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In 60 Seconds: Price Transparency

*PDF Download: In 60 Seconds – Price Transparency

Healthcare price transparency is a rare bipartisan issue—with almost 90 percent public support. A whopping 98% of women age 40 and under support it. Yet, efforts to make price transparency a reality have been clouded and shrouded by healthcare lobbyists and special interest groups who want to keep patients in the dark.

We would never agree to buy anything without knowing how much it is going to cost. Prices in health care should work the same way.

Here’s the breakdown in 60 seconds: 

What’s at Stake:

We would never agree to buy anything without knowing how much it is going to cost.

Prices in health care should work the same way. We should:

  • Be able to plan ahead for how to pay and shop among providers.
  • Make informed, value-driven decisions about our care.
  • Know what our out-of-pocket costs will be, as well as what costs, markups, discounts, and payments others pay on our behalf

Price transparency is not an end in itself, but will deliver:

  • Better information and choices for patients
  • Greater accountability system-wide and restored trust between patients and providers
  • Greater competition, and ultimately, lower costs

How Can We Get There? The Administration Can:

1. Establish requirements for system-wide, net price transparency. (HHS)

  • Patients have a right to their “Health information,” which should include net pricing information.
  • “Net price information”—a full picture of costs, markups, discounts, and payments.
  • “Information blocking”—keeping price information from patients should be illegal.
  • Only systemic, full net price transparency will bring systemic change.

2. Make Medicare transparent. (CMS)

  • Medicare insures nearly 60 million seniors and hugely influences pricing.
  • Medicare rates for each code, bundled and unbundled, should be public. Transparency and accountability should be basic expectations.
  • Medicare Advantage plans should be required to share net price information with patients.
  • Hospitals who receive Medicare dollars—public money—should be accountable to the public with net price transparency as a Condition of Participation.

3. Make employer plans transparent. (ERISA)

  • Employer plans should be required to provide net price information to employees and link to pricing information from other insurers.
  • “Reasonable compensation” rules can make contracts between employers and insurers/third-party administrators (TPAs) compliant only if net price information is delivered.
  • With these two above changes, insurers and TPAs will only be able to compete if they provide net price information.

Misperceptions and Facts:

Misperception: It doesn’t really matter to patients how much something costs insurers and other third-party payers who pick up most of the costs.

Facts: While it’s true that our current healthcare payment structure includes many middlemen, it still matters to patients what services cost.

  • Consider uninsured or cash patients: it certainly matters to them.
  •  Many patients with insurance have high deductibles, so must pay the costs for their health care services until they spend a certain amount.
  • The copay or cost-sharing that patients are responsible for is often a function of the total bill, meaning the sticker price does matter because it affects how much patients pay.

Misperception: Medicine is different: If you need something done, it has to be done, regardless of cost.

Facts: Sometimes, in an urgent situation, patients will not think about cost because their life or health is at risk: They will go to the closest emergency department or seek care in the most timely or convenient way. However, most healthcare services are “shoppable,” meaning patients have time to look around and plan for how and where to spend their dollars.

Misperception: Because most people have insurance, out-of-pocket health costs aren’t that big of a concern.

Facts: Most Americans have insurance, but in spite of this, health costs continue to be a top concern.

  • In fact, Gallup recently reported that Americans had to borrow $88 billion to pay for health care bills last year, and sadly one in four people skipped a health care treatment, service, or screening because of costs.

Misperception: Price transparency is too complicated; it will take 10 years to figure it out.

Facts: We know this isn’t true: Hospitals are merging and purchasing doctors’ practices all the time. We know net pricing information is shared in these negotiations. Why can’t it be shared with the public?

Misperception: We can achieve price transparency simply by requiring hospitals to post average prices or out-of-pocket cost estimates for certain standard treatments, or we can just address “surprise billing.”

Facts: There are many recommendations to achieve price transparency, like requiring hospitals to post average prices or addressing surprise billing (out-of-network bills). But these proposals are small steps toward better pricing information and may not provide helpful or actionable information for patients. To achieve real, system-wide price transparency, patients need to have access to net prices—that is, the full picture of markups, discounts, and payments made on their behalf, not just their out-of-pocket costs. Only system-wide, net price transparency will bring systemic change to the way we pay for health care.

In 60 Seconds: The Health Care Debate

*PDF Download: In 60 Seconds – The Health Care Debate

The U.S. doesn’t have a health care crisis, but we do have a health costs crisis.

Americans have access to the best care in the world, with low wait times and high cancer survival rates.

Here’s the issue of health care in 60 seconds:

What’s at Stake:

The U.S. doesn’t have a health care crisis, but we do have a health costs crisis.

Americans have access to the best care in the world, with low wait times and high cancer survival rates.

But Americans lack choice…

  • …in their insurance plans:
    • Most workers simply accept the plan offered by their employer.
    • Most employers only offer one plan.
    • All plans (employer and non-employer) are standardized to meet federal regulations, limiting customization, variety, and market competition.
  • …in their health providers, because insurance plans dictate which doctors are in network and which are not.
  •  … to shop/plan for healthcare services based on price, because there’s no price transparency. We pay for most medical care through a third party, like insurance or a federal program, making it easier for the health industry to hide price information.

This is not a healthy, functional marketplace, and the result is exorbitant costs.

Bad Solution: So-called Medicare-for-All is a new name for the same old harmful approach of
socialized medicine.

NO choice in insurance—all employer and private plans would be eliminated, as well as
Medicare and Medicaid, leaving only one “option.”

NO or minor choice in care—the only way government can control costs is by paying too
little for a service, creating a shortage and long wait times.

Right Solution: Foster a healthy, functional marketplace where all Americans can choose and afford…

  • … an insurance plan.
    • Repeal counterproductive federal regulations that over-standardize insurance plans and make them unaffordable.
    • Unlink employment and insurance to make plans portable, reducing the risk of “coverage gaps” that create the problem of “pre-existing conditions.”
  • …their care and know how much it will cost.
    • Foster new models that empower patients with price information to shop directly for non-urgent services, holding down prices.

Addressing Concerns:

In 60 Seconds: Pre-Existing/Pre-Insured Conditions

*PDF Download: In 60 Seconds – Pre-Existing and Pre-Insured Conditions

Chronic conditions are not the same as “pre-existing conditions”, which is insurance industry shorthand for any condition that pre-existed insurance covering it. From the patient’s perspective, these should be called pre-insured conditions.

Here’s the issue of pre-existing/pre-insured conditions in 60 seconds:

What’s At Stake:

Chronic conditions are not the same as “pre-existing conditions”, which is insurance industry shorthand for any condition that pre-existed insurance covering it. From the patient’s perspective, these should be called pre-insured conditions.

Most people with chronic health conditions have health insurance that helps them with their costly bills. This was also true before the Affordable Care Act (or ObamaCare). That’s because most people get insurance through:

  • an employer (55 percent) or
  • Medicare (18 percent) or
  • Medicaid (18 percent)

And these forms of insurance did not (and do not) deny coverage or upcharge anyone due to health status or history. Furthermore, before the ACA, people were permitted to change insurance plans without being “underwritten” for any condition, so long as they didn’t have a long coverage gap. And new babies, regardless of any condition, were insured at standard rates, so long as they were enrolled right away.

The ACA extended these two rules to the individual insurance market:

  • Guaranteed Issue—requires insurers to
    issue everyone a policy
  • Community Rating—requires everyone
    to pay the same in premium

These rules, while popular and well-intended, are the equivalent of letting your neighbors buy their homeowner’s policy after their house burns down at the same rate as you. It ultimately took away the incentive to buy insurance before getting sick. This made insurance pools less healthy, increased premiums dramatically, and drove many insurers out of the market, shrinking choices on policies and prices.

A Better Solution:
We all want people with chronic conditions to live with confidence that they will not lose access to health care or face financial ruin because of their condition.

First, encourage people to become (and stay) insured before getting sick by making insurance more affordable and portable:

  • Reduce unnecessary regulations that drive up costs and over-standardize plans, mandating features that patients often don’t want or need.
  • Make the link between employment and insurance optional. Allow workers to purchase the insurance plan of their choice (with pre-tax dollars) and keep it, even when they change jobs.

Second, strengthen safety nets for those who need them most. As much as we can try to help people avoid it, a small number of people will still end up getting sick while they lack insurance coverage. For them, we should:

  • Encourage states to create Guaranteed
    Coverage Pools that offer subsidized
    plans. The federal government can fund
    and oversee these programs.

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MORE Ways to Help Afghan Women, Children, And Refugees

Earlier this week, Patrice Onwuka shared information about a drive to help Afghan women, girls and babies who are fleeing. Encouragingly, the drive is now CLOSED after being fully supported.

In order to keep the support coming, IWF rounded up a handful of nonprofits and other efforts offering Afghan women, children, SIVs and refugees much-needed assistance. Many of these groups are national nonprofit organizations that have created emergency funds to address needs in the short-term, but also have the capacity to support long-term efforts as well.

In addition, I wanted to direct you to the Office of Refugee Resettlement under the U.S. Department of Health and Human Services, which offers a state-by-state map featuring links to local area affiliates helping to resettle refugees. This is a great way to figure out how to get involved in YOUR local community.

As for the other opportunities that IWF, see below.

NOTE: The support we received from our IWN members from our last post was nothing short of inspiring, and times like these remind us why we are SO grateful for this community of women who care.

Because we know many non-IWN members are also looking for ways to help Afghan women, children, and refugees, we duplicated this post over at IWF so you can publicly share these donation opportunities with others. See that post and help us share it by clicking here.

No One Left Behind

Afghan translators are under direct threat from the Taliban. No One Left Behind is the only nationwide nonprofit committed to ensuring that America keeps its promise to our allies and their families who risked their lives for our freedom. This organization was in Afghanistan prior to President Biden’s decision to withdraw helping to evacuate SIVs, and will be there after. 76% of donations directly support SIVs and resettlement to the U.S.

Donate here.

Vital Voices

Vital Voices has established an emergency fund for Afghan women and girls. Here’s how the nonprofit describes the effort:

“Vital Voices, in partnership with the Georgetown Institute for Women, Peace and Security, invite you to donate to a special fund and help us act quickly to provide immediate support to at-risk Afghan women and girls. We are connected to a network of women activists in Afghanistan with whom we have worked for the past two decades. We will channel 100% of your donation directly to our partners to support emergency evacuations, emergency housing and resettlement, visa applications, and other emerging priorities.”

Donate here.

(If you’re unable to donate, Vital Voices also organized a petition calling on the Biden administration to not abandon Afghan women and girls. Sign here for free.)

Amazon Refugee Registries

Writer and stay-at-home mom Bethany Mandel rounded up a handful of donation opportunities, including an Amazon gift registry featuring items specifically requested from a Chaplain in Qatar, who is working on the ground to help the well over 150,000 refugees they expect to come through the country this week. That Amazon registry can be found here, along with more details and donation opportunities below. For those with Amazon Prime accounts, this is an easy and practical way to help.

“The biggest needs here are travel-sized toothbrushes/toothpaste, kid-friendly snacks, diapers/wipes, feminine products, and ‘comfort’ toys for children (stuffed animals, crayons, stress balls and the like),” Mandel wrote, adding, “if you’re buying off the Amazon wishlists: Make sure you ship to the gift recipient, not yourself.”

For more opportunities, read Mandel’s full thread by clicking here.

Women for Women International

Women for Women International has been working in Afghanistan since 2002. Since then, the organization says “the Stronger Women, Stronger Nations program has reached more than 127,000 women in five provinces in Afghanistan.”

Its program provides training that “helps women know and defend their rights, lead mentally and physically healthy lives, influence decisions at home and in their communities, generate income, and save money for the future, contributing to economic self-sufficiency in their lives and for their families.”

Women for Women International set up an emergency fund to support Afghan women, and was already able to meet a pledge for a $500,000 matching donation.

Donate here.

Women Refugee Commission

The Women Refugee Commission outlined ways for Americans to “contact your Congressional representative and Senators and urge them to call on President Biden to act now to protect at-risk Afghan women’s rights defenders and provide humanitarian assistance for those left in the country.”

You can also donate here.

U.S.-Afghan Women’s Council

The U.S.-Afghan Women’s Council (USAWC) is a non-partisan public-private partnership that convenes governments, civil society and the private sector around the goal of supporting Afghan women and girl’s education, healthcare, economic empowerment and leadership. The Council leverages public and private resources to advance member-driven initiatives and highlights the experiences and needs of Afghan women and girls. 

In response to the crisis in Afghanistan, the U.S.-Afghan Women’s Council listed a dozen organizations that it has partnered with to raise funds for emergency response.

Access that list here.