Medicare for All: Ending Surprise Medical Bills
Discover how Single-Payer Medicare for All can bring an end to surprise medical bills, addressing an emerging crisis where over half of Americans face unexpected healthcare costs. Learn about the financial impact on families, the lack of coverage for out-of-network care, and the complexities of billing within the healthcare system.
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Presentation Transcript
Single Payer Medicare for All means An End to Surprise Medical Bills
Surprise Bills: An Emerging Crisis More than half of Americans have been surprised by a medical bill they thought would be covered by insurance 57% https://www.norc.org/NewsEventsPublications/PressReleases/Pages/new-survey-reveals-57-percent-of-americans- have-been-surprised-by-a-medical-bill.aspx Accessed Dec 22 2019
Surprise Bills: An Emerging Crisis 42.8% 42.0% 32.3% 26.3% Percentage of privately insured patients with out- of-network billing ER Visits Hospitalizations 2016 2010 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740802 accessed Dec 22 2019
Surprise Bills: An Emerging Crisis Bills of $628 or $2,040 are financial disasters for most working families. $2,040 Dollar amount of out-of-network billing for privately insured patients $804 $628 $220 ER Visits Hospitalizations 2016 2010 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740802 accessed Dec 22 2019
Surprise Bills: An Emerging Crisis Bills of $628 or $2,040 are financial disasters for most working families. Unable to pay 19% Borrow (bank, payday loan, friend, family) 7% How would you pay a $500 unexpected medical bill? 20% Credit card, pay over time 34% Credit card, pay next month Arrange with doc/hospital 13% 7% Pay the Bill Go Into Debt http://files.kff.org/attachment/Topline-Kaiser-Health-Tracking-Poll-Future-Directions-for-the-ACA-and-Medicaid Accessed Dec 23 2019
Many Plans Now Pay Nothing For Out-of-Network Care Small Group Plans Individual Plans Percent with no coverage forout-of- network care 71% 66% 55% 42% 36% 34% 31% 29% 2015 2016 2017 2018 2015 2016 2017 2018 RWJF 10/4/2018
Emergency Care Closest Hospital Can be entirely out of network! Surprise Medical Bills Hospital Care In-network hospital Some physicians out-of-network Assistant surgeons 11.3% Radiologists Anesthesia Pathologists 5.6% 11.8% 12.3% In-network hospital services but some physicians billed out-of-network https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00507 Accessed Dec 22, 2019
Emergency Care Closest Hospital Can be entirely out of network! Surprise Medical Bills Hospital Care In-network hospital Some physicians out-of-network Insurance Directories Confusing and incorrect Networks can change often Balance billing Insurer pays a portion Patient pays the balance
Public Option Medicare for All No change Private insurers can refuse to any cover out-of-network care Problem Solved All facilities covered. Patients never billed directly Emergency Care No change Private insurers can refuse to cover any out-of-network physicians Problem Solved No more networks. Patients are never billed directly Hospital Care No change Networks change; your doctor or hospital may no longer be covered Problem Solved No directories needed. All hospitals and providers covered. Insurance Directories No change Private insurers can refuse to pay out-of-network providers at all Problem Solved Patients never billed directly for medically necessary services Balance billing
Most Americans Want to Fix This Democrats Independents Republicans Support 14% 20% 26% Oppose 84% 78% 71% Do you support or oppose legislation protecting patients from paying the cost not covered by their insurance when they receive care from a provider or hospital who is not in their network? https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-september-2019/ Accessed Dec 21 2019
Most Americans Want to Fix This Overall Support even if it would lead to doctors and hospitals getting paid less? Support 20% Still Support 57% Unsure 17% Oppose 20% Oppose 78% Do you support or oppose legislation protecting patients from paying the cost not covered by their insurance when they receive care from a provider or hospital who is not in their network? https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-september-2019/ Accessed Dec 21 2019
Why Single Payer Medicare for All? Simple Comprehensive benefits for all Americans Any doctor, hospital, or pharmacy across the USA No copays, no deductibles, no surprise bills Get American businesses back to their business Americans are proud of Medicare
Physicians for National Health Program Non-profit, non-partisan, member-supported 501(c)3 Membership open to everyone www.PNHP.org @PNHP Facebook.com/DoctorsForSinglePayer
Optional Supplementary Slides
2/3 of Bankruptcy Filers Cite Medical Bills or Illness-Related Work Loss as a Cause Medical Bills Only 22% Bills + Work Loss 36% Work Loss defined here as Work loss due to illness Work Loss Only 8% No Medical Cause 33% National Survey of Debtors, 2013-2016 Source: Himmelstein, Thorne, Lawless, Foohey, Woolhandler. AJPH 2019;109:431
Most of the Medically Bankrupt Had Insurance at the Onset of Their Illness VA / Military 2% Medicare 10% Private Insurance 60% Medicaid 5% Uninsured 22% Source: Himmelstein et al. Am J Med: August, 2009
Average Deductible Rising $1,655 $1,573 Average Deductible for Covered Workers, Single Coverage $1,505 $1,478 $1,318 $1,217 $1,135 $1,097 $991 $917 $826 $735 $616 $584 2006 2008 2010 2012 2014 2016 2018 Kaiser/HRET Survey of Employer-Sponsored Benefits
Insurance Often Fails to Fully Insure Us 25% Percent of Adults 19-64 under-insured* 23% 22% 20% 17% 15% 16% 16% 10% 9% 9% 5% 0% 2003 2005 2010 2012 2014 2016 2018 Commonwealth Fund Health insurance Surveys 2003-2018 *Under-insurance is defined here as being insured all year, but out-of-pocket expenses were >10% of income (>5% of income if low income) or deductible was >5% of income
Health Costs Force Millions into Debt And to Forego Other Essentials Total borrowing to pay health costs: $88 billion 19% 17% Percent of adults who borrowed money or reduced spending due to health care costs 16% 12% 11% 8% Borrowed Money Groceries Clothing OTC Drugs Utilities Recreation Westhealth/Gallup. Public Perceptions of the US Healthcare System - 2019
Medical Bills Are Most Common Reason for Collection Calls 59% 50% Percent of Consumers Receiving Collection Calls with Specific Type of Debt 40% 37% 30% 28% 20% 21% 10% 14% 11% 0% Medical Telecom Utilities Taxes Legal/ Court Rent Medical collection calls were the only category which did not differ by income Consumer Financial Protection Bureau, January 2017
High Deductible Coverage (HDHP) Compromises Finances and Access 15% 15.4% Percent of Adults 18-64 Not High Deductible 10% 9.0% 8.5% 5% High Deductible 4.1% 0% Problem Paying Bills Delayed/Skipped Care Cohen & Zammitti, NCHS, June, 2017 Based on 2016 NHIS data Note: Of people with job-based coverage, 26.9% had HDHP in 2011, rising to 39.6% in 2016 Note: HDHP = >$1200/$2400 single/family deductible in 2011. $1300/$2600 in 2016
