From the E.R. to the Courtroom: How Nonprofit Hospitals Are Seizing Patients’ Wages – ProPublica

Under federal law, nonprofit hospitals must offer care at a reduced cost to lower income patients, a service often called charity care. But crucial details—how poor patients need to be, how much bills are reduced, and how policies are publicized—are left to the hospital. The Affordable Care Act empowered the IRS to set new requirements for publicizing this information, but those have yet to be finalized.

If a patient can’t pay and Northwest obtains a judgment, it’s too late. Hospital policy says once the collection agency has “incurred legal fees” on a case, the patient is ineligible for charity care, regardless of earnings.

via From the E.R. to the Courtroom: How Nonprofit Hospitals Are Seizing Patients’ Wages – ProPublica.

I’m breaking my break because this spectacular piece of investigative journalism is really all I wanted for Christmas. This is an issue that makes the individual mandate, as Salt-N-Pepa might say, very necessary.

Charity care/financial assistance is available at my academic health system. Patients qualify for financial assistance based on income and payments are calculated with a sliding scale. They may owe nothing, a percentage of the total, or be put on a payment plan. This article uncovers that the criteria for how a patient finds out about or applies for or qualifies for financial assistance is largely left up to the hospital. As a recent cancer patient with massive bills but good insurance and 2/3 of a graduate degree from the academic health system where I received treatment, I still messed up paying the hospital. Medical billing is incomprehensible and damn tricky. Adding the difficulty of applying for financial assistance on top of your stack of bills from many non-communicating entities is the real cherry on top of the garbage sundae. No, it’s an additional garbage sundae on top of the garbage sundae. No, it’s just a pile of garbage.

Bottom line: Access to aid is limited. Barriers to aid are significant. And, most shockingly to me, once you have been sued successfully by the hospital, you no longer qualify for aid. *MIND EXPLODES*

How Obamacare Lowers Your Property Taxes – Forbes

How Obamacare Lowers Your Property Taxes – Forbes.

Key point:

A snapshot of this trend can be seen in Cook County, Illinois, where the public hospital system has seen a decrease in patients who cannot pay their bills thanks to the law’s expanded Medicaid health insurance for poor Americans.

Long and short–Medicaid expansion offers insurance to people in poverty, which is a means to provide payment to public hospitals and health systems that are mandated to give care regardless of an individual’s ability to pay.

Here’s the AHA reports on uncompensated care through 2012 for those who want numbers (before Medicaid/marketplace).

PS- I love working for a public health system because it is the closest thing I’ve seen to fulfillment of that phrase under Lady Liberty’s feet. That’s corny as hell, right?

Breaking ACA data!!

First let’s be clear: this data describes state-run health insurance marketplaces. It describes plans available through those marketplaces. It does not describe group or employer health insurance plans. But, we (or at least I) can assume that there might be a trend worth following. This is the first year where we get a preliminary look at whether the ACA might push premiums down (and I mean relatively–remember most if not all plans were going up by many percentage points year over year before the marketplace).

Modest Premium Changes Ahead in Health Insurance Marketplaces in Washington State and Maryland – The Commonwealth Fund.

Maryland and Washington (state) are two early reporters, and for the benchmark “middle of the road” silver plan premiums for singles, couples, or families are up by less than 1% in MD or 3% in WA. Singles silver plans are down by 1-2% in both states.

Now it is a little apples-to-oranges to make this comparison, and obvi I am using the same foundation to grab it, but I have to stress that pre-ACA premiums were rising at a crazy rate year over year. This report  (Interactive wow I’d insert it but I don’t want any confusion since it is pre-marketplace) maps hows the increase in employer-sponsored premiums related to percentage of household income 2003-2011. In my home state of VA premiums increased 62% (family) and 49% (individual). Ouchie. Overlay a chart of my increasing depression and you’ve got near identical data.

LAST POINT: for everyone who banking on capitalism to bring prices down (god forbid you bring this up on a long car trip with me), per this report here’s a tasty lick:

One factor behind these modest premium increases may be that new carriers entered the marketplaces in both states, fueling competition among plans. In Washington, one carrier, Moda Health, entered the market, and two, BridgeSpan and  Coordinated Care, increased their plan offerings more than threefold. On the whole, the number of silver and gold plans offered nearly doubled from 2014 to 2015. In Maryland, three carriers—Cigna, United Healthcare, and Carefirst (GMSHI)—entered the marketplace.

RAM: Remote Area Medicine

RAM is well know within the VA healthcare community. Clinics are held in tents, trailers, and the Wise County Fairgrounds’ livestock stalls. Lines are legendary. People sleep in cars and on the open ground for days to get a chance to have teeth pulled, rudimentary diagnostics, and the scant amount of education and management of chronic conditions that time allows. Efforts by medical and dental staff are herculean and all volunteer. Patients are nearly all uninsured (which does not at all mean they are not working if you must ask).

This is an access issue, people! RAM was developed to provide care to remote villages in South America. Over 60% of RAM clinics are now in the US. It is the primary source of healthcare for thousands of people in Southwest. WaPo did some great reporting on it this year,  and now we’ve got an independent film coming out.

The WaPo article is titled Misery that Shouldn’t Exist. Cough Medicaid expansion cough cough. More to come on the politics, the policy, the people.

The struggle is real.