Health

Study: Insurers May Using Drug Costs to Discriminate

Published

10 years ago

January 29, 2015

Oakland Post

In this photo taken Aug. 21, 2014 shows health care tax forms 8965, in Washington. Being uninsured in America will cost you more in 2015. In 2015, all taxpayers have to report to the Internal Revenue Service for the first time whether or not they had health insurance the previous year. Most will check a box. Its also when the IRS starts collecting fines from some uninsured people, and deciding if others qualify for exemptions. (AP Photo/Carolyn Kaster)

In this photo taken Aug. 21, 2014 shows health care tax forms 8965, in Washington. (AP Photo/Carolyn Kaster)

KELLI KENNEDY, Associated Press

FORT LAUDERDALE, Fla. (AP) — Insurance companies, perhaps more than previously thought, may be charging the sickest patients extra for drugs under the federal health law, in an effort to discourage them from choosing certain plans, according to a study released Wednesday.

One of the cornerstones of President Obama’s signature health law forbids insurance companies from turning away people with pre-existing conditions such as diabetes or cancer. Yet hundreds of patient advocacy groups say insurance companies have found a way to discriminate against these people, who are more expensive to cover because they require life-long treatments.

The companies do this by putting all of their medications in a special category where the patient is required to pay a percentage of the cost of the drug, rather than a flat co-pay. Some are as high as 50 percent, leaving people on the hook for thousands of dollars. That compares to the average $10 to $40 per-medication co-pay that most pay.

A study published in the New England Journal of Medicine only examined HIV drugs, but noted the problem applies to mental illness, cancer, rheumatoid arthritis, diabetes and other chronic conditions. Patient advocates have complained that prescriptions for these patients were virtually unaffordable in some plans offered on healthcare.gov.

The AIDS Institute even filed a formal complaint with Health and Human Services officials last summer about four plans in Florida. Georgia plans to file a similar complaint, but the scope of the problem has been difficult to gauge as many of the complaints have been anecdotal.

The researchers studied 48 plans in 12 states using the federal marketplace: Delaware, Florida, Louisiana, Michigan, South Carolina, Utah, Illinois, New Jersey, Ohio, Pennsylvania, Texas, and Virginia.

They found that one-quarter of the plans placed all of the HIV drugs into the highest-cost category and required consumers to pay at least 30 percent of the drug costs instead of a flat co-pay. Annual drug costs in these plans were more than triple compared with other plans ($4,892 to $1,615), according to the analysis. And 50 percent had to pay a separate deductible for drugs, compared to only 19 percent of consumers in other plans.

Insurers have historically placed drugs in categories with higher co-pays to encourage consumers to select generic or preferred brand-name drugs. The problem is exacerbated as more plans place all drugs, including generics, in the more expensive category.

“Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans,” the study noted.

Over time, researchers predicted sicker people will enroll in plans that don’t charge such high prices. That means certain plans could have a higher number of sicker, more expensive consumers than their competitors. The federal law has financial protections for those plans but some will be phased out in 2016.

The law does ban insurers from charging an individual more than $6,350 in out-of pocket costs a year and no more than $12,700 for a family policy.

Insurance companies say the main issue is increasing drug costs and they’re shouldering the bulk of it. But they acknowledge the increased prices are also passed onto consumers.

For example, Atripla, the most popular HIV AIDS treatment and one of the highest-selling drugs in the U.S., costs insurers $27,026 a year. Patients only pay a portion of that, said Clare Krusing, a spokeswoman for the trade association America’s Health Insurance Plans.

But insurers noted consumers have the flexibility to choose from plans at all levels with different cost-sharing requirements and that the health law has a component that rewards plans for value and efficiency “not on their ability to attract healthier enrollees,” Krusing said.

Advocates have asked federal health officials to intervene and nearly 300 patient groups sent a letter last month urging Health and Human Services Secretary Sylvia Burwell to beef up enforcement. The federal government has warned against such discrimination.

“We analyze plan information submitted by insurance companies to uncover discriminatory benefit designs, and work with outlier plans to update formularies so they do not discourage enrollment of consumers with specific medical conditions,” agency spokesman Aaron Albright said in an email.

It’s unclear what the penalties are for insurance companies who discriminate.

Meanwhile, insurance officials in some states are stepping in. Three out of four insurance companies restructured their plans in Florida late last year.

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Alameda County

Access Better Health with Medically Tailored Meals – Transforming Health Through Nutrition for Medi-Cal Patients

Launched in 2018, the Medically Tailored Meals pilot program was designed to help Medi-Cal patients with congestive heart failure by reducing hospital readmissions and emergency department visits by providing tailored meals meeting specific dietary needs. The program’s success in improving health outcomes and reducing costly emergency room visits encouraged the Department of Health Care Services (DHCS) to expand the Medically Tailored Meals program to all 58 counties through Medi-Cal transformation and a new set of services called Community Supports.

Published

4 days ago

October 29, 2024

Oakland Post

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The program’s success in improving health outcomes and reducing costly emergency room visits encouraged the Department of Health Care Services (DHCS) to expand the Medically Tailored Meals program to all 58 counties through Medi-Cal transformation and a new set of services called Community Supports.

Medically Tailored Meals are one of 14 new services offered through Medi-Cal that provide members with access to new and improved services to get well-rounded care that goes beyond the doctor’s office or hospital.

Medically Tailored Meals: Overview

Malnutrition and poor nutrition can lead to severe health outcomes, especially among Medi-Cal patients with chronic health conditions. Medically Tailored Meals aim to improve health outcomes, reduce hospital readmissions, and enhance patient satisfaction by providing essential nutrition.

Key Features:

Post-Discharge Delivery: Meals are delivered to patients’ homes immediately following discharge from a hospital or nursing home.
Customized Nutrition: Meals are tailored to meet the dietary needs of those with chronic diseases, designed by registered dietitians (RD) or certified nutrition professionals based on evidence-based guidelines.
Comprehensive Services: Includes medically tailored groceries, healthy food vouchers, and food pharmacies.
Educational Support: Behavioral, cooking, and nutrition education is included when paired with direct food assistance.

Key Benefits:

Address Food Insecurity: Mitigates poor health outcomes linked to food insecurity.

Support Complex Care Needs: Tailored to individuals with chronic conditions.

Improve Health Outcomes: Studies show improvements in diabetes control, fall prevention, and medication adherence.

Patient Testimonial:

“My diabetes has gotten better with the meals. I’ve kept my weight down, and I feel much better now than I have in a long time. I’m one of the people this program is meant for.” — Brett

Eligibility:

Eligible Populations: Eligible Medi-Cal members include those with chronic conditions like diabetes, cardiovascular disorders, congestive heart failure, stroke, chronic lung disorders, HIV, cancer, gestational diabetes, and chronic mental or behavioral health disorders. Also, those being discharged from a hospital or skilled nursing facility or at high risk of hospitalization or nursing facility placement are also eligible.

Service Limitations: Up to two meals per day for up to 12 weeks, extendable if medically necessary. Meals eligible for reimbursement by alternate programs are not covered.

Cost Savings and Improved Health Outcomes:

Health Outcomes: Research indicates a 22% to 58% decrease in emergency department visits and a 27% to 63% decrease in inpatient admissions among Medically Tailored Meals recipients, translating to significant health care cost savings.

Project Open Hand: A Success Story

Project Open Hand has been a leader in providing Medically Tailored Meals, significantly impacting the lives of Bay Area Medi-Cal patients with chronic illnesses. Since its inception, Project Open Hand has delivered nutritious meals to individuals with diabetes, HIV, and other serious health conditions, demonstrating remarkable health improvements and cost savings.

Key Achievements:

Improved Health Outcomes: Project Open Hand’s research found a 50% increase in medication adherence among recipients of Medically Tailored Meals.

Reduced Hospitalizations: Their program showed a 63% reduction in hospitalizations for patients with diabetes and HIV.

Enhanced Quality of Life: Patients reported better health and increased energy levels.

Project Open Hand ensures that each meal is prepared using fresh, wholesome ingredients tailored to meet the specific dietary needs of its clients. By partnering with Medi-Cal managed care plans, Project Open Hand continues to provide life-saving nutrition to those who need it most.

Join Us in Our Mission

You can experience the profound impact of Medically Tailored Meals by joining the Medi-Cal Community Supports services initiative. Your involvement can make a difference in promoting your health through nutrition.

Learn More

For more information about Medically Tailored Meals and how to get involved, call the state’s Medi-Cal Health Care options at 800-430-4263 or contact your local managed care plan.

In Alameda County, Medi-Cal recipients can contact:

* Alameda Alliance for Health: 510-747-4567

* Kaiser Permanente: 855-839-7613

In Contra Costa County, Medi-Cal recipients can contact:
* Contra Costa Health Plan: 877-661-6230

* Kaiser Permanente: 855-839-7613

In Marin County, Medi-Cal recipients can contact:
* Partnership Health Plan of California: 800-863-4155

* Kaiser Permanente: 855-839-7613

In Solano County, Medi-Cal recipients can contact:
* Partnership Health Plan of California: 800-863-4155

* Kaiser Permanente: 855-839-7613
Your health and well-being are your health care provider’s top priority. Medically Tailored Meals are designed to enhance quality of life by advancing health care through the power of nutrition. Experience the benefits today, and take the first step toward a healthier you.

Oakland Post

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California Black Media

Not So Sweet: California State Health Campaign Highlights Dangers of Sugary Drinks

The California Department of Public Health (CDPH) and CalFresh Healthy Living, the state’s nutrition assistance program, recently launched a health campaign to illuminate the risks of drinking sugar-sweetened beverages and the health benefits of hydrating with water. The “Not So Sweet Side” initiative encourages families to make informed decisions about the drinks they choose and to be aware of the sugar content present in them.

Published

4 days ago

October 29, 2024

Oakland Post

iStock Photo

By Edward Henderson, California Black Media

The California Department of Public Health (CDPH) and CalFresh Healthy Living, the state’s nutrition assistance program, recently launched a health campaign to illuminate the risks of drinking sugar-sweetened beverages and the health benefits of hydrating with water.

The “Not So Sweet Side” initiative encourages families to make informed decisions about the drinks they choose and to be aware of the sugar content present in them.

According to the campaign, consuming too much sugar has been associated with an increase in chronic conditions and diseases such as type 2 diabetes, heart disease and tooth decay. African Americans face a higher risk of developing diabetes mellitus, heart disease and tooth decay.

Dr. Redieat Assefa is a pediatrician at Riverside University Health Systems. She spoke at a webinar hosted by California Black Media introducing the campaign to ethnic media publishers across California.

Assefa underscored the importance of reading labels on sugary drinks you may consume and how to identify drinks that contain too much.

“When reading a nutrition label, there are a few key components that I would like us to consider. The first thing is the serving size of your sugary drinks. Is it one can? Is it one bottle? Then you go down to your total carbohydrates, which can be broken down to your fibers and sugary, added sugars or non-added sugars.”

To simplify the process, compare the grams of sugar in a box of Apple Juice with preservatives that could be around 40 grams of sugar and that of natural juice which averages around 6 grams.

Assefa also added that research indicates that African American women who drink one to two sugary beverages daily have an increased risk of type 2 diabetes. Sugary drinks can lead to high blood pressure, hype, and hypertension, contributing to a greater risk of heart disease among African American young adult men who, on average, consume sugary beverages at a higher level than other groups.

Assefa pointed out that there are about 10 teaspoons of sugar in a single can of soda.

Dr. Maxmillian Chambers, a dental professional and public health advocate, also spoke on the panel promoting the campaign highlighting the impact sugary drinks can have on dental health.

“As we continue this dialogue, it’s crucial to turn our focus to oral health, a key component of our overall well-being that doesn’t often receive the attention it deserves. Sugary drinks are a significant contributor to tooth decay. Research shows that drinking more than two eight-ounce servings of sugary beverages per week can drastically increase the risk of cavities. And for our youth, particularly those aged 9 to 18, sugary drinks are primary sources of added sugar in their diets.”

Lakeysha Sowunmi, a mom and public health advocate who has worked to influence state policy and mobilize communities, including churches, around health issues, said, “I work with families on a budget, for example, and help them understand CalFresh and the resources that are available. We talk about portion control. We talk about feeding big families.”

The CalFresh Healthy Living Program is led by CDPH’s Nutrition and Physical Activity Branch. To explore recipes, resources, and tips for making healthier beverage choices, visit http://uncoverhealthyhabits.com/

Oakland Post

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Black History

Health is Our Wealth: An Afrocentric Perspective to Health & Wellness

When I was an early-career mental health professional, my close friend was coming up in his construction career. We came up in the hood together, learning life lessons from living the street life. As we grew in our fields, we wanted to showcase our hard work and income though our appearances and the valuables we owned. I flaunted the flyest sneakers, and he customized his car rims as status symbols. Our understandings of wealth, worthiness, and wellness as young Black professionals reflected Eurocentric materialism, which we have now discovered is unhealthy.

Published

4 days ago

October 29, 2024

Oakland Post

Courtesy of Art Harris.

By Art Harris

It became imperative for us to re-align our concepts of health, wealth and wellness with African-Centered philosophies. This is what Baba Dr. Wade Nobles refers to as Sakhu (Skh), the illumination of the spirit via African science, study, understanding, and knowledge in his book Seeking the Sakhu: Foundational Writings for an African Psychology. It takes awareness, intentionality, and commitment to raising our consciousness and shifting from Eurocentric paradigms of health, wealth and wellness to Afrocentric ones.

Baba Wade teaches us that racism is the pre-existing condition in America and in The Island of Memes: Haiti’s Unfinished Revolution, he explains that the liberation of the African mind can only happen when we return to an African consciousness. Only a healthy mind can produce a healthy body. Many of the unhealthy urges African Americans experience are a result of imagery planted by the mentally ill White supremacist culture. In enslaving and oppressing Africans in America, the White supremacist culture destroyed our ancestral memories, rituals, and conceptions of health.

African-centered anthropologists and scholars have looked to the Nile Valley civilizations of ancient Kemet (Egypt) and Kush to illustrate the historical greatness that is our legacy. Profound teachers, ministers, researchers, and psychologists like Malcolm X, Tony Browder, Dr. Ivan Van Sertima, Dr. Asa Hilliard III, Chiekh Anta Diop, and Drusilla Dunjee Houston highlight the great contributions of African people to the fields of medicine, science, religion, politics, architecture, and more.

In his books Spirituality Before Religions and the Shabaka’s Stone, Professor Kaba Hiawatha Kamene teaches that the principles of Ma’at (truth, justice, harmony, balance, propriety, order, reciprocity) ensured morality and justice were at the center of maintaining a healthy, righteous Kemetian society.

For myself, it took a growth mindset and reading books like New Visions for Black Men and Breaking the Chains of Psychological Slavery by Dr. Na’im Akbar. Now, about 20 years later, my friend and I both have advanced in our fields and we now value health and wealth as it pertains to physical, familial, financial, mental, and spiritual wellness.

As we reconnect to natural approaches to healing and attune with what is/is not healthy for people of African ancestry, then we can realize health, wellness, and joy for our families and communities.

About the Author

Art Harris is a Bay Area native, veteran of the U.S. Navy, licensed marriage and family therapist, and school psychologist. He is the Bay Area Chapter of the Association of Black Psychologists (Bay ABPsi) Continuing Education Unit Co-Coordinator. Bay ABPsi Chapter is a healing resource committed to providing the Post Newspaper with monthly discussions about critical Black Mental Health issues. Please join us at our meetings every 3rd Saturday via Zoom or contact us at bayareaabpsi@gmail.com.