The number of people who have trouble paying their medical bills has plummeted in the last five years as more people have gained health insurance through the Affordable Care Act and gotten jobs as the economy has improved.

A report from the National Center for Health Statistics released Wednesday shows that the number of people whose families are struggling to pay medical bills fell by 22 percent, or 13 million people, in the last five years.

And that’s good news, according to consumer and health policy advocates.

“The effect on families is profound,” says Lynn Quincy, director of the Healthcare Value Hub at the Consumers Union. “Health care costs are a top financial concern for families, far above other financial concerns.”

Quincy says the number one determinant of whether people can pay medical bills is whether they have insurance.

“The fact that this report shows it’s getting easier, it seems like we should lay a good part of this at the door of the ACA,” she says.

The decline in families worrying about medical bills corresponds with a huge increase in the number of people who have health insurance. In 2011, 46.3 million in the U.S. were uninsured. In June of this year, that figure had fallen to 28.4 million people.

Much of that increase is due to the Affordable Care Act, whose insurance exchanges were launched in 2013 for coverage starting in 2014.

About 20 million people this year have health insurance because of the ACA, according to the Department of Health and Human Services. That includes about 10 million people who gained coverage through the expansion of Medicaid and another 10 million who buy insurance on the Obamacare exchanges or are young adults covered through their parents’ insurance.

Kevin Lucia, a research professor at Georgetown’s Health Policy Institute, says the insurance offered under Obamacare has more financial protections than pre-ACA policies.

“The coverage is more protective in many ways,” he says. “It doesn’t include annual limits [or] lifetime limits, and it includes a comprehensive benefit package. That may be contributing to the improved data.”

Some of the relief could also come because more people have jobs, so they can more easily pay their bills.

The unemployment rate has fallen from 9.1 percent in January 2011 to just 4.9 percent in June, according to the Bureau of Labor Statistics.

The finding that people are having an easier time paying medical bills may seem surprising because of reports that insurance premiums and cost-sharing have been rising in recent years.

A report in September by the Kaiser Family Foundation shows that more and more companies are offering their employees health insurance plans that carry higher deductibles.

But Quincy says simply having coverage is the key.

“People speak loudest when they are faced with increasing deductibles and increase cost sharing,” she says. “But nothing determines the affordability of care than that binary equation: Do you have coverage or do you not?”

The report comes just as President-elect Donald Trump is naming officials to his health policy team who are determined to dismantle the Affordable Care Act. Trump has pledged to repeal and replace the health law, and on Tuesday named Rep. Tom Price, R-Georgia, a vocal opponent of Obamacare, to lead the Department of Health and Human Services.

Repealing the law would hurt the people who are seeing relief from high medical bills as highlighted in this report, says Jay Angoff, a former Missouri insurance commissioner who helped implement the Affordable Care Act at HHS.

“There are millions of people who have coverage under Obamacare,” Angoff says. “What are they going to tell those guys?”

Let’s block ads! (Why?)

Rep. Tom Price, a Georgia Republican, is President-elect Donald Trump’s pick for Secretary of Health and Human Services. He is currently chairman of the powerful House Budget Committee.

Price, an orthopedic surgeon for nearly 20 years before coming to Congress, has represented the northern Atlanta suburbs in the House of Representatives since 2005.

If confirmed by the Senate, Price would likely have a central role in the Republicans’ stated plans to dismantle the Affordable Care Act and design a replacement. He has repeatedly introduced legislation to repeal and replace the ACA and is one of hundreds of Republicans who have voted dozens of times to repeal the federal health care law since it was enacted in 2010. Those efforts either didn’t make it to President Obama’s desk or were vetoed by him.

As HHS secretary, Price would not only oversee Obamacare as it currently exists, but also run the government’s largest social programs, including Medicare, Medicaid and the Children’s Health Insurance Program. He would also have authority over the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health and other major health agencies.

HHS employs nearly 80,000 people and is the largest source of funding for medical research in the world.

Politically, Price is conservative. He opposes abortion rights, receiving a 2016 rating of 0 by Planned Parenthood and 100 percent by National Right to Life. He has voted against legislation aimed at prohibiting job discrimination based on sexual orientation; for a constitutional amendment to define marriage as between one man and one woman; and against the bill that would’ve ended the don’t-ask-don’t-tell policy regarding disclosure of sexual orientation in the military.

He has also voted against:

• federal funding for abortion;
• funding for groups like Planned Parenthood;
• a law that now requires the FDA to regulate tobacco as a drug; and
• a bill that would have provided four weeks of parental leave for federal employees.

In 2007, Price voted in favor of a bill that would have granted the so-called pre-born equal protection under the 14th Amendment.

In 2015, Price wrote the language for a bill that is now seen as one of the main paths forward to repeal portions of the ACA. It would employ the same budget reconciliation rules Democrats used to originally pass the law in 2010, but instead the GOP plan would defund Obamacare.

This reconciliation option would leave in place the basic structure of the ACA, including the insurance exchanges and rules that require insurers to cover existing conditions and permit young adults to stay on their parents’ insurance policies until age 26.

But without funding, the exchanges are likely to see an exodus of insurance companies, particularly if expensive requirements are kept in place.

Price, 62, lives in Roswell, Ga., with his wife Betty. He received his medical degree from the University of Michigan.

Let’s block ads! (Why?)

Hospitals have long been reluctant to share with patients their assessments of which nursing homes are best because of a Medicare requirement that patients’ choices can’t be restricted.

For years, many hospitals simply have given patients a list of all the skilled nursing facilities near where they live and told them which ones have room for a new patient. Patients have rarely been told which homes have poor quality ratings from Medicare or a history of public health violations, according to researchers and patient advocates.

“Hospitals are not sure enough that it would be seen as appropriate and so they don’t want to take the chance that some surveyor will come around to cite them” for violating Medicare’s rules, said Nancy Foster, vice president for quality and patient safety at the American Hospital Association.

As a result, patients can unknowingly end up in a nursing home where they suffer bed sores, infections, insufficient staffing or other types of substandard care.

But hospitals’ tight-lipped approach to sharing quality information may soon be changed. The Obama administration is rewriting those rules, not just for patients going to nursing homes but also those headed home or to another type of health facility.

Hospitals will still have to provide patients with all nearby options, but the new rule says hospitals “must assist the patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data” about quality that is relevant to a particular patient’s needs for recovery. The rule was drafted in October 2015.

The administration hasn’t said when it will be finalized. Should it not be enacted before the end of President Obama’s term, its fate becomes uncertain. President-elect Donald Trump has pledged not to approve new regulations unless two existing ones are eliminated.

The quality requirement might have made a difference for Elizabeth Fee, an 88-year-old San Francisco woman who had been hospitalized for a broken hip. Her hospital, California Pacific Medical Center, told her family about its own nursing home but did not tell them that Medicare had given it one star, its lowest quality rating, Fee’s family asserts in court papers.

“I feel we were misled because we believed that Mom was going to a facility that would have given her excellent care,” her daughter Laura Rees said. “And what she got was not even close to that, it was like night and day.”

Enlarge this image

A family photo of Elizabeth Fee shortly before her death. Robert Durell for KHN hide caption

toggle caption

Robert Durell for KHN

At the nursing home, Ms. Fee developed a bowel blockage that went undiagnosed until the morning of the day she died in January 2012. The nursing home and hospital have denied that they provided substandard care and declined to comment. The nursing home closed last year.

Some health systems haven’t waited for Medicare’s rule change to increase the information they provide patients about prospective nursing homes. In Massachusetts, Partners Healthcare, which runs Massachusetts General and Brigham and Women’s hospitals — two teaching hospitals for Harvard University Medical School — endorses 67 nursing homes around the state based on a host of criteria, including state inspections, readmission rates, location and how frequently a doctor or nurse practitioner is at the facility.

Partners believes it doesn’t violate Medicare’s rules because it gives departing patients a complete list of nursing homes while noting on the list which ones are part of Partner’s quality network, said Dr. Chuck Pu, a medical director at Partners. This fall, Partners dropped one of its own nursing homes from its preferred list after it got a poor inspection. “There’s no free pass,” Pu said.

More careful attention to nursing home quality has been encouraged by existing financial incentives created by the Affordable Care Act that cut payments to hospitals if too many patients are readmitted within a month. “The whole idea of preferred provider networks is really going to escalate in the future,” said Brian Fuller, an executive with NaviHealth, a consulting company for hospitals that focuses on patient care after discharge.

Foster, the hospital association executive, said the proposed Medicare rule should make hospitals less wary about giving more detailed guidance. “This signals that it’s okay for knowledgeable folks to really engage in that conversation with patients and their families,” Foster said.

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. You can follow Jordan Rau on Twitter: @jordanrau.

Let’s block ads! (Why?)