By Sara Heath
RevCycle Intelligence, Sept. 17, 2015

Health insurance coverage woes continue to affect a great number of individuals, claims the president of Physicians for a National Health Program (PNHP).

According to a recent press release, Robert Zarr, MD, argues that despite the increase in health insurance coverage since the implementation of the Affordable Care Act (ACA), there are still notable and “unacceptable” disparities in coverage amongst underserved individuals.

According to Zarr, the Census Bureau reported that the number of uninsured individuals dropped from 42 million in 2013 to 33 million in 2014. This considerable drop is perhaps a result of the ACA. As reported by RevCycleIntelligence.com, between 2014 and 2015 the uninsurance rate decreased by 8 percent.

Additionally, the number of individuals forgoing a primary care visit decreased by 3.5 percent, and the number of individuals without easy access to medication decreased by 2.4 percent. Overall, the number of individuals reporting fair or poor health decreased by 3.4 percent.

While Zarr notes that these decreases in uninsurance and its effects are certainly a good thing, there are still considerable issues to address.

“[T]he number of people who remain without coverage is still intolerably high,” Zarr said. “And the Census Bureau report leaves entirely unmentioned the millions of people who have health insurance but who can’t afford to use it because of high deductibles and copays.”

In fact, nearly a quarter of all insured non-elderly adults are underinsured, Zarr added. Of these individuals, 44 percent have gone without a physician visit, medical test, or prescription due to an inability to afford the service.

The head of PNHP acknowledged that having expensive coverage is certainly better than having no coverage, and underscored the detrimental effects of having such a large population of uninsured or underinsured individuals.

Citing a study performed by the American Journal of Public Health, Zarr highlighted statistics regarding the potential effects not having health insurance can cause — that for every 1 million people who do not have health insurance, there are 1,000 deaths linked to that very issue.

“[T]he 33 million people the Census Bureau says were uninsured in 2014 means that approximately 33,000 people died needlessly last year because they couldn’t get access to timely and appropriate care,” Zarr said.

This issue of uninsured populations is also expected to continue. According to the Congressional Budget Office, approximately 27 million people are expected to be uninsured over the next 10 years. Even if all states were to adopt the Medicaid expansion policy within the ACA, there would still be a population of approximately 24 million uninsured individuals.

Zarr provided a possible solution to these health insurance woes: a single-payer, Medicare for all, healthcare system. He stated that a single-payer system could be the singular path toward providing universal healthcare, something he believes a nation with such great wealth should be able to provide its citizens.

“A single-payer system would achieve truly universal care, affordability, and effective cost control. It would put the interests of our patients — and our nation’s health — first,” Zarr said. “We need to move beyond the administratively wasteful, complex and inadequate ACA to a more fundamental, comprehensive single-payer national health program for all.”

http://revcycleintelligence.com/news/health-insurance-coverage-still-low-despite-aca-policies

It is true that I would invest $1 trillion into rebuilding our crumbling infrastructure

By Sen. Bernie Sanders
The Wall Street Journal, Letters, Sept. 17, 2015

Your article “Price Tag of Sanders Proposals: $18 Trillion” (page one, Sept. 15) is misleading.

It is true that I would invest $1 trillion into rebuilding our crumbling infrastructure. Not only would this long-overdue investment make our country more productive and efficient, it would put 13 million Americans to work in good-paying jobs. It is true that I would invest in making all public colleges and universities tuition free and substantially reduce student debt. This higher-education proposal, estimated to cost about $75 billion a year, would be more than paid for by a tax on Wall Street speculation. It is true that I proposed to extend the solvency of Social Security until the year 2065 and to expand benefits. This proposal would be offset by lifting the cap on taxable income above $250,000 a year.

But, here’s where the article is mistaken. While a Medicare-for-all program may cost $15 trillion over 10 years, this proposal would eliminate all payments made by Americans and businesses to health-insurance companies. At a time when the U.S. spends substantially more per capita on health care than does any other country on earth, a single-payer health-care program would substantially lower our total health-care costs and would guarantee health care to all Americans. This approach would end the international embarrassment of the U.S. being the only major country on earth that doesn’t already do this. For The Wall Street Journal to ignore the enormous savings that Medicare-for-all would bring to our wildly inefficient and dysfunctional health-care system is irresponsible.

Sen. Bernie Sanders (I., Vt.) writes from Washington. He is a candidate for the Democratic Party’s presidential nomination.

http://www.wsj.com/articles/ill-create-jobs-provide-better-care-for-less-1442434046

PNHP note: PNHP is a nonpartisan educational and research organization that neither supports nor opposes any candidate for public office.

By Bob Herman
Modern Healthcare, Sept. 16, 2015

The first full year of health coverage expansion under the Affordable Care Act significantly drove down the uninsured rate in 2014, according to U.S. Census Bureau data released Wednesday.

The percentage of Americans who had no health insurance in 2014 “decreased sharply,” the Census Bureau said in its annual report on poverty, income and health coverage. The Census data and the Centers for Disease Control and Prevention’s National Health Interview Survey are considered the gold standards of health insurance statistics.

The uninsured rate was 10.4% in 2014 compared with 13.3% in 2013. It’s the largest drop the Census Bureau has recorded in the past seven years, said Victoria Velkoff, a top statistician at the agency. Although 283.2 million Americans had health insurance last year, 33 million people still lacked coverage, compared with 41.8 million in 2013. 

Medicaid and the health insurance exchanges spurred much of the decline. More than 6.7 million people gained Medicaid coverage last year, a direct result of the ACA’s expansion of Medicaid eligibility to people who make up to 138% of the federal poverty level. Thirty-one states and the District of Columbia have expanded Medicaid. Republicans control the governor’s seat or statehouse in the states that have yet to expand Medicaid, which was made optional under a 2012 Supreme Court ruling. 

Approximately 10 million Americans have purchased coverage through the state and federal exchanges created by the ACA, most of whom receive premium tax credits or cost-sharing subsidies to help pay down their insurance costs. Several million more directly purchase healthcare policies from insurers, often called off-exchange plans.

“There is a healthy increase in the nongroup market and in Medicaid, and this is consistent with what other federal surveys have seen,” said Katherine Hempstead, the director of health insurance research at the Robert Wood Johnson Foundation. “It’s indisputable that there’s been a statistically significant decline in the uninsured.” 

Most people still get their health insurance through their jobs, the Census data confirmed. More than 55% of Americans had employer-based coverage. Government-based plans, mostly Medicare and Medicaid, accounted for 36.5% of health insurance.

Medicaid expansion and the exchanges also fueled the drop in the uninsured rate among low-income earners and minorities. The number of uninsured people who made between $25,000 and $49,999 per year fell by 5 percentage points from 2013 to 2014. The uninsured rate among blacks, Hispanics and Asians all declined by more than 4 percentage points in the same period. 

However, 1 in 5 Hispanics, or 11 million people, still lacked health insurance last year, the most of any race or ethnicity studied by the Census Bureau. The uninsured rates for blacks, Asians and non-Hispanic whites in 2014 were 11.8%, 10.1% and 7.6%, respectively. 

But as many health insurance experts have pointed out, higher rates of health insurance don’t equate to comprehensive coverage. For instance, a recent report from the Commonwealth Fund report showed 14 million adults were “underinsured,” meaning their deductibles and out-of-pocket medical expenses absorbed a sizable portion of their household income. That includes people with employer-based health insurance.

The Census data shows that medical expenses are a major factor for those living in poverty. “We’re witnessing a dramatic acceleration of the trend of shifting more and more medical costs onto the shoulders of patients and their families,” Dr. Robert Zarr, president of Physicians for a National Health Program, a left-leaning group that supports a single-payer insurance system, said in a statement. “Such financial barriers are untenable, economically and morally,” he added.

However, the ACA caps how much people have to pay out of their own pockets. The maximum amount any person has to pay for in-network care next year is $6,850 for individuals and $13,700 for families.

“The main advantage of health insurance is protecting against catastrophic expenses,” Hempstead said. While many low-income earners still may struggle with the health law’s out-of-pocket limits, “it’s nothing like the kind of exposure they used to have,” she said.

The Census Bureau changed its health insurance survey methodology last year to get a more accurate read of who has coverage. Conservatives have criticized the switch. Ed Haislmaier, a senior fellow at the right-leaning Heritage Foundation, said in a statement there are discrepancies between the CMS and Census Bureau data and that there was “little net growth in the number of people with private health insurance coverage.”

http://www.modernhealthcare.com/article/20150916/NEWS/150919913

However, just because you’re insured doesn’t mean you can still afford health care, experts say

By Jennifer Gerson Uffalussy
Yahoo Health, September 16, 2015

The latest census data released today (Sept. 16) shows that the percentage of people without health insurance was 10.4 percent lower than the number of uninsured in 2013. 

While 41.8 million, or 13.3 percent of Americans, were without health insurance in 2013, that number dropped to 33 million — 10.4 percent of Americans — in 2014. 

That’s 8.8 million more people who have health insurance coverage year over year. 

Between 2008 and 2013, the uninsured rate was relatively stable — despite the passage of the Affordable Care Act in 2010. In 2014, thought, the uninsured rate sharply decreased, with the percentage of people with health insurance coverage in 2014 spiking to 89.6 percent. 

(Image: U.S. Census Bureau)

The 2014 numbers show that age is strongly associated with the likelihood that a person has health insurance.  In 2014, 98.6 percent of adults aged 65 years or over had some type of health insurance during the year, compared with 93.8 percent of children under age 19 and 85.7 percent of working-age adults aged 19 to 64 years.

(Image: U.S. Census Bureau)

However, the Congressional Budget Office (CBO) predicts that at least 27 million Americans will be uninsured every year for the next 10 years. And the stakes are high: A study in the American Journal of Public Healthshowed in a given year, there are 1,000 deaths for every 1 million people related to the lack of insurance.

What the Census Bureau report neglects to mention is that for some people, just because they have insurance doesn’t mean they can afford to use it due to high deductibles and co-pays, says Robert Zarr, MD, MPH, president of Physicians for a National Health Program. 

That’s a problem called underinsurance — when people have skimpy policies with high deductibles and copays that leaves them with high out-of-pocket expenses when paying for their health care. 

“A recent study by the Commonwealth Fund shows that about 31 million people who have health insurance – nearly a quarter of all insured non-elderly adults – are underinsured, nearly double the rate in 2003,” Zarr says. “Of these, 44 percent went without a doctor’s visit, medical test, or prescription due to cost, while 51 percent had problems paying off medical bills or were paying off medical debt over time.”

Zarr notes that the average deductible for a family with a silver-level plan— the marketplace standard plan that offers, on average, 70 percent cost coverage for retail medical services — bought through the Healthcare.gov marketplace is estimated to be $6,010. And out-of-pocket costs for copayments and deductibles, after premium payments, for a family of four with an income of about $60,000 per year can be as high as $13,200.

https://www.yahoo.com/health/more-americans-insured-in-2014-data-shows-165337271.html

By Paul Waldman
The Washington Post, Sept. 15, 2015

The big policy headline today comes from the Wall Street Journal, which delivers this alarming message: “Price Tag of Bernie Sanders’ Proposals: $18 Trillion.”

Holy cow! He must be advocating for some crazy stuff that will bankrupt America! But is that really an accurate picture of what Sanders is proposing? And is this the kind of number we should be frightened of?

The answer isn’t quite so dramatic: while Sanders does want to spend significant amounts of money, almost all of it is on things we’re already paying for; he just wants to change how we pay for them. In some ways it’s by spreading out a cost currently borne by a limited number of people to all taxpayers. His plan for free public college would do this: right now, it’s paid for by students and their families, while under Sanders’ plan we’d all pay for it in the same way we all pay for parks or the military or food safety.

But the bulk of what Sanders wants to do is in the first category: to have us pay through taxes for things we’re already paying for in other ways. Depending on your perspective on government, you may think that’s a bad idea. But we shouldn’t treat his proposals as though they’re going to cost us $18 trillion on top of what we’re already paying.

And there’s another problem with that scary $18 trillion figure, which is what the Journal says is the 10-year cost of Sanders’ ideas: fully $15 trillion of it comes not from an analysis of anything Sanders has proposed, but from the fact that Sanders has said he’d like to see a single-payer health insurance system, and there’s a single-payer plan in Congress that has been estimated to cost $15 trillion. Sanders hasn’t actually released any health care plan, so we have no idea what his might cost.

But health care is nevertheless a good place to examine why these big numbers can be so misleading. At the moment, total health care spending in the United States runs over $3 trillion a year; according to the Centers for Medicare and Medicaid Services, over the next decade (from 2015-2024), America will spend a total of $42 trillion on health care. This is money that you and I and everyone else spends. We spend it in a variety of ways: through our health-insurance premiums, through the reduced salaries we get if our employers pick up part or all of the cost of those premiums, through our co-pays and deductibles, and through our taxes that fund Medicare, Medicaid, ACA subsidies, and the VA health care system. We’re already paying about $10,000 a year per capita for health care.

So let’s say that Bernie Sanders became president and passed a single-payer health care system of some sort. And let’s say that it did indeed cost $15 trillion over 10 years. Would that be $15 trillion in new money we’d be spending? No, it would be money that we’re already spending on health care, but now it would go through government. If I told you I could cut your health insurance premiums by $1,000 and increase your taxes by $1,000, you wouldn’t have lost $1,000. You’d be in the same place you are now.

By the logic of the scary $18 trillion number, you could take a candidate who has proposed nothing on health care, and say, “So-and-so proposes spending $42 trillion on health care!” It would be accurate, but not particularly informative.

There’s something else to keep in mind: every single-payer system in the world, and there are many of them of varying flavors, is cheaper than the American health care system. Every single one. So whatever you might say about Sanders’ advocacy for a single-payer system, you can’t say it represents some kind of profligate, free-spending idea that would cost us all terrible amounts of money.

Since Sanders hasn’t released a health care plan yet, we can’t make any assessment of the true cost of his plan, because there is no plan. Maybe what he wants to do would cost more than $15 trillion, or maybe it would cost less. But given the experience of the rest of the world, there’s a strong likelihood that over the long run, a single-payer plan would save America money. Again, you may think single-payer is a bad idea for any number of reasons, but “It’ll be too expensive!” is probably the least valid objection you could make.

There are some proposals that involve spending new money that we never would have spent otherwise, like starting a war that ends up costing $2 trillion. But in every case, whether we’re doing something new or doing something we’re already doing but in a new way, the question isn’t what the price tag is, the question is whether we think what we’d get for that money makes spending it worthwhile.

For instance, Sanders wants to spend $1 trillion over 10 years on infrastructure. That’s a lot of money, but it’s significantly less than experts say we need to repair all of our crumbling roads, bridges, water systems, and so on. And infrastructure spending creates immediate jobs and has economic benefits that persist over time, which we’d also have to take into account in deciding whether it’s a good idea. But just saying, “$1 trillion is a lot of money!” doesn’t tell you whether or not we should do it.

The conservatives who are acting appalled at the number the Journal came up with are also the same people who never seem to care what a tax cut costs, because they think cutting taxes is a moral and practical good, in the same way that liberals think providing people with health coverage is a moral and practical good. For instance, Jeb Bush recently proposed a tax cut plan whose 10-year cost could be as high as $3.4 trillion. That’s a lot of money that the government wouldn’t be able to spend on the things it’s doing right now, although the campaign argues that we’d get much of that money back in increased revenues because of the spectacular growth the tax cuts would create. If you remember the claims that George W. Bush’s tax cuts would create stunning growth and prosperity for all, you might be just a bit skeptical of the Jeb campaign’s similar assertions. But in any case, we can’t evaluate the value of Jeb’s plan just by saying that $3.4 trillion is a big number. If you knew that the average family in the middle of the income distribution would get less than $1,000 from Jeb’s plan, while the average family in the top one percent would get a tax cut of over $80,000, then you’d have a better sense of whether it’s a good or bad idea.

As a general matter, when you see a headline with an unimaginably large number, chances are it’s going to confuse you more than it will enlighten you. The question when it comes to government should always be not what we’re spending, but what we’re getting for what we spend.

https://www.washingtonpost.com/blogs/plum-line/wp/2015/09/15/no-bernie-sanders-is-not-going-to-bankrupt-america-to-the-tune-of-18-trillion/

By Brett LoGiurato
Business Insider, Sept. 15, 2015

Sen. Bernie Sanders (I-Vermont) is pushing back on the eye-popping estimated price tag of his progressive wish list of proposals he has offered on the campaign trail.

The Wall Street Journal reported in a front-page story on Tuesday that Sanders’ proposals would total around $18 trillion over 10 years, which the publication said would amount to the “largest peacetime expansion of government in modern American history.”

That would include an estimated $15 trillion over a decade for a revamping of the federal healthcare system to a government-run, “Medicare for all” single-payer approach.

In an appearance on MSNBC Tuesday, Sanders disputed The Journal’s total. He argued that the paper did not take into account the spending reductions that would come with the enactment of a single-payer-type healthcare plan.

“That is not the reality. We will be responding to The Wall Street Journal on that,” Sanders told MSNBC’s Andrea Mitchell of the overall estimate.

“I think most of the expense that they put in there, the expenditures have to do with the single-payer healthcare system,” he continued. “They significantly exaggerated the cost of that, and they forgot to tell the American people in that article that that means eliminating the costs that you incur with private health insurance.”

Sanders, right now the main Democratic challenger to presidential front-runner Hillary Clinton, has not released a detailed healthcare plan as of yet. The Journal relied on an analysis of similar legislation proposed by Rep. John Conyers (D-Michigan) and sponsored by 44 other House Democrats.

The analysis, which was conducted by University of Massachusetts at Amherst economist Gerald Friedman, would “require $15 trillion in federal spending over 10 years, on top of existing federal health spending,” according to The Journal. 

But the analysis has also been cited favorably by progressive advocates of a single-payer healthcare system, who note that Conyers’ bill would purportedly save nearly $600 billion annually by eliminating administrative waste in the private-insurance industry and cutting prices of pharmaceutical medicine.

“In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else. No other plan can achieve this magnitude of savings on health care,” Friedman wrote in his 2013 analysis.

The Washington Post’s Paul Waldman backed up Sanders on some of his criticism. As Waldman pointed out, the US currently spends about $3 trillion a year — and will spend close to $42 trillion over the next decade — on healthcare. He argued that Sanders’ proposal wouldn’t add on to that total, but rather reallocate the way the US spends money on healthcare.

“By the logic of the scary $18 trillion number, you could take a candidate who has proposed nothing on health care, and say, ‘So-and-so proposes spending $42 trillion on health care!’ It would be accurate, but not particularly informative,” Waldman wrote.

http://www.businessinsider.com/bernie-sanders-wsj-18-trillion

By David Dayen
The Intercept, Sept. 15, 2015

The screaming headline on Tuesday’s Wall Street Journal reads “Price Tag of Bernie Sanders’s Proposals: $18 Trillion.” This would comprise “the largest peacetime expansion of government in American history,” the Rupert Murdoch-owned newspaper warns.

The provenance of the figure is in many ways besides the point. Readers are intended to bug their eyes out at such a massive sum, and tsk-tsk at the deeply unserious, budget-busting promises of a democratic socialist. It’s the numerical version of a smear campaign.

But how did the Journal arrive at $18 trillion? They added up the 10-year price tags of seven programs Sanders has endorsed in his candidacy for president. It turns out that $15 trillion of the $18 trillion, or 83 percent of the total, comes from just one of these programs: establishing a single-payer health care system.

The $15 trillion figure is derived from an analysis of a similar single-payer bill, H.R. 676, introduced in 2013 by Rep. John Conyers. Gerald Friedman, a labor economist at the University of Massachusetts at Amherst, conducted the analysis.

What the Wall Street Journal won’t tell you is that $15 trillion in national health spending over 10 years would represent a massive savings for the United States. Right now we spend at twice that rate for health care. According to the Congressional Budget Office, in fiscal year 2013 alone, the U.S. spent $2.8 trillion on total health expenditures, not including the $250 billion tax break employers get for providing health insurance to their workers.

Accounting for cost inflation in health care and extending that out for 10 years, on our current trajectory we would spend more than $30 trillion, compared to the $15 trillion of a single-payer plan, which would totally supplant it.

The entire point of a single-payer health care plan, aside from covering everyone in the country, is to minimize costs, by reducing administrative bureaucracy, the profit motive and middlemen. It costs far less than the current system, which spends more per capita than any developed health system in the world.

That represents a giant savings for the nation, for employers as well as individuals. Friedman’s analysis, which is literally called “How we can afford a national single-payer health plan,” makes this point repeatedly. Assuming that single-payer is paid for through progressive taxation, people would spend far less for their coverage than they do today, if the Wall Street Journal’s explicitly stated numbers are correct.

full: https://theintercept.com/2015/09/15/wall-street-journals-scary-bernie-sanders-price-tag-ignores-health-savings/