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California Lawmakers Approve Nation-Leading $25 Minimum Wage for Health Workers

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Don Thompson
Fri, 15 Sep 2023 16:12:00 +0000

SACRAMENTO, Calif. — A sweeping agreement between labor and the health industry would gradually raise the minimum wage for hundreds of thousands of health workers in California to a nation-leading $25 an hour while ending a years-long battle over dialysis clinics.

The pact approved by state lawmakers on Thursday, the last day of this year's legislative , would phase in the wage increase for hospitals, nursing homes, and other medical and psychiatric services providers. The bill now heads to the governor's desk. A spokesperson for Democratic Gov. Gavin Newsom, Izzy Gordon, said the governor will evaluate the bill on the merits before his Oct. 14 deadline to act on the legislation.

SB 525 would raise the hourly minimum at large health facilities and dialysis clinics to $23 next year, $24 in 2025, and $25 in 2026. It would boost hourly wages at community clinics to at least $21 in 2024, $22 in 2026, and $25 in 2027. Other health facilities would go to at least $21 an hour in 2024, $23 in 2026, and $25 by 2028.

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The agreement “now strikes an important balance between supporting workers and protecting and access to care in some of our most vulnerable communities,” Carmela Coyle, president and of the California Hospital Association, said in a statement. “The bill creates a pathway to improving wages for our lower-wage health care workers, while also recognizing the needs of our state's most troubled hospitals.”

The deal is a significant union victory during what has been dubbed a “hot labor summer,” with picket lines formed by Hollywood writers and actors, hotel workers, and Los Angeles city employees. Thousands of nurses could be next. Labor also won a $20 minimum wage for California fast-food workers, a significant boost from the current statewide $15.50 minimum wage.

Union say lower-income health workers such as certified nursing assistants, patient aides, and food service workers — many of them racial minorities — need the additional money to keep up. “Health care in California will be more accessible and equitable because workers and providers stood together and stood up for patient care,” SEIU California Executive Director Tia Orr said of the health care deal.

The phase-in would be slower at hospitals with a high percentage of covered by Medicare or Medicaid, rural independent hospitals, and small county facilities. The minimum hourly wage there would go to $18 next year, then increase annually by 3.5% until it reaches $25 in 2033.

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Subsequently, at all sites, the $25 minimum wage would be increased annually to keep up with inflation. However, the bill allows health care facilities to apply for a temporary pause or slower phase-in if they can show state officials that providing the required minimum wage “would raise doubts about the covered health care facility's ability to continue as a going concern.”

State Sen. María Elena Durazo, the Los Angeles Democrat who introduced the bill, called her bill “a first in the nation historic investment in our healthcare workforce.” The measure “is a critical step to ensuring that we are addressing our healthcare workforce shortage,” she said before the bill received final passage late Thursday in the Senate.

As part of the deal, in a separate memorandum of understanding, Service Employees International Union-United Healthcare Workers West would drop its effort to impose regulations on dialysis clinics through legislation and at the ballot box. Voters defeated all three ballot initiatives, most recently last year, but the fight has cost the dialysis industry hundreds of millions of dollars.

California Dialysis Council spokesperson Jaycob Bytel said in a statement that the agreement “protects patients from the ongoing threats at the ballot and in the legislature.” It bars for four years any legislation or statewide or local ballot measures by either SEIU or the dialysis industry.

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The union has pushed for wage boosts in several California . But the agreement bars local governments from requiring higher local minimum wages for health care workers for 10 years, until 2034. Local governments could set higher local minimum wages, but they must include all workers.

The original bill cleared the Senate in May with no votes to spare amid strident opposition from employers, who said they couldn't afford it. The California Chamber of Commerce put the proposal on its annual “job killer” list, a designation that often is enough to kill controversial legislation. The No SB 525 coalition, which included hospitals, doctors, and business and taxpayer groups, had said the bill would cost $8 billion annually, endangering services and leading to higher premiums and higher costs for state and local governments.

who opposed the bill echoed those arguments while saying the increases will harm rural health facilities. “We'll see hospitals go out of service and we will see rural health clinics for sure be severely impacted and probably go out of business,” warned state Sen. Brian Dahle, a Republican who represents rural Northern California.

The bill's opponents also included the California Nurses Association, which said it could prompt employers to lower wages for registered nurses. The association helped scuttle a push for a $25 hourly minimum wage for health workers a year ago. That earlier effort failed in part because it was tied to a delay in earthquake-safety upgrades at hospitals.

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The of California-Berkeley Labor Center projected that the increase would boost wages for more than 469,000 health workers. The center estimates it would most benefit workers of color, who make up 70% of those workers, and women, who represent about three-quarters.

The bump would help about 40% of California's health workers, earning them on average an extra $10,352 a year and reducing their reliance on Medi-Cal, saving between $181 million and $363 million in the second year of the wage increase, according to a legislative analysis. The analysis said opponents' $8 billion cost estimate is overblown because it fails to include billions in state assistance to hospitals.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

——————————
By: Don Thompson
Title: California Lawmakers Approve Nation-Leading $25 Minimum Wage for Health Workers
Sourced From: kffhealthnews.org//article/california-lawmakers-approve-nation-leading-25-minimum-wage-for-health-workers/
Published Date: Fri, 15 Sep 2023 16:12:00 +0000

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Therapists Learn How To Help Farmers Cope With Stress Before It’s Too Late

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Tony Leys
Tue, 25 Jun 2024 09:00:00 +0000

If you or someone you know may be experiencing a mental crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

GRINNELL, Iowa — The farmers' co-op here is a center of hope every spring. It's where farmers buy seed and fertilizer for the summer's crops, and where they seek tips to maximize their harvest of corn and soybeans.

But on a recent morning, a dozen mental health professionals gathered at the Key Cooperative Agronomy Center to discuss why so many farmers quietly struggle with untreated anxiety and depression.

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Studies have concluded that suicide is unusually common among farmers. Researchers believe it's not just because many farmers have other risk factors, such as rural addresses and access to guns.

The tragic trend has caught the attention of the U.S. Department of Agriculture, which sponsors training sessions like the one in Grinnell to help health care professionals learn how to talk to farmers about the pressures they face in wringing a living out of the land.

“A lot of them are born to it. They don't have any choice,” family therapist David Brown explained to the 's participants. He noted many farms have been passed down for generations. Current owners feel that if they fail, they would be letting down their grandparents, , children, and grandchildren.

Brown, who works for Iowa State Extension and Outreach, led the training in Grinnell. He said farmers' fate hinges on factors out of their control. Will the weather be favorable? Will world events cause prices to soar or crash? Will political conflicts spark changes in federal agricultural programs? Will a farmer suffer an injury or illness that makes them unable to perform critical chores?

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Brown said surveys show many farmers are reluctant to seek mental health care, partly because they think therapists or couldn't understand their lives.

Tina Recker, a mental health therapist in northeastern Iowa, attended the training session. She has lived on farms, and she has seen how the profession can become a person's entire identity. “It's just farm, farm, farm, farm,” she told the group. “If something goes wrong with it, that's your whole world.”

It's difficult to estimate how much of farmers' increased risk of suicide is due to their profession.

Part of the reason for the elevated rate could be that many farmers are middle-aged or older , who tend to be more at risk in general. “But it's broader than that for sure,” said Edwin Lewis, a USDA administrator who helps oversee efforts to address the situation.

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The Grinnell training session was part of a federal program called the Farm and Ranch Stress Assistance Network. Lewis said the program, which also funds counseling hotlines and support groups, spends $10 million a year.

Jason Haglund sees the issue from multiple angles. He's a mental health advocate who farms part-time near the central Iowa town of Boone. He and his brother-in-law raise corn and soybeans on the 500-acre farm where Haglund grew up. His family has farmed in the area since the 1880s. His parents hung on despite going into bankruptcy during the 1980s farm crisis, and he embraces his role as caretaker of their legacy.

Haglund is trained as an alcohol and drug addiction counselor, and he co-hosts an Iowa podcast about the need to improve mental health care.

He said it can be stressful to run any kind of family business. But farmers have a particularly strong emotional tie to their heritage, which keeps many in the profession.

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“Let's be honest: Farming at all these days isn't necessarily a good financial decision,” he said.

Farmers traditionally have valued self-sufficiency, he said. They try to solve their own problems, whether it's a busted tractor or a debilitating bout of anxiety.

“With the older generation, it's still, ‘Suck it up and get over it,'” Haglund said. Many younger people seem more willing to talk about mental health, he said. But in rural , many lack access to mental health care.

Farmers' suicide risk is also heightened by many of them owning guns, which provide an immediate means to act on deadly impulses, Haglund said.

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Guns are an accepted part of rural , in which they are seen as a useful tool to control pests, he said. “You can't go into a rural community and say, ‘We're going to take your guns away,'” he said. But a trusted therapist or friend might suggest that a depressed person temporarily hand over their guns to someone else who can safely store them.

Haglund said health care professionals shouldn't be the only ones learning how to address mental stresses. He encourages the public to look into “mental health first aid,” a national effort to spread knowledge about symptoms of struggle and how they can be countered.

A 2023 review of studies on farmer suicides in multiple countries, including the U.S., cited cultural and economic stresses.

“Farmers who died by suicide, particularly men, were described as hard-working, strong, private people who took great pride in being the stoic breadwinners of their families. They were often remembered as members of a unique and fading culture who were poorly understood by outsiders,” wrote the authors, from the University of Alberta in Canada.

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Rebecca Purc-Stephenson, a psychology professor who helped write the paper, said health professionals face two challenges: persuading farmers to seek help for mental stress, then encouraging them to keep coming back for therapy.

Back at the training in Iowa, instructors urged mental health professionals to have flexible schedules, and to be understanding when farmers postpone appointments at the last minute.

Maybe one of their animals is sick and needs attention. Maybe a machine broke and needs to be fixed immediately. Maybe the weather is perfect for planting or harvesting.

“Time is money,” said Brown, the therapist leading the training.

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The session's lessons included what to ask and not ask when meeting farmers. A big no-no is inquiring right away about how much land they are working. “If you ask them how many acres they're farming, that's like asking to see their bank account,” warned Rich Gassman, director of Iowa's Center for Agricultural Safety and Health, who assisted with the lesson.

It would be better to start by asking what they enjoy about farming, the instructors said.

Many farmers also need to talk through emotional issues surrounding when, how, or even if the next generation will take over the family operation.

Tim Christensen, a farm management specialist for Iowa State University Extension and Outreach, said some standard advice on how to deal with stress could backfire with farmers.

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For example, he said, a health care professional should never advise a farmer to relax by taking a couple of weeks off. Most of them can't get away from their responsibilities for that long, he said.

“There's a common saying on the farm: No good vacation goes unpunished.”

Warning Signs of Mental Struggle

The American Foundation for Suicide Prevention lists these signs that a person might be considering suicide:

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  • The person talks about killing themselves, feeling hopeless, having no reason to , being a burden to others, feeling trapped, or having unbearable pain.
  • The person increases their use of alcohol or drugs, sleeps too much or too little, displays fatigue or aggression, withdraws from activities and family and friends, visits or calls people to say goodbye, gives away possessions, or searches online for a way to end their life.
  • People considering suicide often seem depressed, anxious, irritable, angry, ashamed, or uninterested in activities. In some cases, they may appear to feel sudden relief or improvement in their mood.
  • People in crisis can reach the national 988 Suicide & Crisis Lifeline by calling or texting “988.”

——————————
By: Tony Leys
Title: Therapists Learn How To Help Farmers Cope With Stress Before It's Too Late
Sourced From: kffhealthnews.org/news/article/farmer-mental-health-suicide-therapists-iowa-usda/
Published Date: Tue, 25 Jun 2024 09:00:00 +0000

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US Surgeon General Declares Gun Violence ‘a Public Health Crisis’

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Rachana Pradhan and Fred Clasen-Kelly
Tue, 25 Jun 2024 09:00:00 +0000

U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis, as gun deaths and injuries punctuate daily life in America.

On nearly every day of 2024 so far, a burst of gunfire has hit at least four people somewhere in the country. Some days, communities have endured four or five such shootings.

The nation's top doctor called on policymakers to consider gun safety measures such as bans on assault weapons and high-capacity ammunition magazines and universal background checks for all firearm purchases. His advisory also urges a “significant increase” in for research on gun injuries and deaths, as well as greater access to mental and trauma-informed resources for people who have experienced firearm violence.

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In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to data from the Centers for Disease Control and Prevention. An additional 200-plus Americans seek emergency care for firearm injuries each day, according to estimates from Johns Hopkins University research. No federal database records nonfatal gun injuries.

The Office of the Surgeon General does not set or carry out gun policy, but historically its reports and warnings have nudged policymakers and lawmakers to act.

Murthy, a physician, told KFF Health News he hoped to convey the broader toll of gun violence on the nation and the need for an urgent public health response. He cited soaring gun deaths among and and noted that “the mental health toll of firearm violence is far more profound and pervasive than many of us recognize.”

“Every day that passes we lose more kids to gun violence,” Murthy said, “the more children who are witnessing episodes of gun violence, the more children who are shot and survive that are dealing with a lifetime of physical and mental health impacts.”

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Firearm-related homicides over the past decade and suicides over the past two decades have driven the sharp rise in gun deaths, the advisory says.

Guns are the leading cause of death for children and teens, with higher death rates among Black and Hispanic youths. Researchers from Boston University found that during the height of the covid pandemic, Black children were 100 times as likely as white children to experience gun injuries. Hispanic and Asian children also saw major increases in firearm assault injuries during that time, that study showed.

Joseph Sakran, executive vice chair of surgery at John Hopkins Hospital in Baltimore and chief medical officer for Brady United Against Gun Violence, said the surgeon general's declaration is a “historic moment that sounds the alarm for all Americans.”

But Sakran added: “It cannot stop here. We have to use this as another step in the right direction. No one wants to see more children gunned down.”

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Murthy has long said gun violence should be framed as a health issue. He argued that the approach has been successful in combating significant societal problems, citing tobacco control efforts that took hold the then-surgeon general's landmark 1964 report concluding that smoking cigarettes causes lung cancer and other diseases.

“We saved so many lives, and that's what we can do here, too,” Murthy said.

Murthy's move is one of several recent Biden administration actions designed to combat gun violence, as most gun-related measures remain political nonstarters in . Federal officials have allowed states to use Medicaid dollars to pay for gun violence prevention, and the White House has called on hospital executives and doctors to gather more data about gunshot injuries and to routinely counsel about the safe use of firearms.

While available data points to tragic outcomes across American communities, government officials and public health researchers have long been stymied by sparse federal funding devoted to gun violence research and the scope of its health effects.

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“I've been studying gun violence for about 33 years now and there's still some really basic and fundamental questions I can't answer,” said Daniel Webster, a gun violence researcher at Johns Hopkins University.

“To really understand gun violence, you need to do more than just look at publicly available surveillance data,” he said. “You need to actually do in-depth studies involving the populations at highest risk for shooting or being shot.”

A Brady analysis found that of the 15 leading causes of death in the U.S., firearm injuries received the third-lowest amount of federal research funding through the National Institutes of Health for each person who died. The only causes of death that garnered less research funding through NIH were poisonings and falls, according to the analysis.

Sonali Rajan, an adjunct associate professor of epidemiology at Columbia University who researches the effects of gun violence on children, said political and others need to reframe the debate on gun violence from crime to public health.

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“We are raising a whole generation of children for whom exposure to gun violence is normal,” Rajan said.

In Michigan, “we had a kid survive the Oxford High School shooting only to go to Michigan University and see another mass shooting,” she said. “It is unbelievably shameful.”

Serving as President Joe Biden's surgeon general since 2021, Murthy has, at times, caused political controversy with his views on gun violence.

Over a decade ago, former President Barack Obama nominated Murthy to be the nation's top doctor. But Murthy's support for a federal ban on the sale of assault weapons and ammunition and additional restrictions on gun purchases drew the ire of the National Rifle Association, as well as and some Democrats in Congress. The U.S. Senate narrowly confirmed Murthy to the job in December 2014, more than a year after his nomination.

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Murthy has previously issued advisories on social isolation and loneliness, youth mental health, and the well-being of health workers. He said gun violence comes up in many of his conversations with young people about the mental health challenges they're facing.

“Fears around gun violence have really pervaded so much of the psyche of America in ways that are very harmful to our mental health and well-being,” Murthy said.

Many other causes of death are treated differently as to understanding the problems and developing solutions, Webster said. But “that's generally not what we've done with gun violence. We've oversimplified it and overpoliticized it.”

As Sakran put it: “As we look at firearm injuries, there's arguably no public issue that's as urgent.”

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——————————
By: Rachana Pradhan and Fred Clasen-Kelly
Title: US Surgeon General Declares Gun Violence ‘a Public Health Crisis'
Sourced From: kffhealthnews.org/news/article/gun-violence-us-surgeon-general-vivek-murthy-public-health-crisis/
Published Date: Tue, 25 Jun 2024 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/an-arm-and-a-leg-meet-the-middlemans-middleman/

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An Arm and a Leg: Meet the Middleman’s Middleman

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Dan Weissmann
Tue, 25 Jun 2024 09:00:00 +0000

Some people who expected their health insurance to cover some out-of-network care have been getting stuck with enormous bills.

One Kansas , Kansas, couple paid thousands of dollars out-of-pocket and up-front for care. They expected to get a partial reimbursement from their insurer. So, they were shocked when instead they got a bill saying they owed even more than what they'd already paid.

It turns out, a little-known data firm called MultiPlan was working with their insurance company to suggest cuts to their coverage. MulitPlan says it's helping control ballooning health care costs by keeping hospitals and providers from overbilling. But it's often patients left paying the difference.In this episode of “An Arm and a Leg,” host Dan Weissmann breaks down this confusing world of out-of-network care with New York Times reporter Chris Hamby, who recently published an investigation into MultiPlan.

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Dan Weissmann


@danweissmann

Host and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative .

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Emily Pisacreta
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Claire Davenport
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Adam Raymonda
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Ellen Weiss
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Transcript: Meet the Middleman's Middleman

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there! Paul and Kristin live in Kansas City with their two kids. Kristin and their daughter, the older kid– they have some complex medical issues, need to see some specialized folks. And some of those folks don't take Kristin and Paul's insurance. They're “out of network,” so Kristin and Paul pay out of pocket– a lot. Maybe $20,000 a year. BUT their health insurance plan does reimburse some out-of-network care. 

o, in January 2023, Kristin called a help line connected with the insurance plan to find out how that was gonna work. 

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Kristin H: They basically said, sure, easy peasy, you pay and then you get online and you click this form, you show what you paid, and then we send you a check and reimburse you. 

Dan: Kristin was on it. She built a whole spreadsheet to track every bill she paid, every reimbursement form she'd submitted. And she waited for the checks. The insurance company gave itself months just to process the claims. And when they finally sent statements, the statements seemed … weird. They were like: 

Kristin H: Here's what you paid, and here's your discounts, and here's what you may owe. 

Dan: And Kristin was like … what? 

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Kristin H: Because I was thinking, well, I don't owe anything. We paid out of pocket, but then I was thinking, well, this must be the portion that they're paying us back. But then the math didn't add up. 

Dan: Yeah. Not at all. Kristin was expecting to get 50 percent back, like her plan said she would. But this amount wasn't anything like 50 percent. And what's this “discount” business? 

It took months– and a lot of digging from Paul, and ultimately a talk with a Times reporter– before Kristin and Paul understood what was going on, and why it was costing them thousands of dollars. 

What they didn't know until that New York Times story came out was: Someone was making a multi-billion dollar business out of experiences like theirs. As that story made clear, LOTS of people who expected their insurance to cover them for expensive out-of-network care ended up on the hook for a lot more than they'd expected. 

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That story introduced to a character who's become kind of a TYPE on this show. Not a type of person, but a type of business: A middleman that works behind the scenes with insurance companies. So we've seen that dynamic with pharmacy benefit managers– the folks who decide what you can get and for how much– and more recently, we looked at a company that uses an algorithm to justify kicking folks out of nursing homes. The middleman in this New York Times story was a company called MultiPlan. 

Reporter Chris Hamby found MultiPlan and insurance companies they worked with were leaving patients on the hook for huge amounts that they absolutely had not expected to pay. MultiPlan was also, along with those insurance companies, pocketing big fees. That story got some folks' attention. A U.S. Senator has called for action from antitrust regulators. Those regulators might get interested. And we may wanna egg them on– so we're gonna need to understand the whole scheme. Whothis middleman is– MultiPlan– and how they got themselves in the middle of 60 million people's health insurance, by their own estimate … and how they make a lot of money. 

This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I'm Dan Weissmann. I'm a reporter, and I like a . So, our job on this show is to take one of the most enraging, terrifying, depressing parts of American life– and bring you a show that's entertaining, empowering, and useful. 

And this time, I've got help. 

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Chris Hamby: My name is Chris Hamby. I'm a reporter on the investigations desk at the New York Times. 

Dan: Yeah, and of course, Chris is the one who spent months figuring out the story of this middleman company, MultiPlan. 

Chris Hamby: I was poking around a number of areas related to health insurance, and this name just kept coming up. 

Dan: Like in lawsuits. 

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Chris Hamby: And it wasn't always terribly clear what they did exactly or how they were compensated. 

Dan: Or how doctors and patients– regular people– were affected. 

Chris Hamby: So that's why I decided to try and figure this out, and it's sort of an opaque space as so many areas of health care are these days. 

Dan: Yeah. In fact, in order to understand this story at all– to understand who's doing WELL in this scenario– we've gotta peel back a layer. It's something we've talked about here before, but not for a while, and you know, not even my mom remembers everything I've ever said here. 

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This is about the mechanics of how most health insurance people get from their job actually works: about who actually pays medical bills when your insurance settles a claim. It's not the insurance company. It's actually the employer paying those bills. 

Of course, employers don't know how to actually RUN an insurance plan. [Unless the employer is Aetna, I guess]. So they hire insurance companies to administer them. You get a card that says Cigna or Blue Cross, but your employer's funds actually pay the medical bills, so these are called “self-funded” plans. But this is all stuff most of us are just not aware of. 

Here's Chris Hamby: 

Chris Hamby: I hadn't, until about a year ago, even heard of a self-funded plan. And I like to think that I'm reasonably well informed on this stuff. 

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Dan: Yeah, that is putting it mildly. Chris made his name and won a Pulitzer Prize covering workplace health issues. So, just park that for a minute: self-funded plan, where the employer is the “self,” actually paying the bills, and paying the insurance company a fee. The insurance company is a middleman. 

OK, now, next layer: The middleman's middleman. In this case, the company MultiPlan that Chris wrote about. What's their job? So in this story, the job they're doing– their middleman job– is to address what is admittedly kind of a tough question: If you go see somebody– a doctor, a therapist– who doesn't take your insurance, what happens? 

Chris Hamby: How do you determine what a fair amount to pay the provider is? And by extension, how much is the patient potentially on the hook for the unpaid balance? And that has long been a contentious issue. 

Dan: Because, if they don't take your insurance, a provider could charge … absolutely anything. So is your insurer– and again, that's often actually your employer– supposed to pay absolutely anything? How much are they supposed to pay? Figuring that out, it's a job. 

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About 15 years ago, another middleman company doing that job got sued by the NewYork state attorney general. The state said this earlier middleman's way of figuring out what to pay was screwing over both providers and patients. And the state's lawsuit produced a solution. 

Chris Hamby: The insurance companies agreed to fund the creation of a nonprofit entity that was going be sort of an independent, neutral arbiter of fair prices. It was going to collect data from all the insurers and just make it publicly available. Make sure it was transparent to everyone. 

Dan: This nonprofit is called FAIR Health, and its data is actually public. It still exists. Like, you can use it yourself — you can look up the going rate for a knee replacement, a blood test, whatever. 

Chris Hamby: You can plug in your zip code, plug in your medical procedure and see an estimate of what, you know, typical out-of-network charges and in-network charges would be for these. 

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Dan: It's cool! Check it out yourself; it's useful. And all the major insurance companies agreed to use it– to use FAIR Health's benchmarks– to decide what to pay for out-of-network stuff. But, those agreements only committed insurance companies to using FAIR Health for … five years. They expired in 2014. 

Enter middleman companies like MultiPlan, saying to insurance companies: Hey, you COULD use FAIR Health– or you could route out-of-network bills to us: Hire us to get you an even better deal– better prices. 

Chris Hamby: And it's important to note also that this is a time when private equity is investing in , and there are some legitimate concerns about driving up those list prices to ridiculously high levels in a lot of cases. So, there were real issues that insurers were saying that they were responding to at the time.

Dan: OK, so that's the pitch. MultiPlan is saying to insurance companies: We'll help you hold the line. We can save you more money than if you used FAIR Health. Well, kind of. Because here's where we come back to the whole thing about self-funded insurance. MultiPlan isn't saying, “We can save YOU, insurance company, more money than if you used FAIR Health.” They're saying, “We can help you save your CLIENTS– employers who do self-funded health insurance– more money. And when you save them money, you're gonna make money. Because you can charge them a percentage of what you're saving them. And we'll get a percentage too.” A percentage of the savings. On every single bill. That's a very different deal than just using FAIR Health's data. 

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Chris Hamby: FAIR Health is not taking a percentage of the savings that they obtain. They're just selling you their data. And the insurers typically are not charging employers a fee for using FAIR Health's data. But if they use MultiPlan's data, both MultiPlan and the insurer typically charge a fee. 

Dan: A percentage. In examples from Chris's story, the insurance company gets 35 percent of those savings. 

Chris Hamby: And this has become a significant amount of money for a lot of insurance companies. Overall, UnitedHealthcare, is up to, you know, around a billion dollars per year in recent years. 

Dan: UnitedHealthcare collects like a billion dollars in fees for these services, basically, for using MultiPlan specifically? 

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Chris Hamby: And they couch that by saying some other out-of-network savings programs, but yes. 

Dan: Whooh! 

Chris Hamby: One thing that the insurers say is that the employers are aware of this; they've signed up for it. 

Dan: That employers are hiring, say, Cigna, with MultiPlan to find savings. And employers are agreeing to the fees. 

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Chris Hamby: Where it gets a little bit dicier from the employer's perspective is when you see claims where, for instance, you end up paying the insurance company more in fees than you paid the doctor for treating your employee. 

Dan: yeah, one example from Chris's story: An out-of-network provider wanted more than $150,000 on one bill. And after the insurance company and MultiPlan did their bit, the employer, a trucking company, ended up paying $58,000. Eight thousand for the provider, and $50,000 to the insurance company and MultiPlan. So, on the one hand, the employer maybe saved $90,000. But paying $50,000 for “cost containment?” Maybe doesn't sound like such a bargain. 

Some employers and a union that runs a health plan have filed lawsuits looking for some of that money back. And there's also a big irony here because MultiPlan's pitch is, you need us because sticker prices are super-wildly high. But MultiPlan isn't doing anything to contain the sticker prices as a systemic problem. In fact, the higher providers crank up their sticker prices, the more money MultiPlan and the insurance companies they work with can make. But then there's a big question too, which is, what happens to the rest of that bill for the sticker price? Who pays that? That's next … 

This episode of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News. The folks at KFF Health News are amazing journalists. Their work wins all kinds of awards, every year. We're honored to work with them. 

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So, a provider sends a bill. MultiPlan and the insurance company say, “Woah, way too much.” And then what happens? Well, it depends. Sometimes, MultiPlan negotiates with the provider. They've got people who do this. And those negotiators drive hard bargains. According to Chris's story, negotiators sometimes tell providers: Here's my offer, you've got a few hours to take it or leave it, and my next offer might be lower. 

Chris talked with a pediatric therapist who said an offer based on MultiPlan's calculation was less than half of what Medicaid pays. Less than half. And Medicaid rates– they're notoriously pretty low. Chris talked with some of MultiPlan's negotiators too. 

Chris Hamby: It was interesting because some of the negotiators felt that they were doing their part to hold down costs and really sort of stick it to providers and hospitals that were price gouging. 

Dan: But …one told Chris she knew the offers she made– they weren't fair. “It's just a ,” another one said. “It's sad.” And maybe the difference is that some of these negotiators were thinking of a big hospital charging $150,000  for something. And maybe some of them were thinking of someone like that therapist– the one who got offered less than half of Medicaid's rate. 

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And I'm not gonna get into the question of who should be doing this kind of negotiating, or what's fair. I mean, not today, anyway. Because: in a lot of cases with MultiPlan, there's no negotiation at all. Negotiation only happens when the employer has told the insurance company, look, protect my people. Figure out SOMETHING with the provider so they don't go after my workers for the rest. 

But that doesn't always happen. A lot of the time, what happens is: The provider sends a bill. The insurance company kicks in whatever it decides to … and that's it. 

So Chris's story with a woman who had surgery. With MultiPlan's help, her insurance company decided to pay about $5,400. And she got stuck with a bill for more than $100,000. 

And then there's Kristin and Paul in Kansas City. They paid their bills upfront and then looked to get reimbursed– kept a spreadsheet. But when their claims finally got processed, the numbers didn't add up. Here's what they saw: Like pretty much every insurance plan, Kristin and Paul's had a “deductible”– an amount they had to pay out of pocket before insurance would reimburse anything. 

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Kristin H: Then I started watching the deductible and you know, when I calculated my spreadsheet of how much we had paid out of pocket, and when we saw what was on like our out-of-network spend, those two weren't matching. 

Dan: She really couldn't figure this out. 

Kristin H: I just kind of handed over all of my spreadsheets to Paul, and so that's when he started digging into the “your discount.” 

Dan: “Your discount…” That was this mysterious number on all the statements from the insurance company. In addition to the provider's rate, and what insurance might pay, the statements listed, quote, “your discount.” 

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Paul H: And I'm like, what is this? I don't understand why it's talking about a discount. We are paying cash out of pocket to the provider at their billed rate, and our insurance is saying that there's some sort of discount. 

Dan: After a bunch of phone calls, he figured it out: The discount was … the difference between the amount on the bill and what the insurance company– with MultiPlan's help– had decided was a “fair price.” 

Paul H: For example, an occupational therapy bill that might be $125, this third party adjuster might come back and say, essentially what the market rate for that should be is $76. And so, your discount, quote, unquote, is $49. 

Dan: Except of course, it wasn't a discount for Kristin and Paul. They had already paid that $49, when they paid the provider upfront. Once Kristin and Paul learned what the “discount” actually meant, they started to understand who actually got the benefit– the insurer. Because … 

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Kristin H: That discounted rate is actually what will be applied to your deductible. So you're not going to hit your deductible nearly as quickly as you think. Right? Because we've essentially ignored half of your payment. 

Dan: This hits Kristin and Paul in two ways. 

First, it means they're actually spending a lot more before their insurance kicks in. It also means that when their insurance does start reimbursing them a percentage of what they've spent, the insurance is only paying a percentage of that lower amount. Overall, it means the reimbursements Kristin and Paul get are gonna be thousands of dollars less than they'd expected. 

I mean, it took a LOT of work for Kristin and Paul to figure this out. At one point, Paul posted to Reddit asking for help– that's where Chris Hamby found him. In Paul's post, he noted how nobody ever even mentioned this third-party adjuster– not until he had already talked to his insurance company for what he said was “about 18 times.” Frequently on hold for 45 minutes or more. 

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Kristin says once they finally figured out what was going on, they could figure out how to budget for it. There were sacrifices. She stopped seeing one of her providers as often. But finally figuring out what was going on also allowed them to live with it. 

Kristin H: The infuriating part was telling, like doing exactly what we were told to do, following the process, and then feeling like you are crazy. Like why, why doesn't this make sense? You know? And so I think I'm fortunate that Paul just wouldn't let it die and was gonna research until he figured it out. 

Dan: You did all of the work, you tracked it down, you identified the problem, and you, as you say, kind of resigned yourself to it. You're like, okay, this Goliath is not– we don't have the slingshot for this. Goliath is stomping all over our town, and we have to live in that reality. the knowledge, having done that work, gives you, it sounds like, an ability to have some peace. Like having tracked it down means that this sucks, but it's not the same as living in a situation where like, now what? Like anything could happen.

Kristin H: Yeah, you feel crazy or hopeless. You know? Like I've done everything and this doesn't … So there's just the sense of like, am I missing something? You know, is there anything left for me to do? I recognize that everyone is not like this, but for me, knowledge is a gift. 

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Dan: Chris Hamby says there's rarely a way to get this kind of knowledge in advance. He says you're unlikely to find these kinds of details in your insurance plan document. 

Chris Hamby: It typically will not say when you go out of network, we're going to send your claim to a third party that you've never heard of to price it. It will just give some sort of vague language about competitive rates in your geographic area. And if you call up in advance of seeking the care to try and get an estimate, most of the time you will not get much more specifics than that. They tell you you have to just go and they'll process the claim and you'll see when the explanation of benefits comes through. 

Dan: Yeah, and look, I hate to get you even angrier, but Chris says the rules can change on you, without notice. 

Chris Hamby: A lot of people that I talk with also have seen no change in their insurance plan, but they've seen their reimbursement rates decline over time. 

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Dan: Turns out, behind the scenes, their insurance made a switch from a service like FAIR Health, which looks at what's getting paid in general, to a service like MultiPlan, which looks for the steepest possible price cuts. 

Chris Hamby: And the difference between those two amounts can be vast. So you have people who in some cases stop seeing their doctors because their costs doubled almost overnight. 

Dan: Oh god. And still. Better to know. Better that as many of us know as possible. That's why Chris reviewed more than 50,000 pages of documents, and interviewed more than a hundred people for that story. And why lawyers for the New York Times helped get courts to agree to give him documents that had been under seal. 

Kristin and Paul– who had figured most of this out for themselves– they definitely appreciated all that work. 

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Paul H: When Chris published the article that he did, it was very validating to know we're not the only ones who are in this same boat. And there's actually people who have had far worse experiences than ours. Like, ours kind of pale in comparison. And then immediately, like, within 24 hours to see 1,500 or 1,600 comments on the article talking about it. It's like, okay, I might not have the stone that can slay the giant, but maybe The NewYork Times has the right sling and they might have the right stone to at least start the conversation. 

Dan: A few weeks after Chris's article came out, U.S. Senator Amy Klobuchar sent the top federal antitrust regulators a letter: She wanted them to take a hard look at MultiPlan. 

Chris Hamby: She expressed concern about the potential for price fixing here. 

Dan: Actually, Chris says some providers have already filed lawsuits against MultiPlan based on antitrust allegations. 

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Chris Hamby: The idea is that all the insurance companies outsource their pricing decisions to a common vendor. They're essentially fixing prices via algorithm is the allegation. 

Dan: As we noted here a few episodes ago, these antitrust regulators in the Biden administration have gotten pretty feisty. [That was the episode about the cyberattack on a company called Change Healthcare. It was called “The Hack,” if you missed it. Pretty fun!] 

And I mean, those antitrust regulators have their work cut out for them. And a lot of targets. But I do want to egg them on here. I suspect you do too. Meanwhile, you're egging US on. 

Listener 1: The first thought that went through my head was I'm going to fight this because this is absolutely ridiculous. I've already paid for this. 

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Dan: A few weeks ago, we asked you for stories about your experiences with sneaky fees, often called facility fees. 

Listener 2: When the facility fee is twice the office visit fee, it's just crazy. I mean, it's a 10-minute appointment for a prescription. 

Dan: You came through, and now we're making some calls, digging in for more details, and learning so much. We're gonna have a sneak preview for you in a few weeks. Till then, take care of yourself. 

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta and Claire Davenport– our summer intern. Welcome aboard, Claire!– and edited by Ellen Weiss. Adam Raymonda is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Gabrielle Healy is our managing editor for audience. Gabe Bullard is our engagement editor. Bea Bosco is our consulting director of operations. Sarah Ballama is our operations manager. 

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An Arm and a Leg is produced in partnership with KFF Health News. That's a national newsroom producing in-depth journalism about healthcare in America and a core program at KFF, an independent source of health policy research, polling and journalism. Zach Dyer is senior audio producer at KFF Health News. He's editorial liaison to this show. 

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor, allowing us to accept tax-exempt donations. You can learn more about INN at INN.org. Finally, thanks to everybody who supports this show financially. You can join in any time at https://armandalegshow.com/support/

Thanks for pitching in if you can, and thanks for listening.

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

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——————————
By: Dan Weissmann
Title: An Arm and a Leg: Meet the Middleman's Middleman
Sourced From: kffhealthnews.org/news/podcast/meet-the-middleman-for-middlemen/
Published Date: Tue, 25 Jun 2024 09:00:00 +0000

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