It Costs How Much??
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Happy Monday Healthcare Advocates
I appreciate all of you advocating for healthcare reform. When we raise our voices we will be heard. Please send any topics on which you’d like more data either in the newsletter of privately. You can use the comment button at the bottom of the newsletter.
Medical Price Transparency
Ok, I know that sounds like an oxymoron. But there has been some movement in this area. Congress is reviewing two bills that would force pharmacy benefit managers to be more transparent and, in the case of S. 1339. remit the bribes they have taken back to the insurance companies/sponsors. The PBMs are working on ways to weasel out of it by renaming their kickbacks but we push forward. Remember that Universal Healthcare takes care of the problem by negotiating for the whole country. Just like it is done in most of the developed world.
ACTION
Tell your senators to enact the bipartisan Pharmacy Benefit Manager Transparency Act, S. 1339. No more bribes and kickbacks. Just fair prices. You can find your senator’s contact info here. A sample email is below. Remember to include your name and city and state. Feel free to personalize.
Subject Pharmacy Benefit Manager Transparency
I am your constituent and I am tired of pharmacy benefit manager price gouging. They use sleazy kickbacks and rebates to put drugs on the insurance formularies because they make more money from them. Make them stop it. When oil companies did this we enacted ANTI TRUST legislation to protect the public. Until you enact Universal Healthcare (S 1655 or HR 3421) ENACT S 1339, the Pharmacy Benefit Manager Transparency Act. Thank you.
(name) (city/state)
Back to the Story
How about transparency with respect to health insurance companies and hospitals? I mean, few of us go to restaurants where the menu has no prices listed. In 2022, the federal government put rules in place that require insurance companies to publicly post what they pay doctors and hospitals. The penalty for non-compliance is pretty good. $100/day/enrollee. So if you have 10,000 clients that’s $1,000,000/day for non-compliance. It’s a start. (link to NPR story). BTW, here is the US government website on price transparency for health insurance plans.
In 2021 hospitals were also supposed to post common prices for non emergency services. Congress passed a law and that was supposed to take care of it. Procedures, time in the operating room, drugs, all are supposed to have readily available prices listed. Before we go too far, remember that each patient requires a different collection of services to accomplish one procedure. Although government data shows that hospitals’ compliance with price transparency rules has improved, it is now 70%. Updating the requirements of that law is the focus of a new proposal by the Biden administration, which aims to further standardize the required data, increase its usefulness for consumers, and boost enforcement. Even when that is done each patient’s bill for similar services will vary. I need 10 stitches you need a staples, etc. In the engineering world we just say that your mileage may vary.
The rule also requires the data to be easily accessible on websites. The penalties for non compliance also increase using a scaling factor based on the number of beds in the hospital and public humiliation on the CMS website, sort of a page of shame. Again, here is a link to the proposed rule on the CMS website.
EXTRA CREDIT
You can tell the Center for Medicare and Medicaid Services what you think about the new rule. On their website they are accepting comments until 09/11/2023 at 11:59 pm EDT. Go to their site and click the button “Submit a Formal Comment”. Where it asks what it concerns (after putting in your comment) I chose individual.
You could say something like this. “It’s about time to make hospitals post costs for services they provide. It is not fair for patients to be mistreated consumers without access to costs beforehand. We can make informed decisions, we are adults, but we need them to provide the data. Enact this rule to protect the public, until we have universal healthcare.”
Well Done - You’re making it another good day for healthcare reform!!
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/addr/
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Plan
Reproductive Health
NARAL - Pro Choice America
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
Insurance Commissioner in your state- This website can get you their phone number.
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