Democrats are not yet on the same page about what health care reform proposals to include in their infrastructure bill. As a former health insurance executive, I’ve got a suggestion: lower deductibles and co-pays. And do it fast.
Some Democrats seem to be turning a blind eye to the fact millions of Americans WITH INSURANCE can’t use it anymore.
A favorite campaign talking point last year was that 150 million Americans have private insurance and don’t want to lose it. What most politicians avoided saying is that more and more of those Americans can’t use their insurance.
That’s because insurance companies like the ones I used to work for are now making people pay thousands of dollars out of their own pockets before they’ll pay a dime.
NEWS FLASH: The main reason voters ranked health care so high last year was not because 29 million of us are still uninsured. It’s because voters are seeing big insurers make record profits while they can’t even afford to pick up their prescriptions.
So here’s a new talking point for you: IT’S THE DEDUCTIBLES, STUPID! They have gotten sky high, and are going higher and higher every year.
As Vox’s Dylan Scott reported this week, research shows that “even small out-of-pocket costs, as little as $10, can lead patients to postpone lifesaving medical treatment.”

vox.com/policy-and-pol…
And a brand new study, funded by the National Institute on Aging, found that when Medicare beneficiaries were charged just $10.40 more for a prescription, their monthly mortality rates increased NEARLY 33%.

ama-assn.org/delivering-car…
Other studies have found that people in private plans are in similar dire straits. So I ask you: is it an exaggeration to say that politicians are letting insurers get away with murder by allowing payers to jack up deductibles to the point Americans are dying?
As @POTUS considers how to structure his health care reform proposals, one thing is clear: Washington must reduce what all working Americans pay in co-pays and deductibles.

Anything less may have dire consequences for Democrats at the ballot box.
Here's hoping the next story @JStein_WaPo writes will be about what Dems plan to do to help middle-class Americans actually use their health insurance.

washingtonpost.com/us-policy/2021…

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More from @wendellpotter

9 Apr
The only reason you’re seeing this Tweet by me is because of a man named Stan Brock – whose work inspired me to leave my old job as an insurance executive.

Few people in my life have been as consequential as Stan. And he’s been even more consequential to thousands of others.
A remarkable movie about him has just been released, and I hope you’ll watch it.

"Medicine Man: The Stan Brock Story" is screening nationwide til April 20 as part of the Cleveland International Film Festival @CIFF and it’s in competition for the festival’s Global Health Prize.
Stan, who starred in the popular TV series Wild Kingdom when I was a kid, went on to found Remote Area Medical in the ‘80s to fly doctors to remote parts of the globe. He was shocked when folks from the US started begging him to bring free medical care to their communities.
Read 9 tweets
23 Mar
10 years ago today, on the 1st anniversary of the Affordable Care Act, I wrote about the good things the law did, but stressed that we needed to view it as only the *starting* point of a journey toward needed reform.

Unfortunately, we have not made much progress on that journey.
Although ~20 million now have health insurance as a result of the law, a huge growing percent can’t use that insurance to get the care they need. That’s because Congress & the Obama admin were too focused on premiums... exactly what the insurance industry wanted them to focus on!
Focusing on premiums meant that Dems gave scant attention to how insurers would pick Americans’ pockets by jacking up *deductibles* year after year. In fact, deductibles are patients’ biggest struggle now, more than having enough doctors in-network, or even the price of premiums.
Read 10 tweets
4 Mar
As a former health insurance exec who quit the business, let me tell you: No one will be more excited about the new COVID package than my old friends in the corporate insurance industry. It would funnel $48 billion of taxpayer $ to them, after their most profitable year to date.
The COVID bill would temporarily pay for ACA marketplace plans & COBRA subsidies for people who lost their jobs and insurance. That would check off a major item on insurers’ wishlist because it guarantees payment to our wasteful system that’s burdened by 30% administrative costs.
A more economical approach? Open our existing Medicare program (with a 2% admin. cost) for the Americans hardest-hit by COVID-19. This would allow folks to access the care many desperately need without Uncle Sam (you) footing a bloated bill.
Read 4 tweets
25 Feb
As a former health insurance exec, here's a trick my old industry does that is particularly vile: The @USChamber has cultivated a brand synonymous w/ small town pride & local business. But here's the truth: these orgs are front groups for the corporate health insurance industry.
A new report from the @NYHCampaign & NY Metro Chapter of @PNHP reveals why local and regional Chambers & other business groups in NY lobby against single-payer health plans, even though it would financially benefit their small business members: actionnetwork.org/user_files/use…
Why are these business groups fighting policies that would help their Main Street members? The answer, as always, is the corrupting influence of big money.
Read 13 tweets
29 Jan
I applaud the Biden team and @ERIC_Yale’s focus on equity in the vaccine rollout, working to address what this pandemic has been a harsh reminder of: too many Americans of color face vast inequality in our health care system. And it’s systemic.
As health insurers have pushed premiums and deductibles higher over the past decade, people of color, especially those with lower incomes than whites, have been harmed disproportionately.
In 2019, before the pandemic, the U.S. Census found the median white household had $76,000 a year in income. That number dropped to $56,000 for hispanic households, and $45,000 for black households.
Read 14 tweets
28 Jan
I know @joebiden means well in reopening the enrollment period for ACA marketplaces, so more people can sign up for coverage. But as an expert in the health insurance industry, I have a big concern: many people who sign up for these plans won’t be able to use them. Here’s why:
Many who sign up for an Obamacare plan can’t use it because they have to pay thousands out of pocket before coverage kicks in. A recent Commonwealth Fund study found 42 % who bought coverage through exchanges were underinsured because of the amount they had to pay out-of-pocket.
Almost 1/3 with coverage through employers are underinsured because of unaffordable deductibles. More than 1/4 with crappy insurance -- that’s what it is -- said they delayed needed care because of the cost & nearly half said they had medical bill and debt problems.
Read 8 tweets

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