PNHP

PNHP Newsletter: Fall 2023

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

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If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

Come to Atlanta for PNHP’s Annual Meeting

Research Roundup

PNHP Chapter Reports

SNaHP Chapter Reports

35th Anniversary House Parties

PNHP in the News

PNHP News and Tools for Advocates

PNHP Holds Messaging Training on Medicare Advantage

On August 24th, PNHP hosted a training for members and activists on how to talk about Medicare Advantage (MA) to different audiences. Drs. Ed Weisbart and Susan Rogers, as well as PNHP staff Dixon Galvez-Searle and Gaurav Kalwani, each gave an overview on the best tactics to use when speaking to physicians, members of the public, and policymakers about MA.

Below are some of the most important elements to consider in your own activism. These tips will be especially helpful when you are attempting to get people to fill out our beneficiary and physician surveys, sign our MA petition, and join PNHP.

For Physicians

  • Connect with personal and patient stories: Regardless of their level of policy knowledge, physicians will resonate most with your own stories of how MA has brought harm to your patients or others.
  • Focus on professional autonomy: Emphasize the ways in which MA prevents physicians from doing their jobs, by making them deal with prior authorization, claim denials, and other headaches. Make sure you name specific insurance companies as the culprit here.

For the General Public

  • Qualify the term “Medicare Advantage”: While it’s best to be clear when using the term Medicare Advantage and avoid potentially turning someone off with terms like “Medicare Disadvantage,” you can emphasize the problems with the program by calling it something like “corporated-controlled Medicare Advantage” or “so-called Medicare Advantage.” 
  • Focus on “reclaiming” Medicare: Remind people that Medicare is their program, paid for by their tax dollars, which are currently being funneled into big insurance companies while undermining our beloved public insurance programs.

For Policymakers

  • MA is radically changing Medicare: Remind them that Medicare was created to be a social insurance program, and that letting insurers take it over is a fundamental change to that model. Insurer “innovations” like narrow networks and prior authorization are contrary to the spirit of the program, lead to worse care outcomes, and have no place in Medicare.
  • MA redirects public dollars to private hands: MA costs more than TM, and that money is going directly from taxpayers into corporate profits. This money was supposed to be spent on patient care, and it should be.

For Everyone

  • Lead with shared values, not problems: You’ll have more success connecting with people by opening with easily agreeable statements. Data supports focus on family, community, fairness, and freedom, so use openings like: “Do you have a minute to talk about making sure seniors in our community get the best possible care?” 
  • Don’t shield the culprits from view: Insurance companies are not well-liked by anybody in this country, so it’s important to make them the face of Medicare Advantage, rather than the government. Make sure to specify the companies doing harm here, and show that they are the ones raiding the Medicare trust fund. Avoid using statements that imply the government is “broken”, which could make private alternatives seem more attractive.
  • Focus on tangible patient harms: Have stories and data ready to go that show why narrow networks, surprise bills, and care delays/denials are harmful and even fatal to patients. Explain how traditional Medicare does not have these problems, and why private insurance always will. 
  • Inspire hope: Don’t exclusively go negative, because we want people to believe that things can change. Talk about the improvements we want to see in Medicare, and the future we’re fighting for. 

Find more materials on Medicare Advantage in our latest Kitchen Table Campaign toolkit, and at ProtectMedicare.net.

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Massachusetts Medical Society Passes Single-Payer Resolution

Following many months of intense and dedicated organizing by PNHP members and allies in the state, the Massachusetts Medical Society (MMS) House of Delegates passed a resolution stating: 

“That the MMS supports and will advocate for universal access to equitable, comprehensive, affordable, high-quality, administratively streamlined health care through a national health program, as well as through legislation at the state level, and will continue to explore and evaluate payment structures that may be able to achieve these goals.”

This exciting development in Massachusetts offers inspiration and several useful lessons for members to apply in their own efforts to pass single-payer resolutions in various regional and specialty-based medical societies.

Dr. C. Frazer Shipman, a member of PNHP for 30 years, helped lead this campaign from the beginning. The effort began at the district-level, with a resolution based on one of PNHP’s sample resolutions receiving positive feedback in the Franklin District Medical Society, and from there making its way to the full state House of Delegates in 2022. Over the next year, the resolution team recruited many PNHP members who were also part of the MMS to testify in support of the resolution. Because of these efforts, testimonies were 3-to-1 in favor of single payer.

“I used PNHP data and their sample resolution to work with members of my local district,” said Dr. Shipman. “Many Mass physicians and Medicare for All advocates worked hard to pass the wording quoted above, including the Berkshire and Hampshire Districts, PNHP National, the Boston PNHP Chapter, and Mass-Care.”

By working together with like-minded allies, understanding the environment of their medical society, and planning an extensive campaign of recruitment and engagement, these physicians and advocates were able to push Massachusetts health care in a more progressive direction.

If you would like to do the same in your local medical society, please reach out to our national organizer, Lori Clark, at lori@pnhp.org to discuss beginning your own resolution campaign.

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PNHP Joins Be A Hero at DC Rally Against Corporate Profiteering in Medicare

Dr. Steve Auerbach (R) joins a contingent of New York City retirees, organizers from Be a Hero, and activists from other Medicare-for-All advocacy groups for an anti-Medicare Advantage action in D.C. on July 25.

On July 25th, PNHP joined with Be a Hero and other organizational allies as well as members of Congress like Senator Elizabeth Warren (D-MA), Rep. Mark Pocan (D-WI), and Rep. Barbara Lee (D-CA) to rally against corporate raiding of taxpayer dollars through the Medicare Advantage program. 

Members of Congress and advocates alike spoke about the myriad issues with Medicare Advantage, told personal stories of loved ones who were harmed by the greed of the insurance industry, and demanded a true solution to the health care woes of this country that would provide coverage to each and every person.

Introducing Rep. Lee, PNHP’s own Dr. Steve Auerbach stated the problem succinctly. “Denials and delays and narrow networks are killing Americans every day,” he said. “The leeches of private insurance are sucking out taxpayer dollars that should be going to patient care. Medicare Disadvantage is bad for patients, doctors, and hospitals.”

Several members of Congress pointed to issues in prior authorization, upcoding, and other abuses that give away money to corporate insurers while leading to worse care for seniors and people with disabilities.

“It is time to crack down on these abuses,” said Senator Warren. “Instead of giving away extra money to private insurance companies, we can strengthen traditional Medicare.”

The rally was followed by a day of lobbying, wherein advocates visited various Congressional offices to speak with their elected officials on the need to crack down on the corrupt and corporate-controlled Medicare Advantage program.

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Meet Rebecca, Our New National Organizer

Rebecca Delay, PNHP National Organizer

Previous Experience: I am a recent Master’s in Public Policy graduate with a certificate in health policy. The scope of my experience ranges from Congressional intern to lobbying with Planned Parenthood and publishing research in The Contraception Journal.

What drew you to PNHP? Throughout my career, I have been trying to find the bridge between my interests in health and medicine, with the world of politics. PNHP provided me the outlet to use my health policy background to pursue my personal activism goals.

What are you looking forward to working on over the next 12 months? I am excited to bring a rejuvenated enthusiasm to the PNHP team and network. I also look forward to creating partnerships within the single-payer movement with other social justice organizations.

What’s a fun fact about yourself? I am a dedicated sports fan, originally from Oakland, CA. Go Raiders!

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Come to Atlanta for PNHP’s Annual Meeting and 35th Anniversary celebration

Dr. Camara Jones will deliver the keynote address at this year’s Annual Meeting.

PNHP’s 2023 Annual Meeting and Leadership Training, along with the 2023 SNaHP Summit, will be held Nov. 10-12 in Atlanta. We will celebrate 35 years since PNHP’s incorporation, strategize for the path to achieving Medicare for All, and hear from our keynote speaker, Dr. Camara Jones.

Camara P. Jones, M.D., M.P.H., Ph.D., is a family physician, epidemiologist, and past president of the American Public Health Association whose work focuses on naming, measuring, and addressing the impacts of racism on the health and wellbeing of the United States and the world.

When planning your travel, don’t forget to join us for PNHP’s 35th Anniversary celebration dinner on Saturday, Nov. 11, and stay for a public action on Sunday, Nov. 12. More event details (including hotel booking information and meeting registration) can be found at pnhp.org/meeting.

You can send a student to the 2023 SNaHP Summit, being held in Atlanta in conjunction with PNHP’s Annual Meeting, by making a gift to the Nick Skala Student Activist Fund. Use the card enclosed with this newsletter or go to pnhp.org/SkalaFund to support the future of our movement.

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Research Roundup

Data Update: Health Care Crisis by the Numbers

Barriers to Care

At least 1.7 million Americans rely on health sharing plans: Data from 16 sharing plans provided the first national count of the number of Americans relying on these schemes, which arrange for people to pay one another’s medical bills. At least 11 of the plans operated in or advertised in all 50 states; these plans are usually organized around people with common religious beliefs. Because sharing plans are not held to the same consumer protections and regulations as insurance plans, costs can easily spiral out of control. Markian Hawryluk, “At Least 1.7M Americans Use Health Sharing Arrangements, Despite Lack of Protections,” KFF Health News, 6/14/23.

Majority of insured adults experience problem using health coverage: 58% say they have experienced a problem using their insurance in the past 12 months–these include denied claims, network issues, and pre-authorization issues. Adults in fair or poor health as opposed to good health were more likely to experience problems, with 67% of these adults reporting an issue. Among the 58% who had problems, 17% were unable to receive recommended care as a result. 15% experienced a decline in their health, and 28% said they paid more than they expected for care. Pollitz et al., “KFF Survey of Consumer Experiences with Health Insurance,” KFF, 6/15/23.

Data on denials is shrouded in mystery: There is a serious lack of transparency around data on insurance claim denials. Limited government data suggests insurers deny between 10% and 20% of claims, but these are only aggregated numbers and do not explore differences in types of care or insurance. 85% of people with insurance say they want regulators to compel insurers to disclose how often they deny claims. Robin Fields, “How Often Do Health Insurers Say No to Patients? No One Knows,” ProPublica, 6/28/23.

Hospital consolidation leads to inpatient pediatric service closures: A study in JAMA Pediatrics found that inpatient pediatric services had decreased across the study period, going from being offered at 41.5% of 4,876 hospitals in 2011 to 32.6% of 4,551 hospitals in 2020. Of 1,088 hospitals further studied, 235 joined a larger health system during the study period. Joining a larger health system was significantly associated with a loss of inpatient pediatric services within five years. Dave Muoio, “Hospital consolidation followed by inpatient pediatric service closures, study finds,” Fierce Healthcare, 6/6/23.

Healthcare costs projected to grow 7% in 2024: Factors accounting for this increase include providers dealing with higher expenses and seeking rate increases during contract negotiations with insurers. The projection, made by consultants at  PricewaterhouseCoopers, tops previous estimates in 2022 and 2023, which were 5.5% and 6%, respectively. To create these estimates, the consultancy spoke with actuaries who work with insurers covering 100 million employer-sponsored members and 10 million Affordable Care Act members to forecast healthcare inflation. Results were weighted by each health plan’s size. Alex Kacik, “Healthcare costs to grow 7% next year: PwC,” Modern Healthcare, 6/29/23.

Patients with Parkinson’s disease face barriers seeing a neurologist: An estimated 90% of people living with Parkinson’s disease (PD) in the U.S. are covered by Medicare. PD beneficiaries number 685,116, or 1.2% of the total Medicare population. Compared to the overall Medicare population, 56.3% are male (vs 45.6%), 77.9% over age 70 (vs 57.1%), 14.7% people of color (vs 20.7%), and 16.0% are rural residents (vs 17.5%). 40% of PD beneficiaries did not see a neurologist at all during the calendar year, and only 9.1% visited a movement disorder specialist. Few beneficiaries diagnosed with PD use recommended services such as physical, occupational, or speech therapy. People of color and rural residents were least likely to access a neurologist or therapy services. Despite 52.9% of beneficiaries being diagnosed with depression, only 1.8% had a clinical psychology visit. Pearson et al., “Care access and utilization among Medicare beneficiaries living with Parkinson’s disease,” NPJ Parkinson’s Disease, 7/10/23.

Youth face issues accessing opioid addiction medication: From 2015 to 2020, the proportion of buprenorphine prescriptions dispensed for youths age 12-19 decreased for commercial insurance from 29.8% to 22.9%, for self-pay from 13.2% to 7.6%, and for assistance from 18.2% to 8.9%. While total prescriptions dispensed decreased 17.5%, the proportion of prescriptions paid by Medicaid, the payer with the greatest share of prescriptions in 2020, increased from 27.1% to 44.3%. In the South, prescriptions had higher out of pocket costs, a higher proportion were paid by self-pay and assistance, and a lower proportion were paid by Medicaid. Prescriptions in rural counties followed similar patterns to the South. Terranella et al., “Out-of-Pocket Costs and Payer Types for Buprenorphine Among US Youth Aged 12 to 19 Years,” JAMA Pediatrics, 8/7/23.

Price of elder care continues to increase: Fueled by increases in the elderly population, the price of nursing home care increased by an average of 2.4% each year between 2012 and 2019, for a cumulative increase of 20.7%. In 2021, the median cost to stay in a private room in a nursing home in the U.S. is $9,034 per month. The median cost to stay in a semi-private room in a nursing home was $7,908 a month, and the median cost to stay in an assisted living facility was $4,500 per month. Alejandra O’Connell-Domenech, “Price of elder care soars as demand increases, baby boomers age,” The Hill, 8/13/23.

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Medicare & Medicaid Issues

Medicaid disenrollments continue: As of August 24, at least 5.4 million Americans have lost their Medicaid coverage. Disenrollment rates vary from 72% in Texas to 8% in Wyoming. Across all states, 74% of people have lost coverage for procedural reasons rather than changing eligibility. In the 15 states reporting age breakouts, more than 40% of disenrollments were of children. KFF, “Medicaid Enrollment and Unwinding Tracker,” 8/24/23.

Crowdfunding is only hope for many diabetes patients: A study examining 313 crowdfunding campaigns found that the median goal for campaigns was $10,000, and only 14% of campaigns reached their goal, though with a median of $2,600 raised. 27% of people said they had insurance, but nearly all said their out of pocket costs were too high or coverage was too sparse. 6% requested money specifically for insulin, 10% requested money for insulin pumps, and 6% requested money for a continuous glucose monitor. Kristen Monaco, “When Insurance Doesn’t Cut It, Diabetes Patients, Turn To Crowdfunding,” MedPage Today, 6/7/23.

Medicare Advantage Payments higher than previously estimated: MedPAC has estimated annual overpayments in Medicare Advantage to be about 6% of $27 billion. A new study estimates that, because of the impact of “favorable selection,” this amount is actually closer to more than 20% or $75 billion annually. Adriel Bettelheim, “Medicare Advantage overpayments higher than estimated: study,” Axios, 6/14/23.

Medicare Advantage quality bonus program has questionable benefits: Combined, United Healthcare and Humana received $4.7 billion in bonuses for their MA plans last year. Issues in star rating calculation, difficulty in measuring quality, and rating inflation contribute to a system where payments do not reflect actual quality of care. In 2014, the average star rating across Medicare Advantage contracts was 3.86, compared with 4.15 in 2023. Mari Devereaux, “Medicare Advantage quality bonus program needs reform: Urban Institute,” Modern Healthcare, 7/6/23.

Medicare Advantage insurer pays largest fraud settlement in Maine state history: Martin’s Point Health Care Inc. will pay almost $22.5 million to resolve allegations of submitting inaccurate codes for MA enrollees to increase Medicare payments. The company was accused of submitting inaccurate diagnosis codes for enrollees in Maine and New Hampshire between 2016 and 2019. The allegations against the provider originated from a whistleblower complaint; the whistleblower will receive a portion of the settlement, around $3.8 million. AP, “Health care provider to pay largest Medicare fraud settlement in Maine history,” 7/31/23.

CMS sets higher payment hikes for hospitals: Inpatient hospitals will receive a higher rise in payments from CMS than initially proposed. Acute care hospitals in compliance with various guidelines will receive a 3.1% net increase in Medicare payments in fiscal 2024, an increase from the original hike of 2.8% proposed in April. CMS also set a 0.2% reimbursement increase for long-term care hospitals. Lauren Berryman, “CMS sets pay hikes for inpatient, long-term care hospitals,” Modern Healthcare, 8/1/23.

Georgia Medicaid work program off to slow start: Despite projections from the Georgia Department of Community Health that indicated up to 100,000 people could benefit from Georgia’s Medicaid work program, known as Pathways to Coverage, just 265 applications had been approved by August of this year. At the same time, Georgia has cut more than 170,000 adults and children from Medicaid as it continues its review of the 2.7 million Medicaid recipients in the state. Sudhin Thanawala, “Georgia Medicaid program with work requirement off to slow start even as thousands lose coverage,” AP, 8/19/23.

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Pharma

Severe shortages in cancer drugs: A survey of cancer centers revealed that 93% of centers are experiencing a shortage of carboplatin, and 73% are experiencing a shortage of cisplatin. These medications are used to treat a wide variety of cancers, including lung, breast, prostate, and gynecologic cancers, as well as lymphomas and leukemias. Only 64% of centers reported being able to keep all patients on a carboplatin regimen without delays or claim denials. National Comprehensive Cancer Care Network, “NCCN Releases Statement Addressing Ongoing Chemotherapy Shortages; Shares Survey Results Finding More than 90% of Cancer Centers are Impacted,” 6/7/23.

Large drug distributor sued by tribe over opioid crisis: A lawsuit was filed by the Cherokee Nation on behalf of the entire 400,000-citizen tribe in Oklahoma state court, alleging negligence on the part of the distributor, Morris & Dickson. The suit states that between 2010 and 2014, the distributor shipped more than 3.7 million pills to just five pharmacies in counties populated by tribal members. More than 5,200 people died of drug overdoses in Oklahoma from 2014 to 2020. David Ovalle, “Opioid distributor, already facing license revocation, sued by tribe,” Washington Post, 6/8/23.

Drug and supply chain burdens plague health systems: Large health systems are seeing shortages of upwards of 600 products and 200-300 drugs a month. Providers are 2.5 times more likely to experience shortages on products in markets that have two or fewer manufacturers accounting for more than 80% of market share. Nearly half of respondents (48.6%) to a survey of health and supply chain officials said they had to cancel or reschedule cases or procedures at least quarterly in 2022 due to product shortages. Adriel Bettelheim, “Health systems plagued by spot shortages scramble for essentials,” Axios, 6/29/23.

$2.9 million gene therapy for severe hemophilia approved by FDA: Roctavian was approved for adult patients with severe cases of hemophilia A. Approval was based on a three-year study showing a 50% reduction in annual bleeding incidents among 134 patients who received the treatment. Traditional infusions for this condition cost about $800,000 annually for a typical patient. The maker estimates about 2,500 U.S. patients will be eligible to receive the therapy under the terms of the FDA’s approval. Last year, Hemgenix, a similar gene therapy for hemophilia B, was approved and became the most expensive drug of all time at $3.5 million. Matthew Perrone, “$2.9 million gene therapy for severe hemophilia is approved by FDA,” AP, 6/29/23.

Nevada reaches $1 billion in total opioid settlements: Nevada reached a $285 million settlement with Walgreens regarding the chain’s role in the opioid epidemic. Nevada’s total anticipated payments from opioid claims now amount to $1.1 billion. Most recently, the state reached a $193 million agreement with Teva Pharmaceuticals in June and a $152 million deal with CVS in May. AP, “Nevada secures $285M opioid settlement with Walgreens, bringing total settlements to $1 billion,” 7/5/23.

5 largest pharma firms earned $81.9 billion last year: The combined stock buybacks and dividends of the companies increased by $4.4 billion and $2.5 billion, respectively, from 2021 to 2022. Pfizer’s net income was over $31.4 billion during fiscal 2022, a 42.5% increase from 2021. Shareholders of Pfizer received more than $10.9 billion in stock dividends and buybacks. Last year, Merck’s net income was over $14.5 billion, and more than $7 billion was spent on shareholder dividends. Taylor Giorno, “Top 5 largest US pharma firms’ net earnings topped $81.9 billion last year: watchdog,” The Hill, 7/24/23.

Uninsured patients paying up to $330 for Eli Lilly’s insulin: Despite the company’s pledge to cut its list price for its insulin to $25 per vial, a survey of more than 300 pharmacies across all 50 states by Senator Elizabeth Warren’s office found that uninsured patients paid an average of $98 for the drug. A third of drug stores charged $164 or more for the company’s insulin, with the highest-priced pharmacy charging $330. Chain stores charged uninsured patients an average of $123 per vial, compared to $63 at independent pharmacies. Patrick Wingrove, “Uninsured US patients pay up to $330 for Eli Lilly’s $25 insulin, Senator Warren says,” Reuters, 7/13/23.

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Health Inequities

Burden of obesity falls on marginalized groups: Non-Hispanic Black adults have the highest obesity rates of any racial group–four out of five Black women have obesity. Approximately 45.6% of Hispanic adults are living with obesity as well. The prevalence of obesity is six times higher in rural America compared to urban America, and poverty is strongly correlated with obesity. Despite this, coverage is limited, and less than 2% of those eligible for anti-obesity medications are prescribed them. Health Equity Coalition for Chronic Disease, “Advancing Equity: The Urgent Need to Confront Disparities in Obesity,” June 2023.

OBGYNs say effects of Dobbs decision overwhelmingly negative: 68% of 569 board-certified OBGYNs surveyed say the effects of the decision have made the management of pregnancy-related emergencies worse, while 64% say the ruling has worsened pregnancy-related mortality. 70% believe that the decision has widened racial and ethnic inequities in maternal health care. 61% of OBGYNs practicing in states where abortion is banned are worried about their own legal risk when making decisions on patient care. Kim Bellware and Emily Guskin, “Effects of Dobbs on maternal health care overwhelmingly negative, survey shows,” Washington Post, 6/21/23.

Black, rural, southern women most in need of maternal care assistance aren’t getting it: Not one site funded by a federal program created to improve rural maternity care is located in the Southeast, which has the largest concentration of predominantly Black rural communities. Among the initial 2019 grant awardees, the awardee in Texas reported that 91% of people it served were Hispanic. New Mexico’s awardee reported that 59% of recipients were Hispanic, and Missouri reported that 22% of beneficiaries were Black. In all cases, the majority were Medicaid enrollees. Sarah Jane Tribble, “Black, Rural Southern Women at Gravest Risk From Pregnancy Miss Out on Maternal Health Aid,” KFF Health News, 6/22/23.

Transgender individuals face higher suicide rates: A study of individuals in Denmark found that transgender individuals had a rate of suicide attempts 7.7 times higher than nontransgender individuals. The study also found that transgender individuals have a 3.5 times higher suicide mortality and a 1.9 times higher suicide-unrelated mortality Suicide attempt rates per 100,000 person–years were 498 for transgender individuals and 71 for nontransgender individuals. Erlangsen et al., “Transgender Identity and Suicide Attempts and Mortality in Denmark,” JAMA, 6/27/23.

State-level maternal mortality rates are higher for Black and Native individuals: In 2019, maternal mortality rates in most states were higher among American Indian and Alaska Native and Black populations than among Asian, Native Hawaiian, or Other Pacific Islander; Hispanic; and White populations. Between 1999 and 2019, observed median state mortality rates increased from 14 to 49.2 among the American Indian and Alaska Native population, 26.7 to 55.4 among the Black population, 9.6 to 20.9 among the Asian, Native Hawaiian, or Other Pacific Islander population, 9.6 to 19.1 among the Hispanic population, and 9.4 to 26.3 among the White population. In each year between 1999 and 2019, the Black population had the highest median state maternal mortality rate. Fleszar et al., “Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States,” JAMA, 7/3/23.

Rural Americans struggle to afford health care: As compared with similarly high-income nations, rural Americans have a harder time affording medical care and are more likely to skip care because of costs. 22.8% of rural Americans have had serious problems paying or were unable to pay medical bills, compared to 8.9% of rural Australians and 6.5% of rural Canadians. Similarly, 36% of rural Americans skipped needed care due to costs, compared with 14.4% of rural Canadians and 11.3% of rural French. Munira Z. Gunja, “Rural Americans Struggle with Medical Bills and Health Care Affordability,” The Commonwealth Fund, 7/24/23.

Hispanic families kept out of Medicaid by poor administration: Reaching someone at Florida Medicaid’s call center took an average of two and a half hours for Spanish speakers, compared with 36 minutes for English speakers. The longest delay experienced for an English speaker in the study was just 50 minutes, far shorter than the average wait for Spanish speakers. Almost a third (30%) of all Spanish calls were disconnected before the caller reached a human being; by contrast, only 10% of English calls were dropped. UnidosUS, “At Florida’s Medicaid call center, long and discriminatory delays prevent eligible families from keeping their health care,” 8/17/23.

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Profiteers in Health Care

California hospitals ask for bailout despite billions in profits: The California Hospital Association has requested a $1.5 billion bailout from the state government, despite the hospital industry taking in $9.2 billion in patient revenue in 2021. One of the country’s richest hospitals, Cedars-Sinai Health System in Los Angeles, received a $28 million grant from a charity that collects money from other hospitals, many of which serve California’s poorest residents. Samantha Young and Angela Hart, “California Hospitals Seek a Broad Bailout, but They Don’t All Need It,” KFF Health News, 5/5/23.

Class action lawsuit against Aetna and Optum proceeds: A judge for the U.S. District Court for the Western District of North Carolina certified the class-action lawsuit, which includes more than 87,700 people and nearly 2,000 health plans. The suit alleges that Aetna and Optum used misleading billing practices, developing “dummy code” that was intended to bury fees and pass off administrative fees as medical expenses. The initial plaintiff sued in 2015 after her cost for physical therapy doubled under an Aetna plan. Nona Tepper, “Aetna, Optum to face revived ‘dummy code’ lawsuit,” Modern Healthcare, 6/7/23.

Fraudsters trick poor and homeless people into signing up for unaffordable ACA plans: The federal agency overseeing the marketplace said that for the fiscal year ending September 30, 2022, the agency received more than 25,000 complaints from people saying that they had been enrolled in policies without their consent or that incorrect information was submitted for them by an agent or broker. CMS said it performed more than 700 license verifications because of these issues during the same period. Daniel Chang, “Fraudsters Are Duping Homeless People Into Signing Up for ACA Plans They Can’t Afford,” KFF Health News, 6/13/23.

Nonprofit hospitals collect public money while exacerbating debt: 41% of adults in the U.S. have some form of medical debt, and 73% of adults with past-due medical debt report owing at least some of that debt to hospitals. Nearly 60% of community hospitals in the country are privately operated nonprofits, and while these nonprofit hospitals received $28 billion in tax benefits in 2020, they only spent about $16 billion on free or reduced-price charity care. The median nonprofit hospital only spends 1.5% of hospital expenses on charity care. Brian Stauffer, “In Sheep’s Clothing: United States’ Poorly Regulated Nonprofit Hospitals Undermine Health Care Access,” Human Rights Watch, 6/15/23.

Physician-owned hospitals have lower costs: An analysis of around 1,100 non-physician owned hospitals and 150 physician-owned hospitals found that prices negotiated between hospitals and commercial insurers for eight common procedures were 33.7% lower at physician-owned hospitals compared with non-physician owned hospitals. This could potentially be due to the fact that physician-owned hospitals treat fewer Medicaid patients and provide less charity care, although these factors were controlled for in the study. Wang et al., “Comparison of Commercial Negotiated Price and Cash Price Between Physician-Owned Hospitals and Other Hospitals in the Same Hospital Referral Region,” JAMA Network Open, 6/23/23.

Private equity grows in anesthesiology and emergency medicine: From 2009 to 2019, physician groups owned by private equity or publicly traded companies grew from 3.2% and 8.6% of the national anesthesia and emergency medicine markets, respectively, to 18.8% and 22.0%. Over the same period, the five largest independent anesthesia practices and five of the six largest independent emergency medicine practices were acquired by private equity or publicly traded companies. Also during this period, the share of the population living in a highly concentrated anesthesia market increased from 16.8% to 34.4%. Adler et al., “Measuring private equity penetration and consolidation in emergency medicine and anesthesiology,” Health Affairs Scholar, July 2023.

Biden administration takes aim at facility fees: The Biden administration announced a plan to mandate transparency in facility fees, which are charged by hospitals when they provide services in an outpatient location. In 2022, a 15-minute doctor visit in a hospital-owned clinic cost Medicare $189, of which facility fees accounted for $121 of the charge. The same visit cost $92 in a freestanding doctor’s office. Between 2004 and 2021, facility fees in emergency departments rose by 531%. Annalisa Merelli, “New Biden initiative targets controversial hospital ‘facility fees’ that often surprise patients,” STAT News, 7/7/23.

Health CEOs made more than $4 billion last year: The CEOs of more than 300 publicly traded health care companies made a combined $4 billion in 2022. This number is actually an 11% decrease from the $4.5 billion CEOs made in 2021. The 10 highest-paid CEOs made a collective $1.4 billion. The average health CEO salary for 2022 was $13 million. The median bonus payment for these CEOs was around $700,000. Once again, the highest-paid CEO overall was Moderna’s Stéphane Bancel, who took in $398 million. Herman et al., “Health care CEOs hauled in $4 billion last year as inflation pinched workers, analysis shows,” STAT News, 8/17/23

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Studies and analysis of interest to single-payer advocates

“Alleviating Medical Debt in the United States,” by Nishant Uppal, M.D., M.B.A.; Steffie Woolhandler, M.D., M.P.H.; and David U. Himmelstein, M.D., New England Journal of Medicine, 9/7/23. “The persistence of medical debt and low levels of charity care at nonprofit hospitals (despite the financial assistance mandate in the Affordable Care Act) indicate that more muscular policies are needed.”

“How Health Insurers and Brokers Are Marketing Medicare,” Jeannie Fuglesten Biniek; Alex Cottrill; Nolan Sroczynski; Meredith Freed; Tricia Neuman; Breeze Floyd; Laura Baum; and Erika Franklin Fowler, KFF, 9/15/23. “TV ads for Medicare Advantage often showed images of a government-issued Medicare card or urged viewers to call a ‘Medicare’ hotline other than the official 1-800-Medicare hotline. More than a quarter of all airings (27%) included a government-issued Medicare card or image that resembled it, including 28% of insurer-sponsored airings and 21% of airings sponsored by brokers and other third-party entities, a trend that CMS has flagged as potentially misleading to beneficiaries. Roughly 16% of airings featured a privately-run phone line described as a ‘Medicare’ hotline, most of which were sponsored by brokers and other third-party entities.”

“Medicare’s Affordability Problem: A Look at the Cost Burdens Faced by Older Enrollees,” by Faith Leonard; Gretchen Jacobson; Sara R. Collins; Arnav Shah; and Lauren A. Haynes, Commonwealth Fund, 9/19/23. “The likelihood of having problems paying medical bills or debt was significantly higher for older adults with Medicare Advantage than those with traditional Medicare. Differences in the percent with medical bill or debt problems were significant among those with income between 200 percent and 399 percent of FPL and not statistically significant for those with higher or lower incomes.”

“Our Payments, Their Profits: Quantifying Overpayments in the Medicare Advantage Program,” by Physicians for a National Health Program, October 2023. “By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these—or other crucial aspects of Medicare and Medicaid—could be funded entirely by eliminating overcharges in the Medicare Advantage program.”

“Tiny, Rural Hospitals Feel the Pinch as Medicare Advantage Plans Grow,” by Sarah Jane Tribble, KFF Health News, 10/23/23. “Medicare Advantage growth has had an outsize impact on the finances of small, rural hospitals that Medicare has designated as ‘critical access.’ Under the designation, government-administered Medicare pays extra to those hospitals to compensate for low patient volumes. Medicare Advantage plans, on the other hand, offer negotiated rates that hospital operators say often don’t match those of traditional Medicare.”

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PNHP Chapter Reports

Georgia

In Georgia, members held a 35th anniversary social and fundraiser, attracting over 40 attendees and raising just over $2000. The chapter also hosted the Atlanta premiere of “American Hospitals,” as well as a Universal Health Care Symposium at Grady Memorial Hospital.

To get involved in Georgia, please contact Dr. Elizabeth McCord at eomccord@gmail.com.

New Hampshire

In New Hampshire, members of Granite State PNHP hosted two public screenings of the film “American Hospitals,” and held post-film panel and discussion sessions. The chapter is also currently planning a campaign to have the New Hampshire Medical Society pass a resolution endorsing a “Simplified Public Payer System.” Finally, members will gather at the Dartmouth-Hitchcock Academic Center for a PNHP membership meeting this fall.

To get involved in New Hampshire, please contact Donald Kollisch at Donald.o.kollisch@dartmouth.edu.

New York

Activists in New York City celebrate the 58th anniversary of Medicare, while calling for an end to privatization.

In New York, the PNHP NY-Metro chapter joined forces with local health justice advocacy groups, especially retiree groups opposing MA, to celebrate Medicare’s birthday outside Sens. Gillibrand and Schumer’s offices on July 28, 2023. With approximately 70 participants in attendance, activists celebrated with a piñata and cupcakes before attempting to deliver two oversized birthday cards to the legislative offices. This summer, the chapter also had its first in-person fundraising reception since 2019, celebrating their 2023 Single Payer Champions. This year, the chapter honored CIR-SEIU, local business Buunni Coffee, and NY-Metro board member Dr. Marc Lavietes. Approximately 80 people bought tickets, and the reception included live music and a silent auction.

To get involved in the New York metropolitan area, please contact Mandy Strenz at mandy@pnhpnymetro.org.

Eastern Pennsylvania

Dr. Walter Tsou (R) delivers postcards to the office of Sen. John Fetterman (D-PA).

In Eastern Pennsylvania, chapter members visited Rep. Dwight Evans (D-PA) on the 58th anniversary of Medicare to ask him to cosponsor the Medicare for All bill. The chapter also met with state representative Arvind Venkat, who is also a physician from the Pittsburgh area, to discuss the possibility of proposing a state single-payer bill. On June 3, members gathered at Mt. Airy Day, a major community event in Philadelphia where they collected over 200 postcards for Congressional leaders to support a national single payer bill.  These cards were hand-delivered to Senators Casey and Fetterman and Representatives Evans, Scanlon, Houlihan, Dean, and Boyle.

To get involved in Eastern Pennsylvania, please contact Dr. Walter Tsou at macman2@aol.com.

West Virginia

Our chapter in West Virginia continues to grow, and its website went live for the first time in March. Members have been holding regular monthly meetings with speakers on topics such as health care economics, social security, and updates from other state chapters. Efforts continue on membership recruitment at renewal at both state and national levels, as well as national phone banking efforts.

To get involved in West Virginia, please contact Dr. Daniel Doyle at doyledan348@gmail.com.

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SNaHP Chapter Reports

Florida State University

SNaHP students at Florida State University have been busy recruiting new members, tabling at student events, and giving presentations. The chapter has also participated in advocacy efforts at the state level through their partnership with the recently consolidated Florida chapter of PNHP. Finally, the chapter has begun collaborating with the SNaHP chapter at the University of Florida, and both chapters are planning to host an event together in the coming year.

To get involved at Florida State University, please contact Xan Nowakowski at xnowakowski@fsu.edu.

Penn State

Students at Penn State have been working hard to prepare for the upcoming school year. The chapter has been working with their Hershey campus counterpart on goals of recruitment and becoming fixtures on their respective campuses. Some of their plans include strategizing around activities fairs, organizing a summer social event to stir conversation around single payer, and putting together a six-part fall seminar series to educate students on the health system and how they can work to fix it with Medicare for All.

To get involved at Penn State, please contact Andrew Meci at ameci@pennstatehealth.psu.edu.

University of Buffalo

At the University of Buffalo, SNaHP students tabled during orientation week for incoming M1 students and had many sign up to be a part of the organization. Members also attended a Community Health Fair at the local Hopewell Baptist Church hosted by the Student National Medical Association; they used this opportunity to go out in the community and educate their neighbors on PNHP’s mission and the benefits of a national healthcare system.

To get involved at the University of Buffalo, please contact Colin Marchincin at cmarchin@buffalo.edu.

University of Minnesota-Twin Cities

University of Minnesota-Twin Cities medical students celebrate their city council victory on Instagram.

The SNaHP chapter at University of Minnesota-Twin Cities co-hosted a viewing and panel discussion of “American Hospitals,” along with Minnesota Nurses Association, PNHP MN, Health Care for all MN, SEIU MN, MN COPAL, and Arts and Medicine UMN. Members met with City Council member Robin Wonsley to request that the Minneapolis City Council create a resolution opposing the merger of hospital systems Fairview Health Services and Sanford Health. The resolution passed unanimously, and the merger was later canceled. Finally, five chapter members participated in PNHP MN’s summer internship program.

To get involved at the University of Minnesota Twin Cities, please contact Sonja Knudson at knuds155@umn.edu. 

University of Missouri-Columbia

Students at the University of Missouri-Columbia’s SNaHP chapter organized a monthly repeating voter registration event at their community health clinic for uninsured patients. The chapter also organized a speaking event with PNHP Board Secretary Dr. Ed Weisbart, who spoke to students about reaching across the aisle on discussions around Medicare for All. Finally, members held an educational event for medical students to learn the basics on the Medicare and Medicaid programs.

To get involved at the University of Missouri-Columbia, please contact Lauren Nowakowski at Lmndn9@umsystem.edu. 

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35th Anniversary House Parties

PNHP National Coordinator Dr. Claudia Fegan and immediate past PNHP President Dr. Susan Rogers hosted a house party in Illinois which was attended by 15 people. Highlights included an engaged discussion on single payer, vegetarian hors d’oeuvres, and homemade sangria! Almost everyone who attended donated, and a lapsed member rejoined PNHP along with making a sizable donation. Drs. Fegan and Rogers also secured 7 new donors, had a new member join, and even inspired an attending couple to host their own event! From a goal of $2000, they raised over $2800.

PNHP national coordinator Dr. Claudia Fegan (standing) and PNHP immediate past president Dr. Susan Rogers hosted a 35th anniversary house party during Medicare anniversary weekend in late July.

PNHP Board Member Dr. Eve Shapiro hosted a house party in Arizona along with a co-host. Dr. Shapiro invited people who she knew were interested in the issue of single payer, but not all of them were health professionals. Many invitees came from connections with the local Democratic Party and other progressive activists. Dr. Shapiro felt that having guests invite their own interested friends was key to hosting a successful event, as was encouraging discussion and providing plenty of food and drinks. From a goal of $3500, Dr. Shapiro raised over $4600.

Dr. Nancy Greep hosted a house party in California. She sent out invitations to friends, people who signed PNHP petitions, and neighbors. Dr. Greep invited SNaHP students who really livened up the party and were great at communicating about PNHP with guests. She also prepared a short PowerPoint presentation for guests, which helped to explain PNHP’s mission and what donations would be used for. Overall, Dr. Greep raised $2000.

Dr. Nancy Greep (back row, holding dark blue mock picture frame) hosted a 35th anniversary house party during Medicare anniversary weekend in late July.

PNHP member Dr. Leo Alonso hosted a house party in Florida. He invited about 18 friends who shared like-minded views on health care. Dr. Alonso prepared PNHP goodies like stickers and pens, and included a QR code to make on-the-spot donations. After a dinner of homemade pizza and Cuban sandwiches, everyone gathered for a lively and cerebral discussion on Medicare for All, asking questions about how the program would work, common arguments against it, and related issues like fraud in Medicare Advantage. 

Dr. Wayne Strouse hosted a house party in New York. Although some of the planned activities couldn’t be carried out due to weather and timing issues, the party was nonetheless successful. Dr. Strouse gave a talk about his experiences living and working in New Zealand, drawing on his experience with the single-payer health care system there to explain what PNHP was working toward in the U.S. The party successfully brought in new donors to PNHP, and raised $1300 on a $500 goal.

Dr. Jessica Schorr Saxe hosted a house party in North Carolina along with Dr. Susan Rucker and Dr. Andrea Desantis. They had food from countries with single-payer, and info by each food station on that country’s particular health system. About 35 people attended from a variety of backgrounds. The hosts spent a few minutes speaking about PNHP and the goals of the fundraising, and then gave a brief ask with the pitch of what PNHP is up against from the investment industry. Several new members and donors came out of the party, and hosts raised  over $7600!

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PNHP in the News

News items featuring PNHP members

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Op-eds by PNHP members

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Letters to the editor by PNHP members

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2023 Annual Meeting

Online registration has closed—but onsite registration will be available in Atlanta!

Location

The PNHP Annual Meeting and SNaHP Summit will be held at the Crowne Plaza Atlanta – Midtown, located at 590 W Peachtree St NW, Atlanta, GA 30308.

Sleeping rooms are available at the Crowne Plaza for $169/night and may be booked two ways:

  • Online HERE, click “Book Now” and use the group code PNH in the “rate preference” selection.
  • Call 404-877-9000 and ask to speak with a reservations agent. Be sure to mention you are booking with the Physicians for a National Health Program group.

Sleeping room reservations must be made by Thursday, Oct. 19.

Schedule of Events

Note changes to the schedule from previous years when planning your travel.

  • Full Annual Meeting agenda HERE
  • Full Leadership Training agenda HERE
  • Full SNaHP Summit agenda HERE

Friday, Nov. 10

  • Optional Single Payer and PNHP 101 session, 12:00 p.m.
  • Leadership Training, 1:00 p.m. – 5:10 p.m.
  • Note: There is no Leadership Training dinner this year
  • SNaHP and residents session with CIR, 7:00 p.m. – 8:30 p.m.

Saturday, Nov. 11 

  • SNaHP welcome session, 8:00 a.m.
  • PNHP Annual Meeting, 9:00 a.m. – 5:15 p.m.
  • Dedicated SNaHP Summit sessions will be held throughout the day
  • Member Interest Group meetings and social hour, 5:15 p.m. – 7:00 p.m.
  • PNHP’s 35th Anniversary Dinner, 7:00 p.m. – 9:00 p.m.

Sunday, Nov. 12

  • SNaHP Summit, 9:00 a.m. – 12:00 p.m.
  • Regional meetings, 9:30 a.m. – 10:30 a.m.
  • PNHP Board of Directors meet and greet, 11:00 a.m. – 12:00 p.m.
  • Public Action, early afternoon, exact start time and location TBA, expect to finish by 3:00 p.m. – bring your white coat!

To request a meeting for a Member Interest Group (MIG), please contact deputy director Matt Petty at matt@pnhp.org.

This conference will not be livestreamed in its entirety, but recordings of select sessions will be made available after the meeting.

Speakers

Keynote Speaker: Camara P. Jones, MD, MPH, PhD, “Confronting Racism Denial: Naming Racism and Moving to Action”

Dr. Camara Jones is Past President of the American Public Health Association and Commissioner, O’Neill-Lancet Commission on Racism, Structural Discrimination, and Global Health.

Health Policy Update: Adam Gaffney, MD, MPH and James Waters

Dr. Adam Gaffney is Past President of PNHP, assistant professor of medicine at Harvard Medical School, and a pulmonary and critical care physician at Cambridge Health Alliance. James Waters is an executive board member of SNaHP and third-year medical student at Cooper Medical School of Rowan University.

Messaging Medicare Advantage: Jay Marcellus

Jay Marcellus is Director of Narrative at ASO Communications, which applies tools from cognition and linguistics to uncover where people are capable of going and how to use our words, images, and stories to move them. ASO has more than a decade’s experience creating, testing, and implementing narratives to achieve progressive wins in the U.S., Australia, and elsewhere.

Building Progressive Power, Lessons from Georgia: Keron Blair

Keron Blair is Chief of Field and Organizing at the New Georgia Project, a nonpartisan effort to register, civically engage, and build power in Georgia for its growing population of Black, brown, young, and other historically marginalized voters.

Meeting Chair: Philip Verhoef, MD, PhD

Dr. Phil Verhoef is president of PNHP, an adult and pediatric intensivist, and clinical associate professor of medicine at the John A. Burns School of Medicine at the University of Hawaii-Manoa.

Student and Resident Scholarships

Scholarships are available to students and residents to cover a portion of the cost of travel, and for housing in PNHP’s block of student rooms. Apply today HERE; more information is available HERE. Applications are due by August 31.

PNHP members and the public can support PNHP’s student outreach programs by making a GIFT to the Nicholas Skala Student Fund.

Related Action

The Georgia chapter of PNHP is organizing a public action on Sunday, November 12. We will meet at the Martin Luther King, Jr. National Historical Park at 1:00 p.m. and march to the recently closed Atlanta Medical Center for a rally at 1:30 p.m.

PNHP-GA will be joined by national PNHP members, health professionals attending the annual meting of the American Public Health Association, and numerous local health justice organizations to demand full Medicaid expansion in Georgia.

Related Event

The 2023 Health Activist Dinner at APHA will be held on Sunday, Nov. 12, at Paschal’s. Registration and information on honorees will be available soon. PNHP is a co-sponsor of this event.

Covid Safety Protocols

PNHP’s Board of Directors and medical experts have established the following Covid safety protocols for the conference:

  • Vaccination requirement within the last 12 months; to ease on-site registration, please email your proof of vaccination to admin@pnhp.org
  • Facemasks recommended while not actively eating or drinking

Previous Annual Meetings

Click HERE to access archival material from last year’s Annual Meeting in Boston. Click HERE to view photos from the conference.

Attending the 2023 PNHP Annual Meeting and SNaHP Summit is entirely voluntary and requires attendees to abide by any applicable rules of conduct, or local or state laws, that may be announced at any time. Attendees acknowledge the highly contagious and evolving nature of Covid-19 and voluntarily assume the risk of exposure to, or infection with, the virus by attending the Meeting, and understand that such exposure or infection may result in personal injury, illness, disability, and/or death. Attendees release and agree not to sue any persons or entities responsible for coordinating or organizing the PNHP Annual Meeting and SNaHP Summit in the event that they contract Covid-19. Attendees agree to comply with all Covid-related procedures that may be implemented at the Meeting, including mask-wearing.

Kitchen Table Campaign: Medicare Disadvantage

PNHP is committed to focusing on specific “Kitchen Table” issues, to show how single-payer Medicare for All would address Americans’ most pressing health care problems. See below for materials related to our Summer 2023 issue, the so-called “Medicare Advantage” program, and scroll to the bottom for a list of additional topics.

Medicare Disadvantage (Summer 2023)

What happened when policymakers invited big insurance companies like Cigna and UnitedHealthcare to administer Medicare benefits? Nothing good. These companies followed the same old script: restricting seniors’ choice of doctor, delaying or denying medically necessary care, and laughing all the way to the bank.

We encourage you to share the materials below with your colleagues, family members, friends, and neighbors during the summer of 2023 to remind them that the growth of Medicare Advantage is a kitchen table issue…and that Medicare for All would deliver better coverage, more meaningful choices, and true financial freedom.

Learn more about Medicare Advantage

Raise the alarm about Medicare profiteering by writing an op-ed or letter to the editor. Looking for tips on getting published? Email PNHP communications specialist Gaurav Kalwani at gaurav@pnhp.org.

PNHP report on Medicare Advantage overpayments

In the fall of 2023, PNHP published a report detailing the many ways that so-called “Medicare Advantage” plans overcharge taxpayers. We found that total overpayments amount to at least $88 billion, and potentially up to $140 billion, each and every year.

By simply eliminating these excess payments, we could fund valuable improvements to the Traditional Medicare program, such as eliminating Part B premiums altogether or adding comprehensive dental, vision, and hearing benefits.

Dr. Ed Weisbart: Don’t let naked profiteering destroy our Medicare

Presented by PNHP national board secretary Dr. Ed Weisbart to members of Puget Sound Advocates for Retirement Action (PSARA) on March 20, 2023. PowerPoint slides available HERE.

Survey for physicians and Medicare beneficiaries

We urge our members and chapters to distribute these surveys at public events! Questions? Email PNHP national organizer Lori Clark at lori@pnhp.org.

Day of action in Washington, D.C.

PNHP was proud to join our friends at Be a Hero, Social Security Works, Public Citizen, and National Nurses United—along with dozens of New York City retirees, legislative champions, and patients affected by Medicare Advantage—for a DC Day of Action on July 25, 2023.

Host a house party in support of our MA campaign

  • Complete house party planning guide, including FAQs, a checklist, and a sample house party agenda
  • Complete house party communications guide, including sample language for emails, texts, voicemails, and social media posts
  • Set up your very own personal fundraising page to fight Medicare privatization

Fighting profiteering in the Medicare program is one of the main priorities of PNHP’s 35th anniversary campaign. Questions? Email PNHP national organizer Lori Clark at lori@pnhp.org.

Social media materials

Download our series of eight (8) “scam alert” graphics HERE, and an additional Medicare Advantage meme HERE. Questions about social media? Email PNHP communications specialist Dixon Galvez-Searle at dixon@pnhp.org.

Additional topics

Review previous installments of the Kitchen Table Campaign, and stay tuned for additional topics in the future:

PNHP Newsletter: Summer 2023

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

Save the Date: Nov. 10-12 in Atlanta

Research Roundup

PNHP Chapter Reports

SNaHP Chapter Reports

How You Can Support the Medicare for All Act

PNHP in the News

PNHP News and Tools for Advocates

SNaHP Students Pass Single-Payer Neutralization Resolution at AMA Medical Student Section

(L to R) SNaHP leaders Shruthi Bhuma, Joely Hannan, Donald Bourne, Joey Ballard, and Swathi Bhuma celebrate their victory at the AMA student meeting on June 8.

Four years ago, SNaHP students and community allies led an action at the annual meeting of the American Medical Association (AMA). The aim was to expose the AMA’s involvement in the Partnership for America’s Health Care Future, a dark money lobbying group that pulled together some of health care’s biggest profiteers to spread misinformation about Medicare for All.

Activists rallied outside the AMA meeting and organized a die-in during the opening ceremonies, garnering significant attention from media, political figures, and physicians as to the AMA’s inclusion in the insidious collective. Shortly after, the AMA was forced to withdraw from the partnership.

While getting the AMA out of the group was a huge victory, it remains a stubborn obstacle to the advancement of the single-payer movement and does not represent the true views of the majority of doctors across the country. That is why four years after their initial action, a group of SNaHP students have successfully passed a resolution at the AMA Medical Student Section calling on the AMA to remove all anti-single payer language from its stances and drop its decades-long opposition to Medicare for All.

SNaHP students worked on this effort for months, researching the resolution process, planning out their testimony, and establishing plans for every potential scenario at the meeting. Their work paid off, and the resolution passed unanimously. 

“Surveys show that more and more physicians are open to the idea of a single-payer system,” said Donald Bourne, an M.D./Ph.D. student at the University of Pittsburgh and a member of the resolution group. “It’s time our AMA updates its policies in accordance with the viewpoints of its membership.”

Now that the resolution has passed, the next goal is to get it through the AMA House of Delegates and ensure that the AMA entirely retracts its opposition to single payer. This will lay the foundation for a campaign to have them fully and openly endorse improved Medicare for All, and finally become a true representative for our physicians.

If you are interested in helping lead an effort to get a single-payer resolution passed in any medical society you are a member of, fill out our campaign interest form HERE. Questions? Email lori@pnhp.org for more information!

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Members Host House Parties for PNHP’s 35th Anniversary

PNHP president Dr. Phil Verhoef urges single-payer supporters to ramp up their activism during a video that played during 35th anniversary house parties.

As part of our 35th anniversary campaign, PNHP is raising funds for a variety of important goals. During our first phase, we sought to build support for our SNaHP student activists, and in the second, we are digging deep on efforts to protect Medicare from privatization. Several PNHP members have hosted house parties with like-minded colleagues, family, and friends to raise money for our initiatives and introduce more people to PNHP and the Medicare for All movement.

We interviewed members to learn more about their experience hosting a party for PNHP. If you are interested in hosting but unsure how to get started, check out these tips! 

If you have additional questions, please contact lori@pnhp.org for more information on how to get started. 

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Getting House Party Attendance and Donations … Make it Fun!

“We featured food from countries with universal health care! Poutine (Canada), sushi (Japan), Chinese (Taiwan), pasta (Italian), and pretzels/pretzel dough balls (Germany), with wine/beer only from such countries. We let people arrive and mingle, and then around 6, we gathered for a short presentation and then a stimulating discussion about single payer and issues at both the local and national level. Have fun with it, don’t stress, and be flexible!” – Dr. Philip Verhoef, HI

“It was great to have a co-host to help with invites (together we invited over 150 people) and coordinating food. We asked people who we know are interested in the issue, although not necessarily health professionals, and invited many people we know through our connections with the local Democratic party. Having margaritas to drink helped also!” – Dr. Eve Shapiro, AZ

“We did a phone banking session to reach out to members, and also sent out digital invites. We additionally created a 4-person Host Committee that was responsible for sending a separate invitation to 10-15 potential donors. We held the event at a local tavern and had some appetizer platters and custom PNHP 35th Anniversary cake and cookies. We had a book display and several activities that served as conversation starters: a single payer board where attendees could vote on the strongest argument for single-payer healthcare, a wheel to spin for PNHP merch and free drinks, and other games. I would encourage people to team up with a co-host or two as that can really increase the odds of having more people attend and donate.” – Dr. Belinda McIntosh and PNHP Georgia

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Medicare for All Bills Introduced in Congress

In May, Sen. Bernie Sanders and Reps. Pramila Jayapal and Debbie Dingell introduced in both houses of Congress the Medicare for All Act of 2023. Senator Sanders and Representative Japayal held a town hall meeting before the bill was introduced, where PNHP leaders Dr. Adam Gaffney and Dr. Sanjeev Sriram spoke on the need for this crucial legislation.

“As a critical care physician, I have seen patients with life-threatening illnesses from chronic conditions that were not treated because they could not afford the care,” said Dr. Gaffney. “Medicare for All will solve that.”

Dr. Sriram remarked on the latest crisis in American health care, as the Medicaid unwinding process threatens to remove insurance coverage for millions of vulnerable families and children. “If you don’t pick up the phone at the right time, or if you don’t fill out a form correctly,” he said, “your family and your kids could lose your Medicaid. We need a better system.”

The Medicare for All Act of 2023 includes a number of improvements and changes to the previous version of the bill in the areas of women’s and LGBTQ+ health, which have both been under attack across the country. All reproductive health care, including abortion care and contraception, are now explicitly covered under this legislation, and the same is true of all gender affirming care.

“These additions are extremely important to me as a physician, an activist, and an advocate for women’s health,” said PNHP Vice President Dr. Diljeet Singh. “Given the current campaign against women and the LGBTQ+ community in the U.S., it is crucial that we stand up for their right to access these necessary and often lifesaving treatments.”

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PNHP Wins Crucial Victory Against ACO REACH

Since the inception of Direct Contracting in the final days of the Trump administration, and its rebranding as the REACH program by the Biden administration in early 2022, PNHP has led the charge against this dangerous attempt to privatize Traditional Medicare. REACH allows third-party entities (often private insurers) to administer Traditional Medicare benefits. Under this program, seniors and people with disabilities who specifically choose a government-run plan are instead pushed into private management, often without their knowledge or consent.

PNHP was quick to recognize the dangers of REACH, and put together a coalition of over 300 grassroots organizations from across the country to demand an end to the program. We were joined in our efforts by members of Congress like Rep. Pramila Jayapal, as well as thousands of individual activists. Together, we applied consistent pressure on the Biden administration to end REACH and save Medicare from further corporate encroachment.

After months of campaigning, our work paid off. In a speech given to the California Public Employees’ Retirement System (CalPERS) on January 17, Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler revealed that there are no plans to further expand the number of organizations or beneficiaries in the controversial model.

While the fight to end the program immediately and permanently is not over, PNHP’s victory on REACH demonstrates the power of our activism and the importance of fighting to protect Medicare as the necessary foundation for a true single-payer health care system. We will continue these efforts as we mount a campaign against rampant profiteering in the Medicare Advantage program.

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Save the Date: Nov. 10-12 in Atlanta

Join us for PNHP’s in-person Annual Meeting, Leadership Training, and SNaHP Summit—scheduled for Nov. 10-12 in Atlanta.

Celebrate 35 years of single-payer advocacy with a weekend of learning, strategizing, and organizing … as well as our special 35th anniversary dinner on Sat., Nov. 11.

PNHP activists rally outside Grady Hospital in Atlanta during our last annual meeting there, in 2017.

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Research Roundup

Data Update: Health Care Crisis by the Numbers

Barriers to Care

Family caregivers report worse experiences with for-profit hospice care: A survey of over 600,000 respondents across 3107 hospices found that caregivers reported worse experiences on all measures at for-profit hospices compared to non-profit hospices. Overall, 31.1% of for-profit hospices rated 3 or more points below the national average rating, compared to just 12.5% of non-profit hospices. Additionally, more non-profit hospices were highly rated, with 33.7% of non-profit hospices scoring 3 or more points above the national average and only 21.9% of for-profit hospices doing the same. Price et al., “Association of Hospice Profit Status With Family Caregivers’ Reported Care Experiences,” JAMA Internal Medicine, 2/27/2023.

More paid sick leave leads to more cancer screenings: In areas with policy-driven paid sick leave mandates, breast cancer screenings increased up to 4% and colorectal cancer screenings increased between 6-8%. Looking solely at workers who were gaining sick leave for the first time under new mandates, breast cancer screenings went up 9-12% and colorectal cancer screenings went up 21-29%. Callison et al., “Cancer Screening after the Adoption of Paid-Sick-Leave Mandates,” New England Journal of Medicine, 3/2/23.

Long COVID patients more likely to struggle with care access: Adults with post-COVID-19 condition (PCC, or long COVID) were more likely to report challenges meeting health care needs when compared with adults never diagnosed with COVID, or who had COVID but recovered. Adults with long COVID were more likely to report issues with cost (27% vs 18.3% and 17.5%), finding clinicians accepting new patients (16.4% vs 10.1% and 10.7%), getting a timely appointment (22% vs 14.4% and 13.9%), and getting health care authorization (16.6% vs 10.8% and 10.3%). Karpman et al., “Health Care Access and Affordability Among US Adults Aged 18 to 64 Years With Self-reported Post–COVID-19 Condition,” JAMA Network Open, 4/10/23.

Access to gender-affirming care is in increasing danger: 19% of transgender youth live in states where gender-affirming care for children is banned. At least 11 states exclude coverage of gender-affirming care in state Medicaid programs, while 15 states ban care for transgender youth entirely. In the first three months of 2023, more bills have been introduced attacking transgender health care than in the last 6 years combined. In April of 2023, Missouri became the first state to effectively ban care for all transgender people, regardless of age. Movement Advancement Project, “LGBT Policy Spotlight: Bans on Medical Care for Transgender People,” April 2023.

After Roe, Americans report abortions as harder to get: 54% of Americans say it would be very easy or somewhat easy to get an abortion where they live, down from 65% in 2019. 42% say it would be very difficult or somewhat difficult, up 10% from 2019. 34% of adults say that abortions should be easier to access in the area where they live, an increase of 8% from 2019. 62% of Americans say that abortion should in general be legal in all or most cases, largely unchanged from four years ago. Pew Research Center, “Nearly a Year After Roe’s Demise, Americans’ Views of Abortion Access Increasingly Vary by Where They Live,” 4/26/23.

Medical debt associated with significantly higher cancer mortality: For every one percent increase in the population with medical debt, there was a 1.12 increase in death rates (per 100,000 person-years) from cancer. The highest increases associated with medical debt were seen in lung cancer, colorectal cancer, and female breast cancer. In counties where the exact amount of medical debt was known, for every $100 increase in the median debt carried by the population, there was a statistically significant increase of 0.86 per 100,000 person-years in age-adjusted mortality rates for all malignant cancers. Hu et al., “Association of medical debt and cancer mortality in the US,” Journal of Clinical Oncology, 5/31/23.

Higher co-pays for heart failure and diabetes medications lead to nonadherence: Insured patients with heart failure and diabetes who had high or medium co-pays for their medications (defined as greater than $50 or between $10 and $50) were less likely to have an adequate level of medication adherence than those with low co-pays (defined as less than $10). For GLP1-RA therapies like Trulicity, adherence was achieved for 71.9% with a low co-pay, 65.7% for a medium co-pay, and 59.9% with a high co-pay. For SGLT2i therapies like Farxiga, adherence was achieved for 77.1% with a low co-pay, 71.5% with a medium co-pay, and 72.1% with a high co-pay. Essien et al., “Association of Prescription Co-payment With Adherence to Glucagon-Like Peptide-1 Receptor Agonist and Sodium-Glucose Cotransporter-2 Inhibitor Therapies in Patients With Heart Failure and Diabetes,” JAMA Network Open, 6/1/23.

Medical debt burdens 1 in 10 adults in Los Angeles county: 810,000 residents of the county owe a total of more than $2.6 billion as of 2021. ​​Medical debt in the county disproportionately affects the uninsured and underinsured, low-income residents, and Black and Latino populations, and negatively impacts factors such as housing, employment, food security, and access to prescriptions and health care. Roughly 30% of adults with trouble paying medical debt owe less than $1,000. About half of those who took on credit card debt to pay off the bills or were unable to pay for necessities owe less than $2,000. Work, “Personal Medical Debt in Los Angeles County Tops $2.6 Billion, Report Finds,” KFF Health News, 6/7/23.

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Medicare & Medicaid Issues

Arkansas plans shortest Medicaid redetermination timeline: Although more than one-third of Arkansas’ three million residents depend on Medicaid, state officials announced plans to complete the redetermination process in just half a year, raising fears that many in the state will be kicked off the rolls despite still being eligible. In 2018, new Medicaid work requirements in Arkansas led to an estimated 140,000 people losing coverage, despite 95% of those affected still being eligible. Over 420,000 people have been identified by the state as appearing to be ineligible and needing to go through redetermination, with an additional 240,000 going through the regular renewal process over the year. Messerly, “Why one state’s plan to unwind a Covid-era Medicaid rule is raising red flags,” Politico, 2/27/2023.

Medicare Advantage now covers half of all eligible beneficiaries: Of the 59.8 million people in Medicare Part A and B, 30.2 million are on a private plan. In 2007, just 19% of the eligible population was in the program, but that figure has grown steadily each year. In 2021, MA enrollees submitted a total of 35 million prior authorization requests. Biniek et al., “Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans,” KFF, 5/1/23.

Early Medicaid unwinding data shows disenrollment is largely procedural: Of those evaluated, the disenrollment rate ranges from 10% in Virginia to 54% in Florida. In Indiana, West Virginia, Arkansas, and Florida, more than 80% of those taken off the rolls lost coverage due to procedural reasons rather than changing eligibility. In Florida alone, nearly 250,000 people have lost their Medicaid coverage. Tolbert et al., “What Do the Early Medicaid Unwinding Data Tell Us?” KFF, 5/31/23.

Medicare Advantage overpayments lead to huge insurer profits: A significant portion of the $2.8 billion insurer Humana made in profit in 2022 was due to Medicare Advantage overpayments, and without those payments, it could have suffered a loss of as much as $900 million. In total, the federal government overpaid an estimated $20.5 billion to private insurers running Medicare Advantage plans. Because of these overpayments, Medicare costs from 2023 to 2031 will be $600 billion higher than if Medicare Advantage beneficiaries were instead enrolled in traditional Medicare. Cunningham-Cook and Perez, “The $20 Billion Scam At The Heart Of Medicare Advantage,” The Lever, 5/26/23.

Medicaid is crucial for improving health equity: Large proportions of groups of color depend on Medicaid for insurance coverage. Among adults below 65, 29% of Black people, 22% of Hispanic people, 33% of American Indian or Alaska Native people, and 38% of Native Hawaiian or Other Pacific Islander people are on Medicaid. The numbers are even higher for minors, with 60% of Black children, 55% of Hispanic children, 59% of American Indian or Alaska Native children, and 52% of Native Hawaiian or Other Pacific Islander children on Medicaid. Hispanic and Black people are predicted to be disproportionately affected by the disenrollment process, and face greater rates of churn in renewing coverage. Medicaid expansion has helped reduce racial and ethnic disparities in coverage, and of the 1.9 million people in a coverage gap in non-expanding states, 32% are Black and 24% are Hispanic. In general, nearly two-thirds of the 7.4 million people eligible for Medicaid but not enrolled are people of color. Guth et al., “Medicaid and Racial Health Equity,” KFF, 6/2/23.

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Pharma

Eli Lilly avoids Medicaid rebates by cutting insulin prices: A provision in the Inflation Reduction Act forces drug producers to pay Medicaid rebates when they increase the price of drugs faster than the rate of inflation. An additional provision in the American Rescue Plan removes a cap on the price of these rebates, which currently are restricted to the drug’s list price, in 2024. To avoid having to pay Medicaid $150 per vial of Humalog, Eli Lilly lowered the price of the drug by 70%, and additionally lowered the price of its biosimilar drug Lispro to $25 a vial, after years of dramatically raising prices for both medications. Wilkerson, “By cutting insulin prices, Eli Lilly avoids paying big Medicaid rebates,” STAT News, 3/6/23.

Foundation charges $83,000 for unproven cancer drug: The medication, a customized five-month series of vaccine shots, costs $83,000 out of pocket and is being sold under an FDA policy that allows drugmakers to charge patients for unproven medicines under compassionate use (although actually charging patients in such cases is rare). So far, 26 patients have ordered the drug. The drug is reported to be promising by scientists but has no guarantee of success. Saltzman, “Foundation stirs controversy by charging cancer patients $83,000 for unproven but promising experimental drug,” Boston Globe, 3/4/23.

Biden administration fines 27 drugmakers for price increases: For raising the prices of medication faster than the rate of inflation, the administration will fine drugmakers Pfizer, AbbVie, Gilead, Endo, Leadiant Biosciences, and Kamada. Pfizer had the highest number of medications on the list, with five drugs named (and one more made by a company Pfizer recently acquired for $43 billion). The drugmakers will have to pay Medicare back by the amount the price hike exceeded inflation, though the actual payments will not be due until 2025. Cohrs, “Biden administration to fine manufacturers of 27 medicines for price hikes,” STAT News, 3/15/23.

Moderna plans to increase price of vaccines: Following the end of COVID-19 emergency provisions, Moderna and Pfizer both plan to increase the price of their vaccines, with Moderna charging $130 a shot up from the $25-30 charged during the pandemic. The U.S. government contributed $1.7 billion toward research and development leading to the company’s vaccine. Moderna CEO Stéphane Bancel reportedly made $398 million last year from a combination of salary, bonuses, and realized gains of stock. The company also repurchased $3.3 billion in shares in 2022. Newman, “Moderna CEO defends price of COVID shot at Senate hearing,” Healthcare Dive, 3/22/23.

Johnson & Johnson proposes settlement for cancer-causing talc powder: The company agreed to pay $8.9 billion to roughly 70,000 plaintiffs to settle claims that its talc powder caused ovarian cancer and mesothelioma. Under this plan, each plaintiff would receive roughly $120,000, while the average medical costs for an ovarian cancer patient are around $225,000. If the presiding judge accepts the deal, 75% of plaintiffs would need to sign off on the offer for it to take effect. In previous litigation regarding the talc powder, Johnson & Johnson faced a verdict of $4.7 billion, later reduced to $2.1 billion after appeals. In 2020, the company settled 1,000 cases for $100 million. Dunleavy, “Johnson & Johnson’s $8.9B bankruptcy settlement is ‘unworkable,’ talc plaintiff lawyer says,” Fierce Pharma, 4/10/23.

Teva to pay $193 million to Nevada in opioid settlement: The settlement concerns Teva’s use of marketing practices that fueled opioid addiction, and follows a nationwide settlement of $4.3 billion with the company last year. Teva’s settlement with Nevada will be paid in installments from 2024 to 2043. From 1999 to 2020, over half a million people in the U.S. have died of drug overdose, with opioids being involved in a significant portion of those overdoses. Pierson, “Teva to pay Nevada $193 million over role in opioid epidemic,” Reuters, 6/7/23.

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Health Inequities

Racial disparities in child gun injuries and deaths widened during pandemic: The lowest rate of child shootings was found in non-Hispanic White children, at 0.54 per 100,000 person-years, and the highest rate was found in non-Hispanic Black children, at 21.04 per 100,000 person-years. The Black-White disparity in relative risk grew from 27.45 to 100.66 during the pandemic. The Hispanic-White disparity tripled, and the Asian-White disparity nearly tripled. Overall, there was nearly a 2-fold increase in child firearm assault rates. Jay et al., “Analyzing Child Firearm Assault Injuries by Race and Ethnicity During the COVID-19 Pandemic in 4 Major US Cities,” JAMA Network Open, 3/8/23.

Sudden unexpected infant deaths rise significantly among Black children: Although general infant mortality reached a record low in 2020, sudden unexpected infant deaths (SUID), which include SIDS as well as accidental suffocation or strangulation, did not. The SUID rate for non-Hispanic Black children saw by far the most significant rise, going from 192.1 deaths per 100,00 live births in 2017 to 214 deaths per 100,000 live births in 2020. The ratio of SUID in non-Hispanic Black infants compared to non-Hispanic White infants went from 2.2 in 2017 to 2.8 in 2020. Shapiro-Mendoza et al., “Sudden Unexpected Infant Deaths: 2015–2020,” Pediatrics, 3/13/23.

Maternal mortality in the U.S. continues to increase: Deaths due to pregnancy and childbirth continued to rise significantly in 2021. 1205 women died of maternal causes in 2021, compared with 861 in 2020 and 754 in 2019. The overall maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with 23.8 in 2020 and 20.1 in 2019. Mortality rates increased across all racial and ethnic groups studied; the rate for non-Hispanic Black women was 69.9, 2.6 times the rate for non-Hispanic White women of 26.6. Hoyert, “Maternal Mortality Rates in the United States, 2021,” National Center for Health Statistics, March 2023.

Poverty is the fourth-leading cause of death in the U.S.: In 2019 alone, 183,000 deaths among people aged 15 years or older were associated with poverty. Poverty caused 10 times as many deaths as homicide. Only heart disease, cancer, and smoking are responsible for more deaths. People living with incomes less than 50% of the U.S. median have roughly the same survival rates as those with greater incomes until their 40s, at which point the two groups diverge and those in poverty die at significantly higher rates. Brady et al., “Novel Estimates of Mortality Associated With Poverty in the US,” JAMA Internal Medicine, 4/17/23.

Racial disparities in premature pandemic deaths: For all groups of color, premature death rates (defined as death before age 75) saw a steeper increase than in White people. From 2019 to 2022, the increase in the Hispanic premature death rate was 33%, compared with 14% for White people. Premature deaths among White people resulted in an average of 12.5 years of life lost, compared to 19.9 years of life for Hispanic people and 22 years of life for American Indian and Alaska Native people. Communities of color make up 40% of the total U.S. population, but saw 59% of the country’s premature pandemic deaths. McGough et al., “Racial disparities in premature deaths during the COVID-19 pandemic,” Peterson-KFF Health System Tracker, 4/24/23.

LGBTQ youth are in a mental health crisis: 41% of LGBTQ young people seriously considered attempting suicide within the last year, and 14% actually attempted it, with even higher rates being reported among transgender youths, nonbinary youths, and youths of color. 56% of LGBTQ young people who wanted mental health care were not able to get it. Just 38% of LGBTQ young people found their home to be LGBTQ-affirming. Nearly 1 in 3 LGBTQ young people said their mental health was poor most of the time or always due to anti-LGBTQ policies and legislation. Nearly 2 in 3 LGBTQ young people said that hearing about potential state or local laws banning people from discussing LGBTQ people at school made their mental health a lot worse. The Trevor Project, “2023 U.S. National Survey on the Mental Health of LGBTQ Young People,” 5/1/23.

Many Black Americans live in cardiological care deserts: An estimated 16.8 million Black Americans live in counties with limited access to cardiology specialists, with over 2 million of these living in counties with no cardiologists whatsoever. Residents in these counties may have to commute well over 80 miles to receive cardiological care. Heart disease is the leading cause of death for non-Hispanic Black men and women, and predominantly Black counties have an average score of 4.6 on the cardiovascular risk index, as compared to the national average of 2.9. Cisneros, “More Than 16 Million Black Americans Live in Counties With Limited or No Access to Cardiologists,” GoodRx, 5/2/23.

Inequities exist in treatment of opioid use disorder: Although Black people in the United States have seen a greater increase in opioid overdose-related mortality than other groups since 2010, racial differences in prescription of medications used to treat addiction remain. A sample of Medicare claims data from 2016-2019 identified 25,9054 events related to opioid use disorder. Of these, 15.2% were in Black patients, 8.1% in Hispanic patients, and 76.7% in White patients. Buprenorphine was given after 12.7% of events in Black patients, compared with 18.7% in Hispanic patients and 23.3% in White patients. Naloxone was given after 14.4% of events in Black patients, compared with 20.7% in Hispanic patients and 22.9% in White patients. Benzodiazepines were given after 23.4% of events in Black patients, compared with 29.6% in Hispanic patients and 37.1% in White patients. Barnett et al., “Racial Inequality in Receipt of Medications for Opioid Use Disorder,” New England Journal of Medicine, 5/11/23.

Even highly rated hospitals give disparate care: Across all hospitals in a study of more than 10 million patients in 15 states, Black and Latino patients experienced 34% higher rates of sepsis after surgery than white patients, and Black patients experienced 51% higher rates of dangerous blood clots as surgery-related complications. Even at “A”-rated hospitals, the rate of perioperative hemorrhage in white patients was 2.01 cases per 1,000 at-risk discharges, compared with 2.80 cases for Black patients. Devereaux, “Health, safety disparities persist in highly rated hospitals: Leapfrog Group,” Modern Healthcare, 6/7/23.

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Coverage Matters

Insurance coverage moderates inequalities in cancer diagnosis: Among women with cervical cancer, non-White women of all studied racial and ethnic groups had lower proportions of diagnosis of early-stage cancer. In terms of coverage, 57.8% of women with private or Medicare insurance received an early-stage diagnosis, compared with 41.1% of women with Medicaid or who were uninsured. More than half of the racial and ethnic inequities in diagnosis of advanced-stage cancer were found to be associated with lack of insurance coverage, ranging from 51.3% for Black women to 55.1% for Hispanic or Latina women. Holt et al., “Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status,” JAMA Network Open, 3/10/23.

Veterans struggle with financial burdens of health care: 12.8% of veterans reported problems paying medical bills, 8.4% had foregone medical care, and 38.4% were somewhat or very worried about paying medical bills if they got sick or had an accident. The percentage of veterans somewhat worried about paying medical bills was lower for veterans with VA health care only (22.8%) and those with Tricare (16.3%) compared to veterans with private insurance, both with VA health care (33%) and without VA health care (30.2%). Cohen and Boersma, “Financial Burden of Medical Care Among Veterans Aged 25–64, by Health Insurance Coverage: United States, 2019–2021,” National Center for Health Statistics, 3/22/23.

Uninsured face disparities in cancer risk factors: While 12% of Americans smoked cigarettes in 2021, 20% of the uninsured smoked. Quit ratios among those who have smoked were lower for the uninsured as well, with 67% overall vs. 40% for the uninsured. 64% of women aged 45 years and older were up to date with breast cancer screening, but only 29% of uninsured women. 75% of women 25-65 were up to date with cervical cancer screening, but only 58% of uninsured women. 59% of adults 45 years and older were up to date with colorectal cancer screening, but only 21% of uninsured adults. American Cancer Society, “Cancer Prevention & Early Detection: Facts & Figures 2023-2024,” 5/2/23. 

Anti-poverty programs ameliorate brain development and mental health issues: Programs like TANF and Medicaid reduce neurological issues associated with child poverty. For example, in some states, disparities in hippocampal volume between high and low income children were 43% smaller in states that expanded Medicaid than those that did not. Disparities in internalization of psychological issues between high and low income children were similarly smaller in Medicaid-expanding states than non-Medicaid-expanding states. Weissman et al., “State-level macro-economic factors moderate the association of low income with brain structure and mental health in U.S. children,” Nature Communications, 5/2/23.

Vulnerable mothers depend on Medicaid or must self-pay: In 2021, 51.6% of births were covered by private insurance, 41% by Medicaid, 3.4% by other insurance, and 3.9% by self-pay. Self-paying mothers were more likely to receive late or no prenatal care. 78.8% of mothers under 20 were on Medicaid, compared with 27.4% of mothers aged 35 and over. Just 10.4% of mothers with less than a high school education had private insurance, compared with 84.8% of mothers with a bachelor’s degree or higher. Similarly, mothers with less than a high school education were most likely to self-pay at 13.2%. Among Black and Hispanic mothers, 64% and 58.1% of deliveries, respectively, were covered by Medicaid, compared with 22.5% of Asian, 23.2% of American Indian or Alaska Native, 28.9% of Native Hawaiian or other Pacific Islander, and 28.1% of white mothers. Valenzuela, “Characteristics of Mothers by Source of Payment for the Delivery: United States, 2021,” National Center for Health Statistics, May 2023.

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Profiteers in Health Care

Hospital industry group narrative does not match data: Despite claims from these groups that hospitals are in a dire financial situation, profit margins hit all-time highs in 2021, and hospitals received almost $200 billion in government subsidies. In addition, tax exemptions for nonprofit hospitals in 2020 were estimated at around $28 billion, nearly double the total cost of charity care provided by these hospitals at $16 billion. Herman, “Hospitals are not crumbling, Medicare experts tell Congress,” STAT News, 3/20/23.

Cigna denies claims without reading them: Over a period of two months in 2022, Cigna denied over 300,000 requests for payment, spending an average of 1.2 seconds on each case. A single medical director working for the insurer reportedly rejected roughly 60,000 claims in one month. Corporate documents show that Cigna estimated only 5% of people would appeal a denial from their system. Rucker et al., “How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them,” ProPublica, 3/25/23.

Nonprofit hospitals do not spend enough on charity care: Of 1773 nonprofit hospitals evaluated, 77% spent less on charity care than they received in tax breaks (referred to as a “fair share deficit”). The total of all fair share deficits amounted to $14.2 billion–enough to erase the medical debts of 18 million Americans or rescue 600 rural hospitals from closure. Many of the hospitals with the largest deficits received millions in COVID-19 relief aid and ended the year with high net incomes. The hospital with the highest fair share deficit, UPMC Presbyterian Shadyside, saw a difference of $246 million. Lown Institute, “Fair Share Spending, 2023,” 4/11/23.

Health insurance CEOs see record-breaking salaries: In 2022, the CEOs of the seven major publicly traded health insurance and services conglomerates — CVS Health, UnitedHealth Group, Cigna, Elevance Health, Centene, Humana, and Molina Healthcare — combined to make more than $335 million. This number is 18% higher than the previous record from 2021, mostly due to increasing stock prices. Just one executive, Joseph Zubretsky of Molina, made $181 million as head of a company that owes 80% of its revenue to Medicaid programs. Herman, “Health insurance CEOs set another record for pay in 2022,” STAT News, 4/27/23.

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Studies and analysis of interest to single-payer advocates

“Century-Long Trends in the Financing and Ownership of American Health Care,” by Adam Gaffney, M.D., M.P.H.; Steffie Woolhandler, M.D., M.P.H.; and David U. Himmelstein, M.D., The Milbank Quarterly, 4/24/23. “Over the past century, the tax-financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance. For-profit ownership of health care facilities has also increased in recent decades and now predominates for many health subsectors. A rising share of physicians are now employees. US health care is, increasingly, publicly financed yet investor owned, a trend that has been accompanied by rising medical costs and, in recent years, stagnating or even worsening population health.”

“The Association of Childbirth with Medical Debt in the USA, 2019-2020,” by Jordan Cahn M.D., M.Sc.; Ayesha Sundaram M.D.; Roopa Balachandar M.D.; Alexandra Berg M.D.; Aaron Birnbaum M.D.; Stephanie Hastings D.O.; Matthew Makansi M.D.; Emily Romano M.D.; Ariel Majidi M.D.; Danny McCormick M.D., M.P.H.; & Adam Gaffney M.D., M.P.H., Journal of General Internal Medicine, 5/18/23. “Postpartum women experience higher levels of medical debt than other women; poorer women and those with common chronic diseases may have an even higher burden. Policies to expand and improve health coverage for this population are needed to improve maternal health and the welfare of young families.”

“The $20 Billion Scam At The Heart Of Medicare Advantage,” by Matthew Cunningham-Cook and Andrew Perez, The Lever, 5/26/23. “Humana is the most prominent example of how insurers have built a major cash cow out of systematically overbilling Medicare Advantage, the private Medicare program operated by private interests. These overpayments are symptomatic of a broader profit-driven policy agenda that seeks to completely privatize Medicare, one of the nation’s most popular social programs, and lock program recipients into subpar private insurance plans, even when they get sicker and need the best care possible.”

“Projected Health Outcomes Associated With 3 US Supreme Court Decisions in 2022 on COVID-19 Workplace Protections, Handgun-Carry Restrictions, and Abortion Rights,” by Adam Gaffney, M.D., M.P.H.; David U. Himmelstein, M.D.; Samuel Dickman, M.D.; Caitlin Myers, Ph.D.; David Hemenway, Ph.D.; Danny McCormick, M.D., M.P.H.; Steffie Woolhandler, M.D., M.P.H., JAMA Network Open, 6/1/23. “Outcomes from 3 Supreme Court decisions in 2022 could lead to substantial harms to public health, including nearly 3000 excess deaths (and possibly many more) over a decade.”

“It’s Not Just You: Many Americans Face Insurance Obstacles Over Medical Care and Bills,” by Reed Abelson, New York Times, 6/15/23. “The survey also underscored the persistent problem of affordability as people struggled to pay their share of health care costs. About 40 percent of those surveyed said they had delayed or gone without care in the last year because of the expense. People in fair or poor health were more than twice as likely to report problems with paying medical bills than those in better health, and Black adults were more likely than white adults to indicate they had trouble.”

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PNHP Chapter Reports

California

In California, multiple chapters have been at work on several initiatives. PNHP-Ventura members Dr. Helen Petroff and Dr. Leslie-Lynn Pawson attended the All Members Advocacy Meeting of the California Academy of Family Physicians (CAFP) in Sacramento. There, Dr. Petroff and Dr. Pawson presented testimony to the CAFP Board of Directors in support of their resolution supporting single payer. Members also conducted a presentation on single payer to the student volunteers and nursing staff at the WestMinster Free Clinic in Oxnard, CA, in order to build their pipeline of activists. PNHP-Humboldt has passed several resolutions against Medicare privatization, placed ads for universal health care in a local publication, and is currently promoting a presentation of the film “American Hospitals.” Multiple chapters also attended a protest against Rep. Kevin McCarthy to advocate for the protection of Social Security and Medicare.

To get involved in California, please contact Dr. Nancy C. Greep at ncgreep@gmail.com. 

Drs. Nancy Greep (R) and Stephen Vernon carry a PNHP California banner at rally against U.S. House Speaker Kevin McCarthy’s stances on Medicare and Social Security.

Maine

Members of Maine AllCare held a statewide town hall-style meeting with about 40 attendees, providing updates on chapter activities and hosting a Q&A. The chapter also completed a series of six lunchtime information sessions with state legislators on a variety of aspects of universal health care, including the effects of our current system on rural providers. Finally, outreach to the Maine congressional delegation on Medicare for All continues.

To get involved in Maine, please contact Karen Foster at kfoster222@gmail.com.

New York

In New York, PNHP-NY Metro had their annual Lobby Day in support of the NY Health Act. This year they took the special step of having the introductory cohort of their Universal Health Legislative Advocacy Fellowship schedule, coordinate, and lead the meetings. The chapter also hosted a forum on maternal health and the shortcomings of the current health system for mothers. Discussing how racism impacts quality of and access to care for mothers of color, the event highlighted the stories of a number of patients who spoke at a panel with birth workers. Finally, members held a showing of “American Hospitals” followed by a panel discussion.

To get involved in New York, please contact Mandy Strenz at mandy@pnhpnymetro.org.

North Carolina

Drs. Jessica Schorr Saxe (L) and George Bohmfalk (R) meet with HHS Secretary Xavier Becerra during his recent visit to North Carolina.

In Charlotte, members of Healthcare Justice-NC spoke with HHS Secretary Xavier Becerra on his visit to North Carolina and encouraged him to reverse Medicare privatization via Medicare Advantage and ACO REACH. Members also participated in a health fair at Johnson C. Smith University, an HBCU in Charlotte. Board Member Dr. Doug Robinson gave the first of several mini-lectures to Mecklenburg County Commissioners to encourage them to pass a resolution supporting Medicare for All. Finally, chapter chair Dr. George Bohmfalk met with Georgia senator Jon Ossoff to discuss Medicare for All.

To get involved in Charlotte, please contact Dr. George Bohmfalk at gbohmfalk@gmail.com.

In Asheville, members of Health Care for All Western North Carolina (HCFAWNC) participated in the MLK Peace March and obtained signatures for the Medicare for All petition they’re presenting to the city council this year. Additionally, members held several presentations at local Democratic meetings and in retirement communities. Finally, the chapter presented a Medicare for All resolution to the Asheville Reparations Commission’s Health & Wellness Subcommittee, where it was well received.

To get involved in HCFA-WNC, please contact Terry Hash at theresamhash@gmail.com.

Oregon

In Oregon, members sponsored a panel at the Oregon Health Forum entitled “Lessons from Abroad: What can other nations teach Oregon about efficient healthcare?” Panelists included Dr. Donald Berwick of Massachusetts, Dr. Irene Papanicolas of Brown University, Reginald Williams of the Commonwealth Fund, and Jack Friedman of PacificSource Health Plans. The moderator was Tina Edlund, former healthcare advisor to past governor Kate Brown. The chapter also issued a letter supporting full legislative funding of SB 1089, a bill to establish a universal health care plan for Oregon.

To get involved in Oregon, please contact Dr. Samuel Metz at pnhp@samuelmetz.com.

Pennsylvania

In Western Pennsylvania, members met with newly elected Rep. Chris Deluzio in advance of the release of the new Medicare for All bill. They discussed the health ramifications of the train derailment in East Palenstine, OH, which is located on the border of PA, in his district, and revisited the case of Libby,  Montana, where the federal government provided Medicare for all residents of the area after a disaster. They also met with newly elected Congressional Rep. Summer Lee to discuss the release of the Medicare for All bill, and successfully encouraged her to sign on. Members also had several meetings with Allegheny County Council representatives to explore the possibility of placing a non-binding referendum supporting a single-payer health care system on the ballot.

To get involved in PNHP-Western Pennsylvania, please contact Judy Albert at jalbertpgh@gmail.com.

West Virginia

Our chapter in West Virginia continues to grow, and its website went live for the first time in March. Members have been holding regular monthly meetings with speakers on topics such as health care economics, social security, and updates from other state chapters. Efforts continue on membership recruitment at renewal at both state and national levels, as well as national phone banking efforts.

To get involved in West Virginia, please contact Dr. Daniel Doyle at doyledan348@gmail.com.

Drs. Bill Bronston (L) and Elaine Silver-Melia attend a screening of “American Hospitals” in Sacramento on April 26.

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SNaHP Chapter Reports

SNaHP Ohio

The collection of chapters comprising SNaHP Ohio have come together to form the first statewide SNaHP Coalition, which they will use to organize, pass resolutions, and advocate for single payer health care at the state level. One of their first efforts was to pass a resolution at the Ohio State Medical Association eliminating previous policy language explicitly opposing Medicare for All and public options, which they successfully did. The group is also fundraising for organizations leading the Ohio abortion ballot initiative through sales of merchandise promoting Medicare for All.

To get involved with SNaHP Ohio, please contact Justin May at mayjf@mail.uc.edu.

Northeast Ohio Medical University students attend a meeting of the Akron City Council on March 13. Students testified in support of using Covid recovery funds to relieve medical debt.

Creighton University (Arizona)

SNaHP students at Creighton University in Arizona collaborated with the Creighton Justice in Medicine club to host a Single Payer 101 and myth-busting event and discussion, which was attended by over 20 students. The chapter also created a Political Advocacy Committee to write and pass resolutions, and met with organizers, PNHP members, and other students to plan a resolution campaign. Finally, members hosted events on health care economics and an educational event on ACO-REACH.

To get involved with SNaHP at Creighton University, please contact Allison Benjamin at allisonbenjamin7@gmail.com. 

Dell University (Texas)

Students at Dell University in Texas held a lecture series over the course of a semester for medical students and undergrads on issues in the U.S. health system, the promise of single payer, and community organizing to achieve it. Featured speakers included Ed Weisbart, M.D. (PNHP), Liana Petruzzi, Ph.D. (UT Austin Social Work), Kellen Gildersleeve, R.N. (National Nurses United, Austin), Rachel Madley, Ph.D. (US Rep. Pramila Jayapal), and Yosha Singh, M.P.H. (Dell Med SNaHP). The chapter also worked with Austin City Council member Vanessa Fuentes to lobby the city to introduce a resolution in support of Medicare For All, which was passed in early May. Lastly, the chapter’s co-presidents wrote an op-ed on the urgency of Medicare For All and why it can particularly benefit Texas in the context of Medicaid unwinding after the public health emergency. The op-ed was published in the Austin Chronicle and was used as the basis for planning an op-ed workshop for our members which is forthcoming.

To get involved with SNaHP at Dell University, please contact Rohit Prasad at rohit.prasad@utexas.edu.

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How You Can Support the Medicare for All Act

  • Visit https://pnhp.org/legislation, where you can read about the bills and use our simple webform to send a cuztomizable email message to your representative and both of your senators, based on whether or not they have co-sponsored. 
  • Schedule an in-person meeting with your representative and with each of your senators—or with a health policy staffer at their district office. 
  • Write an op-ed or letter to the editor supporting the Medicare for All Act.

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PNHP in the News

News items quoting PNHP members

“No, COVID-19 isn’t ‘over’—but millions of Americans’ Medicaid coverage is about to be,”  The Real News Network, 4/7/23, featuring Dr. Margaret Flowers

“A conversation with doctors who support universal healthcare,” KALW, 4/12/23, featuring Dr. Susan Rogers

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Op-eds by PNHP members

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Letters to the editor by PNHP members

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The Medicare for All Act of 2023

On May 17, 2023, Rep. Pramila Jayapal, Rep. Debbie Dingell, and Sen. Bernie Sanders introduced the Medicare for All Act in the U.S. House (H.R. 3421) and U.S. Senate (S. 1655). These landmark pieces of legislation would finally establish a single-payer national health program in the United States.

PNHP welcomes these bills and urges Congress to move quickly to guarantee universal coverage, comprehensive benefits, and zero out-of-pocket costs for all U.S. residents.

Overview of the Medicare for All Act

Activism on the Medicare for All Act

  • Send an email to your representative and and ask them to co-sponsor the bill.
  • Call your representative and senators at (202) 224-3121 and ask them to co-sponsor.
  • Schedule an in-person meeting with your representative and with each of you senators—or with a health policy staffer at their district office; this is a crucial part of building relationships with your legislators.
  • If your representative or senator is already a co-sponsor, thank them for their support and ask them to be even more public in their single-payer advocacy. See the Congressional website for a list of current co-sponsors in the House and Senate.
  • Seek out allied organizations, both locally and nationally, to expand the reach of your activism. Review these lists of hundreds of organizations that have endorsed Medicare for All in the House and Senate.
  • Write an op-ed or letter to the editor supporting the Medicare for All Act.

Introductory town hall

PNHP national board member Dr. Sanjeev Sriram and PNHP past president Dr. Adam Gaffney participated in a Medicare for All Town Hall with fellow health professionals and single-payer champions on May 16, 2023.

Introductory press conference

Social media graphics

PNHP Newsletter: Spring 2023

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

Save the Date: Nov. 10-12 in Atlanta

Research Roundup

PNHP Chapter Reports

Protect Medicare Photo Petition

PNHP in the News

PNHP News and Tools for Advocates

PNHP celebrates 35th anniversary

This year, PNHP celebrates 35 years since its founding in 1988. In the decades since its beginning, our organization has grown from a small handful of physicians in a room in Massachusetts to over 26,000 members in chapters across the country, as well as thousands of medical students on dozens of campuses. During that time, we have cemented ourselves as leaders in the fight for health justice in the United States. Our ideas formed the intellectual foundation of the single-payer movement, and the Medicare for All bill as it exists today is a product of our expertise.

To commemorate these achievements and look forward to an even brighter future, PNHP has launched a 35th anniversary campaign, which kicked off with an activist meeting on February 23rd. Attendees new and old from across the organization came together to reminisce about their entrance into PNHP and the single-payer movement. Participants discussed our many recent accomplishments, such as successfully pressuring the Biden administration to freeze the REACH program and helping to pass single-payer resolutions in cities like Atlanta. At the end of the meeting, former president Dr. Susan Rogers and SNaHP leader Emily Huff laid out the plans for the year ahead.

The 35th anniversary campaign will go on throughout the year. First, we will use it to build support for the future of our movement, our SNaHP student activists. Next, we will dig deep on our efforts to protect Medicare from privatization, which threatens to kill Medicare for All before it has even started. Finally, we will use the campaign to greatly expand our circle of active physician members. Our efforts will culminate at the PNHP Annual Meeting in Atlanta on November 10-12, where we will convene with a much stronger and more formidable organization.

In order to make this initiative as successful as possible, we will need your help. Please go to pnhp.org/35years to learn more about our different fundraising and volunteer opportunities, including signing up to host a house party as well as starting a peer to peer fundraising campaign. We have an incredibly exciting year ahead of us, as we begin to build the power we need to finally win improved Medicare for All. 

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PNHP welcomes new president Dr. Philip Verhoef

Dr. Verhoef began his term as president in December of last year, taking over from past president Dr. Susan Rogers. He is an adult and pediatric intensivist, as well as a Clinical Associate Professor of Medicine at the John A. Burns School of Medicine at University of Hawaii-Manoa. 

He first became interested in the movement in the late 2000s when working as a resident in California during a time when doctors were trying to get a single-payer bill passed in the state. Dr. Verhoef moved to Chicago and shortly thereafter joined up with PNHP-Illinois and the Illinois Single Payer Coalition, eventually becoming President of both groups. He joined PNHP’s national board as an adviser in 2014, and since then has been an integral part of our organizing and strategic efforts across the country.

At a time when we are on one hand facing threats to our public health care in the form of Medicare Advantage and REACH, and on the other seeing public interest and enthusiasm for single payer at its highest level ever, he is well poised to lead PNHP on both fronts. Under Dr. Verhoef, we will generate the widespread grassroots support and political power required to take on the insurance companies, build a base of allies, and finally win the health care system that all of us deserve. We would be remiss not to thank our immediate past president Dr. Susan Rogers for her indomitable leadership over the last few years, which has made PNHP a more powerful organization ready to meet these challenges. Please join us in giving her our gratitude, and welcoming Dr. Verhoef as our new president!

PNHP immediate past president Dr. Susan Rogers (L) and PNHP president Dr. Phil Verhoef at the 2022 Annual Meeting in Boston.

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Organizing team brings pediatricians into single-payer activism

Pediatricians and medical students across PNHP’s membership have begun working on a campaign to bring more pediatricians into our movement, with the eventual goal of getting pediatric societies in America to endorse single payer as the only real solution to the health care problems that children and families face in this country. We interviewed Sam Accordino, a medical student and SNaHP member on the organizing team, to learn more about their work.

PNHP Pediatric Organizing Team members; Front row (L to R): Dr. Philip Gioia, Michael Massey, Dr. Winnie Lin, Dr. Eve Shapiro, Dr. Jane Katz Field, Dr. Steve Auerbach; Back row (L to R) Dr. Phil Verhoef, Dr. Sanjeev Sriram, Dr. Ndang Azang-Njaah.

What drew you to the pediatric organizing campaign? I was drawn to this campaign because it presented an opportunity to advocate for the betterment of health care in America, particularly as it relates to that of children and families. I felt that this initiative was something that I had a passion for being involved with, as I have a particular interest in becoming a pediatrician in my future.

What are you most excited about working on in the campaign over the next few months? I am most excited about getting to collaborate with current pediatricians, while also learning about their experiences with health care and the ways that they became inspired to support this campaign.   

Why should other pediatricians and medical students join the campaign? Other pediatricians and medical students should consider joining this campaign because it presents an involving and rewarding commitment to bettering the health of the children in America that we are empowered and dedicated to care for either now or in the future.  

If you are interested in becoming a part of the pediatrics organizing team, please contact lori@pnhp.org! 

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Save the Date: Nov. 10-12 in Atlanta

Join us for PNHP’s in-person Annual Meeting, Leadership Training, and SNaHP Summit—scheduled for Nov. 10-12 in Atlanta.

We’ll convene for a weekend of single-payer workshops, plenary sessions, keynotes, and (most importantly) opportunities to meet with like-minded colleagues who are fighting for health justice across the U.S.

PNHP activists rally outside Grady Hospital in Atlanta during our last annual meeting there, in 2017.

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Research Roundup

Data Update: Health Care Crisis by the Numbers

Barriers to Care

Banning abortion would increase maternal mortality by 24%: A nationwide abortion ban would lead to an estimated additional 210 maternal deaths per year. Among non-Hispanic Black people, deaths would increase by 39%. Looking at only the states which have banned or are likely to ban abortion, maternal mortality increases vary, with some states seeing as much as a 29% increase. Stevenson et al., “The maternal mortality consequences of losing abortion access.” SocArXiv, 6/29/2022.

Americans are skipping therapy to save money: A third of American adults in therapy reported canceling a session due to out-of-pocket costs, and 48% of these adults say they would quit therapy altogether if costs increased. Among adults who stopped going to therapy, 22% cited the cost as a reason, and 15% cited changes of their insurance coverage. The average out-of-pocket monthly cost for therapy is $178, and reaches as high as $300 a session in some major cities. Ingram, “Cost Remains Significant Barrier to Therapy Access, Verywell Mind Survey Finds,” Verywell Mind, 5/9/2022.

Health care costs more concerning to Massachusetts residents than pandemic: Residents ranked the cost of care as three times as important as the pandemic. 42% of residents have put off care because of the cost, and 26% have put off purchasing prescription drugs. 80% believe it is extremely important to take action on health care costs, and 85% believe that the government should be doing more on this issue. Every age group and income bracket ranked cost as their most important issue in health care currently. Blue Cross Blue Shield of Massachusetts, “Massachusetts Residents Cite Health Care Costs, Not COVID, As Primary Health Care Concern,” 9/8/2022.

Americans are deeply dissatisfied with American health care: 56% of Americans believe that health care is handled poorly (defined as “not too well or not at all well”) in the United States. 74% believe that prescription medication costs are handled poorly, and 70% say the same about mental health care. Nearly 80% of Americans are at least moderately concerned about getting access to quality health care. This fear is especially pronounced among Black and Hispanic Americans, with almost 60% expressing extreme concern about access to quality care. Meanwhile, two-thirds of Americans view health care coverage as a government responsibility, and about 40% of Americans support a single-payer health care system. Seitz, “Americans give health care system failing mark: AP-NORC poll,” Associated Press, 9/12/2022.

Sexual assault survivors deal with extreme costs after seeking care: Emergency department costs for sexual assault survivors seeking medical care averaged $3,551. Survivors of sexual abuse during pregnancy faced the highest costs, at an average of $4,553. Just one-fifth of survivors seek out medical care after an assault, with fear of high costs being a likely contributor. 16% of these patients were expected to pay their bills out-of-pocket, and even individuals with employer-sponsored insurance paid an average of 14% of the total emergency visit cost. Dickman et al., “Uncovered Medical Bills after Sexual Assault,” New England Journal of Medicine, 9/15/2022.

1 in 10 individuals in the US has medical debt: 15.3% of uninsured individuals carry medical debt, compared with 10.5% of privately insured individuals. The mean amount of medical debt in 2018 was $21,687 per debtor. Factors such as hospitalization, disability, being on a high-deductible health plan, being on a Medicare Advantage plan, and having no insurance coverage were associated with a higher risk of having medical debt. Living in a Medicaid-expansion state was associated with a lower risk of medical debt. Losing insurance coverage, becoming newly disabled, and becoming newly hospitalized between 2017 and 2019 was associated with taking on medical debt by the latter year. Himmelstein et al., “Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US,” JAMA Network Open, 9/16/2022.

Adults with diabetes are skipping doses: More than 1.3 million Americans have skipped insulin doses, delayed purchasing the drug, or otherwise rationed it due to escalating costs. Around 16.5% of American adults with diabetes who need insulin did not take their dosage as prescribed due to financial considerations. Around 20% of younger adults have rationed insulin, as compared with 11% of adults 65 and older. Insulin rationing is higher among Black individuals compared to White and Hispanic individuals. Gaffney et al., “Prevalence and Correlates of Patient Rationing of Insulin in the United States: A National Survey,” Annals of Internal Medicine, November 2022.

Out-of-pocket spending in health care growing fast: In the United States, Out-of-pocket health care expenditures rose 10.4% in 2021, the highest rate in several decades. This increased spending was driven at least partially by demand for dental services, eyeglasses, and medical supplies. By contrast, overall health spending only grew by 2.7%, in large part due to a lower level of pandemic-related spending. Medicaid spending grew by 9.2%, Medicare spending by 8.4%, and employer health spending by 6.5%. Owens, “Out-of-pocket health costs spiked in 2021,” Axios, 12/15/2022.

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Health Inequities

Access to in-school mental health services decreases for Black and Latino students in New Jersey: From 2008 to 2020, the statewide average of mental health professionals in public schools in New Jersey went from 8.2 per 1,000 students to 8.6 per 1,000 students. For White students, this number went from 7.4 to 8.5. However, the number of mental health professionals for Black students went from 10.3 to 8.5, and the number of professionals for Latino students went from 9 to 8.4. In general, the poverty rates for Black and Hispanic children in New Jersey are more than three times that of White or Asian children. Weber, “New Jersey’s Black Students Suffer a Decline in Access to School Mental Health Staff,” New Jersey Policy Perspective, 9/7/2022.

Racial disparities in mortality increase for many groups during the COVID-19 pandemic: With a few exceptions, almost all racial and ethnic groups across all ages saw an increase in their all-cause mortality rate compared to White individuals at the start of the pandemic, and during subsequent COVID surges. Before the pandemic, Black individuals of all ages had a mortality rate 1.19 times that of White individuals. During the initial wave of the pandemic, this rate increased to 1.77 times White individuals. For American Indian or Alaska Native individuals under age 65, all-cause mortality rates went from 1.74 times White individuals pre-pandemic to 2.25 times during the summer 2021 surge. While Asian and Hispanic populations had lower all-cause mortality rates as compared with White populations before the pandemic, these advantages shrank during the initial and subsequent COVID waves. Aschmann et al., “Dynamics of racial disparities in all-cause mortality during the COVID-19 pandemic,” PNAS, 9/20/2022.

Black Michiganders comprised 60% of Monkeypox cases in the state, but only 17% of vaccine doses: 70% of the doses of the Monkeypox vaccine in Michigan went to White residents. Although Detroit, a majority Black city, saw 38% of Michigan’s known monkeypox infections, with 102 of the state’s 265 identified cases, the first doses of the vaccine went to Oakland and Washtenaw counties. Shamus, “Black Michiganders got 60% of monkeypox cases, only 17% of vaccines,” Detroit Free Press, 9/29/2022.

Maternity care deserts increase in the United States: Since 2020, an additional 1,119 counties in the US have become maternity care deserts, areas with little or no access to maternity care services. Overall, more than 2.2 million women of childbearing age live in a maternity care desert, and more than 146,000 babies have been born in these deserts since 2020. Medicaid covers nearly half of births in maternity care deserts, compared with 40.1 percent in counties with full maternity care access. In 2020, 1 in 4 Native American babies and 1 in 6 Black babies were born in areas of limited or no access to maternity care services. “Nowhere to Go: Maternity Care Deserts Across the U.S.,” March of Dimes, October 2022.

Veteran care wait time disparities increase during pandemic: In the pre-pandemic era, Black and Hispanic veterans had waiting times which were on average 2.1 days longer and 1.3 days longer, respectively, than White veterans for orthopedic services. During the pandemic, wait times for both orthopedic and cardiology services increased for Black, Hispanic, and White veterans, with Black and Hispanic veterans seeing an overall greater increase in wait time in both categories. Black veterans saw mean wait time increases of 4.7 days for cardiology and 4.1 days for orthopedics, Hispanic veterans saw increases of 5.1 days for cardiology and 4.4 days for orthopedics, and White veterans saw increases of 4.5 days for cardiology and 3.8 days for orthopedics. Gurewich et al., “Disparities in Wait Times for Care Among US Veterans by Race and Ethnicity,” JAMA Network Open, 1/3/2023.

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Coverage Matters

Out-of-pocket costs for Naloxone soar for uninsured patients: From 2014 to 2018, the average out-of-pocket cost for the opioid overdose reversal medication Naloxone decreased by 26% for insured patients, but increased by 606% for uninsured patients. This increase was even higher for some specific brands of the drug. From 2015 to 2016, the average out-of-pocket cost to uninsured patients for the brand Evzio rose 2429%. Peet et al., “Trends in Out-of-Pocket Costs for Naloxone by Drug Brand and Payer in the US, 2010-2018,” JAMA Health Forum, 8/19/2022.

Adults in Medicaid-enrolled families largely unaware of renewals resuming: 62% of adults with family Medicaid enrollment heard nothing at all about Medicaid eligibility redetermination and the coming end of the continuous coverage requirement. 16.2% of adults heard some about this issue, while 15.7% heard only a little. Just 5% of adults reported hearing a lot about future Medicaid renewals. Of those who had heard from a state agency or health plan about the upcoming change, only 21.3% were told how to get assistance with the process, and only 29% were informed of their options should they become ineligible for Medicaid. Haley et al., “Most Adults in Medicaid-Enrolled Families Are Unaware of Medicaid Renewals Resuming in the Future,” Urban Institute, 11/15/2022.

Young adults in Medicaid-expansion states see improved cancer survival: In states that expanded Medicaid, two-year overall survival for young adult cancer patients rose from 90.4% to 91.9%. In states that did not expand Medicaid, survival increased from 89% to 90.1%, giving the Medicaid-expansion states an advantage of around 0.4%. Survival rate increases associated with Medicaid expansion were concentrated by type in female breast cancer and by stage in patients with stage IV disease. Ji et al., “Survival in Young Adults With Cancer Is Associated With Medicaid Expansion Through the Affordable Care Act,” Journal of Clinical Oncology, 12/16/2022.

Fewer postpartum hospitalizations in states that expanded Medicaid: The rate of hospitalizations of either the newborn baby or mother in the first 60 days following birth decreased by 17% in states that expanded Medicaid. Approximately 75 percent of this decrease can be attributed specifically to a smaller number of childbirth-related hospitalizations. The rate of hospitalization between 61 days and six months after birth decreased by 8% in Medicaid-expansion states as well. Steenland and Wherry, “Medicaid Expansion Led to Reductions in Postpartum Hospitalizations,” Health Affairs, January 2023.

Millions set to lose Medicaid coverage as public health emergency ends: As the government winds down the Medicaid continuous coverage requirement, millions of Americans may lose their coverage either through ineligibility or by falling through the cracks of the renewal process. Anywhere between 5 and 14 million Americans could be kicked off their current Medicaid coverage, with the federal government estimating 6.8 million people will lose coverage despite still being eligible under Medicaid requirements. In the years since the pandemic began, the number of Americans on Medicaid and CHIP, the Children’s Health Insurance Program, grew by almost 20 million, to a total enrollment of 90.9 million. Yu, “6.8 million expected to lose Medicaid when paperwork hurdles return,” NPR, 1/24/2023.

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Commercial Insurance

Patients with chronic diseases face substantially higher financial difficulties: Comparing commercially insured individuals with no chronic conditions to those with 7-13 chronic conditions, the latter group had higher probabilities of having medical debt in collections (7.6% vs 32%), delinquent debt (14% vs 43%), and a low credit score (17% vs 47%). Among those with medical debt in collections, the estimated amount owed for those with several chronic conditions was also significantly higher ($784 vs $1252). Becker et al., “Association of Chronic Disease With Patient Financial Outcomes Among Commercially Insured Adults,” JAMA Internal Medicine, 8/22/2022.

Claim denials and delayed insurer payments increasing: 67% of healthcare leaders have seen an increase in denied claims in the past year, compared with 33% of leaders who saw an increase in denied claims in 2021. In hospitals, the initial claim denial rate increased from 10.2% in 2021 to 11% in 2022. Denial value went from 1.5% of health systems’ gross revenue in January 2021 to 2.5% in August 2022. Providers are also waiting longer for payment from insurers, with the proportion of claims taking more than 90 days after reception to be paid rising from 32% in January 2021 to 37% in August 2022. Deveraux, “Health systems see increasing claim denials as payer ‘delay tactic,’” Modern Healthcare, 11/21/2022.

Lack of competition in health insurance markets: Health insurance giants dominate the market in the United States, and are gaining even more control. 75% of metro areas lacked a competitive market for commercial insurance, compared with 73% the previous year. In 91% of regions, one insurer controlled at least 30% of the market. When it came to Medicare Advantage, a single carrier enrolled more than half of beneficiaries in 34% of markets. In most states, two insurers hold at least 50% of the overall market share. Tepper, “Health insurance markets lack competition, AMA reports,” Modern Healthcare, 11/1/2022.

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Profiteers in Health Care

Private equity’s takeover of medicine continues: In 2021, private equity firms spent over $200 billion on more than 1,400 health care acquisitions. Companies owned or managed by these firms have paid fines of more than $500 million since 2014 to settle at least 34 lawsuits under the False Claims Act. Some specialties, such as anesthesiology and gastroenterology, have been largely taken over by private equity, while regulators ignore the more than 90% of private equity investments that fall below the government’s $101 million antitrust review threshold. Schulte, “Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties,” Kaiser Health News, 11/14/2022.

Vaccine producers keep billions in payments for canceled doses: Gavi, the humanitarian vaccine organization, purchased Covid vaccines from drug companies as part of its global vaccination program known as Covax. These companies together made $13.8 billion from the vaccines distributed through the program so far, but they refuse to return the $1.4 billion paid for vaccine orders that have since been canceled as the program winds down. Novavax, for example, is refusing to refund $700 million for vaccines it never gave to the program. Nolen and Robbins, “Vaccine Makers Kept $1.4 Billion in Prepayments for Canceled Covid Shots for the World’s Poor,” New York Times, 2/1/2023.

Nursing home owners paid themselves millions while residents suffered: Of the more than 600 nursing homes in New York, almost half hired companies run or controlled by their owners to perform various services, paying themselves well above market rates while the federal government doled out millions of dollars of pandemic relief money to those same homes. Together, these corporations made profits of $269 million on an average margin of 27%, while conditions in homes steadily deteriorated among staff shortages and scores of deaths from COVID and other illnesses. Rau, “Nursing home owners drained cash while residents deteriorated, state filings suggest,” NPR, 1/31/2023.

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Medicare and Medicaid Privatization

Department of Justice joins False Claims Act lawsuit against Cigna: The suit was filed in 2017 by a service provider for Cigna’s Medicare Advantage (MA) subsidiary. Cigna is accused of using improper diagnosis coding to cheat the government out of $1.4 billion during the years 2012-2019. The codes used to collect this money allegedly did not reflect the actual condition of patients, and diagnoses lacked the testing and imaging information necessary to prove the existence of the ailments. Moreover, the beneficiaries did not receive treatment for the conditions that were reported on the diagnostic codes. Kacik, “DOJ joins Cigna Medicare Advantage Fraud Case,” Modern Healthcare, 8/25/2022.

Centene settles overcharging allegations with 14 states: The company, which is the nation’s largest Medicaid managed care operator, has reached settlements with these states to resolve allegations of overcharging state Medicaid programs for prescription drugs. These settlements to date have totaled over $800 million dollars in the following states: California, Texas, Ohio, Indiana, Illinois, Mississippi, Iowa, Kansas, New Hampshire, Washington, Oregon, Massachusetts, New Mexico, and Arkansas. The largest settlements thus far have been in California ($215 million), Texas ($165 million), and Ohio ($88 million). Liss, “Centene reaches $215M settlement with California,” Healthcare Dive, 2/9/2023.

Big Insurers expanding Medicare Advantage plans in 2023: Aetna is expanding its MA offerings from 1,875 counties to 2,014 counties. UnitedHealthcare is growing from 2,629 counties to 2,798 counties. Elevance Health, formerly Anthem, which has more than 1.6 million MA beneficiaries, is expanding into 210 new counties. Cigna will expand from 477 counties to 581 counties, and Humana will expand to 140 new counties. Jaspen, “Big Health Insurers Will Expand Medicare Advantage to Hundreds of New Counties for 2023,” Forbes, 10/1/2022.

Government audits uncover millions in Medicare Advantage overpayments: 90 audits which examined billings from 2011 through 2013 uncovered around $12 million in net overpayments for the care of just over 18,000 patients. 71 audits uncovered net overpayments, and 23 audits showed overpayments of over $1,000 per patient on average. UnitedHealthcare and Humana accounted for 26 of the 90 audits. Schulte and Hacker, “Audits – Hidden Until Now – Reveal Millions in Medicare Advantage Overcharges,” Kaiser Health News, 11/21/2022.

Medicare Advantage plans associated with higher mortality for complex cancers: For patients undergoing surgery for cancers located in the lungs, esophagus, pancreas, stomach, liver, and rectum, enrollment in an MA plan was associated with a lower probability of treatment in a high-volume hospital with physicians experienced in treating complex cancers. Compared with patients in Traditional Medicare, patients in MA with stomach and liver cancer were 1.5 times likelier to die within a month after their surgeries, and patients with pancreatic cancer were twice as likely to die in the same time frame. Patients on Traditional Medicare were more likely to be treated at a teaching hospital (23% vs 8%), a hospital accredited by the Commission on Cancer (57% vs 33%), or a National Cancer Institute-designated cancer center (15% vs 3%). Raoof et al., “Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients,” Journal of Clinical Oncology, 11/10/2022.

New audits in Medicare Advantage will recoup hundreds of millions in overpayments: The audits will proceed under a new rule finalized by the Biden administration. The first year of audits will cover 2018 plans, from which the government estimates it will get back $479 million from MA insurers. Over the next decade, from 2023 to 2032, this number is expected to increase to $4.7 billion, which is overall higher than the previous estimate of $381 million per year from annual audits. Herman and Bannow, “Medicare Advantage insurers to repay billions under final federal audit rule,” STAT News, 1/3/2023.

MA plans denying inpatient claims at greater rates: Inpatient claim denial rates for MA plans through November 2022 stood at 5.8%, as compared with 3.7% for all other payer categories. Looking just at payers within MA, providers wrote off 8.5% of inpatient revenue as uncollectible in 2022, up from 4.7% in 2021. In terms of overall revenue, providers wrote off 3.6% as uncollectible in 2021 and 5.9% as uncollectible in 2022. Many MA plans have adopted strict criteria for authorization which has led to this increased rate of inpatient denial. Lagasse, “Medicare Advantage plans denying more inpatient claims,” Healthcare Finance, 2/21/2023.

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Pharma

Online prescriptions drive huge pharmaceutical profits: An explosion in telehealth has led to increased prescription of drugs through the internet, with one prescribing service estimating that more than 90% of eligible patients who finish their intake forms get a prescription for the drug they clicked on. The drug industry spends $25 billion a year on marketing, and has recently increased its direct-to-consumer ad spending as a result of this newfound wave of telehealth prescriptions. Between 1997 and 2016, online direct ad spending by pharmaceutical companies increased by around $500 million. Palmer, “‘This is pharma’s dream’: How drugmakers are turning telehealth into a marketing gold mine,” STAT News, 9/14/2022.

High drug prices are not justified by research and development costs: For 60 drugs approved by the FDA between 2009 and 2018, there was no correlation between estimated research and development investments and drug costs at launch, 1 year after launch, or in the year 2021. These drugs accounted for 17.7% of all drugs authorized by the FDA over the period. The idea that high prices are needed to make back the money spent on creating the drug is thus unsupported by data. Wouters et al., “Association of Research and Development Investments With Treatment Costs for New Drugs Approved from 2009 to 2018,” JAMA Network Open, 9/26/2022.

Drugmakers raising prices on a large group of medications: Companies including Pfizer, GlaxoSmithKline, and Sanofi are expected to raise prices on more than 350 drugs in 2023. These price increases come after pharmaceutical companies already raised prices on more than 1,400 drugs in 2022, the most since 2015. The average increase in drug prices was 6.4% in the previous year. Some drugs with planned price increases include the shingles vaccine Shingrix (7%), the CAR-T cell therapies Abecma and Breyanzi (9%), and the autoimmune treatment Xeljanz (6%). Erman and Steenhuysen, “Exclusive: Drugmakers to raise prices on at least 350 drugs in U.S. in January,” Reuters, 12/30/2022.

Novel drugs are debuting at record high prices: The median annual price for drugs newly approved by the FDA in 2022 is $222,003. The median in the first half of the year was $257,000, and the median in the second half was $193,900. One of the drugs approved in the second half of 2022, a one-time gene therapy known as Hemgenix, is the most expensive drug in history at $3.5 million. The average price of a newly launched cancer drug in 2021 was $283,000, up 53% from the average price in 2017. Beasley, “U.S. new drug price exceeds $200,000 median in 2022,” Reuters, 1/5/2023.

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Studies and analysis of interest to single-payer advocates

“Arizona’s debt collection reform – a small step towards health justice,” by Christopher Robertson; Steffie Woolhandler; David U Himmelstein, The BMJ, 11/23/22. “US patients can incur medical debt either because they lack health insurance coverage (11.4% of Arizonans; 8.6% of Americans nationwide) or because their insurance policies leave them exposed to substantial costs through deductibles and co-payments, which federal law allows to be as high as $15,000 a year for families. As a result, Americans carry a total of at least $88bn in medical debt, and it’s the most common adverse item on credit reports.”

“Hospital Expenditures Under Global Budgeting and Single-Payer Financing: An Economic Analysis, 2021-2030.” by Adam W. Gaffney; David U. Himmelstein; Steffie Woolhandler; James G. Kahn, International Journal of Social Determinants of Health and Health Services, 1/30/23. “We estimate that non-federal hospital operating budgets will total $17.2 trillion between 2021 and 2030 under current law versus $14.7 trillion under single-payer with global budgeting.”

“LIFE AND DOLLARS: a health care insider’s account of how prior authorization really works.” Anonymous, HEALTH CARE un-covered, 1/30/23. “By having prior authorizations in place, did anything actually improve in your overall patient population? The answer is probably no, because the purpose of prior authorizations is to save dollars, not improve patient outcomes, regardless of what they say.”

“Accountability for Medicare Advantage Plans is long overdue.” by Physicians for a National Health Program, 3/1/2023. “The long unbroken record of gaming the payment system and overpayments to MA plans without evidence for improved outcomes (and easily gamed quality metrics do not qualify as evidence of improvement) point to the folly of expecting capitated fiscal intermediaries to reduce Medicare cost.”

“Chronic Illness in Children and Foregone Care Among Household Adults in the United States: A National Study,” by Narm, Koh Eun M.D., M.S.; Jenny Wen, M.D., M.P.H.; Lily Sung, M.D., M.S.; Sofia Dar, M.D.; Paul Kim, M.D.; Brady Olson, M.D.; Alix Schrager, M.D.; Annie Tsay, M.D.; David U. Himmelstein, M.D.; Steffie Woolhandler, M.D., M.P.H.; Natalie Shure, M.A.; Danny McCormick, M.D.; Adam Gaffney, M.D., Med Care, 4/1/2023. “Adults living with children with chronic illnesses may sacrifice their own care because of cost concerns. Reducing out-of-pocket health care costs, improving health coverage, and expanding social supports for families with children with chronic conditions might mitigate such impacts.”

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PNHP Chapter Reports

California

In California, PNHP-CA members across various chapters have been busy with a myriad of initiatives. PNHP-Ventura led a successful effort to get the City Council of Ojai to pass a resolution in support of single payer. During the recent open enrollment period, organized groups of PNHP-Humboldt County members attended Medicare Advantage information sessions, using questions to expose the deficiencies of MA programs and urge seniors in attendance not to sign up. PNHP-Napa convinced Congressman Mike Thompson to write to Secretary Becerra and ask him to terminate REACH. Finally, PNHP Bay Area organized a webinar on building business support for single payer. Members of all chapters have also been presenting on single payer at a variety of conferences, CME sessions, and Grand Rounds.

To get involved in California, please contact Dr. Nancy C. Greep at ncgreep@gmail.com.

Activists in Humboldt County, Calif. draw attention to the privatization of Medicare. Photo credit: Mark Larson

Georgia

PNHP-GA leader Dr. Henry Kahn.

In Georgia, PNHP members hosted a Fall Social at Manuel’s Tavern in Atlanta. Over 15 chapter members joined the event, and shared stories about their lived experiences with our failing health care system. Steering Committee members Belinda McIntosh and Henry Kahn collaborated with the Florida PNHP chapter on various outreach efforts, strengthening the relationship between the two groups. Finally, the chapter engaged with members of the Atlanta City Council prior to their historic passing of a resolution supporting the Congressional Medicare for All bill HR 1976.

To get involved in Georgia, please contact Dr. Elizabeth McCord at eomccord@gmail.com. 

Kentucky

In Kentucky, members of Kentuckians for Single Payer Healthcare (KSPH) produced weekly radio shows, interviewing physicians and others on issues related to local health care, VA care, value-based payments, and Medicare privatization. Two of the shows featured members of the Board of Supervisors in Dunn County, Wisconsin, and Dr. Pam Gronemeyer in southern Illinois, on their successful Improved Medicare for All ballot questions. Several members participated in the presentation of a Grand Rounds on health care systems sponsored by the Greater Louisville Medical Society for the Kentucky Medical Association. In December, KSPH hosted a virtual webinar on Medicare Privatization and ACO REACH featuring Dr. Corinne Frugoni, past president of PNHP-CA.  Finally, members worked to get union and central labor council resolutions passed calling for an end to ACO REACH.

To get involved in Kentucky, please contact Kay Tillow at nursenpo@aol.com or Dr. Garrett Adams at kyhealthcare@aol.com. 

Maine

In Maine, members worked on a campaign to endorse candidates for the state legislature and recognize those who support the mission to bring universal single-payer health care to all Maine residents. In addition, the chapter launched a weekly series of Lunch and Learns for Maine legislators, with speakers from current and former members of Maine AllCare as well as the related 501(c)(4) organization Health Care for All Maine. Finally, members of the chapter are participating on a committee of the Maine Medical Association to update their statement on health reform, with the goal of achieving an endorsement of language around single payer and universal health care.

To get involved in Maine, please contact Karen Foster at kfoster222@gmail.com. 

Missouri

PNHP members in Missouri held a Zoom meeting to discuss several items mainly related to efforts to educate people across the state about single-payer health care. They talked about whether and how PNHP strategies might be applied in the state, how best to utilize the documentary “American Hospital,” and possibilities for an online book club. Several members have also committed to making calls to get lapsed members back into the organization. Even without in-person gatherings, the chapter continues to work on building power and advocating for fundamental health care reform in Missouri.

To get involved in Missouri, please contact Dr. Ed Weisbart at missouri@pnhp.org.

“American Hospitals,” the new documentary from business leader Richard Master, premieres this spring.

New Jersey

The New Jersey chapter, also known as the NJ Universal Health Care Coalition, conducted a poll in collaboration with the Rutgers University Eagleton Center for Public Interest Polling which found that 70% of New Jersey voters support Medicare for All. In addition, members of the chapter met with Congresswoman Mikie Sherill to express their strong opposition to the REACH program (part of a larger campaign of writing letters to all NJ legislators informing them of the issue). Dr. Lloyd Alterman also had a letter to the editor on ACO REACH published in the state’s largest paper, the Star Ledger.

To get involved in New Jersey, please contact Dr. Alterman at lloydalterman52@gmail.com. 

New York

In New York, PNHP-NY Metro Chapter is helping to build power through its inaugural cohort of the Universal Healthcare Legislative Advocacy Fellowship. This nine month program is intended for students and providers new to the movement, and focuses on building a set of advocacy and organizing skills that will enable them to become leaders in organizing efforts like the push for the NY Health Act. The chapter also held a picnic in Central Park to welcome new students to their programs and do outreach for the fellowship program as well as the Annual Meeting. Finally, the chapter is continuing to support the campaign against the city’s attempt to move retirees onto a Medicare Advantage plan – in particular, they have helped allies to develop strategic tools and institute an educational forum allowing a wide coalition of healthcare and labor groups to engage with the NY City Council.

To get involved in New York, please contact Mandy Strenz at mandy@pnhpnymetro.org.

Dr. Oli Fein (center) joins a rally in support of New York City retiree’s health benefits on Oct. 30.

North Carolina

In North Carolina, members of Health Care for All-NC wrote and distributed a Medicare-for-All Voter Guide designed to inform the state’s residents about whether candidates supported a universal single-payer health system. The information in this nonpartisan guide was gathered using a candidate questionnaire compiled by Dr. Jonathan Kotch, Jonathan Michels, and SNaHP member Emma Tayloe. By compelling representatives to take a stand on the issue and keeping voters informed, chapter members helped to advance the cause of single payer in the state.

To get involved in Health Care for All-NC, please contact Jonathan Michels at jonscottmichels@gmail.com. 

In Asheville, members of Health Care for All Western North Carolina (HCFA-WNC) threw a postcard party, mailing out over 100 postcards to help get out the vote in the area. The chapter also presented on “Why M4A” now to the retirement community of Givens Estates, and showed the PNHP video on ACO REACH to OLLI, an educational program series for retired citizens in the area. Members also participated in a Holiday Parade for Peace along with the Only One Earth Coalition.

To get involved in HCFA-WNC, please contact Terry Hash at theresamhash@gmail.com.

Members of Health Care for All Western North Carolina—including Dr. Steve Legeay (R) and Jeri Legeay—march in the Asheville Holiday Parade hosted by the One Earth Coalition on Nov. 19.

Health Care Justice NC in Charlotte has been gathering contact information and emailing legislative aides of all HR 1976 cosponsors, as well as Democratic members of the Energy & Commerce and Ways & Means Committees, to encourage them not to sign the annual letter circulated by the health insurance lobby expressing support of Medicare Advantage. The chapter also raised money that allowed five student leaders to attend the annual meeting in Boston last year. Finally, board member Zach Thomas composed, produced, and performed with other members in “Roll, Justice, Roll,” a new music video promoting Medicare for All with an emphasis on racial, gender, and other injustices.

To get involved in Health Care Justice NC, please contact Dr. George Bohmfalk at gbohmfalk@gmail.com. 

West Virginia

One of PNHP’s newest chapters, in West Virginia, continues its activities around membership, education, and collaboration. Recruiting new members continues to be a top priority, with the chapter conducting phone outreach to state members and participating in the national membership renewal drive. A website is under development, and monthly meetings continue to be held featuring speakers from across the organization and beyond. Lawmakers in the state have not been receptive to visits or letters, so PNHP-WV has organized several protests at their offices to make their voices heard in ways that cannot be ignored. Finally, the chapter continues to collaborate on occasion with other groups working on health care reform, such as the WV Citizen Action Group and the WV Health Care for All Coalition.

To get involved in West Virginia, please contact Dr. Daniel Doyle doyledan348@gmail.com.

Wisconsin

The PNHP chapter in Wisconsin held a get together for medical students at Hoyt Park in Madison, which drew 30 attendees. There, members discussed issues related to medical education, research, patient access to care, and health care disparities. The chapter also hosted a booth at the Wisconsin LaborFest in Madison to promote Medicare for All. Finally, the chapter interviewed 3 candidates for the Wisconsin Senate race to ascertain their views on health care and promote PNHP’s vision of Medicare for All to them.

To get involved in Wisconsin, please contact Dr. Timothy Shaw at wisconsin.pnhp@gmail.com.

PNHP Wisconsin members Dr. Laurel Mark (L), Dr. Mark Neumann (center), and Madrigal von Muchow (R) table at the Wisconsin LaborFest on Sept. 5.

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Protect Medicare Photo Petition

Medicare advocates have stood up by the thousands to demand the Biden administration end the REACH program—a transparent attempt to privatize Traditional Medicare that threatens the future of public health care in the U.S.

Nearly 20,000 have signed our online petition, and many have also submitting photo petitions. To submit your own photo petition, print this sign, take a selfie with it, and email your photo to lori@pnhp.org.

PNHP leaders use our photo petition sign to demand an end to the Medicare REACH program.

PNHP has posted more than 200 #StopREACH photo petitions to our social media channels, demonstrating widespread support for ending the program. Please share the following threads on your personal accounts!

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PNHP in the News

News items quoting PNHP members

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Op-eds by PNHP members

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Letters to the editor by PNHP members

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Celebrating 35 years of single-payer activism

Click HERE to volunteer for our 35th anniversary campaign!

Throughout 2023, PNHP members will work diligently to strengthen our membership, funding, and organizing power. We will build support for our student activists (the future of our movement); dig deep on our efforts to defeat Medicare privatization (an existential threat to public health care); and work to expand our circle of active physician members (a crucial part of the coalition we need to win).

Our efforts will culminate at the PNHP Annual Meeting in Atlanta on November 10-12, where we will convene with a much stronger and more formidable organization. Here are some of the ways YOU can volunteer to help make this vision a reality:

Set up a personal fundraising page

Personal fundraising pages are a great way to engage your colleagues, friends, family members, and neighbors in our 35th anniversary campaign. Click HERE to set up your page; if you have any questions, or would like one-on-one support, please email dixon@pnhp.org;

Additional actions you can take to strengthen PNHP during our 35th anniversary campaign:

  • Host a house party: See our planning toolkit for organizing your PNHP house party, as well as our communications toolkit for promoting your event. Questions? Reach out to lori@pnhp.org.
  • Submit a video story: Tell us who brought you into PNHP! Use Dr. Jonathon Ross’ terrific video as inspiration and submit your 60-90 second clip to dixon@pnhp.org;
  • Donate $35 (or $350 or $3,500…) in honor of 35 years. Thank you to the generous PNHP members who have already made substantial donations to our campaign fund!

Check back later this spring for a complete peer-to-peer fundraising toolkit, a complete house party toolkit, and additional materials related to our 35th anniversary campaign.

2022 Annual Meeting Materials

PNHP’s 2022 Annual Meeting in Boston drew physicians, students, health professionals, and advocates from across the country for our first in-person conference in three years. Please see below to access a selection of archival recordings, slideshows, and handouts from the meeting. To view photos from the meeting, visit our Flickr page.

During the conference, we encouraged PNHP members and supporters to post to social media using the hashtag #PNHP2022. Click here to read member tweets, and be sure to follow PNHP on Twitter and Facebook so you can continue sharing single-payer content in the future.

SNaHP Summit (Nov. 4)

Agenda & schedule for the SNaHP Summit

Pre-Summit Single-Payer 101: Why we need Medicare for All, presented by Susan Rogers, M.D., President, Physicians for a National Health Program

You are the next generation of single-payer organizers, presented by Sanjeev Sriram, M.D., M.P.H., National Board Member, Physicians for a National Health Program, (download slideshow here)

Welcome to the 2022 SNaHP Summit, presented by Robertha Barnes, Inclusivity & Outreach Co-Chair, Students for a National Health Program; and Ryan Parnell, Executive Board Member, Students for a National Health Program, (download slideshow here)

Communication & Messaging small group discussion, led by Edward Si, Executive Board Member, Students for a National Health Program; and Dixon Galvez-Searle, Communications Specialist, Physicians for a National Health Program, (download slideshow here and worksheet here; see below for video of NEOMED SNaHP student Emily Huff testifying before the Kent, Ohio City Council in support of Medicare for All)

Research small group discussion, led by Meghan Swyryn, Executive Board Member, Students for a National Health Program; Robertha Barnes, Inclusivity & Outreach Co-Chair, Students for a National Health Program; and Gaurav Kalwani, Communications Specialist, Physicians for a National Health Program, (download slideshow here)

Direct Action & Allies small group discussion, led by Samuel Lee and Ryan Parnell, Executive Board Members, Students for a National Health Program, (download slideshow here)

Resolutions small group discussion, led by Donald Bourne, M.P.H., Executive Board Member, Students for a National Health Program; and Kaytlin Gilbert, National Organizer, Physicians for a National Health Program, (download discussion outline here)

Union organizing—Residency and beyond, presented by Andy Hyatt, M.D., Board Adviser, Physicians for a National Health Program; and Meghan Swyryn, Executive Board Member, Students for a National Health Program, (download slideshow here)

Committee and Interns and Residents stands with SNaHP, including messages of support from Michael Zingman, M.D., M.P.H., Secretary-Treasurer, CIR/SEIU and former Executive Board Member, Students for a National Health Program; and Lorenzo A. González, M.D., M.P.L., President, CIR/SEIU

🎵 Solidarity Forever 🎵

Leadership Training (Nov. 4)

Agenda & schedule for the Leadership Training

Where PNHP has come from, presented by Susan Rogers, M.D., President, Physicians for a National Health Program

Answering difficult questions, discussion led by Sanjeev Sriram, M.D., M.P.H., National Board Member, Physicians for a National Health Program; and Winnie Lin, M.D., Co-Organizer, Physicians for a National Health Program—Illinois Chapter

Annual Meeting (Nov. 5)

Agenda & schedule for the Annual Meeting

Health Policy Update, presented by Adam Gaffney, M.D., M.P.H., Immediate Past President, Physicians for a National Health Program; and Donald Bourne, M.P.H,, Executive Board Member, Students for a National Health Program, (Dr. Gaffney slideshow—with alternate visuals by Dr. Ed Weisbart—here; Donald Bourne slideshow here)

Keynote: The Privatization of Everything, presented by Donald Cohen, Executive Director of In the Public Interest and co-author of The Privatization of Everything

#StopREACH and all attempts to privatize Medicare, presented by Oli Fein, M.D., Chair, Executive Committee, Physicians for a National Health Program, NY Metro Chapter

Opportunities for federal action, presented by Rachel Madley, Ph.D., Legislative Assistant to Rep. Pramila Jayapal; Alex Lawson, M.P.P., Executive Director, Social Security Works, (ask your rep. to co-sponsor Medicare for All here)

Lessons from Covid-19 in caring for the underserved, presented by Nicte Mejia, M.D., M.P.H.; and Claudia Fegan, M.D., National Coordinator, Physicians for a National Health Program, (download slideshow here)

Building business support for single payer, presented by Wendell Potter, Health insurance industry whistleblower and former VP, Cigna, (download slideshow here)

Saving the VA from privatization, presented by Suzanne Gordon, health care journalist and author of Our Veterans: Winners, Losers, Friends and Enemies on the New Terrain of Veterans Affairs, (download slideshow here)

Building alliances: Lessons from the New York Health Act, presented by Judith Esterquest, Ph.D., Board Member, Physicians for a National Health Program, NY Metro Chapter; Morgan Moore, Executive Director, Physicians for a National Health Program, NY Metro Chapter; and Mandy Strenz, Chapter Coordinator, Physicians for a National Health Program, NY Metro Chapter, (download slideshow here)

Medicare Advantage: What single payer advocates need to know, presented by Ed Weisbart, M.D., National Board Member, Physicians for a National Health Program, (download slideshow here)

Reproductive rights in a post-Roe era, presented by Diljeet Singh, M.D., Dr.P.H., National Board Member, Physicians for a National Health Program; Judith Albert, M.D., National Board Member, Physicians for a National Health Program; and Ashley Duhon, M.D., Board Adviser, Physicians for a National Health Program, (download slideshow here)

PNHP’s resolutions campaign, presented by Donald Bourne, M.P.H., Executive Board Member, Students for a National Health Program; Max Brockwell, NEOMED SNaHP; and Michael Kaplan, M.D., Chair, AAFP Single Payer Member Interest Group, (download slideshow here)

Ensuring vaccine equity, presented by Aparna Nair-Kanneganti, (download slideshow here)

Organizing physicians through unionization presented by Andy Hyatt, M.D., Board Adviser, Physicians for a National Health Program; and A. Taylor Walker, M.D., M.P.H., Regional VP, Committee of Interns and Residents, (download slideshow here)

Keynote: The Hidden Toll of Racism on American Lives and on the Health of Our Nation, presented by Linda Villarosa, contributor to The New York Times’ 1619 Project and author of Under the Skin: The Hidden Toll of Racism on American Lives and the Health of Our Nation, (download slideshow here; alternate video recording here)

Health activist awards

Dr. Quentin Young Health Activist Award, presented to Henry Kahn, M.D., Founding Member, Physicians for a National Health Program by Karen Hochman, M.D., Co-Chair, Physicians for a National Health Program—Georgia Chapter

Dr. Quentin Young Health Activist Award, presented to Eve Shapiro, M.D., M.P.H., National Board Member, Physicians for a National Health Program by Claudia Fegan, M.D., National Coordinator, Physicians for a National Health Program

Nicholas Skala Student Activist Award, presented to Edward Si, Executive Board Member, Students for a National Health Program by Ed Weisbart, M.D., National Board Member, Physicians for a National Health Program

🎵 Roll, Justice, Roll 🎵

Next steps for PNHP

PNHP president-elect Phil Verhoef, M.D., Ph.D., concluded the conference by leading a discussion on the four pillars of activism that our Board of Directors has identified for the coming year. Please fill out our Call to Action form to signal your commitment to one of these pillars in 2023. You may also:

  • Contact Ed Weisbart, M.D. at edweisbart@gmail.com to get involved with “legislative advocacy and chapter development”
  • Contact Sanjeev Sriram, M.D., M.P.H. at jeevs25@gmail.com to get involved with “building a narrative against the health care profiteers”
  • Contact Mary O’Brien, M.D. at maryeobrien318@gmail.com to get involved with “building alliances”
  • Contact Donald Bourne, M.P.H. at Bourne.Donald@medstudent.pitt.edu to get involved with “organizing doctors in medical societies”

Give us your feedback

If you attended the 2022 Annual Meeting, Leadership Training, and/or SNaHP Summit, please fill out your evaluation(s) if you have not already done so. Your feedback will help us make next year’s conference even better for our members, our supporters, and our movement.

  • SNaHP Summit evaluation HERE
  • Leadership Training evaluation HERE
  • Annual Meeting evaluation HERE

If you have additional feedback, please email organizer@pnhp.org.

2022 Annual Meeting & SNaHP Summit Evaluations

Thank you for attending PNHP’s 2022 Annual Meeting, Leadership Training, and/or SNaHP Summit. Please complete the relevant evaluations below, based on which sessions you attended.

If you have additional feedback, please email organizer@pnhp.org.

  • SNaHP Summit evaluation HERE
  • Leadership Training evaluation HERE
  • Annual Meeting evaluation HERE

PNHP Newsletter: Fall 2022

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

Research Roundup

PNHP Chapter Reports

PNHP in the News

PNHP News and Tools for Advocates

PNHP’s in-person Annual Meeting returns, Nov. 4-5 in Boston

After two years of meeting virtually, PNHP members and allies will once again gather in-person for our Annual Meeting and Leadership Training. This year’s conference, themed “Brick by Brick: Building the Movement for Medicare for All,” will take place Nov. 4-5 at the Boston Park Plaza.

Our keynote speakers for Boston will address some of the most far-reaching and pressing issues facing the Medicare-for-All movement. Linda Villarosa, contributor to The New York Times’ 1619 Project and author of the just-published Under the Skin: The Hidden Toll of Racism on American Lives and the Health of Our Nation will discuss the necessity of confronting systemic racism as part of any effort to achieve health justice, and Donald Cohen, co-author of The Privatization of Everything, will discuss the profiteering that threatens Medicare and Medicaid alongside every other public good in the United States.

L to R: Annual Meeting keynote speakers Linda Villarosa and Donald Cohen, PNHP president-elect Dr. Philip Verhoef, and PNHP president Dr. Susan Rogers

PNHP is also thrilled to be hosting the Students for a National Health Program (SNaHP) Summit on Nov. 4, immediately preceding this year’s Leadership Training. Typically held in the spring, the SNaHP Summit is a chance for medical and health professional students to meet like-minded colleagues, strategize for the year ahead, and organize around tangible goals that advance the single-payer movement, both inside and outside of their institutions.

It’s been three long years since PNHP members have been able to gather in-person for an Annual Meeting. In that time, the work of our movement has become more urgent than ever; please join us as we engage in a long overdue weekend of learning, connecting, and strategizing for our shared goal: single-payer Medicare for All.

Online pre-registration is open through Sunday, October 30 at pnhp.org/meeting.

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Annual Meeting Covid-19 protocols

PNHP’s Board of Directors and medical experts have established Covid safety protocols for the Annual Meeting that include a surgical facemask requirement while not actively eating or drinking; proof of vaccine within the last 5 months (physical card, photo, or electronic record is fine); and proof of a negative Covid test (time-stamped photo of a rapid antigen test is fine) taken within 24 hours of the Summit.

In addition, while the conference includes meals, times designated for food service will not contain programming so that participants can eat away from the main conference room should they choose.

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Why single-payer advocates and VHA defenders must join forces

Healthcare journalist Suzanne Gordon

By Suzanne Gordon

It’s no surprise to PNHP members that the same vested interests opposed to Medicare for All want to undermine the Veterans Health Administration (VHA), our largest public health care system.

Run by the Department of Veterans Affairs (VA), the VHA is our best working model of socialized medicine. VHA care-givers are not a collection of physician practices or specialty services reimbursed by private insurers, Medicare, or Medicaid on a “fee for service” basis. All VHA doctors, nurses, therapists, and other personnel are salaried, like members of the UK National Health Service.

VHA staff provide high-quality care to nine million patients that is better coordinated and more cost effective than in the private sector. The VHA plays a major “teaching hospital” role in training thousands of new doctors, nurses, and other health care professionals. It doesn’t compete with other hospital chains by spending huge sums on advertising and marketing.

In 2018, corporate Democrats and conservative Republicans took a sledge hammer to the VHA when they passed the VA MISSION Act. As implemented by Donald Trump and now Joe Biden, this legislation has siphoned billions of dollars away from the VHA’s direct care budget and steered that money toward private doctors and for-profit hospitals often less well prepared to treat veterans.

The VHA has been partially converted into a Medicare-style payer of bills submitted by other health care providers. The powerful private interests that have acquired this new $30 billion a year federal revenue stream want to preserve and expand it—just like operators of Medicare Advantage plans and newly minted ACO REACH entities hope to profit from further diversion of seniors from traditional Medicare.

The community-labor campaign to save the VHA from further privatization and the PNHP-led resistance to Medicare profiteering relies on many of the same allies and faces common adversaries. They are parallel struggles in the same fight to build on what’s best in American health care—and we’ll all have a better chance of winning if we work more closely together.

Healthcare journalist Suzanne Gordon is a longtime PNHP supporter and co-founder of the Veterans Healthcare Policy Institute. She will lead a workshop on protecting the VHA from profteers at the PNHP Annual Meeting on Nov. 5. Her new book is called “Our Veterans: Winners, Losers, Friends and Enemies on the New Terrain of Veterans Affairs” from Duke University Press.

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Responding to attacks on abortion access across the U.S.

When the U.S. Supreme Court issued its ruling in Dobbs v. Jackson Women’s Health Organization earlier this summer, overturning nearly 50 years of federal abortion protections, it prompted a wave of shock, anger, grief and, ultimately, organizing among Americans who care deeply about reproductive justice.

Against this backdrop, PNHP board advisers Drs. Diljeet Singh and Ashley Duhon, along with PNHP national board member Dr. Judith Albert, are planning a workshop for the Nov. 5 Annual Meeting in Boston. Their goal is to brainstorm appropriate responses to this severe curtailing of abortion access, seek ways to support patients and frontline providers, and amplify the work of abortion rights activists both inside and outside of the medical profession. Focusing intently on reproductive justice is both crucial and long overdue.

“We do not always focus on how equity is one of the important principles of single payer,” says Dr. Singh. “Now we have no choice but to talk about it and to rally around it.”

To read PNHP’s statement in response to the Dobbs decision, visit pnhp.org/AbortionStatement. To connect with fellow reproductive justice activists within PNHP, contact Dr. Singh at diljeetksingh@gmail.com.

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Pediatricians organize for single payer within their medical society

At last year’s virtual Annual Meeting, PNHP launched a series of Member Interest Groups (MIGs) based on medical specialties, lived experiences, and areas of interest. One of these groups, our Pediatrics MIG, is planning to ramp up their activism with an in-person meeting in Boston on Nov. 5. At the top of their agenda will be organizing within the American Academy of Pediatrics as part of PNHP’s ongoing Medical Society Resolutions campaign.

“There are a lot of pediatricians within PNHP, but the Academy has been resistant to anything on single payer,” says Dr. Eve Shapiro, a PNHP national board member who is active within the MIG. Dr. Shapiro envisions brainstorming with her colleagues in Boston to better understand roadblocks within the Academy, organize a sign-on letter for pediatricians and, ultimately, win passage of a single-payer resolution.

“Seeing large medical organizations saying Medicare for All is a good idea is powerful,” she says. “It can move the issue forward.”

To get involved with the Pediatrics MIG, contact Dr. Shapiro at evecshapiro@gmail.com. For questions about other MIGs, contact Kaytlin Gilbert at kaytlin@pnhp.org. To learn more about organizing within medical societies, contact Lori Clark at lori@pnhp.org.

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Meet Lori Clark, PNHP National Organizer

Previous Experience: At the Jane Addams Senior Caucus, I built a powerful base of leaders who were bonded not by candidates or party, but by a vision for a better future.

What drew you to PNHP? I wanted to join an organization that was interested in investing in the development of its members, building power, and developing a roadmap to take back control of our health care system from big corporations and the insurance industry.

What are you looking forward to working on over the next 12 months? I am looking forward to working together to create a new organizing model that grows PNHP’s collective power, and helping to develop a strategic roadmap that advances the single-payer movement.

What’s a fun fact about yourself? I lived in an apartment for over a year before I knew that the oven did not work.

Connect with Lori at lori@pnhp.org.

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Meet Gaurav Kalwani, PNHP Communications Specialist

Previous Experience: I previously worked in nuclear and cyber policy research at the Carnegie Endowment for International Peace in Washington, D.C.

What drew you to PNHP? As a progressive, I believe that implementing Medicare for All is the best way to fix our country’s deeply flawed health care system. I myself come from a family of doctors, so I’ve always had an appreciation for their leadership and impact in the communities they serve, and I know that if they advocate for single payer, people will listen.

What are you looking forward to working on over the next 12 months? I’m most looking forward to working on our campaign to stop the privatization of Medicare, as well as planning for our annual meeting in November!

What’s a fun fact about yourself? Every year, I go to a documentary film festival in Columbia, Mo. known as True/False.

Connect with Gaurav at gaurav@pnhp.org.

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Research Roundup

Data Update: Health Care Crisis by the Numbers

Barriers to Care

98 million skipped care or cut back on basic needs: Health care costs pushed 38% of American adults to delay or skip health care, cut back on driving, utilities or food, or borrow money to pay for medical bills in the first half of 2022, including 26% who only delayed or avoided care. Lower-income households were hit hardest, with 62% making cutbacks. But high income households were not immune, with 19% of households making at least $180,000 cutting back. “Estimated 98 Million Americans Skipped Treatments, Cut Back on Food, Gas or Utilities to Pay for Healthcare,” West Health-Gallup, 8/4/2022

Americans with serious illness unable to get care: Among households where a member has been seriously ill in the past year, 19% report they delayed care or were unable to get care when they needed it, including 24% of Black households. Lack of health insurance was not the primary factor: more than 80% reported having health insurance. Black respondents reported greater rates of poor treatment, with 15% saying they were disrespected, turned away, unfairly treated, or received poor treatment because of their race or ethnicity, compared with 3% of white respondents. “Personal Experiences of U.S. Racial/Ethnic Minorities in Today’s Difficult Times,” NPR-Robert Wood Johnson Foundation-Harvard T.H. Chan School of Public Health, August 2022

Older adults skip basics to pay for health care: Americans aged 50 and older report forgoing needed treatments because of the cost of care, including 26% of adults age 50 to 64 and 12% of adults 65 and older. Similarly, 18% of people 50 to 64 and 11% of people 65 and older report skipping medication to save money. Large majorities of older adults say health care costs are a major or minor burden, including 72% of people age 50 to 64 (24% major burden, 48% minor burden) and 66% of people 65 and older (15% major burden, 51% minor burden). Willcoxon, “Older Adults Sacrificing Basic Needs Due to Healthcare Costs,” Gallup, 6/15/2022

Insurance is third greatest living expense: Health insurance premiums account for 10.69% of an average U.S. salary, costing $6,487.20. This was the highest living expense after rent and childcare. Health insurance costs relative to salary vary by geography: in four states, insurance costs average at 15% of salary or more, including West Virginia at 20.9%. “Salary vs Health Insurance,” NiceTX, July 2022

Majority of U.S. adults had medical debt in past 5 years: A Kaiser Family Foundation survey finds 41% of adults currently have debt due to medical or dental bills, and an additional 16% have had medical or dental debt in the past five years that has since been paid off. Among subgroups reporting current medical debt are 56% of Black adults, 50% of Hispanic adults, 26% of households earning $90,000 or more, and 22% of adults age 65 and older. Medical debt is less common in states that expanded Medicaid (39%) than in states that did not (47%). Medical debt also forces households to change their behaviors, with 63% of adults with medical debt saying they cut back on spending for food or other basic household items, 40% who took an extra job or worked more hours, and 28% who delayed a home purchase or education for a member of their household. Lopes et al., “Health Care Debt in the U.S.: The Broad Consequences of Medical and Dental Bills,” Kaiser Family Foundation, 6/16/2022

Even the best U.S. states are outpaced by peer countries: A Commonwealth Fund analysis finds that Americans – regardless where they live – have lower life expectancy and greater incidence of avoidable mortality than other middle- and high-income countries. The U.S. ranked 31st among 38 peer countries on life expectancy at birth (78.8 years in 2019) and avoidable deaths before age 75 (272 per 100,000). State level analysis shows that even the states with the best outcomes are below average compared with peer countries, and the states with the lowest life expectancies and highest rates of avoidable deaths have worse outcomes than the worst-ranked peer countries. Radley et al., “Americans, No Matter the State They Live in, Die Younger Than People in Many Other Countries,” To the Point (blog), Commonwealth Fund, 8/11/2022

U.S. spends heavily on cancer care, gets middling outcomes: Among 22 high-income countries, the U.S. has the highest spending on cancer care – over $200 billion in 2020, or $584 per person – yet overall cancer mortality is only slightly better than average. Median per capita spending among the 22 countries was $296. After adjustments for smoking rates, U.S. cancer mortality was higher than nine other countries, and researchers found no association between cancer care expenditures and cancer mortality. Chow et al., “Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries,” JAMA Health Forum, 5/27/22

U.S. men report poorer health, more cost-related access problems: A survey of men in 11 high-income countries shows U.S. men have the highest rates of avoidable deaths (337 per 100,000 vs. 156-233), multiple chronic conditions (29% vs. 17-25%), and hypertension (37% vs. 20-28%).The U.S. was tied with Switzerland for having the highest out-of-pocket health spending, with 33% reporting having out-of-pocket costs of $2,000 or more, and 37% reporting cost-related access problems, compared with 7% to 25% in other countries. U.S. men were second behind Australia for having mental health needs, and second behind Sweden for not having a regular doctor or place of care. Only 37% of U.S. men rate their country’s health care system as “good” or “very good” compared with 60% to 88% of men in other countries. Gunja et al., “Are Financial Barriers Affecting the Health Care Habits of American Men?” Commonwealth Fund, 7/14/2022

Diabetics face catastrophic insulin costs: Among the 7 million Americans who use daily insulin, 14.1% spent more than 40% of their post-subsistence income (after food and housing) on insulin, considered a “catastrophic” level. Patients with private insurance or no insurance paid the most out of pocket, while Medicaid beneficiaries were 61% less likely to have catastrophic spending. Bakkila et al., “Catastrophic Spending on Insulin in the United States, 2017-18,” Health Affairs, July 2022

Majority of hepatitis C patients don’t get curative treatment: Despite having a treatment that cures more than 95% of patients with hepatitis C, less than one-third of infected people with insurance get the treatment. The lowest rates of treatment were among adults aged 18-29 and Medicaid recipients. Among Medicaid patients, treatment rates were lower for Black patients and in programs with treatment restrictions. Coverage restrictions can include preauthorization requirements, clinical or social eligibility restrictions, or medical specialist prescribing. Prevalence of treatment within 360 days of a positive test were 23% for patients with Medicaid, 28% with Medicare, and 35% with private insurance. Thompson et al., “Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019-2020,” Centers for Disease Control and Prevention MMWR, 8/12/2022

Childbirth is costly despite insurance: Health care costs for women who give birth average $18,865 more than for women who do not give birth, including $2,854 more in out of pocket expenses. The analysis of women in large group health plans estimated the health costs associated with pregnancy, delivery, and postpartum care. Rae et al., “Health costs associated with pregnancy, childbirth, and postpartum care,” Peterson-Kaiser Family Foundation Health System Tracker, 7/13/2022

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Health Inequities

Physician face time increases, but disparities grow: Over the past 40 years, the amount of time patients spend annually with outpatient physicians increased to 60.4 minutes in 2018, up from 40 minutes in 1978, mainly due to an increase in average visit duration (15.4 minutes to 22.2 minutes). Time with primary care physicians fell, however, from 33.8 minutes to 30.4 minutes – owing to fewer primary care visits – while time spent with surgeons and medical specialists increased (12.1 to 12.6 minutes with surgeons, 15.4 to 17.4 minutes with medical specialists). While face time increased among all racial and ethnic groups, white patients continue to get more physician time than their Black and Hispanic counterparts. The white-Black gap increased from 13.1 to 22.9 minutes, while the white-Hispanic gap rose from 11.6 to 14.7 minutes. White patients spent significantly less time with specialists than their Black and Hispanic counterparts. Gaffney et al., “Trends and Disparities in the Distribution of Outpatient Physicians’ Annual Face Time with Patients, 1979-2018,” Journal of General Internal Medicine, 6/6/2022

Disparities, barriers persist despite insurance: Black patients enrolled in employer-sponsored commercial insurance are more likely to be burdened by chronic diseases, experience barriers to care, and have unmet social needs according to a study sponsored by Morgan Health, a JP Morgan Chase & Co. initiative. Black enrollees are 15.6 percentage points more likely than white enrollees to have uncontrolled high blood pressure and 5.3 percentage points more likely to have diabetes, after adjusting for age and sex. Black enrollees were 4.9 percentage points more likely to visit an emergency department and were 9.8 percentage points more likely to be food insecure. “Health Disparities in Employer-Sponsored Insurance,” Morgan Health and NORC, July 2022

More Black patients, less reimbursement: An analysis of Medicare data shows hospitals serving a disproportionate share of Black patients receive 21.6% lower payments for patient care per day than other hospitals. Hospitals serving Black patients averaged a loss of $17 per patient day versus an average profit of $126 at other hospitals. After adjusting for patient case mix and hospital characteristics, Black-serving hospitals still received $238 less in revenue per patient day than other hospitals, and $111 less in profits. Researchers estimate $14 billion would have been required to equalize reimbursement levels at Black-serving hospitals in 2018. Himmelstein et al., “Hospitals that Serve Many Black Patients Have Lower Revenues and Profits: Structural Racism in Hospital Financing,” Journal of General Internal Medicine, 8/5/2022

Medicaid utilization lower among Black patients: Medicaid spends an average of $317 less on Black enrollees than their white counterparts after adjusting for demographics, health status, and source of care. Black enrollees had fewer primary care encounters than white enrollees (19.3 fewer per 100 enrollees annually) but more emergency department visits (9.5 more per 100 enrollees). Among children, Black enrollees had 90.1 fewer primary care encounters per 100 enrollees. Wallace et al., “Disparities in Health Care Spending and Utilization Among Black and White Medicaid Enrollees,” JAMA Health Forum, 6/10/2022

Early Covid vaccine rollout plagued by disparities: U.S. health care facilities in counties with a high proportion of Black residents were less likely to receive Covid-19 vaccines in May 2021. Facilities in counties with at least 42.2% Black residents were less likely to administer Covid vaccines than facilities in counties with less than 12.5% Black residents. In urban areas, counties with large Black populations were 32% less likely to provide vaccinations than urban counties with low Black populations. Researchers also found facilities in rural counties and counties in the top quintile of Covid mortality were also less likely to administer Covid vaccines. In rural counties with large Hispanic populations, facilities were 26% less likely to administer vaccines than in rural counties with low Hispanic populations. Hernandez et al., “Disparities in distribution of COVID-19 vaccines across US counties: A geographic information system-based cross-sectional study,” PLOS Medicine, 7/28/2022

Disparities in monkeypox infections, vaccinations: Early data indicates racial disparities in monkeypox infections, unaddressed by vaccination. As of the end of July, 26% of known monkeypox cases were among Blacks and 32% were among Hispanics. Vaccinations have gone to whites, including 55% of vaccine recipients in Chicago and 63.5% in Washington, D.C. Black people are disproportionately diagnosed with monkeypox in North Carolina (70%) but only 22% of vaccine doses have gone to Black men, approximately mirroring the state’s population. In Georgia, 71% of cases have been among Black men, while only 44.5% of people vaccinated were Black. Johnson et al., “White People Get Bigger Share of Monkeypox Shots, Early Data Show,” Bloomberg, 8/11/2022; McFarling et al., “New data from several states show racial disparities in monkeypox infections,” STAT News, 8/11/2022; Pratt, “Racial disparities revealed in monkeypox vaccination data,” Atlanta Journal-Constitution, 8/18/2022

Disparities in drug overdose deaths: Deaths from unintentional or undetermined overdose increased by 44% among Black people compared with 22% for white people in 2020, Black incidence of death rose from 27 deaths per 100,000 people to 38.9 versus an increase from 25.2 to 30.7 for whites. Death rates also increased for American Indian or Alaska Native people by 39% (from 26.2 to 36.4) and 21% among Hispanics (17.3 to 21). Black youths age 15 to 24 saw an 86% increase in overdose deaths, the largest increase of any age or racial group. Black men 65 and older were nearly seven times as likely as white men to die from an overdose. At the same time, Black people were less than half as likely as white people to have received substance use treatment. Kariisa et al., “Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019-2020,” Centers for Disease Control and Prevention MMWR, 7/19/2022

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Coverage Matters

Single Payer could have saved thousands of lives: Single-payer health care could have prevented 338,594 Covid-19 deaths in the U.S. from the beginning of the public health emergency to mid-March 2022. Researchers estimate that if everyone in the country was provided with comprehensive care for free at the point of service, 131,438 people who died from Covid-19 could have been spared in 2020 alone, and roughly 80,000 people with other diseases could have been saved that year. More than 207,000 additional Covid-19 deaths could have been averted in 2021 and the first three months of this year. The U.S. also could have saved $105.6 billion in health care costs associated with hospitalizations from the disease—on top of the estimated $438 billion that could be saved in a non-pandemic year. Galvani et al., “Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic,” PNAS, 6/13/22

More non-Covid deaths in states with greater uninsurance: The White House Council of Economic Advisors found that states with high uninsurance rates had more non-Covid “excess deaths” during the first two years of the pandemic. They estimate that each 10 percentage point increase in a state’s uninsurance rate was associated with a 4.8 percentage point increase in excess deaths. “Excess Mortality during the Pandemic: The Role of Health Insurance,” White House Council of Economic Advisors, 7/12/2022

Uninsurance associated with late-stage cancer diagnosis, lower survival: A new study shows that people without insurance are significantly more likely to be diagnosed with late-stage cancers and face lower survival rates than their insured peers. The difference was particularly marked for six cancers – prostate, colon, non-Hodgkin lymphoma, oral cavity, liver, and esophagus – where uninsured individuals diagnosed with stage 1 disease fared worse than insured people diagnosed with stage 2 disease. The analysis suggested that people without health insurance were more likely to postpone doctor visits, resulting in a late-stage diagnosis, the researchers said. But people without health insurance coverage were also more likely to have worse short- and long-term survival rates after diagnosis. Uninsured individuals fared worse within each stage for all of the 19 cancers combined. Zhao et al., “Health insurance status and cancer stage at diagnosis and survival in the United States,” CA: A Cancer Journal for Clinicians, 7/13/2022

Suicide deaths rose less in states that expanded Medicaid: Suicide is the 10th leading cause of death in the U.S. and the second leading cause of death in people age 10 to 34. Suicides have been steadily increasing since 1999, with a mean increase of 1% per year from 1999 to 2006 and 2% per year from 2006 to 2018. However, researchers found that death by suicide increased less in states that expanded Medicaid coverage, suggesting the blunting of rising suicide rates among adults age 20 to 64 could be linked to better access to mental health care. Patel et al., “Association of State Medicaid Expansion Status with Rates of Suicide Among US Adults,” JAMA Network Open, 6/15/2022

Paid sick leave tied to fewer ER visits: From 2011 through 2019, in states that put paid sick leave policies in place, ED visits fell 5.6% — or about 23 fewer visits per 1,000 people per year. The biggest drops came from Medicaid patients, with big declines in visits that could have been handled in primary care: for adults, dental problems, mental health issues, and substance use disorder; and for kids, asthma. Ma et al., “State Mandatory Paid Sick Leave Associated with a Decline in Emergency Department Use in the US, 2011-19,” Health Affairs, August 2022

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Commercial Insurance: A Hazardous Product

ACA insurers deny nearly one in five claims, but won’t tell patients why: ACA Marketplace insurers denied, on average, nearly one-fifth (18%) of in-network claims. And for 72% of denials, the explanation that insurers offered was “all other reasons.” As a result, for nearly three-quarters of all denied non-group qualified health plan claims, the reason is unclear. Denial rates vary by state: Mississippi and Indiana patients experienced the highest denial rates; insurers there denied 29% of all in-network claims. Only 1% of ACA Marketplace plan enrollees appealed their denied claims, and of those, nearly two-thirds (63%) were still denied coverage at the end of the appeal process. Pollitz et al., “Claims Denials and Appeals in ACA Marketplace Plans in 2020,” Kaiser Family Foundation, 7/05/2022

U.S. administrative costs once again prove high: Billing and insurance-related costs for inpatient bills ranged from $6 in Canada to $215 in the U.S., according to a microlevel accounting study of 5 nations. Australia, which has a mix of public and private payers, was similar to the U.S. The other nations included in the study were Germany, the Netherlands, and Singapore. Richman et al., “Billing and Insurance-Related Administrative Costs: A Cross-National Analysis,” Health Affairs, August 2022

Blues not paying taxes: A dozen Blue Cross Blue Shield (BCBS) insurers have not paid any net federal taxes since 2017 when Congress repealed the alternative minimum tax, while the government has refunded $6.6 billion to those insurers. Meanwhile, a federal judge approved a $2.67 billion antitrust settlement against 34 BCBS plans. Herman, “Many Blue Cross Blue Shield plans aren’t paying taxes — and instead are swimming in refunds,” STAT News, 6/15/2022; Tepper, “Judge approves Blue Cross Blue Shield $2.67B antitrust settlement,” Modern Healthcare, 8/9/2022

Cigna profits up: Cigna’s net income rose 6.2% to $1.5 billion for the second quarter of 2022, driving the company’s medical loss ratio (MLR) to 80.7%, compared with 84.4% for the same period in 2021. Reduced emergency department and surgery utilization drove the decline in spending, while Cigna also repriced its government-sponsored business to lower its MLR. Tepper, “Low medical spending drove Cigna’s quarterly profit,” Modern Healthcare, 8/4/22

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Privatizing Medicare and Medicaid

Diabetes patients in Medicare Advantage plans have worse health: Type 2 diabetes patients on Medicare Advantage (MA) plans are more likely to have worse health than those in Traditional Medicare (TM), with MA patients having statistically significant higher systolic blood pressure (+0.2 mmHg) and worse blood glucose control (+0.1% A1C). While MA patients were more likely to receive preventive treatment, they were less than likely than TM patients to receive newer, more expensive treatments like SGLT2 inhibitors (5.4% in MA vs. 6.7% in TM) and GLP-1 receptor agonists (6.9% in MA vs. 9.0% in TM). Essein et al., “Diabetes Care Among Older Adults Enrolled in Medicare Advantage Versus Traditional Medicare Fee-For-Service Plans: The Diabetes Collaborative Registry,” Diabetes Care, 7/6/2022

Blues expand their Medicare Advantage market: Health Care Service Corp. (HCSC) plans its largest expansion ever into Medicare Advantage (MA). HCSC – which sells Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas – plans to expand its MA business into 150 new counties for 2023. The previous year, HCSC’s MA plans expanded to 90 new counties, increasing membership by 10,000. Tepper, “HCSC doubles down on Medicare Advantage as market share declines,” Modern Healthcare, 8/3/2022

Phantom docs pervade Medicaid managed care: Only one-third of mental health prescribers listed in Oregon’s Medicaid directories provided care to Medicaid patients in 2018. Nearly six in ten providers (58.2%) in network directory listings were “phantom” providers who did not see Medicaid patients, including 67.4% of mental health prescribers. Zhu et al., “Phantom Networks: Discrepancies Between Reported and Realized Mental Health Care Access in Oregon Medicaid,” Health Affairs, July 2022

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Health Care for Profit

NHS outsourcing associated with more deaths: Outsourcing in the U.K.’s National Health Service to private, for-profit providers corresponds with an increase in treatable mortality and a decline in the quality of care, resulting in an additional 557 deaths between 2014 and 2020. From 2013 to 2020, outsourcing grew from 3.9% to 6.4%, with £11.5 billion given to private companies. Each 1% annual increase in outsourcing spending was associated with a 0.38% increase in treatable mortality (0.29 deaths per 100,000). Goodair & Reeves, “Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013-20: An observational study of NHS privatisation,” The Lancet Public Health, July 2022

Health industry profits set to increase: McKinsey & Company estimates health care earnings will rise by 6% each year between 2021 and 2025, resulting in $31 billion in profits for the health industry. Increased profits are expected to come from government programs like Medicare Advantage and Medicaid managed care, and increased demand for non-acute care. Meanwhile, HCA Healthcare told investors they expect to pass along rising costs to commercial insurers through price negotiations, while UnitedHealth Group indicated receptiveness to higher prices. Singhal & Patel, “The future of US healthcare: What’s next for the industry post-COVID-19,” McKinsey & Company, 7/19/2022; Muoio, “Health Systems Confident Payers Will Concede Higher 2023 Rates,” Fierce Healthcare, 7/29/2022

CEOs cash in: The chief executives of approximately 300 health care companies reaped $4.5 billion in 2021, with an average CEO receiving $15.3 million, according to a STAT analysis. The highest paid CEOs usually come from pharmaceutical and medical device companies. Regeneron CEO Leonard Schleifer took in $453 million, or 10% of the total. Salaries make up less than 6% of pay, while realized gains of stock awards compose the greatest portion of pay packages. By comparison, average U.S. household income is $67,000. The $4.5 billion total could provide health insurance to 580,000 individuals for one year. Herman et al., “Health care’s high rollers: As the pandemic raged, CEOs’ earnings surged,” STAT News, 7/18/2022

ED facility fees higher at for-profit hospitals: High-acuity self-pay patients who visited for-profit emergency departments (EDs) were charged an average of $1,218 more than similar patients at non-profit EDs in 2021. Higher facility fees were also charged at hospitals with more than 250 beds (by $826) and system-affiliated EDs (by $311). EDs in high-poverty areas charged $450 less, on average, than EDs in affluent communities. Henderson & Mouslim, “Hospital and Regional Characteristics Associated with Emergency Department Facility Fee Cash Pricing,” Health Affairs, July 2022

Amazon continues foray into health care: Tech giant Amazon will acquire boutique primary care chain One Medical for $3.9 billion. One Medical has 767,000 enrolled patients. Amazon’s health care business includes a virtual and in-home urgent care service and an online pharmacy. Amazon previously acquired PillPack for $753 million in 2018 to jump start its pharmacy business. Lerman & Shaban, “Amazon will see you now: Tech giant buys health-care chain for $3.9 billion,” Washington Post, 7/21/2022

Private Equity draws attention for foray into hospice and autism care: Private Equity (PE) ownership of hospice agencies increased from 106 (3.4% of total hospices) in 2011 to 409 (7.3%) in 2019. Nonprofits represented 72% of hospices acquired by PE in that time. PE is also entering the child autism therapy business, alarming parents, clinicians, and experts. They say PE investments in Applied Behavior Analysis therapy has degraded the quality of service, turning it into “fast food therapy” that could even be harmful for children. Hawryluk, “Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care,” Kaiser Health News, 7/29/2022; Bannow, “Parents and clinicians say private equity’s profit fixation is short-changing kids with autism,” STAT News, 8/15/2022

Unions growing among younger physicians: Coinciding with an increase in union organizing nationally, the Committee of Interns and Residents reports its membership has grown by 37.5% since 2019, adding 6,000 new members to bring its current membership to 22,000. Over the past two years, the Union of American Physicians and Dentists has grown by 9.9% and now represents 5,000 professionals. Organizers say the growth is driven by concern over personal protective equipment and worker and patient safety during the Covid-19 pandemic, along with the increasing number of physicians who are directly employed by health systems rather than practicing independently. Christ, “More physicians seek unions amid changing landscape, COVID-19,” Modern Healthcare, 7/20/2022

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Pharma

New drugs, new high prices: The average cost of newly launched drugs increased by 20% per year from 2008 ($2,115) to 2021 ($180,007). Even after adjusting for manufacturer discounts, prices rose by 11% each year. At the same time, a greater proportion of new drugs are high priced, with 47% costing $150,000 or more in 2020 and 2021, compared with 9% of drugs launched from 2008 to 2013. So far this year, the median annual price of 13 new novel drugs for chronic conditions is $257,000. Rome et al., “Trends in Prescription Drug Launch Prices, 2008-2021,” JAMA, 6/7/2022; Beasley, “Newly launched U.S. drugs head toward record-high prices in 2022,” Reuters, 8/16/2022

Bias pervades drug effectiveness studies: Drug, medical device, and biotech industry-sponsored cost effectiveness analyses (CEAs) are twice as likely to report a treatment as cost effective compared with independently conducted CEAs. Incremental cost effectiveness ratios (ICERs) from industry-sponsored CEAs were 33% lower than from non-industry studies. Treatments with lower ICERs are more likely to receive insurance coverage approval. Xie, “Industry sponsorship bias in cost effectiveness analysis: registry based analysis,” BMJ, 6/22/2022

More industry bad behavior: Biogen agreed to pay $900 million to settle a whistleblower case alleging the company paid kickbacks to physicians for its multiple sclerosis drug and disguised marketing programs as educational sessions. Meanwhile, AbbVie was reprimanded by a U.K. pharmaceutical trade group for code of conduct violations. The Prescription Medicines Code of Practice Authority criticized the company’s sales reps for “strategic loitering” and circumventing hospital Covid-19 non-essential visitor restrictions. Silverman, “Biogen agrees to pay $900 million ot settle whistleblower case alleging kickbacks and sham speaking events,” STAT News, 7/20/2022; Silverman, “AbbVie is scolded by a trade group over sales rep ‘strategically loitering’ in a hospital,” STAT News, 7/27/2022

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Dark Money in Health Care

Medicare increases payments to hospitals following key lobbying: Hospitals will receive a 4.3% increase in payments for inpatient services in 2023, the largest rate increase in 25 years. This follows lobbying from hospital groups after the Centers for Medicare and Medicaid Services proposed a 3.2% increase. Medicare will also increase payment rates for hospices (3.8%), inpatient rehabilitation (3.2%), and inpatient psychiatric services (2.5%). Herman, “Hospitals win higher payments from Medicare after lobbying campaign,” STAT News, 8/1/2022; Goldman, “CMS hikes Medicare pay for rehab, psychiatric and hospice providers,” Modern Healthcare, 7/27/2022

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Studies and analysis of interest to single-payer advocates

“The maternal mortality consequences of losing abortion access,” by Amanda Jean Stevenson, Leslie Root, Jane Menken, SocArVix Papers, 6/29/2022. “After the first year of no abortion occurring, we estimate increased exposure to the risks of pregnancy would cause an increase of 210 maternal deaths per year (24% increase), from 861 to 1071. The increase would be greatest among non-Hispanic Black people, for whom it would be 39%.”

“Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries,” by Sooyoung Kim,Tyler Y. Headley,Yesim Tozan, PLOS Medicine, 8/16/2022. “We observed that countries with greater progress toward UHC [Universal Health Coverage] were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.”

“Trends in Out-of-Pocket Costs for Naloxone by Drug Brand and Payer in the US, 2010-2018,” by Evan D. Peet, Ph.D.; David Powell, Ph.D.; Rosalie Liccardo Pacula, Ph.D., JAMA Health Forum, 8/19/2022. “This observational study of 719,612 pharmacy claims data shows that OOP costs of naloxone grew substantially beginning in 2016. However, OOP costs did not increase for all patients and all brands of naloxone but primarily for uninsured patients and for the Evzio brand.”

“Association of Chronic Disease With Patient Financial Outcomes Among Commercially Insured Adults,” by Nora V. Becker, M.D., Ph.D.; John W. Scott, M.D., M.P.H.; Michelle H. Moniz, M.D., M.Sc.; Erin F. Carlton, M.D., M.Sc.; John Z. Ayanian, M.D., M.P.P., JAMA Internal Medicine, 8/22/2022. “This cross-sectional study of commercially insured adults linked to patient credit report outcomes shows an association between increasing burden of chronic disease and adverse financial outcomes.”

“CMS Should terminate the Medicare Advantage Program,” by Physicians for a National Health Program, 8/25/2022. “It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive insurance business model, and the Medicare Advantage program should be terminated.”

“Uncovered Medical Bills after Sexual Assault,” by Samuel L. Dickman, M.D.; Gracie Himmelstein, M.D., Ph.D.; David U. Himmelstein, M.D.; Katherine Strandberg, M.P.A.; Alecia McGregor, Ph.D.; Danny McCormick, M.D.; Steffie Woolhandler, M.D., M.P.H., The New England Journal of Medicine, 9/15/2022. “Our findings indicate that an estimated 17,842 persons who sought emergency department care related to sexual assault [out of 112,844 such visits in 2019] were expected to pay the often-substantial costs themselves. Other data indicate that even privately insured sexual assault victims pay, on average, 14% of emergency department costs out-of-pocket.”

“Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US,” by David U. Himmelstein, M.D.; Samuel L. Dickman, M.D.; Danny McCormick, M.D., M.P.H.; David H. Bor, M.D.; Adam Gaffney, M.D., M.P.H.; Steffie Woolhandler, M.D., M.P.H., JAMA Network Open, 9/16/2022. “In this cross-sectional and cohort study of survey data from 2017 to 2019, 10.8% of adults carried medical debt, including 10.5% of the privately insured, and 9.6% of residents of Medicaid-expansion states, significantly fewer than in non-expansion states. Over 3 years, decreases in health status and coverage loss were significant risk factors associated with acquiring medical debt, which was, in turn, associated with a significant 1.7-fold to 3.1-fold higher risk of worsening housing and food security.”

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PNHP Chapter Reports

California

Activists call for the end of Direct Contracting and REACH at a Medicare anniversary action in San Francisco on July 29.

In California, Dr. Ana Malinow organized an action outside the Federal Building in San Francisco to both celebrate the 57th anniversary of Medicare being signed into law and to warn against creeping privatization of the program through schemes like Direct Contracting and REACH. The event, titled “Make it a Birthday, Not a Funeral,” was emceed by Dr. Corinne Frugoni and sponsored by Senior Disability Action, the California Alliance for Retired Americans, and DSA San Francisco, among other organizations. In terms of online activism, the California chapter launched its new website (pnhpca.org), developed in large part by chapter co-chair Dr. Kathleen Healey, and celebrated the release of a health care savings calculator from Healthy California Now (healthyca.org/calculator), which benefited from the contributions of Drs. Hank Abrons and Jim Kahn.

To get involved in California, contact Dr. David Leibowitz at dleibow@gmail.com. 

Georgia

In Georgia, chapter leaders renewed their efforts to engage with members of the Atlanta City Council in support of a municipal Medicare-for-All resolution. Leaders also reached out to Sens. Raphael Warnock and John Ossoff to thank them for supporting a pair of ultimately unsuccessful amendments to the Inflation Reduction Act that would have extended dental, vision, and hearing coverage to Medicare patients and basic health coverage to residents of states that have not expanded Medicaid.

To get involved in Georgia, contact Dr. Liz McCord at pnhpgeorgia@gmail.com. 

Illinois

Chicago-area activists rally outside the offices of commercial health insurance company Centene on August 22.

In Illinois, members of PNHP and the Northwestern University Students for a National Health Program (SNaHP) chapter joined ONE Northside in a spirited demonstration outside Centene’s Chicago office. They demanded that the insurance company stop its fraudulent denial of claims for being “out of network,” highlighting the case of a community member who was wrongfully billed $999 for routine blood work and who had spent countless hours challenging the error. Ultimately, activists demanded that commercial insurance companies be replaced by a health care system that is publicly financed, nonprofit, and fully accountable to the public: improved Medicare for All.

To get involved in Illinois, contact Dr. Monica Maalouf at mmaalouf88@gmail.com.

Kentucky

In Kentucky, chapter members participated in a Continuing Medical Education (CME) program sponsored by the Kentucky Medical Association titled, “The U.S. Healthcare Delivery System: Where it Succeeds, How it Fails to Meet the Needs of Patients and Providers, and Options for Change.” The program was organized by Dr. Susan Bornstein and took place over Zoom on August 17. On July 30, members celebrated Medicare’s 57th birthday by distributing flyers urging an end to Direct Contracting and REACH at Louisville farmers’ markets, and at a Madison County picnic.

To get involved in Kentucky, contact Kay Tillow at nursenpo@aol.com or Dr. Garrett Adams at kyhealthcare@aol.com. 

Maine

PNHP’s Maine chapter, Maine AllCare, has formed a new 501(c)(4) organization, HealthCare for All Maine, that will engage in lobbying efforts to bolster single-payer legislation. A team of activists within the chapter has also formed a Physician Working Group that is focused on messaging to medical professionals and updating the Maine Medical Association’s position on single payer.

To get involved in Maine, contact Karen Foster at kfoster222@gmail.com. 

Minnesota

In Minnesota, a group of 17 rising 2nd-year medical students and graduate students working towards their MPH participated in the chapter’s Summer Education Program. Seven of these students completed individual projects as part of a paid internship, and shared them at the PNHP Minnesota Annual Summer Picnic on August 12. Activists also joined forces with Health Care for All Minnesota to table at the Twin Cities Pride Festival in June and at the Minnesota Farmfest in early August. In late August and early September, more than 50 volunteers tabled at the Minnesota State Fair, spreading the word about single payer to crowds totalling over two million for the week.

To get involved in Minnesota, contact Jen Crawford at pnhpminnesota@gmail.com. 

Jen Crawford of PNHP-MN (L) and Anne Jones, R.N. of Health Care for All MN table at the Twin Cities Pride Festival on June 25.

New Hampshire

In New Hampshire, chapter leaders worked with state legislators to explore a bill that would form a multi-state single-payer compact, seeking power in numbers and collaboration among activists and legislatures seeking to pursue state-level initiatives. Physician members also made presentations to the SNaHP chapter at the Geisel School of Medicine at Dartmouth.

To get involved in New Hampshire, contact Dr. Donald Kollisch at donald.o.kollisch@dartmouth.edu.

New Jersey

The New Jersey Universal Healthcare Coalition finalized plans to collaborate with Rutgers University on a poll of voters across the state, seeking to gauge their opinion of our current health care “system” and assess their enthusiasm for single-payer reform. Several members are also planning to present resolutions to the Medical Society of New Jersey.

To get involved in New Jersey, contact Dr. Lloyd Alterman at lloydalterman52@gmail.com.

New York

In New York, PNHP’s New York-Metro chapter announced the hiring of a new Executive Director, Morgan Moore, who has been instrumental to the growth of the chapter in recent years. When the Covid-19 pandemic hit, she played a major role in transitioning chapter activities online and continuing the series of high-quality monthly educational forums at PNHP NY Metro. She also launched the chapter’s #MedStoryMonday social media campaign, where health workers are encouraged to share their personal stories of how the for-profit health insurance system has negatively impacted their ability to provide care. Morgan started as Executive Director September 1 and Mandy Strenz, who had been serving as Acting Executive Director, returned to her role as Chapter Coordinator. Earlier in the summer, the NY Metro chapter collaborated with other local advocacy groups to celebrate the anniversary of Medicare and Medicaid. Members presented oversized birthday cards to the offices of Sens. Gillibrand and Schumer, urging them to fight back against profiteering by ending Medicare Direct Contracting and REACH.

To get involved in New York, contact Morgan Moore at morgan@pnhpnymetro.org.

Activists with PNHP-NY Metro celebrate the 57th anniversary of Medicare at a July 29 gathering in New York City.

North Carolina

Doug Robinson, M.D. (R) and Megan Dunn, R.N. of Health Care Justice-NC deliver sheet cakes to local legislators ahead of Medicare’s 57th birthday.

Health Care Justice – North Carolina in Charlotte celebrated Medicare’s birthday by delivering sheet cakes decorated with faux Medicare cards, balloons, and information about Direct Contracting and REACH to local Congressional offices. The chapter also developed a two-page letter containing information about PNHP and Medicare for All (available at healthcarejusticenc.org) which they encouraged members to print and deliver to their health care providers during office visits. On August 21, members continued their annual tradition of marching in the Charlotte Pride Parade.

To get involved in Health Care Justice-NC, contact Dr. George Bohmfalk at gbohmfalk@gmail.com or Dr. Jessica Schorr Saxe at jessica.schorr.saxe@gmail.com.

Members of Healthcare For All – Western North Carolina in Asheville held a public downtown rally to celebrate the 57th anniversary of Medicare. Activists brought banners, gift bags, and sidewalk chalk for visitors to write big, bold messages about what Medicare means to them and why it needs to be protected from profiteers. Chapter leaders also held a well-attended informational meeting at a local retirement community where they screened “FIX IT” and fielded many concerned questions about Direct Contracting and REACH; similar events will be held on a monthly basis going forward.

To get involved in Health Care for All WNC in Asheville, contact Terry Hash at theresamhash@gmail.com. 

Vermont

In Vermont, students who participated in the Northern New England online internship program continued their single-payer activism by giving presentations to a variety of groups, including the League of Women Voters’ National Convention and One Payer States.

To get involved in Vermont, contact Dr. Betty Keller at bjkellermd@gmail.com or Ted Cody tscody@vermontel.net. 

Washington

The PNHP Washington chapter worked closely with Puget Sound Advocates for Retirement Action, Health Care is a Human Right WA, and other progressive organizations to protest the ongoing privatization of Medicare. On July 29, the day before Medicare’s 57th birthday, members of this coalition joined forces to rally and picket outside the regional office of the Dept. of Health and Human Services in Seattle, demanding an end to Direct Contracting and REACH and eventually securing a meeting with the Regional Director of HHS. In early August, PNHP-WA co-sponsored a “Righteous Mothers” benefit concert to stop the privatization of Medicare, during which Medicare-for-All Act lead sponsor Rep. Pramila Jayapal addressed the crowd.

To get involved in Washington, contact pnhp.washington@gmail.com.

PNHP-WA members rally with health justice allies from Puget Sound Advocates for Retirement Action, and numerous other organizations, outside the regional office of HHS on July 29.

West Virginia

In West Virginia, chapter members collaborated with five local health activist groups to plan and host a “Happy Birthday Medicare and Medicaid” event in Charleston on July 30. The event took place at a Federally Qualified Health Center, and the chapter continued sending letters to similar FQHC providers throughout the state telling them about PNHP and inviting them to join. Chapter leaders also drafted an anti-REACH resolution that was eventually passed by the West Virginia Democratic Party, and sent letters to Gov. Justice and all state legislators opposing any legislation that criminalizes health care providers and patients for providing or receiving abortion services.

To get involved in West Virginia, contact Dr. Dan Doyle at pnhp.wv@gmail.com.

PNHP-WV chapter members celebrate the 57th anniversary of Medicare with an event at the Kanawha City Health Center in Charleston on July 30.

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PNHP in the News

News items quoting PNHP members

“Prescription for Healthcare: Threats to Medicare,” WFHB Community Radio, 9/05/2022, featuring Dr. Ana Malinow

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Op-eds by PNHP members

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Letters to the editor by PNHP members

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PNHP Newsletter: Summer 2022

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

Research Roundup

PNHP Chapter Reports

PNHP in the News

PNHP News and Tools for Advocates

PNHP launches “Summer of Action” against Medicare profiteering

After several months of intense educating and organizing by PNHP and our allies, the Centers for Medicare and Medicaid Services (CMS) announced the termination of the controversial Medicare Direct Contracting model in February, admitting the program “did not align” with the Biden administration’s vision. At the same time, CMS said it planned to replace DC with a nearly identical program called “ACO REACH.” 

CMS’ “rebranding” of Direct Contracting to REACH taught PNHP some important lessons. First, we knew that our work made an enormous impact — CMS would have never canceled the program if not for our campaign. But it wasn’t enough. We learned that we could never end Medicare profiteering unless we organize a powerful, national, grassroots movement. 

To meet that challenge, PNHP expanded our organizing, working with chapter leaders to give dozens of presentations to community and senior groups. Along with our allies, we helped pass anti-DC/REACH resolutions in the Seattle City Council and the Arizona Medical Association. 

The organizing paid off. On May 23, PNHP hosted our biggest event ever: The launch of our “Summer of Action” against Medicare profiteering. More than 3,000 activists participated in this online event, where they learned the nuts-and-bolts of Direct Contacting and REACH, heard powerful testimonials from Medicare beneficiaries, and were inspired to take action by Congresswomen Katie Porter and Pramila Jayapal. 

Anyone can get involved in our Summer of Action against Medicare profiteering. Here’s how: 

  • Call President Biden at (202) 456-1111 and demand he use executive action to end Direct Contracting and REACH (the White House switchboard is only open from 11 am – 3 pm ET on Tuesdays and Thursdays). 
  • Call your U.S. representative and senators using the U.S. Capitol Switchboard at (202) 224-3121, and demand they join the fight against Direct Contracting and REACH. 
  • Sign and share our petition against Medicare profiteering at ProtectMedicare.net/REACHPetition.
  • Join our national Day of Action on July 30 (Medicare’s Anniversary). Contact organizer@pnhp.org to find out more.

Go to ProtectMedicare.net to find campaign updates, sample scripts, fact sheets, videos and more.

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Activists win resolutions against Direct Contracting/REACH in Seattle and Arizona

Medicare advocates are celebrating two big victories in the movement to protect Medicare from profiteering and privatization.

In Seattle, seniors from the Puget Sound Advocates for Retirement Action, along with PNHP’s Washington Chapter, proposed a resolution against Medicare Direct Contracting and REACH. The resolution, which demands that the Dept. of Health and Human Services and President Biden immediately end Direct Contracting/REACH and protect Medicare from profiteering, was introduced by Councilmember Teresa Mosqueda and passed unanimously on April 26. 

That same week, PNHP members Dr. Eve Shapiro and Dr. Michael Hamant introduced and successfully passed a similar resolution at the annual meeting of the Arizona Medical Association. 

PNHP Board member Dr. Eve Shapiro and Dr. Michael Hamant introduced a successful resolution against Medicare profiteering in the Arizona Medical Association.

Drs. Shapiro and Hamant explained to their colleagues that since most physicians are now employed by large groups or health systems, they may find themselves practicing in Direct Contracting Entities (DCEs) without their knowledge or consent. Among concerns cited by the resolution is that “DCEs are allowed to keep as profit and overhead what they don’t pay for in health services, therefore giving them a dangerous financial incentive to restrict seniors’ care.” 

The Seattle and Arizona resolutions are part of PNHP’s strategy to expand the fight against Medicare profiteering into every state and Congressional district in the nation.

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APHA endorses single payer

PNHP member (and former SNaHP leader) Dr. Anthony Spadaro worked with several PNHP colleagues to win a single-payer endorsement in the American Public Health Association.

After years of education and organizing by PNHP members, the 25,000-member American Public Health Association (APHA) strongly endorsed a Medicare for All policy at its most recent annual meeting, concluding that, “The most equitable and cost-effective health care system is a public, single-payer system.”

The policy statement was crafted by a working group of the APHA’s Medical Section, which included PNHP leaders Drs. Anthony Spadaro, Oli Fein, and Gordy Schiff, working with colleagues in the epidemiology, public health, pharmacy, and social work professions. 

The working group published the position paper, “The American Public Health Association Endorses Single-Payer Health System Reform,” in the June 2022 edition of Medical Care, the official journal of the Medical Care Section of the APHA. 

“The APHA is our nation’s strongest voice for public health, and I’m thrilled that my colleagues came together to support single payer as the solution to our fragmented and profit-oriented health system,” said Dr. Spadaro, a resident emergency medicine physician at the University of Pennsylvania and former board member of Students for a National Health Program. 

The APHA resolution is part of PNHP’s Medical Society Resolutions campaign, which seeks to organize the medical profession by passing Medicare-for-All resolutions in every medical society in the U.S. The MSR campaign has passed resolutions in the American College of Physicians, the Society of General Internal Medicine, and the Hawaii, Vermont, New Hampshire and Washington state medical societies. 

For more information on the PNHP Medical Resolutions Campaign, visit MedicalSocietyResolutions.org.

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Dr. Rob Stone: My gift of stock is an investment in the future of Medicare for All

Dr. Rob Stone encourages members to make a gift of stock to PNHP.

PNHP is known for its independence and unwavering commitment to a gold standard in health policy, in large part because of how we’re funded —  by dues and donations of our members, never with corporate money that could compromise our mission. 

This spring, longtime PNHP member Dr. Rob Stone discovered a new way to support PNHP’s mission: Through a generous gift of stock. 

Dr. Stone, a palliative medicine physician, lives with his wife Karen in Bloomington, Indiana. He’s been a PNHP member since 2000, including roles as a board member and advisor, and usually donates about $1,000 per year to PNHP. 

But when he turned 70 earlier this year, Dr. Stone began thinking more about his retirement and his legacy in the health justice movement. He’d been especially excited about PNHP’s campaign to stop Medicare privatization through Direct Contracting, and how important that was for the future of Medicare for All. 

As he thought about how he could better support PNHP, Dr. Stone inherited Microsoft stock from his mother, who bought it in the 1980s; the stock had appreciated in value to about $40,000. 

“I did the math and realized that if I sold the stock and kept it, I’d have to pay about $5,000 in capital gains taxes,” said Dr. Stone. “But if I donated the stock to PNHP, I would get a $40,000 tax deduction.”

What was more important was the incredible impact that his gift could make to PNHP’s mission. 

“I’ve been very excited about the work that PNHP has been doing over the past year and was thrilled that I had an opportunity to help keep that momentum going,” Dr. Stone added. “My mother always encouraged me to give and to lead by example, and I’m hoping that my gift of stock will encourage other PNHP members to do the same.” 

Part of Dr. Stone’s stock gift will support the Dorothy W. Stone Scholarship to help medical students attend PNHP’s Annual Meeting in November. 

“I strongly encourage other members to think about donating stock to PNHP,” said Dr. Stone. “It’s easy. You get huge tax benefits, and you can make Medicare for All part of your legacy.”

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PNHP Board nominations accepted during August

Nominations for PNHP’s Board of Directors will be open from August 1 to 31, with seats up for election in all regions and for at-large representation. Recent bylaws changes expands the number of seats on the Board, so that more members have the opportunity to serve on PNHP’s leadership team. The Board invites nominations and applicants from members interested in contributing to a diverse Board of Directors.

The following seats up for election for 2-year terms: 

  • At-large (1 seat)
  • North East region (2 seats)
  • South region (2 seats)
  • North Central region (2 seats)
  • West region (1 seat)

Questions about qualifications and expectations should be sent to deputy director Matthew Petty at matt@pnhp.org. Nominations (by self or others) are due to matt@pnhp.org by August 31, 2022. Ballots for electronic voting will be circulated in September 2022; please make sure your current email address is on the file with PNHP’s national office.

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Research Roundup

Data Update: Health Care Crisis by the Numbers

Barriers to Care

Americans forego care due to cost: More than half of adults (51%) report that in the past year, they have delayed or gone without medical services due to costs, including 35% who put off dental services, 25% who put off vision care, and 24% who delayed general visits to their health provider. Kirzinger et al., “Health Tracking Poll March 2022: Economic concerns and health policy, the ACA, and views of long-term care facilities,” Kaiser Family Foundation, 3/31/2022

Cancer patients go into debt for care: More than half (51%) of U.S. cancer patients have gone into debt to cover the cost of care. Of those who incurred debt, 53% faced collections and 46% saw their credit scores drop; 62% have since delayed or avoided medical care, while half have sought the least expensive treatment options due to debt. In order to pay for cancer care, more than a quarter (28%) of patients depleted most or all of their savings, 28% have gone into credit card debt, 20% borrowed money from family and friends, and 11% took out another type of loan, like a payday loan or home refinancing. More than a third of cancer patients (36%) cut back on food, clothing, and basic household expenses. “Survivor Views: Cancer & Medical Debt, February 2022 Survey Findings Summary,” American Cancer Society, 3/17/2022

Women in the U.S. face worse health care and outcomes than peer countries: Nearly half (49%) of women of reproductive age in the U.S. skip or delay care because of costs, a rate more than double that of most peer nations. More than half (52%) of women in the U.S. report problems paying medical bills, compared to 10% in the U.K. Over one-quarter (27%) of American women spent $2,000 or more in out-of-pocket medical costs, as compared with less than 5% percent of women in the U.K., France, and Netherlands, and less than 10% in Germany, New Zealand, Canada and Norway. American women have the highest rate of avoidable deaths, and the U.S. maternal mortality rate is three times higher than France and seven times higher than Germany. Gunja et al., “Health and Health Care for Women of Reproductive Age: How the United States Compares with Other High-Income Countries,” Commonwealth Fund, 4/05/2022

Americans lack access to primary care: Compared to a set of 10 other wealthy nations, Americans are the least likely to have a longstanding relationship with a primary care provider, least likely to have access to home visits by a primary care provider, and are the least likely to be able to see a provider after regular office hours. The U.S also has the largest income gap between generalist and specialist physicians ($236,000 vs. $526,000 per year) and the highest medical school tuition. FitzGerald, “Primary Care in High-Income Countries: How the United States Compares,” Commonwealth Fund, 3/15/2022

High costs keep Medicare beneficiaries from critical treatments: Medicare Part D beneficiaries who did not receive subsidies to cap or lower their out-of-pocket costs were nearly twice as likely to not fill prescriptions for serious health conditions, since Part D drug costs can reach $10,000 or more. Among patients without subsidies, 30% did not fill their prescriptions for cancer drugs, 22% did not fill prescriptions for hepatitis C, and more than 50% did not fill therapies for high cholesterol or immune disorders. Dusetzina et al., “Many Medicare Beneficiaries Do Not Fill High-Price Specialty Drug Prescriptions,” Health Affairs, April 2022

Disparities plague drug affordability in Medicare: Among Medicare beneficiaries, 3.5 million seniors (6.6%) and 1.8 million under-65 adults with disabilities (22.7%) had difficulty affording their medications in 2019. Hispanic/Latinx and Black seniors were roughly 1.5 times more likely to have affordability problems compared to white seniors, and two times as likely not to get needed prescriptions due to cost. Among beneficiaries with diabetes, 10% of seniors and 26% of under-65 disabled adults reported medication affordability problems. Tarazi et al., “Prescription Drug Affordability among Medicare Beneficiaries,” U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation, Office of Health Policy, 1/19/2022

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Health Inequities

Major racial disparities among cancer patients with COVID-19: Black cancer patients who were infected with COVID-19 had worse outcomes than similar white patients, with higher rates of hospitalization, intensive care unit admission, and mechanical ventilation. Black patients also experienced higher rates of lung, heart, and vascular complications, acute kidney injuries, and all-cause mortality, and were less likely to be treated with remdesivir and more likely to be treated with hydroxychloroquine. Fu et al., “Racial Disparities in COVID-19 Outcomes Among Black and White Patients with Cancer,” JAMA Network Open, 3/28/2022

Immigrants face major barriers to care:  In 2020, more than one in four (42%) undocumented immigrants and 26% of documented immigrants were uninsured, compared to 8% of U.S. citizens. More than a quarter (28%) of undocumented children and 17% of documented children were uninsured, compared to 4% of children with citizen parents. The vast majority of immigrants (83%) were employed or lived with someone who was employed full-time (the same rate as citizens), but undocumented immigrants are not eligible for any kind of financial assistance through Medicaid coverage or tax credits. Income is also a barrier to care, as 44% of undocumented immigrants and 39% of documented immigrants are low-income, compared to 25% of citizens. “Health Coverage of Immigrants,” Kaiser Family Foundation, 04/06/2022

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Coverage Matters

Diabetic amputations higher in states that didn’t expand Medicaid: Among patients of color that were hospitalized for diabetic foot ulcers in the two years after the implementation of the ACA, researchers found a 9% increase in major amputations in states that did not expand Medicaid, but no change in states that did expand. For uninsured adults, the amputation rate decreased 33% in expansion states but did not change in non-expansion states. Tan et al., “Rates of Diabetes-Related Major Amputations Among Racial and Ethnic Minority Adults Following Medicaid Expansion Under the Patient Protection and Affordable Care Act,” JAMA Network Open, 3/24/2022 

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Commercial Insurance: A Hazardous Product

Commercial insurers delay and deny care: Despite an agreement between the insurance industry and the AMA to streamline the prior authorization (PA) process, 84% of physicians report that the number of PAs required for prescriptions and medical services has increased over the last five years, with 65% saying that it is difficult to determine whether a prescription or medical service requires PA. Physicians report phone calls as the most common method for completing PAs (59%), with 45% of providers always or often using fax machines. An overwhelming majority (88%) of physicians report that PA interferes with continuity of care. “Measuring progress in improving prior authorization: 2021 Update,” American Medical Association, May 2022

High-deductible health plans (HDHPs) a major barrier to mental health care: When employers switched their employees into HDHPs, enrollees with depression were 18% less likely to seek outpatient care, those with ADHD were 15% less likely, and those with anxiety were 14% less likely. Inpatient hospital admissions also dropped significantly for HDHP enrollees with depression (19%), anxiety (16%), and ADHD (6%). After employers switched to HDHPs, overall plan spending for depression, anxiety, and ADHD dropped by $1,137, $984, and $868, respectively, but individual employees’ own spending increased by $326, $321, and $281, respectively. The switch to HDHPs also caused enrollees with anxiety or depression to skip preventative care such as breast, cervical, and prostate cancer screenings, as well as flu and pneumonia vaccinations. Fronstin and Roebuck, “How Do High-Deductible Health Plans Affect Use of Health Care Services and Spending Among Enrollees with Mental Health Disorders?” Employee Benefit Research Institute, 3/10/2022

Commercial insurers won’t pay for catheter supplies: Nearly 80% of catheter users with commercial insurance had to pay out-of-pocket (OOP) for catheters and catheter supplies, including 88% of those on UnitedHealthcare, 79% on BCBS, and 75% on Aetna, compared to 53% of those on public plans. Commercial plan enrollees paid more than three times the amount in OOP catheter expenses ($1,621) than those in public plans ($531). United Healthcare members faced the highest average OOP costs at $2,188 per year. “National Survey Among Catheter Users: A Study to Examine Catheter Usage and Catheter Coverage by Health Plan,”  Spina Bifida Association and Duke Health, 3/16/2022

COVID survivors slammed with medical bills: Getting hospitalized for a serious case of COVID-19 left many commercially insured patients with bills averaging $1,600 to $4,000. More than one in ten patients (11%) with commercial insurance and 9.3% of patients with Medicare Advantage had more than $2,000 in bills in the first six months after a COVID-19 hospitalization. For patients hospitalized for pneumonia, OOP spending exceeded $2,000 for 12.1% with commercial insurance and 17.2% with Medicare Advantage plans. Chua, et al., “Out-of-Pocket Spending for Health Care After COVID-19 Hospitalization,” American Journal of Managed Care,  3/16/2022

Insurers celebrate record profits in early 2022: The six largest commercial insurers pocketed a combined $11.2 billion in the first three months of this year. UnitedHealth Group was the most profitable, reporting $5 billion in profit in the first quarter of 2022, followed by CVS Health (Aetna) with $2.3 billion, Anthem at $1.8 billion, Cigna at $1.2 billion, and Humana at $930 million. Minemyer, “UnitedHealth was this quarter’s most profitable payer—again,” Fierce Healthcare News, 5/9/2022

Insurance CEOs pocket millions in compensation: CEOs at the six largest commercial insurers earned nearly $115 million in combined total compensation last year. The late Michael Neidorff, former CEO of Centene, topped the list with $20.6 million in total compensation for 2021; followed by Karen Lynch of CVS Health (Aetna) at $20.4 million; Gail Boudreaux of Anthem with $19.3 million; David Cordani of Cigna with $19.9 million; Andrew Witty of UnitedHealth Group with $18.4 million; and Bruce Broussard of Humana with $16.5 million. Minemyer, “Centene’s Michael Neidorff was the highest-paid payer CEO last year. Take a look at what other execs earned,” Fierce Healthcare News, 4/27/2022

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Privatizing Medicare and Medicaid

Commercial insurers drive up federal health spending: In 2020, commercial insurers’ overhead totaled $301.4 billion, up from $236.6 billion in 2019. Commercial Medicare Advantage plans accounted for $63.4 billion of that total, up 41.2% from 2019. The overhead of commercial insurers who run Medicaid managed care plans was $55.5 billion, up 64.9% from 2019. Hartman et al., “National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic,” Office of the Actuary, CMS, published in Health Affairs, 12/21/2021

Medicare Advantage (MA) spending drags down Medicare budget in pandemic: Due to the sharp drop in utilization, 2020 spending on Part A and B services for Traditional Medicare (TM) decreased 5.8% from 2019, the first time annual spending has declined in more than 20 years. However, total Medicare spending increased because the federal government increased payments to commercial MA plans by 6.9%, since MA payments were determined in mid-2019 and not adjusted to reflect lower utilization. Biniek et al., “Traditional Medicare Spending Fell Almost 6% in 2020 as Service Use Declined Early in the COVID-19 Pandemic,” Kaiser Family Foundation, 6/1/2022

Medicare watchdog slams inflated Medicare Advantage costs: In 2020, Medicare paid 4% more for beneficiaries enrolled in MA than it would have if those beneficiaries were in Traditional Medicare. Medicare overpaid MA insurers by $12 billion just from upcoding alone. According to MedPAC, “The MA program has been expected to reduce Medicare spending since its inception … but private plans in the aggregate have never produced savings for Medicare, due to policies governing payment rates to MA plans that the Commission has found to be deeply flawed.” The Commission also noted that, “These policy flaws diminish the integrity of the program and generate waste from beneficiary premiums and taxpayer funds.” “Report to the Congress: Medicare Payment Policy,” Medicare Payment Advisory Commission, 3/15/2022

Medicare Advantage plans use prior authorization (PA) to deny needed care: An HHS watchdog found that among commercial MA plans’ PA denials, 13% were for services that met Medicare coverage rules and that the denials likely prevented or delayed necessary care. They also found that 18% of the MA plans’ denied payment requests met Medicare coverage rules and MA billing rules, and were thus improperly denied. “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” U.S. Dept. of Health and Human Services Office of the Inspector General, 4/28/2022

Nearly half of seniors don’t understand limitation of MA plans: In a new survey, more than one-third (35%) of Medicare Advantage (MA) enrollees mistakenly believe they don’t have to stay in-network for care, while another 11% weren’t sure, and only half (50%) of MA enrollees said they understood that they don’t have free choice of provider. Grunebaum, “8 in 10 Rate Understanding of Medicare Advantage Good or Very Good: Survey,” MedicareGuide.com, 5/08/2022 

Rampant health disparities among Medicare Advantage enrollees: Black, Indigenous and Alaska Native patients experienced the most significant disparities in clinical care among Medicare Advantage enrollees in 2021. American Indian and Alaska Native enrollees ranked lowest among all demographic groups for breast cancer screenings, respiratory conditions, and diabetes care. Compared to all MA enrollees, Black enrollees were less likely to receive follow-up care after emergency department visits for mental and behavioral health events, and also faced the most adverse prescribing practices, with clinicians more likely to dispense medications with significant side effects to Black people. Martino et al., “Disparities in health care in Medicare Advantage by race, ethnicicty and sex,” CMS Office of Minority Health, April 2022

High rate of “ghost” physicians in privatized Medicaid: In a study of four states from 2015 to 2017, researchers found that Medicaid managed care (or MMC, run by commercial insurers) provider network directories overstate how many physicians actually offer care to Medicaid enrollees. They found that 16% of adult primary care physicians listed in MMC networks qualified as “ghost physicians,” meaning they did not file any Medicaid claims in a year, and almost a third of MMC outpatient primary care and specialist physicians saw less than 10 Medicaid patients a year. Psychiatry was the specialty most likely to include ghost physicians, with 35% of MMC-contracted psychiatrists not seeing any Medicaid patients. Among all MMC-contracted providers, 25% of primary care doctors delivered 86% of the care, while 25% of specialists on average provided 75% of the care. Ludomirsky et al., “In Medicaid Managed Care Networks, Care Is Highly Concentrated Among a Small Percentage of Physicians,” Health Affairs, May 2022

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Health Care for Profit

Surge in private equity (PE) in health care: Total PE investment in the health care industry has increased 20-fold, from $5 billion annually in 2000 to $100 billion in 2018. Annual PE acquisitions grew from 78 in 2000 to 855 in 2018. Appelbaum and Batt, “Private Equity Buyouts in Healthcare: Who Wins, Who Loses?” Institute for New Economic Thinking Working Paper Series, No. 118, May 2020

Private equity (PE) acquisition of hospitals leads to reduced staffing, higher profits: Between 2005 and 2014, hospitals acquired by PE firms saw a 1.78 percentage point increase in operating margins, along with a 2.79% decrease in bed count (about 4.43 beds). PE acquisition also reduced full-time equivalents (FTEs) staffing by 5.05%, an average loss of 36.97 FTE staff, with total nursing FTEs reduced by 4.38% or 10.52 FTE nurses. The ratio of outpatient to inpatient visits also decreased by 4.58%, indicating an increase in inpatient utilization likely due to more aggressive price negotiation for inpatient care with commercial insurers. Cerullo et al., “Financial Impacts And Operational Implications Of Private Equity Acquisition Of US Hospitals,” Health Affairs, April 2022

Higher nursing staff levels save lives: In a study of over 700,000 Medicare beneficiaries with sepsis, researchers found that an increase in registered nurse hours per patient day was associated with a 3% decrease in 60-day mortality, suggesting that hospitals that provide more RN hours of care could likely decrease sepsis deaths. Cimiotti et al., “Association of Registered Nurse Staffing With Mortality Risk of Medicare Beneficiaries Hospitalized With Sepsis,” JAMA Health Forum, 5/27/2022

Nursing home unions save lives: Nursing home labor unions were associated with 10.8% lower resident COVID-19 mortality rates, and 6.8% lower worker COVID-19 infection rates. Researchers estimate that 8,000 fewer resident deaths would have occurred if all nursing home staff were unionized during the pandemic, since labor unions were associated with better infection control policies and COVID-19 outcomes for essential workers. Dean et al., “Resident Mortality and Worker Infection Rates from COVID-19 Lower in Union Than Nonunion U.S. Nursing Homes, 2020–21,” Health Affairs, 4/20/2022

Investor-owned hospitals push more low-value care: “Low-value care” refers to medical services for which the potential for harm far outweighs the potential for benefit, such as spinal fusions for back pain, Pap smears for elderly women, and meniscus removal for degenerative knee joints. Researchers found that health systems that were primarily investor-owned performed more low-value care. In contrast, the systems that had the lowest levels of low-value care were those with a higher concentration of primary care physicians, a medical teaching program, and those that provide more uncompensated care. Segal et al., “Factors Associated with Overuse of Health Care Within U.S. Health Systems: A Cross-sectional Analysis of Medicare Beneficiaries From 2016 to 2018,” JAMA Health Forum, 1/14/2022

Nonprofit hospitals got big tax breaks with little charity care: Out of the 275 nonprofit hospital systems, 227 had “fair share deficits,” meaning they spent less on charity care and community investments than they received in tax breaks. Total “fair share deficits” amounted to $18.4 billion in 2019. The top five offenders were Providence Saint Joseph Health ($705 million more in tax breaks than it spent on charity care), Trinity Health ($671 million), Mass General Brigham ($625 million), Cleveland Clinic Health System ($611 million), and UPMC ($601 million). “Fair Share Spending: How much are hospitals giving back to their communities?,” Lown Institute, 4/12/2022

Majority of physicians now corporate employed: Physician practice acquisitions increased during the COVID-19 pandemic, and now nearly three out of four (74%) physicians are employed by hospitals, health systems, and other corporate entities such as private equity firms and health insurers. Nationally, hospitals and other corporations acquired 36,200 additional physician practices between 2019 and 2021, leading to a 38% increase in the percentage of corporate-owned practices. During that time, more than 108,000 physicians became employees of hospitals or other corporate entities (with 58,000 in hospitals and 50,500 in other corporate entities), a 19% increase. More than 75% of those employees (83,000) made the shift after the start of the pandemic. “COVID-19’s Impact on Acquisitions of Physician Practices and Physician Employment 2019-2021,” Avalere Health, April 2022

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Pharma

Another year, another drug price hike: In early 2022, pharmaceutical companies raised wholesale prices by a median of 4.9% on more than 450 prescription medicines. United Therapeutics increased the price of its childhood cancer medication, Unituxin, by 9.9%, following a 9.9% increase in 2021 (it now retails for $14,349 per vial). Recordati raised the price of Neoprofen, a drug that treats premature infants at risk of a congenital heart defect, by 10% in 2020, 2021, and 2022 (it now retails for nearly $3,000). Leadiant hiked the price of a 50-year old cancer drug, Matulane, by more than 15% (it now retails for $11,969). Vertex raised the price of Trikafta, a cystic fibrosis medication that has no competitors and already has a list price of more than $311,000 for an annual supply, by 4.9% in 2022. Pfizer raised prices for roughly 100 drugs, including a 16.8% price hike for its injectable hydrocortisone product and a 6.9% increase on breast cancer drug Ibrance. Silverman, “Drug makers ring in the new year with 5% price hikes on hundreds of medicines,” 1/03/2022; “Brand Drug List Price Change Box Score,” 46Brooklyn Research, 1/05/2022

Drug prices outpace inflation: Half of all drugs covered by Medicare Part D (50% of 3,343 drugs) and nearly half of all Part B covered drugs administered by a physician (48% of 568 drugs) had price increases greater than inflation between July 2019 and July 2020. Among those drugs, one-third (668 drugs) had price increases of 7.5% or more. Among the most expensive price hikes were Eliquis, a blood thinner used by 2.6 million beneficiaries, with a 5.9% price increase; Revlimid, a treatment for multiple myeloma used by 44,000 beneficiaries, with a 6.5% increase; and Xarelto, a blood thinner used by 1.2 million beneficiaries, with a 4.1% price increase. Cubanski and Neuman, “Prices Increased Faster Than Inflation for Half of all Drugs Covered by Medicare in 2020,” Kaiser Family Foundation, 2/25/2022

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PNHP statement on abortion rights

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Studies and analysis of interest to single-payer advocates

“Response To: Cost-Sharing: Implications of a Well-Intended Benefits Strategy,” by Shannon M Rotolo, PharmD, BCPS, Journal of Managed Care and Specialty Pharmacy, May 2022. “United States could move toward a single-payer system with no premiums, no deductibles, and no copayments. Pharmacists in patient-facing roles would no longer need to provide support or coaching on health insurance literacy and no longer need to help patients choosing a plan that is “best” for them but potentially still inadequate. All patients would have consistent and transparent coverage from birth to death, regardless of their socioeconomic status.”

“Response to: A Potential Path to Universal Coverage With Medicare Advantage for All,” by Adam Gaffney, MD, MPH; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH. “Patients want good health care coverage and unrestricted choice of physicians and hospitals, not, as this Viewpoint suggests, choice of which insurance plan processes the bill. ‘MA for All’ would perpetuate the upward spiral of health care spending, divert more medical resources to insurers, and restrict choice. Far from looking to MA as a model for reform, we should question whether it should play any role at all.”

“Healthcare and Racial Justice: Systemic Change Is Needed for a More Equitable Health System,” by The Campaign for NY Health and the Black, Puerto Rican, Hispanic and Asian Legislative Caucus, 5/04/2022. Using New York State level data, the report found that Black Americans are 10% less likely than their white counterparts to hold employer-sponsored health coverage, and are also more likely to hold medical debt and to die from pregnancy-related causes. Black and Latinx Americans are less likely than white Americans to have jobs that permit remote work; and more likely to live in communities experiencing health provider shortages.

“Universal health coverage as hegemonic health policy in low- and middle-income countries: A mixed-methods analysis,” by Daniel Smithers, MD and Howard Waitzkin, MD, Social Science and Medicine, June 2022. Globally, the concept of “universal health coverage” (UHC) usually calls for public spending to buy health insurance from private corporations for those without insurance, as opposed to “Health care for all” (HCA), which provides the same comprehensive services for an entire population. UHC has become the dominant policy option favored by political and economic elites around the world, but further enhances the wealth and power of private corporations, without providing comprehensive services to all people.

“Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic,” by Alison P. Galvani, Alyssa S. Parpia, Abhishek Pandey, Pratha Sah, Kenneth Colón, Gerald Friedman, Travis Campbell, James G. Kahn, Burton H. Singer, and Meagan C. Fitzpatrick, PNAS, 6/13/2022. The fragmented and inefficient healthcare system in the U.S. leads to many preventable deaths and unnecessary costs every year, especially during a pandemic. Researchers estimate that a single-payer universal health care system would have saved 212,000 lives in 2020 alone, and also calculated that$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a Medicare for All system.

“Medical Documentation Burden Among U.S. Office-Based Physicians in 2019: A National Study,” by Adam Gaffney, MD, MPH, Stephanie Woolhandler, MD, MPH, Christopher Cai, MD, David Bor, MD, Jessica Himmelstein, MD, Danny McCormick, MD, MPH, David U. Himmelstein, MD, JAMA Network, 3/28/2022. In this cross-sectional study, U.S. physicians spent a mean of 1.77 hours daily completing documentation outside office hours in 2019, and an estimated 125 million hours total documenting outside office hours. Nearly 57% percent of physicians said time spent documenting reduces the time they can spend with their patients. Relative to EHR users in other nations, U.S. physicians spend more time documenting in the EHR, with outpatient notes approximately times longer.

“COVID-19 Testing and Incidence Among Uninsured and Insured Individuals in 2020: a National Study,” by Adam Gaffney, MD, MPH, Steffie Woolhandler, MD MPH, and David U. Himmelstein, MD, Journal of General Internal Medicine, 2/09/2022. In 2020, uninsured adults (including many with chronic diseases) were less likely than the insured to have been tested for COVID-19 despite having higher rates of positive test results. Nearly one-third (32.8%) of the insured were tested compared to 26.2% of the uninsured. Among those tested, the positivity rate was almost double among uninsured (21.7%) relative to insured (11.1%) individuals. 

“Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills,” by Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, Kaiser Family Foundation, 6/16/2022. Substantial shares of adults carry debt from medical and dental bills that they have paid off by taking on other forms of debt, including credit cards, personal bank loans, or loans from family and friends. The KFF Health Care Debt Survey finds that four in ten adults have some form of health care debt. Yet the likelihood of having health care debt is not evenly distributed. Uninsured adults, women, Black and Hispanic adults, parents, and those with lower incomes are especially likely to say they have health care-related debt.

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PNHP Chapter Reports

Arizona

In Arizona, PNHP members Drs. Michael Hamant and Eve Shapiro successfully introduced and passed a resolution at the annual meeting of the Arizona Medical Association demanding that the Dept. of Health and Human Services and President Biden administration immediately end Medicare Direct Contracting and REACH. Drs. Hamant and Shapiro explained to their colleagues that since most physicians are now employed by large groups or health systems, they may find themselves practicing in DCEs without their knowledge or consent. To get involved in Arizona, contact Dr. Shapiro at evecshapiro@gmail.com.

Colorado

In Colorado, PNHP leaders helped to organize and host the One Payer States Meeting on May 21. The conference was co-sponsored by PNHP-CO, the Colorado Foundation for Universal Health Care and Health Care for All Colorado. To get involved in Colorado, contact Dr. Rick Bieser at rgbieser@gmail.com.

Activists take part in a mock “die-in” for single payer at the One Payer States meeting in Colorado on May 21. Photo credit: Darral Freund.

Georgia

In Georgia, a mix of new and experienced PNHP members — ranging from medical students to retirees —  gathered in April to discuss single payer and celebrate the founding of three new Georgia Students for a National Health Program (SNaHP) chapters at Emory, Morehouse, and the Medical College of Georgia. In May, PNHP-GA assembled a Steering Committee to coordinate statewide education and organizing campaigns; the Committee’s first task is to work with allies like National Nurses United (NNU) to request that Georgia Senators Warnock and Ossoff co-sponsor the Senate single-payer bill. To get involved in Georgia, contact Dr. Elizabeth McCord at eomccord@gmail.com.

Illinois

In Illinois, Dr. Pam Gronemeyer of southern Illinois worked with allies in Missouri to pass a Medicare-for-All resolution in the St. Louis City Council (see Missouri report). PNHP-IL members worked with other local health advocates to protest the closing of CVS pharmacies in underserved neighborhoods; co-chair Dr. Anne Scheetz spoke at the coalition’s May 27 press conference in Chicago. To get involved in Illinois, contact Dr. Monica Maalouf at mmaalouf88@gmail.com.

PNHP-Illinois and a coalition of local health advocates protest the closure of CVS pharmacies in underserved neighborhoods on May 27. The closures will force seniors and those on Medicaid to travel long distances to fill prescriptions and receive vaccines.

Kentucky

In Kentucky, PNHP members have given presentations about Medicare for All to several candidates running for Congress, including one Republican. PNHP’ers have also been active in the campaign to protect Medicare from Direct Contracting and REACH by publishing opinion pieces in local news outlets and winning endorsements for the campaign from a number of Kentucky organizations, including the Kentucky AFL-CIO. To get involved in Kentucky, contact Kay Tillow at nursenpo@aol.com or Dr. Garrett Adams at kyhealthcare@aol.com. 

Missouri

PNHP’s Missouri chapter spent much of the past year organizing a diverse coalition in support of a Medicare-for-All resolution in the St. Louis City Council. On March 4, Drs. Nat Murdock, Monique Williams, and Ed Weisbart presented the resolution to the City Council’s Black Caucus. Then on May 12, Dr. Weisbart, Angela Brown (CEO of the St. Louis Regional Health Commission), and patient advocate Chris Wilcox presented the resolution to the City’s Health and Human Services Committee, with a unanimous vote to support the resolution by both the committee and the full Board of Aldermen. To get involved in Missouri, contact Dr. Weisbart at pnhpMO@gmail.com.

PNHP Board member Dr. Ed Weisbart (center top) presents a Medicare-for-All resolution to the St. Louis Board of Alderman on May 12. The resolution passed with a unanimous vote.

New Jersey

In New Jersey, PNHP-NY Metro board member Dr. Leonard Rodberg made a presentation about Medicare Direct Contracting/REACH to the NJ Universal Healthcare Coalition meeting on April 23. The coalition is working to pass resolutions in the Medical Society of New Jersey, including a resolution supporting Medicare for All and a resolution opposing Direct Contracting/REACH. To get involved in New Jersey, contact Dr. Lloyd Alterman at lloydalterman52@gmail.com.

New York

In New York, PNHP’s New York-Metro chapter continues its monthly education forums; recent topics include pharmaceutical pricing, and abortion and reproductive health care in a post-Roe environment. NY-Metro held its annual Lobby Day on May 3, where advocates met with 13 state legislators to ask their support for the single-payer NY Health Act as well as the End Medical Debt Act, a new bill that would prohibit hospitals and insurance companies from placing liens on patients’ property or garnishing wages to pay medical debt. The chapter is also helping New York City public worker retirees fight the forced transition from Traditional Medicare to Medicare Advantage by urging NYC City Council members to sign a letter to the mayor asking him to keep the TM plan. On May 14, NY-Metro chapter members joined the “Bans Off Our Bodies” abortion rights march across the Brooklyn Bridge; several members provided medical support to marchers. This summer, the chapter is implementing a new communications strategy which includes publishing several letters and op-eds in local news outlets, as well as a social media campaign called #MedStoryMondays, where medical workers share their stories of how the current system has failed them or their patients. To get involved in New York, contact Mandy Strenz at mandy@pnhpnymetro.org.

PNHP NY-Metro chapter members support New York City public worker retirees as they fight the forced transition from Traditional Medicare to Medicare Advantage at a rally on April 13.

North Carolina

Health Care Justice – NORTH CAROLINA in Charlotte held its annual membership meeting on March 31 with 70 health care advocates in attendance, including several elected officials. The group focused on the dangers of profiteering in Medicare through Direct Contracting/REACH. Chapter members participated in the May 14 “Bans Off our Bodies” rally for abortion care. Thanks to organizing by the North Carolina Medicare For All Coalition (a statewide coalition of 45 organizations), the North Carolina Democratic Party officially added single-payer Medicare for All to its platform at the party’s meeting on June 17. To get involved in Health Care Justice-NC, contact Dr. Jessica Schorr Saxe at  jessica.schorr.saxe@gmail.com.

Health Care for All NC Raleigh members have been active in the Poor People’s Campaign, sending Medicare for All postcards to elected officials and sending a delegation of health care workers to the PPC Moral March in Washington on June 18. Chapter leaders have also been engaged in speaking events: Drs. Jonathan Kotch and Howard Eisenson spoke about single payer to faculty and trainees at Duke Medicine, and Jonathan Michels spoke to students at the Wake Early College of Health and Sciences who are now forming their own SNaHP chapter. To get involved in Health Care for All NC in Raleigh, contact Jonathan Michels at jonscottmichels@gmail.com.

Members of Healthcare For All – Western North Carolina in Asheville met with U.S. Senate candidate Cheri Beasley to urge her support for Medicare for All. Chapter leaders also hosted presentations on Medicare privatization through Direct Contracting and REACH at two large retirement communities in Asheville. To get involved in HCFAWNC, contact Terry Hash at theresamhash@gmail.com. 

Pennsylvania

In Pennsylvania, PNHP’s Eastern PA chapter leader Dr. Walter Tsou gave a Grand Rounds on COVID-19, institutional racism, and health reform at Penn Family Medicine. Health Care for All Philadelphia participated in the annual “Mt. Airy Day” event where they explained their opposition to Medicare Direct Contracting and REACH to elected officials in attendance. To get involved in Pennsylvania, contact Dr. Tsou at macman2@aol.com.

Vermont

Dr. Betty Keller, President of Vermont PNHP, meets with Sierra Shockley, an M2 at the Univ. of Louisville School of Medicine who is participating in the Northern New England Summer internship for medical students.

PNHP Vermont has given several presentations about the privatization of Traditional Medicare through Direct Contracting and REACH; several of these presentations have been recorded and broadcast on local access television stations. The PNHP Northern New England Summer internship just wrapped up with 13 medical students from Kentucky, Missouri, Arizona, Texas, Louisiana, Florida, New Jersey, New York, and Michigan. To get involved in Vermont, contact Dr. Betty Keller at bjkellermd@gmail.com or Ted Cody tscody@vermontel.net.

Washington

PNHP Washington has been very active in the campaign to stop Medicare privatization. Several of the chapter’s monthly educational forums have been focused on this topic, including a talk from Donald Cohen, author of “The Privatization of Everything,” as well as several training sessions on Direct Contracting and REACH. PNHP-WA worked closely with Puget Sound Advocates for Retirement Action, Health Care is a Human Right WA, and other allies to successfully pass an anti-DC/REACH resolution in the Seattle City Council. They also met with staff for U.S. Rep. Suzan DelBene, Sen. Maria Cantwell, and Sen. Patty Murray, urging them to fight back against DC/REACH. To get involved in Washington, contact pnhp.washington@gmail.com.

West Virginia

In West Virginia, PNHP and SNaHP members meet monthly to plan organizing tasks and discuss health care policy topics. Chapter members have given presentations about Direct Contracting/REACH to senior groups and will continue outreach to other health reform groups. Chapter leaders are actively recruiting new members at the state’s FQHCs with the goal of having at least one active member in each of the state’s 55 counties. To get involved in West Virginia, contact Dr. Dan Doyle at pnhp.wv@gmail.com.

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PNHP in the News

News Items Quoting PNHP Members

“Seniors’ Medicare Benefits Are Being Privatized Without Consent,” The Lever, 4/11/2022, featuring Dr. Ed Weisbart and Kip Sullivan

“Secret Trump Program To Privatize Medicare Needs to End,” The Thom Hartmann Program, 5/02/2022, featuring Dr. Susan Rogers

“New Stealth Attack on Medicare Opens Door to Privatization,” Rising Up with Sonali, 5/24/2022, featuring Dr. Ana Malinow

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Opinion pieces by PNHP members

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2022 Annual Meeting

Click HERE to access archival materials from our Nov. 4-5 conference in Boston!

Location

The Annual Meeting and related events were held at the Boston Park Plaza, located at 50 Park Plaza at Arlington Street, Boston, MA 02116.

Covid Safety Protocols

PNHP’s Board of Directors and medical experts have established Covid safety protocols for the Annual Meeting that include a surgical facemask requirement while not actively eating or drinking; proof of vaccine within the last 5 months (physical card, photo, or electronic record is fine); and proof of a negative Covid test (time-stamped photo of a rapid antigen test is fine) taken within 24 hours of the Summit.

Speakers and Program

See below for final scheduled; conference speakers included:

  • Linda Villarosa, contributor to The New York Times’ 1619 Project and author of Under the Skin: The Hidden Toll of Racism on American Lives and the Health of Our Nation (speaking Saturday late afternoon)
  • Donald Cohen, executive director of In the Public Interest and co-author of The Privatization of Everything (speaking Saturday late morning)
  • Philip Verhoef, M.D., Ph.D., president-elect, PNHP
  • Susan Rogers, M.D., president, PNHP

SNaHP Summit: Friday, Nov. 4, 8:00 a.m. to 12:00 p.m. Final schedule HERE

Leadership Training: Friday, Nov. 4, 1:00 to 5:00 p.m.; small group meetings 5:00 to 6:30 p.m.; dinner 6:30 to 8:00 p.m. Final schedule HERE

Annual Meeting: Saturday, Nov. 5, 9:00 a.m. to 5:00 p.m.; small group meetings 5:00 to 7:00 p.m.; dinner (with programming) 7:00 to 9:00 p.m. Final schedule HERE

To request a meeting for a Member Interest Group (MIG), please contact deputy director Matthew Petty at matt@pnhp.org 

This conference was not livestreamed in its entirety, but recordings of select sessions are available at pnhp.org/boston22.

Student and Resident Scholarships

Scholarships were provided to 74 students and residents, helping to cover the cost of travel, lodging, and registration.

PNHP members and the public can support PNHP’s student outreach programs by making a GIFT to the Nicholas Skala Student Fund.

Related Action

Public health workers at the APHA Annual Meeting participated in a “Rally for Public Health Reproductive Justice” on Sunday, Nov. 6 at 1:00 p.m. The rally was held outside the Boston Convention and Exhibition Center entrance on Summer St.

This demonstration against the recent Dobbs v. Jackson Women’s Health Organization decision and continuing attacks on reproductive justice was endorsed by multiple APHA sections and caucuses (Maternal Child Health, Black, Women’s, Peace, LGBT, Socialist, and others); Massachusetts Planned Parenthood; Medical Students for Reproductive Choice; and Physicians for National Health Program.

Related Event

The 2022 Health Activist Dinner at APHA was held Sunday, Nov. 6 from 6:00 to 9:00 p.m. PNHP was a co-sponsor of this event.

This year’s honorees included Michelle Morse, M.D., M.P.H. (Paul Cornely Award); Riyadh Lafta, M.B.Ch.B., Ph.D. (Edward Barsky Award); and Rep. Ayanna Pressley (Paul Wellstone Award). Ted Brown, Ph.D., delivered a keynote address on “A Heroic History of the U.S. Health Left.”

Previous Annual Meetings

Click HERE to view photos from our previous in-person Annual Meeting (2019 in Philadelphia).

Click HERE for materials from our (fall) 2021 virtual Annual Meeting, HERE for materials from our (spring) 2021 virtual Leadership Training, and HERE for materials from our (fall) 2020 virtual Annual Meeting.

Attending the 2022 PNHP Annual Meeting is entirely voluntary and requires attendees to abide by any applicable rules of conduct or local or state laws that may be announced at any time. Attendees acknowledge the highly contagious and evolving nature of Covid-19 and voluntarily assume the risk of exposure to or infection with the virus by attending the Meeting and understand that such exposure or infection may result in personal injury, illness, disability, and/or death. Attendees release and agree not to sue any persons or entities responsible for coordinating or organizing the PNHP Annual Meeting in the event that they contract Covid-19. Attendees agree to comply with all Covid-related procedures that may be implemented at the Meeting, including mask-wearing.