Affordable Care Act Trumped

Donald Trump, President of the United States, has taken steps to systematically change America’s health insurance system. He has failed on his promise to pass healthcare reform through Congress due to lack of support, mostly from the destabilization the American Health Care Act (AHCA) and Better Care Reconciliation Act (BCRA) would have caused for premium costs and uninsured rates. The morning of October 12 he signed an Executive Order undermining the Affordable Care Act (ACA) and opens the door to low-benefit insurance despite lack of Congressional support. Later that night, Trump ordered an immediate end to subsidies to insurance companies that help cover low-income Americans between 100% to 250% of the Federal Poverty Level (FPL).

 

Trump has repeatedly called the ACA (aka Obamacare) a “disaster” that is “failing” despite the more than 50 million uninsured in 2009 decreasing to 28 million uninsured by 2017. Since taking office the Trump administration has been criticized for “sabotaging Obamacare” by using ACA funds for anti-Obamacare ad campaigns, cutting the enrollment period in half, and planning weekly 12-hour maintenance outages to the ACA enrollment websites during the enrollment period. These most recent executive orders enables insurers to offer plans that provide few benefits, so seemingly less expensive premiums would leave patients with high out-of-pocket costs, and directly impacts low-income Americans and may lead to many losing coverage or making impossibly difficult decisions of whether to eat or receive health care.

health-insurance-2574809_640In a recent blog post we dove into the details of understanding health insurance, including how the nuances are often overlooked or misunderstood by many politicians. Trump claims his executive orders will promote competition within insurance companies that will drive down costs while improving care. Experts say that removing subsidies and essential health benefits will destabilize the insurance market, driving up the cost of premiums while consumers lose options and benefits—the same concerns that caused the “Trumpcare” bills to fail in Congress.

 

There will be further developments in health care in America, and NeedyMeds will try to keep up-to-date on the details. We at NeedyMeds prefer to remain apolitical—we work in a diverse office with people of varying backgrounds and views—but we believe in being informed and that those in need deserve care. It should be clear that NeedyMeds supports improved access to care as well as lower costs for medications and healthcare services for all.

NeedyMeds also encourages Americans to be active in the legislative process: If you have an opinion on the future of the Affordable Care Act or other healthcare issues in the United States, call 202-224-3121 to reach the U.S. Capitol switchboard; from there you can be connected to your elected House Representative or Senator’s office.

 

NeedyMeds will continue to provide information as the need for assistance navigating the often expensive landscape of health care rises. The NeedyMeds website has databases of Patient Assistance Programs (PAPs), Diagnosis-Based Assistance (DBAs), and Free/Low-cost/Sliding-scale Clinics to help those in need. The NeedyMeds Drug Discount Card can save users up to 80% off the cash price of prescription medications for those without insurance or choose to use the card instead of insurance. In addition to the plastic card, the card is available in a printable form or a smartphone app for Apple and Android devices. For more help finding information, call our toll-free helpline Monday-Friday 9am-5pm Eastern Time at 1-800-503-6897.

Children’s Health Insurance Program (CHIP) Expires

Congress has allowed the Children’s Health Insurance Program (CHIP), which insures 9 million children in the United States, to expire. The program provided coverage for children in families making under 200% Federal Poverty Level (FPL) as well as to pregnant women. CHIP played a huge part in decreasing the rate of uninsured children from 14% in 1997 to 4.5% in 2015. By taking no action to renew the program before September 30, 2017 the U.S. Congress allowed the program to lose future funding, putting millions of American children at risk of major health complications from ordinarily treatable conditions.

baby-210194_640CHIP covers comprehensive coverage for children, including routine check-ups, immunizations, doctor visits, prescriptions, dental and vision care, inpatient and outpatient hospital care, laboratory and x-ray services, and emergency services. The out-of-pocket costs are different depending on which state a family is living in, but they will not exceed 5% of a family’s annual income. For the 9 million children covered by CHIP, many live with chronic health conditions like diabetes that could cost a family much more than 5% of their annual income were they to lose their coverage.

In the House of Representatives, partisan differences in whether CHIP should be funded by taking money from Medicare and the Affordable Care Act (ACA) to offset the cost of the program are also taking their toll and drafting the bill to cut healthcare funding Americans also rely on. Due to Congress’ inaction, funding for CHIP programs has ceased on the federal level and now states have limited funds allocated for paying for CHIP services—funds that at least ten states will exhaust before the end of 2017 and an additional 32 states will run out by March 2018. States are now working to ensure the future of programs or risk terminating enrollment before the end of the year.

 

There will be further developments in health care in America, and we at NeedyMeds will try to keep up-to-date on the details. We at NeedyMeds prefer to remain apolitical—we work in a diverse office with people of varying backgrounds and views—but we believe in being informed and that those in need deserve care. It should be clear that NeedyMeds supports improved access to care as well as lower costs for medications and healthcare services for all.

NeedyMeds also encourages Americans to be active in the legislative process: If you have an opinion on the future of CHIP or other healthcare issues in the United States, call 202-224-3121 to reach the U.S. Capitol switchboard; from there you can be connected to your elected House Representative or Senator’s office.

 

We at NeedyMeds will continue to provide information as the need for assistance navigating the often expensive landscape of health care rises. The NeedyMeds website has databases of Patient Assistance Programs (PAPs), Diagnosis-Based Assistance (DBAs), and Free/Low-cost/Sliding-scale Clinics to help those in need. We also have information on camps and retreats or academic scholarships for children and their loved ones affected by illness. The NeedyMeds Drug Discount Card can save users up to 80% off the cash price of prescription medications for those without insurance or choose to use the card instead of insurance. In addition to the plastic card, the card is available in a printable form or a smartphone app for Apple and Android devices. For more help finding information, call our toll-free helpline Monday-Friday 9am-5pm Eastern Time at 1-800-503-6897.

Mental Illness Awareness Week

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For over 25 years, the first full week of October has been Mental Illness Awareness Week. One in five, or 20% of the population, live with some kind of mental health condition, with one in 25 living with a serious mental illness that substantially limits one’s life activities. Those living with mental illness fight stigma while trying to survive under internal duress. Awareness is important so that resources are made available to those who need them and the stigma and misconceptions surrounding mental illnesses will be reduced.

Everyone has stress and difficult emotions on occasion, and this is completely normal. Mental illness, however, is any condition that makes it difficult to function in daily life. It can affect relationships or job performance, and is caused by any number of complex interactions within the human brain. Mental illness can range from anxiety or mood disorders like depression, psychotic disorders like schizophrenia, eating disorders, or addictive behaviors.

Depression is the leading cause of disability in the world, with 16 million American adults living with major depression. Eighteen percent of adults in the US experience anxiety disorders such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and/or specific phobias ranging from a fear of spiders to a fear of pickled vegetables.

Mental illnesses do not just present in adults. More than one out of five children aged 13-18 (21.4%) have experienced a severe mental disorder at some point during their life, with 13% of children 8-15 experiencing the same. Seventy percent of the youth in the juvenile justice system have at least one mental health condition and at least 20% live with serious mental illness. Half of all chronic mental illnesses begin by age 14.

Mental illness is prevalent in homeless populations, with an estimated 26% of adults staying in shelters living with serious mental health conditions and approximately 46% with both mental illness and/or substance abuse. One in five state prisoners have a recent history of mental illness. Mood disorders such as depression or bipolar disorder are the third most common cause of hospitalizations in the US across ages 18-44. Serious mental illness costs America $193.2 billion in lost earnings per year.

NeedyMeds has Diagnosis Information Pages for various mental illnesses including depression, obsessive-compulsive disorder, and schizophrenia. We also have information for over 3,000 free, low-cost, or sliding-scale clinics throughout the country that offer counseling or mental health services. Search your ZIP code for clinics that may offer Counseling/Mental Health Services near you, or call our toll-free helpline for information at 1-800-503-6897 (open Monday through Friday, 9am to 5pm ET).

 

We encourage everyone to educate themselves, strive to understand the difficulties people around us live with, and to replace stigma with hope and support. If you or someone you know is suffering from a mental illness, it is important to know that no one is alone in their struggle. Call for assistance, whether help is needed immediately or long-term.

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
NeedyMeds Toll-Free Helpline: 1-800-503-6897

Understanding Health Insurance

by Richard Sagall, M.D.

Insurance is really a simple concept. But few people, and even fewer politicians, seem to understand how insurance works and why so many of the promises we hear are impossible.

Here are the basic concepts of insurance:

 

Number 1 – You Never Win with Insurance – You always lose with insurance. Think about what happens when you have health insurance.

 

Outcome 1 – You get sick, perhaps really sick, and you suffer while ill. You may experience long-term or even permanent disability from your illness. Or, in the worst case, you die. Your health insurance helps with the cost, but in any case, you suffer.

 

Outcome 2 – You spend a lot of money on premiums getting nothing in return. It’s true that you remain physically healthy, but, due to the high cost of health insurance, you may not be so financially healthy. So, you also suffer, just in a different way.

 

Number 2 – What You Really Get from Insurance – Or perhaps more accurately, what you should be getting from health insurance. What you are paying for with health insurance is a sense of comfort that you won’t experience severe financial hardship or go broke if you get sick or need health care.

 

post-thumbWe know health insurance doesn’t buy good health because people with health insurance get sick and even die from their illnesses. It’s true that some health insurance programs pay for certain screening tests and even an annual physical. But neither guarantee good health.

 

The fallacy is assuming health insurance does provide adequate coverage to prevent financial hardships. All too often it doesn’t. Half or more of middle-class bankruptcies are due directly to medical expenses. So much for buying financial security.

 

Number 3 – Affordable Health Insurance Provides Access to Health Care – Affordable health insurance and affordable access to health care are two completely different things. Sometimes there is an overlap, but all too often there isn’t.

 

Too many people can only afford a policy that covers catastrophic health problems. The policy may have a high deductible – the amount you have to spend before the policy provides any coverage. And then there may be high copays – your share of healthcare costs once insurance kicks in and pays something.

 

The insurance may help if you suffer a very expensive illness or injury and run a bill in the tens to hundreds of thousands of dollars. But it does little for the routine office visit or prescription you fill.

 

Number 4 – Insurance Companies Have Limited Sources of Income – Even though many insurance companies are multi-billion dollar enterprises, they have few sources of income – basically two.

 

Source 1 – Premiums. This is the income they collect from you and me and, in many cases, our employers. It also includes government subsidies for those who qualify under the Affordable Care Act (ACA) and other programs.

 

Source 2 – Investment Income. Insurance companies have a huge cash flow. Imagine all the money they collect in health premiums. What do they do with that money, also called the “float,” while waiting to pay your healthcare bills? They invest it in stocks, bonds, mortgages and other investments.

 

Source 3 – Claims Processing. Even though I said insurance companies have two sources of income, there is a third. Some insurance companies provide services to smaller insurance providers or self-insured companies. They provide all of the services needed to run the insurance program for them.

 

Number 5 – Insurance Companies Have Limited Expenses – Despite being huge multi-billion dollar companies, their expenses fall into only three categories.

 

Expense 1 – Benefits. This includes your doctor bills, hospital bills, medication costs, ambulance rides and other health-related costs that your insurance covers. It’s to their benefit to keep costs down and they do this in numerous ways. One is to discourage you from incurring any medical expenses. They may have high deductibles and copays requiring you to spend a lot before insurance kicks in. They may pay for preventative measures designed to keep you healthy. And they may negotiate discounts from physicians, pharmacies, hospitals and other providers of health-related services.

 

Expense 2 – Administration. This is the cost of running the company, processing and paying claims, payroll, taxes, advertising, etc. Operating costs are generally estimated to consume around 20% of premium costs. (By means of comparison, the operating costs for Medicare are around 2-4%.)

 

Expense 3 – Net Margin. This is another word for “profit.” This is what the investors are really concerned about – how much they make for their investment. Some insurance companies are non-profits and, at least in theory, there are no investors who reap the benefit if there’s a profit.

 

Where Your Premium Dollar Goes

Prescriptions – 22%

Physician Services – 21%

Outpatient Services – 20%

Inpatient Services – 16%

Operating Costs – 18%

Net Margin – 3%scales-2579312_640

 

Number 6 – It All Balances Out – All the numbers have to work out – income has to cover all the expenses – or the insurance company sustains a loss. And that’s a situation that can’t last very long. How do insurance companies deal with a loss – increase income (read as “increase premiums”) or cut expenses (usually meaning “pass more costs to the insured”)? Nearly 80% of expenses are benefits so that’s where savings can be the biggest.

 

Number 7 – There’s No Such Thing as a Free Lunch. It’s All a Matter of Cost Shifting – Anyone who shows up at the emergency department has to, by law, be seen and treated. This is true even if the person has no insurance and no way of paying the bill. How does the hospital recoup the cost of this “charity care?” By passing the cost on to the paying patients which, in many cases, means passing it on to the insurance company. The other option is the hospital runs in the red. And that can’t last too long before it has to close.

 

So, hospital charity care is really forcing you and all the other patients to be charitable and pay for the free care.

 

Number 8 – Cutting Down on Risk – Another way for insurance companies to cut expenses is to cover more healthy people and cover fewer sick people.

 

Option 1 – Cover More Healthy People – That’s one of the core features of ACA – require everyone, even those at low risk of using it, to purchase health insurance. The healthy people don’t cost as much as the pay in premiums. This “surplus” helps cover the costs of the sicker people.

 

Option 2 – Cover Fewer Sick People – Another core feature of ACA is no pre-existing condition exclusion or increased rate. This means sick people (read “more costly to insure”) don’t pay more for insurance because their higher costs are being covered by the healthier people.

 

Conclusion – When looked at this way, health insurance is quite simple. The fair solution is fairly straightforward:

 

Step 1 – Require everyone to buy health insurance. Remember, those of you who are healthy now, you are only one auto accident or illness away from becoming a person with an expensive pre-existing condition.

 

Step 2 – Lower costs by adopting a Medicare-for-all approach. Medicare must be doing something right if administrative costs are only 2-4% of costs.

 

Step 3 – Everyone should work on adopting a healthier lifestyle to lessen illness and injury – the real drivers of healthcare costs.

 

Rich Sagall MDRichard J. Sagall, MD, is the president and co-founder of NeedyMeds. He spent 25 years practicing family and occupational medicine. He now devotes his time to NeedyMeds and Pediatrics for Parents (www.pedsforparents.com), a children’s health newsletter.

Health Tips for Back-To-School

It is the time of year that children have returned to school where they will be exposed to lots of new experiences and ideas but also higher risk of exposure to viruses and other illnesses. Here are tips to ensure your children have a successful and healthy time in school.

  1. Vaccinations are the best course for preventing illness. In addition to the vaccines recommended by your doctor, the Center for Disease Control and Prevention recommends an annual flu vaccine for everyone over 6 months of age.

  2. Sleep is essential to keep children (and adults) focused throughout the day. Adults need about eight hours of sleep, while young children often need more. It’s important to set a bedtime that ensures they get enough sleep, and to keep a consistent schedule.

  3. It is never too early to teach good hygiene habits. To help children avoid getting sick and prevent them from bringing germs home, it’s important to show them how to wash their hands after using the restroom or before eating.

  4. A healthy diet can help children grow and learn more effectively, as well as keep their immune systems primed to fight off illness. Avoid junk food and soft drinks, and consider packing children’s lunches with healthy snacks.

  5. Going back to school is stressful for both parents and kids; for some children, it may be a new sensation. Help manage stress by talking to children about anything bothering them and take care not to overload anyone’s schedule. Schoolwork is important, but it is essential for mental health to relax, play, and spend time with family.file0001321608732

  6. Student backpacks should never weigh more than 10-20% of a child’s body weight, and should be adjusted properly to the bottom of the pack so it sits at the child’s waist.  Encourage children to use both shoulder straps; slinging a backpack over one shoulder can strain muscles and hurt one’s back.

  7. If your child has a chronic health condition, ensure the school nursing staff is aware and carefully go over any emergency plans with your child and school health personnel.

Children of different ages may have different experiences in school, but these tips are a good foundation to staying healthy while learning and growing. If you are having trouble accessing vaccination or other services, NeedyMeds has a database of over 15,000 free, low-cost, and sliding-scale medical clinics all over the country. The NeedyMeds Drug Discount Card can be of help for prescribed medicines, even over-the-counter medications. The free discount card is also available as an iPhone and Android app. For children affected by a chronic health condition, there may academic scholarships or extracurricular camps and retreats available. For more information, call our toll-free helpline at 1-800-503-6897 Monday through Friday, 9am to 5pm Eastern Time.

 

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