When Ohio schoolteacher Lisa Rupp’s son needed emergency surgery following an accident in 2017, she assumed her health care plan would cover his treatment at the in-network hospital where he was taken.
She was wrong.
A month after the surgery, the insurance company told her it would pay only $2,000 of the $19,000 medical bill. Her family was on the hook for the rest.
“We’re not prepared to pay that kind of money,” Rupp told the Dayton Daily News.
Why the surprise bill? While the treatment took place at an insurance-approved caregiver, the plastic surgeon who worked on her son was out-of-network.
“It’s one thing if it’s discussed from the outset and it’s disclosed before the procedure occurs so they can make an informed decision as consumers, as patients,” Rupp’s attorney, Adam Sadlowski, told the Daily News. “But it’s not and it’s not by accident.”
Surprise billing like the kind the Rupps are fighting is just one of the reasons access to affordable health care is considered the most pressing issue Americans face.
Headed into the 2018 midterm elections, voters identified it as more important than the economy, gun policy, or immigration when choosing a candidate.
“Health care is one of the few issues that impacts virtually every person living in this country in one way or another,” said Mark Miller, Executive Vice President of Health Care for Arnold Ventures. “So the issue is inevitably going to get a tremendous amount of attention. But the fact that it often ranks as the number one concern on the minds of voters should tell you something about their lack of confidence in the ability to receive quality care at an affordable price.”
In an effort to improve a system that weighs so heavily on the minds — and pocketbooks — of Americans, Arnold Ventures has partnered with organizations such as Yale University, the Brookings Institution, and the National Governors Association, investing nearly $2 million in an attempt to better understand the issue of out-of-network billing and what steps can be taken to minimize its impact on individuals and families.
“What we’ve done in this country is allow a system to develop where price is dictated primarily by the companies and individuals who stand to profit from higher costs,” Miller said. “Health systems and doctors often dictate the cost of procedures and treatments, while pharmaceutical companies hold enormous sway over the price of prescription drugs.”
As a result, family budgets continue to be squeezed and the financial well-being of businesses strained. Seventeen percent of U.S. adults identify health care costs as the most important financial problem facing their family. Businesses also face steep financial demands, as they typically cover 20 cents out of every health care dollar spent in the United States.
And it’s getting worse. Total health expenditures in the United States have risen from $1.4 trillion in 2000 to $3.5 trillion in 2017, an increase of 150 percent.
The costs don’t necessarily translate into a healthier America. The United States ranks No. 1 in annual per capita spending on health care costs ($3.4 trillion overall/$10K per person), and yet ranks No. 34 on the world’s list of healthiest countries.
The fact that health care is the top concern of folks across America is proof that the system needs to be changed, Miller said.
“If we were enjoying an efficient and affordable system,” he said, “we probably wouldn’t think about it as much as we do.”
The amount that total health expenditures in the United States have risen since 2000.