Debunking Myths, Logging On & Falling Behind, 5 Reasons Why

President Trump announced last week that hospitals receiving COVID-19 bailout funds could not engage in surprise billing of coronavirus patients. While it’s encouraging to see some action on a practice that has long harmed American families (while lining the pockets of private equity firms), it simply is not enough — questions remain about implementation, and it doesn’t protect all patients. 

So what can be done? Congress needs to enact legislation that prohibits all providers from directly billing insured patients and limits what providers are paid for surprise bills by insurers. A benchmark approach requiring insurers to pay providers a local, market-based rate is already included in several bipartisan bills that advanced out of House and Senate committees, but as my colleagues Erica Socker, Alexandra Spratt, and Mark Miller report in the best explainer I’ve read on the subject, opponents have spun a number of myths about this solution. They’re easily debunked. 

Myth: Insurance companies stand to benefit from the windfall in savings that would result from a locally-based market rate for out-of-network care.
 

Reality: The savings arising from a benchmark approach would lead to lower premiums for consumers and employers, higher wages for American families, and savings to taxpayers.

Bottom line: Surprise billing hurts everyone. It has inflated premiums by more than 3 percent, roughly a $40 billion increase in health care costs annually, according to research by Yale’s Zack Cooper and colleagues, and the relationship between premiums and wages has been well-established. Private equity firms exploiting this market failure reap so much from surprise billing that they funded a $53 million lobbying and ad campaign to stop Congressional action.

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Related: Why didn’t Congress act on surprise medical bills? The answer, as The Daily Beast writes, is a story as old as Washington.

Related: A bombshell of an article from the New Yorker on how private equity firms have perpetuated surprise billing practices at the expense of American consumers.

Reducing corrections populations and compassionately releasing some individuals is good for public health, safety, and the economy amid COVID-19. At Arkansas’ Cummins Unit, almost all of the men in one housing barracks tested positive for the coronavirus. In the federal system, more than a dozen prisoners have died and more than 700 prisoners and staff are infected. Riverside County saw a startling jump in cases. The infection rate at Chicago’s Cook County jail is the highest in the country. And there’s Louisiana, and Texas, and the list goes on. 

There are jurisdictions taking the smart steps of releasing some offenders, but bolder action is needed. Our Prisons Team explains why:

#1 A large percentage of people in jails and prisons are older and/or medically vulnerable — making them automatically higher risk for serious illness or death.

On average, imprisoned people are physiologically 10 to 15 years older than their community counterparts of the same age.

#2 COVID-19 containment measures are impossible in jails and prisons due to their design, operation, and often overcrowded, unsanitary conditions.

Social distancing is impossible, and incarcerated people have limited access to soap and water, must pay for personal hygiene products, and are often prohibited from possessing sanitizing supplies such as bleach and hand sanitizer.

Nick Turner, whose 'serendipitous' start at Vera Institute has become his life's work. His story is one of those classic American tales: the intern who rose through the ranks to become president of the organization. He calls his start there “a nice reminder that, in some respects, life kind of happens by accident, not by planning.” And with the pandemic throwing any and all planning out of the window, Vera has had to rethink how it pursues its mission. That means focusing on the life or death task of keeping people out of prisons and jails and considering what post-pandemic criminal justice reform looks like. (“Will people care less?”) He also talks about the surprising appetite from corrections leaders to reimagine prisons, why New Orleans is a critical city for reform, and what he would do with two extra hours a day. (Don’t tell his wife and kids — or maybe, do).

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Philadelphia has become an epicenter of the nation's opioid epidemic, and nowhere is the crisis more evident than Kensington, a neighborhood in east Philadelphia that has been called the largest open air drug market on the East Coast. Now COVID-19 has shuttered businesses, changed the way policing is done in the neighborhood, and left an already vulnerable and unsheltered community even more vulnerable. How do you manage one public health crisis on top of another? On The Why podcast, Annette John-Hall of WHYY talks to Mike Newall of The Philadelphia Inquirer, who went to Kensington to explore how the pandemic is unfolding there.