Anyone ElseTerrified about Repeal of ACA Bill
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Why the short-term health plans Trump favors are cheap: They shortchange you on care
new statistical releases... reveal exactly why these plans are less expensive and less useful...Short-term plans are cheaper because the insurers that issue them spend only pennies on actual healthcare for policyholders.
https://www.latimes.com/business/story/2019-08-12/...
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Financial Hardship, Psychological Distress Hurting Working-Age Cancer Survivors, CDC Says
cancer survivors of working age had significantly higher annual out-of-pocket (OOP) medical expenditures than those without a cancer history. More than a quarter of adults aged 18 to 64 years reported they had trouble paying bills because of cancer, and over one-third reported psychological distress. The average annual OOP spending per person was significantly higher among cancer survivors ($1000; 95% CI, $886-$1113) than among persons without a cancer history ($622; 95% CI, $606-$639). even those with health insurance went into medical debt or filed for bankruptcy because of cancer, the report noted. The percentage of survivors who reported experiencing material or psychological financial hardship was higher among minority racial/ethnic groups than among whites. It was also highest for persons aged 40 to 49 years.
https://www.ajmc.com/focus-of-the-week/financial-h...
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Colleagues: ACA open enrollment approaches. Details for many plans are already posted. Of course, every region is different, but I do want to share a concern: I live in a major metro area and the less expensive plans in my area now seem to include only one oncologist. For the entire region. (Plus one whom I gather is a hematologist.) I have not had time to follow up and do additional research, make calls, ask questions, etc, but I wanted to suggest that you allow plenty of time to research plans in your area in case access has changed. Good luck!
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lumpie, I also will need to sign up again for ACA but I’m confused... what do you mean when you say that one of the oncologists is also a hematologist ? thank you so much for providing so much important information here on this topic as well as the research one
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Hi Lumpie Medicare part A & B will cover cancer treatment. Medicare part B is subtracted from your social security payment. Part B pays 80% of the cost for chemo, radiation, and test done as an outpatient. Medicare Advantage plans usually are not the best choice for a cancer patient. If you sign up for a Medigap policy within the first 6 months after turning 65 insurers cannot turn you down or charge you more for a pre-existing health condition. But after that enrollment period everything changes and it may be more difficult to enroll. Before my cancer diagnosis I decided on the Medigap policy because I wanted to keep my doctor and I am glad I did. You don't have that choice with the Medicare Advantage policy. Everyone takes Medicare. Medicaid is a different story. A Oncologist Hematologist is a cancer doctor who also treats blood cancer like Lymphoma/Leukemia. I see one for BC, he is trained in Oncology.
My friend has ACA, her monthly payment was over $700.00 and her deductible is $7000.00. She just got disability for ovarian cancer and that will cover her monthly payment, but not the deductible. There has to be a better way. I like Trump's idea about crossing state lines to get a better, less expensive plan in another state.
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thanks flashlight for the explanation!!
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Air Ambulances Are Bankrupting Us (and No One Cares)
It's skyway robbery
Dr. Marty Makary.... He is a professor of surgery at Johns Hopkins and wrote a new book, The Price We Pay, about how the medical industry is price gouging everyone.... one of the chapters in his book... is about air ambulances. air ambulances are out-of-network for patients' insurance. So what ends up happening? The patient has a disaster... {months later} You get this surprise bill and you don't know what to do.
How can we fight back? ... sunlight is the best disinfectant. What if we actually publish all the fees these air ambulances are charging?
{I'll add contact your legislators!}
https://www.medpagetoday.com/blogs/zdoggmd/83054?x...
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april1964: It is not uncommon for oncology and hematology to be combined into a single practice with some practicing oncology and some hematology. (Think about Leukemia which is a blood cancer.) Some physicians may practice both, especially in rural areas where there are fewer specialists.
flashlight: Thanks for these tips. It is IMPORTANT to realize that in MOST but not all states, there are very different rules for those who are *under 65* and on Medicare vs those over 65. Those under 65 in MOST but not all states are NOT able to purchase Medigap plans (without underwriting). That means we have 2 options: Medicare A, B & D which leaves us liable for 20% of our bills with NO cap on the amount. Or a Medicare Advantage plan. If we do not have enough savings to cover the out of pocket 20% every year until we are 65, then we are essentially forced to go with a Medicare Advantage plan.
Those over 65 have MANY more options. And you are correct that it is VERY important to sign up when you are first age-eligible (age 65). Otherwise, you pay a penalty *for the rest of your life*! I have to agree - everyone I talk with seem very happy about their Medicare coverage.
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thanks lumpie!!!
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Expensive Medicare Patients Aren't Who You Think
Then who are these chronically costly patients?
"...more than a quarter of patients who are super expensive in a given year -- the top 10% of expenditures -- remain in that top 10% for the following two years. ...chronically expensive patients don't typically experience lots of expensive hospital stays. Their hospitals' expenditures are usually trumped by other expenses. More precisely, chronically expensive Medicare enrollees incur about $13,000 in hospital costs, a significant figure for sure. But over the same time, they incur more than $16,000 in outpatient costs and over $15,000 in medication expenses. It's also pretty hard to find lots of wasteful spending among these chronically expensive patients in terms of, say, preventable hospitalizations or unnecessary tests and procedures. Out of $70,000 of annual expenses, only $4,000 was deemed to be "potentially preventable" by the researchers.
https://www.medpagetoday.com/blogs/kevinmd/82931?x...
{$15k in medication expenses is in the top 10%? Oh dear. That's us.}
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Cancer Patient Implores Congress to Allow Prescription Drug Price Negotiations
Witnesses at hearing on Rx bill say measure would make medicines affordable
by Dena Bunis and Sarah Adler, AARP, September 25, 2019Critics of HR 3 suggested at the hearing that forcing pharmaceutical companies to negotiate...would inhibit the innovation needed to develop and market new lifesaving cures. Gerard Anderson, a professor at the John Hopkins Bloomberg School of Public Health, said that "research and development is less than 20 percent of the cost of operating most large drug companies. If pushed to lower prices, I would assume drug companies would continue their investment in research and development because without new products the brand name drug companies have nothing to sell."https://www.aarp.org/politics-society/government-e...
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House Leaders Unveil Bill to Lower Prescription Drug Prices
Medicare could negotiate prices, and out-of-pocket costs would be capped
by Dena Bunis, AARP, September 19, 2019 Under HR 3, called the Lower Drug Costs Now Act of 2019, the secretary of the Department of Health and Human Services (HHS) would identify 250 brand-name drugs each year that cost Medicare the most money and do not have generic competitors. The government would then negotiate the price of at least 25 of those medications each year directly with the companies. In addition, HHS would be required to negotiate the price of insulin, a drug whose costs per patient nearly doubled from 2012 to 2016... "The burden of out-of-control drugs is one issue that touches everyone in America,"... "The status quo is simply unacceptable," "The problem now, ...is that drug companies basically charge whatever they want."
The bill also would cap annual out-of-pocket prescription drug expenses for Medicare beneficiaries at $2,000.
https://www.aarp.org/politics-society/government-e...
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The True Cost of Healthcare
By David Belk, MD
http://truecostofhealthcare.org/
{This is an interesting website, developed by a physician. Provides an informative background on healthcare, health insurance, and pharmaceutical issues. Also draws some conclusions about problems with our current arrangements. He comments explicitly on problems he observes.}
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Many on Medicare Have 'Serious Problem' Paying Medical Bills
Paying for prescription drugs was the most serious financial problem for Medicare beneficiaries in 2018
More than half of Medicare beneficiaries who dealt with a serious illness reported having a "serious problem" paying a medical bill, according to a study in Health Affairs
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.00362
https://doi.org/10.1377/hlthaff.2019.003620 -
DOCUMENTS REVEAL HOSPITAL INDUSTRY IS LEADING FIGHT AGAINST MEDICARE FOR ALL
INVESTOR-OWNED HOSPITALS are leading the fight against the creation of a comprehensive, universal health care system, according to corporate filings reviewed by MapLight and The Intercept.
Tenet Healthcare, the nation's third-largest investor-owned operator of hospitals, has donated nearly $630,000 to the Partnership for America's Health Care Future, or PAHCF, a dark-money organization created last year to erode public support for Medicare for All, a government-run plan that would provide health care for all Americans.
PAHCF's incorporation records list a lobbyist for the Federation of American Hospitals, a trade organization that represents Tenet and other investor-owned hospitals, as one of its authorized representatives.
Earlier this year, the federation's CEO, Chip Kahn, publicly took credit for the idea of forming PAHCF, according to Modern Healthcare. Kahn is best known for creating the health insurance industry's "Harry and Louise" advertising campaign against the Clinton administration's health care reform plan in the '90s, and he was reportedly involved in negotiating a backroom deal with the Obama White House to remove a public health insurance option from the Affordable Care Act. The federation paid Kahn almost $2.6 million last year.
A July filing by PAHCF in Washington, D.C., lists the Federation's former senior vice president, Jeff Cohen, as a PAHCF board member. The filing doesn't name any additional members. A PAHCF spokesperson said that Cohen is no longer part of their board.
Cohen recently left the Federation to become the top lobbyist at HCA Healthcare, another member of both the Federation and the PAHCF campaign against Medicare for All. HCA, which dealt with fraud accusations while under the stewardship of then-chief executive Rick Scott (who is now a U.S. senator), owns 185 hospitals.
https://theintercept.com/2019/10/15/medicare-for-all-hospital-tenet/
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New Trump administration rules force hospitals, insurers to give consumers more information on health-care rates
Under one rule slated to take effect in 2021 and resisted for months by the health-care industry, hospitals must for the first time reveal the discounted rates they negotiate privately with insurers for a list of 300 services patients can schedule in advance, including X-rays and cesarean deliveries.
The administration is also proposing to require most health plans that Americans get through their jobs to disclose the rates they negotiate with hospitals and doctors in their insurance network and amounts paid to doctors out of network.
Earlier this year, a Washington-based federal judge ruled the administration did not have the authority to compel the drug industry to disclose drug prices in television advertisements. And the administration withdrew a major effort to rein in drug prices by prohibiting rebates to insurance middlemen following criticism the changes could increase Medicare premiums before next year's election.
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Survey: Nearly 23% of Americans can't afford prescribed drugs More than 1 in 5 Americans responding to a poll said there had been a time in the last 12 months when they or someone in their household could not afford a drug prescribed to them, according to Gallup, and more than 13% said a friend or family member had died in the last five years after being unable to pay for treatment. The poll found a majority of adults, regardless of income level, employment or education status, support legislation designed to reduce prescription drug prices at the expense of drugmakers.
https://edition.cnn.com/2019/11/12/health/us-cant-afford-health-care-trnd/index.html
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Verma Slams Nonprofit Hospitals That Sue Patients for Payment
CMS administrator also trumpets new hospital, insurer transparency rules
Centers for Medicare & Medicaid Services Administrator Seema Verma blasted nonprofit hospitals for suing patients, plugged new price transparency rules, and blamed the uptick in the nation's uninsured rate on the Affordable Care Act (ACA), during an interview and panel discussion at the U.S. News & World Report Healthcare of Tomorrow summit Tuesday.
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This resource may be helpful to someone:
Corporate Angel Network is the only charitable organization
whose sole mission is to transport cancer patients to the hospital at which they need to be in order to receive a specialized form of treatment. Simply put, we pair empty seats - on both private and corporate planes - with qualified patients who need the rides... at no cost. This not only improves the patients' chances of survival but at the same time, it reduces their emotional stress, physical discomfort, and financial burden.
Eligibility (as of posting)
At Corporate Angel Network, our mission is to arrange free travel on private planes for cancer patients, bone marrow donors and recipients and stem cell donors and recipients.
If you are a patient or a donor, we ask that you meet the following criteria:
- You are a cancer patient, a bone marrow donor or recipient, or a stem cell donor or recipient.
- You will be traveling to a treatment, consultation, or check-up.
- You will be traveling to recognized treatment centers as listed with the National Cancer Institute or the American College of Surgeons.
- You are mobile and able to walk up the steps of a corporate aircraft without assistance.
- You do not require oxygen, IV medication, or medical assistance while onboard the plane.
http://corpangelnetwork.org/#/home
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Hospitals Sue Trump to Keep Negotiated Prices Secret
The administration wants to require hospitals to reveal the rates they privately negotiate with insurers for all sorts of procedures, amid the public outcry over surprise medical bills.
https://www.nytimes.com/2019/12/04/health/hospital...
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Medicare Advantage Enrollees Discover Dirty Little Secret
Getting out is a lot harder than getting in
Also called Part C, these plans can cover a broad array of health services at low cost -- that is, until one gets sick, at which point out-of-pocket costs can soar. But once in an MA plan, getting out can be even less affordable.
...if beneficiaries enroll in a Medicare Advantage plan at age 65 and want to get out, they must do so within 1 year, and then they have another 63 days from the disenrollment date to buy a Medigap plan without risk of coverage denial or being subject to underwriting.
{This article is not about the ACA, but is important info re access to care and Medicare options.}
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Published 10 hours ago
Sally Pipes: Sanders, Warren want 'Medicare-for-all' like Canada – But Canadian health care is awful
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I'm sure Canada's program is not perfect, but most forum participants from Canada seem to think it is pretty good. Hospitals in rural areas of Canada are faring better than those in rural areas in the States. Regarding wait times... I've had some fairly shocking wait times on my "private" employer-based plan here in the U.S. - so it's not like we get guarantees. I've always found it s a little odd that Americans don't want the government involved in their health care but they have no problem with their employer being involved in it - including determining what care they will get. It sounds a bit feudal when you think about it. The reality is, most people really have no idea how good their health insurance is until they have a major need.
Irony of irony, this comes as I am reviewing options for health coverage for next year. It is troubling that everything seems so tenuous...so many providers are "excluded" from plans. Others are added and dropped. Drugs might be covered... but might not... It is nearly impossible to travel on the plans we have now because care is by locality. Going out of town is risky. Heaven help you if you need to help care for a family member who lives out of your area. We pay double what other first world countries pay... for this? I find it extremely frustrating. I just don't believe we can't do better than this.
The Fox interview includes a number of false or misleading and incomplete statements. People can certainly have different outlooks and preferences about the direction reforms to health should take but .... this is not helpful. Which is too bad because I would hope that people who spend their careers working on health care issues would have something to contribute to the discussion.
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This is what I want to see regarding Medicare prescription prices: a cap on what Medicare recipients pay. Democrats propose a cap at $2,000 a year. Republicans suggest $3,100. Next year I may be paying close to $10,000 for Verzenio because currently there's no cap on Medicare drug copays.
It sounds like it has a while to push something through, but both political sides seem to have understood that voters are demanding something be done with drug prices.
**Part of the NPR article:
Practically everyone is frustrated by high prescription drug prices. Voters have made clear they want Congress to do something about them.
On Thursday, the House of Representatives passed a bill that tries to deliver on that. It was a mostly party line vote — all Democrats voted to pass it, along with two Republicans.
The bill, HR 3, titled the Elijah E. Cummings Lower Drug Costs Now Act, is highly unlikely to get through the Senate, and the White House has announced that President Trump would veto it if it came to his desk.
But it does have several components that are reflected in other proposals in Congress, including a bipartisan bill in the Senate that might have better prospects.
"Obviously, Speaker Pelosi's proposals are the most ambitious — they're also the furthest from becoming actual law," says Benedic Ippolito, an economist at the American Enterprise Institute, a conservative think tank in Washington.
The bill lays out a vision for how Democrats would like to remake prescription drug pricing in this country, which could be seen as a promise to deliver on a bill like this if voters choose Democrats in the upcoming election.
Ippolito says he is glad to see some real proposals to address this issue. "It's not every day that we see both parties actively proposing legislation to meaningfully reduce drug prices," he says. "Whether one loves HR 3 or not, I think it's still a good thing that we have both parties taking this issue seriously."
******. Limit out-of-pocket costs for Medicare enrollees
Right now, there's no limit for how much seniors and others on Medicare spend on drugs out of pocket — unlike in most insurance plans. This bill would set a limit for Medicare patients at $2,000 a year.
It's not just seniors who get a break here. Right now, after enrollees have spent several thousand dollars on drugs, they're on the hook for 5% of ongoing costs, their prescription drug plan pays 15% and Medicare pays 80% — drug companies don't pay any part of it. Under the bill, that splitting gets changed around: Patients pay nothing after they hit the new cap, drug companies pay 30% and Medicare and health plans pick up the rest.
Stacie Dusetzina, a health policy professor at Vanderbilt University who has written extensively about Medicare Part D, says that drug prices were overall "much lower" in 2003, when Medicare Part D became law. (Before that, Medicare didn't cover drugs at all.) And, she says, many new, high-cost treatments have entered the market since then.
"In areas like cancer or multiple sclerosis or hepatitis C, all of these treatments are very, very expensive," she says. "So even if you only have to pay 5% of the drug's price, it gets incredibly expensive for the patient, and there's just no limit."
There's widespread agreement in Congress that this needs to be fixed. The bipartisan bill in the Senate has a similar redesign of who pays for expensive drugs, and it has an out-of-pocket cap for enrollees, although it's set a bit higher — at $3,100 per year
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The House Just Passed Its Prescription Drug Plan — Here's What's In It
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House Dems Pass Bill to Lower Drug Prices
Aims to rein in costs by allowing price negotiation in Medicare; Republicans call it "deader than a doornail"
The House voted 230-192 on Thursday, along party lines, to pass a bill championed by Democrats that aims to lower drug costs by allowing price negotiation in the Medicare program. The bill would also establish a $2,000 out-of-pocket cap on Medicare Part D drugs.
Republicans argued that the bill would hamstring innovation and bankrupt start-ups, and stressed that it would never be passed into law. The Senate has no plans to vote on the bill, and if it were to reach the White House, the president would veto it, they said.
The White House had been working with Congress on the drug pricing bill, and some provisions, including the idea of an international pricing index, were borrowed from President Trump himself.
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Just what I posted above, Lumpie.
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DevineMrsM: Yes. Same legislation. It's getting coverage in many outlets. Would love to see progress on at least some of these concerns.... fear that current atmosphere on Capitol Hill will make that challenging.
*Correction* I thought that there was a Republican alternative bill in the Senate. Upon further review, I believe that that alternative was in the House (HR 19). It would have created a Part D out of pocket max at $3100 and allowed health plans to make insulin not subject to deductibles. It would require disclosures about drug prices (like large price increases) and discounts and make it harder to delay generics and biosimilars. It adds feminine or menstrual care products to the list of qualified medical expenses for the purposes of tax-favored health accounts. It waives Medicare coinsurance for colorectal cancer screening tests. Unfortunately, it doesn't look like it would do much on drug costs overall. You can read a summary of the House Republican alternative here: https://republicans-energycommerce.house.gov/wp-content/uploads/2019/12/HR19_Section-by-Section_FINALDRAFT_v4.pdf)
If anyone knows of corresponding legislation in the Senate, please share. Thanks.
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Trump health promises thwarted by feuding aides, shifting orders
Bitter infighting among President Trump's top health officials — as well as his own shifting demands on signature policies — have undermined key planks of the president's health-care agenda as he girds for a tough reelection campaign, according to current and former administration officials. https://www.washingtonpost.com/health/trump-health-promises-thwarted-by-feuding-aides-shifting-orders/2019/12/11/7bf4f3e4-1c3b-11ea-87f7-f2e91143c60d_story.html?utm_campaign=to_your_health&utm_medium=Email&utm_source=Newsletter&wpisrc=nl_tyh&wpmm=1{This article provides some background on efforts Trump and Republicans have made on health related issues and why we have not seen a more comprehensive plan.}0 -
Pre-existing conditions are most important to President Trump, as well as getting prescription drug prices down. But I can't see anything on any seriously important issue getting done during 'impeachment.' And that could go on for 5 years until he's re-elected and impeached again. They promised today to keep impeaching him as many times as necessary. Trump will work with anyone who wants to deal rightly with pre-existing conditions and lower drug prices. But doing the real work of Congress is just not happening now as they believe impeachment is more important. If things ever get back to 'normal' then I think former ACA folks will be happier with what they get.
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