The Kaiser Daily Health Policy Report today links to a Philadelphia Inquirer article, the second installment in a series called “Falling Through: Casualties of the Health Insurance Crisis,” profiling the obstacles that people with chronic illnesses face in obtaining affordable health insurance.
Private insurance becomes unaffordable to many with chronic conditions because insurance companies are permitted to “cherry-pick” customers based on pre-existing conditions. The man profiled in the Philadelphia Inquirer article was diagnosed with a chronic illness shortly after letting his health coverage lapse.
“When he felt better, he looked to buy insurance, but couldn’t find anything affordable.
The cheapest he was able to find, he said, cost him $1,000 a month only for himself, and that covered only 50 percent of his medications.
‘The cost of insurance is astronomical,’ he says, ‘and so is the cost of getting sick. I play a game: How long can I stay well?’
‘One anti-inflamatory, Pentasa, is $392 a month,’ he says. ‘The amount they want me to take – I take half of that.'”
Read the full article here.
You can now access 2007 data on the health insurance status of women in each state by visiting statehealthfacts.org.
Statehealthfacts.org is a project of the Kaiser Family Foundation that provides up-to-date, easy-to-use health coverage data for all 50 states, based on population subset (men, women, children, low-income people) and insurance-type (employer-sponsored, Medicaid, the uninsured).
The Treasury Department’s proposal of a $700 billion bailout package in the face of this financial crisis has a lot of people wondering what this will mean for our next president’s spending plans and tax policies. Two recent articles, published in BusinessWeek and The New York Times, examine some of the heaviest costs of using taxpayer money for this purpose.
“The more funding the financial bailout demands, the tougher the trade-offs the [next president] will have to consider when it comes to his priorities. Spending on health-care reform or tax cut packages will likely take the first hit.” – BusinessWeek
“A $700 billion Wall Street rescue plan would likely delay some campaign spending promises…‘Does that mean that I can do everything that I’ve called for in this campaign right away, probably not. I think that we are going to have to phase it in. A lot of it is going to depend on what our tax revenues look like,’ Obama said.” – NY Times
High-deductible health plans have been supported by some policymakers as a strategy for reducing the number of uninsured Americans. But a new issue brief released by Minority Health Initiaves at Families USA discusses the ways in which such policy would disproportionately burden racial and ethnic minorities with unaffordable health care expenses.
The issue brief identifies three serious concerns with the impact of high-deductible health plans on communities of color:
High out-of-pocket costs;
Incentives to delay or avoid necessary care; and
Barriers that will widen the health disparities gap.
Read more here.
Workers are shouldering higher health care costs as more employers demand bigger out-of-pocket payments from employees before their insurance kicks in, a study out today shows.
Annual deductibles — the amount employees pay out of their own pockets for medical care before their insurance coverage starts — jumped an average of 29%, to $1,344, for those with family coverage, the survey says. It was conducted by the non-partisan Kaiser Family Foundation, which studies health policy, and the Health Research & Educational Trust, an affiliate of the American Hospital Association that studies health issues.
Deductibles rose an average 21% this year to $560 for single workers.
Kaiser President Drew Altman says researchers saw a “noticeable growth in high-deductible plans. … We may be seeing the tip of the iceberg toward less comprehensive, skimpier coverage.”
The survey of 1,927 employers found that 18% of insured employees pay at least $1,000 before their coverage starts — up from 12% in 2007. Among companies with fewer than 200 employees, 35% offer coverage with deductibles of at least $1,000, up from 21% last year. Most covered workers are allowed some preventive care outside the deductible.
Some employers raised workers’ deductibles this year to stabilize premiums, the monthly cost of coverage.
The Kaiser survey showed that the overall cost of health insurance premiums went up 5% this year, the smallest increase since 1999. The share workers paid remained about the same.
A separate survey out last week found that employers, who are struggling to provide insurance as their own costs soar, see little relief from the presidential candidates’ health plans. “Employers are still deeply troubled by not seeing any hope on the horizon in bringing down health care costs,” says Peter Lee, executive director of the Pacific Business Group on Health, a coalition of large and small employers that was not involved with either report.
The survey by the American Benefits Council, a trade association representing employers, asked corporate benefit managers about health policy ideas that would impact their workforce. It did not identify the ideas with either presidential candidate but briefly described the plans that Democratic presidential nominee Barack Obama and Republican presidential nominee John McCain are proposing. Of the 187 benefit managers who responded:
•46% said requiring employers to offer coverage or pay into a public fund to help provide it, as Obama supports, would have a strong negative effect. About 14% viewed the idea positively.
•74% said ending the tax-free status of workers’ health insurance benefits, as McCain advocates, would be strongly negative, while 5% viewed it positively. McCain wants to offset the tax on health benefits with a tax credit of $2,500 for individuals and $5,000 for families.
Copyright 2008 USA TODAY, a division of Gannett Co. Inc.
What’s at stake in health care reform? Take a look at a recent article from the Heritage Foundation, which proposes many ways to deny comprehensive reproductive health care, especially to young women and women on Medicare and Medicaid, in any effort at health care reform.
by Lois Uttley on September 12, 2008 – 8:00am
Recently, a great deal of public attention and public policy has been focused on protecting the religious and ethical beliefs of health providers. As your council discusses this issue, I urge you to consider another imperative – protecting the rights of patients to receive accurate medical information and needed treatment in a timely manner. In a pluralistic society such as we have in the United States, public policy must carefully balance the needs and rights of all affected parties.
Let’s use an example to make this discussion very concrete:
A 19-year-old rape victim – let’s call her Sally — is brought to a hospital emergency department by the police. The physician who treats her numerous injuries – Let’s call him Dr. Brown — omits any mention of the potential to prevent pregnancy from the rape by using emergency contraception, because he does not approve of it for religious reasons. Many hours later, Sally leaves the hospital without being informed about emergency contraception, or offered the medication. A friend takes her back to the college dorm where they live and Sally, exhausted, falls asleep for 24 hours. Because emergency contraception is the most effective when taken shortly after unprotected intercourse, Sally’s opportunity to prevent pregnancy has now been greatly diminished.
What has just happened? Is this proper medical care? What are Sally’s rights? What are Dr. Brown’s? And, how should they be properly balanced?
The patient’s rights
Let’s start with Sally. After all, the patient is supposed to be the focus of what the health professions now refer to as “patient-centered care.” According to the Institute of Medicine, “patient-centered care is defined as health care that establishes a partnership among practitioners, patients and their families (when appropriate) to ensure that decisions respect patients’ wants, needs and preferences and solicit patients’ input on the education and support they need to make decisions and participate in their own care.”
One of the central tenets of patients’ rights and “patient-centered care” is the right to informed consent. For a patient to make an informed decision about medical treatment, he or she must have knowledge of all potential treatment options, and their risks and benefits. In this case, the rape victim has not been informed about an important potential treatment option – use of emergency contraception to prevent pregnancy. As it happens, Sally is one of the millions of American women of reproductive age who are not aware of EC. So, Sally has had no opportunity to consider this option or use her own moral, ethical or religious perspectives to decide whether she wishes to risk the chance of bearing the child of a rapist. Further, she has had no chance to discuss with her physician the potential medical complications of an unplanned pregnancy, in view of her existing medical conditions, which include diabetes.
How could this violation of patients’ rights be corrected? The simplest method would be to require all hospital emergency department personnel, including Dr. Brown, to always offer EC to rape victims who are of reproductive age…
For the full article, please visit: http://www.rhrealitycheck.org/blog/2008/09/11/testimony-before-presidents-council-bioethics-protecting-patients-rights
Worse for Women An Analysis of the Effects Senator McCain’s Health Plan Would Have on Women’s Access to Health Care
By Jessica Arons, Karen Davenport, Stephanie Bell, Amy Yenyo
September 10, 2008
Senator John McCain’s health plan would drastically restructure America’s health care system, with especially devastating effects on women. The health plan of the Arizona senator and Republican presidential nominee would dangerously destabilize the employer-based health insurance system upon which 160 million non-elderly Americans rely for their health care, steering them instead toward the individual market where basic medical needs often are not covered.
Tens of millions of women would be at risk of losing their current insurance coverage even though they use health care services more frequently than men, suffer chronic illness more often than men, and require maternity care and other reproductive health services. Specifically, under the McCain health plan:
- More than 59 million women who receive their health insurance through their job, or their spouse’s job, are at risk of losing that insurance
- More than 30 million women with employer-sponsored health insurance who suffer from a chronic condition could lose their coverage, find it harder to obtain coverage, or have to purchase supplemental insurance to cover their chronic condition
In addition, Sen. McCain’s health plan would erode important state requirements aimed specifically at protecting women’s access to some of their most basic health needs. By permitting plans to cherry-pick their state of residence as well as enabling plans to sell policies without regard to state insurance rules through so-called “association health plans,” Sen. McCain’s plan would encourage insurers to eliminate coverage of basic health services. These state requirements include:
- Twenty-nine states require cervical cancer and Human Papillomavirus screening Sixteen states require coverage of the HPV vaccine
- Thirty-one states require comprehensive drug benefit plans to include contraception
- Twenty-one states require coverage of maternity care
- Forty-nine states require breast reconstruction
Depending on where a woman lives, the state protections at risk include:
- Direct access to obstetricians/gynecologists
- Annual breast, ovarian, and cervical cancer screening
- Sexually transmitted infection screening
- Prohibitions on gender-based premium rating
- Limited definitions of pre-existing conditions that prevent surgeries like Caesarean sections from limiting women’s coverage
Rather than giving women more control over their health care decisions, as Sen. McCain promises to do, his health plan would take away women’s ability to access critical health care services.
For the full article, please visit: http://www.americanprogressaction.org/issues/2008/womens_health_mccain.html
Medical Homes Can Reduce Hospitalizations and Total Health Care Costs
Findings from a new study published today in Health Affairs provide evidence that the patient-centered medical home model can improve quality of care and reduce health care costs. According to first-year results from pilot-test sites, Geisinger Health System in Pennsylvania–which has adopted the model–has managed to reduce hospital admissions by 20 percent and save 7 percent in total medical cost
For the full case study, please visit: http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=704008
By CARLA K. JOHNSON, Associated Press Writer Wed Sep 10, 12:44 AM ET
Only 2 percent of graduating medical students say they plan to work in primary care internal medicine, raising worries about a looming shortage of the first-stop doctors who used to be the backbone of the American medical system.
The results of a new survey being published Wednesday suggest more medical students, many of them saddled with debt, are opting for more lucrative specialties.
Just 2 percent of nearly 1,200 fourth-year students surveyed planned to work in primary care internal medicine, according to results published in the Journal of the American Medical Association. In a similar survey in 1990, the figure was 9 percent.
Paperwork, the demands of the chronically sick and the need to bring work home are among the factors pushing young doctors away from careers in primary care, the survey found.
“I didn’t want to fight the insurance companies,” said Dr. Jason Shipman, 36, a radiology resident at Vanderbilt University Medical Center in Nashville, Tenn., who is carrying $150,000 in student debt.
Primary care doctors he met as a student had to “speed to see enough patients to make a reasonable living,” Shipman said.
Dr. Karen Hauer of the University of California, San Francisco, the study’s lead author, said it’s hard work taking care of the chronically ill, the elderly and people with complex diseases — “especially when you’re doing it with time pressures and inadequate resources.”
The salary gap may be another reason. More pay in a particular specialty tends to mean more U.S. medical school graduates fill residencies in those fields at teaching hospitals, Dr. Mark Ebell of the University of Georgia found in a separate study…
For the full article, go see: