By Kay Tillow

May 15, 2018

On May 14, 2018, Kentucky Voices for Health sponsored a conference in Lexington on the high costs of healthcare in Kentucky.  Lynn Quincy of Altarum, a research group funded by the Robert Wood Johnson Foundation, reported on a recent poll of Kentuckians.  The survey showed that 72% experienced healthcare affordability burdens in the past year and even more are worried about affording healthcare in the future.

More than half (55%) of Kentucky adults who needed healthcare encountered one or more cost barriers.  They delayed going to doctors or didn’t go at all, skipped tests or treatments, did not fill prescriptions, cut pills in half, or had problems getting mental healthcare.

The only good news from the survey is that there is bipartisan dissatisfaction with the health system and overwhelming support for change.  Broken down by affiliation, only 25% of Republicans, 16% of Democrats, and 17% of neither think we have a great healthcare system in the US.

And 74% said the US healthcare system needs to change:  75% of Republicans, 78% of Democrats, 69% of neither.

A panel of patients who had experienced some of these problem made them real.

Kristi Roberts works for an electric motor company in Lexington, Kentucky.  The company opened in 1948 and has 15 employees.  Since the company hired its first non-family member in 1978, it has always provided health insurance.

Roberts reported that this year there will be about a 27% increase in the cost of the policy.  The cost will leap from an annual $78,000 to $103,000 for the coverage for individuals.  Even if the company switched to a plan that covers only catastrophic events, the company’s costs would still rise by 21%.

“That is unaffordable,” said Roberts as she added the fact that there are only three insurers from which they can make the purchase—Humana, Aetna, and UnitedHealthcare—and the costs are basically the same thing.

“The company is in danger of not being able to provide healthcare,” she said.  “If that happens, half of the employees will not be able to afford it and will go without.”

Jane Harrod spoke next, “Praying nothing happens is my health insurance plan since my divorce.”  She had an accident in the second year of the Affordable Care Act.  She had been purchasing insurance, but then couldn’t pay for it and let it lapse.

Harrod raises livestock, farms, tends greenhouses, and does landscaping in the Lawrenceburg area.  While she was doing fencing for hogs a metal bar hit her in the head “leaving me half blind in the right eye.”  Her doctor said she needed surgery or would lose sight in that eye.  She had the surgery in Lexington which cost $6,800, “more than 1/3 of what I make in a year.”

Harrod was able to get help from the Department for the Blind but she had a rough year being immobilized during the recovery.  She is now on Medicaid but suffers from teeth issues.  “I went to the dentist but they offered only to pull the tooth—they won’t fix it on Medicaid.”

She said “It’s debilitating–I feel like I’m living in a society where I’m considered of such small value even though I raise food.  We need to get the profit out of health care.  I wish we lived in a country that would value people.”

Debbie McAfee, who works as an advocate for the Multiple Sclerosis Society, spoke of her fight for drugs and care.  She was diagnosed with MS in May of 2006.  Medicare was her secondary insurance until her husband retired and it became her primary coverage.  Then limitations popped up.

She said that when Medicare is your primary insurance, you no longer qualify for the co-pay plans offered by the drug companies.  MS patients need medications to survive and to minimize deterioration.  “The sooner you get on the meds the better off you are,” said McAfee.

She reported that a drug that was $8,000 in 1993 cost $91,000 in 2017.  All of the necessary drugs for MS patients are $80,000 to $90,000 a year.  There were four drugs when she was first diagnosed.  “Now there are 16—but the new ones come out on the market at a much higher level.”

Megan Naseman is the human resources coordinator for the Mountain Association for Economic and Community Development in Berea.  She said that all of the health insurance options now offer less coverage for more money.  “It’s hard to know what to do,” she said.  “We can’t budget.  We are likely switching carriers in coming years to one with a narrower network and a higher out of pocket maximum.”

Then Naseman related her personal story.  Her physician said that she had to get her asthma under control and prescribed a medication.   When Naseman went to fill the prescription, she was told that the cost would be $20.  But then her name was flagged, and the cost would be $1,200 because she had insurance.

“I had to borrow to pay for this medicine to breathe,” said Naseman.  “So obscene—either $20 or $1,200.”

This past winter, Naseman got the flu, went into septic shock, and spent some time in the ICU.  She was still suffering from symptoms after she went home.  Concerned about the recurrence of sepsis, one night she called the nurse at her insurance company to see if a trip to the emergency department would be covered.  Anthem had stated that the company can deny payment if they determine that the visit wasn’t an actual emergency. The nurse told Naseman that they could not say if it would be covered.
“After paying $4,500 in medical expenses since January, I just couldn’t risk another big bill.”  She spent the night worrying and monitoring her temperature until the little clinic opened.

She expressed disgust that “the professionals don’t have the authority to authorize care.”

Her insurance company has denied a CT scan for a test her doctor says she needs.  “It’s infuriating and exhausting.”

Emily Beauregard, Executive Director of the Kentucky Voices for Health, asked the panelists a question:  What is one thing you would change about the health care system?

Roberts responded, “The decisions for care should have nothing to do with anyone who is not a professional caregiver.”

Harrod said “A nonprofit system is what we need.”

McAfee spoke of drugs just being tweaked in order to raise prices after the patent was over and of Big Pharma doing all they can so there can be no generic competition.  “The profit motive is driving healthcare—not the physicians—it’s at the higher level and that’s what we need to change.”

Naseman said “I agree.  When someone gets sick they should just have to worry about getting well.  Medical experts should determine what procedures are approved—not the ones in billing.”

State legislators Senator Morgan McGarvey and Representatives Wilson Stone and Kimberly Moser then took the stage.  They spoke of the need to deal with prior authorization, surprise billing, the cost of air evacuation, addiction, the $1 tax on cigarettes, and the lack of high quality jobs.  McGarvey summed up the feeling “There is no silver bullet answer” to these costs.

The session ended with a call for everyone to work to come up with the solutions.  The conference provided valuable data illustrated by passionate human stories.  The patients all cited the profits as the problem.

No one pointed out that other industrialized countries annually average under $5,000 per capita for health care while the US spends about $10,000.  Yet US outcomes are generally worse in life expectancy, infant mortality, and most other measures.  Italians live four years longer, on average, than people in the US.

Those other wealthy nations have determined to cover everyone and to publicly fund care through some form of single payer or national health service.  That allows them to expand care to everyone while bringing the costs under control.  These countries do not allow private for-profit insurers to sit astride their healthcare systems collecting billions in public subsidies as they price care beyond the means of patients.

Sitting in the US Congress now is a single payer bill, HR 676, Expanded and Improved Medicare for All, that would cover us all and rein in the costs.  It has 122 cosponsors and could be passed in the blink of an eye if the nation rose up to demand it.

Unfortunately, there was no single payer question on the Kentucky survey.  It’s hard for a research group funded by the Robert Wood Johnson Foundation to project a solution that is in contradiction to the interests of its board members.  RWJ includes pharmaceutical and medical device companies that profit from the current system.  Former Senator Bill Frist sits on the board of the RWJ Foundation.  He and his family have profited in the millions as they built the investor-owned Hospital Corporation of America.

Frist currently co-chairs the Bipartisan Policy Center which promotes health care change.  But the changes projected include “policies that promote stable private insurance markets.”  That group is working to block the tide of sentiment for the single payer solution.

The work of building the already majority single payer movement into an effective political force will have to be done by the rest of us.