Real World Health Care Blog

Tag Archives: health insurance

ACA Update: When Medical Insurance Doesn’t Result in Medical Care

Amid continuing partisan debate on Capitol Hill about the Affordable Care Act, the facts are clear: the law has significantly reduced the number of uninsured Americans. Last week the federal government issued a report indicating more than 16 million people who did not have health insurance before have gained coverage thanks to the ACA. According to the Department of Health and Human Services, these gains have delivered the largest drop in the uninsured rate in four decades, bringing that rate down to 13.2 percent.

Linda Barlow

Linda Barlow

“These numbers prove the Affordable Care Act is working, and families, businesses and taxpayers are better off as a result,” said HHS secretary Sylvia Burwell.

While few would dispute that having medical coverage is better than not having medical coverage, coverage is not always a panacea for all ills. First, consumers need to take advantage of the coverage they now have. The federal government recognizes the gap between having medical insurance and getting medical care and has established a website to help consumers use their new marketplace coverage.

For about 19 percent of privately insured adults, higher cost-sharing responsibilities are to blame for the lack of medical care received. Fortunately, the number of Americans reporting they did not receive needed health care because of its cost dropped for the first time last year since 2003, falling from 80 million in 2012 to 64 million in 2014. Still, twenty-one percent of adults with health insurance spent 5 percent or more of their income on out-of-pocket health care costs during 2014, and 13 percent spent 10 percent or more, according to a report from the Commonwealth Fund.

These underinsured Americans face tough choices every month: Do they use their limited funds to pay for needed health care visits, therapies and procedures, or do they use that money for essentials like rent, utilities, child care and food?

Our sponsor, the HealthWell Foundation, believes that no American should go without essential medications and other therapies because they cannot afford them. The Foundation has helped more than 200,000 underinsured patients afford their medical treatments since its launch in 2004. As we recognize the fifth anniversary of the passing of the ACA, we want to know if you agree. Has the ACA helped you and your loved ones receive needed care, or are high out-of-pocket costs still keeping you from seeking the care you need? Let us know in the comments.

Patient of the Month: Sharon Harris Survives Lupus and Pays It Forward

Sharon Harris remembers February of 2002. She remembers where she was, what she was wearing, and what she was feeling. Most of all, she remembers the day she was diagnosed with lupus.

SharonHarris1

Sharon Harris, lupus awareness advocate and founder of Lupus Detroit

May is Lupus Awareness Month. Lupus is a chronic inflammatory disease that occurs when the body’s immune system is unable to distinguish between foreign illnesses and the body’s own tissue and organs. Inflammation caused by lupus can affect joints, skin, kidneys, blood cells, brain, heart, lungs, and other organs. Although there is no cure for lupus, there are numerous medications that can alleviate its symptoms.

Sharon had just graduated from Florida A&M University in Tallahassee when she received her diagnosis. “I was 22 at the time, fresh out of college,” Sharon said. “You’re taught while you’re growing up to learn your manners, respect your elders, and get a good education. No one tells you about an autoimmune disease that you will have for the rest of your life.”

Nor had anyone told her what having lupus would entail. “I immediately went into battle mode,” she said. “I had graduated from college. I had traveled 1200 miles from my family to make my journalism degree happen, and I was going to fight.”

“But, as soon as I got my fight on, that’s when all the pain started.”

Sharon experienced a flare-up of symptoms. It would be an understatement to say that the rest of that winter was difficult for her. Her hair began to fall out. She suffered from constant fatigue and pain. In the month of February alone, Sharon lost thirty pounds.

After beginning treatment on several different medications, Sharon started feeling better by that summer. One Wednesday during a Bible study, Sharon was asked what she would do if it were her last day on Earth.

“I said I wanted to see the world,” Sharon said. “Because if lupus was going to take me out, then it was going come and find me in Paris on the Eiffel Tower or on a beach in the Virgin Islands.”

By chance, Northwest Airlines (now Delta) had put out an ad to recruit flight attendants. It was a dream job for Sharon. The job provided her with better insurance, and on her off days she could fly to any location on Northwest’s roster. Just as she had hoped, Sharon got a chance to see the world. Amazingly, Sharon started to find that her experience with lupus was helping her have a healthier mindset. “It really made me think of life in a whole different way, and just literally live. Just really get out there and live,” she said.

Sharon eventually moved back to Tallahassee, opening an eyelash parlor and holding down an office job. At that point, she experienced another flare-up. “In October in Tallahassee it is still 100 degrees outside, and I was wearing a wool coat,” Sharon said. “I was so sick.” Sharon packed up and returned to her hometown: Detroit, MI.

Now, too sick to work and without a job, Sharon did not have health insurance. The lupus was attacking her kidneys and the medicine that she was prescribed cost upwards of $3,000 for a month’s supply. Despite pinching pennies to afford her daughter’s medication, Sharon’s mother was willing to refinance her house to save her only child’s life.

That’s when Sharon’s luck shifted. One day, she visited a local lupus organization with the intention of buying a t-shirt, and she ended up walking out with a new job. Her new public relations position did not include benefits but being employed allowed her to purchase health insurance.

Although she had insurance, her share of the payments for her four medications was unaffordable; one of the therapies alone cost more than $1,000 per month. That’s when Sharon found out about the HealthWell Foundation from a Google Alert. HealthWell is a nationwide non-profit providing financial assistance to insured patients who are still struggling to afford the medications they need (and sponsor of this blog).

“Literally, HealthWell saved my life,” Sharon said. “I didn’t have to incur any debt, my mother didn’t have to refinance her house, and HealthWell saved the day.”

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And Sharon wanted to save the day for others like her. She has become a leading activist for lupus awareness, starting her own advocacy group called Lupus Detroit, which offers lupus patients emergency grants. Sharon points out that there are two colors that are used for lupus awareness, orange and purple. She opted for orange for her organization because the color is “louder” and garners more attention. “Lupus needs all of the attention that it can get,” Sharon said.

Sharon is currently in remission and has been doing well since receiving a grant from HealthWell in 2011 that allowed her to afford her medications. “I was inspired by the work that HealthWell does to help people with their medications,” she said. “I just don’t believe that someone should have to choose between paying for their medication and feeding their children.”

And neither do we, Sharon. Keep up the excellent work.

If you are inspired to help, consider raising awareness during Lupus Awareness Month and showing your support. Here are some suggestions:

  • Make a donation to HealthWell’s SLE Fund in honor of a family member or loved one who is battling lupus.
  • Celebrate World Lupus Day on Saturday, May 10th.
  • Put on Purple on Friday, May 16th and visit The Lupus Foundation of America’s website at www.lupus.org to learn how you can show your support.
  • Find your local Lupus Foundation of America chapter to learn about activities in your area.

Has lupus touched your life? Do you have plans to show support during Lupus Awareness Month? Share your story in the comments section.

Categories: Cost-Savings

Experts Say More Med Students Good News for U.S. Health Care

Fresh data released just last week demonstrates that new student enrollment at medical schools is on the rise nationwide.

Paul DeMiglio

Paul DeMiglio

The Association of American Medical Colleges (AAMC) announced Thursday that the total number of those who applied to and were accepted into medical school grew by 6.1 percent this year to a record 48,014. This figure beats out
— by 1,049 students — the previous all-time high set in 1996. The AAMC, which represents U.S. hospitals, health systems, Department of Veterans Affairs medical centers, academic societies and 141 accredited U.S. and 17 accredited Canadian medical schools, also found that:

  • The number of first-time applicants climbed to 35,727 (5.5 percent increase).
  • The number of students enrolled in their first year of medical school went past 20,000 for the first time. 

“At a time when the nation faces a shortage of more than 90,000 doctors by the end of the decade and millions are gaining access to health insurance, we are very glad that more students than ever want to become physicians. However, unless Congress lifts the 16-year-old cap on federal support for residency training, we will still face a shortfall of physicians across dozens of specialties,” AAMC President and CEO Darrell G. Kirch, M.D. said in a statement. “Students are doing their part by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment. Now Congress needs to do its part and act without delay to expand residency training to ensure that everyone who needs a doctor has access to one.”

Record-breaking enrollment is also being seen at colleges of osteopathic medicine, where 20% of medical students are enrolled. Although they make up a smaller number of students, their growth rates increased even faster. In an announcement released Wednesday by the American Association of Colleges of Osteopathic Medicine (AACOM), experts say this trend will help offset the looming primary care crisis that will result from a growing shortfall in the number of doctors.

Enrollment at colleges of osteopathic medicine has almost doubled over the past decade, with the number of students who applied this year hitting 16,454. Other key findings, according to AACOM, show that:

  • Osteopathic medical colleges saw an 11.1 percent increase in first-year student enrollment for 2013, bringing total enrollment to 22,054.
  • 4,726 new osteopathic physicians graduated this past spring, representing an increase of more than 50% over the number of such graduates 10 years ago.

“Because large numbers of new osteopathic physicians become primary care physicians, often in rural and underserved areas, I’m hopeful that the osteopathic medical profession can help the nation avoid a primary care crisis and help alleviate growing physician shortages,” Stephen C. Shannon, DO, MPH, President and CEO of AACOM, said in a statement. “Interest in osteopathic medical education is at an all-time high.”

Primary care physicians are expected to be hit harder than any other specialty, with a projected shortage of about 50,000 by 2025. 

So what exactly is osteopathic medicine and osteopathic physicians (DOs)? According to AACOM, which represents the nation’s 30 colleges of osteopathic medicine at 40 locations in 28 states, DOs offer a comprehensive, holistic approach to medical care.

One in five medical students are now enrolled in osteopathic medical schools, and this percentage will grow even more as new campuses open and colleges continue to expand to keep pace with more students.

Now it’s your turn. What are potential advantages and disadvantages of more medical school graduates – to cost, care and access? Will the rise in new enrollment be enough to offset expected physician shortages? Tell us what you think.

Adherence Training Key to Improved Coordination of Care, Use of Specialty Drugs

I have been fortunate enough in my career to do humanitarian work in East Africa, and I have witnessed incredible health care service performed despite a paucity of resources. Conversely, one of the many health care tragedies in that part of the world is the downward therapeutic outcome spiral due to unattended simple maladies. An untreated toe could turn into a raging skin infection or worse. A simple break of a person’s leg improperly set could leave that person crippled for life.

Joel L. Zive

Joel L. Zive

In the United States, we have a different set of complex issues affecting our health care system. But there is a beacon of hope with some of the most vexing health care issues:  specialty drugs. Yes, they have annual costs that approach the length of phone numbers, but research and development costs must be taken into consideration.

Yet when one evaluates the pain and suffering these compounds alleviate – sometimes also saving money for our health care system in the areas of solid organ transplant rejection, HIV, Multiple Sclerosis and Cancer for example – real value emerges.

Despite their high expense, there are organizations, including the HealthWell Foundation, that help patients pay for access to these medications. And do not forget social workers, case managers and an army of master insurance billers in doctor’s offices and pharmacies across the country.

Yet these drugs carry with them a promise and a peril: A promise if their regimens, with high pill burden, are adhered to and the side-effects are understood. And a peril to the patient and unnecessary high cost to our health care system.

What person who deals in specialty drugs has not been brought to the brink of tears due to the frustration of non-adherence? Of a transplant patient who never told their pharmacist or transplant coordinator that he stopped taking their immunosuppressive medications and lost their transplanted organ? The efforts of the pharmacists, nurses, prescribers, surgeons, transplant coordinators, social workers that were wasted along with precious time and money are horrifying.

On the other hand, you have a patient newly transplanted or newly diagnosed with a complex disease. Frightened, scared — even angry — wondering whether they can afford medications to stave off dialysis or stay alive. In my career, I have seen first-hand examples of turnarounds in patients’ attitudes and quality of life due to these medications and adherence training:

  • A kidney transplant patient who was on dialysis for years who saw other patients go into dialysis walking, then in a wheelchair, then on a gurney before expiring.
  • Another patient at the dialysis center who announced one day, “I give up.” This individual had sufficient motivation but still needed guidance and assurance he would get his medications in a timely manner. Now, this person is rebuilding a life for himself and his family.
  • A woman tired, frail and scared lying in a hospital bed post-transplant wondering how she will live the rest of her life. With encouragement and adherence training she is now flying cross-country to see her relatives.
  • Another patient was diagnosed with relapsing remitting Multiple Sclerosis in the prime of his life. Yes, he had difficulty dealing with his insurance company and their specialty pharmacy.  But he had help and encouragement from an outside specialty pharmacy. And with patience and persistence from others he is now in graduate school.

What do these examples underscore? That although the United States enjoys an abundance of health care resources compared to Africa, what we’re missing is the coordination of care. Sometimes this is due to the health care system and sometimes this is because of the patient.

There are a couple of strategies providers can employ to improve this situation:

  • This scenario I saw first-hand in Rwanda.  If a pharmacist senses there is something not right mentally with the patient, he can contact a social worker in the clinic for further workup.
  • Another approach includes an agreement among the multidisciplinary team about what the adherence goals  should be. If the goals seem to be remiss, then the pharmacist could be notified, and he could handle the issue or direct it to the appropriate provider.

In both cases, there is feedback among the health care team. In the area of specialty drugs, adherence training can fill and highlight these gaps to the patient’s benefit.  As my colleagues in East Africa have told me, “We admire your health care system.”

We have many issues to be worked out and negotiated in the weeks, months and years ahead.  But let’s use adherence training to give my colleagues overseas something they can aspire toward and emulate.

What other strategies can providers employ to improve coordination of care? How can hospitals, government and health care industry stakeholders coordinate to become part of the solution when it comes to more effective adherence training?

Implementation of Health Care Law Expanding Coverage to More Young Adults

LJB head shot 03

Linda Barlow

For the first time in nearly a decade, the number of 19-25 year-olds gaining access to health insurance is on the rise, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey. Researchers point to a provision in the 2010 Patient Protection and Affordable Care Act (PPACA or ACA), which allows young adults to stay on their parents’ health insurance until age 26, as a likely cause of this groundbreaking trend.

“The early provisions of the Affordable Care Act are helping young adults gain coverage and improving the affordability of health care during difficult economic times for American families,” said Sara Collins, Ph.D., a Commonwealth Fund vice president and lead author of the Biennial Survey’s report, Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act.

The improvements in young adult health coverage are significant, according to the Biennial Survey:

  • Nearly eight in 10 (79 percent) of Americans ages 19-25 reported that they were insured at the time of the survey in 2012, up from 69 percent in 2010, or a gain in health insurance coverage for an estimated 3.4 million young adults.
  • The share of young adults in this same age group who were uninsured for any time during the year prior to the survey fell from 48 percent in 2010 to 41 percent in 2012 – an estimated decline of 1.9 million, from 13.6 million uninsured young adults in 2010 to 11.7 million in 2012.

Of the estimated 3.1 million young adults who are now covered through the ACA, 60 percent are leveraging it for mental health, substance abuse, or pregnancy treatment, according to a study from the Employee Benefits Research Institute (EBRI). For one large, national employer profiled in the study, the newly-covered young adults used about $2 million in health care services in 2011 – about 0.2 percent of the employer’s total health spending.

Access is a major barrier to care for young adults, who were previously terminated from their parents’ plans when they turned 19. According to the Henry J. Kaiser Family Foundation (KFF), young adults typically face difficulties obtaining their own coverage because they work in entry-level, low-wage or temporary jobs that are less likely to provide health insurance. Lack of insurance makes it harder for young adults to receive adequate medical care –  a problem that plagued one in five young adults before the ACA began to take effect.

“Young adult women have additional health needs and are particularly vulnerable when they are uninsured, as they are at an age when they require reproductive health services,” noted Karyn Schwartz and Tanya Schwartz, authors of KFF’s Issue Paper, How Will Health Reform Impact Young Adults? “Having health insurance and consistent access to the medical system may increase the likelihood that they receive timely pre-natal care if they become pregnant.”

Meanwhile, some skeptics are expressing concerns about key aspects and implications of the Act, from objecting to young single males being required to purchase a plan including maternity benefits and well-baby coverage – to others saying that full implementation of the ACA in 2014 will mean much higher premiums for young adults. Many have challenged these assertions, however, noting that the ACA’s age-based pricing requirements are largely in line with premiums individuals are paying now.

Although the news for young adults is mostly good, the survey also found that 84 million people – nearly half of all working age U.S. adults – went without health insurance in 2012, or faced out-of-pocket costs that were so high relative to their income that they were considered “underinsured.”

The survey did indicate that 87 percent of the 55 million uninsured Americans in 2012 are eligible for subsidized health insurance through the insurance marketplaces or expanded Medicaid under the ACA. Up to 85 percent of the 30 million uninsured adults also might be eligible for either Medicaid or subsidized health insurance plans with reduced out-of-pocket costs.

Click here to learn more about pricing options for young adults seeking health insurance coverage.

Now it’s your turn. Does rollout of the ACA mean more accessible and affordable health insurance coverage, or will it drive up costs, particularly for younger Americans? Get the conversation started.

Categories: Access to Care