HEALTH CARE un-covered

HEALTH CARE un-covered critically examines the U.S. healthcare system, particularly the impact of Medicare Advantage plans and the practices of major health insurers. It highlights issues like aggressive marketing, profit-driven decision-making, and the effects on patients' access to care and costs. The series advocates for transparency, regulation, and reform.

Medicare Advantage Plans Health Insurance Practices Healthcare Costs Patient Access to Care Healthcare Regulation Political Influence Healthcare Reform

The hottest Substack posts of HEALTH CARE un-covered

And their main takeaways

While UnitedHealth reports $24 Billion in profits, Americans faced 200% increases in out-of-pockets over last decade

259 implied HN points • 21 Jan 22

UnitedHealth made a record profit of $24 billion, which is the highest ever for any U.S. insurer. This raises concerns about how the company is managing its resources while also charging customers more.
Americans have seen their healthcare costs skyrocket, with out-of-pocket expenses increasing by 200% over the last decade. This means people are paying much more for healthcare, even when they have insurance.
Health insurance premiums and deductibles now take a larger share of people's incomes, affecting families in many states. Many insured people are still struggling to afford care due to higher costs.

HOW IRONIC: Corporate health insurance consultants blame high medical costs on our "bad habits" and "overuse" of system.

139 implied HN points • 21 Oct 22

🏥 Health Politics Healthcare Costs Insurance Issues Medical Debt Patient Advocacy

Health insurance consultants often blame people's bad habits for rising medical costs, while huge insurance companies are making record profits. This seems very unfair to the average person trying to access affordable care.
Many insured Americans are still struggling with medical debt and high out-of-pocket expenses. It's tough when even people with insurance can't afford their medications or treatments.
The focus should be on the greed of insurance companies rather than blaming individuals. Insurers could help lower costs, but they often choose profit over patient care, leaving many people in financial trouble.

Interested in health care? This is what you should be reading.

199 implied HN points • 13 May 22

🏥 Health Politics Healthcare system Insurance Issues Policy Analysis Patient Advocacy

Healthcare in the U.S. can be very expensive, even for people who have insurance. Many are struggling to pay out-of-pocket costs and are skipping necessary doctor visits or medications.
People often turn to GoFundMe pages to raise money for their medical expenses. Sadly, those who are most likely to succeed in this fundraising are usually the privileged ones, making the problem worse for those in need.
There are serious flaws in Medicare's prescription drug coverage, leading to high costs for many older Americans. Some can face over $10,000 a year on medications, which highlights the need for better healthcare solutions.

Big insurer Anthem took in $38 billion in the first 3 months of 2022. Most of it by far came from taxpayers.

199 implied HN points • 28 Apr 22

🏥 Health Politics Health Insurance Public funding Medicare Medicaid

Anthem's revenue has shifted significantly, with most of its income now coming from taxpayer-funded programs like Medicare and Medicaid rather than private-paying customers.
The employer-based health insurance system is declining rapidly as many employers can no longer afford to provide coverage, affecting the number of private-paying customers.
Despite growing profits largely from private-paying clients, many of Anthem's customers are struggling to afford out-of-pocket costs, leading to increased financial hardships.

Judge halts New York City's plan to redirect tax dollars to private health insurance companies

119 implied HN points • 29 Nov 22

🏥 Health Politics Healthcare policy Insurance Issues Medicare Public Health

A judge stopped New York City's plan to move municipal retirees into private Medicare Advantage plans. This decision allows them to stay in traditional Medicare without facing penalties.
The city's plan aimed to save $600 million by pushing retirees into private insurance options, but this would have burdened taxpayers across the country. The plan depended on federal subsidies to work.
There are concerns about Medicare Advantage plans, as they can limit access to necessary care and lead to higher out-of-pocket costs for retirees. Many believe that staying in traditional Medicare is safer and more reliable for their health needs.

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What I'm reading in health care this week.

99 implied HN points • 30 Jan 23

🏥 Health Politics Healthcare policy Medicare Insurance Issues Patient Care

Doctors are facing a lot more claim denials this year, which is making their jobs harder and causing burnout. There's a push from healthcare providers for the government to change the rules around prior authorizations to help ease this burden.
Patients with diabetes are struggling when companies switch them to high-deductible health plans. These plans can increase the chances of serious health issues and financial troubles for patients who need regular care.
The government is looking closely at Medicare Advantage plans due to concerns about overpayments to insurers. Changes could be on the way that would affect how these plans operate and the money insurers can make from them.

DON'T MISS: Rep. Schakowsky (D-IL) and I exposed Medicare Advantage in Newsweek

119 implied HN points • 16 Nov 22

🇺🇸 U.S. Politics Healthcare Legislation Politics Insurance Reform

Medicare Advantage is designed to benefit insurance companies and their shareholders, often at the expense of actual patient care. It's important for seniors to understand how this program works and what alternatives are available.
Many Americans are struggling with high out-of-pocket costs for healthcare, and there's a need for reform to reduce these financial burdens. Changes are necessary to ensure health insurance is more affordable.
Engaging with policymakers from both political parties is crucial to make progress in healthcare reform. Discussions are ongoing about the need to improve Medicare and tackle issues caused by big insurance companies.

IT'S JUST SPIN: UnitedHealth Group touts out-of-pocket savings that patients will never see.

159 implied HN points • 19 Jul 22

🏥 Health Politics Healthcare policy Insurance Public Health Pharmaceuticals Healthcare Costs

Only a small percentage of UnitedHealth policyholders will actually benefit from announced out-of-pocket savings, making the impact very limited.
The company's marketing creates a misleading impression that many will save money, but most won't qualify for these benefits.
UnitedHealth seems more focused on boosting profits and shareholder returns than on genuinely helping patients with affordable medications.

These two helped get us into the health care mess we're in. Maybe they can help get us out.

199 implied HN points • 18 Mar 22

🏥 Health Politics Healthcare policy Medical Debt Consumerism Public Health

High-deductible health plans make people avoid necessary care because they can't afford the out-of-pocket costs. This leads many to skip doctor visits and medications.
Many Americans with insurance are still facing financial struggles, often leading to medical debt and even bankruptcy. This happens because their insurance doesn't cover enough of their medical expenses.
Healthcare executives need to rethink their strategies. The current focus on 'consumerism' has created serious problems for patients, pushing many to choose between essential care and basic living expenses.

Americans (with insurance) can't afford their medical care. They're turning to GoFundMe.

179 implied HN points • 19 Apr 22

🏥 Health Politics Healthcare Insurance Costs Policy Access

Many Americans, even those with health insurance, are struggling to pay medical bills due to high deductibles and out-of-pocket costs. This has led some to seek help through platforms like GoFundMe.
People with chronic conditions, like cancer, are especially at risk of financial troubles. Even after meeting their deductible, they often face new costs each year, making it difficult to afford necessary care.
The issue of high medical costs can affect anyone, as most people will have a chronic condition at some point in their lives. It's a growing crisis that impacts both health and finances.

[VIDEO] My advice as you pick a health insurance plan for 2023

99 implied HN points • 07 Dec 22

🏥 Health Politics Health Insurance Public Health Policy advocacy

When choosing a health insurance plan, look beyond just the monthly premium. Consider the total out-of-pocket costs before your benefits start.
It's important to compare different plans and understand what you'll have to pay for services and prescriptions.
Be mindful of enrollment deadlines so you don't miss out on getting the coverage you need.

How Big Insurance, PBMs, the FDA, Congress and AstraZeneca made me pay so much for my inhaler.

139 implied HN points • 25 May 22

🏥 Health Politics Healthcare Costs Pharmaceuticals Insurance Legislation Regulation

The cost of inhalers in the U.S. has been rising, mainly due to a lack of generic options and practices by insurance companies and manufacturers that keep prices high.
Most inhalers approved since the 1980s are brand-name drugs, and companies use tactics like patent extensions to block generic versions, resulting in long periods of high costs.
People can save money on medications by ordering from countries like Canada or New Zealand, where prices are often much lower and generics are more readily available.

Must-read for US employers and lawmakers: 43% of working adults are functionally uninsured

99 implied HN points • 05 Oct 22

🏥 Health Politics Insurance Access Costs Legislation Public Health

43% of working adults in the US have inadequate health insurance, making them functionally uninsured. This is a significant concern for many families.
Costs are a big problem; 46% of people delayed or skipped medical care because they couldn't afford it, and many struggle with medical bills.
Low-income individuals and people of color are more likely to be underinsured, facing bigger gaps in coverage and high out-of-pocket costs.

Big insurer Cigna took in $44 billion in the first 3 months of 2022. 75% came from its drug business.

139 implied HN points • 06 May 22

💰 Finance Health Insurance Corporate Earnings Pharmacy Benefits Profit Margins Market Trends

Cigna's huge revenue of $44 billion in just three months shows they are making a lot of money, mainly from their drug business. This means health insurers can earn a lot just from selling medications.
Cigna's profits rose by 12% compared to last year, and they expect even more profits moving forward. This makes investors happy and boosts the company's stock value.
Many Cigna customers face high deductibles and out-of-pocket costs, making it hard for them to afford care. This highlights a problem in the healthcare system where profits might come at the expense of customers' financial wellbeing.

My video comment letter on FTC meeting today regarding PBM business practices

159 implied HN points • 17 Feb 22

🏥 Health Politics Healthcare policy Health Insurance Pharmaceuticals Public Health Consumer Advocacy

Pharmacy Benefit Managers (PBMs) are having a big impact on drug prices and people's ability to afford medications. Many Americans are struggling with high out-of-pocket costs and can't pick up their prescriptions.
Big companies like UnitedHealth, CVS Health, and Cigna dominate the PBM market and have merged with health insurers. This has led to higher deductibles and premiums, putting families in financial trouble, even as these companies are making huge profits.
The practices of these large PBMs can hurt independent pharmacies and might not benefit consumers. There is a call to investigate how these companies operate and how their actions affect patients and healthcare costs.

Millions of Americans can't afford their out-of-pocket costs. We want to tell those stories.

99 implied HN points • 21 Sep 22

🏥 Health Politics Health Insurance Patient Advocacy Legislation Healthcare Reform

Many Americans struggle to afford their out-of-pocket healthcare costs, often leading them to delay necessary medical care. High-deductible health plans are making it harder for people to afford the care they need.
The Affordable Care Act has a flaw, with high out-of-pocket costs causing many insured individuals to feel like they are 'functionally uninsured'. This means they have insurance but can’t afford to use it.
Insurance companies continue to raise costs, which puts more financial pressure on families. Without action, more people will find themselves unable to afford their healthcare, even if they have insurance.

Here is what you need to know in healthcare this week.

119 implied HN points • 27 May 22

🏥 Health Politics Healthcare policy Insurance Issues Pharmaceuticals Patient Advocacy Medicare

Big Insurance companies have gotten very powerful and can make it hard for patients to get the care they need. They create many barriers, like high costs and complex approvals.
Some healthcare organizations that once supported Big Insurance are now worried about its growing power and are asking the government to step in. They realize their previous choices contributed to the problem.
Legislation is being introduced to limit the influence of Pharmacy Benefit Managers (PBMs) and ensure patients have better access to medications. More people are speaking out about the negative impacts of PBMs on drug costs.

Rep. Katie Porter's Patients Before Profit Act is exciting.

139 implied HN points • 03 Mar 22

🏥 Health Politics Insurance Reform Public Health Legislation Patient rights Healthcare access

The Patients Before Profits Act aims to protect patients by preventing insurance companies from cutting coverage during public health emergencies.
This bill stops insurers from lowering payments to doctors and healthcare workers during crises like pandemics.
It highlights how some insurance companies made huge profits while cutting reimbursements, hurting both doctors and patients.

As big insurance announces record profits, skyrocketing out-of-pockets (finally) take center stage.

99 implied HN points • 01 Aug 22

🏥 Health Politics Insurance Political Response Public Perception Healthcare Costs

Insurance companies are making big profits, but many families can't afford their healthcare costs. This is making people push for change.
High out-of-pocket expenses, like deductibles, are making it hard for people to use their health insurance. They often avoid seeking care because of these costs.
Voters are worried about rising healthcare costs, especially out-of-pocket payments, and they want to see candidates make this a priority.

Despite well-funded opposition, momentum for dental therapy continues (and Americans are already benefiting)

99 implied HN points • 27 Jul 22

🏥 Health Politics Dental care Healthcare policy Public Health Advocacy

Dental therapists are similar to nurse practitioners and help with tasks like cleanings and fillings. They have been around for over 100 years in other countries.
Many states in the U.S. are now allowing dental therapists to practice due to a shortage of dentists and the lack of access to dental care for many people.
The movement for dental therapy started in Alaska and has grown across the country with support from various organizations, helping people get the dental care they need.

Wall Street investors punish Cigna for not promising them bigger profits.

139 implied HN points • 04 Feb 22

🏥 Health Politics Healthcare system Insurance Industry Investor Relations Prescription drugs

Cigna's stock dropped significantly because investors were unhappy with the company's profit expectations for the year. This shows how much pressure companies face to make big profits.
Instead of using their money to help customers with lower premiums and out-of-pocket costs, Cigna preferred to buy back shares to boost profits just for shareholders.
Overall, more people are feeling underinsured as healthcare costs rise, even with higher premiums, just so big companies like Cigna can keep investors satisfied.

UnitedHealth Group has fewer private paying customers than in 2012, but its remaining customers are paying way more in premiums and deductibles

79 implied HN points • 18 Oct 22

🏥 Health Politics Health Policy Insurance Medicaid Medicare

UnitedHealth Group has fewer private customers than it did ten years ago, but the ones it has are paying significantly more in premiums and deductibles.
The average family plan has become much more expensive, and employees are shouldering more of the costs than they used to.
As insurance companies keep raising prices while offering less coverage, people are essentially paying more for fewer benefits over time.

SOCIALISM FOR THEM: 60% of Anthem’s 2021 revenue was subsidized by American taxpayers.

119 implied HN points • 01 Feb 22

🇺🇸 U.S. Politics Healthcare Public Policy Insurance Corporate Influence Economic Inequality

Anthem, a major health insurance company, got 60% of its 2021 revenue from taxpayer money. This means a lot of their profits depend on government funding.
While Anthem's profits have soared, many Americans are seeing higher health insurance deductibles and premiums that take up a big part of their budgets.
Most of Anthem's recent growth comes from government programs like Medicaid and Medicare, rather than traditional health plans that people used to buy directly.

80% of UnitedHealthcare’s growth is coming from Uncle Sam.

159 implied HN points • 02 Jul 21

🇺🇸 U.S. Politics Healthcare policy Government programs Medicare Advantage Insurance Industry

Most of UnitedHealthcare's growth, about 80%, comes from government programs like Medicare and Medicaid. This shows how much the company relies on taxpayer money.
Since the Affordable Care Act, UnitedHealthcare has shifted from individual customers to mainly serving Medicare and Medicaid patients. This change has helped them grow significantly in the last decade.
Private insurance revenue has only seen modest growth, while government revenue has tripled. This trend raises concerns about the privatization of Medicare and how it affects overall healthcare.

U.S. Chamber of Commerce Swings Into Action to Protect Health Insurers’ Profits at the Expense of Its Members

139 implied HN points • 24 Aug 21

🇺🇸 U.S. Politics Health Policy Corporate Influence Insurance Industry

The U.S. Chamber of Commerce is actively defending employer-sponsored health insurance, which is important for insurers' profits. They claim it provides significant value, but many people have lost this coverage, especially during the pandemic.
Recent legislation in some states for public health options is making insurers nervous. They see any movement towards alternatives to employer-sponsored insurance as a threat to their profits.
The insurance industry is using powerful lobbying and public relations strategies to protect their interests in Washington. They are pushing hard to maintain the status quo, especially as proposals for public options or Medicare expansion gain traction.

All you need to know about health care this week.

79 implied HN points • 24 Jun 22

🏥 Health Politics Insurance Issues Patient Care Medical Research Racial Disparities

41% of Americans have health care debt, showing a huge problem with medical costs in the country.
People with high-deductible health plans often delay necessary treatments due to costs, which can worsen their health outcomes.
Even those with insurance can struggle financially, leading many to seek help from friends or crowdfunding for medical expenses.

The FTC decided not to investigate PBM business practices. But there is a silver lining.

99 implied HN points • 18 Feb 22

🏥 Health Politics Insurance Costs Regulation

The FTC decided not to investigate pharmacy benefit managers (PBMs), but some commissioners are still concerned about rising out-of-pocket costs for patients at pharmacies. This is a positive sign for future inquiries about healthcare costs.
Many people with insurance are struggling to afford their medications because of high deductibles and costs demanded by their insurers. This issue is causing serious financial problems for families.
Three big companies control a large portion of the PBM market and are making significant profits while many insured Americans can't afford necessary medicines. The investigation should consider how these companies' practices affect patients.

Interested in health care? This is what I'm reading this week.

79 implied HN points • 03 Jun 22

🏥 Health Politics Health care Legislation Mental health Insurance Access

Senator Manchin is discussing a new version of the Build Back Better bill, which could cap Medicare drug costs for seniors. This change could help many older Americans save money on their medications.
The Senate is also considering a telehealth 'Bill of Rights' to make mental health services easier to access. It’s important because many people struggle to get the mental health care they need due to insurance barriers.
There's a trend of insurance companies providing care themselves, called 'pay-viders.' This can lead to higher profits for these companies, but it also raises questions about whether it helps patients receive better care.

Manchin: "[West Virginians] live within their means." In reality, the state is #1 in medical debt collections.

99 implied HN points • 04 Nov 21

🇺🇸 U.S. Politics Healthcare policy Economic Policy Social programs Legislation

West Virginia has serious issues with medical debt, leading the nation in collections. This showcases the struggles many residents face in affording healthcare.
Capping out-of-pocket costs for Medicare recipients could really help people in West Virginia. It would make medications more accessible for those who are struggling financially.
Senator Manchin's views do not reflect the reality of many West Virginians. People are trying hard to manage their finances but find it tough due to high medical and living costs.

Despite a profitable 2021, expect higher deductibles and premiums in Aetna's health plans for 2022.

79 implied HN points • 15 Feb 22

🏥 Health Politics Health care Insurance Investments Market Trends

Aetna's health plans will have higher deductibles and premiums in 2022, which can make healthcare more expensive for customers. Even though they made money in 2021, people will likely pay more out of pocket.
Even with big profits last year, investors are worried about how CVS/Aetna will perform this year. They became anxious after the company slightly lowered its cash flow expectations, leading to a drop in stock prices.
Enrollment in Aetna's health plans has declined over the years as premiums increased. Many companies are offering less coverage, forcing people to pay more themselves instead, while the company focuses on boosting investor profits.

The $140 billion the New York Times says Americans owe in medical debt is just the tip of the iceberg.

99 implied HN points • 21 Jul 21

🏥 Health Politics Medical Debt Insurance Issues Patient Advocacy Healthcare Costs Public Policy

Americans owe $140 billion in medical debt, but this number is likely much larger. Many people are also using credit cards to cover healthcare costs, which adds to the debt.
A significant amount of medical debt comes from insured people, not just the uninsured. High deductibles make it hard for many to afford care even with insurance.
High-deductible health plans can be risky, as they can lead to big out-of-pocket costs when people get sick. This situation needs more attention from lawmakers to protect individuals from financial ruin.

We launched a coalition to lower out-of-pocket costs and help end medical bankruptcies

59 implied HN points • 15 Sep 21

🏥 Health Politics Healthcare Reform Social justice Public Health

A new coalition called Lower Out-of-Pockets NOW aims to reduce the high costs people pay out-of-pocket for medical care. This is to help stop families from going into debt because of medical bills.
High out-of-pocket costs are a big reason why many people in the U.S. face bankruptcy, even if they have health insurance. Many are skipping necessary treatments or medications because they can't afford them.
The coalition wants Congress to prioritize insurance reforms to lower these costs, especially for Medicare beneficiaries and those with low incomes or chronic conditions.

Once health care's “good guy," Kaiser Permanente is being investigated for defrauding taxpayers.

59 implied HN points • 02 Aug 21

🏥 Health Politics Medicare Advantage Insurance Practices

Kaiser Permanente is under investigation for allegedly defrauding taxpayers by making Medicare patients appear sicker than they are. This means they might be getting more money from the government than they're supposed to.
The company once had a good reputation as a nonprofit but seems to have started using similar tactics as for-profit companies to keep up in the competitive health insurance market. They began drifting from their basic HMO model into high-deductible plans.
Many people are moving to Medicare Advantage plans because they often offer better benefits compared to traditional Medicare. This shift makes it important for Congress to improve traditional Medicare to keep it competitive.

Insurers are trying to buy good will for the inequalities they help create. See how.

59 implied HN points • 27 Jul 21

🏥 Health Politics Health Equity Insurance Issues Policy Analysis

Big health insurers are focusing on profits instead of addressing health inequalities. They're making large profits while many people suffer from inadequate healthcare.
Insurers are trying to improve their image by claiming to support health equity, but they're not investing enough to make a real difference. Their top executives are earning much more than what’s being spent on addressing health issues.
High-deductible insurance plans make healthcare unaffordable for many, leading to more people being underinsured, especially among communities of color. This situation is creating more financial stress and worsening health outcomes for those affected.

The vast majority of Centene and Humana's $209 billion in revenues came from taxpayers.

39 implied HN points • 25 Feb 22

🏥 Health Politics Insurance Market Government Policy Medicare Advantage

The majority of revenues for Centene and Humana come from taxpayers, with about $209 billion in total revenues last year. This means the public is funding a big part of their business.
Almost 44 million Americans were enrolled in plans from these two companies, but only a small fraction, about 3.7 million, were private-paying customers. Most of their earnings rely on government programs.
Both companies have not seen much growth in their individual plans over the past decade, and costs like deductibles for private patients have increased significantly. This shows a shift in focus towards government-funded health programs.

UnitedHealthcare is caught in a PR nightmare. Here’s what they did and how it'll soon be your nightmare.

59 implied HN points • 24 Jun 21

🏥 Health Politics Healthcare policy Insurance Issues Public Health Patient Advocacy

UnitedHealthcare plans to deny ER claims if their nurses decide patients weren't sick enough. This could leave many with unexpected bills after emergencies.
The company's recent policy change sparked a major public relations crisis, leading to widespread backlash from doctors and healthcare organizations.
Despite delaying the policy for now, UnitedHealthcare may implement it later, risking patient safety and putting profits over care.

Congress must cap increasingly lethal Medicare out-of-pocket requirements

39 implied HN points • 25 Oct 21

🏥 Health Politics Medicare Insurance Healthcare Costs Legislation

Medicare costs are rising, making it harder for seniors to pay for care. Many people with Medicare can face high out-of-pocket expenses that lead to debt or avoiding necessary treatment.
Congress should put a cap on out-of-pocket costs for Medicare. This could help seniors save money and get the care they need without falling deep into debt.
Medicare Advantage plans often seem attractive, but they can have hidden costs that can be very high. Seniors need to be careful in choosing their plans to avoid surprises.

The journey that led me to become a whistleblower began on Spear Branch Road in Tennessee.

19 implied HN points • 04 Aug 21

🏥 Health Politics Healthcare Whistleblowing Public Health Policy Personal narrative

A turn in life can happen from a mix of small experiences and bigger events. Everyone has their own journey that shapes who they become.
Growing up in a small, close-knit community can create a strong sense of belonging and influence one's values. The memories and lessons from family and neighbors stay with us.
Challenges, like financial struggles, can lead to big life changes. These tough times often shape our outlook on life and push us towards new paths.

Biden's crackdown on monopolies gave a pass to health insurers when they should have been the focus.

19 implied HN points • 13 Jul 21

🇺🇸 U.S. Politics Healthcare policy Regulation Monopolies Political Accountability Consumer Rights

Health insurers have grown a lot since 2008, with some now being among the largest companies in America. This is a big change that affects consumers' choices and costs.
Despite the focus on hospitals and drug companies, health insurers haven't faced much scrutiny for rising costs. The current system allows insurers to raise prices without clear benefits for consumers.
The idea of having real choices in health insurance is mostly a myth. Many people find they have limited options, especially if their employer decides their coverage.

Wendell Potter: I've been alive for 70 years. It is time for me to speak up like I never have before.

19 implied HN points • 24 Jun 21

🏥 Health Politics Healthcare policy Insurance Issues Whistleblowing Advocacy Transparency

Wendell Potter, a former health insurance executive, plans to reveal how health insurance companies operate and make decisions that affect people's lives. He aims to shed light on the industry’s practices and motivations.
He emphasizes that he has changed his approach and now wants to share the truth after years of misleading customers for profit. Potter feels less fearful as he approaches his 70th birthday, motivating him to speak out more.
Potter's experiences also include a personal journey, sharing stories from his life that influenced him, and inviting others to contribute their own insights about unethical practices in the industry.