Tag Archives: insurance

Mayo Clinic faces questions over CEO’s ‘prioritized’ patients remark

Mayo Clinic is facing questions from the state of Minnesota after its CEO told employees that if patient conditions are equal, its hospitals should prioritize privately insured patients over those under government-subsidized programs such as Medicaid.

John Noseworthy’s comments were made late last year in a videotaped speech to staff but surfaced only this week after a transcript of his speech was obtained by the Star Tribune newspaper.

The Mayo Clinic has verified the transcript is accurate.

Noseworthy said in a statement that medical need will always be the top factor in scheduling an appointment.

“In an internal discussion I used the word ‘prioritized’ and I regret this has caused concerns that Mayo Clinic will not serve patients with government insurance. Nothing could be further from the truth,” he said, adding that the hospital is committed to serving patients with government insurance.

“Changing demographics, aging of Americans and budgetary pressures at state and federal government pose challenges to the fiscal sustainability in healthcare today,” he said. “While these discussions are uncomfortable, they are critical for us to be able to meet the needs of all of our patients.”

Minnesota Department of Human Services Commissioner Emily Piper said she was surprised and concerned by Noseworthy’s earlier comments and has questions about what they really mean and how Noseworthy’s directive would be carried out.

The department is looking into whether there are possible violations of civil and human rights laws.

The agency also is reviewing its contracts with Mayo Clinic to ensure the hospital is meeting its obligations to serve patients in public programs.

Last year, Noseworthy told staff that when Mayo Clinic has expertise that can’t be found elsewhere, it will always take patients, regardless of how they are paying for care.

“We’re asking. if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so . we can be financially strong at the end of the year to continue to advance our mission,” Noseworthy said in the transcript.

Mayo Clinic spokeswoman Duska Anastasijevic said the speech stressed the need to increase privately insured patients, but not at the expense of government insured patients.

Mayo Clinic said about half of the services it provides go toward those enrolled in government programs. The clinic said it provided $629.7 million in care to people in need in 2016, including $546.4 million that wasn’t covered by Medicaid or other programs for the uninsured or underinsured.

The statement said that as Mayo’s percentage of publicly funded patients has grown, to now roughly 50 percent, the health system is working to increase commercially insured patients.

“To fund its research and education mission, Mayo needs to support its commercial insurance patient numbers in order to continue to subsidize the care of patients whose insurance does not cover the cost of their care,” the statement said.

Piper said Noseworthy’s statements do not reflect routine hospital practices and she found them to be troubling.

As Human Services commissioner, Piper is focused on ensuring access to health care for those enrolled in public programs. She said providers have to follow the law and uphold agreements to provide such care. She said that in her view, nothing that is happening with the health care law on the federal level changes those requirements.

“Health insurance coverage for health insurance coverage’s sake is not the end goal,” she said. “It’s access _ that’s what’s important.”

Anastasijevic said Minnesota Medicaid patients are and will continue to be scheduled the same as patients with commercial insurance.

WalletHub: Milwaukee in top 10 cities most affected by ‘Trumpcare’

Source: WalletHub

With the average health-insurance premium estimated to rise 15-20 percent in the next two years and federal tax credits expected to decrease under the recently proposed American Health Care Act, the personal-finance website WalletHub conducted an in-depth analysis of cities most affected by the GOP health plan, which it referred to as “TrumpCare.”

To gauge the impact of the Republican-proposed health plan on people who buy their own insurance, WalletHub’s analysts compared 457 U.S. cities based on the differences in premium subsidies that the average household would receive under “Obamacare” and “Trumpcare.”

The impact on Milwaukee:
 

  • Average Obamacare Premium Subsidy: $5,707
  • Average Trumpcare Premium Subsidy: $5,000
  • Subsidy Difference: -$707
  • Milwaukee ranks 78th most affected overall and 10th most affected among large cities.

On the web

https://wallethub.com/edu/cities-most-affected-by-trumpcare/33588/

Spring storm: Activists gathered outside Ryan’s Racine office to protest health care plan

About 250 people from Illinois and Wisconsin assembled outside House Speaker Paul Ryan’s office in Racine March 14 to demand he drop his health care repeal plan.

The demonstration took place days after the Congressional Budget Office’s analysis showed the House GOP health plan would cause 24 million Americans to lose their health coverage.

People from Fair Economy Illinois and the Jane Addams Senior Caucus joined with members of Citizen Action of Wisconsin — all People’s Action organizations — and with SEIU Healthcare Wisconsin and the Wisconsin Alliance for Retired Americans.

Protesters marched from Racine’s Monument Square on Main Street to Ryan’s office with cans of dog and cat food — the kind of lunch organizers say some seniors will have  if House Republicans pass their health plan is passed.

Outside the speaker’s office, people shared stories and fears of living without health insurance.

Reggie Griffin, of Chicago, is in his 70s and works as a home caregiver. He said he would be devastated by the defunding of Medicare because of chronic health conditions. “I want to live a life of dignity,” Griffin said, according to a news release from organizers of the protest. “There are some members of Congress, like Speaker Paul Ryan, who think I don’t deserve to live with dignity.”

“This is a huge test for our democracy, because the Republican repeal can’t survive once the people understand it’s true implications,” said Robert Kraig, executive director for Citizen Action of Wisconsin.

“This attack on seniors and families will devastate Midwest communities. It is irresponsible and ruthless,” added Anna Marin, manager of civic engagement for the Jane Addams Senior Caucus.

One of the speakers at yesterday’s action, Tammy Wolfgram, is a small business owner from Hartland.

Before the passage of the Affordable Care Act, Wolfgram, her husband and her daughter could not find any health insurance company that would sell them coverage because all three had pre-existing conditions.

She said they struggled to afford costly insurance with high deductibles on Wisconsin’s high-risk pool.

“If ACA is repealed, I don’t know what we will do,” Wolfgram said.

A report by the Congressional Budget Office released this week shows 14 million people will lose their insurance coverage by next year and 24 million by 2026.

“Anyone who believed GOP promises that people would still have health insurance under the Republican repeal plan now know that they were lied to; they are going to be left out in the cold,” said LeeAnn Hall, co-director of People’s Action and executive committee member of Health Care for America Now.

Deciphering CBO’s estimates on the Republicans’ health bill

The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government.

The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

Here are some of the CBO highlights:

• $337 billion reduction in the deficit. That’s CBO’s estimate over the next decade, taking into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenue from the repeal of the taxes imposed by the ACA to pay for the new benefits.

• 24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that the drop will kick in quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

• 15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

• 15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”

• 95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024, since the bill would phase out those payments to states as patients cycle in and out of eligibility.

• 14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.

• $880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

 

Sanders announces health care rallies from coast to coast

U.S. Sen. Bernie Sanders says more than 100 rallies will take place from coast to coast on Feb. 25 to fight Republican attempts to take health care away from 20 million Americans.

Sanders, in a statement, said, “The American people will let Republicans know they are standing against their attempts to repeal the Affordable Care Act, throwing 20 million Americans off of their health insurance, privatizing Medicare, making massive cuts in Medicaid, raising the cost of prescription drugs for seniors and, at the same time, giving a massive tax break to the top 1 percent. The American people want to improve the Affordable Care Act, not destroy it.”

Sanders, the Senate Democrats’ outreach leader, and Senate Democratic Leader Chuck Schumer previously sent a letter calling for rallies to oppose efforts by President Donald Trump and Republicans in Congress to repeal the Affordable Care Act.

Said Schumer and Sanders in the letter, “The Republican Party’s plan to repeal the Affordable Care Act is in chaos. Public support for the law is at an all-time high, while the number of Americans supporting its immediate repeal without a replacement has dipped below 15 percent. It is critical we seize this momentum.”

For details on where rallies will take place, click here.

Obamacare came to Montana Indian Country and brought jobs

The Affordable Care Act created new health coverage opportunities for more than half a million Native Americans and Alaska Natives — and jobs have followed on its coattails.

In Montana, this is playing out at the Blackfeet Community Hospital. It’s the only hospital on the Blackfeet reservation and has been mostly funded — and chronically underfunded — by the Indian Health Service, which has been in charge of Native American health care since its founding in the 1950s.

But now, many Native Americans have been able to afford health insurance on the Obamacare exchange, and last year, Montana expanded Medicaid. Now, about one in seven reservation residents gets Medicaid.

Blackfeet Community Hospital needed to build an infrastructure to deal with the byzantine bureaucracy that comes with taking Medicaid and private insurance. The tribe’s community college started a new curriculum to help meet the growing demand for people in Indian country to process insurance claims.

Blackfeet tribal member Gerald Murray took the courses. “I got a contract before I graduated in April, and then the day of graduation in May it became permanent so I applied for it,” he said.

Murray’s experience is an example of the health care law’s transformative power in Native American communities, said Montana’s director of American Indian Health, Mary Lynn Billy-Old Coyote.

“To me, there’s opportunity there to not only build health care, but to build your entire community and build jobs,” said Billy-Old Coyote.

Unemployment on most of Montana’s Indian reservations is at least double the rest of the state. And people who are working don’t always get health insurance with their jobs.

So ACA subsidies that bring down the cost of insurance premiums are a big deal, Billy-Old Coyote said.

Most Montanans, Native or not, can now get policies for about $75 a month. It is a big change for the reservation communities where people are accustomed to the underfunded IHS, which often didn’t pay for care unless someone was in immediate danger of losing life or limb.

“Now you’ve got an opportunity for American Indian people to truly have access to private insurance,” she said. “You have access to greater networks of providers and specialists, and all the things we generally don’t see you have access to.”

Medicaid expansion had a lot to do with the number of health care jobs in Montana growing by 3 percent last year, according to state statistics. And schools in Montana, including tribal colleges, are offering more classes in health care fields.

At Blackfeet Community College, 23-year-old Leroy Bearmedicine is working toward certification as an emergency medical technician.

“I’d like to become a registered nurse at some point, maybe even work my way up to flight nurse — something to get the adrenaline going,” he says.

Native American leaders have seen the Affordable Care Act as a means to remedy a series of broken promises by the federal government to care for them. They now fear that promise, too, will fade. One estimate suggests Montana will lose 3,000 health care jobs if the Affordable Care Act is repealed.

This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News. It is published here under a creative commons license agreement and courtesy of KHN.

6 surprising health items that could disappear with ACA repeal

The Affordable Care Act of course affected premiums and insurance purchasing. It guaranteed people with pre-existing conditions could buy health coverage and allowed children to stay on parents’ plans until age 26. But the roughly 2,000-page bill also included a host of other provisions that affect the health-related choices of nearly every American.

Some of these measures are evident every day. Some enjoy broad support, even though people often don’t always realize they spring from the statute.

In other words, the outcome of the repeal-and-replace debate could affect more than you might think, depending on exactly how the GOP congressional majority pursues its goal to do away with Obamacare.

No one knows how far the effort will reach, but here’s a sampling of sleeper provisions that could land on the cutting-room floor:

CALORIE COUNTS AT RESTAURANTS AND FAST FOOD CHAINS

Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law. Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay. One thing that is still unclear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead?  Results are mixed. One large meta-analysis done before the law went into effect didn’t show a significant reduction in calorie consumption, although the authors concluded that menu labeling is “a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”

PRIVACY PLEASE: WORKPLACE REQUIREMENTS FOR BREAST-FEEDING ROOMS

Breast feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace — other than a bathroom — to do so in private. In addition, most health plans must offer breastfeeding support and equipment, such as pumps, without a patient co-payment.

LIMITS ON SURPRISE MEDICAL COSTS FROM HOSPITAL EMERGENCY ROOM VISITS

If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the law provides some limited assistance. If you are in a hospital that is not part of your insurer’s network, the Affordable Care Act requires all health plans to charge consumers the same co-payments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could “balance bill” you for its costs — including ER care — that exceed what your insurer reimburses it.

If it’s a non-profit hospital — and about 78 percent of all hospitals are — the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That’s compared with their gross charges, also known as chargemaster rates.

NONPROFIT HOSPITALS’ COMMUNITY HEALTH ASSESSMENTS

The health law also requires non-profit hospitals to justify the billions of dollars in tax exemptions they receive by demonstrating how they go about trying to improve the health of the community around them.

Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop — and update annually — strategies to meet these needs. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.

A WOMAN’S RIGHT TO CHOOSE … HER OB/GYN

Most insurance plans must allow women to seek care from an obstetrician/gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also related screenings for such things as high blood pressure or cholesterol.

AND WHAT ABOUT THOSE THERAPY COVERAGE ASSURANCES FOR FAMILIES WHO HAVE KIDS WITH AUTISM?

Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That’s because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such speech therapy for a child who never learned how to talk, or to maintain a patient’s current level of function. The law requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This story from HKN is published under a Creative Commons license.

Vowing to jettison Obamacare, Republicans face immediate resistance and risks

The 115th Congress started work Tuesday with Republican majorities in both the House and Senate in agreement on their top priority — to repeal and replace the 2010 health law, the Affordable Care Act, also known as Obamacare.

“The Obamacare experience has proven it’s a failure,” House Majority Leader Kevin McCarthy, R-Calif., told reporters at an opening day news conference.

But that may be where the agreement among Republicans ends.

Nearly seven years after its passage, Republicans still have no consensus on how to repeal and replace the measure.

“It is risky business,” said Thomas Miller, a conservative economist and former Capitol Hill aide now at the American Enterprise Institute.

Republicans, he said at a recent AEI forum, are “very good at fire, aim, ready.” But with more than 20 million Americans getting coverage under the law, GOP lawmakers will have to tread carefully, Miller warned. “The hard one is when you’re trying to defuse what’s already been out there, cutting the wires on the bombs sequentially” so as to avoid a messy and destructive explosion.

Republicans are reportedly discussing a range of options for disassembling Obamacare, but analysts who have been involved in the intricacies of health policy for decades warn no replacement strategy will be easy.

The most immediate problem for the GOP is that even with majorities in both chambers of Congress, they do not have the 60 votes needed to overcome Democrats’ objections in the Senate. (There are 52 Republicans in the Senate now.) That means they won’t be able to pass a full repeal of the law on their own and it is unlikely eight Democrats would join to overturn President Barack Obama’s signature legislation.

Even if they did have the votes standing by, they don’t have anything teed up to replace the health law.

“It’s not that Republicans don’t have replace bills. They have a couple dozen,” said Douglas Badger, who oversaw health policy in the White House for President George W. Bush and worked for the Senate GOP leadership prior to that. “The problem is they don’t have consensus,” he said at the AEI forum.

Still, doing nothing, or even waiting, is not an option given that these lawmakers have been vowing to repeal the law almost since the day it passed in 2010.

“You have to pass something,” said Miller, “and whatever you pass you call repeal.”

The leading option under consideration is “repeal and delay.” The idea is to use the budget process to overturn the tax-and-spending parts of the law, but delaying the effective date to buy time for Republicans to agree on a replacement bill.

But there are problems with that strategy. One is political — Democrats are already crying foul.

“It’s not acceptable to repeal the law, throw our health care system into chaos and then leave the hard work for another day,” incoming Senate Minority Leader Charles Schumer, D-N.Y., said Tuesday.

Added Sen. Richard Durbin, D-Ill., “it’s not repeal and delay, it’s repeal and retreat.”

The plan also has raised concerns in the health industry. The goal of delaying the repeal date is to let people who have obtained insurance under the health law keep it while a replacement is formulated. But that is by no means guaranteed.

Insurance analysts have said that any more uncertainty in an already fragile marketplace could easily prompt insurers to leave the individual market, which would put at risk coverage for not just the roughly 10 million people who are purchasing plans there under the health law, but also the roughly 10 million people who previously had individual policies. (Another 10 million people have gained coverage under the health law through an expanded Medicaid program for those with low incomes.)

Without specific help for insurers from Congress, which would likely include insurance payments Republicans have called bailouts, “the market will begin to crumble” quickly, said Robert Reischauer, former president of the Urban Institute.

House Majority Leader McCarthy told reporters Tuesday that “no decisions have been made yet” on how Republicans might want to help stabilize the insurance market while they seek a replacement plan.

The individual insurance market could also be rattled if the incoming Trump administration decides not to appeal a lawsuit brought by congressional Republicans who argued that the Obama administration was illegally using money to pay insurers to subsidize health costs for some low-income customers buying individual plans on the health law’s marketplaces. If the new administration bows out of the suit and those subsidies, insurers would not get reimbursed for the expenses, and some analysts predict it could force companies to leave the market.

On the other hand, attempting to repeal and replace the law in a single bill also could pose problems.

Repealing and replacing together “looks less like repealing than fixing,” said Badger. “That could cause some angst” among the GOP base that wants Obamacare to be fully eliminated.

And Democrats point out that Republicans are equally guilty of overpromising the benefits of overhauling the health care system, albeit in a very different way.

The goals currently being talked about by Republicans — including making health care more affordable, covering more people, reducing government spending and giving states more flexibility — “are impossible to achieve,” within acceptable GOP budget limits, said Reischauer at the AEI event. “There are going to have to be some tradeoffs,” he said, as Democrats found when they tried to accomplish roughly those same goals.

Made available from Kaiser Health News under a creative commons agreement. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Doctors, hospitals say ‘show me the money’ before treating patients

Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Oklahoma. But the plan has a deductible of $5,000 apiece, and Boxley’s doctor said he won’t do the surgery until she prepays her share of the cost. His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

“I’m so angry,” Boxley said. “If I need medical care I should be able to get it without having to afford it up front.”

At many doctors’ offices and hospitals, a routine part of doing business these days is estimating patients’ out-of-pocket payments and trying to collect it up front.

Eyeing retailers’ practice of keeping credit card information on file, “there’s certainly been a movement by health care providers to store some of this information and be able to access it with patients’ permission,” said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Massachusetts, who works with hospitals on addressing financial barriers to care.

But there’s a big difference between handing over a credit card to cover a $20 copayment versus suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient’s credit limit. Doctors may refuse to dispense needed care before the payment is made, even as patient health hangs in the balance.

The strategy leaves patients financially vulnerable. Once a charge is on a patient’s credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer’s commitment that the charge was justified, so nonpayment is more likely to harm a credit score.

Approximately three-quarters of health care and hospital systems ask for payment at the time services are provided, a practice known as “point-of-service collections,” estimated Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group. He could not say how many were doing so for higher priced services or for patients with high-deductible plans, situations that would likely result in out-of-pocket outlays of hundreds or thousands of dollars.

“For providers, there’s more risk with these higher deductibles, because the chance of being able to collect it later diminishes,” Gundling said.

But the practice leaves many patients resentful.

After arriving by ambulance at the emergency department, Susan Bradshaw lay on a gurney in her hospital gown with a surgical bonnet on her head, waiting to be wheeled into surgery to remove her appendix at a hospital near her home in Maitland, Fla. A woman in street clothes approached her. Identifying herself as the surgeon’s office manager she demanded that Bradshaw make her $1,400 insurance payment before the surgery could proceed.

“I said, ‘You have got to be kidding. I don’t even have a comb,’” Bradshaw, a 68-year-old exhibit designer, told the woman on that night eight years ago. “I don’t have a credit card on me.”

The woman crossed her arms and Bradshaw remembers her saying, “You have to figure it out.”

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments to reduce bad debt from patients with increasingly high deductibles, the risk is that patients will delay care and end up in the emergency room, Rukavina said. “Patients are essentially paying for their procedures up front,” he said. “It may not be a significant amount compared to their salary, but they don’t necessarily have it available at the time of service.”

The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm. While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so, the analysis found.

Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year, according to the Kaiser Family Foundation’s annual survey of employer health insurance. (KHN is an editorially independent program of the foundation.)

Boxley pays $110 a month for her family plan. She could not afford the premiums on plans with lower deductibles that her employer offered. She plans to talk with the doctor and hospital about setting up a payment plan so she can get the surgery in January.

“I’ll make payments,” Boxley said, although she acknowledged what she could pay monthly would be small. If that doesn’t pan out, she figures she’ll have to use student loan money she got for graduate school to cover what she owes.

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it’s not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians’ board of directors.

Bradshaw finally got her appendix removed by calling a friend, who read his MasterCard number over the phone. The surgery was uneventful and Bradshaw was home within 24 hours.

“It’s a very murky, unclear situation,” Friedman said of Bradshaw’s experience, noting that a case might be made that her condition wasn’t life threatening. “At the very least it’s poor form, and goes against the intent if not the actual wording of EMTALA.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Published courtesy of Kaiser Health News.

Q&A: A look at the cancer some believe linked to Vietnam War

A rare bile duct cancer that may be linked to time served in the Vietnam War is quietly killing some former soldiers.

The disease can be caused by liver flukes, a parasite found in raw or undercooked fish that is common in parts of Asia.

Some veterans are fighting for the Department of Veterans Affairs to recognize their disease as service-related so they can receive benefits, but most claims are denied.

 

WHAT ARE LIVER FLUKES?

Liver flukes are parasites ingested in raw or undercooked freshwater fish. They are endemic in parts of Southeast Asia, including Vietnam, along with other areas, mainly in China and South Korea. Some 25 million people are infected with the worms. Liver flukes die when frozen, but they can survive fermentation or pickling. Visitors traveling in endemic areas can also be infected.

 

WHAT IS CHOLANGIOCARCINOMA, AND HOW DO LIVER FLUKES CAUSE IT?

Cholangiocarcinoma is a rare cancer that affects the bile duct. Liver flukes are a risk factor; others include hepatitis B and C, cirrhosis and bile duct stones. After the worms are ingested, they can live for more than 25 years in the bile duct, causing inflammation and scarring that can eventually lead to cancer. The disease is difficult to treat, with many victims dying within months of diagnosis. A patient typically does not experience any symptoms, such as jaundice, until the end stages.

 

CAN THIS CANCER BE TREATED?

Bile duct cancer is unusual because it can be prevented in some cases. Pills can wipe out liver flukes early on, but the medicine is not effective in later stages after the worms have died and scarring has occurred. Surgery is possible in some cases, but the survival rate is only about 30 percent for five years, said Dr. Gregory Gores, a gastroenterologist and executive dean of research at Mayo Clinic. Affected countries, such as Vietnam and Laos, have not conducted extensive research to determine the extent of the problem. The world’s highest rate of cholangiocarcinoma _ about 84 new cases per 100,000 people — is found in northeastern Thailand where many people eat a popular raw fish dish. In the U.S., cholangiocarcinoma is extremely rare, with around 1.7 in 100,000 people diagnosed each year.

 

WHAT IS THE CONNECTION TO VIETNAM VETERANS?

Men who served in the Vietnam War and ate raw or poorly cooked fish, sometimes while on patrol in the jungle after their rations ran out, could have been infected by liver flukes. Left untreated, they can experience symptoms related to bile duct cancer decades later. Because the disease is so rare and awareness about liver flukes is poor in the U.S., many veterans may not be aware of the possible connection to their service time.

 

ARE VETERANS WITH THIS CANCER ELIGIBLE FOR FINANCIAL HELP?

Each case is examined individually, and it’s up to veterans to prove to the Department of Veterans Affairs that their cancer is “as likely as not” related to their service time. The VA says fewer than 700 cholangiocarcinoma patients have passed through its medical system in the past 15 years. In part because they are unaware of the potential link to their war days, only 307 of the veterans submitted claims for benefits over that period. Even though the VA sometimes approves the link between wartime service and cholangiocarcinoma, the vast majority of claims — 3 out of 4 — are rejected, according to data obtained by The Associated Press through the Freedom of Information Act.