Medicare for All

As we record this, the New York Knicks just might be poised to make history and win their first NBA championship since 1973 (Go Knicks!), but we’re here today to talk about a potential win that could be even bigger for New York than the Knicks taking it all… the passage of The New York Health Act! The New York Health Act, currently working its way through the NY state legislature, would guarantee high-quality, comprehensive healthcare to every single New Yorker, and – it turns out – save families, counties, cities, schools, and taxpayers billions of dollars! We’ve got two of the leaders of the Campaign for New York Health to bring us up to speed on the bill and tell us more about how they’re working to make universal healthcare a reality in the Empire State! https://www.youtube.com/live/hodcUC-pgIg?si=2BjDQV6L-ogqZZHx Campaign for New York Health Our guests for this episode are Campaign for New York Health Executive Director Melanie D’Arrigo and Managing Director for Results for Development Dr. Cheryl Cashin. You can read the NY Health=NY Wealth report that details how passing the New York Health Act would guarantee healthcare for every New Yorker AND save billions of dollars for individuals, families, and entire counties, cities, and towns on their website. Medicaid Work Requirements Those new Medicaid work requirements are about to cause millions of Americans to lose their healthcare. This is a policy that was disastrous for Medicare in the 1990s and disastrous in all the states where it’s been tried for Medicaid so far. You have until July 30, 2026 to submit a public comment and let Chuck Grassley know how you feel about his ghoulish enthusiasm for making the lives of poor people shorter and more difficult. Follow and support the pod! Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare-NOW Education Fund! Chip in here to support our work!

We usually stick to the healthcare news here, but this time, we’re covering a story happening right in our own backyard that could have huge public health consequences. Corpus Christi, Texas is about to be the first American city to run out of water, which threatens the health and wellbeing of the entire city, and especially the folks who are already in precarious health situations. Today we’re talking to local activist Isabel Araiza about what’s happening in Corpus, why we let big businesses put a price tag on our public goods, and why this isn’t just a Texas problem. PLUS, the latest healthcare news! https://www.youtube.com/live/MEXnETtAWP8?si=XdjYVL9C_YtAHmKF Isabel Araiza was born and raised in Corpus Christi. She earned her PhD in Sociology from Boston College and returned to Corpus to teach. She’s currently an Associate Professor of Social Sciences at Del Mar Community College. For the Greater Good Coastal Bend, the grassroots group Isabel co-founded has been advocating for quality of life issues in the Coastal Bend since 2016. You can find out more about their work here. For a Perfect Union has produced an excellent video about the Corpus Christi water crisis featuring Isabel and other local activists. Please watch and share to help spread the word! Follow and support the pod! Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare-NOW Education Fund! Chip in here to support our work!

We spend a lot of time griping about the insidious power of corporate health insurance in our healthcare system here. But you would expect that taxpayer funded public programs for our most vulnerable friends and neighbors are free from profiteering right? Sadly, no. Medicaid – the public program that serves the lowest income Americans, plus some people with disabilities, and a lot of the country’s long-term care – has been extensively privatized in most states. Hoping to trim budgets, most states have outsourced Medicaid recipients to “Medicaid Managed Care Organizations,” which are actually private insurance companies. And with private insurance comes the barriers to care we know all too well, like prior authorizations, denial of claims, and narrow networks. These are all part of the private insurance/public programs business model: the more care they avoid paying for, the more money from those capitated payments they get to keep. But today we have a rare ray of sunshine: a state showing there’s another way to provide care, not just coverage, to some of their most vulnerable residents. In 2012 Connecticut kicked the private insurance-run Managed Care Organizations out of their Medicaid program. They took on Big Insurance and won. Our guest today will walk us through how it went down. Sheldon Toubman has been a litigation attorney for Disability Rights Connecticut since 2021, and a leader of the efforts to remove Managed Care Organizations from the state’s Medicaid program. Before that, he was a staff attorney with New Haven Legal Assistance Association (NHLAA), where he spent 30 years representing and working on behalf of Medicaid enrollees. He engages in a variety of strategies on behalf of people with disabilities, from litigation to legislative advocacy and public education through media, webinars and other means. https://www.youtube.com/watch?v=zM7dRzHkVu0&t=1804s Show Notes Sheldon tells us that before 2012, Connecticut’s Medicaid program was bifurcarted: eligible kids, pregnant people, and families were in a capitated Managed Care Organization (MCO) model and people with disabilities were in a fee-for-service program. (Medicaid is funded with federal dollars, but unlike Medicare, states design the programs and make all the decisions about plans.) With a fee-for-service model, the state takes on the risk. With the MCO model, the MCO receives a per-person/per-month fee (a “capitated payment”) from the state, and they have to provide the care; if the patient requires less care, the MCO keeps the money, but if the patient requires more care, the MCO has to pay for the amount above the per-person/per-month fee. MCOs had a financial incentive to deny care so they could recoup more money. Beginning in the late 1990s, Medicaid advocates began a campaign of lawsuits and lobbying to remove Managed Care from their Medicaid program. Hartford, Connecticut is known as the insurace capital of the US, so this was a tough fight. Insurance companies fought this campaign because public programs are a major profit center for insurers, often more profitable than private employer-sponsored insurance. The insurance industry claimed they provided excellent care for less money, and coordinated care in a way that’s not possible with the fee-for-service model. The insurance industry also ran ads about all the jobs they provide, and legislators were afraid to tangle with them. When the state asked for data about how the MCOs spent public dollars, they refused to provide it. So advocates only had anecdotal information, and it was hard to refute the claims the MCOs made about how well they served patients. One of the anecdotal complaints they heard the most was the lack of access to providers. Advocates convinced the state to check the insurance company provider network lists, so the state instituted a Secret Shopper survey to analyze them. They found that patients could get an appointment with supposed in-network providers only 25% of the time, across all the MCOs Connecticut contracted with. Around the same time, one of the lawsuits resulted in a decision that the MCOs were subject to the Freedom of Information Act (FOIA) forcing them to give their data to the state. The state and advocates learned not only that the MCOs put up barriers to deny care, but also that providers weren’t getting paid (despite the MCOs’ claims they paid better than Medicaid rates). Providers were fed up with the MCOs and thus had no incentive to take Medicaid patients. During the 2010 gubernatorial race, Medicaid advocates shared all this information with the candidates. They were lucky that the winner, Dannell Malloy, didn’t have any allegiance to the insurance industry. Once he was in office, Gov. Malloy responded to the 12 year campaign by Medicaid advocates by directing the state to take the risk back by going back to fee-for-service. They put out a Request for Proposal (RFP) for companies to provide administrative services for medical, dental, behavioral health, and medical transportation on a non-risk basis. Thus, those entities wouldn’t have a financial stake in denying claims and narrowing networks. The Governor also instituted a Primary Care Case Management model to actually manage care. After 2012 Connecticut saw a huge improvement in access to providers. Removing MCOs from the program was a huge incentive for them to sign up to care for Medicaid patients. The state has saved billions of dollars. The medical loss ratio is about 97%: that means 97% of the tax dollars are going to provide care to patients, with only 3% going to overhead, marketing, lobbying, and huge salaries and bonuses for insurance company executives. The Primary Care Case Management model is really coordinating care for about 50% of patients. Today’s Connecticut Medicaid program isn’t perfect; provider rates for specialists and behavioral health providers aren’t ideal. But thanks to the work done in 2012, they know what those rates are and can address them head on. Sheldon notes that insurance companies that sell Medicare Advantage plans operate on the same MCO model with similar results: barriers to and denial of care, and profiteering. Connecticut’s model could be applied in other states and nationwide for a Medicare for All type system. Sheldon’s advice to other states: conduct Secret Shopper surveys! Publicize that the state isn’t holding contractors accountable for how tax dollars are being spent. Toxify the industry so politicians won’t want to be on their side. Follow & Support the Pod! Don’t forget to like this episode and subscribe to The Medicare for All Podcast on  Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

The United States is unique among industrialized nations. Lucky for us, we can accumulate medical debt! Most industrialized and some developing nations have national healthcare programs that guarantee care to their residents. But we in the richest nation in the world have the freedom to get insurance through the free market, and go into debt when it doesn’t cover the care we need! USA USA USA! According to the Kaiser Family Foundation (KFF), while over 90% of Americans have health insurance, we owe at least $220 billion in medical debt. Approximately 14 million people owe more than $1,000, and about 3 million owe more than $10,000. When the debt is cast more widely to those who have put medical bills on their credit cards or borrowed money to pay them, KFF found that 41% of adults have healthcare debt. According to the US Census Bureau in 2021, Black and Latinx households are disproportionately affected by medical debt.   Today we’ll dive into the topic of medical debt: who has it, who profits off it, and what can we do about it?  https://www.youtube.com/watch?v=dZPd1kFbEuE Show Notes What causes medical debt? Believe it or not, our freewheeling use of the healthcare system is not to blame. In the US medical debt is caused by the high prices charged by hospitals, pharmaceutical companies, and insurance companies. While most industrialized nations have some means of controlling prices, in the United States the healthcare industry sets prices more or less however they want. As a result, according to a nationwide poll in 2022, over a five year period more than half of US adults report going into debt because of medical bills. Debt is preventing Americans from saving for retirement, paying for college, or buying a home.  The 2022 poll found that 1 in 7 people reported being denied care due to unpaid bills. Two-thirds of those polled reported putting off necessary care due to cost.  This is all despite the Affordable Care Act expanding insurance coverage to more Americans than ever before. Insurance companies increasingly shift costs onto patients, with higher deductibles and more claim denials. According to the 2022 KFF poll, 61% of insured Americans had medical debt in the previous five years.  What makes medical debt so dangerous? We know health systems are denying care to patients who have unpaid bills. And we know people put off care so they don’t incur more debt. Those barriers to care make us sicker, and they disproportionately impact people with higher rates of chronic conditions. The Commonwealth Fund found that 54% of people with employer coverage who skipped or delayed care reported getting sicker; 61% in individual market plans and 63% with Medicare reported the same. A 2024 study published in the Journal of American Medical Association found that medical debt is associated with higher mortality and premature death. What happens when you can’t pay your medical debt? When you think about all the real people on the end of those medical debts, that makes it all the harder to swallow a fact that gets relatively little attention in the broader conversation. Medical debt collection is a for-profit business. In many cases, non-profit hospitals sell debts to for-profit medical debt collections agencies. Some health systems even operate their own for-profit debt collection arms. Think of it: They set the prices for their services as high as they want, and on the other end of the equation, they’re making money off debt collection.  Dr. Luke Messac of Brigham and Women’s Hospital testified at a July hearing of the Senate Health, Education, Labor and Pensions Committee that he learned that his and many other hospitals as well as collection agencies report sick, vulnerable patients to credit bureaus, garnish wages, seize bank accounts, and seek warrants for their arrest. And again, we have to highlight the evil practice of hospital systems that restrict patients from getting needed follow-up treatment until their debt is paid.  These are not just a few bad apples. Aggressive debt collection tactics are widespread: a KHN investigation in 2022 examined billing and financial aid at 528 hospitals across the country and found: more than ⅔ sue patients or take actions like garnishing wages. About ⅔ report patients to credit rating agencies, which negatively affects their credit scores and hurts their ability to get housing or jobs. A quarter of hospitals sell patient debts to debt collectors About ⅕ deny care to people with outstanding debt Medical debt doesn’t always go on your credit rating: Unpaid medical debt that is sent to collections can be reported to credit bureaus after one year, then remains on your credit report for seven years. As of a rule that went into affect April 11, 2023, medical debt can only impact your credit rating if it’s over $500. CPFD’s new rule would prevent debt of any amount from appearing.  WATCH: If you need a moment of levity, a few years ago, John Oliver did a segment about the “grimy business” of debt collection. How do we fix this? Until we have a Medicare for All system that takes the profit motive out of healthcare, controls prices for care, and gives patients access to treatment with no cost at the point of delivery, we will continue looking for new and creative ways to help people survive in our messed up healthcare system. Fortunately, many Americans and even some of our elected officials are good at coming up with creative ways to help each other in times of crisis. Some solutions would be relatively simple for Federal, state or even local governments to enact: Charity Care Eligibility: We have to hold non-profit, tax-exempt hospitals responsible for providing what’s known as “charity care.” In exchange for their tax-exempt status, non-profit hospitals are supposed to provide care and help patients determine if they’re eligible for free or reduced cost care or Medicaid. One problem is that charity care standards are vague; as a result, KFF found that charity care costs represented 1.4% or less of operating expenses at half of hospitals in 2020. Another barrier to access is that hospitals make applying for this kind of assistance overly complicated, something a patient in a health crisis rarely has the capacity to do. One solution is for the IRS to use existing authority to allow hospitals to verify patient income in real time, so they can access financial assistance or Medicaid. Hospitals could use software that’s widely available to “cut off medical debt at the source” and ensure that eligible patients receive assistance when they walk in the door for care. But they aren’t currently required to do this by federal law. Buying and Forgiving Medical Debt: We’ve all contributed to GoFundMes to help people with medical bills by now. Another way to crowdfund medical debt: for ten years, an organization called Undue Medical Debt (formerly known as RIP Medical Debt) has offered Americans an easy way to buy up and forgive other people’s medical debt for pennies on the dollar (without lining the pockets of a corporate crowdfunding platform). Any individual can buy up medical debt for pennies on the dollar and go to sleep at night knowing they helped ease the burden on a fellow American. Taking that idea to a new level, some cities and counties like St. Paul, Minnesota and Wayne County, Michigan have used federal ARPA dollars to buy up the medical debt of some of their residents. St Paul, MN with a population of just over 300,000 erased $100 million in medical debt for 43,000 residents. We know that when debt is erased, especially for lower-income families, that leaves more money for rent, groceries, and the other things needed to lift people out of poverty. While this doesn’t address the root cause of medical debt, Medical Debt Cancellation Act of 2024: In May of this year, Representatives Ro Khanna of California and Rashida Tlaib of Michigan, and Senators Bernie Sanders of Vermont and Jeff Merkley of Oregon introduced legislation to eliminate $220 billion in debt, wipe it from credit reports, and limit the accrual of future debt. The bill create a grant program within the Department of Health and Human Services to to cancel medical debt, prioritizing vulnerable populations and debt owed to safety net hospitals. Consumer Financial Protection Bureau rulemaking to remove medical debt from credit reports: A proposed rule change by Biden Administration/Consumer Financial Protection Bureau announced on 6/11/24 would prevent almost any medical debt from appearing on credit reports. State Efforts: according to a 2023 Commonwealth Fund analysis, 20 states have financial assistance standards, and 27 have community benefit standards. The strength of these standards vary, as does eligibility to receive financial assistance, but several states have robust protections: 8 states have laws limiting or prohibiting interest that can be charged on medical debt. However, the laws don’t extend to third party debt collectors, who hospitals often engage. 3 states limit hospital or debt collectors’ ability to sue patients for debt. Illinois prohibits lawsuits against uninsured patients who demonstrate inability to pay. 11 states prohibit or set limits on liens or foreclosures for medical debt. California and New Mexico prohibit liens and foreclosures for low-income populations. New York and Maryland fully prohibit them. 21 states have wage garnishment protections that exceed federal standards. California prohibits all wage garnishment for low-income populations, and New York fully prohibits wage garnishment to recover medical debt. In July we learned about North Carolina’s new plan to give hospitals additional Medicaid dollars if they forgive the debt of around 2 million residents. CMS approved the plan. In June of 2024 Minnesota passed the Debt Fairness Act, pushed by Attorney General Keith Ellison (an M4A champ who was our chief author in the House during his terms in Congress) that will Ban providers from withholding necessary care due to unpaid debt Eliminate the automatic transfer of medical debt to a patient’s spouse Establish protections from unethical medical debt collection Require providers to publish their debt collection practices Create a new process to help people dispute coding and billing errors The Republican plan: Surely Donald Trump and JD Vance have a plan to address this crisis. Just kidding. Literally nothing comes up if you Google their names plus medical debt. Conclusion Medical debt is a shameful part of our broken healthcare system. Relieving medical debt isn’t the solution. It is the right thing to do to relieve millions of Americans from immediate stress and hardship so they can focus on their health. But the real solution is a national health plan with price controls for providers based on what it costs to provide care, and low-to-no cost at the point of care, so patients can get care when they need it, without worrying about the debts afterward. With the patchwork of limited protections and relief on top of a system that allows unfettered profiteering by the healthcare industry, medical debt will continue to be a problem for Americans until we address the PRICE of care. Until then, we’ll keep you posted on mutual aid efforts that help Americans survive our healthcare hellscape. Do you have a story about the way your community is coming together to support people who need healthcare? Please share it by emailing us at info@healthcare-now.org. Follow and Support the Pod! Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.Don’t forget to like this episode and subscribe to The Medicare for All Podcast on your favorite podcast platform!

If there’s one thing everyone is talking about these days, it’s JD Vance’s affinity for couches. But if there are two things everyone is talking about, it’s Vance’s couches and Project 2025. You may be wondering, what is this mysterious project, and what does it have to do with me? Well, it turns out, a lot! Project 2025 is the right-wing map to a terrifying future, and if its proponents have their way, the future of healthcare is especially grim. Today, we’re doing a deep dive into what this thing is and how it could change healthcare as we know it. https://www.youtube.com/watch?v=a4kYQ-Hh5pY Show Notes Gillian Mason, Healthcare-NOW’s Executive Director, has read Project 2025 so you don’t have to. P25 is the brainchild of the Heritage Foundation, the think tank founded in 1973 because conservative businessmen thought Richard Nixon was too liberal (remember that Nixon created the EPA and advocated for a better national health plan than Obamacare, so they weren’t all wrong). They really hit their stride during the Reagan administration when they wrote his policy playbook, which they called the “Mandate for Leadership” — Reagan implemented or initiated about 60 percent of the 2,000 policy changes they recommended. They do this Mandate for Leadership report now every presidential cycle, and it’s been pretty influential whenever a Republican wins. These people are unabashed fascists. We use that term a lot kind of casually but these guys literally fit the Merriam-Webster Webster dictionary definition: “a political philosophy, movement, or regime that exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition.” The Heritage Foundation’s whole deal is consolidating all authority in the office of the president so he can implement severe economic and social regimentation based on nationalism and barely-veiled-when-it’s-not-just-blatant racism. Project 2025 It’s the “Mandate for Leadership” for this election season, so it’s supposed to be a template for Trump’s next four years. Although reading Project 2025 would make you think it was a room full of monkeys at typewriters type situation, it was actually written by a room full of Trump’s cronies. Hundreds of people contributed to writing and researching this thing, and a hefty percentage were former Trump appointees and employees of the administration. Also, VP pick JD Vance just wrote the foreword for an upcoming book by Kevin Roberts, the head of the P25 team. Vance has also been a mouthpiece for some of the wilder shit in P25. Trump claims he really doesn’t know much about P25. But it’s still worth talking about because COINCIDENTALLY it turns out that a lot of his policies are the same as the ones in P25. The Premise: The liberals in Washington, in cahoots with Chinese Communists and the “totalitarian cult known today as ‘The Great Awokening’” have put “the very moral foundations of our society are in peril.” (This is not an exaggeration— it’s literally all on the first page) P25 has 4 main goals: Restore the family as the centerpiece of American life and protect our children. Dismantle the administrative state and return self-governance to the American people. Defend our nation’s sovereignty, borders, and bounty against global threats. Secure our God-given individual rights to live freely—what our Constitution calls ‘the Blessings of Liberty.’” All the recommendations are laid out systematically according to the different areas of the federal government they want to control (The Executive Office, Department of Homeland Security, Intelligence Services, Media Agencies, etc.) We’ll mainly be focusing on healthcare today but context is important so here are a few highlights of what they’re planning to give you some flavor: Reclassify most federal employees as appointees Mass arrests and deportations of undocumented immigrants Defund PBS Reinstate work requirements for the Special Supplemental Nutrition Program for Women, Infants & Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP). Get rid of protections for trans folks in Title 9. Roll back regulations on the production of baby formula So what do these policy geniuses have to say about healthcare? Their overall goals are: “Protecting Life, Conscience, and Bodily Integrity”: in a nutshell, a freakout about sex and gender and scientific research that bothers the consciences of conservative Christians. “Empowering Patient Choices and Provider Autonomy”: more free market competition gobbledegook about healthcare. We know that health isn’t a commodity. We don’t make decisions on health the same way we do when buying a tv or car. You can’t diagnose yourself and shop for bargains, or keep using that old busted kidney until Best Buy has a new one on sale. You also can’t comparison shop for health insurance. Markets just don’t work in healthcare. When they talk about choices, they want you to have the choice to create more profit for insurance companies. Their philosophy is that government programs like Medicare and Medicaid victimize poor people by making them depend on the state, therefore having more “choices” of private insurance are inherently better for poor people, or something. “Promoting Stable and Flourishing Married Families”: they are very worried about fatherless families, government subsidization of single-motherhood and disincetivization of work. This section also includes 50 Ways to Stop an Abortion including bringing back the Comstock Act of 1873. “Preparing for the Next Health Emergency”: they are still so mad about the COVID-19 pandemic, they are dying to make sure we do absolutely nothing. “Instituting Greater Transparency, Accountability, and Oversight”: This one is kind of interesting – they’re mad at Big PhRMA because vaccines are bad, so they want to stop private corporations, including Big PhRMA, from “capturing” federal agencies by putting their money into public-private partnerships. They also proclaim “we must shut and lock the revolving door between government and Big Pharma. Regulators should have a long “cooling off period” on their contracts (15 years would not be too long) that prevents them from working for companies they have regulated. Similarly, pharmaceutical company executives should be restricted from moving from industry into positions within regulatory agencies.” This sounds pretty good to us, actually. Unfortunately they also want to stop government negotiations over prescription drug prices. So our takeaways: ever since the GOP tried to overturn the ACA, they haven’t had a coherent health policy. Project 2025 really doesn’t move the needle. It’s mostly culture war nonsense that does not project any kind of vision of what they want to see in the future. While most opinion polls show that healthcare costs are still a major issue for American voters, they don’t touch on the topic in Project 2025. They would privatize all of our public programs, making more profits for insurance companies and putting fewer resources into patient care. Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

It’s the most wonderful time of the year! For activists in the movement to make Medicare for All a reality, this is the week when we gather to plot, scheme, and kvetch. Welcome to the 2024 Annual Medicare for All Strategy Conference, “Healthcare Beyond the Ballot Box,” organized by Healthcare NOW! For those of you who are attending the conference right now, you are getting a sneak preview of our Very Special Conference Episode! Since our theme this year is about what happens to Medicare for All in an election year — and beyond — we wanted to invite some of our favorite policy people with their fingers on the pulse of what’s happening in DC to help us sort out what’s happening with healthcare on Capitol Hill and what role we can play to get some justice out of DC in the coming year! https://www.youtube.com/watch?v=n36v0eTV1a8&t=1167s powerpress Our guests are Eagan Kemp and Alex Lawson. Eagan Kemp is the health care policy advocate for Public Citizen’s Congress Watch division. He is an expert in health care policy and served as a senior analyst at the U.S. Government Accountability Office prior to coming to Public Citizen. Alex Lawson is the Executive Director of Social Security Works, the convening member of the Strengthen Social Security Coalition— a coalition made up of over 340 national and state organizations representing over 50 million Americans. Show Notes With one of our major candidates being a guy who is solidly against Medicare for All and the other being Trump, is 2024 a bad federal election cycle, or the worst federal election of our lifetime, and why? Alex puts a positive spin on it: we are closer to M4A with a Biden presidency than any other Democratic presidency. He’s definitely not a M4A guy, but all his other economic policies are based on Sanders-esque populism, rather than Obama-esque neo-liberalism. We’ve seen Biden enact serious corporate reform in several sectors, and in a second Biden administration, taking on corporate greed and sociopathy in health insurance is on the agenda. On the other hand, we know exactly what’s at stake with another Trump presidency, driven entirely by profit for his billionaire friends. Eagan notes that there has been movement on Medicare in recent years, including die-hard GOPs shying away from talking about cuts to Medicare until after the election. At the same time, we’re seeing Biden moving more toward the M4A movement and the folks trying to expand and improve traditional Medicare. We’re seeing insurance companies running scared, feeling the pressure from our movement in a way they haven’t before. Alex notes that Biden’s economic vision contains a lot that Medicare for All folks can work with. Our movement worked hard to expand Medicare to include vision, hearing, and dental, which was ultimately included in Biden’s Build Back Better plan. We didn’t get that, but we did get prescription drug negotiations, which is a huge part of improving Medicare before we expand it to everyone. (Go back and listen to another episode where we were joined by Alex to discuss prescription drug negotiations for more details.) We’ve also seen a lot of good work against Medicare privatization, via Medicare Advantage, and that solidarity has moved the ball a lot – more than ever before to restrain private insurance companies. We didn’t just give up when we knew Biden wouldn’t sign M4A; we pivoted to expanding benefits and reversing the privatization with a lot of success. Eagan found a silver lining in – of all places – the subject of private equity in healthcare. He thinks we’ve passed the peak of PE ravaging healthcare, and they are now backing off the healthcare sector in part because of increased pressure from the DOJ, FTC and HHS. That’s due to pressure from doctors, patients, and whistleblowers. Eagan also notes that the Trump administration pilot of throwing seniors in traditional Medicare into private relationships with providers. Our movement worked with seniors to fight that off, and get the Biden administration to curtail the scariest parts of the “Direct Contracting Entities.” Alex credits FTC Chair Lina Khan for challenging corporate power and winning, in a way the FTC hasn’t in decades. Next up the FTC is teeing up UnitedHealth and their massive monopoly. Industry is scared. The movement is putting on the pressure, the agencies are getting wins and the media is starting to pay attention. Ben says we’re seeing a significant shift in Democratic strategy around healthcare reform, away from the ACA model of just giving more money to private insurance, and toward taking on the industry and cutting off some of their income streams. When we look at issues like prescription drug negotiations or curbing Medicare Advantage where we’ve gained some ground over the past year, it’s been due in large part to activists increasing the pressure. Public Citizen is working on M4A resolutions, seeing more excitement especially in southern states. Alex says politicians are lagging indicators (they don’t start reflecting public opinion for a while after a shift happens) and he’s noting that even some are finally ready to accept that privatizing Medicare is ripping us off and killing people. Another big shift is on the issue of the age of eligibility for Medicare. Not long ago we were fighting off attempts to raise the age to 67. Now President Biden is talking about lowering the age. Biden continues to feel the pressure on healthcare andhas resulted in some real progress. We talk about the good, the bad, and the ugly post-election scenarios. Good would be a Democratic trifecta (there’s a path, if you squint a little) where we could make a lot of progress toward expanding and improving Medicare. In the Fair column would be another Biden presidency with a divided congress, in which case our movement will have to continue to work on executive actions the president could take. Ugly would be a Republican trifecta, which will immediately mean huge corporate tax cuts and possibly right-wing violence like we saw on January 6. In that case, our job will be to stand in solidarity with our allies against fascism. It’s becoming harder and harder for people – politicians and voters alike – to deny that we’re on a bleak path. There’s been a real change on the hill, driven by organized people pushing for a better future. We’re seeing real results like drug price negotiations, insulin price reform, and bills addressing medical debt. If we want to continue the work, one of the most important things we can do is get and stay engaged with our Members of Congress, and start building relationships with the people who are waiting in the wings to run for something in the future. Get involved in local elections now, and those are the folks who will be running for Congress and President in the near future. Tell them your stories! We may never have the perfect scenario with the perfect elected officials, but we need to be ready for M4A to have a moment. Keep building so we will be as ready as we can be. Alex leaves us with the story of Eugene V. Debs. Socialist and labor leader Debs ran for president and lost several times (1904, 1908, 1912, 1920), but was all lost for his pro-worker priorities? A little over a decade after Debs’s final loss, Frances Perkins and the New Dealers essentially put forth his whole platform and got it done during the Roosevelt administration. If we don’t win M4A, don’t throw up your hands and give up. Keep laying the foundation so we’re the ones who are ready when the time comes. TL;DR: organize, organize, organize. If you’d like to hear more presentations from the 2024 Medicare for All Conference, visit the Healthcare-NOW Youtube channel! Like and Support the Pod Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! This show is a project of the Healthcare-NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org. It’s end-of-year giving season, and thanks to a generous matching gift from the United Steelworkers Union, every dollar you give will be doubled, so please make your way to our website and chip in!

The U.S. is wrestling with a massive mental health crisis – impacting young people in particular. Half of young adults and one-third of all adults report that they always feel anxious or have often felt anxiety in the past year. One-third of respondents could not get the mental health services they needed. Why? 80% say they couldn’t afford the cost and more than 60% said that shame and stigma kept them away. The shortage of mental health providers also means that care can be very hard to find, even when we try hard to find it. Usually on the Medicare for All Podcast, we focus on the stories we think you need to know about. Today we decided to scrap the show and come up with a plan to get an hour of free therapy!* (*Not really. None of this information is intended as medical advice.) Our guests today are Dr. Pamela Fullerton and Lindsay Baish. Lindsay is a therapist and an Licensed Professional Counselor (LPC) in Illinois and a certified trauma professional – and former volunteer for the podcast. Dr. Pamela Fullerton, Ph.D., is the founder and clinical director of Advocacy & Education Consulting, a counseling and consulting organization dedicated to ensuring social justice and advocacy through equitable access to mental health and well-being services. She is a Latina bilingual Certified Clinical Trauma Professional (CCTP), a Certified Dialectical Behavior Therapy professional (C-DBT), a Certified Clinical Anxiety Treatment Professional (CCATP), a Certified Grief Informed Professional (CGP), and a clinical supervisor and consultant specializing in working with BIPOC communities, undocumented communities, immigration and acculturation, trauma, anxiety, life transitions, and career counseling. In addition to being a professional writer and speaker, Dr. Fullerton is an adjunct instructor in the Counselor Education department at Northeastern Illinois University. She is also a volunteer contributing writer for three publications and runs a nonprofit to support Latinx youth in the Chicagoland area. Dr. Fullerton consults for two behavioral health advisory boards, Sinai Urban Health Institute (SUHI) and Illinois Unidos/Latino Policy Forum, providing advice and input to assist in promoting health equity and justice initiatives for underserved communities in Illinois. https://www.youtube.com/watch?v=GGql7_NXhts Show Notes Pam tells us that counselling is a subset of psychiatry and psychology that started as a movement for career development for veterans returning from war. The profession started helping people through life transitions puts people and their lives and livelihoods at the center. Lindsay notes that a lot of the language of mental healthcare is used interchangeably, but there are distinctions: psychologists have PhDs and can provide therapists; psychiatrists have MDs and can prescribe medications. Counselors and therapists can diagnose but not prescribe. Congress passed the Mental Health Parity and Addiction Equity Act in 2008 to prevent insurers from providing worse coverage for mental health than they do for medical or surgical treatment. However, mental health providers are not usually treated the same as medical doctors when it comes to insurance coverage and payments. Historically, counselors are the newest mental health clinicians on the scene and are more limited by insurers than more established clinicians like social workers or psychologists. Insurers often only reimburse for certain therapeutic models of care (Cognitive Behavioral Therapy, for example) leaving other kinds of counseling uncovered in the midst of a crisis in mental healthcare. Pam tells us that a big part of her job is the extra work to navigate her patients’ insurance plans, Medicare and Medicaid in order to get coverage for their care. Most Americans can’t afford to pay out of pocket for mental healthcare. Counselors just got approved for Medicare reimbursement on January 1, 2024, but Pam tells us her first application was denied, as was Lindsay’s supervisor’s. Couples and family counselors were just approved for Medicare as well. Lindsay notes that no two insurance companies pay out the same rates, so some plans are not worth taking because the payout will be late, small, and requires hours of red tape to receive. Ben calls this “rationing by inconvenience.” Illustrating the troubling priorities of the healthcare industry related to mental health, Lindsay shares a story about the Diagnostic and Statistical Manual (DSM), the encyclopedia of mental health diagnoses. The DSM is put together by the American Psychological Association, where panels of providers create and refine criteria and definitions for diagnoses. Those panelists are required to disclose who they have received funding from including pharmaceutical companies and insurance companies. A recent study found $14 million in undisclosed industry payments to some of those panelists, representing countless conflicts of interest. Americans have responded in a lot of different ways to the difficulty of getting mental healthcare including millions who go to TikTok for mental health advice. On the bright side, many of us have found out we aren’t alone helping to reduce the stigma of talking about mental health. Unfortunately social media has also disseminated misinformation leading to mistaken self-diagnoses. Lindsay is actually on TikTok, talking about her specialty areas and social liberation issues in psychology, because it provides a space for some people who don’t feel welcome in the traditional healthcare setting. Since COVID, we’ve seen the rapid growth of virtual mental health services. This feels a bit like the Uber-ization or Airbnb-ification of mental health services. In theory these platforms are great for access, but many are poorly regulated and the therapists are often not held to professional standards. The FTC found that one platform, Better Help, sold patients’ data. One of the things we always say about Medicare for All is that it would take the business out of healthcare. What would it look like if we took the business out of mental healthcare? Currently most Americans’ insurance is tied to employment, and that plan can change due to their employer’s bottom line. There’s something particularly insidious about developing a trusting therapeutic relationship with a mental health professional only to lose coverage and having to start over finding another provider who will accept the new plan. Pam dreams of a healthcare system divorced from profit, where we can do more preventative mental healthcare and collective healing, and not wait until someone is in crisis. Follow & Support the Pod! Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

Occasional fistfights aside, most of our legislators make the choice to use their words when they’re angry, and a lot of those words go into public letters they write to presidents, officials, and even each other. Despite the fact that no one else in this country has written or read a letter in decades, the public comment letter is still popular with politicians, who have elevated this obscure literary genre to a competitive sport, using these letters to demonstrate their power, build alliances, and shape policy. Today we’re going to focus on one ongoing battle of letters over one of our favorite topics: the privatization of Medicare through a program known as Medicare Advantage. We’ll talk about how all the players in the debate about Medicare Advantage are engaging in that battle, and how it could impact our access to healthcare! https://www.youtube.com/watch?v=MmM6HrIiS8o Show Notes We’ve recorded a bunch of episodes about Medicare Advantage! Medicare Advantage was created as a private, for-profit alternative to traditional (or public) Medicare, was the promise of lower costs… which never happened. Surprise: Medicare Advantage plans are FAR more expensive to taxpayers than traditional Medicare for covering the same person, costing taxpayers $7 billion more per year than if everyone were just covered by traditional Medicare. (source) It’s the healthcare Joe Namath, Jimmy JJ Walker, and Big Papi are selling to seniors with big promises of coverage for vision and dental care, transportation, groceries, and more – for $0 premiums. Free shit! Private companies drain public money to provide generally substandard insurance. These companies are exploiting a legit problem in Medicare, where many seniors are forced to pay premiums for medigap plans to cover stuff like chewing and seeing. If you can’t afford the premiums for Medigap coverage, but you need to chew or see, you might be forced into an Medicare Advantage plan just because that’s what you can afford month-to-month. And that could be fine… until you need care and find out that the copays and deductibles are too high, there are super limited networks, or the insurance company refuses to pre-authorize your treatment. But many of these MA plans don’t come through on their wild promises, and in fact, seniors end up being pushed out of MA and back into original Medicare when they are sick and actually need care. Private insurance companies love collecting money,but they hate paying money for the service they’re supposed to provide. Go figure!  We put out a report about this! Taking Advantage Who’s Who? AHIP: “America’s Health Insurance Providers” is the trade organization for the health insurance industry. Unsurprisingly, they are big proponents of Medicare Advantage. AHIP has written their own comment letters to CMS (the Center for Medicare and Medicaid Services) advocating for expansions to the MA program since at least 2015. Lately they also began coordinating their besties in the House and the Senate to write letters on their behalf. They claim that Medicare Advantage will expand the program to more seniors, and present some of their own research: MA will bring more money into the Medicare system… because MA plan holders use less care. (nothing to brag about!) MA is serving a diverse populatio “As of 2021, approximately 59% of Hispanic or Latino/a individuals and 57% of Black individuals eligible for Medicare choose Medicare Advantage plans. Overall, 54% of Medicare beneficiaries who belong to diverse populations choose Medicare Advantage.” Turns out if you set out to exploit a diverse demographic of people, you can! In 2021, 70 members of congress signed “dear colleague” letter, initated by initiated by Reps. Val Demings (D-FL), Mike Gallagher (R-WI), Marc Veasey (D-TX), and Gus Bilirakis (R-FL). In 2023 – 60 Senate signers – a good example of how this is insidiously bipartisan, John Fetterman signed right next to Ted Cruz In 2024 – 60 Senators, but only 16 reps signed on to their version. That’s because of the OTHER letter, which Congresswoman Pramila Jayapal has been whipping up support for in the house. The Good Guys Organized resistance to Medicare Advantage is actually fairly new (last few years)! Just a couple of weeks ago a COUNTER letter was to Biden and the agencies that run Medicare calling for major reforms to Medicare Advantage and essentially pointing out that it sucks. The letter was led by three Reps – Jayapal, DeLauro, Schakowski – was ALSO signed by 70 Representatives, so suck on that AHIP! (P.S. there are 435 voting members of Congress, so most of Congress is taking the cowardly fence-sitting approach to Medicare Advantage) (source) The letter makes four demands, one of which is already kinda sorta happening: Ban Medicare Advantage plans from creating prior authorization barriers that can’t be used in traditional Medicare, such as “step therapy.” (Banned by Obama, un-banned by Trump, and… allowed under Biden. Grrr.) Require Medicare Advantage plans to include all providers in their networks that are included in the public Medicare plan. One trick MA uses is to have extreme limited networks, so you might not be able to get certain types of care at all in your area. Stop overpaying Medicare Advantage by preventing “upcoding” and paying them the accurate amount for the patients they cover Finally, use all the savings to expand Medicare coverage for everyone: we could cover dental, vision, and hearing with money leftover; or we could reduce or eliminate the premiums and deductibles that Medicare enrollees still have to pay. This last bit is particularly important, since it’s problematic to just end the MA program – this would require many low-income people to spend more to buy Medigap plans. They’d have much better coverage, but many can’t afford that better coverage.  There will be a separate Senate letter, but we don’t have details yet. (There’s still time to ask your Senator to sign on.) What does the Other Letter mean? It’s a show of power in a legislature where it’s difficult to put progressive policy up for a vote and actual voting ends in gridlock. Based on the numbers, we can see the tides turning on Medicare Advantage. Remember that even though these letters are important for signaling shifts in the balance of power, the real organizing happens at the grassroots level, not on Capitol Hill. Follow, Like & Support the Pod! Don’t forget to like this episode and subscribe to The Medicare for All Podcast on your favorite podcast platform! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org. Resources Jayapal Press release: https://jayapal.house.gov/2023/02/16/jayapal-delauro-schakowsky-lead-effort-to-reform-medicare-advantage/ Jayapal Full letter and signers: https://jayapal.house.gov/wp-content/uploads/2023/02/230216-MA-Letter-Final-with-Signatures3.pdf AHIP press releases: https://www.ahip.org/news/press-releases