Health Insurance News Triplet: Déjà Vu & Powerfully True

November 16, 2022

Summary: Three recurring health insurance news themes are so potent, they should become a meme: 1) Private insurers pursue profit via manipulation; 2) Even insured patients bear massive cost burdens; and 3) There’s strong popular support for fundamental reform. Let’s roll with this meme!

How Medicare Advantage Scams Seniors | Opinion
Rep. Jan Schakowsky & Wendell Potter
Newsweek
Nov 15, 2022

Where billions of dollars flow, deceptive actors follow. And nowhere does deception run deeper than how health insurers lure seniors into Medicare Advantage plans—only to leave many retirees struggling to cover their out-of-pocket requirements when their incomes are their lowest. …

Medicare Advantage is a health insurance program in which private health insurers are reimbursed generously by the federal government for providing insurance coverage, sometimes with additional benefits, to retired Americans. This incentivizes insurers to sign up as many elderly folks as they can. While many Medicare Advantage plans provide some coverage for dental, vision and hearing and discounts on gym memberships, their ads obscure the often-life-threatening restrictions and bank-account draining demands that are common in Medicare Advantage plans….

One in four Medicare Advantage plans are being falsely advertised. …

In just one year, [diagnostic] upcoding accounted for $12 billion in additional payments to Medicare Advantage plans.

Financial Outcomes After Traumatic Injury Among Working-Age US Adults With Commercial Insurance
JAMA Health Forum
Nov 11, 2022
By Scott JW et al.

Results

The 3165 working-age adults in the postinjury cohort were similar demographically to the 2223 patients in the comparison [pre-injury] cohort. The postinjury cohort had a 23% higher likelihood of having medical debt in collections (754 [23.8%] vs 429 [19.3%]; a 70% higher amount of medical debt in collections ($2087 vs $1227), and a 110% higher bankruptcy rate (39 [1.2%] vs 13 [0.6%]). No significant differences were found regarding credit scores or nonmedical debt in collections.

Oregon Voters Approve Ballot Measure To Recognize Health Care As A Human Right
DailyWire.com
Nov 15, 2022
By Dillon Burroughs

Oregon voters have approved [50.6%] a measure that recognizes health care as a human right.

“It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right,” the amendment reads.

Comment by: Jim Kahn

Over the 1.5 years of HJM posts, patterns emerge. As I was perusing topics for today’s blog, I encountered a strikingly familiar trio of important stories: private insurers mislead, beneficiaries become indebted, and people want real change. This trifecta is a meme.

The Newsweek op-ed by Schakowsky and Potter highlights how private insurers – who run Medicare Advantage plans – mislead beneficiaries with overblown promises of coverage and bilk the government of tens of billions a year with exaggerated diagnoses. This is a persuasive synthesis of recently reported misbehavior by Medicare Advantage, the predominant source of growth for private insurers. ACO REACH in traditional Medicare poses similar privatization risks.

The JAMA Health Forum article reveals the high medical debt and bankruptcies borne by privately insured patients who experience traumatic injury. This is a compelling clinical example of data on the general population: 40% of adults have medical debt (average $2,500) and there are >250,000 annual medical bankruptcies.

The news from Oregon confirms that voters support a fundamental commitment to health care justice. The margin was narrow, and operational details were omitted, but the statement of values aligns with polling that indicates two-thirds support for government funding of health care.

Insurer profits, patient debt, and a popular craving for real reform: this is where we are in 2022.

Memes are motivating. Let’s use this one to help us achieve the change that would make it anachronistic.