Here is what you need to know in healthcare this week.
I read all this stuff so you don't have to.
Is this what happens when you let them eat cake? You no doubt have heard that the price of insulin has gone up a lot in recent years–and keeps going up. But if you’re not a diabetic, you might be wondering why members of Congress are paying so much attention to it and why the House-passed Build Back Better Act, which went nowhere in the Senate, included a provision that would have capped out-of-pockets for diabetics with insurance at $35 a month. Well, it’s because there are far more diabetics in the United States than there were just a decade or so ago, and insurance companies are making those unfortunate folks, young and old alike, pay far, far more out of their own pockets for the medication than they used to.
Researchers at the Kaiser Family Foundation released a report a few days ago showing that out-of-pocket spending by people with Medicare Part D for insulin products quadrupled between 2007 and 2019, increasing from $236 million to almost $1 billion. And during that time, the number of Medicare Part D enrollees using insulin doubled.
The KFF report cited a Center for Medicare and Medicaid Services document that included a stat I hadn’t seen before and that blew me away: One of every three Medicare beneficiaries now has diabetes. And CMS says it won’t be long until one of every two Medicare beneficiaries has diabetes. Sadly, many Americans with diabetes are dying prematurely because they don’t have enough cash to cover their health plans’ out-of-pocket requirements, which have skyrocketed in recent years.
Aw, geez, Fargo. Those KFF researchers say you guys up in the North Country are paying a heck of a lot more out-of-pocket for your insulin than the rest of us. Scroll through that KFF report and you’ll see something very weird and, to me, inexplicable: South Dakotans spent $822 on average out-of-pocket on insulin in 2019, way more than twice what Californians spent: $323–the lowest in the country.
South Dakota’s neighbors with diabetes are also shelling out much more than diabetics in most other states. In fact, people in the contiguous upper Midwestern states of Iowa, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin spend way more out of pocket on insulin than folks in other parts of the country, all $700 or more a year on average. If I lived up there, I’d be calling my congressman right now.
Wendell Potter NOW is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Speaking of out-of-pockets… A study published in the American Journal of Managed Care found that employees in high-deductible health plans who earn less than $75,000 a year “have lower rates of usage and spending on preventative care, while having higher rates of acute care utilization.” Who could ever have guessed that would happen? "High-deductible health plans shift the cost of care to plan holders," the authors of the study said, according to HealthLeaders Media. "This can lead to reduced utilization of care. High-deductible health plans have potential negative consequences for individuals earning a low salary." Potential? Ya think?
Such a deal. Let’s just keep privatizing Medicare because, you know, private insurers do such a better job than the government when it comes to controlling costs, right? Well, no. Not even close. According to a Rand study funded by the Robert Wood Johnson Foundation, “employers and private insurers paid 224% of what Medicare would pay for the same services at the same facilities across all hospital inpatient and outpatient services on average in 2020.” In Florida, South Carolina and West Virginia, it was 310% or higher. Put simply, big hospital systems can have their way with private insurers. Here’s something else you should know: not only do insurers have to pay hospitals far more than Medicare does, they also don’t really want to pay less. That’s because the more health care costs go up, the more they can charge their customers in premiums. Remind me again what the health insurance industry’s “value proposition” is.
Of course, Gail is going to ring that bell: One of the big insurers just keeps changing its name. Anthem, which not so long ago was known as WellPoint, has renamed itself once again. Fierce Healthcare reported that “Anthem's shareholders have signed off on the insurer's corporate rebrand as Elevance Health.” And guess where the WellPoint/Anthem/Elevance execs are going to go to celebrate? Where else but Wall Street! “Anthem will commemorate the name change on June 28 by ringing the opening bell at the New York Stock Exchange before trading under the new ticker ELV, the company said in an announcement.” Being a former health insurance company flack who mastered corporate speak, I truly admired what Anthem’s flacks had CEO Gail Boudreaux saying: “The result of today’s vote reflects the shareholders’ affirmation that our company continues to transform to a lifetime, trusted health partner that offers a range of health-related services, including traditional health benefits. This change is the next important chapter in our journey, and better reflects our business and the company we are today…Fueled by our bold and ambitious purpose to improve the health of humanity, I look forward to creating opportunities to deliver innovative products and services as well as move health forward, in order to better serve the needs of our consumers, care providers, communities, partners, and associates.” Let’s all put June 28 on our calendars and tune in to CNBC at 9:30 a.m. EDT sharp to see Gail ring that damn bell! (Confession: I helped arrange two NYSE bell-ringings for my Cigna CEO back in the day. It doesn’t get much more exciting and meaningful than that for corporate bigwigs.)
Just one more on out-of-pockets, this one from out of right field. Under the headline, “The Out-of-Pocket Cost Ponzi Scheme,” RealClearHealth (part of the right-leaning RealClearPolitics), reported that:
According to one study, for 2020, over half of people who have health insurance provided by their employer are enrolled in a high-deductible health plan with significant out-of-pocket costs due to deductibles and coinsurance requirements. In five years, analysts forecast, close to three-quarters of patients in employer-sponsored plans will be enrolled in these plans.
High deductible plans can be a wise economic choice for healthy people as they may carry lower premiums. But what happens when members of these plans get sick?
Average annual out-of-pocket costs for an individual in a high deductible plan were $4,425 in 2020 and can be significantly higher for a family. If you are diagnosed with cancer, you may be required to take thousands of dollars out of your savings or even go into debt to pay for your oncology medicine on top of ever-increasing healthcare premiums.
That really is real clear. I’ve heard folks on the left say almost exactly the same thing. Maybe the left and the right can come together on this issue. I’m going to encourage that.