“Health plans, and the companies that administer them, have excluded key behavioral treatments, such as therapies for substance use and autism, and offered inadequate networks of mental health providers, according to a 142-page report released Jan. 17 in conjunction with the Treasury and Health and Human Services departments.
The report, which the agencies are required to file regularly to Congress, also detailed the results of secret shopper surveys of more than 4,300 mental health providers listed in insurance directories and found an “alarming proportion” were “unresponsive or unreachable.” Such error-ridden plans, commonly known as ghost networks, make it harder for patients to get the treatment they need, ProPublica has previously found.
Since 2021, the Labor Department has addressed violations in health plans that serve more than 7 million people, according to the report. The agency has worked to remedy the problems by seeking changes to plan provisions, policies and procedures, as well as working to ensure wrongly denied claims were paid.
But the report acknowledged that while plans and insurers have made some progress, they continue to fall short.”
“this particular fight was not actually about putting the interests of patients against those of rapacious corporations. Anthem’s policy would not have increased costs for their enrollees. Rather, it would have reduced payments for some of the most overpaid physicians in America. And when millionaire doctors beat back cost controls — as they have here — patients pay the price through higher premiums.”
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“the avarice and inefficiencies of private insurers are not the sole — or even primary — reasons why vital medical services are often unaffordable and inaccessible in the United States. The bigger issue is that America’s health care providers — hospitals, physicians, and drug companies — charge much higher rates than their peers in other wealthy nations.”
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“In 2023, the average physician salary in the United States was $352,000. In Germany, that figure was $160,000; in the United Kingdom, it was $122,000; in France, it was $93,000.
This discrepancy is partly explained by the fact that those European nations have more socialized health care systems, in which the government imposes more cost controls on medical providers. In the past, progressives have emphasized that a Medicare-for-all system would reduce overall health care costs by forcing providers to accept lower payments.
With its new policy, Anthem was attempting to do precisely this: force anesthesiologists to accept lower rates of reimbursement.
And the case for forcing down payment rates for anesthesiologists is especially strong. According to Medscape’s 2024 Anesthesiologist Salary Report, the average salary for an American anesthesiologist in 2023 was $472,000. This represented a $70,000 increase over the field’s average salary in 2022. This puts anesthesiology in the top 10 highest-paid physician specialties in the United States.
If we want America’s health care system to treat more patients — while charging us all less money for coverage — then there is no alternative to forcing myriad specialists to accept lower payment rates.”
“the shooting came at a time when health care seemed to be experiencing a bit of a surge in importance among Americans after the election. The share of registered voters who named it as the most important issue facing the country in YouGov/The Economist tracking polls had gradually declined from around 10 to around 7 percent throughout 2024, and even fewer, 4 percent, said it was the top issue specifically in determining their vote in the election. But after the election, that number has gone back up to between 8 and 11 percent.
A YouGov poll last week also found that more Americans, 49 percent, had an unfavorable view of the American health care system than the 42 percent who had a favorable one. Other polling suggests that Americans are as unhappy as they ever have been in recent years with the current state of health care. And while many Americans pointed fingers at the opposing party for the problems they see, more than 6 in 10 overall agreed that pharmaceutical and health insurance companies, as well as corporate executives like Thompson, were to blame for problems in the American health care system.
The U.S. remains unique among its peer nations in relying on a for-profit health insurance system and, as Mangione’s own writings alluded to, many Americans have expressed rage at a system that can deny coverage for people’s medical treatments while making shareholders and CEOs very rich. Despite decades of presidents trying to ensure universal access to health insurance, about 8 percent of Americans remained uninsured as of last year, and a higher percentage, about a quarter of American adults, said they or a family member had struggled to afford health care over the past year, whether they were insured or not.
By and large, Americans are unhappy with the costs of care and often find their insurance difficult to use. The share who rated the quality of health care in this country as “excellent” or “good” was just 44 percent in Gallup’s annual health and health care survey, conducted Nov. 6-20, its lowest point since 2001, when Gallup began asking the question. Even fewer, 28 percent, said the same about health care coverage — i.e., what insurance programs do — the lowest it has been since 2008″
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“A growing share of Americans in Gallup’s surveys seem to want the government to take action to improve health care access: 62 percent said it was the federal government’s responsibility to ensure all Americans have health care, the highest it’s been since 2007. Republicans are the least likely to agree with this sentiment — 32 percent said so, compared to 90 percent of Democrats and 65 percent of independents — but those numbers have increased by around 20 percentage points among all three groups over the past decade or so.
Perhaps surprisingly, YouGov polling found that around two in three Americans are at least somewhat satisfied with their health insurance plans — but that topline figure doesn’t capture a lot of nuance. For example, 89 percent of those with Medicaid were satisfied with their health coverage, compared to 75 percent who are covered by an employer-sponsored plan. Unsurprisingly, those who had had an insurance claim denied were also more likely to be dissatisfied with their coverage.
And despite many being mostly satisfied with the plans they have, a high number of Americans still experience problems using them. KFF, a nonprofit health policy research organization, found in a survey last year that 58 percent said that they had at least some trouble using their insurance in the previous year — including issues like denied claims or difficulty accessing in-network providers — and nearly half of whom said their biggest problem was not resolved to their satisfaction. Overall, 18 percent of Americans with health insurance had experienced a denied claim, and those were more common among people with private or employer-sponsored insurance. Around a quarter of those who’d had a claim denied suffered serious consequences, like a decline in health or not receiving recommended medical care.”
A main point to having private versions of Medicare ran by for-profit health insurance companies as an alternative option to Traditional Medicare is to save the taxpayer money by taking advantage of efficiencies gained in private competition and private flexibility while also
“For millions of families, a spike in health care costs might be around the corner because crucial subsidies are set to expire at the end of next year. Some families will see their premiums rise by thousands of dollars; others might lose their insurance altogether.
In 2021, President Joe Biden signed into law the American Rescue Plan Act, which included a provision that enhanced the premium tax credit — a piece of the Affordable Care Act (ACA) that subsidized the cost of premiums for some lower- and middle-income families. The Biden-era enhancements, which essentially expanded the number of people who qualify for the tax credit, were originally set to expire at the end of 2022, but Congress extended them through 2025 when it passed the Inflation Reduction Act. (For families at or slightly above the poverty line, the enhanced tax credit subsidizes the full premium. For people making more than 400 percent of the poverty line — people who were previously ineligible for this subsidy — it caps their premiums to 8.5 percent of their income.)
The enhanced premium tax credits contributed to a record number of insured people in the United States. In February 2021, before Congress expanded the premium tax credits, 11.2 million people were enrolled in health coverage through ACA marketplaces. By 2024, that number shot up to 20.8 million people.
There are many reasons for the dramatic increase in marketplace coverage — including the fact that millions of people were disenrolled from Medicaid coverage after Covid emergency measures lapsed and had to turn to other forms of insurance, including the marketplace — but the enhanced premium tax credit played a critical role. Its expansion was the main reason so many more people were able to enroll in health care coverage from the ACA marketplace, according to the Kaiser Family Foundation.
If Congress allows the enhanced premium tax credits to expire, millions of people will see a noticeable rise in out-of-pocket expenses. Many will likely lose their coverage, and that’s without considering how much more will be at stake if Medicaid gets slashed as well. For low-income families, particularly those who live just above the poverty line, that could be a nightmare.”