Terminated workers are paying an average of $429 a month this year for individual HMO coverage, compared to $399 for the same coverage in 2009, according to a survey conducted by Aon Consulting. COBRA coverage for an entire family now costs an average of $1,251, up from $1,171 per month at this time last year. With COBRA costs on the rise and the average unemployment check totaling less than $300 a week, a growing number of jobless Americans are no longer able to afford their health insurance plans.
Families are having to choose between having health insurance or keeping a roof over their head and food on the table. A family who has a member with medical needs is between a rock and a hard place.
John Zern, executive vice president and Health & Benefits Practice director with Aon Consulting, said the costs of COBRA are rising because so many people are using the system.
In an effort to spread the misery around:
Current employees should also expect to see their plans become more expensive in the next couple of years as employers shift the costs over to them. The Aon survey found that 65 percent percent of employers plan to increase cost-sharing in 2011 for deductibles, co-pays and out-of-pocket maximums, and 57 percent of companies polled said they will ask employees to contribute more for the overall cost of health care next year.
If you want to know how the health care reform law affects you, Healthcare.gov is one of the best places to go. And now they’ve made it possible to look up coverage options for your situation and your location. Check it out:
The global economic crisis has affected routine health care more in the US than in countries that have universal systems;
The study, published by the National Bureau of Economic Research, finds that “Americans, who face higher out-of-pocket health care costs, have reduced their routine medical care” much more than people in Britain, Canada, France and Germany.
and
Among Americans responding to the survey, they said, 26.5 percent reported reducing their use of routine medical care since the start of the global economic crisis in 2007.
This proportion dwarfs the comparable numbers for other countries: 5.3 percent in Canada, 7.6 percent in Britain, 10.3 percent in Germany and 12 percent in France.
“Even in countries with universal coverage, individuals pay some medical care costs out of pocket,” the researchers noted.
Cutbacks were generally correlated with the size of out-of-pocket costs, the researchers found. The proportion of people reporting reductions in routine care was smaller in Britain and Canada, where the co-payments are lower, than in France and Germany, where somewhat larger co-payments are required.
This isn’t a surprise. People who have difficult choices to make about keeping a roof over the family’s head and food on the table will ignore their own health issues for as long as possible. Sadly, this will mean ignoring problems until they reach a critical stage, which will mean that many will die for want of routine care.
Economic desperation is why massive free medical clinics are a draw, like this one at the beginning of the month. From HuffPo:
A massive free health clinic for uninsured people in Washington, D.C. on Wednesday morning attracted nearly two thousand people, from infants to the elderly, all taking advantage of free doctor attention, blood tests and cancer screenings they otherwise wouldn’t be able to afford.
The story profiles two men in their fifties who were laid off from their good jobs where they had insurance. They just can’t afford COBRA.
One of the men is quoted:
“Did I think I was gonna be coming to a free health clinic after working as a teacher for 24 years? No,” he told HuffPost. “My resumé speaks for itself.
Last month, Lynne Bolton wrote about Working America’s efforts to support striking nurses in Minnesota.
Last week, those nurses got resolution: They ratified a new contract.
After more than three months of tense negotiations that included a 24-hour strike, some 12,000 nurses in Minnesota’s Twin Cities yesterday voted to ratify a new three-year contract with 14 area hospitals. The new pact contains no concessions or give-backs and maintains the pension plan.
Although they did not win new safe staffing language they sought, the nurses maintained safe staffing language already in their contract, in which a nurse has a right to close a unit when it becomes unsafe to admit any more patients. The nurses are members of the Minnesota Nurses Association (MNA), an affiliate of National Nurses United (NNU).
As Lynne wrote, this is about solidarity—nurses are fighting for their patients and being supported in that fight by their communities, by other unions, and by organizations like Working America.
This is what health insurance giant Wellpoint has been doing to women diagnosed with breast cancer:
None of the women knew about the others. But besides their similar narratives, they had something else in common: Their health insurance carriers were subsidiaries of WellPoint, which has 33.7 million policyholders — more than any other health insurance company in the United States.
The women all paid their premiums on time. Before they fell ill, none had any problems with their insurance. Initially, they believed their policies had been canceled by mistake.
They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.
Once the women were singled out, they say, the insurer then canceled their policies based on either erroneous or flimsy information.
Murray Waas’ investigation of this outrageous practice focuses on three women. One of them had to wait five months for the double mastectomy required by her aggressive cancer. In that five months, the size of her tumor had more than tripled. Another woman received coverage through her mastectomy and reconstructive surgery, but then was dropped by her insurer as she struggled to recover from a life-threatening staph infection. She was unable to get needed reconstructive surgery for the after-effects of that infection and can no longer work. She had been well-to-do and now lives on food stamps and spends her time looking for charities that will help her with her medical and other bills.
Those are horrific stories, and more horrific because they are not isolated:
The investigation last year by the House Energy and Commerce Committee determined that WellPoint and two of the nation’s other largest insurance companies — UnitedHealth Group Inc and Assurant Health, part of Assurant Inc — made at least $300 million by improperly rescinding more than 19,000 policyholders over one five-year period.
WellPoint itself profited by more than $128 million from the practice, and the committee suggested that the figure might be largely understated because the company refused to provide information about cancellations by several subsidiaries.
This is a massive story—in importance and in detail. Read the whole thing, if you can stand to.
This year’s crop of college graduates may have trouble finding a job, given the state of the economy. But some of them will have a much easier time keeping health insurance while they look.
Insurance giant United HealthCare said it would implement, as of today, a requirement of the new health care law that allows young adults who are no longer full-time students to remain on their parent’s health plans until they reach the age of 26. WellPoint, too, announced it would do the same thing, effective June 1.
Since this provision of the new health care law doesn’t go into effect until September, this is significant:
United figures the change in policy could help at least 150,000 graduating seniors and their families from having to find temporary coverage between this spring and the time the new requirement becomes effective.
(This is an effective and meaningful move by United and Wellpoint. But insurance companies, by definition, still care more about profit than about your wellbeing.)
I’m reminded of these famous lines by the great Walter Huston in the film The Treasure of the Sierra Madre:
“Hey, you fellas, how ’bout some beans?… Want some beans?… Goin’ through some mighty rough country tomorrow – ya better have some beans.”
A quick look at just some of what’s coming up.
Senate Banking Committee chairman Chris Dodd (D-CT) will unveil his plan for financial regulatory reform today, following months of delays in pursuit of Republican support that never materialized (again). Key issues include whether the plan will sufficiently tighten regulations on derivatives trading, really make “too-big-to-fail” banks a thing of the past, and whether the regulatory prohibition on commercial banks’ acting as investment banks or hedge funds (the so-called “Volcker Rule”) will be re-instituted.
But the biggest question is what will become of the Obama administration’s proposed Consumer Financial Protection Agency (CFPA), will it emerge as an independent agency or be contained within the Federal Reserve in a weaker, more advisory role. The latter is something many of the Federal Reserve’s current and former consumer protection advisers actually oppose.
Meanwhile, at long last the final stages of passing a significant health care reform plan appear to be approaching this week in Congress. It will have to overcome the massive insurance industry-led lobbying effort trying to stop it. A variety of votes in both the House and the Senate will be needed to pass health care reform with the crucial improvements to the Senate bill agreed to by the White House and Democratic Congressional leaders. But one thing is clear, and that is that the big student loan reform plan (SAFRA) will be included in the House and Senate reconciliation fix for health care and will need only 50 votes in the Senate. Now that would be a Win-Win.
On the all-important jobs front, the initially-bipartisan-then-not bill to provide employers with tax credits for hiring returns to the Senate for final action, where some are talking about pulling an all-nighter. A much larger bill to continue the extensions of current unemployment insurance and COBRA subsidies through the end of 2010 passed the Senate last week but because it differs from an earlier version passed by the House, the measure still awaits further action. And that can’t come too soon for the 11 million Americans now receiving unemployment benefits, as the current jobless aid extensions are still set to expire March 31.
A piece of the health care reform issue we don’t hear much about is the very serious shortage of primary care physicians:
The annual number of American medical students who go into primary care has dropped by more than half since 1997. It’s hard to get an appointment with the doctors who remain. In some surveys, as many as half of primary-care providers have stopped taking new patients. The other half are increasingly overworked and harried. Clearly we need to find a way to increase their ranks, and both the congressional health-care bills and President Obama’s reform proposal make moves in that direction. But those efforts are somewhat limited, and a more comprehensive solution could be thwarted by the same thing that’s stalled the rest of health-care reform so far: politics.
The reason behind America’s doctor gap is a matter of money. The average income in primary care is somewhere in the mid-$100,000s, which sounds like a lot but is less than half what specialists such as radiologists and dermatologists make. Given that doctors may graduate with as much as $200,000 in med-school debt, it’s easy to see why primary care started hemorrhaging recruits more than a decade ago and why radiology and other well-paid, high-tech specialties took off in popularity.
The field has since entered a vicious cycle. As fewer people have entered primary care, the doctors who are left have been forced by tight schedules to shortchange some patients, forgoing the long, meandering chats that used to be a big part of checkups in favor of 15-minute, checklist-style appointments. The close relationships that general practitioners once had with patients drew many idealistic students into the field. Now recruiters face an extra-tough sell: they have to convince bright young would-be docs to pursue a career that won’t pay very well and won’t be as emotionally fulfilling as it once was.
Some medical schools around the country now have programs that pay a portion of the med student’s tuition, in exchange for them doing their training in rural areas. There is also the National Health Service Corps where scholarships and loan repayment are available to medical professionals who go to work in an underserved area. Programs like this are especially important in rural areas. From their website:
About the National Health Service Corps
Since 1972, more than 30,000 clinicians have served in the Corps, bringing high quality health care to places and people without access to even basic services.
Nearly 80 percent stay in the underserved area after fulfilling the NHSC service commitment; more than half make a career of caring for underserved people.
Last year, about 3,500 NHSC providers cared for 4 million people — changing their own and their patients’ lives.
Average hours dropped from about 55 to 51 hours per week from 1996 to 2008, according to the analysis, appearing in Wednesday’s Journal of the American Medical Association.
That’s the equivalent of losing 36,000 doctors in a decade, according to the researchers. And it raises policy questions amid a looming primary care doctor shortage and Congress considering an expansion of health insurance coverage that would mean more patients.
One can certainly suppose (correctly) that overwork and burnout may be reasons why doctors are working fewer hours, but money also seems to be a big motivator:
Payment issues may have played more of a role. The overall decrease in hours coincided with a 25% decline in pay for doctors’ services, adjusted for inflation. And when the researchers looked closely at U.S. cities with the lowest and highest doctor fees, they found doctors working shorter hours in the low-fee cities and longer hours in the high-fee cities.
One way to address the problem of doctor shortages is to have patients see nurses, physician’s assistants, and nurse practitioners for routine care - all of whom can detect a serious problem and pass it on to a doctor. In some rural areas this is already happening, out of necessity.
The American Medical Association and doctors groups don’t like this. Even though there is a serious shortage of primary care docs, the AMA is opposed to letting nurse practioners have a greater role in primary care.
The American Medical Association sparked harsh criticism from nursing groups when it released a report in October bluntly questioning whether nurse practitioners “are adequately trained to provide appropriate care.” To back up its claims, the report cites recent studies that question the prescription methods of some nurse practitioners, as well as a survey that reported only 10 percent of nurse practitioners questioned felt well prepared to practice primary care.
The nurses are fighting back:
Responding to the AMA in December, the American Nurses Association and more than two dozen other nurses’ organizations termed the report “misleading,” saying it “contains numerous factual misrepresentations.” Their letter rebuked the AMA for its “attempt to change the perceptions of NP practice as anything other than fully qualified professionals working within a legally established scope of practice.”
In addition to the common sense aspect, using nurse practitioners also saves money:
In September, the nonpartisan Brookings Institution’s Engelberg Center for Health Care Reform issued a report by 10 experts that said one way to curb health care spending is to encourage states to permit “greater use of nurse practitioners, pharmacists, physician assistants, and community health workers.” Meanwhile, a blue-ribbon committee working under the aegis of the Institute of Medicine and Robert Wood Johnson Foundation is planning to make extensive recommendations later this year on the future of nursing.
Instead of big, howling egos, it would be nice to see more creative solutions. A small town in northern NH was fortunate enough to have one solution given to them. A wealthy summer resident of Tamworth, NH started the Tamworth Community Nurses Association. Mrs. Elizabeth Whittemore left behind an endowment, so that all residents of Tamworth could have access to health care. That was over 80 years ago. The town of Tamworth still has a nurse that sees patients in her office or makes house calls. Free.
In the interest of full disclosure, I know JoAnn Rainville, the Tamworth Community Nurse. I live in a nearby town. The kind of care she provides, saves money. In rural areas, duplicating this kind of service makes sense, especially as we face a shortage of primary care doctors and the possibility of millions of Americans becoming insured.
We’re often told by those who oppose health insurance reform that “everyone has access to health care.” By this, they mean that everyone must be treated in the emergency room. Of course, by the time someone goes to the ER, it’s an EMERGENCY, and often one that might have been prevented with routine care. It’s also going to be an enormous bill for treatment.
As for the outcome, a new study shows that uninsured patients in the ER are twice as likely to die:
Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study.
The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable.
That this study shocked doctors and researchers should tell us something. People who don’t have insurance do not get quality health care, even in the event of an emergency:
“I’m really surprised,” said Dr. Eric Lavonas of the American College of Emergency Physicians and a doctor at Denver Health Medical Center. “It’s well known that people without health insurance don’t get the same quality of health care in this country, but I would have thought that this group of patients would be the least vulnerable.”
The study was unable to pinpoint why the uninsured are twice as likely to die in the ER, just that this frightening discrepancy exists.
In the study, the overall death rate was 4.7 percent, so most emergency room patients survived their injuries. The commercially insured patients had a death rate of 3.3 percent. The uninsured patients’ death rate was 5.7 percent.
This is well beyond man bites dog: After squeezing policyholders, insurance giant WellPoint decided it still wasn’t making enough and sued the state of Maine—an entire state for refusing to guarantee its profit margin.
