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Bernie has no shot against Trump? Think again.

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8 minutes ago, HipKat said:

Derrrr Fact!!! duhhhhhhhhhhhh

Ever notice no one ever quotes you unless they're making fun of you?? Sorry I had to be the one to point that out.

Oh wait, you went to college, You already knew that

Lol it's so true. The dumbest smarty on the range for sure.

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2 minutes ago, f8ta1ity54 said:

Lol it's so true. The dumbest smarty on the range for sure.

LOL.  I'm gutted.  Nimrods insulting me.  Whatever will I do???  :classic_ohmy:

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Just now, HipKat said:

What's he up to, like 15K now?

I think that a very conservative estimate.

How many different lies did he tell about the imminent threat? And what the Iranians were targeting?  It went from 1 US embassy, to 2 US embassy's, to 3 US embassy's to 4 US embassy's.  Trump's story changes every time he is interviewed that the defense secretary Mark Esper can't keep up.

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L*t is a loser

 

My adapt a Bill is Brandon Beane.

 

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46 minutes ago, f8ta1ity54 said:

Are public goods "free stuff"? 

They are to me.  I'd see it differently if I had a job.  :niterider:

 


process.jpg

 

Fuck this team

I'll tie a frying pan to my ass so you hurt your penis, you ****ing homo!

Shut the fuck up dark cloud pussy

Anyone who is foolish enough to not be a Buffalo Bills fan can go f*ck themselves with a wooden shovel handle.

image-trump-emoticon.png

also, all that shit in your signature is beyond annoying. just like you.

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6 minutes ago, Thebowflexbody said:

LOL.   Trump over Bernie the Socialist any day.  Every day.

Serious question, why is socialism worse than free market capitalism in the specific case of healthcare? 

Why do you want to make Pharmaceutical and health insurance companies filthy rich?


L*t is a loser

 

My adapt a Bill is Brandon Beane.

 

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1 minute ago, junglesouljah said:

Serious question, why is socialism worse than free market capitalism in the specific case of healthcare? 

Why do you want to make Pharmaceutical and health insurance companies filthy rich?

He doesn't understand the question


“There he goes. One of God's own prototypes.

A high-powered mutant of some kind, never even considered for mass production.

Too weird to live, and too rare to die.”

 

Twitter: @HKTheResistance

 

HipKat, on *** other h***, is genuine, unapoli***tically nasty, and w**** his hea** on his ******. jc856

I’ll just forward them to Bridgett. comssvet11

Seek help. soflabillsfan

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5 minutes ago, HipKat said:

He doesn't understand the question

He hasnt heard a different answer on fox yet.

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1 minute ago, Woody said:

They are to me.  I'd see it differently if I had a job.  :niterider:

Even if you have a job, what happens when you get a life threatening disease or injury and your insurance company denies paying for health care dispute you paying for insurance premium for years?

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Insurance companies aren’t doctors. So why do we keep letting them practice medicine?

(iStock) (Minerva Studio/iStock) (iStock) (Minerva Studio/iStock)
By William E. Bennett Jr. 
Oct. 22, 2019 at 8:00 a.m. EDT

William E. Bennett Jr. is an associate professor of pediatrics at the Indiana University School of Medicine.

We know how important it is to have insurance so that we can get health care. As a physician, parent and patient, I cannot overemphasize that having insurance is not enough.

As a gastroenterologist, I often prescribe expensive medications or tests for my patients. But for insurance companies to cover those treatments, I must submit a “prior authorization” to the companies, and it can take days or weeks to hear back. If the insurance company denies coverage, which occurs frequently, I have the option of setting up a special type of physician-to-physician appeal called a “peer-to-peer.”

 

Here’s the thing: After a few minutes of pleasant chat with a doctor or pharmacist working for the insurance company, they almost always approve coverage and give me an approval number. There’s almost never a back-and-forth discussion; it’s just me saying a few key words to make sure the denial is reversed.

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Because it ends up with the desired outcome, you might think this is reasonable. It’s not. On most occasions the “peer” reviewer is unqualified to make an assessment about the specific services. They usually have minimal or incorrect information about the patient. Not one has examined or spoken with the patient, as I have. None of them have a long-term relationship with the patient and family, as I have.

The insurance company will say this system makes sure patients get the right medications. It doesn’t. It exists so that many patients will fail to get the medications they need.

 

I’ve dealt with this system from the patient side, as well. My daughter has a rare genetic disorder called Phelan-McDermid Syndrome, which causes developmental delay, seizures, heart defects, kidney defects, autism and a laundry list of other problems. She receives applied behavior analysis therapy, an approach often used for autism, and which has been wildly successful in improving her skills and communication. But recently, our health insurer reduced the amount of therapy they thought she needed.

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While I know what levers to pull from the physician side, a patient’s options are completely unclear. I probably have better access than almost anyone else can get, yet the ability of my daughter’s providers to mitigate denials for services they deem appropriate is slow and often ineffective.

My daughter can languish for months or years not receiving care that every highly qualified person who treats her agrees she needs. While we wait, the window to give her a little bit more function, a little bit less suffering and a little better life gets smaller.

 

Consumers have a right to appeal denials for health-care services, but regulations still largely focus on the process, not the content. For instance, insurers are required to notify you in writing of a denial, and patients have the right to an internal appeal; if that fails, some states also allow for an external review.

AD

This sounds good, as most denials are related to specific provider choice or contractual issues, which are relatively easy to remedy (but a problem nonetheless). But other denials are a judgment of some test or treatment as “not medically necessary.”

Insurance companies know that many patients don’t bother to appeal at all. A smaller fraction ask for an internal review, and still fewer seek or even know about external review options available in most states. Of the cases that do end up under external review, almost a third of all insurer denials are overturned. This is clear proof that whatever process insurers have to determine medical necessity is often not in line with medical opinion. A study of emergency room visits found that when one insurance company denied visits as being “not emergencies,” more than 85 percent of them met a “prudent layperson” standard for coverage.

 

Some might argue that it makes sense to have two doctors discuss a case and then come to a consensus on the most cost-effective approach for an individual. That’s not what is happening. This is a system that saves insurance companies money by reflexively denying medical care that has been determined necessary by a physician. And it should come as no surprise that denials have a disproportionate effect on vulnerable patient populations, such as sexual-minority youths and cancer patients.

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We can do better. If physicians order too many expensive tests or drugs, there are better ways to improve their performance and practice, such as quality-improvement initiatives through electronic medical records.

When an insurance company reflexively denies care and then makes it difficult to appeal that denial, it is making health-care decisions for patients. In other words, insurance officials are practicing medicine without accepting the professional, personal or legal liability that comes with the territory.

 

We don’t have to put up with this. Health care in the United States is shockingly opaque; it’s time to take insurance companies out of our decision-making process."

https://www.washingtonpost.com/opinions/2019/10/22/insurance-companies-arent-doctors-so-why-do-we-keep-letting-them-practice-medicine/

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Even the Insured Often Can't Afford Their Medical Bills

The debate over the future of healthcare is obscuring a more pedestrian reality: Insurance may handle most costs, but many Americans still need to turn to charity for help when they get sick.

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Elaina Natario / Katie Martin / The Atlantic
 
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A chance trip to Long Island’s Adventureland amusement park just might have saved Cassidy McCarthy’s life. After Cassidy—whose family calls her Cassie—then 4, complained about pain and nausea following a ride on the Ladybug rollercoaster, her dad, Daniel, a registered nurse, felt her stomach and discovered a small bump. A CT scan ordered up at a local hospital’s emergency room revealed a kidney tumor.

It was another seemingly chance decision by Daniel McCarthy to sign on as a volunteer firefighter more than a decade ago that saved the family’s finances in the wake of Cassidy’s diagnosis with cancer. As it turned out, that activity allowed him to ask The Heather Pendergast Fund, a foundation set up in 2009 to help out the families of Long Island’s volunteer firefighters and EMS workers with their children’s medical expenses, to pay many of Cassidy’s medical bills.

McCarthy says the charitable foundation was a financial lifeline. Cassidy quickly racked up more than several thousand dollars in out-of-pocket medical expenses—for the surgeon, the anesthesiologist, radiologists, chemotherapy, you name it—since the family’s insurance policy had a $6,000 deductible. A few months later, Pendergast came through again when McCarthy lost his job at a local nursing home and rehabilitative center and the family suddenly had to find money for COBRA payments, which, at $2,100 a month, were more than the monthly mortgage payment on their West Babylon, Long Island, home.

The Platinum Patients
Each year, one in every 20 Americans racks up just as much in medical bills as another 19 combined. This critical 5 percent of the U.S. population is key to solving the nation's health-care spending crisis.
Read more

“I don’t know how people who don’t have resources do this. I don’t. Many people work three, four jobs, and can’t afford the time to volunteer in an organization like the fire department that would be able to help them. There are many people living out there that need help that can’t find it,” McCarthy says.

The current debate over the future of the Affordable Care Act is obscuring a more pedestrian reality. Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills. The point of insurance is to protect patients’ finances from the costs of everything from hospitalizations to prescription drugs, but out-of-pocket spending for people even with employer-provided health insurance has increased by more than 50 percent since 2010, according to human resources consultant Aon Hewitt. The Kaiser Family Foundation reports that in 2016, half of all insurance policy-holders faced a deductible, the amount people need to pay on their own before their insurance kicks in, of at least $1,000. For people who buy their insurance via one of the Affordable Care Act’s exchanges, that figure will be higher still: Almost 90 percent have deductibles of $1,300 for an individual or $2,600 for a family.

 

Even a gold-plated insurance plan with a low deductible and generous reimbursements often has its holes. Many people have separate—and often hard-to-understand—in-network and out-of-network deductibles, or lack out-of-network coverage altogether.  Expensive pharmaceuticals are increasingly likely to require a significantly higher co-pay or not be covered at all. While many plans cap out-of-pocket spending, that cap can often be quite high—in 2017, it’s $14,300 for a family plan purchased on the ACA exchanges, for example. Depending on the plan, medical care received from a provider not participating in a particular insurer’s network might not count toward any deductible or cap at all.

At the same time, the most recent Report on the Economic Well-Being of U.S. Households, an annual survey conducted by the Federal Reserve Board, found that 44 percent of adult Americans claim they could not come up with $400 in an emergency without turning to credit cards, family and friends, or selling off possessions. When this reality combines with healthcare bills, the consequences can be financially devastating.  A 2015 poll by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health discovered that 26 percent of those who took part in the survey claimed medical bills caused severe damage to their household’s bottom line. A poll conducted earlier this year by Amino, a healthcare-transparency company, with Ipsos Public Affairs, found that 55 percent of those they surveyed claimed they had at least once received a medical bill they could not afford. No surprise, then, that the Consumer Financial Protection Bureau reported earlier this year that medical debt was the most common reason for someone to be contacted by a debt collector.

 

This spending is most pressing for households with the highest medical bills, the 5 percent of Americans who make up 50 percent of the country’s healthcare costs. Medicare, Medicaid, and private insurers will spend $40,375 on average per patient for someone in this group. Their out-of-pocket spending will be much less: on average, $2,582.90. This isn’t, in the scale of things, a lot of money—but given Americans’ straightened personal finances, it’s more than many can easily access.  

This isn’t, it’s important to point out, a static group. A chronic illness can land someone in this category but, given the increasing prevalence of high-deductible plans, so can something as simple as a broken bone or an emergency appendectomy. Although some people will be in this group year after year, many will cycle in and out, and nearly everyone will be in it for some brief period. The fact is that nearly any illness or injury can lead to unexpected bills, and few are able to absorb those shocks without difficulty. Yet, despite the commonness of such problems, there is little in the way of a system for helping people out through these times.

“Do I pay the doctor bill because I’m getting collection notices? But I gotta pay my mortgage, I gotta pay my electric bill, I’ve gotta pay the rent.”

Some of these people will declare bankruptcy. How many is the subject of controversy. A famous study—co-authored by Elizabeth Warren—found that suffering from a medical misfortune was the most common reason for ultimately leading someone to petition the courts for relief from their financial obligations, but another study pointed to unnecessary spending prior to the medical crisis.

As it turns out, determining what counts as a medical expense is difficult. It’s not simply doctor bills. In addition to the not-covered deductibles, there is transportation to and from medical appointments, parking fees at many hospitals, and often childcare expenses while parents are in treatment or at appointments. Time for cooking will be limited, so take-out bills can pile up, too.  

 

And families that experience an illness are often hit by a double whammy—they lose income at the same time their financial needs grow, often cutting back on work hours or leaving work altogether, either voluntarily or not. McCarthy, for one, recently filed a lawsuit against his former employer, Daleview Care Center in Farmingdale, Long Island, claiming he was let go because of the amount of work he missed as result of his daughter’s illness, a violation of several laws including the Family Medical and Leave Act. In legal filings, Daleview denied McCarthy’s allegations, but the company did not return requests for comment.

“The families get to the point where it’s, ‘What do I do? Do I pay the doctor bill because I’m getting collection notices? But I gotta pay my mortgage, I gotta pay my electric bill, I’ve gotta pay the rent.’ That’s where we come in,” Tom Pendergast of the Heather Pendergast Fund told me. “They can pay their mortgage, their rent, their electric bills and not have to worry about the medical part of it.”

For many, the idea of charity to help those in need out—which is, after all, what saved the McCarthy family from financial disaster—holds much in the way of appeal, speaking to both a sense of generosity and a can-do spirit. It somehow seems, well, American, to think individual donations can compensate for a broken, expensive system that views illness as a moneymaking opportunity. So there is crowdfunding, small foundations like the Pendergast Fund, hospital-charity programs for the needy, and disease-specific resources. These efforts are patchy, and often inadequate, but they’re what’s available. Their strengths and their failings reveal a lot about the broader American healthcare system—something that is all too easy to ignore till it is your life or the life of a loved one at stake.

 

***

CancerCare was founded in 1944 as a bereavement-support organization, but quickly began helping people with the disease manage their financial issues as well. “The first hospital bill we paid, in 1944, was to Memorial Sloan Kettering for $13 and change,” said Patricia Goldsmith, the organization’s chief executive officer. Today, finances are why between 60 and 70 percent of those who contact the organization reach out, and the dilemmas are the same as those people who turn to The Heather Pendergast Fund face.  “For the most part, people call us because they are in some kind of financial crisis,” says William Goeren, CancerCare’s director of clinical programs. “The prices have increased ... so that really puts the burden on the patient, who is weighing, ‘Do I pay for my mortgage or should I pay for my diagnostic test?’ These are the calls we are getting.”

CancerCare attempts to head off these sorts of financial issues, while still offering emotional support to people in need. They offer a bereavement camp—located in Pennsylvania’s Poconos—and counseling groups for cancer sufferers and their children alike. They also distribute more than $4 million in transportation, home-care, and childcare assistance.  

“If for some reason we got $500 million tomorrow to support co-pay assistance, we could distribute that money likely within two months.”

But the heart of CancerCare’s aid is distributed through their disease-specific prescription co-pay funds, which award anywhere between $4,000 and $15,000 per patient to income-eligible patients. (“Income eligible” varies based on the fund, but is generally anywhere between 250 and 500 percent of the federal poverty line.) Last year, the organization distributed slightly more than $14.2 million in total.

Such funds are not without controversy. The cost of treating cancer, a disease that will be newly diagnosed in just under 1.7 million Americans in 2017, is skyrocketing. According to research published in the Journal of Oncology Practice, the average cost of a year of a cancer treatment drug in 2000 was less than $10,000 in total. By 2005, that had more than tripled to between $30,000 to $50,000 annually. In 2012, 12 out of the 13 drugs newly approved for cancer cost more than $100,000. Another study, this one published in JAMA Oncology, found the price of one month of an oral-cancer medication increased from $1,869 in 2000 to $11,325 in 2014. As insurance companies, desperate to clamp down on their own expenses, cut reimbursements for the more expensive drugs, and employers, hoping to cut their own costs, push employees into high-deductible health-insurance plans, more of this cost ends up being picked up by the patients.

 

A paper published by the journal Health Affairs in 2013 found cancer patients are more than twice as likely as their peers without the disease to declare bankruptcy. The consequences of this expense goes beyond the patient’s checkbook: Last year researchers writing for the Journal of Clinical Oncology found that cancer patients who declared bankruptcy were significantly more likely to die than those who did not need to ask the courts to discharge their debts. The reasons for the increased mortality are unclear: It’s possible people with shaky finances are less likely to receive adequate treatment, but it’s also possible stress is a contributor.

Many believe the 2003 passage of Medicare Part D, which established coverage for pharmaceutical costs, is partially responsible for the price surge. The same legislation allowed for non-profit patient-advocacy groups to establish co-pay funds that could be funded by the pharmaceutical industry. (The CancerCare Co-Payment Foundation was established in 2007, for example.) These co-pay funds are meant by the organizations offering them to help people, but critics maintain the pharmaceutical-company contributions to organizations like CancerCare and others like it should be viewed less as charity and more as cover for the ever-increasing cost of their medications, since these donations allow pharmaceutical companies to stick insurance companies and government programs like Medicare with an ever-greater bill, while helping the consumers cover their share of the tab. “Co-pay programs are meant to mitigate criticism of high drug prices, deflect legislation on drug pricing, get around payer restrictions and get patients on expensive drugs they will stay on for a long time,” says Adriane Fugh-Berman, an associate professor at Georgetown University Medical Center and an expert on physician-industry relationships.

 

The amount of money is also not enough. The phrase “drop in a bucket” barely does it justice. When CancerCare opened a $1.6 million fund for the co-payment of multiple myeloma medications this past April, it was exhausted within two days, Goldsmith told me. “I guarantee you tomorrow if for some reason we got $500 million tomorrow to support co-pay assistance, we could distribute that money likely within two months,” she said. But it is, she points out, better than not distributing the money at all. “I can tell you that that amount of money often makes the difference between people being able to get their treatment and not get their treatment.”  

This is hardly unique to CancerCare. Alan Balch, the chief executive officer of the Patient Advocate Foundation, which provides both case-management services and administers co-pay funds for a range of diseases and distributed more than $50 million in assistance in the fiscal year that ended in June of 2016, tells me that while some co-pay funds remain open for a considerable period of time, others open and close quickly. “There’s only so much money that is available at any one time and there’s so much demand for it,” he says.

The evidence is clear when you visit the websites of the funds. The Patient Advocate Foundation’s chronic pain fund? Its aid is limited to $1,500 and you need to apply when it’s taking applications. “Effective 01/18/2017, we are unable to process applications that are pending or accept new or renewal applications at this time. Should additional funding for Chronic Pain Fund applicants become available in the future, it will be necessary to re-apply if assistance is still needed.” The Patient Advocate Foundation’s multiple-sclerosis and renal-cell-carcinoma funds have been closed to new applicants since 2016. It helps to have a more popular disease: Everyone I interviewed told me it was a lot easier to find funds to assist sufferers of, say, breast cancer, than it was an unusual malignant tumor. “The rarer the cancer, the less likely there will be funding for that cancer,” said William Goeren of CancerCare.

 

For patients, this can seem like an elaborate, never-ending maze—and there is no central clearinghouse for the information. The Leukemia & Lymphoma Society’s Co-Pay Assistance Program will cover blood transfusions, chemotherapy, and radiation therapy, among other things, but not diagnostic procedures like surgery or lab work. United Way offerings vary by locality. Still others, like the Pendergast Fund, are targeted to small populations and can fly under the raadar. The hospital where Cassidy McCarthy received her treatments, for example, did not inform the family about the Heather Pendergast Fund, but the organization’s work is well known in Long Island’s firefighting community. “The chief of the fire department came to me and goes, ‘Well, there’s this Pendergast Fund so any bills you have, just give them to me,’” McCarthy recalled.

And even when medical supplicants find programs, they are not guaranteed aid even if they meet all the eligibility requirements. Amanda Collins, 36, is a Bartlesville, Oklahoma, resident who found herself financially scrambling after first her husband and then herself suffered a succession of medical crises. When the family finally obtained health insurance through Sooner Care—that’s Medicaid in Oklahoma—they were also given a list of local charities that could help out those in need.  She says she learned to call any organization, whether they were  offering aid with medical expenses or electric bills, mighty quick. “Then you call these services, not just for medical help, but any help. They tell you, ‘Oh, you have to hit us on this date,’ or ‘We get funding every month, but our funding is gone by the fifth of the month.’”

 

But for many who do receive monetary aid in the face of a medically induced financial crisis, it helps them, but it doesn’t make their money woes go away. The American Kidney Fund, yet another patient-advocacy fund, put me in touch with Lori Noyes, a 55-year-old nurse living in Upland, California, with her two cocker spaniels, Kirby and Tucker. Noyes’ financial life all but collapsed when a donated kidney she received in childhood failed in early 2014. Her out-of-pocket cost for prescription co-pays was running about $200 a month. Every medical appointment resulted in more bills. “Each little doctor would take a swipe at you,” she told me. Credit-card bills mounted.

Noyes, too, found herself struggling to navigate the charities that could potentially help. When she suffered vision loss following her kidney transplant and could no longer drive, it wasn’t anyone at a medical office who informed her of the Service Center for Independent Life, a Claremont, California based organization that helps people with disabilities with everything from transportation to employment assistance. A sympathetic Uber driver told her about the program. Finally, a financial counselor at the DaVita kidney-care location where she received dialysis suggested she reach out to the American Kidney Fund, which offered Noyes help paying her health-insurance bill and Medicare Part D premium. (All end-stage renal-failure patients are eligible for Medicare.) “It gave me wiggle room,” she says.

 

But that still left Noyes with a lot of bills. Even with the help of the American Kidney Fund, Noyes claimed about $22,000 in medical expenses on her taxes in 2014 and $19,000 in 2015, which included everything from dressing supplies and over-the-counter medications to travel expenses to and from the transplant center where she ultimately received a donated kidney. There are few—if any—charitable organizations willing or able to hand out this amount of assistance.

As for hospital-based charity, it can vary widely. Most studies find for-profit hospitals provide less charity care than nonprofit medical centers. But getting aid from a non-profit hospital isn’t exactly a gimme. A paper published by the Brookings Institution in 2015 pointed out that the non-profit hospitals with the most funds that could be devoted to charity care—that is, covering or forgiving medical bills of those who cannot pay full—are not located in the geographic areas where the need is greatest. The higher the wealth in a particular region, the more money a hospital is likely to have for indigent or needy patients. But those patients who need financial assistance are likely to live in lower-income areas where there is less in the way of resources. The paper uses two hospitals in Connecticut’s Fairfield County to make the point. The facility located in the high-income New York City suburb of Greenwich offers assistance to people with higher incomes than one located in Norwalk, a less wealthy town located a mere 15 miles away. But despite the lower ceiling, a much higher percentage of the Norwalk hospital’s bad-debt cases turned out to meet the eligibility guidelines for charity care.  

 

Moreover, in the wake of the Affordable Care Act, a number of nonprofit hospitals actually lowered the eligibility ceiling for charity assistance, thinking that such a change would encourage more people to sign up for health insurance. (For example, BJC Healthcare, headquartered in St. Louis, now only offers aid to people with household incomes of 300 percent of the federal poverty line, compared to 400 percent previously.) But because of the increasingly high deductibles, even people who didn’t meet the threshold for aid under the older, more generous standards are now experiencing financial grief as a result of medical bills. In an effort to cut down on uncollectable bills, a number of hospitals are now teaming up with financial services firms like Commerce Bank to offer time-limited interest free loans to patients something that, while helpful to some, most certainly is not charity.

“Our health-care system is shit and it’s trending shittier.”

When I catch up with Savannah Dray—she calls me from her car, on the way back to her Tallahassee apartment from a chemotherapy session—she begins rattling off her debt. “I have all kinds of medical bills. I have pathology bills. I have radiology bills. I have oral surgeon bills because the disease eroded parts of my teeth and broke them off. Now I have a regular dental as well as an oral surgeon bill. I have bills from my CT scans, which I guess would fall under radiology. I have surgery bills.” Dray, 22, was diagnosed earlier this year with stage-three colon cancer. How much does she owe overall? She can’t tell me. The bills are coming in by the day, and have been pretty much since the January day she doubled over with pain, and went to a nearby emergency room. But it’s definitely more than $10,000. She met her own $6,250 deductible, and then switched over to her husband’s plan when she left work as an assistant manager for a chain store. She now needs to meet that $6,250 deductible too.

A financial counselor at her oncologist’s office told Dray about CancerCare, as well as programs available from the American Cancer Society and Stupid Cancer, an advocacy and aid group for young adults fighting malignancies. But Dray says she was initially so overwhelmed by her illness and all the bills, she didn’t have the energy to reach out. For Dray, crowdfunding was a more familiar process, so she went with that. Only after she raised $4,712 toward a $30,000 goal on a page she set up at GoFundMe did she send an application in to CancerCare for financial assistance.

 

Little wonder, then, that an increasing number of patients turn to crowdfunding even before they investigate more established charitable giving programs. While turning to friends and family and holding fundraisers for medical bills has almost certainly been with us as long as people have paid for assistance when ill, turning to the Internet to plead for help with medical expenses is less than ten years old. Yet it has become all but ubiquitous, seemingly the first thing many people think to do when confronted by a medical crisis or tragedy.  Last year’s Orlando nightclub shootings inspired numerous crowdsharing efforts for everything from survivors medical bills to help for families paying funeral expenses. The same thing happened this year, when two men were killed and another injured by a man shouting anti-Muslim sentiments at a woman wearing a hijab in Portland, Oregon.*

Recommending patients experiencing trouble with their bills give crowdfunding a try has turned into all but a personal-finance trope. “Do you need money for unexpected medical and long-term-care expenses, funeral costs, or a local charitable endeavor? Maybe it’s time to turn to one of the growing number of personal ‘crowdfunding’ sites and ask the public for small donations,” chirped Kiplinger’s last fall. Newspaper articles about successful campaigns are a staple of what remains of the local press and heartwarming articles about the practice abound.

 

The truth is more than a bit darker. A few years ago, Ethan Austin, the co-founder of Give Forward (which recently merged with YouCaring, another crowdfunding site), one of the first sites to realize that crowdfunding could be as useful for people facing medical bills as those seeking to fund an independent film or fund a business venture, spoke to a group of students at New York University’s Stern School of Business about his site. He was blunt about one of the reasons he believed this segment of the online fundraising world had taken off so dramatically. “Our health-care system is shit and it’s trending shittier,” he told the group.  Last year, Nerdwallet broke down the numbers and discovered that just under 50 percent of the money raised by GoFundMe campaigns is somehow related to healthcare. There’s likely a measure of nowhere-else-to-turn desperation involved: A study published earlier this year by Lauren Berliner and Nora Kenworthy, both on faculty at the University of Washington Bothell, found that residents of states that didn’t take advantage of the Affordable Care Act to offer more residents access to Medicaid were over-represented on crowdfunding sites.  

Yet for all the attention paid to crowdfunding, the limited evidence we have shows that for most people, the hype is better than the actual results. A 2015 analysis by Nerdwallet found only 11 percent of healthcare fundraisers on Fundrazr, GiveForward, GoFundMe, Plumfund, and Red Basket met the organizer’s financial target. Berliner and Kenworthy, who studied a random selection of 200 campaigns on GoFundMe, found a very similar result. Nine in 10 were never funded in full.

 

According to Berliner and Kenworthy, most campaigns don’t go viral. Instead, they stay among the ill person’s existing social networks. “There seems to be some allure about what campaigns can do that exceeds what we are seeing they can do,” says Berliner. “It’s probably unlikely that you have some billionaires in your mix who are just looking to swoop in,” adds Kenworthy.

In the healthcare community, some experts are increasingly down on the concept. “We don’t recommend it routinely,” says Anne Bailey, a vice president for patient support at DaVita, the chain of dialysis centers where Noyes received treatment. In her view, crowdfunding works best for a one-time emergency, not a medical issue that will potentially go on for years. “That’s just not an acceptable solution for a long-term chronic medical issue.” For the 5 percent of people with the largest medical bills, crowdfunding is unlikely to come through, or least to come through in a way that solves the financial problem in the long term.

Nonetheless, it’s also true that every little bit helps. If Dray’s campaign hasn’t met her hoped-for expectations, it’s far from useless. She’s already been able to use some of the money to pay for oral surgery, not to mention to make a co-payment for a cardiologist. If not for the GoFundMe and an account on Instagram where she sells her art, she tells me, she’s not sure she could handle her medical bills, keep a roof over her head, and food in the kitchen.

 

***

I spoke with numerous people for this piece who told me that at some point, after all the fundraising, and asking for aid for organizations, and cleaning out of retirement and savings accounts, they simply put all their remaining bills on a credit card, and hoped for the best. They simply couldn’t take the constant barrage of mail from numerous separate medical providers and facilities.

For many, the financial turmoil caused by their illness already adds to the emotional and physical turmoil they are already experiencing. “Many people call us, and I am speaking anecdotally and they are angry. They say I’ve been working my whole life, I’ve paid my taxes, I’ve been diligent, but now I’m being slammed, I have to ask for charity ... There’s shame and anger in that,” says Richard Dickens, CancerCare’s director of client advocacy.  

But there is more than simple embarrassment arguing against this system. It’s the equivalent of taping a few bandages over a gaping wound and hoping for the best. The cost of medical care is so high, and the personal finances of many Americans so tight,  it’s all but impossible for any organization—or all of them—to keep up, and that’s whether or not the charitable contributions they accept are part of the problem or the solution. And this is now. Should Republicans succeed in their effort to repeal the Affordable Care Act, an estimated 23 million people would lose health-insurance coverage over the next decade. That would almost certainly put even more pressure on the charitable resources available to help those in need pay for medical care.  

Yet illness exists in the here and now. People need the money, so we open our wallets and we give what we can, feeling a little good about doing our part. And it does help some: As CancerCare’s Patricia Goldsmith puts it, “I can tell you that that amount of money often makes the difference between people being able to get their treatment, and not get their treatment.”

As for Cassidy McCarthy, she received what the family hopes was her last dose of chemotherapy on May 22. Both she and a brother will be attending a summer camp for children with cancer and their siblings that’s offered free of charge. Daniel McCarthy has a new job, and no longer needs assistance with his insurance premium. When a recent $45 blood-work lab bill recently arrived, the family didn’t forward it to Pendergast. They paid it themselves. “Some other people might need the money,” McCarthy said. If the family is lucky, they’re heading toward the best approach to avoiding big medical bills in the future: good health.


* This article originally stated the location of the attack as Portland, Maine. We regret the error.

HELAINE OLEN is a writer living in New York. She is the author of Pound Foolish and the co-author of The Index Card."
 
Also Trump got caught lying again, big shock.
"

AP FACT CHECK: No, Trump didn’t save preexisting conditions

By HOPE YENJanuary 13, 2020

WASHINGTON (AP) — President Donald Trump made a striking claim Monday, insisting it was he who ensured that people with preexisting medical problems will always be covered by health insurance.

He wasn’t.

He also complained anew that Democrats didn’t allow him to send lawyers to the impeachment inquiry. The opposite is true: Democrats invited him to send lawyers to the inquiry and he said no.

HEALTH CARE

TRUMP: “I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate.” — tweet.

TRUMP: “I stand stronger than anyone in protecting your Healthcare with Pre-Existing Conditions. I am honored to have terminated the very unfair, costly and unpopular individual mandate for you!”

THE FACTS: People with preexisting medical problems have health insurance protections because of President Barack Obama’s health care law, which Trump is trying to dismantle.

 

One of Trump’s major alternatives to Obama’s law — short-term health insurance, already in place — doesn’t have to cover preexisting conditions. Another major alternative is association health plans, which are oriented to small businesses and sole proprietors and do cover preexisting conditions.

Neither of the two alternatives appears to have made much difference in the market.

Meanwhile, Trump’s administration has been pressing in court for full repeal of the Obama-era law, including provisions that protect people with preexisting conditions from health insurance discrimination.

With “Obamacare” still in place, preexisting conditions continue to be covered by regular individual health insurance plans.

Insurers must take all applicants, regardless of medical history, and charge the same standard premiums to healthy people and those who are in poor health, or have a history of medical problems.

Before the Affordable Care Act, any insurer could deny coverage — or charge more — to anyone with a preexisting condition who was seeking to buy an individual policy.

___

TRUMP: “...and, if Republicans win in court and take back the House of Represenatives (sic), your healthcare, that I have now brought to the best place in many years, will become the best ever, by far. I will always protect your Pre-Existing Conditions, the Dems will not!” — tweet.

THE FACTS: Trump and other Republicans say they’ll have a plan to preserve protections for people with preexisting conditions. The White House has provided no details."

https://apnews.com/ce8b02c23096381739418e48fee5c6e1

 

 
 
 
 

 

 

 

 

 


L*t is a loser

 

My adapt a Bill is Brandon Beane.

 

1065198188.jpg.0.jpg

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6 minutes ago, f8ta1ity54 said:

He hasnt heard a different answer on fox yet.

I would be good to have independent thinking skills and critical thinking skills and not blindly believe everything said by the republican propaganda news network.


L*t is a loser

 

My adapt a Bill is Brandon Beane.

 

1065198188.jpg.0.jpg

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1 hour ago, junglesouljah said:

Even if you have a job, what happens when you get a life threatening disease or injury and your insurance company denies paying for health care dispute you paying for insurance premium for years

I'm voting for Bernie so you can chill out with the walls of text.  :niterider:

 


process.jpg

 

Fuck this team

I'll tie a frying pan to my ass so you hurt your penis, you ****ing homo!

Shut the fuck up dark cloud pussy

Anyone who is foolish enough to not be a Buffalo Bills fan can go f*ck themselves with a wooden shovel handle.

image-trump-emoticon.png

also, all that shit in your signature is beyond annoying. just like you.

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2 hours ago, HipKat said:

Anyone that still supports Trump has 2 choices; get deported or stand in front of a firing squad

You are mentally ill my friend

I hope you get the help you need. I really do

  • Thanks 1

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5 minutes ago, HappyWolverine said:

You are mentally ill my friend

I hope you get the help you need. I really do

I would love to see him lead that charge of deportation and firing squad with a bunch of Nancy’s who hate guns. But if big government is what they want it might be what they get.


Racism is evil, and those who cause violence in its name are criminals and thugs, including the KKK, neo-Nazis, white supremacists, and other hate groups that are repugnant to everything we hold dear as Americans.

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2 hours ago, Thebowflexbody said:

LOL.  If Bernie somehow wins he "won't be my President".  See, I'll act like all the dickish libs who say that about Trump.  I was never such an asshole that I ever said Obongo wasn't my President.  But if socialist Bernie wins, I will.  All decorum has gone out the window.  The behavior by the left these last three years is officially a game changer for many.  Me included.

Maybe we can even start the impeachment proceedings January 2021 after all of our riots in December.

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2 hours ago, junglesouljah said:

The "socialized" health care system cost less then the current private health care system that makes Pharmaceutical and Insurance companies rich. Why do you want to make insurance and Pharmaceutical companies rich?

"

Growing up in Canada I never thought much about the healthcare system. When I moved to the US for graduate school, I knew it was strange to not have universal healthcare, but I had a comprehensive health insurance plan from school, so healthcare wasn't an ever-present issue on my mind. 

That changed six months ago, when I started writing about healthcare as a fellow for Business Insider and needed to choose a plan for the first time. 

As a Canadian reporting on US healthcare, I've gained insight into the complicated and often misunderstood debate in the US over single-payer healthcare, and I think I have some of my own insights to offer.

It's true that in Canada, every person has healthcare coverage. But not all costs are covered by the government — private or employer-based insurance pays for dental visits, eye care and prescription drugs. 

Yes, Canada has private insurance.

As Medicare for All takes center stage in the 2020 Democratic presidential debates, Canada is often used as an example for what the US could be with a single-payer system. Prescription medications at a fraction of the price. No surprise billings. An ambulance ride that won't cost you thousands of dollars. Access to providers at all times. It sounds utopian. 

But even Canada's healthcare system is not as socialized as some other systems. In the UK, the government finances healthcare and has the National Health Service (NHS) providing health services that are essentially free to citizens. The British system is even more socialized than Canada's.

Since my arrival to the US, I have encountered certain misconceptions about the Canadian healthcare system that I would like to dispel.

clarrie feinstein photo

Clarrie Feinstein, Business Insider's healthcare fellow  Clarrie Feinstein

Canadian healthcare isn't free 

In general, Canadians pay higher taxes for the country's social safety net, which includes healthcare. In the US, a significant misconception is that people think Canadian healthcare is free. 

But it's paid largely by Canadian tax dollars. While there isn't a designated "healthcare tax," the latest data from the Canadian Institute for Health Information (CIHI) in 2017 found that on average a Canadian spends $6,604 in taxes for healthcare coverage. It's important to note that number changes depending on income. People with higher incomes pay higher taxes, which ends up covering families who earn less.

This is considered to be on the higher end for what other advanced economies pay, like the UK or Australia. Americans, though, spend more than $10,000 per person on healthcare in total, on average.

Even though Canadians pay higher taxes, it ensures that the majority of health services are covered. This includes hospital stays, surgical and maternity services (childbirth, prenatal, postnatal and newborn care), and prescription drugs while in the hospital.

There are also no bills attached to seeing a physician or healthcare provider for primary care or clinic visits. And because health insurance is public, there are also no deductibles — the amount a person pays before insurance kicks in.

Canadians have private insurance options

In Canada certain medical expenses are not covered, like dental care, vision care, prescription medication, podiatry and chiropractics. 

Often, employers offer supplemental private health insurance to their employees to cover some of the expenses that are not covered under the public healthcare plan.

An area of contention in Canadian healthcare is prescription drug costs — surprising considering the constant coverage in the US, which often favorably compares Canadian drug costs to American. 

Earlier this year, 2020 Democratic presidential candidate Bernie Sanders went to Canada to show the inflated cost of insulin for diabetes patients, who can pay up to $300 for a vial of insulin in the US, compared to $30 in Canada. 

Soaring drug prices in the US have become a major point to address in the national healthcare debate. In the US, pharmaceutical companies face little regulation over their prices, compared to Canada, contributing to high drug costs.

Canada's biggest healthcare debate: pharmacare 

Prescription drugs are cheaper in Canada because the government plays a big role in setting their prices.

But a similar battle over drug costs is taking place in Canada. A major issue in the 2019 Canadian federal election was pharmacare, a system which allows the government to help pay for Canadians' prescription drugs. 

Pharmacare is still an undefined concept. It could mean that people who do not have private insurance options through work for prescription drug costs would then have costs covered by the government. Or the government could heavily subsidize the cost for all Canadians, Global News reported.

Recently, the Canadian government announced regulation to reduce patented drug prices which reportedly would save Canadians C$13.2 billion (US$10 billion) over a decade. The move was done with significant opposition from pharmaceutical companies, but is an example of regulating drug costs of drugmakers in Canada, the Guardian reported

Universal healthcare is deeply engrained in Canada's ethos

The idea of universal healthcare—that every citizen has access to healthcare—is a Canadian ethos that is deeply ingrained in the sociopolitical landscape of the country. 

The private healthcare sector in the US allows for more medical innovation, but the high costs and uneven access to care contribute to the country's socioeconomic divides.  

While there are some misconceptions in the US on what Canadian healthcare is and what it covers, there is the basic idea that if one is unemployed or does not make a certain income they will have healthcare coverage. That notion is now at the forefront in America with the Medicare for All debate. "

https://www.businessinsider.com/american-misconceptions-about-canadian-healthcare-2019-11

Thanks, quite an informative knowledeable writing not misrepresenting key points. You'd never make it in the political world.

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1 hour ago, junglesouljah said:

I would be good to have independent thinking skills and critical thinking skills and not blindly believe everything said by the republican propaganda news network.

The same can be said of the majority of the news media you & Hipkat follow and believe.

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2 hours ago, HipKat said:

I'll put my education up against yours any day. You couldn't begin to imagine the things I've done, seen and learned. Things your paltry little ass would run away from. Seriously, what the FUCK have you ever done? 

Well he has stuck his head up #drumpfs ass and is still breathing. So there is that...

 

What have you done?

  • Haha 1

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7 hours ago, Sucked In Again said:

The same can be said of the majority of the news media you & Hipkat follow and believe.

Uh huh, You got most of that line right except you left out the part about how you don't watch Fox News....


“There he goes. One of God's own prototypes.

A high-powered mutant of some kind, never even considered for mass production.

Too weird to live, and too rare to die.”

 

Twitter: @HKTheResistance

 

HipKat, on *** other h***, is genuine, unapoli***tically nasty, and w**** his hea** on his ******. jc856

I’ll just forward them to Bridgett. comssvet11

Seek help. soflabillsfan

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8 hours ago, HappyWolverine said:

You are mentally ill my friend

I hope you get the help you need. I really do

I'm not the one that supports a lying piece of shit, divisive, oompa loompa pretending to be a President

  • Like 1

“There he goes. One of God's own prototypes.

A high-powered mutant of some kind, never even considered for mass production.

Too weird to live, and too rare to die.”

 

Twitter: @HKTheResistance

 

HipKat, on *** other h***, is genuine, unapoli***tically nasty, and w**** his hea** on his ******. jc856

I’ll just forward them to Bridgett. comssvet11

Seek help. soflabillsfan

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11 hours ago, HipKat said:

I'll put my education up against yours any day. You couldn't begin to imagine the things I've done, seen and learned. Things your paltry little ass would run away from. Seriously, what the FUCK have you ever done? 

Ha!  More than you, my friend.  I'm quite well-rounded.  :classic_wink:

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2 minutes ago, Thebowflexbody said:

Ha!  More than you, my friend.  I'm quite well-rounded.  :classic_wink:

Yeah, OK, Hud......


“There he goes. One of God's own prototypes.

A high-powered mutant of some kind, never even considered for mass production.

Too weird to live, and too rare to die.”

 

Twitter: @HKTheResistance

 

HipKat, on *** other h***, is genuine, unapoli***tically nasty, and w**** his hea** on his ******. jc856

I’ll just forward them to Bridgett. comssvet11

Seek help. soflabillsfan

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11 hours ago, junglesouljah said:

Even if you have a job, what happens when you get a life threatening disease or injury and your insurance company denies paying for health care dispute you paying for insurance premium for years?

"

Insurance companies aren’t doctors. So why do we keep letting them practice medicine?

(iStock) (Minerva Studio/iStock) (iStock) (Minerva Studio/iStock)

By William E. Bennett Jr. 
Oct. 22, 2019 at 8:00 a.m. EDT

William E. Bennett Jr. is an associate professor of pediatrics at the Indiana University School of Medicine.

We know how important it is to have insurance so that we can get health care. As a physician, parent and patient, I cannot overemphasize that having insurance is not enough.

As a gastroenterologist, I often prescribe expensive medications or tests for my patients. But for insurance companies to cover those treatments, I must submit a “prior authorization” to the companies, and it can take days or weeks to hear back. If the insurance company denies coverage, which occurs frequently, I have the option of setting up a special type of physician-to-physician appeal called a “peer-to-peer.”

 

Here’s the thing: After a few minutes of pleasant chat with a doctor or pharmacist working for the insurance company, they almost always approve coverage and give me an approval number. There’s almost never a back-and-forth discussion; it’s just me saying a few key words to make sure the denial is reversed.

AD

Because it ends up with the desired outcome, you might think this is reasonable. It’s not. On most occasions the “peer” reviewer is unqualified to make an assessment about the specific services. They usually have minimal or incorrect information about the patient. Not one has examined or spoken with the patient, as I have. None of them have a long-term relationship with the patient and family, as I have.

The insurance company will say this system makes sure patients get the right medications. It doesn’t. It exists so that many patients will fail to get the medications they need.

 

I’ve dealt with this system from the patient side, as well. My daughter has a rare genetic disorder called Phelan-McDermid Syndrome, which causes developmental delay, seizures, heart defects, kidney defects, autism and a laundry list of other problems. She receives applied behavior analysis therapy, an approach often used for autism, and which has been wildly successful in improving her skills and communication. But recently, our health insurer reduced the amount of therapy they thought she needed.

AD

While I know what levers to pull from the physician side, a patient’s options are completely unclear. I probably have better access than almost anyone else can get, yet the ability of my daughter’s providers to mitigate denials for services they deem appropriate is slow and often ineffective.

My daughter can languish for months or years not receiving care that every highly qualified person who treats her agrees she needs. While we wait, the window to give her a little bit more function, a little bit less suffering and a little better life gets smaller.

 

Consumers have a right to appeal denials for health-care services, but regulations still largely focus on the process, not the content. For instance, insurers are required to notify you in writing of a denial, and patients have the right to an internal appeal; if that fails, some states also allow for an external review.

AD

This sounds good, as most denials are related to specific provider choice or contractual issues, which are relatively easy to remedy (but a problem nonetheless). But other denials are a judgment of some test or treatment as “not medically necessary.”

Insurance companies know that many patients don’t bother to appeal at all. A smaller fraction ask for an internal review, and still fewer seek or even know about external review options available in most states. Of the cases that do end up under external review, almost a third of all insurer denials are overturned. This is clear proof that whatever process insurers have to determine medical necessity is often not in line with medical opinion. A study of emergency room visits found that when one insurance company denied visits as being “not emergencies,” more than 85 percent of them met a “prudent layperson” standard for coverage.

 

Some might argue that it makes sense to have two doctors discuss a case and then come to a consensus on the most cost-effective approach for an individual. That’s not what is happening. This is a system that saves insurance companies money by reflexively denying medical care that has been determined necessary by a physician. And it should come as no surprise that denials have a disproportionate effect on vulnerable patient populations, such as sexual-minority youths and cancer patients.

AD

We can do better. If physicians order too many expensive tests or drugs, there are better ways to improve their performance and practice, such as quality-improvement initiatives through electronic medical records.

When an insurance company reflexively denies care and then makes it difficult to appeal that denial, it is making health-care decisions for patients. In other words, insurance officials are practicing medicine without accepting the professional, personal or legal liability that comes with the territory.

 

We don’t have to put up with this. Health care in the United States is shockingly opaque; it’s time to take insurance companies out of our decision-making process."

https://www.washingtonpost.com/opinions/2019/10/22/insurance-companies-arent-doctors-so-why-do-we-keep-letting-them-practice-medicine/

"

Even the Insured Often Can't Afford Their Medical Bills

The debate over the future of healthcare is obscuring a more pedestrian reality: Insurance may handle most costs, but many Americans still need to turn to charity for help when they get sick.

1920.jpg?1497639457
Elaina Natario / Katie Martin / The Atlantic
 
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Like The Atlantic? Subscribe to The Atlantic Daily, our free weekday email newsletter.

 

A chance trip to Long Island’s Adventureland amusement park just might have saved Cassidy McCarthy’s life. After Cassidy—whose family calls her Cassie—then 4, complained about pain and nausea following a ride on the Ladybug rollercoaster, her dad, Daniel, a registered nurse, felt her stomach and discovered a small bump. A CT scan ordered up at a local hospital’s emergency room revealed a kidney tumor.

It was another seemingly chance decision by Daniel McCarthy to sign on as a volunteer firefighter more than a decade ago that saved the family’s finances in the wake of Cassidy’s diagnosis with cancer. As it turned out, that activity allowed him to ask The Heather Pendergast Fund, a foundation set up in 2009 to help out the families of Long Island’s volunteer firefighters and EMS workers with their children’s medical expenses, to pay many of Cassidy’s medical bills.

McCarthy says the charitable foundation was a financial lifeline. Cassidy quickly racked up more than several thousand dollars in out-of-pocket medical expenses—for the surgeon, the anesthesiologist, radiologists, chemotherapy, you name it—since the family’s insurance policy had a $6,000 deductible. A few months later, Pendergast came through again when McCarthy lost his job at a local nursing home and rehabilitative center and the family suddenly had to find money for COBRA payments, which, at $2,100 a month, were more than the monthly mortgage payment on their West Babylon, Long Island, home.

The Platinum Patients
Each year, one in every 20 Americans racks up just as much in medical bills as another 19 combined. This critical 5 percent of the U.S. population is key to solving the nation's health-care spending crisis.
Read more

“I don’t know how people who don’t have resources do this. I don’t. Many people work three, four jobs, and can’t afford the time to volunteer in an organization like the fire department that would be able to help them. There are many people living out there that need help that can’t find it,” McCarthy says.

The current debate over the future of the Affordable Care Act is obscuring a more pedestrian reality. Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills. The point of insurance is to protect patients’ finances from the costs of everything from hospitalizations to prescription drugs, but out-of-pocket spending for people even with employer-provided health insurance has increased by more than 50 percent since 2010, according to human resources consultant Aon Hewitt. The Kaiser Family Foundation reports that in 2016, half of all insurance policy-holders faced a deductible, the amount people need to pay on their own before their insurance kicks in, of at least $1,000. For people who buy their insurance via one of the Affordable Care Act’s exchanges, that figure will be higher still: Almost 90 percent have deductibles of $1,300 for an individual or $2,600 for a family.

 

Even a gold-plated insurance plan with a low deductible and generous reimbursements often has its holes. Many people have separate—and often hard-to-understand—in-network and out-of-network deductibles, or lack out-of-network coverage altogether.  Expensive pharmaceuticals are increasingly likely to require a significantly higher co-pay or not be covered at all. While many plans cap out-of-pocket spending, that cap can often be quite high—in 2017, it’s $14,300 for a family plan purchased on the ACA exchanges, for example. Depending on the plan, medical care received from a provider not participating in a particular insurer’s network might not count toward any deductible or cap at all.

At the same time, the most recent Report on the Economic Well-Being of U.S. Households, an annual survey conducted by the Federal Reserve Board, found that 44 percent of adult Americans claim they could not come up with $400 in an emergency without turning to credit cards, family and friends, or selling off possessions. When this reality combines with healthcare bills, the consequences can be financially devastating.  A 2015 poll by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health discovered that 26 percent of those who took part in the survey claimed medical bills caused severe damage to their household’s bottom line. A poll conducted earlier this year by Amino, a healthcare-transparency company, with Ipsos Public Affairs, found that 55 percent of those they surveyed claimed they had at least once received a medical bill they could not afford. No surprise, then, that the Consumer Financial Protection Bureau reported earlier this year that medical debt was the most common reason for someone to be contacted by a debt collector.

 

This spending is most pressing for households with the highest medical bills, the 5 percent of Americans who make up 50 percent of the country’s healthcare costs. Medicare, Medicaid, and private insurers will spend $40,375 on average per patient for someone in this group. Their out-of-pocket spending will be much less: on average, $2,582.90. This isn’t, in the scale of things, a lot of money—but given Americans’ straightened personal finances, it’s more than many can easily access.  

This isn’t, it’s important to point out, a static group. A chronic illness can land someone in this category but, given the increasing prevalence of high-deductible plans, so can something as simple as a broken bone or an emergency appendectomy. Although some people will be in this group year after year, many will cycle in and out, and nearly everyone will be in it for some brief period. The fact is that nearly any illness or injury can lead to unexpected bills, and few are able to absorb those shocks without difficulty. Yet, despite the commonness of such problems, there is little in the way of a system for helping people out through these times.

“Do I pay the doctor bill because I’m getting collection notices? But I gotta pay my mortgage, I gotta pay my electric bill, I’ve gotta pay the rent.”

Some of these people will declare bankruptcy. How many is the subject of controversy. A famous study—co-authored by Elizabeth Warren—found that suffering from a medical misfortune was the most common reason for ultimately leading someone to petition the courts for relief from their financial obligations, but another study pointed to unnecessary spending prior to the medical crisis.

As it turns out, determining what counts as a medical expense is difficult. It’s not simply doctor bills. In addition to the not-covered deductibles, there is transportation to and from medical appointments, parking fees at many hospitals, and often childcare expenses while parents are in treatment or at appointments. Time for cooking will be limited, so take-out bills can pile up, too.  

 

And families that experience an illness are often hit by a double whammy—they lose income at the same time their financial needs grow, often cutting back on work hours or leaving work altogether, either voluntarily or not. McCarthy, for one, recently filed a lawsuit against his former employer, Daleview Care Center in Farmingdale, Long Island, claiming he was let go because of the amount of work he missed as result of his daughter’s illness, a violation of several laws including the Family Medical and Leave Act. In legal filings, Daleview denied McCarthy’s allegations, but the company did not return requests for comment.

“The families get to the point where it’s, ‘What do I do? Do I pay the doctor bill because I’m getting collection notices? But I gotta pay my mortgage, I gotta pay my electric bill, I’ve gotta pay the rent.’ That’s where we come in,” Tom Pendergast of the Heather Pendergast Fund told me. “They can pay their mortgage, their rent, their electric bills and not have to worry about the medical part of it.”

For many, the idea of charity to help those in need out—which is, after all, what saved the McCarthy family from financial disaster—holds much in the way of appeal, speaking to both a sense of generosity and a can-do spirit. It somehow seems, well, American, to think individual donations can compensate for a broken, expensive system that views illness as a moneymaking opportunity. So there is crowdfunding, small foundations like the Pendergast Fund, hospital-charity programs for the needy, and disease-specific resources. These efforts are patchy, and often inadequate, but they’re what’s available. Their strengths and their failings reveal a lot about the broader American healthcare system—something that is all too easy to ignore till it is your life or the life of a loved one at stake.

 

***

CancerCare was founded in 1944 as a bereavement-support organization, but quickly began helping people with the disease manage their financial issues as well. “The first hospital bill we paid, in 1944, was to Memorial Sloan Kettering for $13 and change,” said Patricia Goldsmith, the organization’s chief executive officer. Today, finances are why between 60 and 70 percent of those who contact the organization reach out, and the dilemmas are the same as those people who turn to The Heather Pendergast Fund face.  “For the most part, people call us because they are in some kind of financial crisis,” says William Goeren, CancerCare’s director of clinical programs. “The prices have increased ... so that really puts the burden on the patient, who is weighing, ‘Do I pay for my mortgage or should I pay for my diagnostic test?’ These are the calls we are getting.”

CancerCare attempts to head off these sorts of financial issues, while still offering emotional support to people in need. They offer a bereavement camp—located in Pennsylvania’s Poconos—and counseling groups for cancer sufferers and their children alike. They also distribute more than $4 million in transportation, home-care, and childcare assistance.  

“If for some reason we got $500 million tomorrow to support co-pay assistance, we could distribute that money likely within two months.”

But the heart of CancerCare’s aid is distributed through their disease-specific prescription co-pay funds, which award anywhere between $4,000 and $15,000 per patient to income-eligible patients. (“Income eligible” varies based on the fund, but is generally anywhere between 250 and 500 percent of the federal poverty line.) Last year, the organization distributed slightly more than $14.2 million in total.

Such funds are not without controversy. The cost of treating cancer, a disease that will be newly diagnosed in just under 1.7 million Americans in 2017, is skyrocketing. According to research published in the Journal of Oncology Practice, the average cost of a year of a cancer treatment drug in 2000 was less than $10,000 in total. By 2005, that had more than tripled to between $30,000 to $50,000 annually. In 2012, 12 out of the 13 drugs newly approved for cancer cost more than $100,000. Another study, this one published in JAMA Oncology, found the price of one month of an oral-cancer medication increased from $1,869 in 2000 to $11,325 in 2014. As insurance companies, desperate to clamp down on their own expenses, cut reimbursements for the more expensive drugs, and employers, hoping to cut their own costs, push employees into high-deductible health-insurance plans, more of this cost ends up being picked up by the patients.

 

A paper published by the journal Health Affairs in 2013 found cancer patients are more than twice as likely as their peers without the disease to declare bankruptcy. The consequences of this expense goes beyond the patient’s checkbook: Last year researchers writing for the Journal of Clinical Oncology found that cancer patients who declared bankruptcy were significantly more likely to die than those who did not need to ask the courts to discharge their debts. The reasons for the increased mortality are unclear: It’s possible people with shaky finances are less likely to receive adequate treatment, but it’s also possible stress is a contributor.

Many believe the 2003 passage of Medicare Part D, which established coverage for pharmaceutical costs, is partially responsible for the price surge. The same legislation allowed for non-profit patient-advocacy groups to establish co-pay funds that could be funded by the pharmaceutical industry. (The CancerCare Co-Payment Foundation was established in 2007, for example.) These co-pay funds are meant by the organizations offering them to help people, but critics maintain the pharmaceutical-company contributions to organizations like CancerCare and others like it should be viewed less as charity and more as cover for the ever-increasing cost of their medications, since these donations allow pharmaceutical companies to stick insurance companies and government programs like Medicare with an ever-greater bill, while helping the consumers cover their share of the tab. “Co-pay programs are meant to mitigate criticism of high drug prices, deflect legislation on drug pricing, get around payer restrictions and get patients on expensive drugs they will stay on for a long time,” says Adriane Fugh-Berman, an associate professor at Georgetown University Medical Center and an expert on physician-industry relationships.

 

The amount of money is also not enough. The phrase “drop in a bucket” barely does it justice. When CancerCare opened a $1.6 million fund for the co-payment of multiple myeloma medications this past April, it was exhausted within two days, Goldsmith told me. “I guarantee you tomorrow if for some reason we got $500 million tomorrow to support co-pay assistance, we could distribute that money likely within two months,” she said. But it is, she points out, better than not distributing the money at all. “I can tell you that that amount of money often makes the difference between people being able to get their treatment and not get their treatment.”  

This is hardly unique to CancerCare. Alan Balch, the chief executive officer of the Patient Advocate Foundation, which provides both case-management services and administers co-pay funds for a range of diseases and distributed more than $50 million in assistance in the fiscal year that ended in June of 2016, tells me that while some co-pay funds remain open for a considerable period of time, others open and close quickly. “There’s only so much money that is available at any one time and there’s so much demand for it,” he says.

The evidence is clear when you visit the websites of the funds. The Patient Advocate Foundation’s chronic pain fund? Its aid is limited to $1,500 and you need to apply when it’s taking applications. “Effective 01/18/2017, we are unable to process applications that are pending or accept new or renewal applications at this time. Should additional funding for Chronic Pain Fund applicants become available in the future, it will be necessary to re-apply if assistance is still needed.” The Patient Advocate Foundation’s multiple-sclerosis and renal-cell-carcinoma funds have been closed to new applicants since 2016. It helps to have a more popular disease: Everyone I interviewed told me it was a lot easier to find funds to assist sufferers of, say, breast cancer, than it was an unusual malignant tumor. “The rarer the cancer, the less likely there will be funding for that cancer,” said William Goeren of CancerCare.

 

For patients, this can seem like an elaborate, never-ending maze—and there is no central clearinghouse for the information. The Leukemia & Lymphoma Society’s Co-Pay Assistance Program will cover blood transfusions, chemotherapy, and radiation therapy, among other things, but not diagnostic procedures like surgery or lab work. United Way offerings vary by locality. Still others, like the Pendergast Fund, are targeted to small populations and can fly under the raadar. The hospital where Cassidy McCarthy received her treatments, for example, did not inform the family about the Heather Pendergast Fund, but the organization’s work is well known in Long Island’s firefighting community. “The chief of the fire department came to me and goes, ‘Well, there’s this Pendergast Fund so any bills you have, just give them to me,’” McCarthy recalled.

And even when medical supplicants find programs, they are not guaranteed aid even if they meet all the eligibility requirements. Amanda Collins, 36, is a Bartlesville, Oklahoma, resident who found herself financially scrambling after first her husband and then herself suffered a succession of medical crises. When the family finally obtained health insurance through Sooner Care—that’s Medicaid in Oklahoma—they were also given a list of local charities that could help out those in need.  She says she learned to call any organization, whether they were  offering aid with medical expenses or electric bills, mighty quick. “Then you call these services, not just for medical help, but any help. They tell you, ‘Oh, you have to hit us on this date,’ or ‘We get funding every month, but our funding is gone by the fifth of the month.’”

 

But for many who do receive monetary aid in the face of a medically induced financial crisis, it helps them, but it doesn’t make their money woes go away. The American Kidney Fund, yet another patient-advocacy fund, put me in touch with Lori Noyes, a 55-year-old nurse living in Upland, California, with her two cocker spaniels, Kirby and Tucker. Noyes’ financial life all but collapsed when a donated kidney she received in childhood failed in early 2014. Her out-of-pocket cost for prescription co-pays was running about $200 a month. Every medical appointment resulted in more bills. “Each little doctor would take a swipe at you,” she told me. Credit-card bills mounted.

Noyes, too, found herself struggling to navigate the charities that could potentially help. When she suffered vision loss following her kidney transplant and could no longer drive, it wasn’t anyone at a medical office who informed her of the Service Center for Independent Life, a Claremont, California based organization that helps people with disabilities with everything from transportation to employment assistance. A sympathetic Uber driver told her about the program. Finally, a financial counselor at the DaVita kidney-care location where she received dialysis suggested she reach out to the American Kidney Fund, which offered Noyes help paying her health-insurance bill and Medicare Part D premium. (All end-stage renal-failure patients are eligible for Medicare.) “It gave me wiggle room,” she says.

 

But that still left Noyes with a lot of bills. Even with the help of the American Kidney Fund, Noyes claimed about $22,000 in medical expenses on her taxes in 2014 and $19,000 in 2015, which included everything from dressing supplies and over-the-counter medications to travel expenses to and from the transplant center where she ultimately received a donated kidney. There are few—if any—charitable organizations willing or able to hand out this amount of assistance.

As for hospital-based charity, it can vary widely. Most studies find for-profit hospitals provide less charity care than nonprofit medical centers. But getting aid from a non-profit hospital isn’t exactly a gimme. A paper published by the Brookings Institution in 2015 pointed out that the non-profit hospitals with the most funds that could be devoted to charity care—that is, covering or forgiving medical bills of those who cannot pay full—are not located in the geographic areas where the need is greatest. The higher the wealth in a particular region, the more money a hospital is likely to have for indigent or needy patients. But those patients who need financial assistance are likely to live in lower-income areas where there is less in the way of resources. The paper uses two hospitals in Connecticut’s Fairfield County to make the point. The facility located in the high-income New York City suburb of Greenwich offers assistance to people with higher incomes than one located in Norwalk, a less wealthy town located a mere 15 miles away. But despite the lower ceiling, a much higher percentage of the Norwalk hospital’s bad-debt cases turned out to meet the eligibility guidelines for charity care.  

 

Moreover, in the wake of the Affordable Care Act, a number of nonprofit hospitals actually lowered the eligibility ceiling for charity assistance, thinking that such a change would encourage more people to sign up for health insurance. (For example, BJC Healthcare, headquartered in St. Louis, now only offers aid to people with household incomes of 300 percent of the federal poverty line, compared to 400 percent previously.) But because of the increasingly high deductibles, even people who didn’t meet the threshold for aid under the older, more generous standards are now experiencing financial grief as a result of medical bills. In an effort to cut down on uncollectable bills, a number of hospitals are now teaming up with financial services firms like Commerce Bank to offer time-limited interest free loans to patients something that, while helpful to some, most certainly is not charity.

“Our health-care system is shit and it’s trending shittier.”

When I catch up with Savannah Dray—she calls me from her car, on the way back to her Tallahassee apartment from a chemotherapy session—she begins rattling off her debt. “I have all kinds of medical bills. I have pathology bills. I have radiology bills. I have oral surgeon bills because the disease eroded parts of my teeth and broke them off. Now I have a regular dental as well as an oral surgeon bill. I have bills from my CT scans, which I guess would fall under radiology. I have surgery bills.” Dray, 22, was diagnosed earlier this year with stage-three colon cancer. How much does she owe overall? She can’t tell me. The bills are coming in by the day, and have been pretty much since the January day she doubled over with pain, and went to a nearby emergency room. But it’s definitely more than $10,000. She met her own $6,250 deductible, and then switched over to her husband’s plan when she left work as an assistant manager for a chain store. She now needs to meet that $6,250 deductible too.

A financial counselor at her oncologist’s office told Dray about CancerCare, as well as programs available from the American Cancer Society and Stupid Cancer, an advocacy and aid group for young adults fighting malignancies. But Dray says she was initially so overwhelmed by her illness and all the bills, she didn’t have the energy to reach out. For Dray, crowdfunding was a more familiar process, so she went with that. Only after she raised $4,712 toward a $30,000 goal on a page she set up at GoFundMe did she send an application in to CancerCare for financial assistance.

 

Little wonder, then, that an increasing number of patients turn to crowdfunding even before they investigate more established charitable giving programs. While turning to friends and family and holding fundraisers for medical bills has almost certainly been with us as long as people have paid for assistance when ill, turning to the Internet to plead for help with medical expenses is less than ten years old. Yet it has become all but ubiquitous, seemingly the first thing many people think to do when confronted by a medical crisis or tragedy.  Last year’s Orlando nightclub shootings inspired numerous crowdsharing efforts for everything from survivors medical bills to help for families paying funeral expenses. The same thing happened this year, when two men were killed and another injured by a man shouting anti-Muslim sentiments at a woman wearing a hijab in Portland, Oregon.*

Recommending patients experiencing trouble with their bills give crowdfunding a try has turned into all but a personal-finance trope. “Do you need money for unexpected medical and long-term-care expenses, funeral costs, or a local charitable endeavor? Maybe it’s time to turn to one of the growing number of personal ‘crowdfunding’ sites and ask the public for small donations,” chirped Kiplinger’s last fall. Newspaper articles about successful campaigns are a staple of what remains of the local press and heartwarming articles about the practice abound.

 

The truth is more than a bit darker. A few years ago, Ethan Austin, the co-founder of Give Forward (which recently merged with YouCaring, another crowdfunding site), one of the first sites to realize that crowdfunding could be as useful for people facing medical bills as those seeking to fund an independent film or fund a business venture, spoke to a group of students at New York University’s Stern School of Business about his site. He was blunt about one of the reasons he believed this segment of the online fundraising world had taken off so dramatically. “Our health-care system is shit and it’s trending shittier,” he told the group.  Last year, Nerdwallet broke down the numbers and discovered that just under 50 percent of the money raised by GoFundMe campaigns is somehow related to healthcare. There’s likely a measure of nowhere-else-to-turn desperation involved: A study published earlier this year by Lauren Berliner and Nora Kenworthy, both on faculty at the University of Washington Bothell, found that residents of states that didn’t take advantage of the Affordable Care Act to offer more residents access to Medicaid were over-represented on crowdfunding sites.  

Yet for all the attention paid to crowdfunding, the limited evidence we have shows that for most people, the hype is better than the actual results. A 2015 analysis by Nerdwallet found only 11 percent of healthcare fundraisers on Fundrazr, GiveForward, GoFundMe, Plumfund, and Red Basket met the organizer’s financial target. Berliner and Kenworthy, who studied a random selection of 200 campaigns on GoFundMe, found a very similar result. Nine in 10 were never funded in full.

 

According to Berliner and Kenworthy, most campaigns don’t go viral. Instead, they stay among the ill person’s existing social networks. “There seems to be some allure about what campaigns can do that exceeds what we are seeing they can do,” says Berliner. “It’s probably unlikely that you have some billionaires in your mix who are just looking to swoop in,” adds Kenworthy.

In the healthcare community, some experts are increasingly down on the concept. “We don’t recommend it routinely,” says Anne Bailey, a vice president for patient support at DaVita, the chain of dialysis centers where Noyes received treatment. In her view, crowdfunding works best for a one-time emergency, not a medical issue that will potentially go on for years. “That’s just not an acceptable solution for a long-term chronic medical issue.” For the 5 percent of people with the largest medical bills, crowdfunding is unlikely to come through, or least to come through in a way that solves the financial problem in the long term.

Nonetheless, it’s also true that every little bit helps. If Dray’s campaign hasn’t met her hoped-for expectations, it’s far from useless. She’s already been able to use some of the money to pay for oral surgery, not to mention to make a co-payment for a cardiologist. If not for the GoFundMe and an account on Instagram where she sells her art, she tells me, she’s not sure she could handle her medical bills, keep a roof over her head, and food in the kitchen.

 

***

I spoke with numerous people for this piece who told me that at some point, after all the fundraising, and asking for aid for organizations, and cleaning out of retirement and savings accounts, they simply put all their remaining bills on a credit card, and hoped for the best. They simply couldn’t take the constant barrage of mail from numerous separate medical providers and facilities.

For many, the financial turmoil caused by their illness already adds to the emotional and physical turmoil they are already experiencing. “Many people call us, and I am speaking anecdotally and they are angry. They say I’ve been working my whole life, I’ve paid my taxes, I’ve been diligent, but now I’m being slammed, I have to ask for charity ... There’s shame and anger in that,” says Richard Dickens, CancerCare’s director of client advocacy.  

But there is more than simple embarrassment arguing against this system. It’s the equivalent of taping a few bandages over a gaping wound and hoping for the best. The cost of medical care is so high, and the personal finances of many Americans so tight,  it’s all but impossible for any organization—or all of them—to keep up, and that’s whether or not the charitable contributions they accept are part of the problem or the solution. And this is now. Should Republicans succeed in their effort to repeal the Affordable Care Act, an estimated 23 million people would lose health-insurance coverage over the next decade. That would almost certainly put even more pressure on the charitable resources available to help those in need pay for medical care.  

Yet illness exists in the here and now. People need the money, so we open our wallets and we give what we can, feeling a little good about doing our part. And it does help some: As CancerCare’s Patricia Goldsmith puts it, “I can tell you that that amount of money often makes the difference between people being able to get their treatment, and not get their treatment.”

As for Cassidy McCarthy, she received what the family hopes was her last dose of chemotherapy on May 22. Both she and a brother will be attending a summer camp for children with cancer and their siblings that’s offered free of charge. Daniel McCarthy has a new job, and no longer needs assistance with his insurance premium. When a recent $45 blood-work lab bill recently arrived, the family didn’t forward it to Pendergast. They paid it themselves. “Some other people might need the money,” McCarthy said. If the family is lucky, they’re heading toward the best approach to avoiding big medical bills in the future: good health.


* This article originally stated the location of the attack as Portland, Maine. We regret the error.

 
HELAINE OLEN is a writer living in New York. She is the author of Pound Foolish and the co-author of The Index Card."
 
Also Trump got caught lying again, big shock.
"

AP FACT CHECK: No, Trump didn’t save preexisting conditions

By HOPE YENJanuary 13, 2020

WASHINGTON (AP) — President Donald Trump made a striking claim Monday, insisting it was he who ensured that people with preexisting medical problems will always be covered by health insurance.

He wasn’t.

He also complained anew that Democrats didn’t allow him to send lawyers to the impeachment inquiry. The opposite is true: Democrats invited him to send lawyers to the inquiry and he said no.

HEALTH CARE

TRUMP: “I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate.” — tweet.

TRUMP: “I stand stronger than anyone in protecting your Healthcare with Pre-Existing Conditions. I am honored to have terminated the very unfair, costly and unpopular individual mandate for you!”

THE FACTS: People with preexisting medical problems have health insurance protections because of President Barack Obama’s health care law, which Trump is trying to dismantle.

One of Trump’s major alternatives to Obama’s law — short-term health insurance, already in place — doesn’t have to cover preexisting conditions. Another major alternative is association health plans, which are oriented to small businesses and sole proprietors and do cover preexisting conditions.

Neither of the two alternatives appears to have made much difference in the market.

Meanwhile, Trump’s administration has been pressing in court for full repeal of the Obama-era law, including provisions that protect people with preexisting conditions from health insurance discrimination.

With “Obamacare” still in place, preexisting conditions continue to be covered by regular individual health insurance plans.

Insurers must take all applicants, regardless of medical history, and charge the same standard premiums to healthy people and those who are in poor health, or have a history of medical problems.

Before the Affordable Care Act, any insurer could deny coverage — or charge more — to anyone with a preexisting condition who was seeking to buy an individual policy.

___

TRUMP: “...and, if Republicans win in court and take back the House of Represenatives (sic), your healthcare, that I have now brought to the best place in many years, will become the best ever, by far. I will always protect your Pre-Existing Conditions, the Dems will not!” — tweet.

THE FACTS: Trump and other Republicans say they’ll have a plan to preserve protections for people with preexisting conditions. The White House has provided no details."

https://apnews.com/ce8b02c23096381739418e48fee5c6e1

 
 
 
 

ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ.  Did you say something?

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9 hours ago, Sucked In Again said:

The same can be said of the majority of the news media you & Hipkat follow and believe.

Precisely.  These cats just don't get it.  Hardly surprising.  Yet amusing.....

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