Letters to the Editor is a periodic function. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.
2018 was a busy 12 months for KHN, harvesting greater than 1,200 medical payments submitted by readers for consideration in our “Invoice of the Month” franchise, an investigative partnership with NPR. These month-to-month dives into sufferers’ cumbersome payments proceed to spawn tales — in addition to proposed adjustments to well being care coverage by legislators.
Sen. Bernie Sanders (I-Vt.) glommed on to the despair of an Arizona couple consumed by well being care debt (“Insured However Nonetheless In Debt: 5 Jobs Pulling In $100Okay A 12 months No Match For Medical Payments,” Dec. 28).
Nobody ought to must work 120 hours per week or 5 jobs to have the ability to get the well being care they want. We want a well being care system that places individuals earlier than income. We want a Medicare for all, single-payer system. https://t.co/p6Nzz16x2J
— Bernie Sanders (@BernieSanders) December 27, 2018
In response to the August “Invoice of the Month” function a few schoolteacher’s $109,000 coronary heart assault, Rep. Lloyd Doggett (D-Texas) tweeted: “Once I heard Drew’s story — an Austin instructor saddled with a $100okay shock invoice after surgical procedure — I reached out to him to share my concern. We mentioned my Finish Shock Billing Act laws, which might finish this predatory observe.”
Once I heard Drew’s story—an Austin instructor saddled with a $100okay shock invoice after surgical procedure—I reached out to him to share my concern. We mentioned my Finish Shock Billing Act laws, which might finish this predatory observe. https://t.co/34FHOQBa4A
— Lloyd Doggett (@RepLloydDoggett) September 1, 2018
Sanders additionally shared that story on Fb, saying: “Our well being care system makes completely no sense. In the event you don’t have medical health insurance, you in all probability can’t afford to get the care you want. And should you DO have medical health insurance, in lots of circumstances you STILL received’t be capable of afford the care you want, on prime of paying a month-to-month premium.”
Outrageous medical payments proved one thing readers may relate to, as they reviewed our end-of-the-year roundup, 12 months One Of KHN’s ‘Invoice Of The Month’: A Kaleidoscope Of Monetary Challenges” (Dec. 21).
Message right here – do not get sick! @UTSWIMchief https://t.co/l8R3hAnTYU by way of @khnews
— David Johnson (@dhjutsw1) January 7, 2019
— Dr. David Johnson, Dallas
Plaudits For ‘Invoice Of The Month’ Sequence
Thanks for publishing these tales. You might be doing a public service. I work in well being companies analysis and know that the costs charged by producers, hospitals and different suppliers are arbitrary. The extra residents are knowledgeable about this, the extra energy we’ve got to vary how a lot well being care prices on this nation.
— Beth Egan, Minneapolis
Sufferers ought to look rigorously in any respect their hospital payments – estimates are that half have errors: exams scheduled however not and charged, medicines not taken., consults by medical doctors who by no means noticed you. Caveat emptor!
— Edward Hoffer MD (@EdwardHoffer1) December 26, 2018
— Dr. Edward Hoffer, Boston
‘Invoice Of The Month’: Recourse For Wounded Skier
Plainly the surgeon and the system producer ought to have paid for Sarah Witter’s second surgical procedure (“After Her Snowboarding Accident, An Uphill Battle Over Snowballing Payments,” Dec. 18). If she really adopted protocol for her rehab, they need to have owned as much as their mistake or to a poor manufacturing approach. Nearly 10 years in the past, I had an higher gastrointestinal collection carried out to observe my non-Hodgkin’s lymphoma. Because of the biopsies, I skilled vital bleeding (the physician stated that he had executed this process a number of instances when the affected person was nonetheless on blood thinners, which I used to be). After I used to be admitted to the emergency room and obtained 4 models of blood, they repeated the process — and charged me for all of it. Luckily, after threatening a lawsuit in opposition to the hospital and the physician, they lastly paid for the emergency room and working expenses.
There nonetheless could also be some aid for Ms. Witter: There are corporations who audit hospital payments and receives a commission in the event that they discover financial savings. When the insurance coverage firm refused to pay the hospital, they need to have referred her to an organization that audits hospital payments.
— Dan Kass, chief shopper of HealthCare Buying Community, Mission, Kan.
On Twitter, readers minced no phrases:
Nicely, what do you count on from a small piece of steel that prices $9,706? No marvel it broke.Invoice Of The Month: $43,208 For Repeat Surgical procedure To Exchange Damaged Medical Machine https://t.co/MLHMIiP1Xo
— Bernie Good (@CBGood23) December 18, 2018
— Bernie Good, Pittsburgh
That is unconscionable. We want #SinglePayer now! No one ought to must struggle with insurance coverage corporations or foot the invoice for a second surgical procedure as a result of system failure. Invoice Of The Month: $43,208 For Repeat Surgical procedure To Exchange Damaged Medical Machine https://t.co/VWM3ALKEhW
— Judy Melinek M.D. (@drjudymelinek) December 18, 2018
— Dr. Judy Melinek, San Francisco
A Dose Of Delusion-Busting
Julie Appleby’s story “Quick-Time period Well being Plans Maintain Financial savings for Customers, Income For Brokers and Insurers” (Dec. 21) perpetuates a standard misunderstanding that incentives for insurance coverage brokers favor promoting short-term over Reasonably priced Care Act plans.
By evaluating a month-to-month fee price of 20 p.c for short-term plans and a flat greenback quantity for ACA insurance policies, the article mistakenly means that fee earnings on short-term plans are persistently larger than people who adjust to the ACA. However the premise misses the essential proven fact that the lifetime worth of a plan — not the month-to-month fee price — determines insurance coverage agent commissions. Quick-term plans are each inexpensive and held by the client for a shorter time period than ACA plans. At eHealth, an ACA plan generates twice the income as every short-term coverage.
Most insurance coverage brokers advocate for shoppers to decide on an ACA plan first, if they’ll afford it, as a result of the protection is much extra complete. Sadly, many People have been priced out of the ACA market and short-term insurance policies could signify the very best viable medical health insurance protection at a worth they’ll afford. Others miss the open-enrollment interval and, with out different choices, face a 12 months with no insurance coverage protection in any respect. The accountability of a great insurance coverage agent is to assist all People achieve entry to the insurance coverage coverage best suited for his or her particular person medical and monetary wants. To do something much less isn’t in the very best curiosity of shoppers or to the long-term success of insurance coverage brokers.
— Scott Flanders, CEO of eHealth, Santa Clara, Calif.
Unhappy Twist On Knee Replacements
It’s true that medical doctors don’t at all times let you know the fact of knee replacements upfront (“Up To A Third Of Knee Replacements Pack Ache And Remorse,” Dec. 25). I needed to have my proper knee changed twice. I had a steel allergy to the primary implant, which I discovered the exhausting manner.
Sufferers must be examined for steel allergic reactions earlier than surgical procedure. I’m so sorry I ever had my knee changed — it hurts worse now than it did earlier than the surgical procedure. I’d not have my different knee changed except I couldn’t stroll. I used to be advised my knee can be nice till after my second surgical procedure, when my surgeon warned me my knee may at all times trigger me ache. That will have been good to know earlier than my first surgical procedure.
— Lesa Lawrence, Dallas
Often we do not hear the draw back of those procedures. However this share appears manner too excessive. #meddevice #hipsnknees https://t.co/H7s9jOhXzy
— Greg Mays (@hips_n_knees) December 26, 2018
— Greg Mays, Nashville, Tenn.
With out knocking complete knee arthroplasty, or TKA, a New Yorker wonders whether or not we’re shifting in the proper path.
TKA positively has room for enchancment however no knowledge I do know that the robotics arms race now underway will assist. Up To A Third Of Knee Replacements Pack Ache And Remorse https://t.co/gaggQ6HnYp by way of @khnews
— wendy diller (@Wendydiller) December 28, 2018
— Wendy Diller, New York Metropolis
Doing The Math On Biologics
The article “Why The U.S. Stays The World’s Most Costly Market For ‘Biologic’ Medication” (Dec. 20) talked about that Cosentyx prices about $15,000 in Europe versus nearly $65,000 in the USA. Whether it is true that somebody should buy a three-month provide for private use in Europe — and if a three-month provide, correctly dealt with, has a shelf life larger than three months — it appears potential for Susie to go to Italy or someplace in Europe each three months for an estimated price of $6,000 a 12 months or much less (with tickets bought upfront). Including to her journey prices the $15,000 annual price of the drug, which conveniently will be self-injected, she may nonetheless make out much better than paying $65,000 a 12 months within the States. Only a thought.
— Abette Jones-Bey, Blue Bell, Pa.
A tweeter provided one rationalization for the pricing disparity:
(Reply? The Pharma lobbyists spend a complete lot on congress individuals.) Why The U.S. Stays The Most Costly Market For ‘Biologic’ Medication In The World https://t.co/nyuTQQs8c3
— Elizabeth Henry (@HenryLeerhenry) December 19, 2018
— Elizabeth Henry, Olathe, Kan.
Signal-Up Season’s Unsung Heroes
Your article on navigators (“Quick On Federal Funding, Obamacare Enrollment Navigators Change Techniques,” Nov. 30) uncared for to say the group of pros greatest suited to assist shoppers choose applicable well being protection: licensed insurance coverage brokers and brokers. Brokers and brokers usually have extra coaching and expertise than navigators. They’re licensed by the states through which they work. The bulk have been in enterprise for greater than 10 years.
Brokers and brokers additionally work with their purchasers year-round, not simply in the course of the six-week open-enrollment interval. A survey carried out by the Kaiser Household Basis discovered that greater than 70 p.c of brokers spend “most” or “lots of” their time explaining protection to their purchasers. It’s no marvel that almost 84 p.c of adults who labored with brokers and brokers when searching for change protection discovered them useful — greater than some other group providing help.
— Janet Trautwein, CEO of the Nationwide Affiliation of Well being Underwriters (NAHU), Washington, D.C.
It has nothing to do with the excessive price of premiums!!!! Whats up – Navigators it isn’t you! Quick On Federal Funding, Obamacare Enrollment Navigators Change Techniques https://t.co/GdPkTIl7AS by way of @khnews
— HAFA (@TheNolanGroup) December 5, 2018
— B. Ronnell Nolan, president and CEO of Well being Brokers for America, Baton Rouge, La.
Entrepreneurs Caught In The Center
I fall into the scenario described in Steven Findlay’s article “Well being Insurance coverage Prices Crushing Many Individuals Who Don’t Get Federal Subsidies” (Dec. 14).
In the event you take a look at the standard prices for a household incomes greater than $100,400 a 12 months who don’t qualify for subsidies, the price is large. Our present premiums for an ACA-compliant coverage are about $1,400 a month with a mixed $13,000 deductible for my spouse and me (we’re self-employed). If in case you have a “dangerous 12 months” — say, a automobile accident the place you might be each hospitalized — your bills soar to an estimated $29,800, or almost 30 p.c of your revenue. This appears to be the technique of the medical health insurance corporations, whereby they need well being care pricing to be a set quantity of complete revenue. The best way they get there may be via lack of transparency.
After Supreme Court docket Chief Justice John Roberts forged the deciding vote across the constitutionality of the ACA “tax” for being uninsured, I left an important company job and have since began a number of corporations and created jobs just because getting medical health insurance via the ACA appeared sure. I’m now within the place the place I’m questioning if I’ll must cease my entrepreneurial actions and discover a company gig once more with insurance coverage. I think I’m not alone on this.
The continued ambiguity round it will have a stifling impact on individuals like us who’re taking the danger to start out companies and create jobs.
— Mick Garrett, Fort Collins, Colo.
“The monetary problem for individuals […] has come into a lot sharper focus in the course of the previous 12 months, as insurance coverage premiums have spiked.”
Hmm… Really feel like I stated one thing like this might occur on the first point out of ACA. Love components of ACA, however…
— Clayton Mowrer (@claytonmowrer) December 18, 2018
— Clayton Mowrer, Kansas Metropolis, Mo.
Band-Help Fixes To ACA Are Like Salt To The Wound
“Ask Emily” columnist Emily Bazar provides a worthy answer which will work for numerous of us and must be explored by these whose family revenue is barely above 400 p.c the federal poverty stage (FPL) (“With out Obamacare Penalty, Assume It’ll Be Good To Drop Your Plan? Higher Assume Twice,” Dec. 5). However there’s a break-even level which will make this answer undoable. Since FPL is a nationwide measure, with simply two states receiving an exception (Alaska and Hawaii) to the revenue ceiling, for anybody who resides in a state with a excessive price of dwelling, such changes to take-home pay can adversely impression their means to afford different requirements of life.
Value of dwelling can fluctuate extensively by state or ZIP code, but the revenue ceiling for ACA subsidies is ready on the nationwide stage. Insurance coverage premiums can also fluctuate amongst counties and even ZIP codes inside a state. Some name this market-based pricing or pricing primarily based on an space’s means to pay (larger common incomes equate to larger premium costs). Nonetheless others name it price-gouging. But once more, the revenue ceiling is ready on the nationwide stage.
I welcome any and all concepts that will permit extra of us to acquire medical health insurance (which, by the best way, doesn’t assure well being care protection). Modifications should be made to the legislation to stage the enjoying subject for shoppers. Till all shoppers have entry to protection on the similar worth, with the identical stage of subsidy be it authorities or employer, then we really are placing band-aids on a coronary heart assault. Till your age, marital standing, place the place you reside and measurement of your employer now not hinder your means to afford medical health insurance protection, there’ll proceed to be these ignored and in danger.
Sadly, our elected representatives at each the state and nationwide stage have little abdomen to face and repair the glitches and inequities within the ACA. Their solely treatment, which comes within the type of a tax on the uninsured, has taken the ACA from an answer meant to carry medical health insurance to all People to a coverage that depends on those that can’t afford medical health insurance and are excluded from the advantages of the ACA to fund it. Now that’s ironic.
— Susan Frangione, Rockville, Md.
Hectoring individuals to purchase one thing they cannot afford is not simply silly – it is a type of shaming and mockery. In fact individuals need medical health insurance – however they’d like to purchase meals and shelter first.
— Rob Levine (@roblevine82) December 5, 2018
— Rob Levine, Minneapolis
What’s Actually Hurting ACA Enrollment
I can let you know the true purpose many People gave up on enrolling in an Obamacare plan this 12 months (“Want Well being Insurance coverage? The Deadline Is Dec. 15,” Dec. 10).
I had a reasonably good medical health insurance plan beneath the Reasonably priced Care Act in 2014-15. In 2015, my revenue modified, and I used to be eligible for Medicaid beneath Illinois’ enlargement of that federal-state program. Nonetheless, in July 2018, Medicaid decided that I now not certified. I went on-line to the ACA market to attempt to discover an ACA plan I may afford. To my shock, the plans out there in 2014 had been now not out there. The 2 dozen plans out there in my space should not ultimate. Some present low protection. Some are from carriers that the majority of my physician teams don’t settle for. Even some “gold”-level plans have extraordinarily excessive copays. Although my premium in 2018 didn’t improve a lot, it was offset by excessive hospital copays and burdensome deductible and coinsurance obligations. Prescription copays had been percentage-based, not a greenback quantity, which made it dearer to pay for prescriptions.
That is all hurting many People in my revenue bracket. The drop in enrollment in ACA plans is as a result of nobody can afford most of those low-level protection plans within the ACA market. And nearly all of the ACA plans have restricted entry to suppliers, particularly specialists, making getting medical remedy close by tough. The ACA has been modified and tweaked in order that many People now not can afford to purchase any of the plans with out going into debt if a critical sickness arises.
— Lena Conway, Naperville, In poor health.