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State Based Universal Health Insurance Trusts
A number of states are not waiting for the federal government to pass a single payer universal health insurance trust. Oregon and Washington and others are considering it.
There are several federal waivers needed to make it work. Medicaid, Medicare, ERISA, and others. Representative Ro Khanna has put forward a bill in the House of Representatives to bundle all the waivers together to help expedite them through all the federal agencies. It is HR 6270, The State Based Universal Health Care Act of 2023.
Senator Ed Markey from MA is introducing the State Based Universal Health Care Act (SBUHCA) in the U.S. Senate. This move brings real hope to activists working for transformation at the state level.
Action
Let’s ask our senators to be cosponsors of the State Based Universal Health Care Act so that states that want to move forward are able to do so. Their contact info is here, https://www.usa.gov/elected-officials.
Or use RESISTBOT via [Apple Messages / WHATSAPP / MESSENGER] or by texting SIGN PREQMK to 50409 on your cell phone to send this message to them:
“I am your constituent. Please cosponsor Senator Markey’s State-Based Universal Health Care Act, the companion bill to Rep. Ro Khanna’s bill HR 6270.
These bills moves us toward universal health care:
Mandates that participating states guarantee healthcare coverage for at least 95% of residents in the first 5 years, thus reducing the uninsured and underinsured populations to less than 5% (currently 30% in most states).
Requires any state-based plan to have benefits equal to or greater than those received by beneficiaries of federal healthcare programs.
Allows states to cooperate on multi-state plans. Section 1332 of the ACA does not.
Enables states to integrate Medicare funds into a state plan. Section 1332 does not. This is critically important for equity.
Thank you!!”
Medicare Advantage Shenanigans
Let’s remember that Medicare Advantage is NOT TRADITIONAL MEDICARE. It is commercial insurance in place of Medicare. The US government pays these commercial insurers between $1000 and $1800 per month for each person they sign up. It is a huge cash cow for insurance companies.
A WSJ investigation found that from 2018 to 2021, private insurers involved in Medicare Advantage made hundreds of thousands of questionable diagnoses that triggered an extra $50 billion in taxpayer-funded payments.
There were questionable diagnoses for potentially deadly illnesses, such as AIDS, for which patients received no subsequent care, and for conditions people couldn't possibly have. Often, neither the patients nor their doctors had any idea this was occurring.
Medicare will pay more to insurers for certain conditions. One example cited in the report was for diabetic cataracts. UnitedHealth members were 15 times as likely to have the diagnoses listed in their medical record compared to the average patient in traditional Medicare.
Eye doctors told WSJ that they doubt that so many patients from one insurer could have the rare disease. In total, the investigation found that 66,000 patients were diagnosed with diabetic cataracts even though they had previously undergone cataract surgery. Cataracts do not return after the damaged lens is removed and replaced by a plastic insert. Another 36,000 members didn’t receive services or prescription medicine for diabetes.
The investigative team from WSJ examined Medicare data under a research agreement with the federal government. Patient names were not included but the data offered details of patient visits to doctors, hospitals, and prescriptions. The team focused on claims that they concluded were for high-risk diagnoses that were added by insurers to the medical records after a doctor’s visit or sending medical workers to conduct home assessments.
According to the analysis, UnitedHeath was paid $8.7 billion in 2021 for the insurer-added diagnoses.
The rules in place allowed Insurance companies to add diagnoses and bill for them even if the doctor did not. CMS has tightened some of the loopholes in 2024 especially with regard to diabetic cataracts but the real problem remains. (RISE)
And here it is:
The government has a Medicare responsibility, Medicare Advantage is an abdication of that responsibility. Traditional Medicare works well at far lower costs but commercial insurers have sewn up enough people in Congress to create the “Advantage” program from which they reap huge profits at patient and taxpayer expense.
You already know what the real answer is - Universal Single Payer Insurance for all of us.
Post Surgery Opioids
A handful of common surgical procedures account for large shares of all opioids dispensed after surgery in children and adults, according to two studies recently published by researchers at the University of Michigan.
The studies, published in Pediatrics and JAMA Network Open, report that the top three procedures for children ages 0-11 account for 59% of opioids dispensed after surgery (tonsillectomies and adenoidectomies 50%, upper extremity fractures 5% and removal of deep implants 4%).
Among those ages 12-21, the top three procedures account for about a third of post-surgery opioid prescriptions (tonsillectomies and adenoidectomies 13%, knee arthroscopies 13% and cesarean deliveries 8%).
For adults ages 18-44, C-sections account for the highest share of opioids dispensed post-surgery (19%), followed by hysterectomies (7%) and knee arthroscopies (6%).
Among those ages 45-64, four of the top five procedures were orthopedic procedures, collectively accounting for 27% of total opioid prescriptions dispensed after surgery.(University of Michigan)
In addition to determining which procedures accounted for the highest shares of opioids, the researchers also examined the size of opioid prescriptions for each procedure. For many procedures, prescriptions were far larger than the amount patients typically need for a particular procedure.
There are opportunities to reduce the amount of opioid painkillers dispensed and possibly addiction issues down stream.
Cancer Research Funding - Extra Credit
Here are just a few recent medical breakthroughs made possible thanks to federally funded government research:
A new drug that could treat ovarian cancer recurrences
The first FDA-approved treatment for advanced cases of a certain type of sarcoma
A new way to deliver drugs directly to the target cancer cells
Everyone is impacted by cancer. There are expected to be more than 2 million cancer diagnoses in the U.S. this year alone – more than ever before. Certain types of cancers are even on the rise in younger people.
Cancer research is one of our best tools to combat these trends. With the help of research, we can get closer to ending cancer as we know it, for everyone.
The American Cancer Society asks you to sign their petition to ask Congress for addition research funding.
You can sign their petition to Congress here.
Resources
Find My Elected Officials
Contact State and Federal Representatives - phone and email
Healthcare Advocacy (Us) Website
Our Newsletter resources including reproductive healthcare - Healthcare Advocacy Reading List
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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Received EOB with erroneous diagnosis of heart transplant when went to see dr for swollen glands. Prescribed antibiotic…. All cured.. dr is removing erroneous diagnosis of heart transplant off of chart however says I must fill out form to remove it from united healthcare database…. Why must I sign for erroneous codes populated on my chart???