Nix repeal--fix the Affordable Care Act? 2

CBS Evening News @CBSEveningNews · 15h
NEW: VP Mike Pence tells @NorahODonnell that “in the days ahead” Pres. Trump could use “executive branch authority”
to take action on health care “to make it clear to every American that those that are facing preexisting conditions…will not be denied coverage.”
1:42 ( https://twitter.com/CBSEveningNews/status/1308482211000262661 )

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Ronald Klain (x-Ebola Car) @RonaldKlain | 1:03 AM · Sep 23, 2020
The simplest executive branch action Trump could take is
to withdraw the US govt filing in the Supreme Court trying to eliminate the Affordable Care Act.
Any other action is BS.

R. Alta Charo, J.D. 2020. Ruthless Health Law. NEJM (September 30, 2020). DOI: 10.1056/NEJMp2030358). DOI: 10.1056/NEJMp2030358 https://www.nejm.org/doi/full/10.1056/NEJMp2030358

...Associate Justice of the Supreme Court Ruth Bader Ginsburg died on September 18, 2020. The election will be held on November 3. And on November 10, the Court will hear oral arguments in California v. Texas, which challenges the individual mandate that requires people to maintain a minimum-coverage health insurance policy (see map). The decision will turn on a number of issues that only a lawyer can love, including who has “standing” to bring a case and whether this one provision, if held unconstitutional, is “severable” from the rest of the law. If it isn’t, then its unconstitutionality would render the entire law unconstitutional. For insurers, employers, and health care providers, such a ruling would be an invitation to chaos, forcing them to scramble to revamp their policies — again. And it would risk once again leaving millions of people in the United States, especially the 133 million with preexisting conditions, unable to obtain or afford insurance.

With U.S. coronavirus cases nearing 7 million and related deaths already exceeding 200,000,1 it seems a particularly poor time to evict people from coverage. And at a time when the dramatic racial, ethnic, and class-based disparities in vulnerability to SARS-CoV-2 have become front-page news, it seems the worst time to exacerbate inequities by reducing access to care.

Ginsburg’s opinions emphasized values pertinent to this and other upcoming cases, particularly values of equality and common interests...

Ginsburg’s passion for equality found particular expression in cases involving the lived experiences of women...

Equal opportunities for women were of especial concern when they hinged on women’s reproductive health...

Ginsburg also focused on the myriad, thinly disguised obstacles to abortion access in the form of state TRAP (Targeted Regulation of Abortion Providers) laws that require clinics to make architectural changes and clinicians to hold various hospital privileges, under the guise of making abortion safer...

Ruth Bader Ginsburg was a tireless advocate for equality. The Supreme Court has been on a trajectory toward limiting reproductive rights and toward limiting remedies for gross inequities in access to health care and voting. She understood that for women to participate in society as equals, they must have control over their bodies and reproductive choices. And in her opinion on the ACA, she reminded us that for all people, participation in society as equals requires access to medical care. In the end, only through our choices in elected leaders and the crafting of legislation can we ensure that a Ruth-less Court does not become a ruthless Court as well.

Hospitals lift curtain on prices, revealing giant swings in pricing by procedure
Samantha Liss and Nami Sumida | March 11, 2021

The eye-popping variations just demonstrate "the total insanity of American healthcare pricing," Niall Brennan, CEO of the payer-backed Health Care Cost Institute, said.

...As of Jan. 1, hospitals must publicly reveal the negotiated rates reached with insurers for services, a landmark shift in the sector notoriously opaque when it comes to pricing. The data offer a peek behind the curtain, exposing prices long kept a secret.

Healthcare Dive analyzed the new pricing data released by a handful of separate health systems across the country and found dramatic price ranges for the same procedure, even within the same hospital. Prices swing widely between markets, too. Healthcare Dive examined the prices for joint replacements and deliveries, including caesarean sections.

While the swings can be eye-popping, the data are not surprising to some researchers and industry experts steeped in the U.S. healthcare system.

"The fact that the price for a knee replacement can vary from $23,000 to $100,000 at a single hospital in one area of the country just demonstrates the total insanity of American healthcare pricing," Niall Brennan, CEO of the Health Care Cost Institute, which is partially-backed by payers, said.

...A review of 1,000 facilities across 27 states found that 30% of providers were not compliant with providing either a consumer-friendly file of prices or a machine-readable one, according to the firm Guidehouse.

The penalty does not have enough teeth, according to some critics including Ladd. The consequence for failing to comply with the rule is a $300 fine per day, which some critics called a pittance.

The lack of compliance makes it difficult to make meaningful comparisons within a single region of competitors and across markets in the U.S.

Plus, there is no central repository for all the data, forcing researchers to hunt and peck around thousands of hospital websites to find the information...

https://www.healthcaredive.com/news/hospitals-price-transparency-spotty-complian...

Biden officials rescind Trump’s okay for Texas’s $100 billion-plus Medicaid plan
The decision is seen as an effort to push Texas officials toward expanding Medicaid under the Affordable Care Act to cover more low-income residents
Dan Diamond | April 16, 2021

The Biden administration on Friday rescinded approval for changes to Texas’s Medicaid program granted by the Trump administration, saying that federal Medicaid officials “materially erred” by speeding approval for the state’s $100 billion-plus request in January.

The decision was characterized as an effort to push state officials toward accepting the Affordable Care Act’s Medicaid expansion, which would cover more low-income residents... Texas, which has more uninsured people than any other state, is one of 12 that have not expanded the program.

“We are rescinding the approval issued on January 15, 2021,” because it did not go through the full federal rulemaking process, Liz Richter, the acting administrator of the Centers for Medicare and Medicaid Services, wrote in a letter to Texas officials ...

https://www.washingtonpost.com/health/2021/04/16/biden-rejects-texas-medicaid-pl...

Affordable Care Act survives third Supreme Court challenge, as case from Trump administration and GOP-led states is rejected
Robert Barnes | June 17, 2021

On June 17 the Supreme Court, in a 7-2 decision, rejected a challenge to the law brought by Texas and other GOP-led states, saying they lacked legal standing.

Justice Stephen G. Breyer wrote the court’s 7-to-2 decision...Justices Samuel A. Alito Jr. and Neil M. Gorsuch dissented.

...The key issue this time was whether a 2017 decision by Congress to remove the penalty for not buying health insurance — the so-called individual mandate — meant that the law was unconstitutional and should be wiped from the books.

That would end popular provisions such as keeping young adults on their parents’ insurance policies and ensuring coverage for those with preexisting medical conditions.

...“Neither the individual nor the state plaintiffs have shown that the injury they will suffer or have suffered is ‘fairly traceable’ to the ‘allegedly unlawful conduct’ of which they complain,” Breyer wrote...“With the penalty zeroed out, the IRS can no longer seek a penalty from those who fail to comply...Because of this, there is no possible government action that is causally connected to the plaintiffs’ injury — the costs of purchasing health insurance.

And the states, he wrote “have not demonstrated that an unenforceable mandate will cause their residents to enroll in valuable benefits programs that they would otherwise forgo.”

To allow the suit to proceed, Breyer wrote, “would threaten to grant unelected judges a general authority to conduct oversight of decisions of the elected branches of government.”...

https://www.washingtonpost.com/politics/courts_law/affordable-care-act-survives-...

Not sure what the price of my myeloma treatment is but it’s in the hundreds of thousands of dollars. 25 days in the hospital this year, all kinds of infusions and drugs, 2 ambulance rides one of which was two hours. A good 20 days worth of hotel time. The rehab stuff post fractured vertebrae. We’re lucky (not necessarily more deserving than anyone else though) to have been able to afford the insurance that paid for almost all of it. A lot of people can’t and would be stuck with a choice of not getting the treatment they needed or being driven into bankruptcy. We need to cover everyone and not just the rich or the shrinking % of the population that can afford insurance.

>6 lriley: I fell of the side of a mountain, and got to say "wow, a cat scan is only $15,000; I thought it would be more" instead of "hmm, how does bankruptcy work?" thanks to the ACA.

>7 prosfilaes: some of your numbers are really weird seen from here. I think a cat scan is more like 10000 DKR here if you look at the cost for the hospital.

>8 bnielsen: The cost of cat scans is complex. Once you've paid the upfront costs, the cost of running the machine is going to be electricity and a technician. Also part of the reason our system is screwed up is because hospitals have to provide emergency care for everyone by law, so they end up with a lot of unpaid bills that effectively get rolled into the price treatments.

My first grandchild will need heart surgery soon after birth. (Hopefully more on manageable end of spectrum.) Son has high deductible so will be costly, but won't bankrupt them--fingers crossed he dotted all the Is and crossed all the Ts. Thanks to ACA, at least Baby won't be haunted for life by "pre-existing condition".

(ETA: just heard from parents that the state will help with at least some of Baby's medical costs.)

>9 prosfilaes: Yes, I know where the high prices come from. They still stagger me.

Woman used Cologuard test seen on TV. (Covered by her insurance.)
Positive result meant she needed colonoscopy after all, but it was now "diagnostic", not "screening".
Her particular insurance did not cover "diagnostic" colonoscopy.
https://www.cbsnews.com/news/cologuard-2000-unexpected-bill-colon-cancer-screeni...
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In similar vein though less costly(?), beware Medicare "wellness visits" with your GP.
If you MD's office adds anything that sniffs of an annula exam, Medicare declines and you will be charged.
I fought for a year but ended up paying for "eye exam", which was actually my GP asking about eye condition under opthalmologist's care.
I now always look for some little issue that allows me to ask for office visit, not wellness visit.

UnitedHealthcare’s plan to stick patients with ER bills has caught them in a PR nightmare. Here’s how they’ll get past it and make it your nightmare.
United’s plan? Refuse to pay your bill if one of their “denial nurses” decides you weren't sick or hurt enough for the ER.
Wendell Potter | Jun 24, 2021

Earlier this month, UnitedHealthcare, the nation’s biggest insurer, quietly posted a policy change that almost no average person would ever see or understand but that, beginning July 1, could have subjected millions of Americans to financial ruin (or worse) after a visit to an emergency room.

...Back in 2019, United did a “study” of its E.R. claims, figured out the average cost of each visit, and did some extrapolating. Even Kaiser Health News published it without questioning the source or the source’s motives. Surprise, surprise: According to KHN, United concluded that “as many as two-thirds of the nation’s 27 million annual emergency room visits could be avoided.” That’s wildly at odds with research from a much more trustworthy source, the Centers for Disease Control and Prevention, which estimates that 3.1% of emergency room visits are non-urgent.

Note to reporters: Use “studies” like that from insurers and outfits like America’s Health Insurance Plans at your own peril. Take it from me: They NEVER do studies that aren’t supportive of some current or planned business practice or propaganda campaign. If the results don’t show what they want, the study will be buried. You’ll never know about it. And when you do get a news release about a study they’ve done or funded, demand to see the methodology. And know that, just as insurers have a long history of cherry picking customers, they have an equally long history of cherry picking data for their “studies.”

...I will be shocked if the company rescinds that policy “fully and permanently.” What it will do is implement the change when the heat is off ,as this new statement on its website implies: “We will use this time to continue to educate consumers, customers and providers on the new program and help ensure that people visit an appropriate site of service for non-emergency care.”

Bottom line: When United does implement the new policy, it will avoid paying for care that people thought were true emergencies.

An untold number of people will just not go to the E.R., and some of them will die.

But United, which last year made $22.4 billion in profits and is now the 7th largest company in America, will make even more money for Sir Witty and the company’s other already rich shareholders.

https://wendellpotter.substack.com/p/united-pr-nightmare

Inflation Greets Retirees Emerging From the Pandemic. Here’s How to Prepare.
By Gail MarksJarvis
Updated June 28, 2021 / Original June 26, 2021

...The Bureau of Labor Statistics tracks the impact of inflation on retirees through an experimental index known as the CPI-E. It adapts the broader consumer-price index to more accurately reflect the difference in how retirees spend compared with working adults. Generally, inflation has hit retirees harder than the general public because of healthcare and shelter. People over 62 spend about 12.2% of their income on medical care, compared with 8.8% by the broad population. Housing is higher for seniors too—taking roughly 46.5% of their budget compared with the general population’s 42.3%, according to recent data.

Yet the cost-of-living adjustments people get annually in their Social Security checks haven’t kept up with the way retirees spend, said (Mary Johnson, an analyst for the Senior Citizens League). That’s in part because Social Security COLAs are established each year based on CPI-W, which measures the impact of inflation on worker prices. The 2021 COLA was based on the distressed 2020 pandemic economy, so retirees got a 1.3% bump to cover prices that the broad CPI recently said are now up 5% year over year.

Social Security provides about a third of elderly income, with 50% of married couples and 70% of singles depending on the monthly benefits for half of their income, according to the Social Security Administration. Even retirees less dependent on Social Security, however, can be vulnerable as they may need to live off savings for a retirement that could last 30 years or more and a sustained run of rising prices would threaten to erode future spending power or deplete savings sooner than anticipated.

...Because of the particular inflation seniors face, people who retired 20 years ago have had their buying power fall 30%, Johnson said. Since 2000, Social Security COLAs have gone up 55%, yet the typical senior’s expenses have grown 101.7%, she said. That includes a 226% increase in Medicare Part B premiums, or the charge people pay each month to get Medicare. And the medical out-of-pocket expenses—not covered by Medicare—have climbed 142%.

Based only on the CPI—and without the extra medical expenses seniors face—a person who retired in 2000 would need about $156,000 now for the same standard of living $100,000 provided when they first retired.

This year, since many people deferred medical care during the pandemic, inflation in healthcare has been modest. But through this decade, retiree healthcare spending is expected to face sharp inflationary pressures. Last year, economist Sean Keehan and colleagues from the Centers for Medicare and Medicaid Services estimated in Health Affairs journal that national healthcare expenditures will grow at 5.4% annually through 2028, and Medicare 7.6% a year—largely because so many baby boomers are retiring.

“It seems that the prudent thing to do is to plan 5% to 6 % out-of-pocket increases a year,” said Michael Chernew, a professor of healthcare policy at Harvard University. But since Congress can change rules around Social Security and Medicare, actual out-of-pocket expenditures for retirees is difficult to predict, he said...

Currently, Johnson estimates the cost of living bump in Social Security next year may be 5.3% if inflation trends continue through this third quarter. But with or without it, the recent chill from inflation has caused some near-retirees to alter their plans.

https://www.barrons.com/articles/inflation-retirement-51624655527

>13 margd: contd.

Health insurers are threatening not to cover some patients’ ER bills
Plans like United Healthcare say it’s necessary to contain health care costs. Experts say it’s the wrong approach.
Dylan Scott | Jul 1, 2021

...The problem is not that patients overuse or misuse the emergency room, said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. Emergency department visits have actually been stable for years and, after a drop during the Covid-19 pandemic, have not yet recovered to previous levels.

If anything, the problem is the prices that hospitals charge for ER services, experts said. Those have been rising in recent years. United may be trying to send a warning on prices to providers with its new policy — “a shot across the bow,” as Hempstead put it — but in doing so, patients are being put at risk of facing huge medical bills they may struggle to pay.

“It’s not fair to patients,” she said. “It puts the patients in the middle.”...

https://www.vox.com/2021/7/1/22557401/united-healthcare-emergency-room-visits-me...

Hospitals Often Charge Uninsured People the Highest Prices, New Data Show
Cash payers are often charged more than insurance companies for the same service by the same hospital, according to a WSJ analysis of previously confidential data
WSJ | July 6, 2021

https://www.wsj.com/articles/hospitals-often-charge-uninsured-people-the-highest...
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Methodology: How the WSJ Analyzed Hospital Pricing Data
As of January, U.S. hospitals are required to disclose the rates for all services that they have negotiated with insurers and the price they charge uninsured people who pay out of their own pocket
WSJ | July 6, 2021

Federal regulations that went into effect in January require U.S. hospitals to disclose the rates for all services that they have negotiated with insurers. For each service—everything from a simple X-ray to an emergency-room visit to a complicated surgery—the disclosures are required to include:

—The “chargemaster,” or list, price that a hospital has set for the service. While this price is rarely charged to anyone, many hospitals use it as a starting point for negotiations over what they will charge.

—The price that a cash-paying patient, such as someone who is uninsured, would be charged for the service.

—Each price that the hospital has negotiated with a private insurer’s Medicare Advantage or commercial (typically employer) health plan...

https://www.wsj.com/articles/methodology-how-the-wsj-analyzed-hospital-pricing-d...

Over-The-Counter Hearing Aids Update
Deb Hipp | July 6, 2021

...The Food and Drug Administration (FDA) is in the process of drafting proposed regulations for over-the-counter (OTC) hearing aids, a brand-new category of hearing aids. Once approved and regulated, OTC hearing aids will likely be more affordable and accessible to consumers than most other FDA-approved hearing aids on the market right now.

What Are Over-the-Counter Hearing Aids?
When the FDA Reauthorization Act of 2017 (FDARA) was signed into law, it included an order for proposed regulations for a new, future category of hearing aids: over-the-counter (OTC) hearing aids. These devices would be available directly to consumers via retail and outline outlets rather than requiring them to go through an audiologist or another hearing health professional for access. However, these new FDA rules are still to be determined.

...The FDA Reauthorization Act of 2017 directed the FDA to develop regulations that would make OTC hearing aids available to the public by 2020. However, the regulatory process stalled due to the COVID-19 pandemic. As of June 2021, the FDA plans to meet on OTC hearing aids during the current rulemaking session, likely publishing new regulations in 2022. Once the FDA regulations are published, OTC hearing aids are expected to become available to the public rather quickly...

https://www.forbes.com/health/healthy-aging/otc-hearing-aids-update/

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ETA:

Maddow Blog @MaddowBlog |
"50 million Americans suffer from mild to moderate hearing loss and only 1 in 7 of those folks actually have hearing aids, and the reason for that is because it can cost up to $5,000 a pair."

"With these changes folks will be able to walk into their local drug store and pick up a pair of hearing aids like they buy a thermometer and it's going to cost a few hundred bucks instead."
-Bharat Ramamurti, deputy director of the National Economic Council @BharatRamamurti

1:32 ( https://twitter.com/MaddowBlog/status/1413682882145624065 )

Google Can Now Help You Navigate the Mess That Is American Healthcare
You can quickly find out if your doctor takes your insurance and whether they speak your language.
Florence Ion | Dec 2, 2021

...Starting today, you can search for these things through Google Search from your phone. As you look for “doctors near me,” Google will offer up a few filters at the top to narrow down your choices, including whether the doctor accepts Medicare.

The health care check extends to private insurance, too, but you’ll have to tap to expand for more information. It’s not always guaranteed to be listed. If insurance information is available, Google will include an external link and direct you there through a separate browser window. If the doctor uses ZocDoc or accepts appointments through an online portal, Google will list that, too. Overall, it’s much easier to search this way than endlessly scrolling through a doctor’s copy-and-paste-a-layout website...

...translate over a dozen languages...types of services...

...Google captures another segment of our lives.

https://gizmodo.com/google-can-now-help-you-navigate-the-mess-that-is-ameri-1848...

Gavin Newsom @GavinNewsom | 10:10 PM · Jun 30, 2022
40th Governor of California.

NEW: Just signed our budget. California will now be the first state in the nation to achieve universal access to healthcare coverage.

This is what being “pro-life” ACTUALLY looks like.

ian bremmer @ianbremmer | 5:40 PM · Jul 2, 2022
political scientist, author, teach at columbia sipa, columnist at time, president @eurasiagroup, @gzeromedia.

one of the most disturbing demographic data trends you’ve ever seen.
the united states—pre-pandemic, mind you—vastly underperforming the g7 in life expectancy

Graph life expectancy by country (1995-2019)