News: Axios Vitals: Debt relief test

Monday, October 31, 2022

Axios Vitals: Debt relief test

Presented By PhRMA

Axios Vitals

By Tina Reed · Oct 31, 2022

🎃 Happy Monday, Vitals readers. Don't forget to watch out for trick-0r-treaters while you're on the way home from work tonight.

1 fun thing: Check out pics from the annual tradition of NICU babies getting dressed up for Halloween at Children's National Hospital and Texas Health Resources.

Today's newsletter is 1,045 words or a 4-minute read.

1 big thing: Arizona tests a progressive take on medical debt relief

Illustration of a dollar-shaped weight causing cracks in the ground

Illustration: Sarah Grillo/Axios

An Arizona ballot initiative addressing medical debt collection could provide an important test next week of whether a populist progressive approach to health care costs can fly in conservative-led states.

Why it matters: The measure limiting how hard creditors can pursue people with outstanding medical bills could become a model in states unwilling to tackle the issue through their legislatures.

It comes as medical debt is weighing on millions of Americans — particularly communities of color — and the aggressive collection tactics of some health systems are coming under heightened scrutiny.

What they're saying: "No one should be trapped in debt simply because they needed medical care, yet tens of millions of Americans are stuck with thousands of dollars of medical debt," Kelly Hall, executive director of the Fairness Project, an organization that pushes such ballot measures, told the Arizona Republic.

The big picture: Unpaid medical bills are the largest source of debt in America.

A KFF analysis of government data earlier this year found about 9% of American adults owed more than $250. About 1% owe more than $10,000.

Zoom in: The Arizona measure, Proposition 209, would reduce the maximum amount of interest creditors can charge on medical debt to 3%, from a previous cap of 10%.

It would also increase the assets exempt from debt collection and allow courts to reduce how much of a person's earnings can be garnished.

The big picture: More states are exploring expanded consumer protections through legislation or other means.

And the Biden administration last spring called for HHS to evaluate providers' billing practices.

Yes, but: Critics have warned efforts targeting medical debt can have unintended and costly consequences.

"It's marketed as a medical debt initiative but yet impacts all collection remedies across the board," Amber Russo, spokesperson for Protect Our Arizona, which opposes the Arizona ballot measure, told Politico.

Read the rest.

2. More chances to enroll in Medicare

Illustration: Aïda Amer/Axios

People who miss Medicare's open enrollment next year because of extenuating circumstances will get a special sign-up period to ensure continuous coverage under a CMS rule finalized Friday, Axios' Maya Goldman reports.

Why it matters: The rule aims to keep people who fall off Medicaid rolls and other groups from falling into a coverage gap. It cold also help those who were incarcerated, got caught up in an emergency or were victimized by a private health plan's administrative error.

CMS previously didn't make such exceptions. Congress required the changes, and the agency proposed them in April.
"These policies would help reduce disparities in care and promote health equity by eliminating barriers to and ensuring ease of enrollment in Medicare, thereby expanding healthcare coverage," the American College of Emergency Physicians wrote in a May letter to CMS.

Zoom out: Seniors can generally opt into their Medicare Part B coverage in the three months before and after their 65th birthday, or in the eight months after their group or employer health coverage ends. If they miss the window, a late fee will be added to their premium for the rest of their enrollment.

Beginning Jan. 1, people who miss those windows due to extenuating circumstances can get Part B coverage without a penalty.

3. Lobbying surged 70% over 20 years

Illustration: Aïda Amer/Axios

Health industries' spending on federal lobbying rose 70% from 2000 to 2020, largely driven by drug and device makers and activities surrounding the Affordable Care Act, Axios' Sabrina Moreno reports from new research in JAMA Health Forum.

Why it matters: A small number of firms spent disproportionate sums on lobbying, which could marginalize others in policymaking.

What they found: The industry as a whole spent $713.6 million lobbying federal policymakers in 2020, compared to $358.2 million in 2000. Drug and device manufacturers accounted for about 43% of the total in 2020, or $308.4 million.

Growth on spending was steeper in the early 2000s, as players adjusted to the ACA and tried to influence its implementation.
Spending was highly concentrated, with the top 10% of firms accounting for 70% of lobbying outlays among payers, 69% among manufacturers and 59% among providers, researchers found.

A message from PhRMA

Americans want policy reforms that improve their insurance

Did you know 39% of insured Americans say they don't understand what's covered by their insurance? Health insurance coverage should be predictable and transparent, and insured Americans agree.

Learn more from PhRMA's latest Patient Experience Survey report.

4. Quote du jour: Mental health crisis teams

Illustration: Shoshana Gordon/Axios

"One of the reasons for having a mental health crisis response, beyond the fact that that's the correct response, is to minimize police interactions with those folks because, frankly, police don't do it well."

— Michelle Gross, president of Twin Cities-based Communities United Against Police Brutality

Many big-city departments have begun sending unarmed mental health professionals to respond to certain 911 calls in the wake of George Floyd's killing by Minneapolis police, Axios Twin Cities' Nick Halter writes with Axios Local reporters around the country.

Why it matters: Backers of the programs say these professionals are better equipped than police to help — and they see the programs as a way to prevent police shootings, including those involving people of color.

How it works: Minneapolis began a pilot in December. In the first six months, mental health professionals responded to 3,300 calls — about 3% of the city's 911 calls.

At a recent Minneapolis public safety hearing, responders shared stories of getting a suicidal resident scheduled for a doctor's visit and helping her set up a safety plan.

5. While you were weekending

Illustration of a desk on a beach under a palm tree.

Illustration: Aïda Amer/Axios

👀 Some of the lone antibody therapies that are helping protect the immunocompromised against COVID could soon be obsolete. (The Atlantic)

👉 Psychiatrists are expressing concern about a rise in online startups prescribing ketamine for Americans with depression, offering little oversight. (Wall Street Journal)

6. 1 last thing: "Never events" at hospitals

On Friday, we told you about a JAMA Health Forum article arguing the idea of a health system pursuing debt collections against low-income patients should be considered "never events."

Be smart: We put out a call to see what else you think should be non-starters in health care.

Here are some of the answers:

Hospitals should "never act in anti-competitive ways to unfairly leverage their market power," said Farzad Mostashari, co-founder and CEO of Aledade, a company that helps doctors set up ACOs.
They should also never enforce five-year, 50-mile non-competes against employed physicians who want to set up their own practices, Mostashari added.
A "hospital should never turn away people based on their sexual or gender identity and should treat them with the same care, respect, and cultural competency as they do for straight/cisgender patients," said Caitlyn Strohmeyer, a health equity educator in Pennsylvania.

A message from PhRMA

How insured Americans navigate unclear insurance coverage

According to new findings, insured Americans favor policy solutions that improve their ability to navigate and access their care while lowering their out-of-pocket costs.

An example: Tackling the barriers introduced by insurers and middlemen like pharmacy benefit managers.