Even the Insured Often Can't Afford Their Medical Bills

Helaine Olen
The Atlantic
Originally published June 18, 2017

Here is an excerpt:

The current debate over the future of the Affordable Care Act is obscuring a more pedestrian reality. Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills. The point of insurance is to protect patients’ finances from the costs of everything from hospitalizations to prescription drugs, but out-of-pocket spending for people even with employer-provided health insurance has increased by more than 50 percent since 2010, according to human resources consultant Aon Hewitt. The Kaiser Family Foundation reports that in 2016, half of all insurance policy-holders faced a deductible, the amount people need to pay on their own before their insurance kicks in, of at least $1,000. For people who buy their insurance via one of the Affordable Care Act’s exchanges, that figure will be higher still: Almost 90 percent have deductibles of $1,300 for an individual or $2,600 for a family.

Even a gold-plated insurance plan with a low deductible and generous reimbursements often has its holes. Many people have separate—and often hard-to-understand—in-network and out-of-network deductibles, or lack out-of-network coverage altogether.  Expensive pharmaceuticals are increasingly likely to require a significantly higher co-pay or not be covered at all. While many plans cap out-of-pocket spending, that cap can often be quite high—in 2017, it’s $14,300 for a family plan purchased on the ACA exchanges, for example. Depending on the plan, medical care received from a provider not participating in a particular insurer’s network might not count toward any deductible or cap at all.

The article is here.

Letter from the American Medical Association to McConnell and Schumer

James Madera
Letter from the American Medical Association
Sent June 26, 2017

To: Senators McConnell and Schumer

On behalf of the physician and medical student members of the American Medical Association
(AMA), I am writing to express our opposition to the discussion draft of the “Better Care
Reconciliation Act” released on June 22, 2017. Medicine has long operated under the precept of
Primum non nocere, or “first, do no harm.” The draft legislation violates that standard on many
levels.

In our January 3, 2017 letter to you, and in subsequent communications, we have consistently
urged that the Senate, in developing proposals to replace portions of the current law, pay special
attention to ensure that individuals currently covered do not lose access to affordable, quality
health insurance coverage. In addition, we have advocated for the sufficient funding of Medicaid
and other safety net programs and urged steps to promote stability in the individual market.
Though we await additional analysis of the proposal, it seems highly likely that a combination of
smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of
important protections such as required benefits, actuarial value standards, and out of pocket
spending limits will expose low and middle income patients to higher costs and greater difficulty
in affording care.

The AMA is particularly concerned with proposals to convert the Medicaid program into a
system that limits the federal obligation to care for needy patients to a predetermined formula
based on per-capita-caps.

The entire letter is here.

The GOP's risky premium pledge

Jennifer Haberkorn
Politico.com
Originally posted June 5, 2017

Senate Republicans may be all over the map on an Obamacare repeal plan, but on one fundamental point — reducing insurance premiums — they are in danger of overpromising and underdelivering.

The reality is they have only a few ways to reduce Americans’ premiums: Offer consumers bigger subsidies. Allow insurers to offer skimpier coverage. Or permit insurers to charge more — usually much more — to those with pre-existing illnesses and who are older and tend to rack up the biggest bills.

Since there’s no appetite within the GOP for throwing more taxpayer money at the problem, Republicans will need to make some hard decisions to hit their goal. But the effort to drive down premium prices will inevitably create a new set of winners and losers and complicate leadership’s path to the 50 votes they need to fulfill their seven-year promise to repeal Obamacare.

“Anyone can figure out how to reduce premiums,” said Sen. Chris Murphy (D-Conn.). “You can reduce premiums by kicking everybody that has a pre-existing condition off insurance or dramatically reducing benefits.”

Republicans say that Obamacare’s insurance regulations are responsible for making coverage prohibitively expensive and contend that premiums would fall if those rules are rolled back. They say they have multiple ideas about how to roll those back while also insulating the most vulnerable but have yet to weave those together into actual legislation.

The article is here.