Summary: “A new Kaiser Family Foundation analysis finds that 52 million adults under 65 – or 27 percent of that population — have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable Care Act. In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis: West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%). States with the most people estimated to have the conditions include: California (5,865,000), Texas (4,536,000), and Florida (3,116,000). Using data from two large government surveys, the analysis estimates the total number of nonelderly adults in each state with a health condition that could lead to a denial of coverage in the individual insurance market, based on pre-ACA field underwriting guides for brokers and agents. The results are conservative because the data don’t include some declinable conditions. The estimates also don’t include the number of people with other health conditions that wouldn’t necessarily cause a denial, but could lead to higher insurance costs based on underwriting.” Source: An Estimated 52 Million Adults Have Pre-Existing Conditions That Would Make Them Uninsurable Pre-Obamacare,” The Henry J. Kaiser Family Foundation.
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Summary: “Are escalator clauses, common to most Managed Care Contracts, the driving force behind trend factors?” Bill Rusteberg writes over at RiskManagers.com, his blog. Bill’s a broker in Texas, and a man with an encyclopedic knowledge of health care. “An actuary’s primer I stumbled upon while reading incredibly boring stuff (my answer to sleeping pills) may provide a clue: ‘Medical cost trends include components for many drivers. Net unit price increases from providers drives half of the effect in general. So a 5% increase in a schedule will drive a 10% overall cost increase. The rest of the components include: increased utilization, coding creep, deductible leveraging, etc…’ This is wildly interesting! Escalator clauses average 5% and more (‘more’ being more common), compounded year after frigging year! (Excuse me but I do get emotional sometimes and it’s not a women thing!) That equals 10% compounded year after year after year.” Bill Rusteberg, “Managed Care Contracts & Trend Factors,” RiskManagers.com.
Summary: “In many low and middle income countries, out-of-pocket healthcare expenditures are high, and can be a significant financial risk to the poor. Universal health coverage (UHC) is about people having access to needed health care without suffering undue financial hardship,” a blog post on the World Bank’s Data Blog says. This map screenshot is not interactive, but the one on the site is. “Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. It is a part of private health expenditure.”Chart: What Share of Health Costs are Paid Out of Pocket?” The Data Blog.
Summary: So you got a huge bill, and you’re sure there’s been a mistake, either in the bill or the insurer’s processing of a claim. You want to appeal, because it’s a lot of money. Here’s a step-by-step course of action. We cannot guarantee that you will win, but at least you will have tried. Read first, and then dive in! And if you want us to help, let us know. Sometimes we can, though arguing bills is not our core business — we love to tell people how to avoid bad bills on the front end if they can. This is Part 2 of a series: You may also be interested in Part 1, “How to find out what stuff costs in advance.”
Summary: “More than a month after my last update detailing Blondie’s labrum tear surgery final claims appeal filing, I received this note from her mother,” writes Mandi Bishop over at Tincture.io, in the third and final part of a series on challenging medical bill denials.
“Dear Mandi and Mike,
I just wanted to let you know that D just finished a meeting with the (employer) person who deals with health insurance issues ( I don’t know the proper title.) Anyway, she said that they just got confirmation that Insurer X has recently finished reviewing our appeal and has deemed that the medical payments will start being paid to the providers! She also said that the appeal you 2 put together on our behalf included all the information that Insurer X SHOULD have received in the first place, and that the Provider X office did not include said info originally like they should have. She also told D that if we have ‘overpaid’ on our part ($$$ that should have been paid by Insurer X) then they will credit those amounts back to our payment card and it will ‘roll-over’ into 2017 for our medical needs in the next year.
I am ecstatic beyond words, and cannot wait until D gets home tonight so we can celebrate. And maybe now he can start sleeping properly too, with this huge burden off his mind.”
Summary: “The incoming Donald Trump administration and Republicans in Congress reportedly are rushing to repeal most of the Affordable Care Act within days of taking office, with a possible delay of a year or two while they craft a replacement package,” Harris Meyer writes over at Modern Healthcare. “They’re also discussing quick administrative moves to unravel the ACA, such as terminating payments to insurers that compensate them for reducing cost-sharing requirements for lower-income exchange plan members. But pro-ACA experts and some insurers warn that repealing the law without passing a replacement, combined with administrative actions undermining the law, could prompt health plans to abandon the individual insurance markets in 2018. That’s because insurers have to calculate and submit their 2018 premiums by spring, and that task will be difficult or impossible if they don’t know the rules of the new Republican-led system. The turmoil likely would affect both the exchange and off-exchange markets, through which nearly 20 million Americans get coverage, they say. ‘I would not be surprised by a stampede to exit the market for fear of uncertainty and the strong potential for adverse selection,’ said Mike Kreidler, Washington state’s insurance commissioner, at a news conference Wednesday organized by the liberal Center for American Progress. Kreidler said he’s already gotten calls from nervous insurance leaders and plans to meet soon with the CEOs of the three major insurers in his state, where half a million people have gotten coverage under the ACA.” Harris Meyer, “A.C.A. repeal without replacement could spur insurance exodus,” Modern Healthcare.
Summary: “If there’s one thing Republicans have been clear about for the past six years, it is that the top of their agenda includes repealing Obamacare,” writes Sarah Kliff over at Vox. “But Obamacare repeal would leave an estimated 22 million Americans without coverage and wreak havoc on the individual insurance market. It’s becoming increasingly clear that Republicans can’t just repeal Obamacare — they need to replace it with something.
It turns out Republicans have a lot of choices: There are at least seven different replacement plans that Republican legislators and conservative think tanks have offered in recent years. I’ve spent the past week reading them, and what I’ve learned is this:
- Yes, Republicans have replacement plans. It is true that the party has not coalesced around one plan — but there are real policy proposals coming from Republican legislators and conservative think tanks. There is a base that the party can work from in crafting a replacement plan.
- There is significant variation in what the plans propose. On one end of the spectrum, you see plans from President-elect Donald Trump and Sen. Ted Cruz that would repeal Obamacare and replace it with virtually nothing. On the other end of the spectrum, there are plans from conservative think tanks that go as far as to keep the Affordable Care Act marketplaces and continue to give low-income Americans the most generous insurance subsidies.
- If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people. In general, conservative replacement plans offer less financial help to those who would use a lot of insurance. This will make their insurance subsidies significantly less expensive than Obamacare’s.
- Economic analyses estimate that these plans reduce the number of Americans with insurance coverage. The actual amount varies significantly, from 3 million to 21 million, depending on which option Republicans pick. They will near certainly provide more coverage than Americans had before Obamacare, but also less than what exists currently under the health law.” Sarah Kliff, “I read 7 Republican Obamacare replacement plans. Here’s what I learned,” Vox.com.
Summary: No one really knows what will happen when Donald Trump takes office, in light of his pledge to repeal the Affordable Care Act. Nothing is as simple as it sounds ever in life; also, Trump will have to contend with the fact that many parts of the A.C.A. were wildly popular with insurance companies, hospitals and other providers, big drug companies and a host of other health care market players who profited from it. Also, it’s wise to recall that health spending has been an engine of the economy; health stocks have boomed, by and large, and health sector jobs have risen consistently for a number of years. So, what will happen? Prognostications abound. Here are some, selected from post-election writings by people who have reason to make wise predictions about the future. But we won’t really know until the new president and congress take their seats in January. So: Fasten your seatbelts.
Summary: Now that we have some distance from Donald Trump’s election victory on Tuesday, we can look to what’s ahead and where we fit in. Trump has been quoted as saying that he will repeal the entire Affordable Care Act, and also that he would repeal only parts of it. Not much is certain at this point.
It’s worth remembering that the insurance companies, the drug companies and hospitals benefited greatly from the A.C.A. So did a vast number of intermediaries. Taxpayer dollars have subsidized insurance for millions of people, who then went out and bought health care. Health stocks boomed, and health sector employment did too. Also, there are certain things a president cannot do without the approval of Congress. And once any attempt at repeal comes to the fore, we can expect armies of lobbyists protecting the interests of their clients.
Despite this uncertainty, we can be sure of a few things. Many people will lose their health insurance in some not especially predictable fashion. The uncertainty will mean that more marketplace actors will be seeking to protect or enlarge their piece of the pie, so we should all keep our hands on our wallets. There will be a lot of anxiety, and a lot of attempts to spin public opinion, so we should all remain as calm and as fact-based and logical as possible.
One other thing is certain: Our work here at ClearHealthCosts is more important now than ever.
We will continue to give you reliable, unbiased, trustworthy information, and to relieve your anxieties in any way possible. For example, if you need a procedure, check out our blog and our price lists to see the variations in pricing, and make the best decisions you can for your health and your pocketbook. If your medication prices skyrocket, use our prescription shopping resources. Got a question? Then go to the blog and search for your topic; chances are, we’ve covered it. Or email me! I’m firstname.lastname@example.org.
And remember this: For routine procedures and for many medications, the cash market is just not that scary. We would never recommend that anyone go without insurance, but we hear a lot from people saying they were insured but they paid less in cash than they would have using their insurance. I’ve written about this and so have others: The Los Angeles Times, the Wall Street Journal.
Also: Your generosity has brought us to over a third of our goal in our crowdfunding campaign on iFundWomen. We need more help, so please: call out to your networks and ask them to support us. Send them this note, with our link to our iFundWomen page. Together we are strong.
We are here to help you through the next few months and years with as much knowledge as we can supply, and we are grateful for the support and trust you have placed in us. And now, back to work.
Jeanne and the ClearHealthCosts team
Summary: We’re often asked how people use our data. One of our most visited posts is this one on “how much does an abortion cost?” This is information that’s hard to find, and we see that a lot of our visitors are typing this into their search bar — or some variant of this wording — particularly on Saturday and Sunday mornings, on smartphones and other mobile devices like iPads and similar tablets. Click here to support our project on iFundWomen to improve our mobile experience.
A lot of the visitors are from college campuses. Here’s a partial census from three days in early November of the networks that sent us people seeking abortion pricing, collected from our web analytics:
Arizona Tri University Network, Austin College, Bard College, Binghamton State University, Boston University, Bryn Mawr College, California State University at Sacramento, California State University, Central Methodist University, Colgate University, Dartmouth College, Drew University, East-West University, ECPI Colleges in Virginia Beach, Emory University, Fordham University.
Iowa State University, Kennesaw State University, Loyola Marymount University, Madonna University, Montana State University, Montclair State University, New York University, Northern Arizona University, Oregon State University, Penn State, Richard Stockton College of New Jersey, Rowan University, Rutgers University, Sonoma State University, St. John’s University –New York, State University of New York at Oswego, State University of New York at Stony Brook, SUNY College at Cortland, SUNY Stony Brook.
Susquehanna University, Syracuse University, Temple University, Tennessee Technological University, Texas A & M University, Texas State University –San Marcos, Texas State University, the University of California at Santa Cruz, Towson State University, Tulane University, University of Alabama, University of California — Riverside, University of California — San Diego, University of California at Berkeley, University of California at Davis, University of Central Florida, University of Connecticut, University of Dayton, University of Florida, University of Georgia, University of Hawaii, University of Houston.
University of Massachusetts, University of Michigan, University of New Haven, University of New Mexico University of Notre Dame, University of Pennsylvania, University of South Carolina, University of Tampa, University of Texas at Austin, Villanova University, Virginia Commonwealth University, Virginia Polytechnic Institute, Washburn University, Washington State University, Wellesley College. Wofford College.