1. Evaluation of Medicare’s Bundled Payments Initiative for Medical Conditions. Karen E. Joynt Maddox, E. John Orav, Jie Zheng and Arnold M. Epstein. N Engl J Med 2018;379:260-9. https://www.ncbi.nlm.nih.gov/pubmed/30021090
2. Medicare ACO Program Savings Not Tied to Preventable Hospitalizations or Concentrated among High-Risk Patients. J. Michael McWilliams, Michael E. Chernew and Bruce E. Landon. Health Affairs 36:2017;2085–2093. https://www.ncbi.nlm.nih.gov/pubmed/29200328
3. Care patterns in Medicare and their implications for pay for performance. Pham, H. H., D. Schrag, A. S. O’Malley, B. Wu, and P. B. Bach. New England Journal of Medicine 2007; 356(11):1130-1139. https://www.ncbi.nlm.nih.gov/pubmed/17360991
4. Time Out — Charting a Path for Improving Performance Measurement. Catherine H. MacLean, Eve A. Kerr and Amir Qaseem. N Engl J Med 2018: 378;19.
5. Adherence and health care costs. Iuga AO and McGuire MJ. Risk Manag Helathc Policy 7:35-44, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/
6. Greater Use of Preventive Services in U.S. Health Care Could Save Lives at Little or No Cost. Michael V. Maciosek, Ashley B. Coffield, Thomas J. Flottemesch, Nichol M. Edwards and Leif I. Solberg. Health Affairs 29: 2010;1656–1660. https://www.ncbi.nlm.nih.gov/pubmed/20820022
7. Healthy Aging Brain Center improved care coordination and produced net savings. French DD, LaMantia MA, Livin LR, Herceg D, Alder CA, Boustani MA. Health Affairs 2014;33:613-8. https://www.ncbi.nlm.nih.gov/pubmed/24711322
8. Adding value to relative-value units. Stecker EC and Schroeder SA. N Engl J Med 2013;369 (23):2176-79. https://www.nejm.org/doi/10.1056/NEJMp1310583?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov
9. Principles Supporting Dynamic Clinical Care Teams: An American College of Physicians Position Paper. Robert B. Doherty and Ryan A. Crowley, for the Health and Public Policy Committee of the American College of Physicians. Ann Intern Med 2013:159;620-626. http://annals.org/aim/fullarticle/1737233/principles-supporting-dynamic-clinical-care-teams-american-college-physicians-position
10. Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries. Antonia K. Bernhardt, Joanne Lynn, Gregory Berger, James A. Lee,Kevin Reuter, Joan Davanzo, Anne Montgomery and Allen Dobson. The Milbank Quarterly, 2016;1-29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020161/
RESEARCH FOUNDATION REPORTS:
1. Uncompensated Care for the Uninsured in 2013: A Detailed Examination. Teresa A. Coughlin, John Holahan, Kyle Caswell, and Megan McGrath. www.kff.org. May 30, 2014 https://www.kff.org/uninsured/report/uncompensated-care-for-the-uninsured-in-2013-a-detailed-examination/
2. Chronic Care: Making the case for ongoing care. Anderson, GF. Princeton, NJ: Robert Wood Johnson Foundation. 2010. The Effects of Medicaid Expansion under the ACA: Updated Findings from a literature Review, Larisa Antonisse, kff.org, Sep 2017 https://www.rwjf.org/en/library/research/2010/01/chronic-care.html
3. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (2013). The National Academies Press Open Book. http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx
4. How have providers responded to the increased demand for health care under the Affordable Care Act? Wishner JB and Burton RA. Urban Institute, November 2017. https://www.rwjf.org/en/library/research/2017/11/how-have-providers-responded-to-the-increased-demand-for-health-care-under-the-aca.html
5. The cost and volume of comparative effectiveness research. In Learning what works: Infrastructure required for comparative effectiveness research: Workshop summary. Holve, E., and P. Pittman. Institute of Medicine. Washington, DC: The National Academies Press. 2011:89-96. https://www.nap.edu/read/12214/chapter/2#10
6. Employer Health Benefits: 2017 Annual Survey. Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, Gregory Foster and Heidi Whitmore. The Kaiser Family Foundation and Health Research & Educational Trust. 2017. https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/view/print/
1. Centers for Medicare and Medicaid Services Financial Report, 2017. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwj63u_W0PTdAhVfIzQIHZnlAmMQFjAAegQIChAC&url=https%3A%2F%2Fwww.cms.gov%2FResearch-Statistics-Data-and-Systems%2FStatistics-Trends-and-Reports%2FCFOReport%2FDownloads%2F2017_CMS_Financial_Report.pdf&usg=AOvVaw1-Udg09bY8IZdj9vcX5H_l
2. Medicare Payment Advisory Commission. Report to Congress: Medicare Payment Policy. Chapter 13. “Status report on the Medicare Advantage Program.” March 2017. http://www.medpac.gov/-documents-/reports
COVID-19 Healthcare News
What we can learn from Taiwan and S. Korea: Early testing, screening and isolation key to COVID-19 containment. Taiwan and S. Korean put plans in place after their experience with SARS and MERS and were prepared when they learned about COVID-19. They were able to contain the virus in a way the U.S. could not due to our lack of planning and centralized healthcare structure. We must prevent this from happening again. We must invest in public healthcare and research. And we need universal healthcare now, not later. The Healthcare Blog, March 16, 2020
Coronavirus could hike premiums by double digits next year. Premiums could go up by 4% to 40% to recover costs of care for COVID-19. This is based on estimates of hospitalization of 400,000 to 3 million people infected with the virus. This is in line with some recent model predictions. Costs would range from $29 billion to $216 billion, based on billed charges; allowed charges would be lower at about $16 billion to $119 billion, respectively. With so many people struggling to pay their bills, this is no time for them to worry about increased costs for health insurance. Now, more than ever, we need Medicare for All. Reported in Healthcare Dive.
Being on Medicare Doesn’t Prevent Problems Paying Medical Bills Due to COVID-19. Having Medicare coverage does not always take away the burden of medical costs. A recent survey showed one in six Medicare beneficiaries had problems getting care or delayed care due to cost, or had problems paying medical bills. The percentage was significantly higher among beneficiaries in fair or poor health and those with low incomes. A larger percentage of beneficiaries enrolled in Medicare Advantage plans reported problems getting care than beneficiaries in traditional Medicare. In addition to being among those at most risk of getting seriously ill if they get COVID-19, many on Medicare may also be financially unable to afford the care they may need. Medicare for All would relieve these financial barriers. Kaiser Family Foundation. April 2, 2020.
A nurse revealed the tragic last words of his coronavirus patient: 'Who's going to pay for it?' Certified registered nurse anesthetist Derrick Smith is no stranger to the horrors of losing patients. But now, the coronavirus pandemic has pushed him into a completely different, "much more terrifying" reality. We are the only advanced country without universal healthcare. Read in CNN
Over 7 million Americans predicted to lose health insurance during coronavirus pandemic due to job losses. This is according to a study in the journal, Annals of Internal Medicine. One of the authors told Newsweek, “The COVID-19 epidemic highlights the folly of tying health coverage to jobs.” The highest rate of uninsured will be in states that did not expand Medicaid under the Affordable Care Act.
Loss of income due to COVID pandemic doesn’t guarantee eligibility for Medicaid or even subsidies under the Affordable Care Act (ACA). A data note from the Kaiser Family Foundation explains the complex situation. Although most children in families of the unemployed will be eligible for Medicaid, parents in many states will not qualify if their unemployment insurance raises their income above the meager limits some states set for eligibility. They may qualify for subsidies for insurance premiums in the ACA marketplace, but by the time they are eligible to apply at the end of the year, their supplemental benefits may run out and their income may then be too low and make them fall in the so-called “coverage gap” if it’s below 138% of the federal poverty level. And they live in a state that did not expand Medicaid eligibility, they won’t qualify for Medicaid either, so they won’t be able to get any insurance.
Administration risks loss of ACA protections for millions. Trump says he will pursue the Administration's lawsuit before the Supreme Court attempting to strike down the Affordable Care Act (ACA) despite the current COVID-19 pandemic. The lack of any plan to replace the ACA would leave millions without health insurance, including many of the 30 million Americans who have lost their jobs due to the virus. In addition, one of the most important protections of the ACA would also be lost--insurance companies would no longer be banned from excluding pre-existing conditions when individuals get new insurance. Millions of people with chronic conditions--exactly those most likely to be affected by COVID-19--would be without any insurance coverage for their usual medical care.This could never happen if we had Medicare for All. Washington Post, May 6, 2020.
Almost 6 million could lose health insurance coverage under the ACA after job loss from COVID-19. An analysis by the Kaiser Family Foundation shows that of 26.8 million who have lost their jobs due to the COVID-19 pandemic, 12.7 million would be eligible for Medicaid or the Children's Health Insurance Plan (CHIP) coverage. Another 8.4 million would be eligible for tax subsidies under the Affordable Care Act (ACA). But 5.7 million who lose their employer health insurance and look to the ACA marketplace for insurance will not be eligible for any subsidies. They will have to pay the full cost. Without any jobs, how will they pay for it?
COVID-19 exposes racial injustice of our healthcare system. The death rate from COVID-19 is 2.4 times higher for blacks than for whites. The death rate is also higher for other minorities. The reason is the higher rate of poverty and reduced access to healthcare. It's time for universal healthcare and an end to racial bias in healthcare access. It's time for Medicare for All. The Color of Coronavirus: COVID-19 deaths by race and ethnicity in the U.S.
States step in where federal government fails to act: the $7,000 COVID test. Prices for lab tests for COVID-19 vary widely around the country and from one lab to another. When a doctor orders the test, patients expect it to be covered. But when the lab is not in the patient’s insurance network, the patient may get stuck with the bill. That’s not supposed to happen, but the federal government has done nothing to prevent it. Some states are rushing to pass laws to keep labs from charging sky high prices and prevent insurance companies from passing charges on to patients. With so many insurance companies and different jurisdictions, it’s hard to make it all work. With a single-payer system like Medicare for All, it would be easy. Read the article about the lab that billed almost $7,000 for a COVID-19 test.
Americans need healthcare. It can’t be tied to their jobs. The dual crises of mass unemployment and the coronavirus have shown the central flaw of the U.S. health care system, according to a NY Times op-ed. It explains how our current system came about by chance after WWII and caused the current inequalities that make healthcare harder to get for low-wage workers and the unemployed and also cause a drag on wages. A new system, not dependent on employers is needed. Read our plan for Medicare for All on our homepage.
What do we know about COVID-19 and children? In an issue brief, the Kaiser Family Foundation looks at the evidence and what it means for school re-opening. Although children are less likely to get severely ill from the virus than adults, some severe complications do happen, and rare deaths have occurred. It’s not clear if they get infected as easily as adults or spread it as much, but outbreaks in schools and daycare centers have occurred. It looks like the low risks reported in countries where schools were re-opened were related to low levels of community transmission at the time. KFF concludes that “where there is already widespread community transmission…the risks of reopening need to be considered carefully.”
Don't count on lower premiums despite pandemic-driven boon for insurers. Healthcare costs resulting from the COVID-19 pandemic have been much lower than expected. The increased costs for care of patients infected with the virus has been much less than the decreased cost resulting from cancelled elective procedures and decreased ER and physician visits by patients trying to avoid contracting the disease. This has led to one large insurer reporting a doubling of its profit in the April-June quarter of this year. But most insurers are still planning to increase premiums in case costs go up later. Read the report in Kaiser Health News.
While Trump Administration cut funding for consumer assistance, 1 in 8 eligible for ACA or Medicaid tried to get help to enroll but couldn’t. A survey by the Kaiser Family Foundation found that many barriers exist that keep eligible people from enrolling in ACA marketplace plans or Medicaid. Many are unaware of options, don’t know where to look for help or can’t find it or get an appointment when they try. Not surprising with funding decreases of 84-90% for customer assistance programs. The survey estimated that 5 million people couldn’t get the help they needed in the past year. Now with COVID-19, many people losing their jobs and health insurance have little confidence they could afford to pay for health insurance. The government offers little help to get them through the maze of options that are available. Healthcare coverage does not help if you can’t enroll. Medicare for All enrollment is automatic.
Cost-sharing relief by private plans during pandemic set to expire soon as profits mount. Because of higher than expected profits, most private plans have waived deductibles and copayments for COVID-19 treatment and have also offered premium credits or rebates. Private plans must to spend at least 80% to 85% of the money they get in premiums on healthcare for those they cover or they have to refund premiums the next year. Due to lower healthcare spending during the pandemic, insurers are set to pay back about $2.7 billion in rebates next year, almost twice as much as last year and 4 times as much as 2018, but a new analysis shows many of their waivers are expiring. What will happen if there’s another spike of COVID-19 cases in the fall? Will private insurers pay up, or hoard their profits?
U.S. medical supply chains failed, and COVID deaths followed. For decades, politicians and corporate officials ignored warnings about the risks associated with America’s overdependence on foreign medical supplies. The Trump administration has blamed China, and its entry into the World Trade Organization in 2001, for the country's dominance over America's medical supplies. But the lure of cheap labor and lower production costs started drawing U.S. companies overseas in the 1970s. By 2020, almost all medical protection supplies in the U.S. were made in other countries. Corporate profits have taken priority over public safety. Read the report of the 7-month investigation by the Associated Press and FRONTLINE in Modern Healthcare.
COVID-19 causes annual decrease in health spending for first time. According to an analysis by the Kaiser Family Foundation (KFF) of data from the Bureau of Economic Analysis, spending on health services dropped over 30% by April 2020 due to the COVID-19 pandemic. This has not happened since the data have become available in the 1960s—expenditures on health services have grown every month previously. Spending has rebounded since the spring and was about 2% lower than last year as of October. The KFF analysis expects 2020 to end about 0.5% lower than 2019. How much decreased utilization has been due to a decrease in unnecessary care as opposed to delayed necessary care is uncertain. Only time will tell what impact the decreased expenditures might have on health outcomes—or on insurance premiums.
COVID-19 likely to make it harder for many to pay premiums and copays while insurers reap big profits. As reported by HealthcareDive, the latest survey from the Commonwealth Fund shows a continued trend of increasing out-of-pocket costs for individuals’ shares of health insurance premiums and copayments over the past 10 years. These costs continue to go up faster than wages. Despite decreased healthcare costs in 2020 related to the pandemic, most insurers are not decreasing their premiums in 2021, citing uncertain future costs. With further lockdowns looming and more job losses likely, the authors of the report suggest that it is likely that middle-income households will find it harder to pay for health insurance premiums and copayments and may decide to give up their insurance altogether in order to pay for more essential items like food and housing. Although Obamacare provides subsidies to low-income individuals with premium expenses for insurance offered through their job that are more than 9.83% of their income—but only if they have single coverage, not a family policy. And Medicaid eligibility criteria are not always easy to meet. It’s time to stop tying health insurance to employment and placing unreasonable limits on financial assistance.
Health insurer Cigna reports huge profits during pandemic. The giant health insurer, Cigna, reported $4.1 billion in profits in the fourth quarter of 2020, up from $977 million during the same time in 2019, according to Becker’s Hospital Review. For all of 2020, Cigna’s profits were a whopping $8.5 billion, compared to $5.1 billion in 2019—that an increase of 67% for the year. In the fourth quarter of 2020, less than 86% of Cigna’s premium revenue was spent on medical care—the rest, 14%, went to profits and administrative costs. For comparison, Medicare spends only 7.4% on administrative costs (only 2.7% if you exclude private insurance plans in Medicare Advantage and drug plans). See ACAMFA’s Medicare for All Plan for a complete explanation (detailed calculations are in Appendix VIIa).