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Tag: Health care costs

  • Transgender adults brace for treatment cutoffs in Missouri

    Transgender adults brace for treatment cutoffs in Missouri

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    Ellie Bridgman spent her Thursday night shift at a local gas station in Union, Missouri, planning for the day she’ll lose access to gender-affirming treatments the transgender and nonbinary 23-year-old credits with making “life worth living.”

    A first-of-its-kind emergency rule introduced this week by Missouri’s Republican Attorney General Andrew Bailey will impose numerous restrictions on both adults and children before they can receive puberty-blocking drugs, hormones or surgeries “for the purpose of transitioning gender.”

    Transgender rights advocates have vowed to challenge the rule in court before it takes effect April 27. But promises of swift legal action have done little to ease the worries of trans Missourians like Bridgman who say it may be time to flee the state.

    Before gender-affirming medical treatments can be provided by physicians, the regulation requires people to have experienced an “intense pattern” of documented gender dysphoria for three years and to have received at least 15 hourly sessions with a therapist over at least 18 months. Patients also would first have to be screened for autism and “social media addiction,” and any psychiatric symptoms from mental health issues would have to be treated and resolved.

    Some individuals will be allowed to maintain their prescriptions while they promptly receive the required assessments.

    Bridgman, who uses she/they pronouns, is autistic and has depression. She said she sees only two options: move across the country, away from all her friends and family, to a state that protects access to gender-affirming care, or accept the serious health risks that could come with illegally buying hormones online.

    She headed to a pharmacy Friday afternoon to pay out of pocket for all her remaining refills.

    “Placing restrictions on transitioning for people with depression is just a way for them to completely bar us from transitioning at all,” Bridgman said. “For lots of trans people, dysphoria is the cause of depression. You can’t treat the depression without treating the underlying dysphoria.”

    Before Bridgman started hormone replacement therapy last summer, she said “life felt meaningless” and suicidal thoughts crowded her head. Gender-affirming care was her “last chance at life,” she said.

    The regulation comes as Republican lawmakers across the country, including in Missouri, have advanced hundreds of measures aimed at nearly every facet of transgender existence, with a particular emphasis on health care.

    At least 13 states have enacted laws restricting or banning gender-affirming care for minors. Bills await action from governors in Montana, North Dakota and neighboring Kansas, and nearly two dozen other states are considering legislation to restrict or ban care.

    National groups advocating for LGBTQ+ rights contend the Missouri regulation — based on a state law against deceptive and unfair business practices — goes further than most restrictions enacted elsewhere.

    Three states have imposed restrictions on gender-affirming care via regulation or administrative order, but Missouri’s regulation is the only one that also limits treatments for adults.

    Cathy Renna, a spokesperson for the National LGBTQ Task Force, said the rule demonstrates how Republicans are now successfully broadening the scope of gender-affirming care restrictions beyond minors, which advocates had been warning about for months.

    “When they see one thing work in one state, they’ll try to replicate it in another,” Renna warned.

    Bailey’s restriction comes after a former employee at a transgender youth clinic in St. Louis alleged that physicians at the Washington University Transgender Center were rushing to provide treatment without appropriate patient assessment.

    Bailey said he is investigating the clinic but has not yet issued a report. The claims of mistreatment have been disputed by others, including another former employee and patients. Neither Bailey nor the university responded to phone and email messages seeking comment.

    Dr. Meredithe McNamara, an assistant professor of pediatrics specializing in adolescent medicine at the Yale School of Medicine, said evidence widely supports maintaining access to hormone therapy and other gender-affirming care.

    As part of a consent process, Bailey’s rule requires that patients be shown materials containing nearly two dozen specific statements raising concerns about gender-affirming treatments — a practice doctors like McNamara have denounced as a form of conversion therapy.

    “There is no evidence that shows that psychotherapy as the only treatment is effective,” she said.

    Stacy Cay, an autistic trans woman in Kansas City, has been stockpiling vials of injectable estrogen in anticipation of restrictions. The 30-year-old comedian and model realized she only required a small dose and has saved up enough estrogen to last about a year. When that runs out, she will have to travel across state lines to fill prescriptions or consider moving elsewhere.

    Cay said her persistent depression will cut off her access to hormones under the regulation and that her autism diagnosis could complicate her path to receiving future care. While the regulation does not specify whether autism disqualifies a person for gender-affirming care, it does mandate an assessment.

    A 2020 study from natural sciences journal Nature Communications estimated that transgender and gender-diverse people, or those whose gender expressions do not conform to gender norms, are 3-6 times more likely to be autistic compared to cisgender people. They were also more likely to have other developmental and psychiatric conditions, including depression.

    “They know a lot of us are autistic, and it’s part of their strategy to paint us as unstable — that we can’t be trusted to make our own medical decisions,” Cay said.

    Attorneys from Lambda Legal and the American Civil Liberties Union say they plan to challenge the new rule in court.

    Missouri falls under the 8th U.S. Circuit Court of Appeals — the same court that upheld a preliminary injunction last year preventing Arkansas from enforcing a first-in-the-nation ban on trans children receiving gender-affirming treatments. Federal judges have also blocked enforcement of a similar law in Alabama.

    Republican legislators leading Missouri’s effort to ban gender-affirming treatments for minors said Friday that they have no plans to expand their legislation to include adults.

    Separate bills passed by the Missouri House and Senate would ban treatments for children younger than 18 but would impose no restrictions for adults who are covered by private insurance or willing to pay for their own health care.

    “I believe it is detrimental to a person’s body, probably even their psyche, to go through treatments like that,” said state Sen. Mike Moon, lead sponsor of the Senate legislation. “Adults have the opportunity to make decisions such as these.”

    ___

    Schoenbaum reported from Raleigh, North Carolina, and Lieb reported from Jefferson City. Associated Press editor Jeff McMillan contributed from Scranton, Pennsylvania.

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  • Iowa won’t pay for rape victims’ abortions or contraceptives

    Iowa won’t pay for rape victims’ abortions or contraceptives

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    DES MOINES, Iowa — The Iowa Attorney General’s Office has paused its practice of paying for emergency contraception — and in rare cases, abortions — for victims of sexual assault, a move that drew criticism from some victim advocates.

    Federal regulations and state law require Iowa to pay many of the expenses for sexual assault victims who seek medical help, such as the costs of forensic exams and treatment for sexually transmitted infections. Under the previous attorney general, Democrat Tom Miller, Iowa’s victim compensation fund also paid for Plan B, the so-called morning after pill, as well as other treatments to prevent pregnancy.

    A spokeswoman for Republican Attorney General Brenna Bird, who defeated Miller’s bid for an 11th term in November, told the Des Moines Register that those payments are now on hold as part of a review of victim services.

    “As a part of her top-down, bottom-up audit of victim assistance, Attorney General Bird is carefully evaluating whether this is an appropriate use of public funds,” Bird Press Secretary Alyssa Brouillet said in a statement. “Until that review is complete, payment of these pending claims will be delayed.”

    Victim advocates were caught off guard by the pause. Ruth Richardson, CEO of Planned Parenthood North Central States, said in a statement that the move was “deplorable and reprehensible.”

    Bird’s decision comes as access to the most commonly used method of abortion in the U.S. plunged into uncertainty following conflicting court rulings on Friday over the legality of the abortion medication mifepristone. For now, the drug the Food and Drug Administration approved in 2000 appeared to remain at least immediately available in the wake of separate rulings issued in quick succession.

    U.S. District Judge Matthew Kacsmaryk in Texas, an appointee of former President Donald Trump, ordered a hold on federal approval of mifepristone. But that decision came at nearly the same time that U.S. District Judge Thomas O. Rice in Washington, D.C., an appointee of former President Barack Obama, essentially ordered the opposite.

    The extraordinary timing of the competing orders revealed the high stakes surrounding the drug nearly a year after the U.S. Supreme Court overturned Roe v. Wade and curtailed access to abortion across the country. President Joe Biden said his administration would fight the Texas ruling.

    In Iowa, money for the victim compensation fund comes from fines and penalties paid by convicted criminals. For sexual assault victims, state law requires that the fund pay “the cost of a medical examination of a victim for the purpose of gathering evidence and the cost of treatment of a victim for the purpose of preventing venereal disease,” but makes no mention of contraception or pregnancy risk.

    Sandi Tibbetts Murphy, who served as director of the victim assistance division under Miller, said the longtime policy for Iowa has been to include the cost of emergency contraception in the expenses covered by the fund. She said that in rare cases, the fund paid for abortions for rape victims.

    “My concern is for the victims of sexual assault, who, with no real notice, are now finding themselves either unable to access needed treatment and services, or are now being forced to pay out of their own pocket for those services, when this was done at no fault of their own,” she said.

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  • California looks to spend some Medicaid money on housing

    California looks to spend some Medicaid money on housing

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    SACRAMENTO, Calif. — At the start of 2022, Thomas Marshall weighed 311 pounds. He had been hospitalized 10 times in five years, including six surgeries. He had an open wound on his left leg that refused to heal — made worse by living in a dirty, moldy house with five other people, two ball pythons, four Chihuahuas and a cage full of rats.

    More than a year later, Marshall has lost nearly 100 pounds. His wound has healed. His blood pressure has returned to normal levels. His foot, which had nerve damage, has improved to the point he goes on regular walks to the park.

    Lots of factors are at play in Marshall’s dramatic turnaround, but the one he credits the most is finally having stable housing, after the nonprofit Sacramento Covered helped him get a one-bedroom, 500 square-foot (46.4-square-meter) apartment in a downtown high rise. He has hardwood floors, white pine cabinets and a glass jar on the counter filled with Bit-O-Honeys.

    “To me it’s the most important 500 square feet I’ve ever had,” he said. “Living here has just improved my well-being in every possible way.”

    Marshall’s story is part of a radical rethinking of the relationship between housing and health care in the U.S. For decades, Medicaid, the joint state and federal health insurance program for people with disabilities or low incomes, would only pay for medical expenses. But last year the Biden administration gave Arizona and Oregon permission to use Medicaid money for housing — a nod to reams of research showing people in stable housing are healthier.

    Now California wants to join those states, building on the success of programs like the one that got Marshall housing. Gov. Gavin Newsom has proposed spending more than $100 million per year in the state’s Medicaid program to pay for up to six months of housing for people who are or risk becoming homeless; are coming out of prison or foster care; or are at risk for hospitalization or emergency room visits.

    It would be the biggest test yet of using Medicaid money for housing. California has the nation’s largest Medicaid program, with more than 13 million patients — or about a third of the state’s population. California also has nearly a third of the nation’s homeless population, according to federal data.

    “It’s a huge step toward breaking down the silos that have gotten in the way of taking care of the whole person rather than limb by limb and illness by illness,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

    It would also be an expensive step. California is expected to have a $22.5 billion budget deficit this year, and it could get bigger in years to come. Meanwhile the state’s Medicaid spending is projected to increase by $2.5 billion over the next three years, according to the nonpartisan Legislative Analyst’s Office.

    “What we’re really doing is expanding the welfare state, which is going to become just a huge financial problem,” said Wayne Winegarden, senior fellow at the Pacific Research Institute, a group that advocates for free-market policies.

    California experimented with using Medicaid money for some housing-related expenses in 2016 when it launched a pilot project in 26 counties. While Medicaid did not pay for rent, it paid for things like security deposits and furniture.

    In Marshall’s case, he pays his own rent, using some of the $1,153 per month he gets from Social Security and Supplemental Security Income. But Medicaid paid for his security deposit, bed, sofa, table, chairs and nearly 3 1/2 gallons of Pine Sol. Marshall said keeping his apartment clean is one thing that helped his leg wound to finally heal.

    Over five years the program has reduced expensive hospital stays and emergency room visits for people on Medicaid, saving taxpayers an average of $383 per patient per year, according to an analysis by researchers at UCLA.

    Now California wants to go further by using Medicaid money to directly pay some people’s rent. Democratic Assemblymember Joaquin Arambula, who chairs the budget subcommittee that will vet Newsom’s proposal, said lawmakers are supportive. Arambula spent a decade as an emergency room doctor.

    “I became very good at being able to get cockroaches out of people’s ears,” Arambula said. “The living conditions of many of our communities, especially in our rural communities, really can affect a person’s ability to get adequate sleep, to be prepared for the next day and to stay healthy.”

    Advocates for homeless people say they welcome such programs but spending more money on rent isn’t enough, noting the state still has a massive shortage of affordable housing.

    Kelly Bennett, founder and CEO of Sacramento Covered, said that during California’s first experiment with using Medicaid money for housing services, it would often take up to eight months for workers to place a patient in an apartment. In some cases, people have waited for years to find a place.

    “Even when you have the deposit money and you have some rental subsidy, it’s still very, very challenging to find units — and to find units where the landlords will lease to our clients,” Bennett said.

    Marshall said he grew up in Sacramento and got a degree in dietic technology and culinary arts. But a 30-year addiction to meth landed him on the streets from the late 1990s through about 2006. He camped at an old landfill, often eating leftovers from people’s picnics at a nearby park.

    He applied for apartments at multiple subsidized housing buildings, but never made it off the wait list. It took him about a year to get his current apartment, where he pays $186 per month with the help of a subsidy.

    “I feel like I’m electric. … I have power and ability to do things that I could not do for a very long time,” Marshall, 64, said. “Whatever years I’ve got left now, I’m going to spend them up here in the glass tower.”

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  • NC approves Medicaid expansion, reversing long opposition

    NC approves Medicaid expansion, reversing long opposition

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    The Republican-controlled North Carolina legislature has given final approval to a Medicaid expansion agreement

    ByGARY D. ROBERTSON Associated Press

    RALEIGH, N.C. — A Medicaid expansion deal in North Carolina received final legislative approval on Thursday, ending a decade of debate over whether the closely politically divided state should accept the federal government’s coverage for hundreds of thousands of low-income adults.

    North Carolina is one of several Republican-led states that have begun considering expanding Medicaid after years of steadfast opposion. Voters in South Dakota approved expansion in a referendum in November. And in Alabama, advocates are urging lawmakers to take advantage of federal incentives to expand Medicaid in order to provide health insurance to thousands of low-income people.

    When Democratic Gov. Roy Cooper, a longtime expansion advocate, signs the bill, it will leave 10 states in the U.S. that haven’t adopted expansion. North Carolina has 2.9 million enrollees in traditional Medicaid coverage. Advocates have estimated that expansion could help 600,000 adults.

    “Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon,” Cooper tweeted.

    The House voted 87-24 in favor of the deal, after little debate. Some members clapped after it passed, which is usually not permitted under chamber rules. The Senate already approved the legislation last week.

    The final agreement also included provisions scaling back or eliminating regulations that require state health officials to sign off before medical providers open certain new beds or use equipment. Senate Republicans demanded the “certificate of need” changes in any deal.

    Republicans in charge of the General Assembly for years had been skeptical about expansion, which originated from the 2010 federal Affordable Care Act. But they have come around to the idea over the past year, deciding that Congress was neither likely to repeal the law nor raise the low 10% state match that coverage requires.

    And a financial sweetener contained in a COVID-19 recovery law means North Carolina also would get an estimated extra $1.75 billion in cash over two years if it expands Medicaid. Legislators hope to use much of that money on mental health services.

    There’s no set start date in the law for expansion under the legislation, but it also comes with one caveat: It can’t happen until after a state budeget is approved. This usually happens in the early summer. Cooper panned that provision, which could give GOP leaders leverage to include unrelated items he may strongly oppose.

    The state’s 10% share of expenses for Medicaid expansion recipients would be paid through hospital assessments. Hospitals also are expected to receive larger reimbursements for treating Medicaid patients through a federal program the state is requested to include in the legislation.

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  • California, drugmaker partner to produce affordable insulin

    California, drugmaker partner to produce affordable insulin

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    DOWNEY, Calif. — The state of California and a generic drug manufacturer announced a 10-year partnership Saturday to produce affordable, state-branded insulin that they hope will rival longtime producers and push down prices for a medication used by millions of Americans.

    The product is not expected on store shelves until at least next year, and it was difficult to predict what effect it would have on a market already shaken by change. Earlier this week another major insulin maker promised steep price cuts as pressure builds on drugmakers and insurers to slash the cost of the drug.

    Democratic Gov. Gavin Newsom said he hoped California’s emergence as an insulin-maker would prompt prices to collapse. Research has shown that prices for the drug have more than tripled in the past couple of decades.

    “We are intent to make this about market disruption,” Newsom said at a ceremony announcing the pact at a pharmaceutical warehouse near Los Angeles. He called it “a game changer” for 8 million Americans who use insulin to treat diabetes.

    Many questions remain. The state and its partner, the nonprofit Civica, have yet to locate a California-based manufacturing facility. Regulatory approvals will be needed. Newsom said a 10- milliliter vial of the state-branded insulin would sell for $30, but it’s possible competitors could slash their prices and undercut the state product.

    “Is this perfect? We don’t know yet,” Newsom acknowledged at one point.

    Just days ago, President Joe Biden said his administration is focused “intensely” on lowering health care costs, including pressuring pharmaceutical companies to lower the costs of insulin. Legislation enacted last year capped copayments for insulin at $35 per month for Medicare beneficiaries. Biden has proposed extending that cap to all Americans.

    Novo Nordisk said Tuesday that it will slash some of its U.S. insulin prices up to 75% starting next year. The announcement comes less than two weeks after rival Eli Lilly said it will drop some of its prices by 70% or more later this year.

    Anthony Wright, executive director of Health Access California, a statewide consumer health care advocacy group, welcomed Newsom’s announcement, saying efforts by California and others to develop a competing generic are likely a factor in getting insulin manufacturers to cut their prices.

    Still, there are obstacles.

    “The work to develop a generic, get FDA approval and set up manufacturing will take real time,” Wright said in an email. “There may even be more time in the effort to get doctors to prescribe the drug, insurers and (pharmacy benefit managers) to include it on their formularies and patients and the public to accept and ask for it.”

    There could be other risks. State analysts have warned that California’s entry into the market could prompt other manufacturers to reduce the availability of their drugs, a potential unintended consequence.

    State lawmakers approved $100 million for the project last year, with $50 million dedicated to developing three types of insulin and the rest set aside to invest in a manufacturing facility.

    Even with the challenges of entering a competitive, established market, Newsom said taxpayers would have “very ample protections.”

    If for whatever reason the deal didn’t work out to the state’s benefit, “there’s all kinds of provisions that would allow us to … pull out,” he said.

    According to state documents, the proposed program could save many patients between $2,000 and $4,000 a year. In addition, lower costs could result in substantial savings because the state buys the product every year for the millions of people on its publicly funded health plans.

    The state also is exploring the possibility of bringing other drugs to market, including the overdose medication Naloxone. The drug, available as a nasal spray and in an injectable form, is considered a key tool in the battle against a nationwide overdose crisis.

    “We are not stopping here,” Newsom said.

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  • California, drugmaker partner to produce affordable insulin

    California, drugmaker partner to produce affordable insulin

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    DOWNEY, Calif. — The state of California and a generic drug manufacturer announced a 10-year partnership Saturday to produce affordable, state-branded insulin that they hope will rival longtime producers and push down prices for a medication used by millions of Americans.

    The product is not expected on store shelves until at least next year, and it was difficult to predict what effect it would have on a market already shaken by change. Earlier this week another major insulin maker promised steep price cuts as pressure builds on drugmakers and insurers to slash the cost of the drug.

    Democratic Gov. Gavin Newsom said he hoped California’s emergence as an insulin-maker would prompt prices to collapse. Research has shown that prices for the drug have more than tripled in the past couple of decades.

    “We are intent to make this about market disruption,” Newsom said at a ceremony announcing the pact at a pharmaceutical warehouse near Los Angeles. He called it “a game changer” for 8 million Americans who use insulin to treat diabetes.

    Many questions remain. The state and its partner, the nonprofit Civica, have yet to locate a California-based manufacturing facility. Regulatory approvals will be needed. Newsom said a 10- milliliter vial of the state-branded insulin would sell for $30, but it’s possible competitors could slash their prices and undercut the state product.

    “Is this perfect? We don’t know yet,” Newsom acknowledged at one point.

    Just days ago, President Joe Biden said his administration is focused “intensely” on lowering health care costs, including pressuring pharmaceutical companies to lower the costs of insulin. Legislation enacted last year capped copayments for insulin at $35 per month for Medicare beneficiaries. Biden has proposed extending that cap to all Americans.

    Novo Nordisk said Tuesday that it will slash some of its U.S. insulin prices up to 75% starting next year. The announcement comes less than two weeks after rival Eli Lilly said it will drop some of its prices by 70% or more later this year.

    Anthony Wright, executive director of Health Access California, a statewide consumer health care advocacy group, welcomed Newsom’s announcement, saying efforts by California and others to develop a competing generic are likely a factor in getting insulin manufacturers to cut their prices.

    Still, there are obstacles.

    “The work to develop a generic, get FDA approval and set up manufacturing will take real time,” Wright said in an email. “There may even be more time in the effort to get doctors to prescribe the drug, insurers and (pharmacy benefit managers) to include it on their formularies and patients and the public to accept and ask for it.”

    There could be other risks. State analysts have warned that California’s entry into the market could prompt other manufacturers to reduce the availability of their drugs, a potential unintended consequence.

    State lawmakers approved $100 million for the project last year, with $50 million dedicated to developing three types of insulin and the rest set aside to invest in a manufacturing facility.

    Even with the challenges of entering a competitive, established market, Newsom said taxpayers would have “very ample protections.”

    If for whatever reason the deal didn’t work out to the state’s benefit, “there’s all kinds of provisions that would allow us to … pull out,” he said.

    According to state documents, the proposed program could save many patients between $2,000 and $4,000 a year. In addition, lower costs could result in substantial savings because the state buys the product every year for the millions of people on its publicly funded health plans.

    The state also is exploring the possibility of bringing other drugs to market, including the overdose medication Naloxone. The drug, available as a nasal spray and in an injectable form, is considered a key tool in the battle against a nationwide overdose crisis.

    “We are not stopping here,” Newsom said.

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  • Governments target medical debt with COVID relief funds

    Governments target medical debt with COVID relief funds

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    Millions of Americans mired in medical debt face difficult financial decisions every day — pay the debt or pay for rent, utilities and groceries. Some may even skip necessary health care for fear of sinking deeper into debt.

    To address the problem, an increasing number of municipal, county and state governments are devising plans to spend federal coronavirus pandemic relief funds to eliminate residents’ medical debt and ease those debt burdens.

    The City Council in the Boston suburb of Somerville last month unanimously passed a resolution to spend $200,000 of the city’s $77 million in American Rescue Plan Act funding that could clear as much as $4.3 million in medical debt, said Willie Burnley Jr., one of the city councilors behind the effort. As many 5,000 of the city’s 80,000 residents could benefit.

    Cook County, Illinois, which includes Chicago, and Pittsburgh, New Orleans and Toledo, Ohio, are among more than a dozen communities that have set into motion or are considering similar plans. Democratic Connecticut governor Ned Lamont last week proposed spending $20 million in ARPA funds to eliminate as much as $2 billion in state residents’ medical debts.

    Unlike credit card or loan debt, medical debt is not a choice, advocates said.

    “Medical debt is something that people can’t help and it’s not their fault,” Burnley said. “No one chooses to get hurt or to get sick.”

    Somerville resident Virginia Faust has health insurance, but she still fell several thousand dollars into debt in 2021 when a mental health emergency required a weeklong hospital stay. The debt affected her credit, and in a cruel irony, put additional stress on her mental health.

    “This would have a tangible effect on my life and relieve a lot of stress,” Faust, 25, said of Burnley’s plan. “It would mean I would be more likely to go to a doctor and get regular checkups.”

    In Toledo, a combined $1.6 million from the city and Lucas County will eliminate as much as $240 million in medical debt for as many as 41,000 residents, according to Ohio state Rep. Michele Grim, who drove the effort when she served as a Toledo city councilor.

    “It’s such a great return on investment,” she said. “I really couldn’t think of a better way to use dollars that were meant to aid in the economic recovery of our citizens.”

    The cities and states are teaming up with RIP Medical Debt, a New York-based nonprofit that since 2014 has used donations to buy huge bundles of debt from hospitals and other health care providers at pennies on the dollar and pay it off. A single donated dollar erases an average of $100 of debt.

    More than 40% of American adults have medical debt and about two-thirds of personal bankruptcies in the nation cite medical debt as a leading cause, said Allison Sesso, president and CEO of the nonprofit.

    The money is coming from the federal government’s $1.9 trillion American Rescue Plan Act, which included $360 billion for local, state, territorial and tribal governments to provide economic relief.

    “This is one of the most impactful and direct ways we can use this money and it would have incredible and quantifiable benefits,” Burnley said.

    Eligibility requirements can vary, but to be eligible in Somerville for the debt relief through RIP Medical Debt, individuals or families can have a household income of up to 400% of the federal poverty — that’s $111,000 annually for a family of four according to federal statistics — or have medical debts that exceed 5% of their annual income.

    There is no need to apply. RIP Medical Debt determines eligibility and the beneficiaries get a letter informing them that their debt has been acquired and canceled. Not everyone will benefit. People whose debt continues to be held by for-profit collection agencies may miss out.

    Unlike federal student loan debt relief, medical debt relief has more widespread and bipartisan support. According to a recent survey by Tulchin Research, more than 70% of Americans support medical debt relief, while only about half of Americans support student loan debt relief. The survey of 1,500 adults had a margin of error of plus or minus 2.5 percentage points.

    Since it’s founding, RIP Medical Debt has raised enough money to eliminate more than $8.5 billion of debt for nearly 5.5 million people. But that’s barely a dent in the total number of people facing tough money choices.

    A 2021 study that appeared in the Journal of the American Medical Association determined that Americans have $140 billion in unpaid health care bills at collection agencies alone, and that debt disproportionately affects the poor.

    Although it’s a good cause, using ARPA funds to discharge medical debt does not address the underlying systemic problem, said Ray Kluender, an assistant professor at Harvard Business School and one of the study’s co-authors.

    Medical debt is a “byproduct of the patchwork way we pay for health care,” he said.

    “While relieving debts after they have gone through the provider collections process won’t address the issues driving the accumulation of these unpaid bills in the first place, it may nevertheless help people who are struggling to pay back their bills,” he said.

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  • California 2024 US Senate contest kicks off at furious pace

    California 2024 US Senate contest kicks off at furious pace

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    LOS ANGELES — California’s U.S. Senate race is unfolding at a furious pace, with candidates reporting seven-figure fundraising and holding competing rallies and campaign events more than a year before the 2024 primary election.

    The fight for the safely Democratic seat held by Sen. Dianne Feinstein, who at 89 is the oldest member of Congress, is shaping up as a marquee match-up between nationally known rivals and is likely to become one of the most expensive Senate races in the country next year.

    On Saturday, Democratic U.S. Rep. Adam Schiff, who rose to prominence as the lead prosecutor in former President Donald Trump’s first impeachment trial, gathered hundreds of supporters in a union hall parking lot for a rally in his hometown of Burbank, California, where he implored the cheering crowd, “Let’s go win this thing.”

    Schiff, who announced his candidacy last month, said he was running for Senate after two decades in Congress “to build an economy that works for everyone, a democracy that will last for all time and a planet that doesn’t melt beneath our feet.”

    A day earlier, Democratic U.S. Rep. Katie Porter brought her Senate campaign to Los Angeles, where she met with local leaders to discuss pollution in lower-income neighborhoods. She said such areas are often overlooked in Washington and Sacramento, where residents’ complaints about unhealthy conditions go unheard.

    Porter, a leader in Congress’ progressive wing, built a reputation for her tough questioning of CEOs and other witnesses at congressional hearings — often using a whiteboard to break down information.

    Other potential contenders for the seat include Democratic Rep. Barbara Lee, a former chair of the Congressional Black Caucus. If she runs and is elected, Lee would be the only Black woman in the Senate.

    Feinstein has yet to say if she will seek a seventh term. In recent years, questions have arisen about her cognitive health and memory, though she has defended her effectiveness. However, her reticence about her future has created a publicly awkward dynamic — the race to replace her is rapidly taking shape, even as the senator remains unclear about her intentions.

    Schiff’s rally, held on a nippy, mostly overcast morning, marked the start of a two-week statewide tour, with stops to include San Diego, Sacramento, Fresno and San Francisco.

    He was joined by his wife Eve, one of his two children, Alexa, and David McMillan, whom the congressman mentored as a youth and considers part of his family.

    After recounting his career as a federal prosecutor, state legislator and member of Congress, Schiff made clear he would anchor his campaign to his role as impeachment manager and Trump’s chief antagonist in Congress. He has been a frequent target of conservatives — Trump in particular — since the then-GOP-led House Intelligence Committee he served on started investigating Trump’s ties to Russia in the 2016 election.

    He mentioned “democracy” more than a half-dozen times in the speech. He’s selling T-shirts and coffee mugs on his campaign website, with the slogan “Democracy Matters.” He called Trump, who has announced his 2024 campaign for the presidency, “a demagogue bent on destroying our democracy.”

    “We investigated Trump. We impeached him. We held him accountable and then we defeated him at the ballot box,” Schiff said to cheers. “And we will defeat him again, if the GOP is foolish enough to nominate him. He will never see the inside of the Oval Office, never again.”

    Trump was impeached in December 2019 on charges he abused the power of the presidency to investigate rival Joe Biden and obstructed Congress’ investigation. The Republican-led Senate acquitted Trump of both charges. In 2021, he became the first president in U.S. history to be impeached twice, this time for inciting the Jan. 6 insurrection at the U.S. Capitol after he lost the 2020 election. He was again acquitted by the Senate.

    Schiff’s other foundational issues include fighting climate change and improving the economy.

    “Too many people are working multiple jobs but cannot pay the rent, afford groceries or pay for lifesaving medication,” he said. “Too many children are growing up in poverty and hungry.”

    Schiff and Porter, both prolific small-dollar fundraisers, already are dueling over campaign dollars and endorsements. Former Democratic House Speaker Nancy Pelosi of San Francisco is backing Schiff, providing Feinstein retires, and Porter is supported by Massachusetts Democratic Sen. Elizabeth Warren.

    Democrats are expected to dominate the contest in the famously liberal state — a Republican hasn’t won a statewide race in California since 2006, and the past two Senate elections had only Democrats on the November ballot.

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  • In new role, Sanders demands answers from Starbucks’ Schultz

    In new role, Sanders demands answers from Starbucks’ Schultz

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    WASHINGTON — As Vermont Sen. Bernie Sanders settles into his new role as chairman of a committee that oversees health and labor issues, he says some corporations “should be nervous.” And the longtime liberal crusader’s first target is Howard Schultz, the interim CEO of Starbucks who has aggressively fought his workers’ efforts to unionize.

    Sanders and the 10 other Democrats on the Senate Health, Education, Labor and Pensions Committee sent a letter to Schultz on Tuesday demanding he testify at a March 9 hearing on his company’s compliance with federal labor laws. If Schultz ignores or refuses the request, Sanders said, he’s willing to use the committee’s subpoena power to force him to appear.

    “This is corporate greed,” said Sanders, 81, who has run for president twice and spent a political lifetime fighting corporations and monied interests over policies that he says hurt the working class. “Workers have a constitutional right to organize. And even if you are a large, multinational corporation owned by a billionaire you don’t have the right to violate the law. And we intend to be asking Mr. Schultz some very hard questions.”

    Sanders’ demand for testimony from Schultz is an opening act in his new role as chairman of the HELP panel, which has expansive jurisdiction over issues that have been central to his more than four decades in public service. And thanks to Democrats adding a seat to their majority in last year’s election, Sanders can fully exercise the oversight powers of the gavel and potentially issue subpoenas without Republican support.

    Sanders said he’s not done challenging individual corporations, mentioning Amazon as another company he believes has acted illegally against unions. And “if you are a multinational pharmaceutical company that’s been ripping off the American people and charging us outrageously high prices, you should be nervous, because I’m going to hold you accountable,” he said in an interview with The Associated Press on Tuesday. “I’m going to do something about it.”

    It’s unclear how much he can accomplish in a divided Congress. While the committee will serve as a bully pulpit for the Senate’s most famous progressive, passing significant legislation through the Senate — not to mention the Republican-led House – will be a heavy-to-impossible lift over the next two years. And finding areas of consensus will be a new test for the cantankerous far-left senator as he is watched uneasily by the industries he regulates and members of his own committee from both parties.

    Sanders said he has “two roles”— one as chairman, with a more realistic focus on results, and another promoting his signature issues like “Medicare for All,” tuition-free college and paid child care, among others. He says he plans to take his “show on the road,” doing a series of town halls, roundtables and field hearings around the country. Next week, he’ll hold a town hall inside the Capitol, bringing teachers unions together to discuss teacher pay.

    “I am chairman of the committee and I want to accomplish as much as I can … that’s what I’m paid to do and I intend to do it,” he said. “On the other hand, there are issues out there that I do not expect will be passed in this Congress, but are very important and they have to be talked about.”

    Republicans are skeptical Sanders can make the kinds of deals necessary to push significant legislation through the committee.

    Utah Sen. Mitt Romney, a Republican on the panel, said Sanders’ style is “a lot of storm and fury” and light on real accomplishments, meaning “little will be done to get through the committee, and very little will reach the floor.”

    Sanders and his Democratic allies point to bipartisan deals he has made in the past, along with some of his unexpected relationships he’s made with Republicans who share slices of his interests. While he spends most of his time talking about his progressive goals, they said, he is also an 16-year veteran of the Senate with an ability to compromise.

    For his part, Sanders noted his deal with the late Sen. John McCain, R-Ariz., to improve veterans’ benefits almost 10 years ago and his work with former rival President Joe Biden, who beat him in the 2020 Democratic primary, to pass COVID relief policy in 2021 and negotiate a massive package of social spending programs that next year. That legislation ultimately stalled.

    On the bipartisan veterans’ legislation, which aimed to improve access to health care after a series of controversies, “he put his heart and soul in it,” said Democratic Sen. Patty Murray of Washington, the previous chairwoman of the HELP committee and a member of the Veterans panel while Sanders and McCain were negotiating. “He learned, he listened, he compromised.”

    Sen. Tim Kaine, D-Va., said Sanders often has a differing view than those in the caucus, “but he usually ends up where the team is.”

    Sanders ticked off Republicans he has worked with — moderate Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, for example, both of whom sit on the committee and have deep interest in rural health issues. He said he’s holding regular meetings with Louisiana Sen. Bill Cassidy, the top Republican on the panel who is known for compromise.

    And this week, Sanders is holding a news conference with Sen. Mike Braun, an Indiana Republican who is on the panel, to demand that railroads provide workers with more sick days.

    Braun said he’s met with Sanders to discuss health care, and while they come at it from opposite angles — Sanders wants it to be government-run, Braun wants to reform the industry to lower costs — they fundamentally agree that there are problems. “When you take everything else away, people are still worried about the high cost of health care,” Braun said.

    Outside of the Capitol, health insurance industry experts are watching what moves Sanders might make around Medicare Advantage, an increasingly popular program where private companies offer plans that are reimbursed by the government for care. Others like health care worker unions are eager to work with Sanders as hospitals around the country grapple with staff shortages and health care worker burnout.

    With his new perch, Sanders seems inclined to stay in the Senate. He said he’s not interested in replacing the departing Labor Secretary, Marty Walsh, and refuses to talk about his own political future at all.

    “I intend to use this committee to address the real issues are facing working class people,” he said.

    ___

    Associated Press writers Amanda Seitz and Seung Min Kim in Washington and Dee-Ann Durbin in Detroit contributed to this report.

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  • Why urgent care centers are popping up everywhere | CNN Business

    Why urgent care centers are popping up everywhere | CNN Business

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    New York
    CNN
     — 

    If you drive down a busy suburban strip mall or walk down a street in a major city, chances are you won’t go long without spotting a Concentra, MedExpress, CityMD or another urgent care center.

    Demand at urgent care sites surged during the Covid-19 pandemic as people searched for tests and treatments. Patient volume has jumped 60% since 2019, according to the Urgent Care Association, an industry trade group.

    That has fueled growth for new urgent care centers. A record 11,150 urgent care centers have popped up around the United States and they are growing at 7% a year, the trade group says. (This does not include clinics inside retail stores like CVS’ MinuteClinic or freestanding emergency departments.)

    Urgent care centers are designed to treat non-emergency conditions like a common cold, a sprained ankle, an ear infection, or a rash. They are recommended if patients can’t get an immediate appointment with their primary care doctor or if patients don’t have one. Primary care practices should always be the first call in these situations because they have access to patients’ records and all of their health care history, while urgent care sites are meant to provide episodic care.

    Urgent care sites are often staffed by physician assistants and nurse practitioners. Many also have doctors on site. (One urgent care industry magazine says, in 2009, 70% of its providers were physicians, but that the percentage had fallen to 16% by last year.) Urgent cares usually offer medical treatment outside of regular doctor’s office hours and a visit costs much less than a trip to the emergency room.

    Urgent care has grown rapidly because of convenience, gaps in primary care, high costs of emergency room visits, and increased investment by health systems and private-equity groups. The urgent care market will reach around $48 billion in revenue this year, a 21% increase from 2019, estimates IBISWorld.

    The growth highlights the crisis in the US primary care system. A shortage of up to 55,000 primary care physicians is expected in the next decade, according to the Association of American Medical Colleges.

    But many doctors, health care advocates and researchers raise concerns at the proliferation of urgent care sites and say there can be downsides.

    Frequent visits to urgent care sites may weaken established relationships with primary care doctors. They can also lead to more fragmented care and increase overall health care spending, research shows.

    And there are questions about the quality of care at urgent care centers and whether they adequately serve low-income communities. A 2018 study by Pew Charitable Trusts and the Centers for Disease Control and Prevention found that antibiotics are overprescribed at urgent care centers, especially for common colds, the flu and bronchitis.

    “It’s a reasonable solution for people with minor conditions that can’t wait for primary care providers,” said Vivian Ho, a health economist at Rice University. “When you need constant management of a chronic illness, you should not go there.”

    Urgent care centers have been around in the United States since the 1970s, but they were long derided as “docs in a box” and grew slowly during their early years.

    They have become more popular over the past two decades in part due to pressures on the primary care system. People’s expectations of wait times have changed and it can be difficult, and sometimes almost impossible, to book an immediate visit with a primary care provider.

    Urgent care sites are typically open for longer hours during the weekday and on weekends, making it easier to get an appointment or a walk-in visit. Around 80% of the US population is within a 10-minute drive of an urgent care center, according to the industry trade group.

    “There’s a need to keep up with society’s demand for quick turnaround, on-demand services that can’t be supported by underfunded primary care,” said Susan Kressly, a retired pediatrician and fellow at the American Academy of Pediatrics.

    Health insurers and hospitals have also become more focused on keeping people out of the emergency room. Emergency room visits are around ten times more expensive than visits to an urgent care center. During the early 2000s, hospital systems and health insurers started opening their own urgent care sites, and they have introduced strategies to deter emergency room visits.

    Additionally, passage of the Affordable Care Act in 2010 spurred an increase in urgent care providers as millions of newly insured Americans sought out health care. Private-equity and venture capital funds also poured billions into deals for urgent care centers, according to data from PitchBook.

    Urgent care centers can be attractive to investors. Unlike ERs, which are legally obligated to treat everyone, urgent care sites can essentially choose their patients and the conditions they treat. Many urgent care centers don’t accept Medicaid and can turn away uninsured patient,s unless they pay a fee.

    Like other health care options, urgent care centers make money by billing insurance companies for the cost of the visit, additional services, or the patient pays out of pocket. In 2016, the median charge for a 30-minute new insured patient visit was $242 at an urgent care center, compared with $294 in a primary care office and $109 in a retail clinic, according to a study by FAIR Health, a nonprofit that collects health insurance data.

    “If they can make it a more convenient option, there’s a lot of revenue here,” said Ateev Mehrotra, a professor of health care policy and medicine at Harvard Medical School who has researched urgent care clinics. “It’s not where the big bucks are in health care, but there’s a substantial number of patients.”

    Mehrotra research has found that between 2008 and 2015, urgent care visits increased 119%. They became the dominant venue for people seeking treatment for low-acuity conditions like acute respiratory infections, urinary tract infections, rashes, and muscle strains.

    Some doctors and researchers worry that patients with primary care doctors – and those without – are substituting urgent care visits in place of a primary care provider.

    “What you don’t want to see is people seeking a lot care outside their pediatrician and decreasing their visits to their primary care provider,” said Rebecca Burns, the urgent care medical director at the Lurie Children’s Hospital of Chicago.

    Burns’ research has found that high urgent care reliance fills a need for children with acute issues but has the potential to disrupt primary care relationships.

    The National Health Law Program, a health care advocacy group for low-income families and communities, has called for state regulations to require coordination among urgent care sites, retail clinics, primary services, and hospitals to ensure continuity of patients’ care.

    And while the presence of urgent care centers does prevent people from costly emergency department visits for low-acuity issues, Mehrotra from Harvard has found that, paradoxically, they increase health care spending on net.

    Each $1,646 visit to the ER for a low-acuity condition prevented was offset by a $6,327 increase in urgent care center costs, his research has found. This is in part because people may be going to urgent care for minor illnesses they would have previously treated with chicken soup.

    There are also concerns about the oversaturation of urgent care centers in higher-income areas that have more consumers with private health care and limited access in medically underserved areas.

    Urgent care centers selectively tend not to serve rural areas, areas with a high concentration of low-income patients, and areas with a low concentration of privately-insured patients, researchers at the University of California at San Francisco found in a 2016 study. They said this “uneven distribution may potentially exacerbate health disparities.”

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  • Washington lawmakers hear testimony on 7 abortion bills

    Washington lawmakers hear testimony on 7 abortion bills

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    OLYMPIA, Wash. — Abortion rights proposals have been front and center in Olympia, Washington, this week as state lawmakers heard hours of public testimony on seven proposals that would reinforce abortion access.

    The emphasis on four legislative committees hearing testimony on abortion bills Tuesday was intended to demonstrate majority Democrats’ support for abortion rights following the U.S. Supreme Court’s decision to overturn Roe v. Wade, The Seattle Times reported.

    The June decision upended nearly 50 years of national abortion protections and sparked action in states throughout the country.

    Lawmakers in Washington have introduced bills that would protect abortion providers in Washington from facing retaliation from other states and lower costs for patients, among others.

    “I think it’s a real statement of our investment in making sure that these policy priorities not only get heard in both chambers, but early enough in session that we can get everything across the finish line,” Sen. Emily Randall, D-Bremerton, said.

    Supporters and opponents of abortion rights testified in person and remotely, many telling personal stories of pregnancy and seeking abortions.

    Abortion has been legal in Washington state since a 1970 statewide ballot referendum. Washington voters in 1991 approved Initiative 120, which codified Roe into state law.

    Democratic Gov. Jay Inslee has asked lawmakers this session to support changing the state constitution to protect abortion rights, and he testified Tuesday in favor of the amendment.

    “What we considered fixed in the American constellation of Democratic values turned out to be very fragile,” Inslee told lawmakers. “And we cannot be lulled into thinking that that same thing cannot be the case in the state of Washington.”

    The amendment faces a challenge in that it requires some Republican support to meet a two-thirds threshold in each legislative chamber. If it passes, the amendment would appear before Washington voters in November.

    Republican Sen. Ann Rivers of La Center questioned Inslee on the need for a constitutional amendment, saying that state law is settled.

    “And look at the makeup of the Legislature and the makeup of our Supreme Court. … Political theater aside, I don’t see any, any world in which Washington state changes course on this issue,” she said.

    “I’m trying to say this in a respectful way: What world are you living in?” Inslee responded. “There is a party in our state that wakes up every single morning trying to take away this right from women. And in multiple states, unfortunately, in multiple states, they have done so effectively.”

    Six other abortion bills require a simple majority to pass and face an easier path. They include a bill that would stop companies from selling data collected from people using apps that track periods and record other health data.

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  • Open enrollment for 2023 health insurance through the public exchange ends Sunday

    Open enrollment for 2023 health insurance through the public exchange ends Sunday

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    Hoxton/Tom Merton | Hoxton | Getty Images

    If you don’t have health insurance for 2023, you may still be able to get it through the public marketplace.

    Open enrollment for the federal health-care exchange ends Sunday, with coverage taking effect Feb. 1. If your state operates its own exchange, you may have more time.

    Most marketplace enrollees — 13 million of 14.5 million in 2022 — qualify for federal subsidies (technically tax credits) to help pay premiums. Some people may also be eligible for help with cost sharing, such as deductibles and copays on certain plans, depending on their income.

    More from Personal Finance:
    3 key moves to make before tax filing season opens
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    So far, nearly 15.9 million people have signed up through the exchange during this open enrollment, which started Nov. 1. Four out of 5 customers can find 2023 plans for $10 or less per month after accounting for those tax credits, according to the Centers for Medicare & Medicaid Services.

    After the sign-up window closes, you’d generally need to experience a qualifying life event — i.e., birth of a child or marriage — to be given a special enrollment period.

    For the most part, people who get insurance through the federal (or their state’s) exchange are self-employed or don’t have access to workplace insurance, or they don’t qualify for Medicare or Medicaid.

    The subsidies are still more generous than before the pandemic. Temporarily expanded subsidies that were put in place for 2021 and 2022 were extended through 2025 in the Inflation Reduction Act, which became law in August.

    This means there is no income cap to qualify for subsidies, and the amount anyone pays for premiums is limited to 8.5% of their income as calculated by the exchange. Before the changes, the aid was generally only available to households with income from 100% to 400% of the federal poverty level.

    The marketplace subsidies that you’re eligible for are based on factors that include income, age and the second-lowest-cost “silver” plan in your geographic area (which may or may not be the plan you enroll in).

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  • Even With Insurance, ERs Can Cost a Bundle

    Even With Insurance, ERs Can Cost a Bundle

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    Jan. 4, 2023 – If you’ve gone to the emergency room recently, you likely know how much such a visit can cost. A new study by researchers at the Kaiser Family Foundation finds that even for people with private insurance who are employed by large companies, the average out-of-pocket cost of an ER visit can exceed their savings.

    In 2019, the study shows, patients enrolled in big companies’ health plans paid an average of $646 in copays and deductibles for each ER visit. A quarter of visits cost more than $907 out of pocket, and another quarter cost under $128.

    About half of households can’t afford to pay the average deductible in an employer-sponsored insurance plan, the report notes. And more than a third of U.S. adults are unable to afford a $400 medical expense without borrowing. 

    While it’s not known how many people don’t go to an emergency room because of the anticipated cost, almost half of U.S. adults report that they’ve delayed care due to costs, according to a recent Kaiser survey.

    One problem that people often face when deciding whether to visit an ER is that they don’t know how serious their condition is and what emergency care will cost, says Hope Schwartz, lead author of the report.

    “When they go to the [ER], they don’t always know what their diagnosis will be and what their treatment costs will be. What we highlighted is that those costs could be very high or very low, and there’s no way to tell beforehand,” she says.

    What Costs So Much?

    Based on the paid claims data used in the study, health plans and patients paid a combined average of $2,453 for an ER visit. A quarter of visits cost $970 or less, and a quarter cost $3,043 or more.

    Emergency room claims include professional fees and facility fees. The facility fees, which cover the cost of a hospital maintaining an ER 24/7, made up 80% of total costs, including a portion of doctors’ claims as well as laboratory and imaging fees. 

    But doctors’ claims for evaluation and management services were the largest part of costs, averaging $1,134 per visit. Procedures and treatments cost over $1,100 per visit, on average, while the average imaging claim cost $483, and the average cost for lab work was $230. 

    Over half of visits generated imaging claims, and about half of visits included lab claims.

    The Kaiser Family Foundation report also looked at the costs of several common ER diagnoses. The most expensive diagnosis was appendicitis, which cost nearly twice as much as heart attacks, partly because it often led to surgery in the emergency room. On average, a visit for appendicitis cost $9,535, of which $1,717 was an out-of-pocket expense.

    In addition, the researchers examined lower-cost diagnoses that generally do not require imaging or extensive treatment in the ER. These included upper respiratory tract infections ($1,535 total, $523 out of pocket), skin and soft tissue infections ($2,005 total, $572 out of pocket), and urinary tract infections ($2,726 total, $683 out of pocket). 

    While these diagnoses can sometimes require admission to the hospital, in otherwise healthy adults they are typically evaluated with basic lab tests, and patients are discharged with prescriptions, according to the report.

    Complexities of Billing

    ER visits are given codes to help show how complex the task or service was during the billing process. These codes have five levels. 

    Less complex visits require straightforward medical decision-making, such as rashes or medication refills. Patients with level 5 codes require highly complex decision-making and include life- or limb-threatening conditions, such as severe infections or heart attacks.

    The less complex visits cost $592, on average, with patients responsible for $205 of that. For the most complex visits, the health plan covered $3,015, on average, or eight times the cost of the lowest-coded visits. 

    On average, patients paid $840 out of pocket for the most complex visits — four times the average costs for the less complex visits.

    One reason for the rise in spending for ER visits is a national shift to higher-level ER billing codes, says Schwartz, who is a Kaiser Family Foundation health policy fellow and a medical student, “There has been good work done showing that [ER] visits are increasingly being billed as a level 4 or 5, whereas in previous years, they might have been billed as a level 3.

    “Whether a hospital bills a level 4 or a level 5 code for your visit can make a really big difference in how much you pay. And if you come in not knowing what services you’re going to get, you don’t know if you’re going to get a level 3, 4, or 5 code, and the costs increase pretty quickly,” she says. 

    Costs Vary by Region

    The report includes an analysis of emergency room costs in the 20 largest metropolitan areas in the U.S. Overall, the researchers found, San Diego had the most expensive ER visits. Emergency rooms in San Diego charged about twice as much per visit, on average, as those in Baltimore.

    While there were expensive areas all across the country, many of the costliest places were in Texas, Florida, California, Colorado, and New York. The report noted that the most expensive regions for ER care did not align with the regions that had the most expensive health care overall. 

    “These comparisons suggest that our findings are not solely related to overall high health care prices in these areas and may reflect other factors, including the age and medical complexity of the population or differences in local norms and practice patterns,” the report says.

    Healthier People

    In addition to these geographical differences, the incidence of emergency room visits by those with employers’ insurance differed from that of the general population.

    During the study year, the report found, 12% of the insured had at least one ER visit — a percentage that didn’t vary for any age group under 65, including children. (No patients 65 or older were included in the study.) 

    By comparison, a government survey shows that in 2019, 21% of all U.S. adults 18 to 44 had one or more emergency room visits. Among those 45 to 64, 20% made at least one ER visit.

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  • Biden signs $1.7 trillion bill funding government operations

    Biden signs $1.7 trillion bill funding government operations

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    KINGSHILL, U.S. Virgin Islands (AP) — President Joe Biden on Thursday signed a $1.7 trillion spending bill that will keep the federal government operating through the end of the federal budget year in September 2023, and provide tens of billions of dollars in new aid to Ukraine for its fight against the Russian military.

    Biden had until late Friday to sign the bill to avoid a partial government shutdown.

    The Democratic-controlled House passed the bill 225-201, mostly along party lines, just before Christmas. The House vote came a day after the Senate, also led by Democrats, voted 68-29 to pass the bill with significantly more Republican support.

    Biden had said passage was proof that Republicans and Democrats can work together.

    Rep. Kevin McCarthy, the House Republican leader who hopes to become speaker when a new session Congress opens on Jan. 3, argued during floor debate that the bill spends too much and does too little to curb illegal immigration and the flow of fentanyl into the U.S. from Mexico.

    “This is a monstrosity that is one of the most shameful acts I’ve ever seen in this body,” McCarthy said of the legislation.

    McCarthy is appealing for support from staunch conservatives in the GOP caucus, who have largely blasted the bill for its size and scope. Republicans will have a narrow House majority come Jan. 3 and several conservative members have vowed not to vote for McCarthy to become speaker.

    The funding bill includes a roughly 6% increase in spending for domestic initiatives, to $772.5 billion. Spending on defense programs will increase by about 10%, to $858 billion.

    Passage was achieved hours before financing for federal agencies was set to expire. Lawmakers had approved two short-term spending measures to keep the government operating, and a third, funding the government through Dec. 30, passed last Friday. Biden signed it to ensure services would continue until Congress sent him the full-year measure, called an omnibus bill.

    The massive bill, which topped out at more than 4,000 pages, wraps together 12 appropriations bills, aid to Ukraine and disaster relief for communities recovering from natural disasters. It also contains scores of policy changes that lawmakers worked to include in the final major bill considered by that session of Congress.

    Lawmakers provided roughly $45 billion for Ukraine and NATO allies, more than even Biden had requested, an acknowledgment that future rounds of funding are not guaranteed when Republicans take control of the House next week following the party’s gains in the midterm elections.

    Though support for Ukraine aid has largely been bipartisan, some House Republicans have opposed the spending and argued that the money would be better spent on priorities in the United States.

    McCarthy has warned that Republicans will not write a “blank check” for Ukraine in the future.

    The bill also includes about $40 billion in emergency spending, mostly to help communities across the U.S. as they recover from drought, hurricanes and other natural disasters.

    The White House said it received the bill from Congress late Wednesday afternoon. It was delivered to Biden for his signature by White House staff on a regularly scheduled commercial flight.

    Biden signed the bill Thursday in the U.S. Virgin Islands, where he is spending time with his wife, Jill, and other family members on the island of St. Croix. The Bidens are staying at the home of friends Bill and Connie Neville, the White House said. Bill Neville owns US Viking, maker of ENPS, a news production software system that is sold by The Associated Press.

    Also in the bill are scores of policy changes that are largely unrelated to spending, but lawmakers worked furiously behind the scenes to get the added to the bill, which was the final piece of legislation that came out of that session of Congress. Otherwise, lawmakers sponsoring these changes would have had to start from scratch next year in a politically divided Congress in which Republicans will return to the majority in the House and Democrats will continue to control the Senate.

    One of the most notable examples was a historic revision to federal election law to prevent a future president or presidential candidate from trying to overturn an election.

    The bipartisan overhaul of the Electoral Count Act is a direct response to-then President Donald Trump’s efforts to persuade Republican lawmakers and then-Vice President Mike Pence to object to the certification of Biden’s victory on Jan. 6, 2021, the day of the Trump-inspired insurrection at the Capitol.

    Among the spending increases Democrats emphasized: a $500 increase in the maximum size of Pell grants for low-income college students, a $100 million increase in block grants to states for substance abuse prevention and treatment programs, a 22% increase in spending on veterans’ medical care and $3.7 billion in emergency relief to farmers and ranchers hit by natural disasters.

    The bill also provides roughly $15.3 billion for more than 7,200 projects that lawmakers sought for their home states and districts. Under revamped rules for community project funding, also referred to as earmarks, lawmakers must post their requests online and attest they have no financial interest in the projects. Still, many fiscal conservatives criticize the earmarking as leading to unnecessary spending.

    ___

    Associated Press writer Kevin Freking in Washington contributed to this report.

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  • EXPLAINER: What happens if COVID asylum restrictions end?

    EXPLAINER: What happens if COVID asylum restrictions end?

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    WASHINGTON — Since the pandemic began, the United States has been using a public health rule designed to limit the spread of disease to expel asylum-seekers on the southern border.

    Title 42, as it’s called, has been used more than 2.5 million times to expel migrants since March 2020, although that number includes people who repeatedly attempted to cross the border.

    The Supreme Court said in a ruling Tuesday that it would keep Title 42 in place indefinitely. The case will be argued in February, and the stay will be maintained until the justices decide the case.

    In November, a federal judge ruled that immigration authorities could no longer use Title 42 to quickly expel prospective asylum-seekers and set a Dec. 21 deadline for its use to end. That set off a legal back-and-forth with a group of conservative-leaning states pushing to keep Title 42 in place and the federal government and immigration advocates say its time is over.

    The change comes as surging numbers of people are seeking to enter the country through the southern border and with Republicans intent on making immigration a key issue when they take control of the House in January.

    A look at Title 42 and the potential impact of the ruling:

    HOW IT STARTED

    In March 2020, the U.S. Centers for Disease Control and Prevention issued an order limiting migration across the southern and northern borders, saying it was necessary to reduce the spread of the coronavirus. The virus was ravaging the U.S., schools were shutting down and hospitals filling up, and President Donald Trump was trying numerous ways to limit migration, his signature political issue.

    The order authorized Customs and Border Protection to immediately remove migrants, including people seeking asylum, to prevent the spread of the virus. The order said areas where migrants were held often weren’t designed to quarantine people or allow for social distancing and could put border personnel and others at risk.

    “The public health risks of inaction are stark,” it said.

    The Biden administration continued the policy. While many Democrats pushed President Joe Biden to overturn Trump’s anti-immigration measures, some — especially in border states — have advocated to keep Title 42, saying the U.S. is unprepared for an increase in asylum-seekers. When the CDC moved to lift it earlier this year, moderate Democrats — including Sens. Mark Kelly of Arizona and Raphael Warnock of Georgia — wanted it to stay.

    THE COURT FIGHT

    In 2021, a group representing immigrants who were denied the right to seek asylum sued to end the use of Title 42.

    As that case made its way through the courts, the CDC announced last April that the rule was no longer needed because vaccines and treatments were becoming much more widespread.

    That sparked Republican-leaning states to file their own lawsuit aimed at keeping Title 42 in place. The states argued that ending the rule would lead to a surge in migrants to their states that would in turn take a toll on their services. That argument found favor with a Trump-appointed judge in Louisiana who ordered keeping the restrictions in place. The judge found Biden’s administration failed to follow administrative procedures requiring public notice and time to gather public comment on the plan to end the restrictions.

    But that ruling was effectively blocked by another federal judge in a separate lawsuit in Washington. That judge, appointed by Democratic President Bill Clinton, ruled on Nov. 15 that the Biden administration must lift the asylum restrictions by Dec. 21. That ruling, addressing broader questions about Title 42, took precedence over the Texas ruling, cheering immigration advocates. In a key development, the federal government did not appeal to keep the public health restrictions in place.

    “The court was correct to find that banning migrants, while allowing the rest of the country to open up, is unlawfully arbitrary, causes grave harm to desperate asylum-seekers, and overrides the United States’ legal commitments to provide a safe haven for those fleeing persecution,” said Lee Gelernt, a lawyer for the American Civil Liberties Union.

    Then a group of conservative states tried to intervene to keep Title 42 in place. They argued that the cancellation of pandemic-era policy “will cause an enormous disaster at the border” and the additional migrants will increase the states’ costs for law enforcement, education and health care. They’ve also argued that they had to intervene after the federal government did not push to keep Title 42 in place. The case has gone all the way up to the U.S. Supreme Court, who last week ordered a temporary stay keeping Title 42 in place so it could thoroughly study each side’s arguments.

    The Supreme Court’s decision Tuesday extended the temporary stay indefinitely as it set a February timetable for hearing arguments.

    DOES TITLE 42 AFFECT ALL ASYLUM-SEEKERS?

    Not really. The Biden administration has not used it with children traveling alone, only single adults or families. And the ban has been unevenly enforced by nationality, falling largely on migrants from Guatemala, Honduras and El Salvador — in addition to Mexicans — because Mexico allows them to be returned from the United States. Last month, Mexico began accepting Venezuelans who are expelled from the United States under Title 42, causing a sharp drop in Venezuelans seeking asylum at the U.S. border.

    Some other nationalities are less likely to be subject to Title 42 because costs or frayed relations with their home countries, Cuba for example, make it difficult for the U.S. to send them back. People from these countries have become a growing presence at the border, confident they will be released in the United States to pursue their immigration cases.

    According to the most recent figures released by Customs and Border Protection officials, illegal border crossings by Cubans and Nicaraguans rose sharply in November while overall migration flows were little changed from October.

    WHAT HAPPENS IF TITLE 42 ENDS?

    If it goes away, asylum-seekers will be interviewed by asylum officers who will determine if they have a “credible fear” of being persecuted in their home countries. If they’re found to face a credible threat, they can stay in the U.S. until a final determination is made.

    That can take years. Although some are detained while their asylum process plays out, the vast majority are freed into the United States with notices to appear in immigration court or report to immigration authorities.

    The Department of Homeland Security said in a memo outlining their preparations for the end of Title 42’s use that the current system is not designed “to handle the current volume of migration nor the increased volume we expect over the coming weeks and months.”

    It said it is preparing for a possible surge by cracking down on smuggling networks, speeding removal of those found to have little basis to stay in the U.S., and working with international partners to stem migration. It said it’s also seeking more money from Congress. Meanwhile, as temperatures plummeted last week, thousands of migrants were gathered on the Mexican side of the border waiting to see what happens if and when Title 42’s use ends.

    Republicans, who will control the House come January, are expected to make immigration a major issue. Already there have been calls to impeach the Homeland Security Secretary Alejandro Mayorkas.

    Some Democrats have also voiced concern about what happens when Title 42 goes away. In a letter to Biden this week, Sen. Joe Manchin of West Virginia and Rep. Henry Cuellar of Texas joined two Texas Republicans — Sen. John Cornyn and Rep. Tony Gonzales — in asking Biden to keep Title 42 in place, saying there was a crisis at the southern border and that DHS hadn’t presented a plan to maintain control there.

    ——

    Follow Santana on Twitter @ruskygal.

    ———

    Follow AP’s complete coverage on immigration: https://apnews.com/hub/immigration

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  • Inflation is slowing, but still high. What you need to know

    Inflation is slowing, but still high. What you need to know

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    NEW YORK — After reaching 40-year highs over the summer, price increases in the U.S. are now steadily easing.

    Consumer inflation slowed to 7.1% in November from a year earlier and to 0.1% from October, the government said Tuesday. Stripping out volatile food and energy prices, so-called core inflation rose 6% over the past 12 months and 0.2% from October.

    Though inflation is slowing, prices remain steep, especially for food and many services.

    Here’s what you need to know:

    WHAT’S GOING ON WITH INFLATION?

    In recent months, there’s been a shift in inflation from goods to services.

    In general, that means prices for goods and gas are rising more slowly than prices for things like dining out, travel, health care, financial services and hospitality. Prices for used cars, furniture, and appliances have moderated.

    Food prices are an exception, driven by more expensive eggs, vegetables, and chicken.

    Kathy Bostjancic, chief economist at Nationwide, noted that core goods prices — once you exclude food and energy — have been slowing dramatically. But services prices, excluding energy, have stayed near a 40-year high.

    WHAT IS CONTRIBUTING TO THE SLOWING OF INFLATION?

    Average gas prices have tumbled from $5 a gallon in June to as low as $3.26 a gallon, according to AAA, below their average a year ago.

    Supply chain snarls are also coming to an end. Ports have cleared ship backlogs. And the cost of shipping a cargo container from Asia has returned to its pre-pandemic price.

    The Federal Reserve’s series of aggressive interest rate hikes have also created downward pressure on prices by making borrowing steadily more expensive.

    WHY ARE SERVICES PRICES RISING MORE THAN GOODS PRICES?

    Some of it is the ongoing shift from the pandemic era, when millions of Americans stayed away from restaurants, postponed vacations and stopped going to concerts or movie theaters. Now, as COVID-19 fades, people are making up for lost time by traveling and dining out again.

    At the same time, spending on goods like exercise bikes, furniture, and cars spiked during the pandemic but is now declining.

    Some economists point to rising wages as a primary cause of increasing service costs, as employers pass on the higher cost of labor to consumers.

    Others say companies have seens that consumers are willing to absorb increasingly higher prices in recent months. As costs for things like shipping have eased, corporations have not always passed those savings on to consumers.

    “If companies don’t feel the pressure and need to discount, they won’t,” Bostjancic said. “They’ve achieved some pricing power, and it’s been good for the bottom line. They’ve profited quite nicely, and they want to hold on to that pricing power as long as possible. As long as the consumer withstands those prices, they won’t change that.”

    WHAT DOES ALL THIS MEAN FOR INTEREST RATES?

    In some ways, the Fed is better suited to combat goods inflation than services inflation. When people buy expensive items like appliances, cars, or furniture, they often borrow money to do so. A high interest rate increases the cost of borrowing, thereby slowing those purchases. The Fed has a less clear pathway to affecting the price of services.

    So while inflation in the goods sector is slowing, inflation in the services sector could prove more stubborn. As people spend down savings they built up during the pandemic, demand may slow. But until those savings are meaningfully depleted, or debt reaches unmanageable levels, spending may continue.

    That said, the Fed’s benchmark short-term rate affects loan rates throughout the economy. The central bank has already weakened the housing market significantly with its tightened monetary policy.

    Chair Jerome Powell has made clear that the Fed will raise its key rate by a smaller increment when it meets Wednesday. Investors foresee a half-point Fed hike, after four straight three-quarter-point increases.

    WHERE DOES INFLATION GO FROM HERE?

    Powell has suggested that housing costs, which have been a major driver of inflation, should start to slow next year — including rent.

    And Gregory Daco, chief economist at EY-Parthenon, suggested that the momentum behind inflation will continue to ease in 2023.

    “We expect to see ongoing downward pressure on the goods front and energy-prices front in the next 12 months,” Daco said. “On the services side, we expect to see some abating pressures, with less demand for travel and leisure over time.”

    Daco predicted there will be downward pressure on housing costs, too.

    SO HOW LOW COULD INFLATION GO?

    The Fed sets a target to keep annual inflation averaging around 2 percent. Before the pandemic struck, inflation was so persistently low that the central bank struggled to even raise it to 2%. (Too-low inflation can slow economic growth by causing people to delay purchases if they think they can buy a product for a lower price later.)

    Some economists are now suggesting that the Fed won’t be able to get inflation down to 2% again anytime soon — and might conclude instead that a somewhat higher inflation target is more realistic.

    IF INFLATION IS SLOWING, WHY DOES IT STILL FEEL PAINFUL?

    Wages haven’t kept up with prices, and lower-income households, which spend disproportionately more on housing, fuel and food, have been hit hardest.

    “We’re not equal in the face of inflation,” Daco said. “If anything, inflation tends to exacerbate inequalities.”

    These factors can lead to a “K-shaped” recovery, in which the performance of different parts of the economy diverges like the arms of the letter “K.” In this scenario, some parts of the economy may experience strong growth while others continue to decline.

    “There’s a wealth effect,” said Nationwide’s Bostjancic. “Upper- and middle-income households have more pandemic-related savings. They always have more of a buffer to withstand downturns than other income groups.”

    Low- and middle-income households may have already exhausted their reserves, Bostjancic noted, and now lack the savings to cope with both higher prices and higher borrowing rates.

    “Even though they’ve seen wage gains, it’s lagged behind inflation,” she said. “So we’ve seen more people turning to credit. We’re not seeing outright delinquencies, but people are falling behind on payments, which indicates there’s stress on the consumer.”

    IS THERE STILL RISK OF A RECESSION?

    Daco indicated that a recession is not looming large on the near horizon.

    “We’ve seen resilience both on the part of the U.S. consumer and business executives,” he said. “Companies haven’t proceeded with broad-based layoffs. As of now, we’re not in a recession, but we’re seeing more hesitance and discretion when it comes to hiring and buying decisions.”

    ———

    Follow all of AP’s financial wellness coverage at: https://apnews.com/hub/financial-wellness

    ———

    The Associated Press receives support from Charles Schwab Foundation for educational and explanatory reporting to improve financial literacy. The independent foundation is separate from Charles Schwab and Co. Inc. The AP is solely responsible for its journalism.

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  • Leonard, George lead Clippers over NBA-best Celtics, 113-93

    Leonard, George lead Clippers over NBA-best Celtics, 113-93

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    LOS ANGELES — Kawhi Leonard came to the bench with a message for his Los Angeles Clippers teammates.

    “Told the guys, ‘Let’s get out and run, let’s play faster,’” coach Tyronn Lue said.

    Behind 26 points from Paul George and Leonard’s season highs of 25 points and nine rebounds, the Clippers routed the NBA-leading Boston Celtics 113-93 on Monday night.

    “When your two best players come back, that’s a lot of energy,” Lue said.

    The Clippers’ defense held the Celtics under 100 points for the first time this season.

    “We did a great job pretty much across the whole board,” George said.

    Leonard also had six assists in his best all-around game of a young season that has been interrupted at times while he eases his way back from ACL surgery that cost him all of last season.

    “Only my ninth game,” Leonard said. “You can’t rush it. Yeah, just got to keep moving.”

    George has been hurt, too, although unlike Leonard, he’s no longer under a minutes restriction.

    “We’re still trying to figure out how we’re going to play on the court with one another,” George said. “It’s just good if both of us are playing aggressive.”

    Jaylen Brown scored 21 points to lead the Celtics, who dropped two in a row for only the second time this season. They had won eight of 10, including a loss at Golden State on Saturday. Jayson Tatum added 20 points — well below his 30-point average — and 11 rebounds, and Malcolm Brogdon had 18 points off the bench.

    “We made a conscious effort to make sure Tatum and Brown played in a crowd all night,” Lue said.

    Having the Celtics and their 21-7 record in town drew one of the Clippers’ biggest crowds of the season and created a playoff-like atmosphere. Boston fans showed out in the same colored gear as Marcus Smart’s green-hued hair.

    But the Clippers made most of the noise.

    Coming off a 2-2 East Coast trip, Los Angeles used a few big runs and solid defense to control the first half and take a 56-47 lead at the break.

    Leonard and George came out shooting to start the third. They each hit a 3-pointer while combining for 13 straight points that extended the lead to 69-55. Luke Kennard came off the bench and keyed a 7-0 run late, hitting a 3 before John Wall’s jumper put the Clippers ahead 88-72 going into the fourth.

    George and Leonard combined for seven straight points in the fourth and Kennard kept hitting, too, pushing the Clippers’ lead to 104-80.

    “How he played was huge, just seeing him get his rhythm back,” Lue said of Leonard. “The last couple games just playing with more pace. He’s been feeling good.”

    The biggest roar came when Smart missed a pair of free throws, ensuring fans free chicken sandwiches. Smart finished with three points and five fouls.

    George and Leonard were part of the Clippers’ 17-8 spurt in the second. Los Angeles ran off 11 points in a row as part of a 20-3 burst in the first.

    TIP-INS

    Celtics: Al Horford (personal reasons) is expected to rejoin the team when it returns home this weekend. … Former Clipper Blake Griffin started in Horford’s place. He picked up a technical foul in the second quarter for grabbing the net.

    Clippers: Norman Powell (left groin strain) is progressing well in individual workouts, but there’s no timetable for his return. … Ivica Zubac was a game-time decision to start after experiencing right groin soreness in Saturday’s game. He had four points, three rebounds and five fouls in 17 minutes.

    UP NEXT

    Celtics: At the Los Angeles Lakers on Tuesday in the second game of a back-to-back on Boston’s second-longest road trip of the season.

    Clippers: Host the Minnesota Timberwolves on Wednesday in the second of five straight home games.

    ———

    AP NBA: https://apnews.com/hub/NBA and https://twitter.com/AP—Sports

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  • Wholesale inflation in US further slowed in November to 7.4%

    Wholesale inflation in US further slowed in November to 7.4%

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    WASHINGTON — Wholesale prices in the United States rose 7.4% in November from a year earlier, a fifth straight slowdown and a hopeful sign that inflation pressures across the economy are continuing to cool.

    The latest year-over-year figure was down from 8% in October and from a recent peak of 11.7% in March. On a monthly basis, the government said Friday that its producer price index, which measures costs before they reach consumers, rose 0.3% from October to November for the third straight month.

    Rising prices are still straining Americans’ finances, particularly for food, rent and services such as haircuts, medical care and restaurant meals. Yet several emerging trends have combined to slow inflation from the four-decade peak it reached during the summer. Gas prices have tumbled after topping out at $5 a gallon in June. Nationally, they averaged $3.33 a gallon Thursday, according to AAA, just below their average a year ago.

    And the supply chain snarls that caused chronic transportation delays and shortages of many goods, from patio furniture to curtains, are unraveling. U.S. ports have cleared the backlog of ships that earlier this year took weeks to unload. And the cost of shipping a cargo container from Asia has fallen sharply back to pre-pandemic levels.

    As a result, the prices of long-lasting goods, from used cars and furniture to appliances and certain electronics, are easing.

    Friday’s producer price data captures inflation at an early stage of production and can often signal where consumer prices are headed. Next week, the government will report its highest-profile inflation figure, the consumer price index. The most recent CPI report, for October, showed a moderation in inflation, with prices up 7.7% from a year earlier. Though still high, that was lowest year-over-year figure since January.

    Federal Reserve Chair Jerome Powell, in a speech last week, pointed to the decline in goods prices as an encouraging sign. Powell suggested that housing costs, including rent, which have been a major driver of inflation, should also start to slow next year.

    The Fed chair also signaled that the central bank will likely raise its benchmark interest rate by a smaller increment when it meets next week. Investors foresee a half-point Fed hike, after four straight three-quarter-point increases.

    Yet Powell noted that services prices, which reflect the largest sector of the U.S. economy, are still increasing at a historically fast pace. Rapidly rising wages are a key driver of services inflation, he noted. That’s because as wages rise, many businesses pass on their higher labor costs to their customers through higher prices, which drives up inflation.

    Pay is still rising quickly and could continue to fuel higher inflation through most of next year. In last week’s jobs report for November, the government reported that average hourly pay jumped 5.1% from a year earlier, far above the pre-pandemic pace. Powell said wage gains closer to 3.5% would be needed to bring inflation down toward the Fed’s 2% annual target.

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  • Health insurance premiums at work didn’t rise in 2022 amid soaring inflation, but the good times won’t last | CNN Politics

    Health insurance premiums at work didn’t rise in 2022 amid soaring inflation, but the good times won’t last | CNN Politics

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    CNN
     — 

    Even though the price of gas, groceries and other essentials shot up in 2022, health care premiums for employer-sponsored coverage remained essentially flat, according to a survey released Thursday.

    Job-based policies for families cost an average of roughly $22,500 in 2022, with workers contributing an average of about $6,100, the Kaiser Family Foundation Employer Health Benefit Survey found. That is basically the same as last year.

    The average cost of single policies was just over $7,900 for this year, with employees responsible for about $1,350.

    Unlike in previous years, premium growth trailed behind the increases in inflation and workers’ wages, which came in at 8% and 6.7%, respectively. That’s because the cost of coverage is typically set months in advance – before inflation really took off.

    Also, utilization of health care services remained low in 2021, so employers that fund their own health plans didn’t spend as much as anticipated, which allowed them to keep premiums steady this year, said Matthew Rae, associate director for the Program on the Health Care Marketplace at Kaiser.

    But workers can expect to feel the sting of inflation when they enroll in coverage for next year, which is happening now at many companies.

    “Employers are already concerned about what they pay for health premiums, but this could be the calm before the storm, as recent inflation suggests that larger increases are imminent,” said Drew Altman, Kaiser’s chief executive officer.

    Other surveys show that premiums and out-of-pocket costs are expected to increase in 2023 at a faster rate than in recent years due to inflation. Hospitals, doctors and other providers are feeling the pricing pressure. Their costs for labor, particularly nurses and service staff, and supplies have increased sharply due to inflation and demand. So they are pushing insurers to raise their reimbursement rates when contracts are up for renewal.

    Nearly 159 million non-elderly people are covered by employer-sponsored health insurance, according to Kaiser.

    For this year, deductibles only inched up. The average annual deductible stands at roughly $1,760 among workers who face a deductible for single coverage. That compares with about $1,670 last year.

    Employers, particularly large ones, see a growing need for mental health services, the Kaiser survey found.

    Nearly half of big companies saw an increase in the share of workers using mental health services, and more than a quarter say that more employees are asking for family leave because of mental health issues.

    But many employers don’t feel they have enough providers in their networks to provide timely access to mental health care, Rae said.

    While 82% of firms said they have a sufficient number of primary care providers, only 44% said the same of behavioral health providers.

    Telehealth remains important, with three-quarters of firms saying telemedicine matters “somewhat” or “a great deal” in providing access to mental health services.

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  • Biosimilars May Finally Stop the Rocketing Cost of Insulin

    Biosimilars May Finally Stop the Rocketing Cost of Insulin

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    Oct. 26, 2022 – Trapper Haskins, a 45-year-old musician with type 1 diabetes, says the price of insulin is a constant stressor in his life. The Nashville resident takes two types of insulin daily and sometimes must ration the medicine because his insurance plan caps how much of the pricey drug he can receive each month. Insulin “isn’t like a high blood pressure medication,” he says. “Some days you need more, and then you get to the end of the month and you’re afraid you’ll run out.” 

    Research shows that among people with type 1 and type 2 diabetes, about one in four must ration their supplies due to cost. In general, most people with diabetes need two or three vials of insulin a month. Each vial can cost hundreds of dollars, meaning patients’ costs could easily reach $1,000 a month.  

    “The price of insulin has tripled in the last 10 years, and it’s creating a national crisis,” says Lizheng Shi, PhD, a professor of health policy at Tulane University in New Orleans.          .

    There are 1.5 million people with type 1 diabetes in the U.S. who can’t buy their own insulin and are entirely dependent on it to keep their blood sugar in a safe range. The vast majority of people with diabetes, some 37 million, have type 2 diabetes, which usually results in the use of blood sugar-reducing medications until insulin is introduced later on because the body no longer responds to its own. 

    The high cost of insulin is largely due to a lack of competition and too few makers of the current products, says Shi. One of the best hopes for more affordable insulin is to increase market competition and drive down prices with the introduction of so-called biosimilar drugs, which are highly similar versions of the original biologic medications – and typically far less expensive. 

    Creating Competition in the Market 

    In July 2021, the FDA approved the first biosimilar product that could be used interchangeably with current insulin products. Called Semglee, it’s a long-acting insulin analog and the generic form of Lantus, the world’s leading basal insulin, whose patent expired in 2016. Semglee, which is made by the drug company Mylan, is now available under some 2022 insurance plans and is approved for patients with type 1 and type 2 diabetes. But Semglee isn’t inexpensive – it’s around $133 per vial without insurance. Some versions of Lantus retail for more than $300. 

    The introduction of insulin biosimilars won’t bring major price cuts anytime soon,  says Jing Luo, MD, an assistant professor of medicine at the University of Pittsburgh. One reason, he says, is that it takes years for drugmakers to develop  the expertise and capacity to scale up production of biosimilars. Still, Luo is optimistic that we’ll get there in the next 2-3 years, and once we do, it could mean insulin would cost 10 times less. 

    Luo cites  the work of the nonprofit Civica Rx. In March, the organization announced it would produce large-scale generic insulin in an effort to drive down cost. 

    The company will produce three forms of insulin to be used interchangeably with Lantus, Humalog, and Novolog. The products will be sold for no more than $30 a vial. They’ve already started building their manufacturing plant in Petersburg, VA, and will have products available for purchase by 2024, pending FDA approval.

    Additionally, the state of California plans to produce its own generic insulin. The state is investing $50 million to make biosimilar insulin products and another $50 million to build a manufacturing facility. 

    Not Soon Enough

    But for many, price cuts aren’t happening fast enough. Allison Bailey of Ames, IA, who has type 1 diabetes, says that it can feel daunting sometimes to find a way to pay, but she couldn’t survive without the life-saving medication. At times, it’s cost her up to $500 to fill her prescription. Bailey was eventually able to adjust her prescription to a less expensive insulin, but the 35-year-old graphic designer says her insurance coverage still takes up a sizable chunk of her monthly expenses.

    The introduction of biosimilars has not driven down the price of insulin fast enough for patients like Bailey, says Robert A. Gabbay, MD, PhD, chief science and medical officer at the American Diabetes Association. That’s why the association is pushing legislation to bring down insulin prices. It lobbied hard to establish a $35-per-month Medicare price cap that will go into effect in 2023. Now it’s focused its efforts on expanding the caps to private insurers, a move that was voted down by Republicans in Congress as part of the Inflation Reduction Act. 

    “We want to see some transparency in pricing; right now, everyone just points fingers at each other and we don’t know who’s to blame,” Gabbay says. 

    But people with diabetes like Haskins and Bailey agree that competition from biosimilars and price caps could help bring down what they view as the exorbitant prices for medications they need. “I’m lucky I have insurance, but for those who don’t, it’s often a life-or-death situation,” says Haskins

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