Medical debt was cut nearly in half in states that expanded Medicaid

“The Affordable Care Act offered states a huge infusion of federal money to expand Medicaid eligibility to low-income adults, and about 30 states took that deal right away in 2014. Since then, new medical debt in those states has fallen 44 percent, a dramatically bigger drop than was seen in the states that refused to expand the program over the same period. Those states showed only a 10 percent decline.”

“nonmedical debt had fallen by similar amounts in expansion and non-expansion states over the time period they studied, 2009 to 2020, strengthening the case that Medicaid expansion was the difference with medical debt.”

“In states that expanded Medicaid, both the lowest- and highest-income groups saw their medical debt drop after expansion, but the amount of medical debt added annually decreased much more for the former (by $180, from $458 to $278) than the latter (by $35, from $95 to $60).
In non-expansion states, on the other hand, the lowest-income group averaged a $206 average increase in new medical debt, from $630 to $836. But the highest-income bracket still saw a small decline in new debt for medical care.”

“Those states are concentrated in the South. Eight of the 12 non-expansion states are in the region. Nearly one in four Southerners have some medical debt in collections listed on their credit report, compared to 10.8 percent of people in the Northeast and 12.7 percent in the West.”

Will the Taliban roll back two decades of public health progress in Afghanistan?

“relatively little attention has been paid to what the Taliban victory will mean for one of the nation’s biggest accomplishments: the sharp decline in child and maternal mortality over the past two decades.

A study in The Lancet Global Health found that between 2003 and 2015, child mortality in Afghanistan fell by 29 percent. While maternal mortality is difficult to estimate, one data set found that deaths in childbirth fell from 1,140 per 100,000 in 2005 to 638 per 100,000 in 2017, or nearly in half.

This progress was not necessarily all generated by the US-led occupation, with aid from international organizations and Afghan-led initiatives contributing heavily; and these estimates rely on household surveys that are difficult to conduct well, especially in poor, war-torn countries with large nomadic populations, meaning they are likely off to some degree.”

“The best-case scenario would be a continued emphasis on the health of women and children, expansion of the developing public health sector — including nutrition, water, sanitation, and housing — and attention to the emerging problem with chronic or noncommunicable diseases.

The health workforce needs continuing support. Things can go bad if restriction of women, both as a health focus and in the workforce, occurs and ideology starts getting in the way of health programming. The health of Afghanistan cannot move forward without continuing external support, and this is likely to be required for some years to come, regardless of who is the government. A plunge back into war and instability is the very worst case imaginable for the health of the country”

Why food and housing assistance is essential for improving America’s health

“There is an underappreciated contributor to the United States’ comparatively poor health: We underinvest in social services that help people live healthier lives and therefore overspend on medical care relative to other developed countries.

The long-term trends in US health care, as I wrote about earlier this week, tell a clear story: Medical outcomes have gotten better, with measures of life expectancy and disease burden improving over the last 25 years, but they haven’t improved as much as they have in other wealthy nations that spend less money on health care than the US.”

“If you combine social services spending with health spending, the US and its peers spend about the same amount of money (a little more than 30 percent of their respective GDPs). But spending in those other countries is weighted more toward social support — food and housing subsidies, income assistance, etc. — whereas America spends more on medical care.”

“Eighteen percent of people in the US live in poverty, compared with 10 percent in other wealthy countries. And we know that people with lower incomes face many structural challenges — lack of access to healthy food, clean water, and fresh air, for starters — that lead to worse health outcomes. When they get sick, they have a harder time both finding a doctor and affording their medical care. In general, they also live with more stress and anxiety than people who make more money, which also has deleterious effects on their health.”

U.S. medical stockpile running low as Delta variant threat looms

“The federal government created the stockpile, originally the National Pharmaceutical Stockpile, in 1999 to counter potential biological, disease and chemical threats to civilian populations. It was eventually renamed the Strategic National Stockpile in 2003, and the Department of Defense was given a role in its management alongside HHS. The stockpile was designed as a stopgap that would allow the federal government to surge supplies to specific areas experiencing disasters or threats, supplementing local procurement efforts. It was not meant to be the sole source for private and public institutions to obtain medical supplies in emergency settings.

Hospitals, public health departments and other health care facilities are supposed to maintain their own stocks of masks, gowns, drugs and ventilators. But during the first months of the Covid-19 pandemic in 2020, they ran out of those basic supplies. The overwhelming number of Covid-19 patients forced both private and public institutions to search for personal protective equipment and therapeutics on the open market.”

“A year and a half into the pandemic, the U.S. still does not have a good way to quickly scale production of drugs and medical supplies needed to help supplement the strategic national stockpile, in part because manufacturers operate on just-in-time principals. Those standards are supposed to minimize inventory and maximize efficiency, but struggle to account for swings in demand.

“Everybody — shippers, hospitals, pharmacy chains — no one wants to hold inventory. Who is going to pay for those expensive medicines sitting there month after month?” O’Toole said. “This is why hospital stockpiles have dwindled.”

The federal government is beginning to work with the private sector to ensure manufacturers have the ability to scale production quickly during large-scale disease outbreaks.

The Biomedical Advanced Research and Development Authority (BARDA) is working with its parent, HHS, to find companies willing to alter their standard manufacturing practices to scale up production of therapeutics and other medical supplies to better prepare for the next pandemic. But expanding manufacturing capacity in the U.S. is not easy, one former Trump administration official who worked with BARDA told POLITICO. It will take years to build facilities, manufacturing lines and hire staff to oversee production, the former official said.”

Charging patients just $10 more for medications leads to more deaths

“Researchers at Harvard University and the University of California Berkeley examined what happened when Medicare beneficiaries faced an increase in their out-of-pocket costs for prescription drugs. They found that a 34 percent increase (a $10.40 increase per drug) led to a significant decrease in patients filling their prescriptions — and, eventually, a 33 percent increase in mortality.

The rise in deaths resulted from people indiscriminately cutting back on medications when they had to pay more for them, including drugs for heart disease, hypertension, asthma, and diabetes.

“We find that small increases in cost cause patients to cut back on drugs with large benefits, ultimately causing their death,” the authors — Amitabh Chandra, Evan Flack, and Ziad Obermeyer — wrote. “Cutbacks are widespread, but most striking are those seen in patients with the greatest treatable health risks, in whom they are likely to be particularly destructive.””

“This finding challenges an important assumption embedded in American health care policy. In the 1970s and ’80s, the RAND Health Insurance Experiment concluded that small copays encouraged patients to use fewer health care services without leading to worse health outcomes. That helped establish a new economic argument for insurers to ask their customers to put more “skin in the game”: it would encourage more efficient use of health care services with no downside.

But that premise presumed people would be rational. For example, if they are being asked to pay more money for prescription drugs, they would cut back on less-valuable medications first. The Harvard/Cal study didn’t detect any such rationality. When costs went up, people just stopped filling their prescriptions for statins — high-value drugs that are effective in preventing heart attacks.

The researchers explained it like this: The way patients behaved when faced with higher out-of-pocket costs would suggest that they placed very little value on their lives. They literally stopped taking high-value drugs because of the price.”

“If patients can’t make good value judgments, the economic argument for cost-sharing starts to crumble, and it starts to seem like eliminating cost-sharing — increasing the likelihood patients will continue to take the medications they need to stay alive — would be a cheap way to “buy” people more health. As the researchers wrote, “improving the design of prescription drug insurance offers policy makers the opportunity to purchase large gains in health at extremely low cost per life-year.””

“Eliminating out-of-pocket costs would come with a price: Insurers would likely charge higher premiums to offset the loss of the copays and coinsurance that currently reduce their direct costs. But if the goal is better health outcomes, that is arguably a price worth paying.”

Argentina becomes the first large Latin American country to legalize abortion

“According to the BBC, a minimum of 350,000 illegal abortions occur annually in Argentina, a figure that some activist groups feel is undercounting the real number. Illegal abortions can lead to health complications and even death for the people who experience them — the World Health Organization estimates that up to 13.2 percent of maternal deaths worldwide can be attributed to unsafe abortions.

Argentina has seen adherence to Catholicism decline in recent years, according to a study from the National Scientific and Technical Research Council (CONICET). The Buenos Aires Times reports that in 2019, 62.9 percent of the population identified as Catholic, a 13.6 percentage point drop since 2008. Simultaneously, while evangelicals gained new adherents, the share of people identifying with no religion grew the most, reaching nearly 20 percent of the population.”

“While Argentina is still a largely Catholic country, this decline could explain why Pope Francis’s comments opposing legalizing abortion did not have an overwhelming effect on the outcome of this vote. Francis, who was born and worked in Argentina for much of his life, has referred to abortion as being part of a “throwaway culture” and has rooted his opposition to the medical procedure as being based in science, according to Crux, a Catholic online newspaper.

According to France 24, Catholics weren’t alone in opposing the measure; they joined forces with the country’s growing evangelical wing to mobilize against abortion. They will likely fight to overturn this measure, especially as this change exposes Argentina’s religious fault lines.

But the victorious activists are the abortion rights feminists who have spent years fighting for abortion legalization.”

“Argentina became the biggest country in Latin America to legalize elective abortion”

This might be your most important flu shot ever

“This fall and winter, health experts expect two types of deadly viruses to be circulating widely in the US. But they don’t yet know what the extent of the damage will be when the two collide.

In the absence of a coherent federal response, the novel coronavirus continues to spread across the country, with several states still battling active outbreaks. Experts estimate it could continue to hospitalize thousands and kill hundreds of people a day into September — likely with more spikes in the coming months.

We’re also now staring down the annual flu season, which typically starts in October and burdens the health care system even in normal years. The 2018–2019 flu season in the US, for example, resulted in about half a million hospitalizations and more than 34,000 deaths. The previous season, deaths were double that. And communities of color, which have already been disproportionately impacted by Covid-19, historically have also been more likely to have chronic health conditions that put them at higher risk of influenza-related complications.”

“One problem is that because influenza and Covid-19 are both respiratory viruses, severe cases will be treated on much of the same limited medical equipment, like ventilators. And because they can have overlapping symptoms, figuring out whether someone has the flu or Covid-19 — or neither — will be tricky but also important.

Fortunately, we already have a safe vaccine for the flu, and nearly 200 million doses are slated to be available in the coming months.”

“The Centers for Disease Control and Prevention (CDC) says that everyone 6 months and older (with very rare exceptions, like a life-threatening egg allergy) should get a flu shot. And this year, it is more crucial than ever to get one, experts say, to reduce the spread of the virus and keep the health care system from being overtaxed with continued surges of Covid-19.”

Health providers’ scramble for staff and supplies reveals sharp disparities

“Doctors, nurses and caregivers at smaller and poorer hospitals and medical facilities across the country are still struggling to obtain the protective gear, personnel and resources they need to fight the coronavirus despite President Donald Trump’s repeated assertions that the problems are solved.

Health care workers at all types of facilities scrambled for scarce masks, gloves and other life-protecting gear at the beginning of the pandemic. The White House was letting states wage bidding wars against one another, rather than establish a central national manufacturing, supply and distribution chain.

But now, health care workers say a clear disparity has emerged and persisted. Larger and richer hospitals and practices outbid their smaller peers, sometimes for protective gear, sometimes to fill in staffing gaps. And some of those having the hardest time are precisely where the virus is spreading.”

America is failing Black moms during the pandemic

“Black women are disproportionately impacted, dying in childbirth at three to four times the rate of white women.”

“Many factors contribute to overall maternal mortality in the US, from underlying conditions like diabetes to a lack of adequate health insurance. All of these disproportionately impact Black women — Black Americans, for example, are 60 percent more likely than whites to be diagnosed with diabetes. And 11.5 percent of Black Americans were uninsured as of 2018, compared with just 7.5 percent of whites.”

“For Black women, “even when we get prenatal care,” Crear-Perry explained, “even when we are normal weight and not obese, even when we have no underlying medical conditions, we are still more likely to die in childbirth than our white counterparts.” In New York City, for example, a 2016 study found that Black patients with a college education were more likely to have pregnancy or childbirth complications than white patients who hadn’t graduated from high school.”

“Part of the issue is that providers treat Black patients differently from white ones. Black women and other women of color often aren’t listened to when they express pain or discomfort, Jamila Taylor, director of health care reform at the Century Foundation, told Vox.
Racist beliefs about people’s bodies and their ability to experience pain are shockingly widespread: Half of the white medical students and residents surveyed in one 2016 study, for example, believed at least one myth about racial differences in pain perception, such as the idea that Black people’s nerve endings are less sensitive than white people’s. The more myths someone believed, the more likely that person was to underestimate a Black patient’s pain.”

“Advocates have long been calling for greater access to non-hospital births, whether at a birthing center or at home, as a way to combat the discrimination Black patients and other patients of color can face in hospital settings. “Other countries that have better outcomes than we do create a system and a network of birth centers and home births that allow for people to make choices based upon their needs,” Crear-Perry said.”

The Real Reason the U.S. Has Employer-Sponsored Health Insurance

“The single largest tax expenditure in the United States is for employer-based health insurance. It’s even more than the mortgage interest deduction. In 2017, this exclusion cost the federal government about $260 billion in lost income and payroll taxes. This is significantly more than the cost of the Affordable Care Act each year.”

“Let’s take a hypothetical married pediatrician with a couple of children living in Indiana who makes $125,000 (which is below average). Let’s also assume his family insurance plan costs $15,000 (which is below average as well).

The tax break the family would get for insurance is worth over $6,200. That’s far more than a similar-earning family would get in terms of a subsidy on the exchanges. The tax break alone could fund about two people on Medicaid. Moreover, the more one makes, the more one saves at the expense of more spending by the government. The less one makes, the less of a benefit one receives.

The system also induces people to spend more money on health insurance than other things, most likely increasing overall health care spending. This includes less employer spending on wages, and as health insurance premiums have increased sharply in the last 15 years or so, wages have been rather flat. Many economists believe that employer-sponsored health insurance is hurting Americans’ paychecks.

There are other countries with private insurance systems, but none that rely so heavily on employer-sponsored insurance. There are almost no economists I can think of who wouldn’t favor decoupling insurance from employment.”