Category Archives: Health care reform

3 angles to pursue when covering medical debt 

Last Monday, the White House announced four steps to ease the burden of medical debt on health care consumers. The announcement didn’t get much coverage, and one online publication labeled the White House’s actions a Band-Aid. 

That characterization seems harsh because, taken together, the steps Vice President Kamala Harris announced are as follows: 

  • Hold medical providers and debt collectors accountable for harmful practices.
  • Reduce the role medical debt plays in determining whether Americans can access credit.
  • Help more than 500,000 low-income veterans get their medical debt forgiven. 
  • Inform consumers of their rights.

Source: Medical Debt Burden in the United States, Consumer Financial Protection Bureau, February 2022.

It could be that the news fell somewhat flat because the announcement followed the federal Consumer Financial Protection Bureau (CFPB) report last month, “Medical debt burden in the United States.” After that report was published, the nation’s three largest credit-reporting agencies made significant changes in how they report medical debt. We covered those news stories in a blog post last week, “Equifax, Experian, TransUnion to remove some medical debt from credit reports.” 

When reporting on medical debt and the White House announcement, it’s easy to neglect three of the most compelling angles to this story, all of which stem from the abnormal nature of the highly complex U.S. health care system. 

First, the nation’s credit reporting system adds a burden to those who cannot afford to pay their medical bills that high-income consumers do not face. 

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Why the US nursing home system is ‘in desperate need of an overhaul’

A recent comprehensive and detailed report from the National Academies of Sciences, Engineering and Medicine called for a revamping of how we care for, finance, and manage nursing homes in the United States, and an overhauling of how employees are hired and trained.

The 600-page report, released on April 6, identified seven major areas requiring transformation to provide high-quality care to all nursing home residents. Strengthening the nursing home workforce, improving emergency preparedness, and increasing the transparency and accountability of nursing homes’ finances, operations and ownership are key goals among the report’s comprehensive recommendations. Efforts will require true collaboration between state and federal authorities, providers, payers and advocates, according to the report’s authors.

The report provides an opportunity for journalists to hold CMS, state officials and owners more accountable for how care is delivered and received for some 1.3 million people in more than 15,000 nursing homes throughout the United States.

“The way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented and unsustainable,” said Betty Ferrell, Ph.D., director of nursing research and education and professor at City of Hope Medical Center and chair of the Committee on the Quality of Care in Nursing homes, during an online presentation of the committee’s conclusions. (The committee’s work is sponsored in part by the John A. Hartford Foundation, which also sponsors AHCJ’s aging core topic area).

“The committee has delivered a blueprint to build a system of care that honors those who call the nursing home their home and the dedicated staff who care for them,” Ferrell wrote in the report.

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Equifax, Experian, TransUnion to remove some medical debt from credit reports 

Photo by wwnorm via creativecommons.org

People in the United States will soon get some help addressing costly health care; three major consumer credit rating agencies are planning to change how they report medical debt.

Starting in July, paid medical collection debt will no longer be included on consumer credit reports, Equifax, Experian and TransUnion said in a joint announcement on March 18. The three agencies also said the time before unpaid medical collection debt would appear on a consumer’s report will be increased from six months to one year.

This change is intended to give consumers more time to work with insurance companies, hospitals and medical offices to address billing disputes before they are reported on credit files. And, in the first half of 2023, the three companies will also no longer include medical collection debt under at least $500 on credit reports.

People struggling to pay hospital bills or copays for cancer treatment often worry about damaging their credit ratings. Lower credit scores can make it tougher to find employment or make major purchases such as a home, noted Rohit Chopra, the director of the federal Consumer Financial Protection Bureau (CFPB) in a March 1 statement. 

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Why limiting insulin out-of-pocket costs solves only part of the problem

Last fall, the U.S. House of Representatives narrowly passed a $2.2 million domestic spending plan called Build Back Better (BBB) that included several health care provisions including one that would limit what patients with diabetes would pay for insulin to $35 per month. One month later, Sen. Joe Manchin (D-West Virginia) effectively killed the legislation when he announced that he could not support the law.

Source: Comparing Insulin Prices in the U.S. to Other Countries, Prepared for the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services by RAND Health Care. September 2020.

Efforts to cap what patients pay for insulin, however, are still under consideration in Congress; some legislation could pass in the coming weeks. If so, health care journalists will need to know how any new law would work. One useful source could be a report last week from the Peterson Center on Healthcare and the Kaiser Family Foundation (KFF), “Out-of-pocket spending on insulin among people with private insurance.”

For health care reporters, there are at least three important concerns to understand about  efforts to limit what patients with diabetes pay for their care.

First, putting a cap on out-of-pocket costs is crucial but amounts to little more than tinkering around the edges of the issue. Patients with diabetes need insulin and supplies to monitor their blood sugar and store and inject insulin. In 2020, researchers for the Commonwealth Fund reported that some 30 million Americans have diabetes, and about 31% of them need insulin to manage the condition. The list prices of many of the newest forms of insulin have risen by 15% to 17% each year since 2012, the report noted.

Second, it’s important to understand that any limit on what patients pay out of pocket for insulin would not address the underlying price of insulin in the U.S., as the Peterson-KFF report explained. What diabetes patients pay for insulin in the U.S. is much higher than it is in other countries, according to a report that the U.S. Department of Health and Human Services (HHS) issued in 2020. For that report, HHS contracted with RAND Health Care to compare what pharmaceutical companies charged for insulin in the U.S. in 2018 against what drug companies charged in 32 other countries that are members of the Organisation for Economic Co-operation and Development (OECD).

The RAND researchers found that the average gross manufacturer price for a standard unit of insulin in 2018 was $98.70 in the U.S., which was more than 10 times higher than the $8.81 price of a standard unit of insulin in 32 other countries.

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5 angles to consider when covering drug-price reform

Want to know why little gets done when the U.S. Congress takes up proposals to control drug prices? One recent headline tells the story in nine words.

On Tuesday, STAT News ran this article, “Three years after the Senate grilled drugmakers … nothing’s changed.” STAT’s Washington correspondent Nicholas Florko reported that the Senate Finance Committee will meet Wednesday (March 16) to discuss what the agenda calls, “Prescription Drug Price Inflation: An Urgent Need to Lower Drug Prices in Medicare.”

Committee Chairman Ron Wyden, D-Oregon, has called the hearing “an opportunity for members to discuss how high drug prices have impacted seniors and families in their states and identify solutions.” But, as Florko noted, lawmakers have had more than a dozen hearings on high drug prices over the past three years and failed to make prescription drugs more affordable.

Florko’s excellent reporting offers four important angles for journalists covering the drug-price-reform issue. The first angle is that prices keep rising and Congress has done little.

In February 2019, for example, the Finance Committee called executives from seven drug companies —AbbVie, AstraZeneca, Bristol Myers Squibb, Johnson & Johnson, Merck, Pfizer and Sanofi — to explain why their drugs were priced so high and why the companies tended to raise prices annually.

But more than three years later, none of those companies has changed its ways, he wrote. What’s more, he added, the list prices for almost all top-selling medications from those companies have increased since the hearing in 2019.

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