Tagged Uninsured

Tennessee Reveals $7.9B Plan To Shift Medicaid Into Controversial Block Grant System

The plan’s likelihood of ever being implemented, however, remains largely unknown. To date, no state has been given permission to rely solely on block grants to cover Medicaid expenses. Gov. Bill Lee, however, remains hopeful, pointing to the fact that the Trump administration has been encouraging states to take more control of their programs.

Do 50 Million People Really Lose Health Coverage Each Year Because Of Their Jobs?

The moderators kicked off the third Democratic debate with the topic of health care, teeing up another round of the ongoing “Medicare for All” debate.

Vermont Sen. Bernie Sanders caught our attention by claiming that 50 million people lose their private insurance every year due to employment changes.

“George, you talked about, was it 150 million people on private insurance? 50 million of those people lose their private insurance every year when they quit their jobs or they go unemployed or their employer changes their insurance policy,” Sanders said.

That sounds like a huge number even before he qualified it by attributing it to job loss and other work-related occasions for an insurance lapse.

We reached out to the Sanders’ campaign to discover the basis for this claim and were pointed to an analysis by the People’s Policy Project, a social Democratic-leaning think tank. That analysis hinges on a question asked as part of a national Centers for Disease Control and Prevention survey in 2014, plus a little basic multiplication.

The survey asked adults between ages 18 and 64, in 43 states: “In the past 12 months was there any time when you did not have any health insurance or coverage?” In response, 12.9% said they had experienced a gap in coverage, while 11.5% said they had been uninsured for more than 12 months.

The think tank analysis then combined those percentages and multiplied them by current population estimates, coming up with “just under 50 million people” who were uninsured for at least part of the year. (It went on to endorse Medicare for All.)

This claim becomes perplexing when you consider the total number of uninsured people in recent years. In 2013, overall there were more than 44 million uninsured, Americansm under age 65. With the initial implementation of the Affordable Care Act, that number steadily declined until last year when it ticked up slightly to 27.5 million.

A Sanders spokeswoman also cited another People’s Policy Project blog post analyzing the number of people who leave their jobs (66.1 million in 2018, it said) and government data on the number of jobs the average worker has had by age 50 (11.9).

The campaign specifically pointed to this sentence in the blog post: “This labor turnover data leaves little doubt that people with employer-sponsored insurance are losing that insurance constantly, as are their spouses and kids.”

The CDC data is compelling, to be sure — but Sanders did not accurately portray what it said on the debate stage, nor did he accurately portray the policy analysis his campaign claimed was his source.

Sanders appears to suggest that one-third of those with private insurance are uninsured for at least a short time every year because of a change to their employment benefits.

In actuality, the CDC data shows that about 24.4% of adults under age 65 in 2014 had experienced at least a gap in insurance coverage in the previous year. The question did not ask respondents to specify the cause.

The age of the report also poses a challenge: The Affordable Care Act’s Medicaid expansion began in 2014, and the report surveyed just 23 Medicaid expansion states at the time. Today, 37 states and the District of Columbia have expanded Medicaid, suggesting the number of people with insurance gaps on an annual basis could have dropped.

And the People’s Policy Project analysis actually refers broadly to 50 million Americans under age 65 who were uninsured, temporarily or otherwise — it doesn’t say those people were uninsured because their job situation changed.

Our Ruling

Sanders said that 50 million of those people lose their private insurance every year “when they quit their jobs or they go unemployed or their employer changes their insurance policy.”

Sanders has a point that coverage continuity is a big problem in a country where roughly 150 million get their insurance from their jobs. But his claim inflates the scope of the problem.

He took a broad finding of the number of people who had experienced an insurance gap for any reason roughly five years ago and misleadingly used it to describe a much narrower segment of the current population who lost insurance because of employment changes.

The claim has an element of truth but leaves out critical information that would give a different impression. We rate the statement Mostly False.

KHN’s ‘What The Health?’: Despite Booming Economy, Uninsured Rate Ticks Up

Can’t see the audio player? Click here to listen on SoundCloud.

The annual report from the Census Bureau, released this week, found that 27.5 million Americans were without health insurance last year, an increase of nearly 2 million from 2017. The 0.5 percentage point increase in the uninsured rate — to 8.5% — was the first in a decade and came as unemployment and other economic indicators have been good.

Meanwhile, the Trump administration signaled that it is moving to ban flavored vaping liquid used in e-cigarettes. Companies making the products have been accused of marketing to underage users with flavors like mango and bubble gum.

And Congress is back from its summer break, with legislation to address rising prescription drug prices and surprise medical bills still on the agenda.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Tami Luhby of CNN and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • The Census Bureau’s report this week defied usual economic models. Normally, the more people employed, the more people insured.
  • Health advocates blame a variety of actions by the Trump administration for the lower rate of insured Americans. Those include policies intended to deter people from staying on or signing up for Medicaid; the elimination of the tax penalty for not having coverage; and the announcement that immigrants’ use of public benefits such as Medicaid could affect their ability to get a green card allowing them to live and work in the U.S.
  • The biggest surprise in the Census Bureau report was the increase in children without insurance. Coverage for kids has generally been a bipartisan goal on Capitol Hill. It’s not clear what caused that drop. It could just be a result of differences in how the survey was conducted, or it may be another sign of immigrants worried about whether using public insurance could lead to their deportation.
  • The administration’s announcement that it is moving forward on a ban of flavored vaping products comes as worries grow among parents and public health officials about an epidemic of lung problems around the country. Among those worried parents is first lady Melania Trump.
  • House Speaker Nancy Pelosi appears to be inching closer to releasing her plan to curb high drug prices. It’s not clear yet whether President Donald Trump will sign on to her effort. But Sen. Chuck Grassley (R-Iowa) is seeking support for his more modest plan instead, arguing to his Republican colleagues that if they don’t stand with him, they may be forced to accept Pelosi’s legislation if she manages to make a deal with the president.
  • Opponents of some of the legislation to curb surprise medical bills appear to have made progress over Congress’ August recess with a major advertising campaign saying the measures would hurt local hospitals and doctors. Advocates say the legislation is not dead, but the strong momentum it had is waning.

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

Julie Rovner: Vox.com’s “This life-threatening pregnancy complication is the next frontier in the abortion debate,” by Anna North

Joanne Kenen: The New York Times’ “Nursing Homes Are a Breeding Ground for a Fatal Fungus,” by Matt Richtel and Andrew Jacobs

Rebecca Adams: Kaiser Health News’ “‘UVA Has Ruined Us’: Health System Sues Thousands Of Patients, Seizing Paychecks And Claiming Homes,” by Jay Hancock and Elizabeth Lucas

Tami Luhby: The New York Times’ “Bernie Sanders Went to Canada, and a Dream of ‘Medicare for All’ Flourished,” by Sydney Ember

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Number Of Americans Without Insurance Rises in 2018

For the first time in a decade, the number of Americans without health insurance has risen — by about 2 million people in 2018 — according to the annual U.S. Census Bureau report released Tuesday.

The Census found that 8.5% of the U.S. population went without medical insurance for all of 2018, up from 7.9% in 2017. By contrast, in 2013, before the Affordable Care Act took full effect, 13.3% were uninsured. It was the first year-to-year increase since 2008-09, Census officials said.

Census officials said most of drop in health coverage was related to a 0.7% decline in Medicaid participants. The number of people with private insurance remained steady and there was a 0.4% increase in those on Medicare.

The increase in the number of uninsured people in 2018 was remarkable because uninsured rates typically fall or hold steady when unemployment rates drop. The U.S. unemployment rate fell slightly from about 4.3% in 2017 to 4% in 2018.

The uninsured rate continued to vary by poverty status and whether a state expanded its Medicaid program under Obamacare. Texas (17.7%), Oklahoma (14.2%), Georgia (13.7%) and Florida (13%) had the highest uninsured rates in 2018, according to the report. None of those states have expanded Medicaid under Obamacare.

The percentage of uninsured children under the age of 19 increased by 0.6 percentage points from 2017 to 2018, to 5.5%.

“The Census data are clear — the uninsured rate for kids is up sharply and it’s due to a loss of public coverage — mostly Medicaid,” Joan Alker, executive director of Georgetown University Center for Children and Families, said in a statement.

“These children are not getting private coverage as the Trump Administration has suggested but rather becoming uninsured,” she said. “This serious erosion of children’s health coverage is due in large part to the Trump Administration’s actions that have made health care harder to access and have deterred families from enrolling their children.”

The share of Americans without medical insurance fell steadily since 2014 but then leveled off in 2017, the year Donald Trump became president.

Health care advocates have complained that efforts by the Trump administration and Congress are jeopardizing insurance enrollment. They point to cuts in outreach programs that aim to tell consumers about their health care options under Obamacare and the elimination of the ACA’s tax penalty for people who don’t have health coverage.

Alker complained that the administration’s policies are causing the loss of children’s coverage. “In a period of continued economic and job growth, we shouldn’t be going backwards on health coverage,” said Judy Solomon, a senior fellow for the Center on Budget and Policy Priorities, a left-leaning think tank. “This backsliding almost certainly reflects, at least in part, Trump administration policies to weaken public health coverage.”

She attributed the drop to the Trump administration making it harder for families to enroll for coverage in Medicaid by curtailing outreach efforts, allowing states to ask for more paperwork and proposing a so-called public charge rule that would make it harder for legal immigrants to get permanent resident status if they have received certain kinds of public assistance — including Medicaid.

A Look Back At Bernie Sanders’ Early Political Career–And A Significant Death–Shows Why He Stakes His Legacy On ‘Medicare For All’

Decades before “Medicare for All” became the buzzword du jour for the elections, Sen. Bernie Sanders, frustrated with how his family struggled to pay for his mother’s care when she was dying, made a trip to Canada. He walked away from that “thrilled” with the prospect of something better than the U.S. health care system. Meanwhile, where do the candidates stand on the proposal? Reuters takes a look ahead of the Democratic debate this week.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! I come bearing bad news for anyone enjoying the slight decrease in D.C. traffic: Congress is back in full force next week. Although we have not had even a slight decrease in health news, I’m sure lawmakers will kick it up even further with gun control, surprise medical bills and, perennially, high drug costs on the expected docket.

For now, here’s what’s been going on during their final week of recess.

President Donald Trump has been coy about what exactly he’s put in his gun violence proposal, but one thing that seems likely: Both parties will be unhappy. (That, at least, seems a sure bet in these divided times.) What you can probably expect to see: an expedited death penalty process, changes to how troubled teens’ sealed records are shielded, and regulations — like “red flag” laws — centered on mental health.

Politico: Trump Prepares to Pitch Gun Proposals Few Really Want

Senate Majority Leader Mitch McConnell is sitting pretty on the sidelines at the moment, waiting to see what the president comes up with.

The Associated Press: McConnell Says He’s Waiting on Trump to Chart Path on Guns

Corporations, though, are taking matters into their own hands. Walgreens and CVS followed in Walmart’s footsteps this week in asking customers not to carry firearms openly in their stores. Walmart — which often tries to stay above the political fray — went further in announcing that it would stop selling ammunition for military-style assault rifles.

The New York Times: Walmart to Limit Ammunition Sales and Discourage ‘Open Carry’ of Guns in Stores

Reuters: Walgreens, CVS, Wegmans Ask Shoppers to Not Openly Carry Firearms

And in a bit of poor optics luck for Texas, a series of laws loosening gun regulations happened to take effect just a day after the state’s latest mass shooting.

Politico: Hours After Shooting Rampage, Texas Gun Laws Loosened

Also, if you want to terrify the bejesus out of yourself, dig into this piece about online forums with a toxic culture of hate that have become breeding grounds for mass shooters and where the inherent anonymity of the internet protects them from law enforcement.

The Wall Street Journal: ‘So What’s His Kill Count?’: The Toxic Online World Where Mass Shooters Thrive

In New York, health officials are eyeing vitamin E oil as a possible culprit in the mysterious vaping-related lung illness sweeping the country. The feds, however, aren’t putting their eggs in that particular basket and said that people should keep an “open mind” about the roots of the outbreak. “People need to realize that it is very probable that there are multiple causes,” said CDC Director Robert Redfield. But with a second death confirmed, officials are scrambling for answers.

Politico: Vitamin E Named as Primary Culprit in Vaping Illness, But Feds Urge Caution

An HHS internal watchdog report detailed the extent of psychological damage suffered by children affected by the “zero tolerance” separation policy. For children so young, it was hard for them to describe their emotional trauma. They were often reduced to complaints about their chest hurting, like “every heartbeat hurts” or “I can’t feel my heart.”

The Associated Press: ‘Can’t Feel My Heart:’ IG Says Separated Kids Traumatized

Crushing medical debt seems to be shaping the future of the country, and 2020 hopeful Sen. Bernie Sanders (I-Vt.) wants to change that. With a proposal that he only hinted at (i.e. did not give any solid details about how to pay for it), he said he would cancel $81 billion worth of medical debt for Americans.

The Washington Post: Sen. Bernie Sanders Teases Plan to Cancel $81 Billion in Americans’ Medical Debt

Meanwhile, despite the attention Sanders and the other progressive front-runners are giving proposals like “Medicare for All,” state lawmakers see defending the health law as the ace up their sleeves in tough elections. Virginia will be a major testing ground for that strategy as Democrats recently secured a big win on expanding Medicaid in the state. They could, however, be vulnerable to Republican messaging on high health care costs because the governor vetoed extensions for short-term plans.

Politico: Democrats Bet Big on Obamacare to Win Virginia Statehouse

So far, the implementation of Medicaid work requirements has been more crash and burn than the graceful transition many Republicans had likely hoped for. But Indiana seems on the path to becoming a model for other states as they add more restrictions to the program. I can explain it no better than Paige Winfield Cunningham at The Washington Post, who wrote: “If Arkansas and Kentucky were heavy-handed in imposing their work requirements, Indiana’s program is more like a tap on the shoulder, advocates argue.”

The Washington Post: Indiana Seeks to Impose Slower, Kinder Work Requirements on Medicaid Recipients

Meanwhile, over in Missouri, expansion advocates are hoping to follow the success of other states by getting the issue in front of voters rather than lawmakers.

The Hill: Advocates Launch Petition to Place Medicaid Expansion on 2020 Ballot in Missouri

The “Guaranteed to Make Everyone’s Blood Boil” award of the week goes to the article about how the Sacklers (the family that founded Purdue Pharma) could emerge from the opioid trials with their personal fortune intact.

The Washington Post: Sacklers Could Hold On to Most of Personal Fortune in Proposed Purdue Settlement

A cluster of HIV cases in West Virginia could be the canary in the coal mine that public health officials monitoring the opioid epidemic have been on the watch for. “This is the nightmare everyone is worried about,” said one expert about the outbreak that appears to be among the largest since one in Indiana’s Scott County four years ago.

Politico: ‘The Nightmare Everyone Is Worried About’: HIV Cases Tied to Opioids Spike in West Virginia County

In the miscellaneous file for the week:

• Reeling from persistent political attacks, Planned Parenthood has announced it will utilize telemedicine and a new app to reach young and rural patients who may have been affected by attempts to chip away at the organization.

The Wall Street Journal: Planned Parenthood to Expand App-Based Health Services to All 50 States

• We as a country are hooked on fast deliveries from Amazon, but there’s a human toll that flies under the radar that goes beyond workers’ pay. This ProPublica-New York Times story starts with the tragedy of a 9-month-old who died in an accident involving an Amazon delivery vehicle and doesn’t get any less heartbreaking as it goes on.

ProPublica/The New York Times: How Amazon Hooked America on Fast Delivery While Avoiding Responsibility for Crashes

• Be sure to check out this fantastic series about how America’s sick, poor and vulnerable will be the ones most affected by the growing climate crisis because they live in urban heat islands.

Howard Center for Investigative Journalism: Code Red: Baltimore’s Climate Divide

• On a much lighter note, scientists may have discovered a gene for left-handedness, which I just find fascinating and may make approximately 10% of my readers happy to know (mostly because it’s linked to having better verbal skills).

CNN: Scientists Identify the Genes Linked to Left-Handedness

• After millions of dollars, thousands of hours of manpower, tons of public outrage and a countless number of headlines from yours truly, the NYC measles outbreak has been declared officially over. The outbreaks in upstate New York still threaten the United States’ status as having eliminated the disease but, for now, public health officials are taking victories where they can get them.

The Washington Post: New York City Declares End to Largest Measles Outbreak in Nearly 30 Years

That’s it for me! Have a great weekend!

More People Actually Went To Emergency Department For Non-Urgent Issues When Medicaid Was Expanded

The study counters a common talking point that expanding the program would get people to stop using the emergency department in non-emergency situations. The author say it’s not surprising because patients under Medicaid don’t have to fear debt collection, removing one big barrier that could deter someone from a hospital visit. So those visits may be perceived as more convenient than a regular doctor’s office, which can be difficult as many providers don’t take Medicaid.

Advocates Want Missouri Voters To Weigh In On Whether State Should Expand Medicaid

Backers of Medicaid expansion in other states have seen success in previous elections when the issue goes in front of voters. The campaign, which is backed by nurses, doctors, hospitals, business executives and health care advocates, needs more than 172,000 signatures to qualify their measure for the 2020 ballot. Other Medicaid news comes out of Florida.