Tag Archives: medicine

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/

House GOP health bill jettisons insurance mandate, much of Medicaid expansion

House Republicans unveiled their much anticipated health law replacement plan Monday, slashing the law’s Medicaid expansion and scrapping the mandate that individuals purchase coverage or pay a fine. But they opted to continue providing tax credits to encourage consumers to purchase coverage, although they would configure the program much differently than the current law.

The legislation would keep the health law’s provisions allowing adult children to stay on their parents’ health insurance plan until age 26 and prohibiting insurers from charging people with preexisting medical conditions more for coverage as long as they don’t let their insurance lapse.  If they do, insurers can charge a flat 30 percent late-enrollment surcharge on top of the base premium, under the Republican bill.

In a statement, House Speaker Paul Ryan (R-Wis.) said the proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with preexisting conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP plan, as predicted, kills most of the law’s taxes and fees and would not enforce the so-called employer mandate, which requires certain employers to provide a set level of health coverage to workers or pay a penalty.

Democrats quickly condemned the bill. “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across American,” House Minority Leader Nancy Pelosi tweeted. “Republican will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

The legislation has been the focus of intense negotiations among different factions of the Republican Party and the Trump administration since January. The Affordable Care Act passed in 2010 without a single Republican vote, and the party has strongly denounced it ever since, with the House voting more than 60 times to repeal Obamacare. But more than 20 million people have gained coverage under the law, and President Donald Trump and some congressional Republicans have said they don’t want anyone to lose their insurance.

When Republicans took control of both Congress and the White House this year, they did not have an agreement on the path for replacement, with some lawmakers from states that have expanded Medicaid concerned about the effect of repeal and the party’s conservative wing pushing hard to jettison the entire law.

Sen. Rand Paul (R-Ky.), one of those favoring a full repeal, tweeted: “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!”

Complicating the effort is the fact that Republicans have only 52 seats in the Senate so they cannot muster the 60 necessary to overcome a Democratic filibuster. That means they must use a complicated legislative strategy called budget reconciliation that allows them to repeal only part of the ACA that affect federal spending.

Beginning in 2020, the GOP plan would provide tax credits to help people pay for health insurance based on household income and age, with a limit of $14,000 per family. Each member of the family would accumulate credits, ranging from $2,000 for an individual under 30 to $4,000 for people ages 60 and higher. The credits would begin to diminish after individuals reached an income of $75,000 — or $150,000 for joint filers.

Consumers also would be allowed to put more money into tax-free health savings accounts and would lift the $2,500 cap on flexible savings accounts beginning in 2018.

The legislation would allow insurers to charge older consumers as much as five times more for coverage than younger people. The health law currently permits a three-to-one ratio.

Community health centers would receive $422 million in additional funding in 2017 under the legislation, which also places a one-year freeze on funding for Planned Parenthood and prohibits the use of tax credits to purchase health insurance that covers abortion.

Both the Energy and Commerce and Ways and Means Committees are scheduled to mark up the legislation Wednesday. The committees do not yet have any Congressional Budget Office analysis of how much the legislation would cost or how many people it would cover.

Party leaders have said they want to have the bill to President Trump next month.

In a statement, senior Democrats on both panels said the measure would charge consumers “more money for less care. It would dramatically drive up health care costs for seniors. And repeal would ration care for more than 70 million Americans, including seniors in nursing homes, pregnant women and children living with disabilities by arbitrarily cutting and capping Medicaid,” said Rep. Frank Pallone of New Jersey and Rep. Richard Neal of Massachusetts.

The House GOP plan makes dramatic changes to Medicaid, the state-federal health insurance program that covers 70 million low-income Americans. The program began in 1965 as an entitlement — which means federal and state funding is ensured regardless of cost and enrollment. But the Republican bill would cap federal funding for Medicaid for the first time.

The federal government picks up between half and 70 percent of Medicaid costs. The percentage varies based on the relative wealth of the state.

Under the GOP plan, federal funding would be based on what the government spent in the fiscal year that ended Sept. 30. Those amounts would be adjusted annually based on a state’s enrollment and medical inflation.

Currently, federal payments to states also take into account how generous the state’s benefits are and what rate it uses to pay providers. That means states like New York and Vermont get higher funding than states like Nevada and New Hampshire and those differences would be locked in for future years.

Republicans have pushed to cap federal funding to states in return for giving them more control in running the program.

The legislation also affects the health law’s expansion of Medicaid, in which the federal government provided enhanced funding to states to widen eligibility. The bill would also end that extra funding for anyone enrolling under the expansion guidelines starting in 2020. But the legislation would let states keep the extra funding Obamacare provided for individuals already in the expansion program who stay enrolled.

About 11 million Americans have gained Medicaid coverage since 2014.

Changing the expansion program is a delicate balance for the Republicans. Four GOP senators from states that took that option said Monday they would oppose any legislation that repealed the expansion.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell.

Provided under a creative commons license by Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation

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.

An apple a day RX? Madison announces program for docs to prescribe fruits, veggies

Some Madison residents are eligible for a program in which doctors prescribe healthy and fresh, organic fruits and vegetables.

The city announced the Fruit and Vegetable Prescription Program — FVRx — is focused at the neighborhood level, with financial support from Wholesome Wave and a partnership between Willy Street Co-op North and UW Health Northeast Family Medical.

Wholesome Wave is a national group dedicated to “affordable, healthy, local food for all.” Its mission is to empower under-served consumers to make healthier food choices by increasing affordable access to fresh, local food. The group funded the pilot with a $23,000 grant to the city of Madison.

Madison Mayor Paul Soglin said in a statement, “By collaborating with partners at Public Health Madison and Dane County, Willy Street Co-opSecond Harvest Foodbank and UW Health Northeast Family Medical Clinic, the city continues to illustrate how government and the community can work hand-in-hand to increase the well-being and health of all of our residents.”

Here’s how the program works: A patient can qualify for aid to help purchase produce and join the co-op if a doctor deems he or she does not have food security. Food security means a person has reliable access to enough affordable, nutritious food.

To qualify for the aid, a patient must answer yes to one of two questions:
• In the last year, have you worried about having enough food until you could buy more?
• In the last year, have you actually run out of food before you could buy more?

The aid comes in the form of a packet that includes a coupon to become a co-op owner and 60 $2 coupons that can be used in the produce department until the end of the year.

Participants can also join a program at the co-op that offers an additional 10 percent off of groceries and a free coupon to attend one of the co-op classes, which would normally charge a fee.

“The co-op is invested in continuing to expand the ways in which we can help address food security in Dane County,” said Kirsten Moore, director of cooperative services.

Moore said data collected from the pilot will help the co-op determine how to continue and fund these type of programs for the future.

“We already have some great ideas to share in the next few months, and we look forward to launching new initiatives to expand these offerings,” Moore said.

 

Study: Doctors devoting more time to computers than patients

For every hour that some doctors devote to direct patient care they may spend about five hours on other tasks, often because they’re tied up with computer work, a new study suggests.

The results are based on observations of just 36 doctors-in-training at one hospital in Switzerland. But research dating back more than half a century has documented physicians dedicating a similar amount of their workdays to direct patient care, said Dr. Nathalie Wenger, lead author of the current study.

“It has not really changed in 50 years,” Wenger, a researcher at the University Hospital of Lausanne, said by email.

During the study period, the doctors spent an average of 1.7 hours per shift with patients, 5.2 hours using computers and 13 minutes doing both, Wenger and colleagues report in the Annals of Internal Medicine.

Patient care might not necessarily be better if doctors had less screen time, but cutting back could still have some advantages, Wenger said.

“It will clearly improve satisfaction of physicians, reduce their stress and improve medical education by freeing up time for that,” Wenger said.

For the current study, Wenger and colleagues observed medical residents for a total of about 698 hours.

Teams of observers recorded the residents’ activities throughout their shifts at the hospital, sorting tasks into one of 22 different categories such as direct or indirect patient care, communication, academic or nonmedical work.

Day shifts typically lasted 11.6 hours, or 1.6 hours longer than scheduled, the study found.

During day shifts, doctors spent about 52 percent of their time on activities indirectly related to patients such as writing in medical records, collaborating with other clinicians, looking for information needed to treat patients and handing off care to other providers.

Physicians spent about 28 percent of their day shifts on direct patient care including clinical exams and medical procedures and rounds done as part of the residency program to review treatment with colleagues.

They spent only about 2 percent of their time communicating with patients and families, and about 6 percent of their time either teaching, receiving training or doing academic research.

During shifts, physicians spent up to about 45 percent of their time on computers, the study found.

Beyond its small size and single site, other limitations of the study include the fact that residents knew they were being observed and may have adjusted their work accordingly, the authors note.

It also wasn’t an experiment designed to prove how different uses of physician time influence patient outcomes.

Still, the findings add to a growing body of research documenting how much of doctors’ time is taken up by administrative tasks, said Dr. Susan Thompson Hingle, a researcher at Southern Illinois University School of Medicine in Springfield who wasn’t involved in the study.

“Having observed residents and talked with residents, I do not think the findings are unique to the Swiss,” Hingle said by email. “It seems as though the studies continue to confirm the enormous administrative tasks that physicians and physicians in training, regardless of level, clinical venue, or geographic location, are faced with.”

Patients often complain that doctors don’t spend enough time with them and that physicians spend more time focused on the computer than on them, Hingle said.

“When our attention is not on the patient, we miss important non-verbal cues; we are distracted and not actively listening; we miss opportunities to build a trusting, healing relationship with our patient,” Hingle added. “Without that trust, patient adherence is less which impacts patient outcomes, and patient satisfaction is less, which also impacts patient outcomes.”

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.

Shots urged as flu cases rise in Wisconsin

Wisconsin health officials say flu cases are on the rise and they are urging people to take precautions like getting a flu shot.

The Wisconsin Department of Health Services said on Dec. 28 there had been 161 influenza cases so far this season, and 95 hospitalizations, including eight children and 78 adults age 50 and older. Of those hospitalized with influenza, 63 percent were 65 or older.

State Health officer Karen McKeown says getting a flu shot is still one of the best ways to protect yourself and your family and friends from complications of the flu.

McKeown says other steps include practicing good hand-washing hygiene, covering your cough and not sharing drinking cups and straws.

 

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.

Trump to nominate women’s health opponent for health secretary

Planned Parenthood Federation of America today expressed concerns about President-elect Donald Trump’s plan to nominate U.S. Rep. Tom Price, R-Ga., to be secretary of health and human services.

Tom Price poses a grave threat to women’s health in this country. If Price had his way, millions of women could be cut off from Planned Parenthood’s preventive health services like birth control, cancer screenings and STD tests. From his plan to take no-copay birth control away from 55 million women and allow insurance companies to charge women more for the same health coverage, to his opposition to safe and legal abortion, Price could take women back decades.

Tom Price has consistently demonstrated that he’s out of touch with women’s lives. Despite the fact that 20.2 million women need publicly funded contraception, he has falsely stated that every single woman in America already has access to affordable birth control.

Our nation’s HHS Secretary should aim to break down barriers to health care. Instead, Tom Price wants to build more. These barriers to care have a disproportionate impact on those who already face inequities and barriers in the health care system – including people of color, people who live in rural areas, people with low incomes, and immigrant communities.

Fear of a Health and Human Services Secretary like Tom Price is why Planned Parenthood has seen a significant increase in in online appointments for birth control, with a more than ten-fold increase in people seeking IUDs the first week following the election. People are worried they will lose their health care.

The Senate should give Representative Price’s record the full examination it deserves.  Each Senator must decide whether a man who wants take away no co-pay birth control coverage from 55 million women is the right choice to serve as the Secretary of Health and Human Services. Meanwhile, we at Planned Parenthood will continue to work to ensure that everyone — including the 2.5 million patients we serve each year — has access to the basic health care they depend on, no matter what.

Despite clear evidence to the contrary, Price believes “there’s not one woman” who doesn’t have access to birth control.

  • Hart Research poll found that one in three women voters have struggled to afford prescription birth control, including 55 percent of young women aged 18 to 34.
  • According to the Guttmacher Institute, 20.2 million women in the U.S. were in need of publicly funded family planning services like birth control in 2014, an increase of 1 million since 2010.

Price wants to repeal the Affordable Care Act, and has supported 65 attempts to repeal it, which means:

  • 55 million women would lose access to no-copay preventive services, including birth control, STI screenings, and life-saving preventive services such as breast cancer screenings and pap tests.
  • Being a woman could once again be considered a pre-existing condition, allowing health insurers to deny health coverage to tens of millions of women.
  • Women would pay an estimated $1 billion more than men for the same health care plans if “gender rating” was allowed again.
  • Millions of low-income women would lose their health insurance, which they have gained through the ACA’s Medicaid expansion. In 2015, Medicaid covered 17% of women ages 19-64 (16.66  million), up from 10% in 2008 (pre-ACA).

Price wants to cut off women’s access to basic health services at Planned Parenthood, which has already been proven to have devastating consequences:

  • A recent study in the New England Journal of Medicine showed that blocking patients from going to Planned Parenthood in Texas was associated with a 35% decline in women in publicly funded programs using the most effective methods of birth control and a dramatic 27% increase in births among women who had previously accessed injectable contraception through those programs.
  • Blocking patients from care at health centers  has a disproportionate impact on communities of color, who already face systemic barriers in accessing quality health care. For example, in Texas, researchers found that more than half of women reported at least one barrier to reproductive health care. Spanish-speaking women from Mexico were more likely to report three or more barriers.
  • In Wisconsin and Texas, researchers found that fewer women could access lifesaving cancer screenings following the closure of Planned Parenthood health centers.  An increase in 100 miles from the nearest health center resulted in a 6 percent decrease in the rate women obtained breast exams, and 9 percent decrease in Pap tests.
  • The CBO projects that the net cost to taxpayers if Planned Parenthood is defunded would be $130 million over 10 years because of an increase in unintended pregnancies without the high-quality contraceptive care we provide.

Despite Price’s repeated statements that “patients, families and doctors should be making health decisions, not Washington DC,” he would interfere with women’s access to safe and legal abortion. In Congress, he has routinely voted in favor of dangerous bills that would:

  • Restrict abortion access;
  • Block access to basic preventive care at Planned Parenthood;
  • Interfere in the doctor-patient relationship;
  • Prevent medical students from being trained on how to provide abortion;
  • Block insurance coverage of abortion;
  • Allow bosses to take away birth control.

Planned Parenthood Federation of America is many things to many people. We are a trusted health care provider, an informed educator, a passionate advocate, and a global partner helping similar organizations around the world. Planned Parenthood delivers vital health care services, sex education, and sexual health information to millions of women, men, and young people.