Season 1 - Episode 3

Helpful Links

This podcast was inspired by the organizations that help people pay off their medical debt. The organization Undue medical debt is a non-profit organization that assists individuals that have egregious medical debt that is no longer manageable and or sustainable. This organization has campaigns that support specific communities by creating funds to pay off medical debt in that community. A $1 dollar donation on average erases $100 of un-payable medical debt. If you would like to look into this organization, please check it out in the link below. 

We also wanted to highlight the free AI tool Fighthealthinsurance.com. This tool assists people in writing insurance appeals that could directly combat bills that were deemed the patient's financial responsibility. If you believe you were wrongly billed for certain services, checking out this tool could assist you in writing an appeal.  

Transcript

Hello Welcome to Mirroring Medicine with Kodi and Isabel! Today we will be discussing social determinants of health in the U.S. This includes the discussion of the many barriers that exist in accessing healthcare. Stay tuned for this discussion.

Storyline 

Isabel:

• We will start off by discussing a large factor that determines the care received by patients: their insurance. As an overview we will be defining some key terms in regards to this conversation.

• 54.8% private (group) - through employer

• Insurance purchased for a large group, usually provided through employers

• 13.9% private (direct purchase) - Individual to insured

• People directly purchasing individual or family plan directly through the insurance company

• 21.2% Medicaid/Children's Health Insurance Program

• limited income and resources - different for each state

• CHIP children are in families with incomes too high to qualify for Medicaid, but too low to afford private coverage.

• “Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.” (Healthcare.gov, 2024)

• ⅓ of california residents are covered through Medicaid 

• 18.5% medicare

• 65 age and older, and with certain disabilities

• 4.9% Military - active duty and veterans 

• Health insurance from  the armed forces

• 8% Uninsured

• No health insurance over all

• Congressional Research Service, 2024

• Overall 92% of U.S. residents have some type of health insurance.

Key Insurance Terms that all should know

• Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. (Healthcare.gov)

• With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.

• Copayment: A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.

• Coinsurance: The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

• Premium: Amount paid every month

• Out of pocket Maximum: The max amount you can spend on your health through health insurance before the maximum is reached and you will no longer be responsible.

This podcast was inspired by the organizations that help people pay off their medical debt. The organization Undue medical debt is a non-profit organization that assists individuals that have egregious medical debt that is no longer manageable and or sustainable. This organization has campaigns that support specific communities by creating funds to pay off medical debt in that community. A 1 dollar donation on average erases $100 of un-payable medical debt. If you would like to look into this organization, please check it out in the link below. 

We also wanted to highlight the free AI tool Fighthealthinsurance.com. This tool assists people in writing insurance appeals that could directly combat bills that were deemed the patient's financial responsibility. If you believe you were wrongly billed for certain services, checking out this tool could assist you in writing an appeal.  

Kodi:

But is this enough to ensure that individuals have access for health care?

• According to the Kaiser Family Foundation survey with included only adults with employer-sponsored insurance 2019

• ⅖ people with employer-sponsored insurance reported having difficulty affording some type of healthcare cost

• 31% of people that fall in this category reported deductibles and surprise medical bills as their top list of affordability problems

• 51% of the people surveyed said that them or someone in their family skipped or postponed medically needed care or prescription drugs because of the cost (Hamel, 2019)

This survey shows that even with insurance people struggle accessing care not because of actually being able to see contracted providers but because of the cost even with insurance. 

This perspective feels important in the aspect of the fact that medical debt is the leading cause of individual bankruptcy (Marketplace, 2024). 

To further elaborate the disparities in the healthcare system.

• Every year fewer and fewer physicians accept new patients with Medicaid.

• Fortune, 2024

• Ex: Dr. Hunter Morgan of Southern California

• Optometrist

• $175 eye exam

• $40 medicaid

Summary:

Today we discussed 2 characters to frame this discussion: Bartholomew and George. They each have insurance; however, their access to healthcare is inequitable. We looked over some US statistics regarding health insurance and defined some key terms to provide our audience more insight into this field. This includes deductible, copay, coinsurance, premium, and out of pocket maximum. We also elaborated on some key studies and theories including the Dahlgren-Whitehead Rainbow (1991) and the Kaiser Permanente study. We also went into an important key player in this socioeconomic health field aka Nancy Adler. Finally, we want to end this off with a charity/organization that this podcast was inspired by which is the “Undue Medical Debt” foundation. If you would like to have assistance in writing a letter for appealing decisions for insurance, a tool that could help is fighthealthinsurance.com. 

Citations

1. U.S. health care coverage and spending. (n.d.). https://sgp.fas.org/crs/misc/IF10830.pdf 

2. Liz Hamel, C. M. (2019, October 8). Kaiser Family Foundation/LA Times Survey of adults with employer-sponsored insurance - Section 2: Affordability of Health Care and insurance - 9302. KFF. https://www.kff.org/report-section/kaiser-family-foundation-la-times-survey-of-adults-with-employer-sponsored-insurance-section-2-affordability-of-health-care-and-insurance/ 

3. David Brancaccio, M. G. (2024, March 27). Why Americans are drowning in medical debt. Marketplace. https://www.marketplace.org/2024/03/27/health-and-wealth-why-americans-are-drowning-in-medical-debt/ 

4. Medicaid & Chip Coverage. HealthCare.gov. (n.d.). https://www.healthcare.gov/medicaid-chip/ 

5. Beam, A., & Press, T. A. (2024, March 21). There’s a huge Medicaid problem in California: Most doctors just won’t see those patients. Fortune Well. https://fortune.com/well/2024/03/21/medicaid-california-unaffordable-most-doctors-dont-treat/ 

6. Deductible - glossary. HealthCare.gov. (n.d.-a). https://www.healthcare.gov/glossary/deductible/#:~:text=The%20amount%20you%20pay%20for,%242%2C000%20of%20covered%20services%20yourself.&text=A%20fixed%20amount%20(%2420,you’ve%20paid%20your%20deductible. 

7. Crompton, Emma, et al. “Patient-Centered Care and Digital Health Interventions: Qualitative Systematic Review of the Perspectives and Experiences of People Living with Long-Term Conditions.” Digital Health, vol. 8, 2022, p. 20552076221129093, SAGE Publications, doi:10.1177/20552076221129093.

8. Adler, Nancy E., and Judith Stewart. MacArthur Scale of Subjective Social Status: Adult Version. Stanford SPARQ, sparqtools.org/mobility-measure/macarthur-scale-of-subjective-social-status-adult-version/. Accessed 10 Nov. 2024.

9. Genzlinger, Neil. “Nancy E. Adler, Psychologist Who Studied Health Disparities, Dies at 74.” The New York Times, 18 Jan. 2024,⁠ www.nytimes.com/2024/01/18/health/policy/nancy-e-adler-death.html⁠.