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Kaiser Health News reported on some changes that insurers are experimenting with. Not all changes are good, but some experimentation can lead to major changes.
As described in Kaiser Health News' article, the North Carolina Blue Cross Blue Shield rolled out an insurance policy this year that does not include an actual network of providers, simply an agreement to pay 140% of what Medicare would pay. On the face of it, this arrangement seems to expose policyholders to an enormous amount of risk. However, this type of policy might work out reasonably for certain groups: for example, policyholders that are healthy and essentially never see a doctor, or policyholders that are picky about which providers they see and are able to pay the difference. The first group might be able to save 15% to 30% in annual premiums, but many years of savings could be wiped out by one catastrophic incident. The second group could find it more freeing to be able to select whichever provider.
Overall, these experiments are signs that the current system is inadequate for many, as well as a manifestation of the hunger that some feel in finding an alternate solution.
The Centers for Medicare & Medicaid Services (CMS) stipulated that starting January 1st of this year, hospitals had to post list prices online. Many hospitals have opted to fulfill the requirement by posting what's known as their chargemaster. Kaiser Health News reports that while the online postings fulfill the requirement from CMS, the lists are largely unintelligible to the average consumer.
To be fair, the chargemasters were primarily intended to serve billing departments and not patients. Translations of the many abbreviations take much effort, and understandably, hospitals are busy. Hopefully, some enterprising firms will undertake the job of making this information more user-friendly across hospitals.
Kaiser Family Foundation released the results of a survey (accompanying commentary) conducted in February, asking Americans about their sentiments regarding prescription drug costs. Highlights include each of the following ideas garnering at least 80% support among respondents: requiring drug ads to include list prices, making it easier for generic drugs to be sold, allowing Medicare to negotiate drug prices, and allowing the importing of drugs from Canada. If these sentiments are truly reflective of the broader population (and if these issues are important to voters), there is hope that elected officials might change some of the current policies.
Fortunately, two-thirds of the respondents who report taking prescription medicines report that paying for their prescriptions is very easy or somewhat easy. On the other hand, almost 30% of respondents (presumably of those who report taking prescription medication) say that they do not take medicine as prescribed because of costs (e.g. not filling a prescription or reducing doses). Prescription drug cost is likely to be one of the issues raised under the broader issue of rising healthcare costs in the next election.
The New York Times published an excellent survey of the political landscape for healthcare in the US. Predictably, many Republicans oppose the Affordable Care Act and want to repeal at least parts of it (there is a lawsuit underway to nullify the key provisions). The main group that the article profiles is a coalition of healthcare stakeholders (including the American Medical Association, the American Hospital Association, America's Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America) that mostly want the Affordable Care Act to stay the same. The healthcare industry is understandably concerned about consolidation of the purchasing power, especially into the hands of the government, given Medicare's history of reimbursing physicians less than other payers. Further to the left are proposals to expand Medicare, either through a "Medicare for All" proposal (authored by Senator Bernie Sanders) or through a more moderate Medicare buy-in proposal. Interestingly, the "Medicare for All" proposal prohibits employers from duplicating benefits, meaning that the effort goes a long way towards weaning Americans off of employer-based coverage.
Clearly, many people think the current healthcare landscape is broken; however, people disagree on the right approach to fix it.
Kaiser Health News published two interesting articles this month that highlighted patients' struggles with medical bills: the earlier one reviewed some legislative proposals intended to limit patient liability in the case of surprise medical billing and emergency care, while the later one recounted some patient experiences with visiting the emergency room. The sustained interest and coverage regarding medical bills suggest that the nation will likely see some movement in this area, especially if the Democratic party gains control of both Congress and the presidency.
The second article highlights how visiting an out-of-network emergency room can be financially devastating. Normally, insurance will limit a person's annual expenses to a number known as the annual maximum out-of-pocket, which is $7,900 for individuals with ACA Marketplace plans in 2019. However, out-of-network medial care is not subject to that limit, even if that care might be emergency care. Hence, emergencies can be very expensive.