Aug
15

I’m turning optimistic…

After too many months of doom-scrolling catastrophic weather events, rising inflation, ridiculously high medical costs, Russian fascism, social media wars over gender issues and elected officials that can’t seem to do anything but campaign for their next election, I’m starting to get just a little optimistic

The economy…is doing pretty darn well. (Most of the below from Scott Galloway)

  • Employment has risen every month this year and we added more than 500,000 jobs in July
  • The unemployment rate is near a 50-year low.
  • Family spending – which accounts for 70% of the economy – has increased five of the last six months.
  • Two out of three companies in the S&P three companies have beaten Wall Street’s revenue estimates, and three in four have beaten earnings estimates.
  • According to one economist peoples’ fears are “completely at odds with the reality. I’ve never seen a disjunction between the data and the general vibe quite as large as I saw.”
  • yeah, inflation…but it was lower in July than June, and gas prices are down 20% from their high earlier this year…

Congress is actually getting a LOT done.

The just-passed Inflation Reduction Act will:

Oh, and the legislation also kept 13 million folks’ health insurance premiums affordable, which will keep more of us alive.

On the state level, it’s not just stupid waste-of-time caterwauling about gender issues… Colorado just passed bi-partisan legislation that “prevents hospitals or their collectors from initiating or pursuing debt collection from a patient if the hospital’s website was not in compliance with the Centers for Medicare and Medicaid Services (CMS)’ price transparency requirements at the time services were delivered”

Kudos to Colorado’s legislators for doing something Congress SHOULD HAVE DONE – put some damn sharp teeth in hospital price transparency legislation.

What does this mean for you?

Things are better than some would have you believe!


Aug
12

Health insurance saves lives

A just-released study shows people with health insurance are a little less likely to die than those without insurance. 

That is not surprising; preventive care, access to medications to control diabetes, hypertension, depression, cancer and the like, and early diagnosis of potentially life-threatening diseases are all going to keep people alive longer.

From the study:

The study approach taken by the research team bypassed concerns raised against previous non-experimental research on this topic.

The outreach intervention was a joint project designed primarily by the Treasury Department’s Office of Tax Analysis, funded by the Department of Health and Human Services (HHS), and implemented by the IRS.

What does this mean for you?

Health insurance saves lives.

For workers’ comp, the implications are clear – workers who have health insurance are likely to be healthier than those without – and therefore more likely to recover from occupational injuries or illnesses.


Aug
1

Just the facts, ma’am…

Today we’re doing a very quick recap of stuff we learned over the last couple of weeks…no opinion here (yeah that was really hard for me…)

Extra credit for identifying the man in the picture…

But first, for those of us perennially mad at ourselves because, well, we screw up and aren’t perfect, read this. Short take – perfectionism…

“…makes for a thin life, lived for what it isn’t rather than what it is. If you’re forever trying to make your life what you want it to be, you’re not really living the life you have.”

Drug prices

Make for great politics…even when all the caterwauling is wrong. The issue is what we – the consumer – pay is NOT what insurers, PBMs, and other payers pay.

That’s due to the “gross-to-net bubble”, a term popularized by the estimable Adam Fein Ph.D.

When rebates and discounts were factored in, brand-name drug prices declined—or grew slowly—in 2021.

So…you getting those rebate checks?

COVID’s origins

Remember the theory that COVID came from a Chinese lab? It is looking increasingly sketchy.

comprehensive, detailed, and multi-factor analysis by scientists from four continents found

the emergence of SARS-CoV-2 occurred via the live wildlife trade in China, and show that the Huanan market was the epicenter of the COVID-19 pandemic.

The peer-reviewed research published in the journal Science covered molecular epidemiology and spatial and environmental analyses.

Investors and physician practices

Private equity investment in physician practices varies a lot by specialty and region. Quick takes…

  • about 5% of physicians were in private equity-acquired practices
  • The highest percentage was in D.C. (18.2%)
  • More than one in ten docs in AZ, CT, FL, MD, and FL were in PE-acquired practices

The researchers wrote…

“Because some private equity acquisitions consolidate physician practices into larger organizations, geographic concentration of private equity penetration may be associated with reduced physician competition, which could lead to increased prices, [emphasis added]

An interactive map and the research report are here.

Gun violence

Gun makers earned over 1 Billion (with a B) dollars from sales of military-style assault weapons over the last decade. A report to Congress found:

  • gun makers marketed to young men by claiming their weapons will put them “at the top of the testosterone food chain”…
  • the weapons were described as an “apex predator”
  • some ads for these weapons “mimic first-person shooter video games popular with children.”

source here

The AR-15 is the most common of these weapons…the NRA named it “American’s Rifle” back in 2016. (and here I always thought it was Davy Crockett’s flintlock rifle…)

(disclosure – I hunt and have several rifles – none are semi-auto like the AR-15)

Workers’ comp physician fee schedules

…are all over the place…Louise Esola at Business Insurance reported on a recent WCRI analysis that found:

About one-quarter of the fee schedule states established their rates for office visits near the Medicare level or below, while about the same number of states set their fees for major surgery at triple the Medicare rates or more in each state…

The study – authored by Olesya Fomenko and Te-Chun Liu and up to date as of this spring – is here. (sorry for misspelling of Dr Fomenko’s  name in  earlier version…darn spellcheck!)

Clearly politics trumps policy…unless someone can tell us why it makes sense for Florida to pay docs below Medicare, while paying hospitals many times Medicare… I’ll stick to politics, campaign contributions, lazy legislators and hand-cuffed or ineffective regulators as the main driver of work comp fee schedules. (oops opinion inserted into post…just can’t stop myself)

Happy August!


Jul
18

(Perhaps) unintended consequences of abortion bans

With all the attention paid to abortion these days, I thought it worthwhile to dig into the financial and health impact of abortion and childbirth.

First, the cost.

Women who give birth incur about $19,000 in additional healthcare costs compared to women who don’t.

And that’s for women covered by large employers’ health plans.

Second, medical debt.

Lower-income adults in the South and/or in states that have not expanded Medicaid are much more likely to have medical debt than the rest of us.

Third, coverage.

About 13 million of us will see their health insurance premiums jump in January unless Congress acts. The issue is subsidies for lower-income folks who get their insurance via the Exchanges will expire at the end of this year unless they are extended. So far, the chances for an extension don’t look promising.

Fourth, societal costs.

  • Almost half of the women receiving abortions have incomes below the poverty line.
  • Lives will be hugely impacted, as “the expansion of abortion access … reduced teen motherhood by 34% and teen marriage by 20%”
  • Women who are denied abortions are three times more likely to be unemployed than women who were able to receive one, according to a 2018 study.
  • Women who were not allowed to access abortion services had nearly a four times greater chance of living below the federal poverty line.
  • And…”research shows that in 2010 the public paid just under $13,000 on “prenatal care, labor and delivery, postpartum care and 12 months of infant care.” per birth.”

Connecting the dots.

States that have or are likely to ban abortion are:

  • unlikely to have expanded Medicaid,
  • have much more restrictions on Medicaid coverage so far fewer people qualify for Medicaid, and
  • therefore many more poor women who are forced to have children will have higher medical debt,
  • will not escape living in poverty, and their child will grow up poor.

What does this mean for you?

If one is going to force people to do things, one should understand and be responsible for the consequences.


Jul
11

Healthcare Sharing Ministries and the brutal reality of medical debt

Last week I posted on Health Care Sharing Ministries, noting I’d been reaching out to the PR firm that works with theAlliance of Health Care Sharing Ministries, the PR people put out a release touting their new accreditation standards.

As I noted last week the accreditation process/requirements don’t appear to require minimum cash reserves, specific expense ratios or meet other financial adequacy minimums and the accreditation board doesn’t include individuals with actuarial or financial credentials.

In English, this is a very big deal. Unlike real health insurers, HCSMs aren’t required to have enough cash to pay your medical bills. Also unlike health insurers, members don’t have any recourse if their “ministry” decides your care isn’t worthy of their support.

This comes on the heels of a recent study that found almost a third of all Americans have medical debt; in their efforts to pay off debt respondents made a number of sacrifices and suffered substantial financial consequences: (actual study and responses from KFF)

  • cutting back on household spending
  • more than four in ten say they or a household member have used up all or most of their savings
  • respondents reported skipping payment on other bills,
  • and delaying college or buying a home, or changing their housing situation, while
  • half of adults with health care debt say they have made what they feel to be a difficult sacrifice in order to pay down their debt
  • One in seven adults with health care debt say they have been denied care by a provider due to unpaid bills

Here’s the truly awful thing…the least fortunate among us are in the worst shape.

I get that some people have had good experiences with HCSMs. I also know others have not, and are now among those with crippling, life-changing medical debt.

What does this mean for you?

HCSMs are no silver bullet…rather they are a “send the check in and hope you are covered if you get hurt or sick” non-solution.

It’s a measure of just how dysfunctional our healthcare system is that HCSMs even exist.

Ed note – I’ve been holding off on this post for days, hoping to hear something from AHCSM. I’ve repeatedly asked the PR firm for more details; evidently the right folks haven’t been able to respond.

I first reached out to the PR contact on June 21, 2022…three weeks ago.

 


Jul
6

Healthcare Sharing Ministries – the latest

Healthcare costs are about to jump again, driven by exploding staffing expenses, continued healthcare provider consolidation, and the brilliant profiteering by some of the largest (mostly for-profit) healthcare systems.

So, what’s a family to do?

A few have turned to Healthcare Sharing Ministries, a thing that looks like health insurance but isn’t. HCSMs purport to “share” health care costs among members in what might best be described as a risk-pooling framework. Almost all claim to be “Christian”, they are largely unregulated (except as charities), don’t comply with insurance regulations or laws in most states, and most have requirements that members:

  • are in good health,
  • make a statement of Christian belief, attend church regularly, don’t use tobacco or have sex outside of marriage and
  • commit to taking care of their own health.

note there are ministries focused on other religious denominations.

So…sounds good right? cheaper healthcare is better…well, HCSMs also:

  • are not legally required to pay your medical bills,
  • require enrollees to do much of the groundwork to get bills paid (negotiate upfront with the provider, get all the paperwork and documentation, pay upfront then seek reimbursement)
  • medically underwrite – meaning they require disclosures of pre-existing conditions and can reject applicants for medical reasons,
  • can refuse coverage to anyone for any reason,
  • have limits on what they’ll pay for healthcare,
  • can’t guarantee healthcare providers will accept sharing ministry coverage, and
  • have appeals processes that aren’t subject to regulatory oversight.

Enrollment is a bit hard to nail down; the Alliance of Health Care Sharing Ministries claims 1.5 million enrollees although it doesn’t specify the year. Other reports indicate AHCSM reported membership was “over 1 million” in February of 2019. Other sources report membership closer to that 1 million figure.

HCSMs tend to be significantly cheaper than health insurance plans, making them increasingly attractive. However, most families that buy health insurance through the exchanges get major subsidies that significantly reduce their premiums.

There have been multiple reports of individuals and families stuck with huge bills after their “Ministry” refused to pay for care. Aliera Healthcare Inc. and Trinity Healthshares, Inc are the most visible example of what can happen without tight regulation. Regulators in multiple states issued cease and desist orders after concluding the companies violated laws; Aliera was found guilty of fraud and filed for bankruptcy late last year.

Tops among concerns is this – HCSMs are NOT required to have enough cash on hand to pay medical bills. Even more concerning, they don’t have to report their finances, cash reserves, expense ratios or other data.

There’s an effort underway to “accredit” HCSMs; the process/requirements don’t appear to address this critical issue and the accreditation board doesn’t include individuals with actuarial or financial credentials.

I’ve asked the lobbying outfit that purports to represent HCSMs for details on the financial portion of that accreditation process. So far they’ve been less than forthcoming.

What does this mean for you?

be very careful.

 


Jun
16

Massacres, mental health, and the Senate’s “plan”

“Plan” is in quotes because as of now, it’s not legislation – just a list of programs and funding mechanisms that are very much a work in progress. It’s anyone’s guess if any legislation will actually become law…although as of now it seems a bit less likely.

Ed note – in my view the provisions of the legislation wouldn’t have much effect at all as they don’t address many of the core issues driving gun violence – except it would allow Dems to say they got a bill passed, and Republicans to tell independent moms that they care about kids.

Gun violence is a public health issue; it fits right into the purpose of public health, namely “reducing and preventing injury, disease, and death and promoting the health and well-being of populations through the use of data, research, and effective policies and practices.”

What’s appalling to me (a gun owner and hunter) is this:

  • More kids are killed by guns than by car accidents – child seats and restraints are the law in most if not all states because elected officials recognized kids were being killed and maimed in accidents.
  • This is especially true for Black kids – guns have been the leading cause of death for black boys over 15 for more than a decade.
  • Laws were passed decades ago to protect kids from lead paint.
  • Backyard pools must be fenced in most areas.
  • Kids can’t buy alcohol or tobacco products because of health risks.
  • When guns are present, suicides are far more likely to result in death; in fact there are far more gun deaths by suicide than homicide.

Yet most states do pretty much nothing to protect kids from gun violence – in fact in many states laws have been passed that increase the risk to children.

The holdup seems to be about two things; so-called red flag laws and the “boyfriend loophole”.

Red flag laws allow for/enable the temporary seizure of weapons and/or prevent weapons purchases by individuals deemed to be a danger to themselves or others. States with effective red flag laws have saved lives; “58 people who threatened mass shootings were disarmed during the first three years of California’s six-year-old red flag program. At least 12 school shootings were averted.”

GOP Senators are raising due process concerns; that is, they want to make sure individuals have their day in court before their guns are taken away.

More problematic is that there are 31 states without red flag laws; Sources indicate a GOP Senator assured his colleagues that “there would be no federal mandate to implement the laws”. Without that “mandate” the red flag provision would be pretty much toothless; states that have been busy making it easier for anyone to get and carry firearms wouldn’t be affected.

Sure those states wouldn’t get the federal funding needed to implement the red flag provisions, but elected officials would tout their willingness to refuse those dollars s evidence of their steadfast opposition to any gun control measures.

The “boyfriend loophole” is also problematic…today unmarried partners who commit domestic violence can buy/keep firearms while spouses who commit domestic violence can’t. (Note it’s not merely “threaten”…in most cases a spouse has to actually do something violent to potentially lose their guns.)

Health care payers

Behavioral health is how this affects health plans and payers.

All kids should be screened for BH concerns – no matter where they live. Care should be provided where needed. This will require additional funding, changes in benefit design for Medicaid, duals, and exchange/group health, and more behavioral health clinicians.

Of course this is politically driven

Sen. Kevin Cramer, R-ND, on Tuesday. “I think we’re more interested in the red wave than we are in red flags, quite honestly, as Republicans and we have a pretty good opportunity to do that,” seemingly a reference to the possibility of Republicans taking control of Congress this fall.

Nice to see a politician publicly state that he cares more about votes than public safety.

What does this mean for you?

Depends – do you have kids? 


Jun
15

Single Payer health insurance and worker’s comp

A couple days ago NCCI’s Laura Kersey penned a piece about key legislative trends, one of which was Single-Payer health insurance. Good research work.

First, let’s define “single payer”. “Single Payer” – by definition – is government-financed and government-managed health insurance. (note Ms Kersey focused on state efforts; for reasons I’ll discuss below states CANNOT have a “single payer”.

Single Payer is a catch-all term for universal health insurance coverage. In some cases there isn’t a “single payer” in an entire nation – our neighbor to the north being one example, Switzerland and Germany are two others. In Canada, each Province is it’s own single payer; in the two European countries there are a variety of independent companies that provide health coverage. Taiwan has one payer for all residents.

There are a LOT of different versions of “single payer”; a discussion is here. Pretty much every country with Single Payer is unique, each with its own nuances. For example,

  • most don’t have government-employed healthcare providers; in many single payer systems, physicians, therapists, hospitals and other providers are private.
    • The UK is an exception; providers are (mostly) employed by the government
  • many are not government-operated; in many systems private insurers contract with the government to handle administration of health insurance – similar to our Medicare
    • Again the UK is an exception

Typically:

  • the government sets pricing/reimbursement policy and actual prices – similar to our Medicare
  • funding comes from some combination of employee, employer, and other taxes; in some countries, insureds pay some form of premiums – similar to our Medicare
  • it covers everyone
  • there is little to no paperwork for patients/consumers; all that is handled by the administrative agency
  • there are minimal or no deductibles, copays, or co-insurance requirements
  • people can buy into supplemental insurance through private insurers

Ms Kersey’s article notes several states have pending or tabled legislation related to single payer.

A key issue here is a very large chunk of spend in each state – as in more than half – comes from the Feds. Thus, unless a state gets waivers from the Feds (which will never happen) exempting Medicare and Medicaid from that state’s Single Payer program, most of the medical dollars aren’t going to be in that state’s program.

I’d suggest how Single Payer would affect comp depends on two core issues:

  • whether care for occupational injuries/illnesses is covered by Single Payer, and
  • whether there is a universal fee schedule.

If WC care is included under Single Payer, it is likely work comp would evolve to an indemnity-only system. This currently exists in several other countries, and seems to work pretty well.

If WC medical care is NOT included in Single Payer, the impact would be driven largely by the presence – or absence – of a universal fee schedule. 

Without that universal fee schedule, providers would likely continue to do their revenue maximization thing, although they’d supercharge those efforts. Why? Because reimbursement from all other payers would drop significantly, and providers would look to comp to replace as much of that lost income as possible.

What does this mean for you?

There will NEVER BE A STATE-BASED OR STATE-SPECIFIC SINGLE PAYER PROGRAM.


May
26

Moms, you can make this stop.

Your kids will never be safe, not as long as pretty much anyone can buy and own and use guns designed only to kill people.

The slaughter has become commonplace…so “normal” that one can now buy casket wraps specifically for kids. 

credit Cara Anthony, Kaiser Health News

Guns were the leading cause of death among children in 2020more kids were shot and killed than died in car accidents.

This year alone 3,044 students aren’t going to graduate because they were shot to death. Thousands of parents and grandparents and neighbors and friends live with their loss – every minute of every day. 

The slaughter of little kids in Texas and elderly Black Americans in Buffalo tore away the comfortable numbness, replacing it with sadness beyond measure…yet somehow we pushed through. A colleague wrote this in an email; “I”m surprised at how much of business life just continued without comment.” That’s on us – each of us.

Here are two things that must be done.

  1. Make background checks effective.
    In the decade since Sandy Hook, we have made zero progress in improving or expanding background checks on gun buyers.  The current process is clearly an abject failure, rendered toothless by “compromise” in Congress. The reality is:

    1. minimal information is required
    2. Background checks aren’t done at gun shows or for private sellers, so anyone can buy a gun in a private transaction.
    3. there are loopholes and gaps that enabled multiple mass killings perpetrated by individuals who never should have been allowed to buy a gun
    4. The bar for denying someone on mental health grounds is very high, requiring that a person has been declared unsound or involuntarily confined to a psychiatric institution by a court or other authority.”
    5. If the FBI (the Federal entity responsible for background checks) can’t make a decision within 3 days, the firearm purchase is automatically allowed.
    6. Many states, the US military, and other data suppliers tasked with sending information to the FBI fail to keep their records complete and up to date, rendering the information they supply to the FBI questionable at best.
    7. What you can do – Please sign this petition, and learn more here.
  2. Ban weapons designed to kill people.
    A good friend, former Green Beret and Vietnam combat veteran said this:As a nation we’ve got to come together and force our politicians to take up the challenge of eliminating the absurdly easy access by civilians to military weaponry and equipment. As someone who has owned guns for over 60 years and carried a shortened M-16 (actually called a CAR-15) for 19 months in combat, I’m saying that there is no reason for a non-military or law enforcement citizen to have a weapon that was intended only for killing other humans. What legitimate non-combat purpose does a 30 round stick magazine or 100 round drum magazine of 5.56mm ammunition have? Why are body armor and Kevlar military helmets permitted to be readily sold to the public with no questions about their intended use? How does one justify needing a 40 round magazine for a pistol? There truly must be a reckoning with our elected officials on both sides of the aisle to force the question of what their honest priorities are: the safety of our people or the continuance of their career funding by arms merchants, gun lobbies and a very small minority of highly vocal citizens who will fulfill their desires no matter what the cost to our society.
    What you can do: Support the Brady Plan.

What does this mean for you?

Take 5 minutes to help prevent a lifetime of grief. Support the Brady Plan

 

 


May
25

This is about your children.

Once again children have been killed.

Yesterday’s slaughter of little children cut me to the heart, coming the day after I spent hours watching our granddaughter. Hours of delight, wonder, love, joy and promise.  Sitting together in a swing as she munched on goldfish, picking dandelions, working on puzzles and learning more colors, doing nose kisses and picking out her outfit for the day (rain boots, shorts, and a favorite shirt, with a pretty awful ponytail (as it always is when grandpa does it)).

I cannot imagine the heartbreak suffered by families in Uvalde Texas, nor can I imagine how this reverberated among parents of kids killed in Sandy Hook Connecticut a decade ago, ripping open wounds painful beyond measure. That’s awful indeed – what’s worse – if that’s possible – is there have been dozens of mass shootings this year alone.

Look at your kids, your schoolyards, your sports fields, your graduation ceremonies and school plays and imagine the impact of a Uvalde/Sandy Hook/Buffalo/Laguna Woods/Milwaukee/Brooklyn/Sacramento.

If we do not do something about gun violence, some of you, dear readers, may come to understand all too well the heartbreak and utter devastation suffered by families victimized by gun violence.

Make no mistake, this butchery would not happen without grandstanding by vote-seeking pols, lax background checks, wildly inadequate mental health care, incredibly permissive concealed carry laws in some states and easy access to guns, many of which serve no purpose other than killing people.

What does this mean for us?

We are failing to protect children, loved ones, parents and family. This is a national disgrace. 

Note – I am a gun owner and hunter. Family members are first responders, former law enforcement and national security.