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Bad News for Retirees: No Social Security Cost-of-Living Increase, Higher Medical Costs for Many

"Most Americans have their outpatient care premiums for Medicare Part B deducted directly from their Social Security checks, and the annual cost-of-living increase usually covers any increase to premiums. When it doesn't, a longstanding 'hold harmless' law protects about 70 percent of seniors from having their Social Security payments reduced. But that leaves about 30 percent of Americans on Medicare to cover a hike to premiums that otherwise would be spread across everyone. That group includes people new to Medicare, federal retirees who don't receive Social Security payments and about 3.1 million people with higher incomes, that is, those making more than $85,000."  MORE >>

Over Half of Americans Have Medical Debt, Even Those with Health Insurance

"69% of respondents who pay for their own health insurance reported medical debt, as did 61% of respondents with policies through their employer and 59% of respondents with no health insurance at all. One reason people with health insurance seem to be more likely to have debt than those without coverage: deductibles."

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Health Insurers' Stocks Drop on More Disappointing Medical Cost News

"[Humana] warned that medical costs were running higher than expected and signaled that the pressure might impact its 2024 results as well.... The company's news, following UnitedHealth Group's recent disclosure of higher fourth-quarter medical costs, adds to Wall Street concerns about health insurers' results[.]"  MORE >>

Supreme Court Provides Good News for Sponsors of Union Retiree Medical Benefit Plans

"[T]he Supreme Court again admonished the Sixth Circuit not to rely on inferences. The Court held that a contract is not ambiguous unless it is subject, by its terms, to multiple interpretations and that the Sixth Circuit -- which was unique in its approach -- erred in its reliance on special inferences in favor of retirees." [CNH Industrial N.V. v. Reese, No. 17-515 (U.S. Feb. 20, 2018, per curiam)]  MORE >>

American Medical Association and State Medical Societies Back Plan Limiting Insurers Administrative Spending

Excerpt: Physician and hospital organizations have expressed general support for a proposal from state insurance commissioners on what health insurers should be allowed to consider medical spending under new health system reform regulations.

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Text of American Bar Association Report on Contingent Fees In Medical Malpractice Litigation (PDF)

68 pages, dated Sept. 20, 2004. Excerpt: Attorney contingent fees have again become the focus of efforts by medical professionals and allied organizations to reduce the costs of medical liability. These efforts ... seek to impose limits on the fees lawyers may charge clients in successful medical malpractice claims and actions. They are premised on the belief that such limits will ultimately reduce costs associated with medical negligence claims.

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Medical Debt Is Putting More Americans Into Financial Crisis

"More Americans than ever, about 92%, now have health insurance -- and simultaneously face enormous bills. Over the last decade, insurers and employers have pushed more cost-sharing onto individuals and families. Now, squeezed by medical costs and inflation, more than 100 million Americans have medical debt and roughly the same proportion report avoiding a prescription because of it."

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Will Amazon's One Medical Discount for Prime Members Make a Dent in American Healthcare?

"The sheer volume of Amazon Prime members and the ability for them to add others to their One Medical subscription means that a very large fraction of the American population is now able to access care provided by One Medical at a discounted rate.... [It] is possible that [Amazon] could eventually disrupt the status quo by undercutting mainstream providers on price and becoming a leader in virtual healthcare delivery."  MORE >>

Even Insured Americans Lack Funds for Out-of-Pocket Medical Costs

"24% of respondents report having no money in their savings accounts and 48% say they have less than $1,000.... 33% of insured Americans cannot go more than one week without a paycheck, while 71% cannot endure a month without pay, leading many (25%) to have to borrow money in the event of a medical emergency.... [M]ore than three-quarters (78%) of insured respondents underestimate their financial exposure to common medical challenges, such as heart disease and breast cancer."

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American Benefits Council Comment Letter to IRS on Notice 2018-71, Employer Tax Credit for Paid Family and Medical Leave

"While the credit is only available for 2018 and 2019 under current law, we believe it is possible Congress may extend the credit in future years. Accordingly, we think it is valuable for the IRS and Treasury to issue proposed regulations that are consistent with Congress' intent to encourage adoption of paid family and medical leave programs."  MORE >>

American Medical Association Urges Ban on TV Drug Ads

"The American Medical Association voted this week in favor of a ban on ... direct-to-consumer advertising of prescription drugs and medical devices.... [O]nly the Food and Drug Administration or Congress has the power to ban pharmaceutical advertising.... 'Today's vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices,' AMA board chair-elect Patrice A. Harris said ... 'Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.' "

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More Americans Could Afford to Pay Their Medical Bills in First Year of ACA Enrollment

"The number of Americans reporting they did not receive needed health care because of its cost dropped for the first time since 2003, falling from 80 million in 2012 to 66 million ... And the number saying they had trouble paying their medical bills or were paying off medical debt fell from 75 million in 2012 to 64 million -- the first time it declined since this question was initially asked in 2005."  MORE >>

How the High Cost of Medical Care Is Affecting Americans

"Nearly half of respondents described the affordability of basic medical care as a hardship for them and their family, up 10 points from a year ago. While the [ACA] has expanded insurance to millions of Americans, including those with existing conditions, it does not directly address cost. And cost is becoming increasingly problematic."

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American Academy of Actuaries Comment Letter to CMS on Medical Loss Ratio Report for Medicare Advantage Plans and Prescription Drug Plans (PDF)

"[F]or consistency in MLR reporting not only among issuers, but also between the commercial and Medicare markets, we encourage CMS to state explicitly within the instructions for the Medicare MLR report that the following questions [from previously-issued FAQs] apply to Medicare MLR as well. If guidance on any of these items for Medicare MLR is not to remain consistent with the applicable guidance for commercial plans, it would be helpful for CMS to provide an explanation of the differences, possibly through a notice of rulemaking process with an opportunity for public comment." [FAQs cited in this letter were issued by CCIIO on May 13, 2011, July 18, 2011, and February 10, 2012.]  MORE >>

Medical Error Cost Calculator Riles American Hospital Association

"An online tool ... which determines the 'hidden surcharge' or costs of a hospital's medical errors, employs a methodology that is 'seriously flawed,' says the American Hospital Association. The Leapfrog Group's new 'Hidden Surcharge Calculator,' a web-based tool, enables employers to add up how much of their health premium dollars go to manage hospital medical errors that harm their employees. The tool determines the costs based on the safety track records of each hospital where their workers received care."

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Americans Having Less Trouble Paying Medical Bills

"[T]here were 57.8 million Americans who had trouble paying their health care bills in the first six months of 2011. That number fell by 3.6 million, hitting 54.2 million in the same span of 2012.... [F]amilies with children under 17 saw a statistically significant change in their ability to pay medical bills that did not occur among families with members between 18 and 64."  MORE >>

Comment Letter by the Medical Loss Ratio Regulation Work Group of the American Academy of Actuaries to CMS on Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (PDF)

"CMS has made a concerted effort , in developing regulations implementing Section 1857(e)(4) of the Social Security Act, to closely mirror the regulations implementing the commercial health insurance MLR provisions enacted under Section 2718 of the Public Health Service Act. Consistency between the Medicare MLR regulation and the commercial MLR regulation is an appropriate approach . Our comments focus on a few areas in which further clarification would be helpful or for which we wanted to provide some additional thoughts based on our experience with the commercial MLR regulation."  MORE >>

Comment Letter by the Medical Loss Ratio Regulation Work Group of the American Academy of Actuaries, to HHS on MLR Reporting Aspects of Proposed Contraceptive Mandate Rules (PDF)

"[I]n situations in which ['zero premium contraceptive-only'] policies are issued to individuals whose underlying comprehensive medical coverage is provided via a self-funded group health plan ..., the issuer (or an affiliate) would be eligible to receive adjustments to any federally facilitated exchange (FFE) user fees it might owe ... All else being equal, a lower level of FFE user fees would lead to higher reported premiums for MLR purposes, a lower reported MLR value, and a potentially higher level of customer rebates."  MORE >>

Trends in Americans' Access to Medical Care, 2007-2010

Despite increases in the number of uninsured, slightly more than one in six Americans -- 52 million people -- reported not getting or delaying needed medical care in 2010, down from one in five -- 58.6 million people -- in 2007.

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Lack of Insurance, High Medical Costs a Problem for More Americans

Excerpt: Americans are struggling to pay medical bills and are accumulating medical debt at an increasing rate, according to a survey released today. 'A perfect storm of negative economic trends is battering working families across the United States,' said the survey by the Commonwealth Fund[.]

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