voted for Republican former President Donald Trump in 2020, and only 42 percent voted for Democrat Joe Biden. Democrats have made universal health care one of their policy priorities while Republicans in Wisconsin have resisted expanding Medicaid and other steps in that direction. What Next? Dunn County Board member John Calabrese, who was part of the effort to introduce the referendum, hopes this referendum will be part of a shift away from seeing expanded health care coverage as a left-vs.-right issue. "I think we can speak to this issue in a way that's not partisan," Calabrese said. Wisconsin polls show our state is split on healthcare. During the 2020 presidential primary, the Marquette University Law School poll found 41 percent of respondents favored Medicare for All, while 53 percent opposed it. A different 2020 poll from Change Research found 60 percent of Wisconsin respondents favored lowering health costs, while only 30 percent favored guaranteeing universal coverage. Our View Commentary by Founding Editor Pat Kreitlow Putting this resolution on the ballot was an idea approved unanimously by the Dunn County Board of Supervisors. Every member—conservative or progressive—sees what Republicans at higher levels refuse to acknowledge: America’s healthcare system—controlled in large part by for-profit insurance corporations—is unsustainable. The time for party politics is over, and leaders of all political stripes need to sit down and answer a question about “what would work better” rather than “how can I use this issue to win elections?” Wisconsin voters now have a chance to tell Congress they, too, should move forward with discussions of how a non-profit national health plan could work. People want solutions, not more partisan games. The Bottom Line Universal health care or not, the country's healthcare system needs to change. Dunn County Board member Monica Berrier put it best: "I don't know how anybody can look at this and think it’s a good situation, but it's the system that we're stuck with. We have a responsibility to demand better of the government that serves us." https://mailchi.mp/couriernewsroom/vote-this-week-the-nicest-player-in-the-nl-central-12644163?e=536c8c7421

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Racism in the Inflation Reduction Act: No Medicaid Expansion – McCanne Health Justice Monitor

Racism in the Inflation Reduction Act: No Medicaid Expansion – McCanne Health Justice Monitor

REACH Won’t Fix the Equity Harms of Value-Based Care – McCanne Health Justice Monitor

REACH Won’t Fix the Equity Harms of Value-Based Care – McCanne Health Justice Monitor

What’s Wrong With Health Insurance? Deductibles Are Ridiculous, for Starters. July 7, 2022 By Aaron E. Carroll, NYT

Dr. Carroll is the chief health officer of Indiana University and writes often on health policy. More than 100 million Americans have medical debt, according to a recent Kaiser Health News-NPR investigation. And about a quarter of American adults with this debt owe more than $5,000. This isn’t because they’re uninsured. More often, it’s because they’re underinsured. 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. Cost-sharing isn’t set up in a thoughtful way such that it might steer people away from inefficient care toward efficient care. Deductibles are, frankly, ridiculous. The use of deductibles assumes that all medical spending is the same and that the system should disincentivize all of it, starting over each Jan. 1. There is no valid argument for why that should be. Flu season peaks in the winter. We were in an Omicron surge at the beginning of this year. Making that the time when people are most discouraged from getting care doesn’t make sense. Co-pays and co-insurance aren’t much better. They treat all patients the same, and they assume that all patients should be treated the same way. In a National Bureau of Economic Research working paper published last year, researchers looked at how increases in cost-sharing affected how older adults, who are more likely to need care, pay for and use drugs. Remember, people age 65 and older in the United States are insured with what most consider to be rather comprehensive coverage: Medicare. The researchers claimed, however, that a simple $10 increase in cost-sharing, which many would consider a small amount of money, led to about a 23 percent decrease in drug consumption. Worse, they said it led to an almost 33 percent increase in monthly mortality. In other words, making seniors pay $10 more per prescription led to people dying. These seniors weren’t taking optional, esoteric, exceptionally expensive medications. This finding was for drugs that treat cholesterol and high blood pressure. In fact, they were considered “high value” drugs because they were proven to save lives. Further, those at higher risk of a heart attack or stroke were more likely to cancel their prescriptions than people at lower risk. People are not smart shoppers or rational spenders when it comes to health care. When you make people pay more, they consume less care, even if it’s for lifesaving treatment. Moreover, a $10 increase in drug cost-sharing is small potatoes compared with what most people have to pay out of pocket for care each year. The average deductible on a silver-level plan on the A.C.A. exchanges rose to $4,500 in 2021. If people tried to buy plans with a lower premium, at a bronze level, the average deductible rose to more than $6,000. Granted, some cost-sharing reductions are available for those who make less than 250 percent of the federal poverty line, but even after accounting for those, the average deductible was more than $3,100 for silver plans. Those who receive insurance from their employers aren’t much better off than those who buy on the A.C.A. marketplaces. The average deductible for insurance offered by large companies in the United States was more than $1,200. At small companies, it was more than $2,000. Those are only the deductibles. After they are paid, people must still cover co-pays and co-insurance until they hit the out-of-pocket maximums. The good news is that the A.C.A. limits these in plans sold in the exchanges. The bad news is that they’re astronomical: $8,700 for an individual and $17,400 for a family. A large majority of Americans don’t have that kind of money sitting in accounts, certainly not after paying an average of about $5,000 in premiums each year for a benchmark individual silver plan. Half of U.S. adults don’t have even $500 to cover an unexpected bill. Anyone who requires significant health care will be out the entire deductible, meaning thousands of dollars, and if severely ill, is likely to hit the out-of-pocket maximum. Of course Americans are in medical debt. The Kaiser Family Foundation estimates the country’s collective medical debt is almost $200 billion. It’s worth noting that the cost of health care in the United States is so high that even expensive premiums are not enough to cover the full amount without significant out-of-pocket spending. That doesn’t mean no better options exist for cost-sharing. We could treat those with diagnosed chronic diseases differently, as many countries in Europe do. It makes sense to try to disincentivize healthy people from overtreatment, but lots of people, including me, need care that costs money every day. It makes no sense to try to persuade me to rethink that. U.S. leaders could also consider adapting a reference pricing system, where the health system determines what constitutes the lowest-cost, highest-quality care and makes that available without any out-of-pocket spending. Cost-sharing can then be applied to other options that might cost more or have less evidence behind them. The purpose of insurance is to protect people from financial ruin if they face unexpected medical expenses. Reducing the amount that they need to pay from six figures to five is necessary, but not sufficient. It’s not enough to give people insurance. That insurance must also be comprehensive.