All you need to know about health care this week.
Did you know that 41% of Americans have some form of health care debt?
Thanks to researchers at Boston University School of Public Health, we’ve known for a couple of years now that Black women who are enrolled in a high-deductible health plan are more likely to experience delays in diagnosis and treatment than white women. Now we’re learning that in general, patients with high-deductible plans, regardless of race or ethnicity, face delays in the detection of metastatic cancer.
That’s according to Harvard Medical School researcher Nicolas Karim Trad, whose study was presented during the annual meeting of the American Society of Clinical Oncology this month in Chicago.
Trad’s research is just the latest showing that American cancer patients with high-deductible health plans not only often experience delays in treatment, but they also have to spend far more for their treatment than patients in low-deductible plans.
In December, a study published in JAMA Network Open found that patients with a variety of cancers spend much more money out of their own pockets than those in traditional plans. They also found that cancer patients in high-deductible plans may be delaying treatment due to higher costs.
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The authors wrote that high deductible health plans “offer poorer protection than traditional insurance against unexpected health care expenses.”
As I wrote a few weeks ago, Jill Eicher of Maryland is one of many American cancer patients in high-deductible plans who have turned to GoFundMe to try to raise money to cover their ever-growing out-of-pocket expenses.
Jill is enrolled in an employer-sponsored high-deductible plan administered by Cigna, but that coverage will stop when her COBRA extension ends on June 30. She told me a few days ago that she has signed up for an Obamacare plan on the Maryland Health Connection that starts on July 1. Unfortunately, Jill’s situation is going from bad to worse, partly because, in the crazy world of American health insurance, deductibles reset at the beginning of every plan year. That means that even though she will be in a new plan on July 1, it won’t cover anything until she has paid several thousand dollars out of her own pocket. Because the plan year begins on October 1, she’ll be right back at square one when her out-of-pocket requirements will start all over again.
“The only policies offered on the MHC that all my doctors take are the Blue Cross Blue Shield PPOs,” she wrote me in an email. “ I chose the one with the lowest total costs (out-of-pocket costs and premiums): the BCBS PPO Gold. My premiums will be $935 a month and annual out-of-pocket costs will be $20,000, so our total costs per year will be $31,000, up from about $20,000 with Cigna, which was an employer group rate. Good God!”
Jill’s husband, Ron, told the couple’s friends in another email this week that they need more help paying for what Blue Cross will not cover. “If you can help, please consider donating to her GoFundMe fund,” he wrote.
Sadly, Jill is one of an untold number of American cancer payments with insurance who have had to resort to asking friends and strangers for financial help. As I wrote back in April, Jill was one of the reasons I began reaching out to nonprofit organizations and businesses to join a coalition focused on ending the uniquely American nightmare of high-deductible plans. To date, more than 60 organizations have joined the Lower Out of Pockets NOW coalition.
In other, related, news…
Kaiser Health News, NPR and CBS published the first of several reports by reporter Noam Levey called Diagnosis: Debt, which examines America’s medical debt crisis.
As Noam wrote in an email: The first installment in the series, which draws on a new KFF poll conducted for the project and original Urban Institute research, reveals that more than 100 million people in the US – including 41% of adults - are now beset by health care debt, a number significantly larger than is generally realized.
The first story in the series “looks at the awesome scale of this problem and how it is upending countless lives across the country.” Accompanying the main story is a feature profiling a group of Americans burdened by medical debt, “including a mother of twins in Chicago forced to work double shifts and borrow from family, a retired Virginia couple driven into bankruptcy and a medical student in Texas harassed for years by debt collectors for a $131 exam she was given after being sexual assaulted.”
Noam says future stories “will explore the burden of medical debt on people with cancer, how this debt is deepening racial disparities and how a burgeoning credit industry is feeding off patients’ inability to pay their bills.”
Noam knows more than just about anybody about America’s medical debt and high-deductible crises. If you haven’t read the prize-winning series he wrote in 2020 for the Los Angeles Times entitled “Inside America’s High-Deductible Revolution,” do it now.
I also encourage you to check out a story journalist Andrew Perez wrote about the recent Remote Area Medical pop-up clinic in Charleston, West Virginia. Headlined, “Health Crisis in Joe Manchin’s Backyard,” Andrew’s story notes that many of the thousands of Americans who go to RAM’s free clinics in West Virginia and across the country have insurance but are burdened by such high out-of-pocket obligations they can’t afford to get care elsewhere.
Andrew quoted Vicki Gregg, RAM’s clinical manager, as saying that, “We take care of the acute problem–if somebody needs to have an eye exam, they can’t afford to go to the doctor, or they can’t afford their deductible.”
As Andrew noted, a high percentage of RAM’s patients come for dental and vision care, neither of which is covered by most health insurance plans, including Medicare. Even seniors enrolled in privately operated Medicare Advantage plans, which claim to cover dental and vision, show up at RAM clinics. That’s because, as Andrew reported, “Private dental insurance plans and Medicare Advantage plans that offer dental coverage do not in reality cover much, because they often include annual maximums of $1,000 or $2,000; once the insurer pays that much, you’re on your own.”