Biden administration trying to tackle medical costs, but is still just working around the edges

Biden administration trying to tackle medical costs, but is still just working around the edges

The Biden administration has been working hard to make the Affordable Care Act, and health insurance in general, work better. They’ve lowered premium payments all the way down to zero for many people in Obamacare (a measure that needs to be passed again before the November election to avoid a bad October surprise of premium hike notifications). They’ve implemented the regulations to end surprise billing for people with insurance, and they’ve worked with credit reporting agencies to get them to stop reporting medical debt. They’re getting rid of the family glitch in the ACA that has made insurance too expensive for many families.

Earlier this week, Vice President Kamala Harris announced new efforts from the White House to ease the burden of unpaid medical bills. “I have met so many people in so many communities in our nation who are struggling with this burden. Many of whom are managing an illness or an injury at the same time and who stay up at night, staring at the ceiling wondering if they’ll ever be able to pay off their medical debt,” Harris said at a press briefing. “No one in our nation should have to endure that. No one in our nation should have to go bankrupt just to get the health care they need.”

In addition to stopping medical debt from wrecking credit scores, the administration is ensuring that it won’t be a barrier to getting a federally-backed housing loan, and will use the CFPB to investigate credit reporting companies and debt collectors who aggressively harass and intimidate people who owe to hospitals and other providers. The CFPB will also provide more consumer education tools to help patients navigate medical debt and billing. The administration is also moving to help get veterans’ medical debt forgiven.

That’s all very good stuff, but it’s almost all going to just help people with insurance. For people without insurance, medical debt and collections and harassment—it’s still a problem, as WBEZ reports.

RELATED STORY: The team got back together, with plans to make Obamacare better

They feature 52-year-old Elma, an undocumented immigrant who didn’t share her last name. She is uninsured—the $500/month premium for insurance from her husband’s job was too expensive for the family to keep, so they dropped it. Because she’s undocumented, she can’t get coverage through Obamacare. She had an emergency gallbladder removal that cost more than $50,0000 at MacNeal Hospital in Berwyn, Illinois. Because of her low income, the Illinois Coalition for Immigrant and Refugee Rights worked with the hospital and Elma to get 100% of that bill written off. However, she still owes more than $8,000 to the providers who are independent of the hospital system. They operate as separate businesses and can charge basically what they want.

For someone with insurance, there’s a fix for that now that the surprise billing law has been implemented. “One of the things that’s frustrating about this is that it’s just enough money to be devastating to the patient, and very little money for the health system to collect,” said Carrie Chapman, senior director of policy and advocacy at the Legal Council for Health Justice in Chicago. She advised on Elma’s case. “Relatively speaking, it’s less than a rounding error in their budget.”

Many people, like Elma, have bills from $10,000 to $20,000 which for a large hospital system is not going break the bank, but will wear a patient living on the margins completely down. “Solo cuando estoy dormida siento paz,” Elma told WBEZ. “Porque nada más despierto y siento, ‘Cómo se va a pagar todo eso?’” (“The only time I feel any peace is when I’m asleep. The moment I wake up, I’m asking myself, ‘How are we going to pay all this?’”)

A recent Kaiser Family Foundation survey found that 13% of uninsured adults are more likely to report having significant medical debt than insured adults, at 9%. The burden of high debt also falls disproportionately on Black and brown people—27.9% of households led by a Black person have medical debt, compared to 21.7% of households led by a Hispanic person, and 17.2% of households led by a white person.

These are among the lowest-income communities, as well, and are the people more likely to have significant debt. Kaiser found that “12% of adults with incomes below 400% of the federal poverty level report having significant medical debt. (In 2019, the federal poverty line was $12,490 for a person living on their own and $25,750 for a family of four.)”

These are also the people who have more health problems and/or disabilities, as debts pile up for their complex care. Kaiser found that “adults living with a disability are more likely than those without a disability to report owing over $250 in medical debt (15% vs. 7%). Similarly, people who report their health status is ‘fair’ or ‘poor’ are more likely to say they owe significant medical debt than those who say they are in ‘very good’ or ‘excellent’ health.”

The moves the administration has made are good, they will help millions of people be freed of the worst of the burdens of medical debt. But having your debt not reported and not damaging your credit isn’t the same as having your medical debt erased. It won’t solve the problem of high deductibles that force patients to go into debt even when they have insurance or provider billing practices that make costs so high.

As far as it’s gone, the Biden administration is doing good stuff. But there’s still a long way to go—including whatever it takes to get Joe Manchin and Kyrsten Sinema to agree to let the health care stuff in the Build Back Better plan (larger subsidies for insurance, a Medicaid expansion workaround for states that have refused it) go forward.

Ultimately, until the United States joins every other advanced nation in the world and decides to provide state sponsored health care as a basic right, these inequities will still exist. They can be minimized, but they can’t be eliminated as long as health care is treated as a commodity.

Powered by WPeMatico

Comments are closed.
%d bloggers like this: