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Millions of Americans can't afford their out-of-pocket costs. We want to tell those stories.
Submit your high deductible horror stories to help make meaningful change.
When I led corporate communications for Cigna, hardly a week went by that my team and I didn’t get a call from a reporter with what we called “horror stories.” Those calls typically involved someone enrolled in a Cigna plan who had been denied coverage for a doctor-ordered treatment.
It was a life-or-death situation in many cases. Just ask the parents of Nataline Sarkisyan, who died at age 17 a few days before Christmas after Cigna refused to cover a liver transplant her doctors were confident would save her life.
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My team’s job was to keep the horror stories out of the media if at all possible, and we had a good track record. On many occasions, just alerting the CEO of a media inquiry would result in immediate approval of whatever a patient’s doctor had recommended. But for every denial that was reversed, countless other horror stories went untold.
Toward the end of my career, we started getting calls about people who had such high deductibles they were not getting the care they needed. They couldn’t afford to pay what in many cases was thousands of dollars out of their own pockets before their coverage kicked in.
They were victims of an incredibly successful industry-wide strategy to move every last one of us, as soon as possible, into what our marketing people euphemistically called consumer-driven health plans. That was easier to sell than what they really were: high-deductible health plans.
High-deductible health plans are a big reason why health insurers are now among America’s biggest and most profitable companies. Any why 100 million of us now have medical debt that many of us will never pay off.
MY NEW TEAM WANTS TO HEAR FROM YOU
You don’t see as many health insurance horror stories in the media as you used to, not because there are fewer of them but because there are far fewer reporters covering companies like Cigna. In the absence of those stories, members of Congress and other policymakers don’t understand the tremendous harm those health plans are inflicting on so many American families.
My colleagues and I at the Lower Out-of-Pockets NOW (LOOP NOW) coalition are determined to change that. Tell us your horror stories and we’ll make sure members of Congress hear them.
HIGH-DEDUCTIBLE PLANS = MEDICAL DEBT
Just this past Friday, NBC News reported on a new study, published in JAMA, that found that among privately insured Americans, “people with high-deductible plans and people on Medicare Advantage were more likely to have medical debt.”
One of the biggest sources of high-deductible horror stories is GoFundMe. Just type “deductible” in the GoFundMe search box and you’ll find hundreds of them. You’ll find that most of them are about Americans with insurance who are struggling to stay alive and out of bankruptcy after being diagnosed with a serious illness, including cancer.
That would come as no surprise to the National Patient Advocate Foundation, which recently released the results of a new study from University of Alabama researchers.
They found that over 30% of insured patients reported trouble paying for health needs. And get this: the rate was highest among respondents on employer-sponsored plans, 59% of whom reported trouble paying for healthcare.
"Not only is this a story about the high cost of cancer, but it’s also a story about how certain insurance plan benefit designs purposefully shift costs to patients in a way that may cause them to delay seeking care."--Kathleen Gallagher, VP of health services at the National Patient Advocate Foundation
WASHINGTON’S HUGE MISTAKE
The Affordable Care Act of 2010 established a ceiling on out-of-pockets for in-network care, but because of pressure from insurance industry lobbyists, Congress set the ceiling absurdly high–and it gets higher every year. This year, families can be on the hook for up to $17,400 before their coverage kicks in. Next year it’ll be $18,200. And that is for in-network care. The sky’s the limit for out-of-network care.
It’s gotten so bad policy wonks needed a new name for middle-class Americans facing such unaffordable out-of-pocket requirements. They came up with “functionally uninsured.” These are people who have health insurance. They just can’t afford to use it.
On the 10th anniversary of the ACA, The New York Times’s Sarah Kliff quoted a former top aide to President Obama as saying that allowing the insurance industry to keep moving people into high-deductible plans–and increasing the out-of-pocket maximum every year–was the ACA’s “biggest flaw.” She wrote that:
When the Affordable Care Act’s architects think about what they wish they had done differently, they often focus on one issue: the deductibles.
“We obviously made a huge mistake,” said Ezekiel J. Emanuel, who advised the Obama White House on health policy at the time…Surveys of health plan enrollees show that deductibles are patients’ biggest struggle, more so than concerns about having enough doctors in-network or even the price of the premiums.
Three years before Kliff’s story appeared, veteran healthcare journalist Trudy Lieberman wrote that “skyrocketing out-of-pocket expenses are the real crisis in the American health insurance system.”
Higher deductibles, coinsurance, and copayments were always going to come back to haunt the Affordable Care Act, which was sold on the rationale that it would make health care more affordable, a dubious premise conveyed by Democrats and advocacy groups in their oft-repeated talking point: “Affordable Quality Health Care for All.”--Trudy Lieberman, Center for Health Journalism, University of Southern California
IT’S GOING TO GET EVEN WORSE FOR MANY OF US
Meanwhile, insurers keep raising premiums to boost profits and keep shareholders happy. In a recent Kaiser Family Foundation survey, 7 out of 10 employers said they expect healthcare benefit costs to rise substantially next year. And 14% said they plan to shift some of those costs to their employees by increasing their out-of-pocket costs. That means even more of us will be functionally uninsured.
With your help–and your stories–the Lower Out-of-Pockets NOW Coalition will make the case to lawmakers and employers to fix this big mistake.
If you or someone you know has a story that needs to be told–and that your member of Congress should know about–please let us know.