Tagged Health Care Costs

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! If you’ve been able to tear your attention away from the soap opera that is the ever-escalating (and public and messy!) feud between HHS Secretary Alex Azar and CMS Administrator Seema Verma, you’re a better person than I. (But hey, I’m not alone — the White House itself is apparently riveted by the drama).

The week kicked off with reports that Verma had filed a claim for $47,000 worth of jewelry and other property that was stolen while she was on a work trip. Then came the accusations that HHS leaked the story and then came more accusations that Verma leaked the info that eventually brought down former HHS Secretary Tom Price.

They were both called to a meeting at the White House and told to make nice. (Oh, to have been a fly on that wall …). Because as fun as it is to watch the drama unfold, the feud seems to be derailing President Donald Trump’s health agenda during a time when that is a less-than-ideal thing to happen.

The Washington Post: Infighting Between Alex Azar, Seema Verma Stymies Trump Health Agenda

OK, onward to the rest of the news of the week before I risk turning into a Page Six gossip column.

House Democrats passed a sweeping drug-pricing bill that would allow Medicare to negotiate drug prices, among other things. Like most bills these days, its purpose is more political than anything else — it will live a full life on the 2020 campaign trail long after it’s killed in the Senate.

The New York Times: House Votes to Give the Government the Power to Negotiate Drug Prices

Stat: Drug Pricing Bill Is a Sneak Peek at Democrats’ 2020 Campaign Message

It was all around not a great weak for drugmakers. The industry was spitting mad at what they deemed was an “unforced error” from Trump that “was a reflection of the weakness of the negotiating skills of the president.” The error? Trump stripped a 10-year exclusivity provision for biologics from the new trade deal with Mexico and Canada.  The blow to pharma is just the latest reminder that they can’t assume any wins just because a Republican is in the White House.

Stat: With New Trade Deal, Trump Deals a Blow to Drug Makers

The government’s word was on trial at the Supreme Court this week when the justices heard arguments over the health law’s “risk corridor” program. It was a slice of the financial carrot to get insurers to participate in the risky marketplaces, but then Congress stripped the funds from the budget. Insurers — who say they’re owed $12 billion — were less than pleased. The justices seemed sympathetic to the insurers, with Justice Stephen Breyer summing it up well: “Why doesn’t the government have to pay its contracts just like everybody else?”

Reuters: U.S. Supreme Court Justices Lean Toward Insurers on $12 Billion Obamacare Claims

And speaking of the health law, the IRS inadvertently ran an experiment on the importance of health coverage when it sent a letter to the nearly 4 million people who were fined because they didn’t have insurance. The letter prompted people to enroll and thus that little letter saved about 700 lives.

The New York Times: The I.R.S. Sent a Letter to 3.9 Million People. It Saved Some of Their Lives.

Back to the Supreme Court: The justices decided to leave in place a Kentucky law that requires physicians to show and describe ultrasounds to patients seeking abortions. The law requires the physicians to continue with the process even if the patient objects and shows signs of distress.

Reuters: U.S. Supreme Court Leaves in Place Kentucky Abortion Restriction

Side note: The story below is less about abortion and more about congressional committees and their inner workings, but I found it a fascinating read (at least for all you wonkish types out there).

Politico: Impeachment Committee’s Rancor Forged by Decades of Abortion Battles

South Carolina is the latest state to be granted a waiver to add work requirements to its Medicaid program. It’s the 10th one so far, but the move is still notable. That’s because, unlike other states, South Carolina never expanded the Medicaid to begin with. That means that the work-age population on its Medicaid rolls is made up almost entirely by poor mothers. Research also suggests that research found the population subject to the new requirements is disproportionately black.

The New York Times: South Carolina Is the 10th State to Impose Medicaid Work Requirements

What a roller-coaster ride this year has been for surprise medical bills. It seemed like low-hanging fruit that even in this particular Congress everyone could agree was bad. But alas, we can always find something to argue about, and progress stalled when lawmakers couldn’t agree on how to solve the problem. Then after months of stagnation, a new deal emerged (which the White House backs). How did they manage that? They actually *gasp* compromised between two of the strategies.

Bills under $750 would be paid at a default price; ones over that could be brought to arbitration, and the final price decision would be binding.

But wait, the ride isn’t over. The House Ways and Means Committee released its own version that would at first let insurers and doctors try to work out payment on their own before an arbitration system kicked in. However it all shakes out, it’s certainly not the easy bipartisan win that was expected.

The Associated Press: White House Backs Emerging Deal on Consumer Health Costs

The Hill: Ways and Means Committee Announces Rival Surprise Medical Billing Fix

South Bend, Ind., Mayor Pete Buttigieg released a list of clients he worked with during his tenure at McKinsey, a powerhouse consulting firm that has drawn fire lately for its work with the Trump administration’s immigration plans. One of Buttigieg’s clients was Blue Cross Blue Shield of Michigan, which eventually went on to lay off about 10% of its workforce. Buttigieg defended his work for the insurer, saying he was focused on administrative costs and cutting overhead expenses.

The New York Times: How Pete Buttigieg Spent His McKinsey Days: Blue Cross, Best Buy, U.S. Agencies

There was nothing particularly notable about Dr. Stephen Hahn’s confirmation process, but I’d be remiss if I didn’t include the fact that the Senate approved him as the new FDA commissioner. Hahn during his hearing sidestepped lawmakers’ attempts to pin him down on e-cigarettes, but any concerns about how he’d handle the epidemic weren’t enough to sink his ship.

The Associated Press: Senate OKs Trump’s FDA Nominee Despite Unclear Vaping Agenda

The FCC approved switching to a three-digit number (988) for the National Suicide Prevention Lifeline. Considering how clunky the old one (800-273-TALK ) was, the change has advocates celebrating. It was interesting that the FCC report had to note that the increase in costs associated with the presumed increase in calls would be offset by avoiding medical expenses such as hospitalizations or emergency department visits.

CNN: FCC Unanimously Approves Proposal for New 3-Digit Number As Suicide Prevention Hotline

A group of doctors carried out a three-day protest in front of a Border Patrol regional headquarters in San Diego. They were demanding that the agency offer flu vaccines to detained migrants — an issue made even more relevant by the fact that three children have died in U.S. custody because of the illness. But Border Patrol says it doesn’t make sense to vaccinate all the people who move through the system.

The Associated Press: Doctors End Protest to Demand Flu Vaccines for Migrants

That’s it from me! Have a great weekend.

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Cost and Quality Courts Elections Health Care Costs Health Industry Insurance Medicaid Pharmaceuticals Public Health The Health Law Uninsured

Watch: The House Approved H.R. 3, The Pelosi Drug Bill. What Does That Mean?

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KHN correspondent Emmarie Huetteman appeared on PBS NewsHour to discuss efforts on Capitol Hill to curb the cost of prescription drugs.

On Thursday, the House approved H.R. 3, the measure introduced by Speaker Nancy Pelosi. But Senate Majority Leader Mitch McConnell has signaled that he will not bring that bill to the floor.

The Senate, though, has another drug bill, this one backed by Senate Finance Committee Chair Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.). Huetteman breaks down the moving parts of these legislative proposals.

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Some Rejoice Over New California Health Insurance Subsidies. Others Get Shut Out.

Syd Winlock bought one of the cheapest health insurance policies he could find for himself and his wife, Lisa, this year: a high-deductible plan with lousy coverage and a $1,500-per-month price tag.

For coverage next year, the Elk Grove, Calif., resident qualifies for new state-funded health insurance subsidies totaling about $870 per month. This aid allows him to buy a better plan with a lower deductible for about $1,200 per month.

That’s still high, he said, but any help is welcome.

“It made a huge difference,” said Winlock, 61, a small-business owner who provides accounting and point-of-sales systems to other businesses. “We were thinking that in 2020 we wouldn’t be able to keep our plan,” let alone afford an upgrade, he said.

Heather Altman, an independent environmental consultant in Long Beach, also hoped to qualify for the new state financial aid. But, after checking with a health insurance agent, she learned she won’t get anything. “At first I thought it might be a mistake,” she said. “It was disappointing.”

Starting Jan. 1, California will offer financial aid to some consumers who buy health coverage through Covered California, the state’s Affordable Care Act insurance exchange.

Some of the subsidies will go to people who already qualify for the federal tax credits available to some Covered California consumers, primarily those with low incomes. But the assistance will also be extended to middle-income people such as Winlock who make too much money to qualify for the federal tax credits and have had to bear the entire cost of their premiums. California will be the first state to offer such help to middle-class consumers.

With open enrollment for Covered California going full steam — sign-ups for 2020 coverage end Jan. 31 — consumers are eagerly trying to determine whether they might qualify for the new aid and, if so, how much.

The results are mixed.

“It’s brought higher-income earners to call me, but most still earn too much” to qualify, said Kevin Knauss, a Sacramento-area insurance agent who also has clients in Los Angeles and the Bay Area. “Others are picking up $15 to $25.”

More than 486,000 people have already qualified for the new state subsidies, with more expected as open enrollment continues, Covered California announced Thursday. This includes about 23,000 middle-income enrollees who make too much to qualify for federal tax credits, said Covered California Executive Director Peter Lee.

Lee added that new enrollment is up by 16% compared with this time last year, largely due to the new state financial aid and insurance requirement.

This “is a small slice of who will sign up,” he said. “We’re optimistic there will be many, many more people covered by these state subsidies for the middle class.”

Earlier this year, Gov. Gavin Newsom signed a 2019-20 state budget that includes nearly $429 million for the subsidies. To help pay for them, the state is imposing a tax penalty starting next year on people who don’t have health insurance — similar to the federal penalty the Republican-controlled Congress eliminated effective this year.

Covered California has estimated that nearly 1 million Californians could benefit from the new state money.

Some of the aid will go to low- and moderate-income people who earn between 200% and 400% of the federal poverty level, or roughly $25,000 to $50,000 for an individual and $51,500 to $103,000 for a family of four, based on 2019 figures. This group also qualifies for federal tax credits. The average household state subsidy in this category would be $21 a month, Covered California estimates.

The majority of the state assistance, however, will go to people whose incomes are between 400% and 600% of the poverty level — too high for federal aid but still low enough to make health care financially challenging. That’s between about $50,000 and $75,000 a year for an individual and $103,000 to $154,500 for a family of four. The average state assistance for this group will be about $460 a month, according to Covered California.

But falling into this income bracket doesn’t guarantee subsidies, as Altman learned.

She estimated she will make $60,000 next year, which puts her within the income range to qualify as an individual, but she won’t be getting any aid, and she doesn’t quite understand why.

Besides income, household size, location and age play a role in eligibility for the subsidies, Covered California’s Lee explained. For example, older people who live in areas with high health care costs have a higher chance of getting help, he said.

Altman, 47, who has severe asthma and is on multiple medications, said she can’t go without coverage, so she will pay $640 every month for a health plan next year, up $70 from this year.

“I was just glad that it was only an 11% increase,” she said. “In previous years, I’ve seen a 20-something percent increase.”

Winlock said he feels grateful he qualified for the state financial aid because it allowed him to buy a better plan. Now he can seek care that he has been avoiding.

“We’re pretty healthy, and I’m very active, but I do have an issue with arthritis that I haven’t been pursuing because just testing alone is very expensive,” he said.

Evette Tsang, an insurance agent in Sacramento, said that while news of financial aid is driving some customers to her office, the new insurance requirement — and the accompanying tax penalty — are ultimately motivating most people to sign up.

People who don’t have insurance in 2020 will have to pay the penalty when they file their state tax returns in 2021. The penalty will amount to $695 for an adult and half that much for dependent children. Some people with higher incomes instead will have to pay 2.5% of their income, which could make their penalty quite a bit heftier.

Tsang saw clients drop their coverage when the federal penalty was eliminated. “Now they’re coming back,” she said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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KHN’s ‘What The Health?’: Legislate-A-Palooza

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The House overwhelmingly passed a 2020 National Defense Authorization that included a provision that would give 12 weeks of paid parental leave for federal workers. The measure is expected to pass the Senate, and President Donald Trump has said he would sign the measure ― a priority for his daughter and special adviser Ivanka Trump ― into law.

Meanwhile, the bipartisan leadership of key health care committees on Capitol Hill announced compromise legislation to address “surprise” medical bills, but a deal on a final package is far from clear. The House passed Speaker Nancy Pelosi’s package to lower prescription drug costs, but the measure is dead on arrival in the Senate, where a bipartisan proposal from leaders of the Senate Finance Committee is pending.

This week’s panelists are Mary Agnes Carey from Kaiser Health News, Kimberly Leonard of the Washington Examiner, Joanne Kenen of Politico and Emmarie Huetteman of Kaiser Health News.

Among the takeaways from this week’s podcast:

  • The House passed a defense measure that includes 12 weeks of paid parental leave — which represents the biggest change to family leave policy since the Clinton administration. It also highlights a rare case of bipartisanship. The measure is on track to clear the Senate, and Trump has said he would sign it into law. The legislation would put parental leave benefits for federal employees more in line with those for military personnel. Federal employees’ benefits are more narrow, though.
  • There has been lots of talk and now maybe some Capitol Hill movement on the topic of surprise medical bill legislation. Earlier this week, the bipartisan leadership of the House Energy and Commerce Committee and the Republican leader of the Senate Health, Education, Labor and Pensions Committee (HELP) announced a compromise measure to curb these often-high unexpected bills. Midweek, the House Ways and Means Committee also announced that it had come to terms on an approach. These are clear signs of progress. What is not clear is when all the parties will coalesce. Key players, such as HELP ranking member Patty Murray (D-Wash.) and Senate Minority Leader Chuck Schumer, have yet to sign on. If a plan doesn’t crystallize in the immediate future, Congress will likely tackle it during the first few months of 2020.
  • Even as the podcast was being taped, the House was taking up H.R. 3, the drug-pricing bill backed by Pelosi. The measure is expected to pass the House easily with Democratic support. But Senate Majority Leader Mitch McConnell has said it will not get a vote on the Senate floor. This is an interesting issue because the problem of the high cost of prescription drugs has the attention of Democrats, Republicans and the White House. House passage could create momentum in the Senate to address the issue through another measure, this one drafted by Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.).
  • The feud between Centers for Medicare & Medicaid Services Administrator Seema Verma and Health and Human Services Secretary Alex Azar continues. The two officials were called this week for White House meetings, but the battle has been open, public and vituperative, and policy areas ― such as the administration’s plan for an Affordable Care Act replacement as well as for high drug costs ― have been affected.
  • Open enrollment for coverage under the Affordable Care Act, or ACA, expires Sunday. So far this year, enrollment is a bit behind last year’s pace. Important reminders: There is automatic enrollment for people who don’t opt for another plan and, if history holds, there will be a last-minute enrollment rush before the deadline.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Mary Agnes Carey: The Washington Post’s “A Stunning Indictment of the U.S. Health-Care System, in One Chart,” by Christopher Ingraham

Joanne Kenen: Politico’s “Impeachment Committee’s Rancor Forged by Decades of Abortion Battles,” by Alice Miranda Ollstein

Kimberly Leonard: Undark’s “Wheelchairs on Planes: Why Can’t Passengers Use Their Own Onboard?” by Michael Schulson. The story appeared on NPR Shots.

Emmarie Huetteman: The New York Times’ “The I.R.S. Sent a Letter to 3.9 Million People. It Saved Some of Their Lives.” by Sarah Kliff

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‘An Arm And A Leg’: Can They Freaking Do That?!?

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A woman gets a bill from a medical testing lab she’s never heard of, for $35. Not long after, a follow-up bill arrives. This one says if she doesn’t pay right away, the price is going up — way up ― to nearly $1,300.

This raises a question that comes up a lot with medical billing: Can they freaking do that?!?

On this episode, we go find out. And, the hunt takes us down two paths looking for answers.

One: Into the world of surprise medical bills.

Two: The land of crazy-high late fees.

Surprise Bills

That original $35 bill is what’s called a “surprise bill.” Patients often get waylaid by these bills when a provider that’s covered by your insurance — like the clinic this woman visited — farms out some part of your health care to a provider — like a lab — that’s not in your insurance network and sets its own rates.

Can the lab do that?!? Just send its own bill for whatever rate it wants?

The answer is: Some states have passed laws to protect consumers from surprise billing, but in lots of places people are left on the hook to pay. So Congress has been looking to create federal-level protections with support from both Democrats and Republicans. And now, at the end of the year, the legislation is showing signs of movement.

Late Fees

That $35 bill raises another question: Can medical labs impose a “late fee” of more than a thousand dollars on a $35 charge?

The answer is: They can try. And a lot of the time, they’ll get away with it.

But we found experts who explain how to fight back. If you’ve got the time and the moxie, you may be able to get the other side to accept a fair offer. Easier said than done — and more work than anybody should have to do — but you’ve got the law on your side.

So, listen up, and get psyched. And mad.

Season 3 is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

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