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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Medical bills still plague Americans, more than a decade after the ACA

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Today’s edition: The National Institutes of Health is preparing an overhaul of policies on government-funded research with draft recommendations expected to be released Friday. The Biden administration seeks to curb the inappropriate use of antipsychotic medications in nursing homes. But first … 

Tens of millions of Americans still report trouble paying medical bills – although the number is ticking down

Patients are struggling to afford their medical bills with a record number of Americans putting off medical care last year due to cost.

Two new reports out this week get at the sheer enormity of the problem, which comes despite the uninsured rate reaching an all-time low early last year.

  • Roughly 38 percent of Americans surveyed said they or a family member postponed medical treatment last year due to cost. That’s the highest rate by five percentage points since Gallup began tracking self-reported delays in medical care in 2001. 
  • One potentially positive trendline: The percentage of people who were in families having problems paying medical bills decreased from 14 percent in 2019 to 10.8 percent in 2021, according to a report out this morning from the federal government that goes through 2021. Yet, those having trouble paying bills totaled 35 million people in 2021 — not exactly a low number. 

The new data comes as massive medical bills are hurting the financial stability of Americans across the country, and those with insurance coverage aren’t immune. The issue underscores the pressing health cost challenges still facing federal and state lawmakers more than a decade after the Affordable Care Act was signed into law. 

Delays in care

According to the Gallup survey, those who reported a postponed treatment within their family were more than twice as likely to say the procedure was for a condition that is serious. 

Specifically, 27 percent of people surveyed say the delay in treatment was for a “very” or “somewhat” serious condition or illness, compared with 11 percent who said it was for a “not very” or “not at all” serious medical issue. 

Who’s being affected? Lower-income adults, younger adults and women are consistently more likely to say they or a family member have delayed care for a serious medical condition. 

The survey didn’t detail why the number of Americans putting off health care grew, though the report noted the change comes amid the nation’s highest rate of inflation in over 40 years. But Ashley Kirzinger, of the Kaiser Family Foundation, told us some of the likely reasons: For those with insurance, an increasing number of people are enrolled in high deductible plans, some of whom budget for their premium costs but not necessarily for a pricey medical bill. For the uninsured, it’s an inability to pay for care out-of-pocket.

Paying medical bills

The rate of people who were in families having problems paying medical bills decreased in 2021, yet “the burden associated with unpaid medical bills remains a public health concern,” according to a report released today from the Centers for Disease Control and Prevention’s National Center for Health Statistics. 

The researchers don’t explicitly say why the change. However, they write that coronavirus relief legislation may have indirectly helped mitigate the impact of the pandemic for those having trouble paying bills. 

For instance: The bills Congress passed provided monetary payments, flexibility with creditors and greater subsidies to afford Obamacare plans. Meanwhile, fewer people went to their doctor for preventive care, outpatient visits and other elective services during the beginning of the pandemic, which may have reduced the potential for medical debt through fewer copays, deductibles and coinsurance.

Who’s being impacted? Women (11.8 percent) were more likely than men (9.7 percent) to report being in families having problems paying medical bills. 

The percentage was higher among Black people (15.8 percent), compared with those who are Hispanic (12.8 percent), White (9.4 percent) and Asian (6.1 percent)

And when it comes to insurance status … More uninsured adults (20.3 percent) were in families having problems paying medical bills, compared with those with Medicaid and CHIP (13.1 percent) and people with private coverage (9 percent). The issue is also hitting people harder in states that haven’t expanded Medicaid.

A widespread issue

The problem of insurmountable medical bills is no secret. This week’s reports come on the heels of a year-long investigation into medical debt by Kaiser Health News and NPR. 

More than 100 million people — including 41 percent of adults — are saddled with debt from medical or dental bills, according to a KFF poll conducted for the news outlets. Unexpected one-time or short-term medical expenses can be a huge contributor to that debt, which has forced people to skip payments on other bills, delay college or buying a home, or change their housing situation. 

Our take: The key question is how will Capitol Hill and state legislatures respond. After a spate of news stories on surprise medical bills, Congress passed legislation to stop patients from inadvertently getting hit with the pricey bills through no fault of their own, though the effort took years. The idea of curbing the high cost of care is bipartisan, but finding consensus on how to do so in a divided Congress is no easy task.


Policy overhaul could set how virology experiments are conducted

The National Institutes of Health is preparing an overhaul of policies on government-funded research, and draft recommendations by its biosecurity board are expected to be released Friday, The Post’s Joel Achenbach reports in a story out this morning. 

Those recommendations could determine how virology experiments are conducted. And they’ll come amid a politically charged environment, as House Republicans — with their new subpoena power — have pledged investigations into the pandemic. That includes the origin of the coronavirus, and what they believe could be the involvement of American scientists and government officials.

The probes into the pandemic’s origin have intensified a debate that had split the mainstream scientific community way before covid-19: Where do scientists and government officials draw the line between the benefits and risks of pathogen research? Leaders of the NIH biosecurity advisory board have said their nearly year-long quest to produce new guidance has been challenging, as they try to strike the right balance.

  • “Critics view pathogen research as the Wild West of science. Virologists have faced online abuse and even death threats amid fears that what they do is dangerous,” Joel writes. “Above all, conjectures that the coronavirus pandemic might have originated from secret laboratory research have cast a shadow over the field.”

Agency alert

Federal officials target inappropriate antipsychotic medications in nursing homes

New this a.m.: The Biden administration is unveiling actions aimed at reducing the inappropriate use of antipsychotic medications in nursing homes, as well as boosting transparency over disputed citations. 

Starting this month, the Centers for Medicare and Medicaid Services is planning to conduct off-site audits to determine whether facilities are accurately assessing and coding residents with a schizophrenia diagnosis. If a nursing home has a pattern of inaccurately coding residents as having schizophrenia, then it’ll impact the star rating the facility receives, and which consumers use to compare the quality of various nursing homes. 

And beginning Jan. 25, the agency will begin publicly displaying the health and safety citations that facilities are disputing. Currently, if a nursing home contests a violation, then that deficiency isn’t posted online until the dispute process is complete, which usually takes 60 days, but can sometimes be longer. According to CMS, displaying such information can “help consumers make more informed choices” when they’re evaluating various facilities. 

The backdrop: This comes as the Biden administration has pledged tougher oversight and steeper penalties for the nation’s poorest-performing facilities. Nursing homes were the epicenter of covid spread during the early days of the pandemic and have faced increased scrutiny since then. 

Industry Rx

Moderna joins Pfizer, GSK in RSV vaccine push for older adults

Drug giant Moderna on Tuesday said its vaccine against respiratory syncytial virus (RSV) reduced the rate of lower respiratory infections in people over 60 by 83.7 percent, making it the third major pharmaceutical company to show such promising results for older adults, Matthew Herper reports for Stat

“Covid has opened everyone’s eyes to what a burden respiratory disease is,” said Jacqueline Miller, Moderna’s therapeutic area head for infectious diseases. “We believe our vaccine, if licensed, may represent another tool in the toolbox to maintain health in those over 60 years of age.” 

Moderna’s successful Phase 3 trial for patients with two or more symptoms forecasts competition with Pfizer and GSK, which have been preparing for a brisk marketing battle for months. In August, Pfizer said its vaccine demonstrated a 66.7 percent reduction in the disease for those with two or more symptoms, while in October GSK said its vaccine lowered infection for the same threshold by 82.6 percent. 

Data on the Pfizer and GSK vaccines have already been submitted to the Food and Drug Administration, with decisions expected in May. Meanwhile, Moderna officials said they are preparing to send their data to the FDA for approval. 

  • “I’ve been working on RSV for a long time and there’s been periodic promises of having an RSV vaccine around the corner, which has never proven to be true,” said Larry Anderson, a professor of pediatric infectious disease at Emory University School of Medicine. “To have three vaccines with a good chance to be licensed and this kind of efficacy data is really pretty amazing.”

In other health news

  • The buzziest conference for health-care investors convened last week, but the event was tinged with anxiety over a major question: Would the massive sums invested in the health care due to covid-19 continue to flow? Kaiser Health News’s Darius Tahir reports from San Francisco. 
  • Hospitals are readying to expand their footprint and raise prices on commercial insurers and workers this year, Stat’s Bob Herman reports.
  • Three accountable care programs will provide services to more than 13.2 million people enrolled in Medicare this year, CMS announced yesterday, as it seeks to grow the number of older adults in such arrangements.

Health reads

The Father of the Abortion Pill (Pam Belluck l The New York Times)

After a Brief Pandemic Reprieve, Rural Workers Return to Life Without Paid Leave (By Jazmin Orozco Rodriguez l Kaiser Health News)

Mix-it-yourself Wegovy? Some are trying risky sources for weight-loss drugs (By Elaine Chen l Stat)

Sugar rush

Thanks for reading! See y'all tomorrow.