Health care trends bleak under insurance system


The landscape in health care is changing in ways that impact the consumer negatively.

Trends indicate that insurers reap greater and greater profits, hospitals and doctors are struggling, and more and more patients are going into debt — all which makes people sicker as they postpone treatment until they wind up in emergency rooms.

We need the New York Health Act to cure our health care ills.

Profits for the largest insurers are soaring. In JustCareUSA.org, Wendell Potter reports that in 2022, “’big insurance revenues reached $1.25 trillion, and profits soared to $69.3 billion.”

Becker’s Payer Issues E-Newsletter’s Jakob Emerson reported last November that health insurance profits in 2022 were $20.6 billion for UnitedHealthcare, $6.7 billion for Cigna, $6 billion for Anthem, $4.2 billion for CVS Health, $2.8 billion for Humana, and $1.2 billion for Centene Corp.

The pharmaceutical business has experienced similar profits. New York City-based Pfizer announced revenues of $100.3 billion in 2022, and according to Nick Dearden of Aljazeera a year ago, Moderna brought in $13 billion in pre-tax profits selling their $2.85 dose for $19 to $24 in this country.

As insurance company profits soar, hospital and provider profits have gone down substantially. A survey by the Chartis Center for Rural Health reported in The Guardian that “2019 was the worst year for rural hospital closures in a decade.”

According to Emerson, Community Health Systems reported a decrease in profits og more than 137 percent. Humana’s profits were down 20 percent. And Tenet reported a 70 percent decline.

“With the evidence piling up, health economists have classified 2022 as the worst financial year for hospitals in decades. Costs keep rising as 84 percent of providers report spending more to comply with new insurance policies, and 95 percent are dedicating more staff to prior authorization requests.”

Referencing an American Hospital Association survey in 2022 Emerson concludes relationships with payers are getting worse. He reports the University of Mississippi Medical Center — the state’s only children’s hospital and organ transplant center —was pushed out of network over reimbursement rates.

Locally, in a year-long standoff between Montefiore Hospital in the Bronx and UnitedHealthcare, UHC refused to accept Montefiore patients as in-network, acoding to Politico. A long-term agreement effective December 2021 finally restored in-network access.

Hospitals attempting to stem the decrease in revenue have increasingly resorted to suing patients. In testimony to legislators, Elizabeth Benjamin reported that the the Community Service Society found in New York state more than 54,000 suits were initiated against patients catastrophically impacting their credit.

The majority of these suits impact the poorest people, and disproportionately fall on people of color.

There is a $1 billion state indigent patient fund available to assist patients, but it is easier and cheaper for the hospital to sue.

The Community Service Society is urging the Assembly to include real hospital financial assistance reform (A.8441) in their one house budget bill.

Last year, the legislature passed a bill to prevent hospitals from putting a lien on a patient’s home or a garnish on their wages. Bills proposed this year would prevent the reporting of medical debt by credit agencies and require hospitals to use one universal form and process to assist patients with medical debt.

The state will either incur additional oversight costs, or the problem will linger as different aspects of medical debt are addressed in various pieces of legislation.

Current legislation simply chips at the symptom of the underlying problem with our health system. The fundamental problem of American health care is the profit-based system. Unlike apples and eggs, for which we can find a substitute in inflationary times, health care is not a commodity. It is a human right, and all of us will need health care sooner or later.

When people become sick, they either must seek medical help or die to spare their families the bruising financial costs. It is time for a universal health care program administered by New York. As state Sen. Gustavo Rivera pointed out on Brian Lehrer’s broadcast, our legislators are accountable to us. Insurance companies are not.

Write, phone, or email your legislator. It is high time for the New York Health Act.

Helen Krim, insurance, health care, New York Health Actg