Posts Tagged "healthcare"

My Hillbilly Roots

J.D. Vance’s rural Kentucky roots, described in his book, “Hillbilly Elegy,” differ from my father’s family in southern Indiana in one important way. Vance’s violent, angry mother was a substance abuser with a trail of failed relationships in her wake. Vance carries the childhood scars. My dad’s family was a bunch of kind, reticent, teetotaling farmers.

Alvin and Lena Belle Blanton and sons Gerald and Leland, 1966.

But the similarities between our families struck me too – Vance called his grandfather Blanton “Papaw,” which I’d always thought was unique to my own Papaw Blanton but, I now know, is an endearment. And believe me, the corn fields and hills of southern Indiana and contiguous Kentucky are more southern than Midwestern. My grandma’s fried chicken was heaven.

The backdrop for Vance’s hillbilly stories emerges front and center in my own take on family: I look at rural poverty through a socioeconomic lens.

Vance, an acclaimed writer and Silicon Valley investment banker, “got out” via the Marine Corps, Ohio State University and Yale Law School. “To move up,” he writes, “was to move on.”  With sheer determination – supported by his tough, caring Mamaw – he overcame long odds, childhood stress-eating, and psychological retreat from a conflict-filled home. His Yale scholarship wasn’t earned on grades but because “I was one of the poorest kids in the school.”

To be clear, I do not see “getting out” as pejorative. Nor does “getting out” mean getting away from family. Rural people relocate in search of better job opportunities than what is available in depressed areas with eerily quiet “downtowns” of struggling or abandoned establishments pushed out of town by big-box retailers like WalMart and fast-food joints. Getting out is code for earning a decent living, buying a modest house, having health insurance, and being able to retire. In short, capturing the American Dream.

In my family, the strategy of getting out worked for some but not for others. Please bear with me through my generational story.

My late father, Leland Blanton, left home – Jasonville, Indiana, population 2,147 – so that my two brothers and I didn’t have to. His father – Papaw – owned a small-town gas station and, due to childhood polio, walked with a cane. A midwife helped my father’s true-grit mother deliver him into a three-room farmhouse with an outhouse. Twenty years later, his ticket out was a high test score that paved the way to becoming a hotshot pilot in the U.S. Air Force in the 1950s and 1960s. Greenland, Saudi Arabia, Morocco, Greece, Germany, Bangkok, Saigon, Turkey – he flew to every corner of the globe. We all lived nearly three years outside Tokyo. …Learn More

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Baker’s Dozen: Popular Retirement Blogs

Appropriately, the most popular blogs over the past six months were about retirement, among both the young adults looking ahead to it and the later baby boomers heading toward it.

Based on page view counts, here were the most-read blogs on Squared Away during the last six months of 2017:

Retirement Calculators: 3 Good Options

Why Many Retirees Choose Medigap

Reverse Mortgage: Yes or No?

Why Most Elderly Pay No Federal Tax

The 411 on Roth vs Regular 401ks

Medicare Advantage Shopping: 10 RulesLearn More

Tax Cuts, Medicare, and the Kids

deficit chartFederal Medicare spending will increase sharply as baby boomers, with their longer life spans than previous generations, sign up in droves. The Social Security Trust Fund also reports that its reserves will be depleted in 2034, requiring either benefit cuts or new revenues to replenish a program that keeps millions of older Americans either out of poverty or just above water.

These two programs currently account for about 40 percent of the federal government’s $3.7 trillion budget. Most people agree that we need to deal with the financial shortfalls in Medicare and Social Security. And there is precedent. Remember the bipartisan 1983 reform that put Social Security on firmer footing by increasing the program’s revenues and gradually raising its Full Retirement Age?

But there is growing concern among retirement experts and advocates for the elderly that the proposed $1.5 trillion in tax cuts will make future reductions to these critical retiree programs all the more likely in order to rein in growing federal budget deficits.

If cuts to Medicare and other social programs follow a tax cut, it would fly in the face of what regular folks said are their top priorities in a new Kaiser Family Foundation poll: Only a small minority of Americans support tax cuts if they involve cuts to Medicare, Social Security, and Medicaid. …Learn More

Retirees say ‘Ugh’ to Medicare Shopping

medicare chartIn terms of popularity, reviewing Medicare plans during the open enrollment, going on now, ranks right up there with doing taxes.

Retirees on Medicare view healthcare as their most burdensome expense.  But they are less likely to comparison shop for Medicare plans than for their groceries and gas, even though plan shopping would probably save more money.

Deciding on a Medicare Advantage plan or deciding to switch to traditional Medicare, with or without a Medigap supplement, is “overwhelming, scary, and has consequences, so we put it off,” said Bart Astor, a spokesman for the insurer WellCare Health Plans, whose nationally representative survey quantified just how much retirees dread Medicare enrollment.

Selecting one path over another also necessitates predicting the impossible: their future health and how much coverage they will need.

Squared Away can’t predict your medical needs in 2018 either.  But perhaps one of these blogs will help you decide which path to take:

  • Free help navigating Medicare’s maze
  • 10 rules for Medicare Advantage shopping
  • Know the pitfalls of spotty hospital coverage in Advantage plans
  • Advantage premiums reflect physician networks
  • Fewer, clearer Medicare Part D choices
  • Avoid initial Medicare enrollment mistakes
  • Medicare primer: Advantage or Medigap?

If you haven’t shopped yet, why not get started on Black Friday?Learn More

Report: Healthcare a Middle Class Crisis

Chart: underinsuredThe state of the nation’s health care system includes these incredible facts:

  • Americans with health insurance who are “under-insured” have more than doubled to 41 million since 2013. They now make up 28 percent of adults.
  • Geographic disparities can be stark. Nearly one in three Floridians and Texans is under-insured, compared with one in five in California and New York. Not surprisingly, insurance deductibles are higher in Florida and Texas.

Much has been made of the fact that many Americans can’t afford their deductibles and out-of-pocket costs when purchasing polices under the Affordable Care Act (ACA).  The new report by the healthcare advocacy organization, The Commonwealth Fund, indicates that both ACA-insured and employer-insured Americans are frequently stretched to the limit.

Middle-class incomes for a family of four range from about $58,000 to $115,000.  The definition of middle-class people who have health insurance but cannot afford it is well-established in the research: their deductibles or other annual out-of-pocket costs exceed 10 percent of their annual household income. (For the poor, the threshold is 5 percent.) …Learn More

Advantage Premiums Reflect Networks

Chart: Medicare premiumsA new study of Medicare Advantage plans in 20 U.S. counties found that plans with higher premiums generally offer broader networks of physicians to their customers.

“There are exceptions but there does seem to be a fairly clear relationship between how much plans are charging and the size of the network,” said Tricia Neuman, a Kaiser senior vice president and one of the study’s authors.

The correlation between premiums and network size is one finding in a rare study that tries to get a handle on the quality of Advantage plans around the country amid a scarcity of data on these plans. An earlier Kaiser study looked at how many of a county’s hospitals and top cancer treatment centers are available in Advantage plans.

Advantage plans are increasingly popular for good reason: they have lower premiums or offer more extras than enrolling in the traditional fee-for-service Medicare program and purchasing a Medigap supplement and Part D prescription drug policy.

They are able to offer lower premiums based, to some extent, on their ability to keep their costs under control, whether this is how much they’re paying to their physicians or to testing labs. But because there is very little data on what Advantage plans pay for medical services, Neuman said that it’s difficult to sort out what is driving the plans’ costs – and, in turn, the premiums customers pay.

However, others argue that an insurer’s degree of control over the costs of its medical providers depends on how much market power it has over the physicians it pays for services. The federal Medicare program, for example, has tremendous clout to set prices for medical services, because it controls a large segment of the demand for health care by elderly beneficiaries relative to the supply of physicians and other medical service providers. Research suggests that Advantage plans may partly control their costs by anchoring their payments to Medicare’s payment rates. However, narrowing the networks may be another way for Advantage plan insurers to gain market clout to control costs.

There is wide variation, from county to county, in the breadth of the physician networks. For example, most of the retirees in Advantage plans in Clark County (surrounding Las Vegas) and in Harris County (Houston) are enrolled in narrow networks. …Learn More

Employer Health Insurance Stabilizes

chart: insurance premiumsOne thing has gotten lost in the turbulence around the fate of the Affordable Care Act (ACA): the health insurance provided by U.S. employers is relatively stable.

Total premiums increased
3 percent for family plans (to $18,764 for the average, combined premium for employers and employees) and 4 percent for single employees’ coverage in 2017 (to $6,690), according to the Henry J. Kaiser Family Foundation’s annual report on the employer health insurance market. Employees enrolled in family plans pay under one-third of this total premium; single people, less than one-fifth.

In contrast, there was a 20 percent spike in 2017 premiums paid by workers lacking employer health insurance who purchase their policies on the state ACA exchanges – and premiums are expected to increase sharply again in many cities in 2018.  While the ACA’s system of mandates and subsidies has pushed the share of Americans covered to record highs, the new challenge clearly is to contain costs.

“It’s really striking how much more stable the group market is than the far smaller marketplaces in the non-group market,” Drew Altman, the Kaiser Foundation’s president, said during a recent webinar. He compared the 20 percent increases and “very high deductibles” typical of ACA plans to modest premium increases and “no real deductible growth this year” for employer health plans.

The rise last year in total employer plan premiums, although somewhat faster than inflation and wages, is an improvement over the 5 percent to 10 percent annual premium growth in the past decade.

No obvious explanation exists for this relative stability, Altman said, especially at a time prescription drug costs are surging and health care providers are consolidating their market power.  “I think it’s healthcare’s greatest mystery right now,” he said about the employer market.

That’s not to say everyone can afford their employer medical plans. …Learn More

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