Health Care Sharing Ministries

Last week, Washington State fined one of the larger health care sharing ministries $150,000 and banned it from offering its product in the state because it was operating as an unauthorized insurer. Other states are warning consumers to watch out for these plans, which can look like insurance but are not.  Health care sharing ministries (HCSMs) are organizations in which members share common religious or ethical beliefs and agree to make payments to (or share) the medical expenses of other members.

The groups originated in the 1980s in small religious communities and were exempted from following coverage guidelines mandated by the ACA. An estimated 1 million people belong to a HCSM, up from 200,000 before the ACA was passed a decade ago. 

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More Than Medicare-for-All: Proposals to Achieve Universal Health Coverage

Since the passage of the ACA, more than 20 million Americans have gained health insurance. But the fight for affordable and accessible universal coverage continues.

Here are just some of the proposals that have been introduced in Congress:

  • The Medicare for All Act of 2019 (H.R. 1384/S.1129) would establish a national health insurance program administered by HHS.
  • The State Public Option Act (H.R. 1277/S.489) would allow states to offer residents of all incomes the option to buy into Medicaid. This option would compete with private plans on the ACA Marketplace.
  • The Medicare Buy-In & Health Care Stabilization Act of 2019 (H.R. 1346) would allow individuals aged 50 to 64 to buy into Medicare and provide some marketplace stabilization.
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Back to Basics: Single Payer & Medicare-for-All

Estimates from the Urban Institute project that in 2020, the federal government will spend $732 billion on Medicare, $464 billion on Medicaid and CHIP, $60.4 billion on the health insurance marketplaces, and $27.5 billion to hospitals for uncompensated care. Households will spend $931 billion, employers will spend $955 billion, state governments will spend $285 billion on Medicaid and CHIP and $17.2 billion for uncompensated care, and providers will spend $24.1 billion.

We’re talking about an insane amount of money – honestly seems like Monopoly money to me.

Reigning in healthcare spending has to be a policy priority, it’s simply unsustainable. Medicare-for-All would shift most of the spending to the federal government, to the tune of $34 trillion over a decade.

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California Adopts Statewide Insurance Subsidies

Not only are the views of the California coast spectacular, but now they come with the bonus of a buffer to the rising cost of health insurance.

California will be the first state to offer state-funded tax credits for insurance purchased through Covered California, the state insurance Marketplace. The federal government offers credits as well, but many people fall into a coverage gap due to earning too much for Medicaid and the federal credit but too little to afford insurance on their own. The California credits will be paid for in part by a new tax penalty on Californians who do not have health insurance.

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Access to Health Care Isn’t Enough

Access to Health Care Isn’t Enough

We’re well into the 2020 presidential election cycle and there are a lot of health care proposals floating around. Most of them want to increase access to insurance and some have a plan to reduce the cost of care. But unfortunately, universal access to health insurance does not equate to health equity or better health outcomes. Health care systems are designed to handle individual medical needs, not the most critical causes of poor health – socioeconomic factors. In the United States, the development and provision of health care has fundamentally misunderstood what health is and what it requires.

A 2017 study in Health Affairs conveyed that the U.S. has one of the largest income-based health disparities in the world. Among the poorest third of Americans in the study, 38.2 percent reported being in “fair or poor health,” compared with 12.3 percent of the richest third. Most of the nations studied had an income-based health disparity, with the exception of Japan and Switzerland.

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The Frustration of Prior Authorization and What It Means For Burnout

Most medical students understand that a good chuck of their day as practicing physicians will involve clicking through electronic health records and completing paperwork. But I do not think it is ever made clear how often we will interact with insurance companies. Of course, this will vary by specialty, but everyone entering medical practice should have a basic understanding of prior authorization.

I recently saw an Instagram post from Dr. Austin Chaing about the frustrations of prior authorization — a process wherein medical care will only be paid for if it has been pre-approved by the insurance company. There are a number of reasons insurance companies require preauthorization, including age, medical necessity, and availability of a generic. If a prior authorization is denied, a healthcare provider may file an appeal based on their assessment of the patient and the recommended treatment or medication.

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The Slow Rise of Telehealth

One of the reasons I wake up early each day is to have (hopefully) around 30 minutes to catch up on the news or some health policy research. Today I hit the snooze button a few too many times, but still managed to sneak in a glance through the December issue of Health Affairs. This month is all about telehealth — the practice of medicine utilizing a range to technologies to connect health professionals to each other and their patients.

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Every Health Policy Term You Need to Know

Bundled Payments. Dual Eligibles. Managed Care. These terms–along with other insurance jargon–are responsible for describing everything from how providers are paid for services rendered to who is eligible for certain insurance benefits.

The incredible folks over at the Association of State and Territorial Health Officials (ASTHO) compiled a 48 page glossary to help facilitate conversations about Medicaid between medical professionals and public health practitioners. We think this resource can be used to learn about a dozens of important, everyday terms that medical students should know should keep in mind! Here’s just a snippet of what ASTHO has put together:

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