Tagged Premiums

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Apologies for unexpectedly going MIA last week, but your girl here decided she needed some firsthand experience with the health care system via a trip to the emergency room. (Hot tip: Stay hydrated during stomach bug season, folks!) Many thanks to the wonderful Damon Darlin (also known as KHN’s executive editor) for filling in last week. Make sure to check it out if you missed it.

Onward to this week, though, where we’re finally starting to slow down as we drift toward the holidays.

“I hate to panic, but …” was a quote from NPR’s coverage of the health law enrollment numbers that pretty much summed up the atmosphere the day before the sign-up deadline. The big number to focus on here is that there are nearly 20 percent fewer new enrollees than at about this same time last year. The lag has advocates pointing nervous fingers at the Trump administration’s efforts to chip away at the health law.

But some experts eschew Chicken Little predictions (at least quite yet), saying that fewer sign-ups don’t necessarily mean more people will be uninsured. For one, the unemployment level is the lowest in decades (although that has nuances that are too complex to get into right here) so people who used to get health law plans might be covered by their employers. Secondly, the sign-up numbers don’t reflect anyone who is sticking with the plan they currently have.

Either way, we won’t have long to wait to see how it shakes out.

NPR: Enrollment in HealthCare.Gov Plans May Be Down for 2019

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming

Amid all that talk of sabotage and low numbers came a study that found 4.2 million Americans are actually eligible to get what amounts to free health care through the exchanges, as an unintended consequence of President Donald Trump nixing key health law payments last year.

The Hill: Study: 4.2 Million Uninsured People Eligible for Free ObamaCare Coverage


A quietly simmering debate over fetal tissue research brewing the past few months has started to come to a boil this week. (Although, if you’ve been reading your Morning Briefing regularly, this won’t come as a surprise.) Back in September, the administration launched an audit of all federally funded research that uses fetal tissue. The far-reaching ramifications were felt recently when a lab that has played an integral role in testing for HIV cures was put on notice that its funding could be canceled.

The sides are firmly drawn here and have deep roots in abortion politics (as witnessed in this quote from CQ’s coverage of Thursday’s heated House hearing on the topic: “Obviously the 800-pound gorilla in the room is that we know aborted tissue is being used,” said Georgia Republican Rep. Jody Hice).

With the National Institutes of Health signaling interest in pumping $20 million into finding an alternative to fetal tissue for research purposes, I don’t think this topic is going away anytime soon.

The New York Times: Fetal Tissue Research Is Curtailed by Trump Administration

The Hill: NIH to Fund Research Into Fetal Tissue Alternatives


The death of a 7-year-old Guatemalan girl who had been taken into Border Patrol custody is likely to intensify scrutiny of the care immigrants detained by the U.S. government are receiving. U.S. Customs and Border Protection said the girl had not eaten or consumed water in several days, and it’s unclear whether the agents had tried to rectify that situation. Advocates are saying the death is reflective of a “culture of cruelty” within the agency.

Meanwhile, there are nearly 15,000 migrant children in detention facilities in the country, where issues with background checks, abuse and neglect continue to make headlines.

The Washington Post: 7-Year-Old Migrant Girl Taken Into Border Patrol Custody Dies of Dehydration, Exhaustion

NPR: Almost 15,000 Migrant Children Now Held at Nearly Full Shelters

More voices are starting join the growing chorus of advocates, doctors and city leaders who oppose the administration’s proposed policy to penalize immigrants who are accepting government aid (such as Medicaid). It’s not just about public health, they say. The policy would also take a heavy financial toll.

Dallas Morning News: Dallas Mayor Says Trump Administration’s Proposed ‘Public Charge’ Rules Would Harm City’s Immigrants, Economy


There was some shade being thrown at the Supreme Court this week, when the justices declined to take up a case on state Medicaid funding and Planned Parenthood. Justice Clarence Thomas called out his conservative colleagues Chief Justice John Roberts and Justice Brett Kavanaugh for dodging the case. “So what explains the court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood,’” he wrote. The case itself was somewhat complex, but essentially the decision leaves in place Medicaid patients’ right to sue over provider issues.

The Associated Press: Justices Won’t Hear States’ Appeal Over Planned Parenthood


The maker of a device that reverses overdoses recently drew fire for jacking up the list price of its injector from $575 to $4,100 during a span of time that opioid-related deaths were also accelerating rapidly. As you can imagine, this did not go over well with either lawmakers or the public when it came to light. Now Kaleo, in damage-control mode, is releasing a generic version that comes with a $178 price tag. The whole journey is quite the snapshot of what’s going wrong with high health care costs.

Stat: Kaleo, Maker of $4,100 Overdose Antidote, to Offer Generic For $178

Speaking of, you have to check out the salacious details emerging in this case that started as an antitrust lawsuit against just two drugs and has ballooned into this sweeping investigation into price-fixing allegations in the generics marketplace.

The Washington Post: Generic Drug Price-Fixing Investigation Expands to 300 Drugs and 16 Companies

Pharma, meanwhile, is sweating over the Democrats taking power in the House. Once a political powerhouse of nearly mythological proportions, the industry has lost clout in recent years, and companies don’t think the new power structure will work in their favor.

Stat: Will Democrats in Congress Keep the Door Open for Pharma — or Slam It?


Whew! That was not as short as expected. Just in case you want some more great reads for your weekend, check out the miscellaneous file:

• What happens to your life when millions of people have witnessed you hit rock bottom? As the opioid epidemic dug deep roots into the country, there was this trend where videos and photos of people overdosing would go absolutely viral. Public health officials and cops at the time justified putting them up because the videos could act as a deterrent for drug use. For the people used as the face of the crisis, however, it was deeply life-altering.

The New York Times: How Do You Recover After Millions Have Watched You Overdose?

• Baby boomers are now aging alone more than any other generation in U.S. history. That isn’t just a sad statistic — it’s also a looming public health crisis. Loneliness has been as closely linked to early mortality as smoking up to 15 cigarettes or consuming more than six alcoholic drinks a day.

The Wall Street Journal: The Loneliest Generation: Americans, More Than Ever, Are Aging Alone

• A rash of recent headlines explores whether trauma is passed down through genes. It’s a very buzzy idea, but the evidence that trauma can leave a signature that lasts generations is circumstantial at best.

The New York Times: Can We Really Inherit Trauma?

 

I’ll leave you with some bah-humbug! warnings about not eating that raw cookie dough this holiday season (even though it’s clearly the best part of making cookies). Have a great weekend!

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Apologies for unexpectedly going MIA last week, but your girl here decided she needed some firsthand experience with the health care system via a trip to the emergency room. (Hot tip: Stay hydrated during stomach bug season, folks!) Many thanks to the wonderful Damon Darlin (also known as KHN’s executive editor) for filling in last week. Make sure to check it out if you missed it.

Onward to this week, though, where we’re finally starting to slow down as we drift toward the holidays.

“I hate to panic, but …” was a quote from NPR’s coverage of the health law enrollment numbers that pretty much summed up the atmosphere the day before the sign-up deadline. The big number to focus on here is that there are nearly 20 percent fewer new enrollees than at about this same time last year. The lag has advocates pointing nervous fingers at the Trump administration’s efforts to chip away at the health law.

But some experts eschew Chicken Little predictions (at least quite yet), saying that fewer sign-ups don’t necessarily mean more people will be uninsured. For one, the unemployment level is the lowest in decades (although that has nuances that are too complex to get into right here) so people who used to get health law plans might be covered by their employers. Secondly, the sign-up numbers don’t reflect anyone who is sticking with the plan they currently have.

Either way, we won’t have long to wait to see how it shakes out.

NPR: Enrollment in HealthCare.Gov Plans May Be Down for 2019

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming

Amid all that talk of sabotage and low numbers came a study that found 4.2 million Americans are actually eligible to get what amounts to free health care through the exchanges, as an unintended consequence of President Donald Trump nixing key health law payments last year.

The Hill: Study: 4.2 Million Uninsured People Eligible for Free ObamaCare Coverage


A quietly simmering debate over fetal tissue research brewing the past few months has started to come to a boil this week. (Although, if you’ve been reading your Morning Briefing regularly, this won’t come as a surprise.) Back in September, the administration launched an audit of all federally funded research that uses fetal tissue. The far-reaching ramifications were felt recently when a lab that has played an integral role in testing for HIV cures was put on notice that its funding could be canceled.

The sides are firmly drawn here and have deep roots in abortion politics (as witnessed in this quote from CQ’s coverage of Thursday’s heated House hearing on the topic: “Obviously the 800-pound gorilla in the room is that we know aborted tissue is being used,” said Georgia Republican Rep. Jody Hice).

With the National Institutes of Health signaling interest in pumping $20 million into finding an alternative to fetal tissue for research purposes, I don’t think this topic is going away anytime soon.

The New York Times: Fetal Tissue Research Is Curtailed by Trump Administration

The Hill: NIH to Fund Research Into Fetal Tissue Alternatives


The death of a 7-year-old Guatemalan girl who had been taken into Border Patrol custody is likely to intensify scrutiny of the care immigrants detained by the U.S. government are receiving. U.S. Customs and Border Protection said the girl had not eaten or consumed water in several days, and it’s unclear whether the agents had tried to rectify that situation. Advocates are saying the death is reflective of a “culture of cruelty” within the agency.

Meanwhile, there are nearly 15,000 migrant children in detention facilities in the country, where issues with background checks, abuse and neglect continue to make headlines.

The Washington Post: 7-Year-Old Migrant Girl Taken Into Border Patrol Custody Dies of Dehydration, Exhaustion

NPR: Almost 15,000 Migrant Children Now Held at Nearly Full Shelters

More voices are starting join the growing chorus of advocates, doctors and city leaders who oppose the administration’s proposed policy to penalize immigrants who are accepting government aid (such as Medicaid). It’s not just about public health, they say. The policy would also take a heavy financial toll.

Dallas Morning News: Dallas Mayor Says Trump Administration’s Proposed ‘Public Charge’ Rules Would Harm City’s Immigrants, Economy


There was some shade being thrown at the Supreme Court this week, when the justices declined to take up a case on state Medicaid funding and Planned Parenthood. Justice Clarence Thomas called out his conservative colleagues Chief Justice John Roberts and Justice Brett Kavanaugh for dodging the case. “So what explains the court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood,’” he wrote. The case itself was somewhat complex, but essentially the decision leaves in place Medicaid patients’ right to sue over provider issues.

The Associated Press: Justices Won’t Hear States’ Appeal Over Planned Parenthood


The maker of a device that reverses overdoses recently drew fire for jacking up the list price of its injector from $575 to $4,100 during a span of time that opioid-related deaths were also accelerating rapidly. As you can imagine, this did not go over well with either lawmakers or the public when it came to light. Now Kaleo, in damage-control mode, is releasing a generic version that comes with a $178 price tag. The whole journey is quite the snapshot of what’s going wrong with high health care costs.

Stat: Kaleo, Maker of $4,100 Overdose Antidote, to Offer Generic For $178

Speaking of, you have to check out the salacious details emerging in this case that started as an antitrust lawsuit against just two drugs and has ballooned into this sweeping investigation into price-fixing allegations in the generics marketplace.

The Washington Post: Generic Drug Price-Fixing Investigation Expands to 300 Drugs and 16 Companies

Pharma, meanwhile, is sweating over the Democrats taking power in the House. Once a political powerhouse of nearly mythological proportions, the industry has lost clout in recent years, and companies don’t think the new power structure will work in their favor.

Stat: Will Democrats in Congress Keep the Door Open for Pharma — or Slam It?


Whew! That was not as short as expected. Just in case you want some more great reads for your weekend, check out the miscellaneous file:

• What happens to your life when millions of people have witnessed you hit rock bottom? As the opioid epidemic dug deep roots into the country, there was this trend where videos and photos of people overdosing would go absolutely viral. Public health officials and cops at the time justified putting them up because the videos could act as a deterrent for drug use. For the people used as the face of the crisis, however, it was deeply life-altering.

The New York Times: How Do You Recover After Millions Have Watched You Overdose?

• Baby boomers are now aging alone more than any other generation in U.S. history. That isn’t just a sad statistic — it’s also a looming public health crisis. Loneliness has been as closely linked to early mortality as smoking up to 15 cigarettes or consuming more than six alcoholic drinks a day.

The Wall Street Journal: The Loneliest Generation: Americans, More Than Ever, Are Aging Alone

• A rash of recent headlines explores whether trauma is passed down through genes. It’s a very buzzy idea, but the evidence that trauma can leave a signature that lasts generations is circumstantial at best.

The New York Times: Can We Really Inherit Trauma?

 

I’ll leave you with some bah-humbug! warnings about not eating that raw cookie dough this holiday season (even though it’s clearly the best part of making cookies). Have a great weekend!

Health Insurance Costs Crushing Many People Who Don’t Get Federal Subsidies

Like millions of Americans in this final week of open enrollment for the Affordable Care Act marketplaces, Diane McCabe is shopping for health insurance.

“At my age, I can’t go without it even though I’m healthy now,” said McCabe, 62, a self-employed real estate agent in Luzerne County, Pa. “But the process is frustrating, and the expense significant.”

That’s because McCabe is one of the 5 million people who buy their own coverage and pay the full cost. Her income is too high to qualify for a government subsidy to help defray the premium.

McCabe this week settled on a $773-a-month policy that has a $4,000 deductible — the amount she’ll have to pay out-of-pocket before insurance kicks in. She estimates that will account for at least 15 percent of her income in 2019.

Under the ACA, people who earn up to 400 percent of the poverty level (about $48,500 for an individual and $100,400 for a family of four in 2019) are eligible for premium subsidies. Eighty-seven percent of the 10.6 million people with ACA plans this year received a subsidy.

Diane McCabe, a self-employed real estate agent in Pennsylvania, says her insurance could eat up 15 percent of her income in 2019. Her husband, Ed, is covered by Medicare.(Courtesy of Diane McCabe)

The financial challenge for people like McCabe has come into much sharper focus during the past year, as insurance premiums have spiked.

These increasing costs plus rising deductibles and copayments have driven millions who don’t get a subsidy to drop their coverage or turn to cheaper, less comprehensive — and sometimes inadequate — insurance.

The Trump administration has highlighted the plight of the unsubsidized and said that its regulatory revamp of the health law will give consumers new, more affordable options. One of the key administration efforts is extending the use of short-term insurance plans that have lower premiums but don’t provide the full benefits that the ACA requires, such as continuous coverage of preexisting conditions or maternity care.

Those plans are not eligible for subsidies now, but, under regulations the administration proposed in October, subsidies could be available starting in 2020.

Critics counter that the administration’s approach runs a high risk of undermining core features of the ACA. And a legal battle over the administration’s proposed new rules is likely.

“The subsidy structure is unquestionably a problem,” said Chris Sloan, a director at Avalere Health, a policy and research think tank in Washington, D.C. “It’s a cruel reality for those above the income cutoffs. But it’s not clear that the administration’s actions are the best solution.”

Opponents of the Trump administration’s proposals contend they could lead young, healthy people to abandon ACA coverage and choose less comprehensive and expensive coverage — leaving more older and sicker people in the exchanges. That would result in steadily increasing costs for those plans, and could eventually destabilize the ACA marketplaces, policy analysts say.

Overall, about 4.4 million fewer people who buy coverage on their own were insured in 2018 compared to 2015, a decline from 18.8 to 14.4 million. Most of the decline occurred among people who don’t get subsidies.

On And Off Insurance

Cameron and Lori Llewellyn, of Dover, Del., have found insurance just too expensive.

In June 2017, Lori left a job that provided the family with good health coverage. She wanted to start her own business — a clothing boutique. Cameron is a self-employed construction contractor.

The Llewellyns tried to enroll in a plan through the ACA exchange in the summer of 2017. But Cameron’s income was too high to qualify for a subsidy. On the open market, they were quoted rates as high as $2,000 a month, with deductibles of $4,000 or more, for themselves and their 8-year-old daughter, Bryce.

They opted instead to go without coverage until the end of 2017. Then again, for this year, they ended up not qualifying for subsidies and decided to go without insurance.

Cameron and Lori Llewellyn would like to buy insurance for themselves and their daughter, Bryce, but have found it too expensive. She is starting her own business and he is a self-employed construction contractor. But they said they may qualify for a premium subsidy in 2019.(Courtesy of Lori Llewellyn)

“We just couldn’t justify the expense, especially with that high of a deductible,” Lori said. “But it wasn’t a comfortable situation. We wanted coverage for all the reasons people know they need it.”

For 2019, the Llewellyns are trying again. They have enrolled through the state ACA exchange in a policy with a premium of $1,286 and a $7,900 deductible, but with a subsidy that will cover the entire premium.

Spencer Ricks, 36, a self-employed attorney in Salt Lake City, is choosing a different path. He, his wife and their 3-year-old daughter bought ACA-compliant coverage in 2016. Their premium rose from around $600 in 2016 to $970 in 2017 with a $10,000 deductible.

Ricks was told his premium for 2018 for the same plan would be $1,200 with a $13,500 deductible. He pulled the plug on the family coverage and instead enrolled his wife — who was pregnant — in a plan costing $570 a month with a $5,000 deductible.

Ricks and his daughter then joined a Christian Healthcare Ministry plan costing $157 a month, with a $10,000 deductible. For 2019, Ricks is enrolling the whole family is another religious-affiliated plan, costing $529 a month with a $2,250 deductible.

But the most prevalent alternative to an ACA plan for people who don’t get subsidies in 2019 is likely to be a short-term plan.

Previously available for only 90 days — primarily to bridge gaps in coverage — the Trump administration expanded that time frame to 364 days.

The plans can be bought at any time, but sales are up now because more people are shopping during the ACA’s open enrollment, said Sean Malia, a senior director at eHealth, an online brokerage.

Melanie and Pete Howell, of Austin, Texas, are among eHealth’s newest customers. They had an ACA plan this year costing $1,100 a month with a $7,000 deductible. It covered the couple and their two children, ages 22 and 17.

The Howells’ income is too high to qualify for a subsidy. When their insurer notified them that the premium was going to $1,400 a month in 2019, they opted for a short-term plan that will cost $380 a month with a deductible of $12,500.

The plan does not cover prescription drugs, and the Howells will pay 30 percent of the costs for doctor, emergency room visits and any surgical procedures.

“This buys us some time at a much more affordable price to figure out what to do for the longer term,” said Melanie Howell.

No Easy Solutions

Although both ACA critics and advocates say that addressing the high cost of coverage for non-subsidized families should be a priority, there are no easy bipartisan fixes in sight.

Many ACA supporters urge legislation that raises the threshold for subsides above 400 percent of poverty — to, say, 600 percent. But that stokes concerns of added federal spending.

A more realistic approach, for now, could be to permit states to experiment with ways to help those over the 400 percent threshold, said Sabrina Corlette, a research professor at the Georgetown University’s Health Policy Institute.

For example, with federal government permission, eight states have already launched, or will in 2019, “reinsurance” programs that redeploy federal dollars to help insurers cover the costs of families with high medical expenses. The programs have kept premium costs down for both people who get subsidies and those who don’t.

Another proposal would permit states more leeway to restructure the ACA subsidies to provide less help to people with high-cost health care needs and more help to those not currently eligible for subsidies.

“Letting states try things out has bipartisan support and there are mechanisms for that already in place,” Corlette said. “It would seem to have the best chance of yielding something useful to help this population [the unsubsidized] for now.”

Without Obamacare Penalty, Think It’ll Be Nice To Drop Your Plan? Better Think Twice

Dana Farrell’s car insurance is due. So is her homeowner’s insurance — plus her property taxes.

It’s also time to re-up her health coverage. But that’s where Farrell, a 54-year-old former social worker, is drawing the line.

“I’ve been retired two years and my savings is gone. I’m at my wit’s end,” says the Murrieta, Calif., resident.

So Farrell plans — reluctantly — to drop her health coverage next year because the Affordable Care Act tax penalty for not having insurance is going away.

That penalty — which can reach thousands of dollars annually — was a key reason that Farrell, who considers herself healthy, kept her coverage.

Now, “why do it?” she wonders. “I don’t have any major health issues and I’ve got a lot of bills that just popped up. I can’t afford to pay it anymore.”

Farrell is among millions of people likely to dump their health insurance because of a provision in last year’s Republican tax bill that repeals the Obamacare tax penalty, starting in 2019, by zeroing out the fines.

The Congressional Budget Office estimated that the repeal of the penalty would move 4 million people to drop their health insurance next year — or not buy it in the first place — and 13 million in 2027.

Some people who hated Obamacare from the start will drop their coverage as a political statement. For people like Farrell, it’s simply an issue of affordability.

Since Farrell started buying her own insurance through the open market in 2016, her monthly premium has swelled by about $200, she says, and she bears the entire cost of her premium because she doesn’t qualify for federal ACA tax credits. Next year, she says, her premium would have jumped to about $600 a month.

Instead, she plans to pay cash for her doctor visits at about $80 a pop, and for any medications she might use — all the while praying that she doesn’t get into a car accident or have a medical emergency.

“It’s a situation that a lot of people find themselves in,” says Miranda Dietz, lead author of a new study that projects how ending the penalty will affect California.

Dana Farrell

People like Farrell whose incomes are too high to qualify for tax credits are especially vulnerable, says Dietz, a research and policy associate at the University of California-Berkeley Center for Labor Research and Education. They must pay the entire premium themselves.

Premiums, even for a bronze plan with a deductible of more than $6,000, are enormous in some cases, she says. “The state’s done a great job of implementing the ACA,” she says, “but there are still Californians who just find insurance out of reach.”

Up to 450,000 more Californians may be uninsured in 2020 as a result of the penalty ending, and up to 790,000 more by 2023, boosting the state’s uninsurance rate for residents under 65 to 12.9 percent, according to the study. The individual market would suffer the biggest losses.

Covered California, the state health insurance exchange, predicts that enrollment in the individual market — both on and off the exchange — could drop by 12 percent next year, says agency spokesman James Scullary.

Exchange officials also blame the end of the penalty for a 3.5 percent average increase in premiums, because the departure of some healthy people from the market will lead to a sicker and costlier insurance pool.

Health insurance can be difficult to afford, but going without it is a “bad gamble,” Scullary says. Keep in mind: More than 22,000 Covered California enrollees broke, dislocated or sprained arms or shoulders in 2017, and 50,000 enrollees were either diagnosed with — or treated for — cancer, he explains.

“We know that none of those people began the year thinking, ‘This is when I’m going to break my arm,’ or ‘This is the year I get cancer,’” he says.

If you’re considering dropping your plan and risking the devastating financial consequences of an unexpected medical expense, check first to see if you can lower your premium.

“A big mistake for people is to look at the notice they get for their current health insurance and see it’s going up a lot and then throw up their hands and decide they’re going to go without,” says Donna Rosato, a New York-based editor at Consumer Reports who covers health care cost issues.

“Before you do that, look at other options.”

The most important thing to do is seek free help from a certified insurance agent or enrollment “navigator.” You can find local options by clicking on the “Find Help” tab on Covered California’s website, http://www.CoveredCA.com.

Next, see if you can qualify for more financial aid. For instance, if your income is close to the threshold to qualify for tax credits through Covered California or another Obamacare insurance exchange — about $48,500 for an individual or $100,000 for a family of four this year — check with a financial professional about adjusting it, Rosato suggests. You might be able to contribute to an IRA, 401(k) or health savings account to lower the total, she says.

Beyond that, be flexible and willing to switch plans, she advises. Consider different coverage levels, both on and off health insurance exchanges. If you’re in a silver-level plan (the second-lowest tier), you might save money by purchasing a less expensive bronze-level plan that has higher out-of-pocket costs but would protect you in case of a medical emergency.

This year, Farrell got a clean bill of health from her doctor after a round of tests. She’s nervous about being without coverage next year, but feels she doesn’t have a choice.

“It’s going to be the first time in my life I’m not going to have insurance,” she says.


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.