Category Archives: Health Care

Hospitals keep ER fees secret. We’re uncovering them.

Source: Sarah Kliff, Vox, 2017-2018

Each year, Americans make 141 million trips to the emergency room. In nearly all those visits, hospitals charge patients something called a facility fee: the price for walking in the door and seeking medical service. Facility fees can be big: Reporter Sarah Kliff has seen charges that range from $533 to more than $3,000. But because these fees are kept secret until you receive your bill, we can’t know how high they get — or how much they vary. We want to bring transparency to these extremely common but little-understood fees. So we have been collecting facility fee bills from our readers as part of a year-long project focused on American health care prices.

Does Socioeconomic Status Account for Racial and Ethnic Disparities in Childhood Cancer Survival?

Source: Rebecca D. Kehm, Logan G. Spector, Jenny N. Poynter, David M. Vock, Sean F. Altekruse, Theresa L. Osypuk, Cancer, Early View, First published: 20 August 2018

From the abstract:
Background:
For many childhood cancers, survival is lower among non‐Hispanic blacks and Hispanics in comparison with non‐Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival.

Methods:
This study used population‐based cancer survival data from the Surveillance, Epidemiology, and End Results 18 database for black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000‐2011 (n = 31,866). Black‐white and Hispanic‐white mortality hazard ratios and 95% confidence intervals, adjusted for age, sex, and stage at diagnosis, were estimated. The inverse odds weighting method was used to test for mediation by SES, which was measured with a validated census‐tract composite index.

Results:
Whites had a significant survival advantage over blacks and Hispanics for several childhood cancers. SES significantly mediated the race/ethnicity–survival association for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non‐Hodgkin lymphoma; SES reduced the original association between race/ethnicity and survival by 44%, 28%, 49%, and 34%, respectively, for blacks versus whites and by 31%, 73%, 48%, and 28%, respectively, for Hispanics versus whites ((log hazard ratio total effect – log hazard ratio direct effect)/log hazard ratio total effect).

Conclusions:
SES significantly mediates racial/ethnic childhood cancer survival disparities for several cancers. However, the proportion of the total race/ethnicity–survival association explained by SES varies between black‐white and Hispanic‐white comparisons for some cancers, and this suggests that mediation by other factors differs across groups.

ACA subsidies cost more per person than Medicaid. Is that sustainable?

Source: Susannah Luthi, Modern Healthcare, August 8, 2018

Government spending on Obamacare premiums has raced past its per-person spending on Medicaid expansion, and the gap is poised to increase—a trend that has some policy experts shaking their heads over the long-term economic picture and at least one major insurer questioning the sustainability of the individual market….

Related:
Enrolling Americans in Medicaid Is Now Cheaper Than Subsidizing Their Obamacare Coverage
Source: Jordan Weissman, Slate, August 10, 2018

Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028
Source: Congressional Budget Office, May 2018
CBO and JCT project that the federal subsidies, taxes, and penalties associated with health insurance coverage for people under age 65 will result in a net subsidy from the federal government of $685 billion in 2018.

Federal Subsidies for Health Insurance Coverage for People Under Age 65: Tables from CBO’s Spring 2018 Projections
Source: Congressional Budget Office, May 2018

CMS’s proposed changes to outpatient services, if finalized, would hurt hospital margins

Source: Diana Lee, Daniel Steingart, Jessica Gladstone, Jonathan Kanarek, Kendra M. Smith, Peter H. Abdill, Moody’s, Sector Comment, August 8, 2018
(subscription required)

On July 25, The Centers for Medicare and Medicaid Services (CMS) proposed several changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, which, if finalized, would generally be credit negative for both not-for-profit and for-profit hospitals. Changes include: (1) site neutral clinic visits, (2) expansion of 340B policy changes to off-campus departments of hospitals, and (3) adding certain nonsurgical procedures as covered procedures at ambulatory surgical centers. While on their own, these proposed changes would not be material to overall sector credit quality, the effects would vary by hospital. In general, the proposal to move certain cardiac procedures to ASCs, if finalized and if adopted by clinicians, would likely have the broadest and most significant effect on the hospital sector. Additionally, to the extent that commercial payors follow suit, each of these changes would have more meaningful effects…..

Graying of U.S. Bankruptcy: Fallout from Life in a Risk Society

Source: Deborah Thorne – University of Idaho, Pamela Foohey – Indiana University Maurer School of Law, Robert M. Lawless – University of Illinois College of Law, Katherine M. Porter – University of California – Irvine School of Law, August 5, 2018

From the abstract:
The social safety net for older Americans has been shrinking for the past couple decades. The risks associated with aging, reduced income, and increased healthcare costs, have been off-loaded onto older individuals. At the same time, older Americans are increasingly likely to file consumer bankruptcy, and their representation among those in bankruptcy has never been higher. Using data from the Consumer Bankruptcy Project, we find more than a two-fold increase in the rate at which older Americans (age 65 and over) file for bankruptcy and an almost five-fold increase in the percentage of older persons in the U.S. bankruptcy system. The magnitude of growth in older Americans in bankruptcy is so large that the broader trend of an aging U.S. population can explain only a small portion of the effect. In our data, older Americans report they are struggling with increased financial risks, namely inadequate income and unmanageable costs of healthcare, as they try to deal with reductions to their social safety net. As a result of these increased financial burdens, the median senior bankruptcy filer enters bankruptcy with negative wealth of $17,390 as compared to more than $250,000 for their non-bankrupt peers. For an increasing number of older Americans, their golden years are fraught with economic risks, the result of which is often bankruptcy.

Prosperity Now Scorecard

Source: Prosperity Now Scorecard, 2018

The Prosperity Now Scorecard is a comprehensive resource featuring data on family financial health and policy recommendations to help put all U.S. households on a path to prosperity. The Scorecard equips advocates, policymakers and practitioners with national, state, and local data to jump-start a conversation about solutions and policies that put households on stronger financial footing across five issue areas: Financial Assets & Income, Businesses & Jobs, Homeownership & Housing, Health Care and Education.

The Scorecard assesses all states on their relative ability to provide opportunities for residents to build and retain financial stability and wealth. The state outcome rankings are a measure of financial prosperity and how that prosperity is shared and safeguarded. The Scorecard ranks the 50 states and the District of Columbia on 62 outcome measures in the five Issue Areas. Data for an additional four measures are published, but states are not ranked on these measures due to insufficient data at the state level. The overall state outcome rank is determined by the rankings each state receives for outcome measures within each issue area. The issue area grades in the Scorecard are distributed on a curve, based on how each state fares compared with all other states.

The Scorecard also separately assesses states on the strength of 53 policies to expand economic opportunity. Taken together, these 53 policies provide a comprehensive view of what states can do to help residents build and protect wealth in the issue areas described above. Unlike the outcome measures, the strength of states’ policies are assessed based on fixed criteria arrived at through consultation with issue experts and Prosperity Now’s own knowledge of policies that are promising, proven or effective in helping families build and protect financial stability and wealth.

In addition to the outcome and policy measures used to assess states, the Scorecard provides additional data to understand financial stability and prosperity in states and communities. For 44 outcome measures, trend data are available for states to track progress over time. The Scorecard also allows you to drill down to the local level—city, county, Congressional district, tribal area and metro area—on up to 26 measures. Additionally, for 21 outcome measures at the state level and 11 at the local level, the Scorecard includes outcome measure estimates disaggregated by race and ethnicity. The Scorecard also disaggregates 14 outcome measures at the state level by disability status, providing for the first time in 2018 a glimpse into the financial challenges facing people with disabilities. While these additional data do not factor into a state’s overall performance in the Scorecard, we provide the data to allow for a more meaningful analysis of financial security and stability in the United States.

Related:
Main findings
Custom reports
Methodology

Differences in Health Insurance Coverage between Part-Time and Full-Time Private-Sector Workers, 2005 and 2015

Source: William A. Carroll and G. Edward Miller, Agency for Healthcare Research and Quality, Statistical Brief #511, April 2018

Highlights:
– In 2015, among non-elderly private-sector workers, those working full time were more than 4 times as likely as part-time workers to be policyholders of employer-sponsored insurance provided through their current main job (66.9 vs. 15.1 percent).
– In 2015, part-time workers were more than 2 times as likely as full-time workers to have other ESI coverage (38.9 vs. 14.5 percent) which accounted for nearly three-quarters (72.0 percent) of all ESI coverage held by part-time workers.
– From 2005 to 2015, the percentage of part-time workers covered by ESI from any source decreased by 10.1 percentage points, from 64.1 to 54.0 percent.
– From 2005 to 2015, the increase in public coverage was larger for part-time workers than for full-time workers (11.3 vs. 2.2 percentage points).
– Both groups of workers had a significant decline in the percentage uninsured from 2005 to 2015, with the uninsurance rate for full-time workers dropping 3.0 percentage points (from 12.6 to 9.6 percent) and the rate for part-time workers dropping 6.6 percentage points (from 19.3 to 12.7 percent).

RAND Hospital Data Web-Based Tool

Source: RAND, 2018

From the summary:
Medicare-certified hospitals and other institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor. Cost reports contain provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data. The Centers for Medicare & Medicaid Services (CMS) maintains the cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS). The RAND Hospital Data tool is an effort to enhance CMS HCRIS data to make them more accessible and useful to a broad audience of academics, analysts, and hospital executives and their consultants. The tool provides users with data sets that are conveniently packaged and documented and that include value-added fields derived from HCRIS data, such as measures of occupancy and profitability. The goal of the tool is to make analytic tasks easier for those who work regularly with the data and to broaden the set of users.

Even Libertarians Admit Medicare for All Would Save Billions

Source: Matt Bruenig, Jacobin, July 30, 2018

A new study from a libertarian think tank admits that Medicare for All would save a whopping $300 billion. …. The report’s methods are pretty straightforward. Blahous starts with current projections about how much the country will spend on health care between 2022 and 2031. From there, he adds the costs associated with higher utilization of medical services and then subtracts the savings from lower administrative costs, lower reimbursements for medical services, and lower drug prices. After this bit of arithmetic, Blahous finds that health expenditures would be lower for every year during the first decade of implementation. The net change across the whole ten-year period is a savings of $303 billion. ….

Related:
The Costs of a National Single-Payer Healthcare System
Source: Charles Blahous, George Mason University, Mercatus Working Paper, 2018

The leading current bill to establish single-payer health insurance, the Medicare for All Act (M4A), would, under conservative estimates, increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation (2022–2031), assuming enactment in 2018. This projected increase in federal healthcare commitments would equal approximately 10.7 percent of GDP in 2022, rising to early 12.7 percent of GDP in 2031 and further thereafter. Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan. It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that healthcare providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance.

Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

Source: Marshall Allen, ProPublica, July 17, 2018

Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing. ….

…. This year, ProPublica and NPR are investigating the various tactics the health insurance industry uses to maximize its profits. Understanding these strategies is important because patients — through taxes, cash payments and insurance premiums — are the ones funding the entire health care system. Yet the industry’s bewildering web of strategies and inside deals often have little to do with patients’ needs. As the series’ first story showed, contrary to popular belief, lower bills aren’t health insurers’ top priority. ….