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Miscarriage or Abortion? The Crisis in 14 States Post Dobbs.

By MIKE MAGEE

“What did they know, and when did they know it?”

These are the questions Americans have become accustomed to asking of their leaders, dating back to Nixon and extending to Trump, and all Presidents in between. But now the same questions have surfaced, to the extreme discomfort of conservative Justices, as death and destruction of lives begins to mount in the wake of the Dobbs decision.

As predicted, graphic cases of young women bleeding out in parking lots after being refused life-saving acute care for miscarriage in 14 states across the nation are being documented and described. These stories are not only affecting the lives of couples across the land, but also threatening the “political lives” of downstream Republicans facing an upcoming election.

The responsible Supreme Court Justices (Alito, Thomas, Gorsuch, Kavanaugh, and Barrett) and their legions of Ivy League clerks had scoured the literature far and wide before making the decision to eliminate women’s reproductive freedom in the U.S. and inflict lasting harm to their life-saving relationships with their local doctors.

Their review had to include Blue Cross & Blue Shield’s timely publication, “Trends in Pregnancy and Childbirth Complications in the U.S.” That report, surveying over 1000 pregnant women ages 18 to 44 in April, 2020, was, in part, designed to understand the impact the Covid epidemic had had on prenatal care nationwide. But what it revealed was that pregnancy complications were up 16% over prior years, in part due to “social barriers such as availability of appointments, lack of transportation or nearby providers.”

A comparison of 1.8 million pregnancies in 2014 versus 2018 demonstrated a severely compromised women’s health support system. 14% did not receive prenatal care in their first trimester, and 34% missed scheduled prenatal visits with 1 in 4 of these suffering complications in pregnancy. The BC/BS summary “underscores the importance of focusing on the health of pregnant women in America, especially as health conditions increase in this population…”

The Conservative Justices were forewarned. Yet they still elected to throw fuel on a maternal health system which was already in flames. They were also aware of a 2021 study that confirmed that miscarriage was 43% more likely in Black women than in their white counterparts.

On May 2, 2022, Justice Alito and his allies engineered the release of a draft of a majority opinion in part to freeze attempts by Chief Justice Roberts to secure a compromise. The leaked document labeled Roe v. Wade “egregiously wrong from the start.”  As predicted, the ruling spawned chaos.  When 14 Red states established total bans on all abortions, miscarrying women seeking help in ER’s literally had to fight for their lives. Their doctors were criminalized. Was this an abortion gone bad?

A miscarriage, or pregnancy loss before 20 completed weeks, is not an uncommon affair. Approximately 15% of pregnancies end in miscarriage, mainly the result of chromosomal or genetic abnormalities. That amounts to some 540,000 women in crisis, which most believe is under-counted. 80% of miscarriages occur in the first 13 weeks of pregnancy.

25% of pregnant women experience some vaginal bleeding in the first trimester. For most (6 in 10) this is self-limiting and they go on to deliver a healthy baby. But for 4 in 10 (or 10% who present with bleeding) they go on to miscarry. All pregnant women who experience vaginal bleeding in early pregnancy need to have a medical examination. Doctors and midwifes check blood work, perform a physical examination, and do an ultrasound examination.

Most pregnancy loss (95%+) occurs before 20 weeks gestation. If miscarriage occurs before 13 weeks, there is a good chance of clearing the blood clots and uterine tissue with medication and no surgical intervention. But if bleeding is severe, or the loss is occurring beyond 13 weeks, dilation and curettage (D&C) is both necessary and at times life-saving. Under anesthesia, the cervix is dilated and any remaining pregnancy-related tissue is gently scraped and suctioned from inside the uterus. Patients are then closely monitored for several weeks for any evidence of continued bleeding or infection.

What did the Justices know, and when did they know it?

  1. They knew that Miscarriages were a medical emergency and exceedingly common.
  2. They knew that 80% occur during the first trimester, and that existing state abortion laws on the books would restrict access to acute life-saving treatments in 14 states.
  3. They knew that pregnancy loss was far more common in non-whites and in rural underserved communities.
  4. They knew that the medical community opposed overturning Roe v. Wade in overwhelming majorities, and predicted maternal loss of life if the Justices proceeded.
  5. They read, two years after their deadly decision, the Commonwealth Report which stated that “The United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80 percent — are likely preventable.”

They knew all this, and they did it anyway.

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

Streamlining Public Benefits Access is a Must to Address Poverty

By ALISTER MARTIN and TARA MENON

If a friend were to ask you which state, Massachusetts or Texas, has a more streamlined federal benefits enrollment program, what would your guess be?

Having screened over 17,000 families and helped them obtain more than $1.8M in federal and state aid through our work in both Massachusetts and Texas, our experiences doing federal benefit enrollment have led us to a surprising conclusion: Texas is leading the way. While Massachusetts has room for improvement, this issue extends beyond a single state—many other states face similar challenges with complex and fragmented benefits systems.

At Link Health, where our work spans the bustling neighborhoods of Boston and Houston, this revelation has been both a surprise and a call to action. In many underserved communities, through partnerships with Federally Qualified Health Centers, our organization seeks to assist eligible people in the navigation and enrollment in benefit programs that address crucial needs like access to affordable internet, food access, healthcare support, and housing resources.

One of the main obstacles we’ve encountered is that people are often unaware of the benefits they qualify for or find the process overwhelming. In states like Massachusetts, separate applications are required for each benefit program, making it harder for families to get the help they need. Programs such as LIHEAP, which offers heating subsidies, Lifeline, which provides internet access for telehealth, and SNAP, which helps with food assistance, all come with different paperwork and requirements. This fragmentation creates unnecessary barriers.

This is not unique to Massachusetts. Across the U.S., many states have similarly disjointed systems, leaving millions of dollars in federal aid unclaimed. It’s estimated that around $140 billion in federal aid goes unclaimed each year due to these inefficiencies.

In contrast, we have found that Texas’s “Your Texas Benefits” platform is efficient and user-friendly. This centralized, comprehensive application process covers a wide range of state benefit programs, including SNAP, TANF, Medicaid, and CHIP, as well as other services like WIC, family violence support, adult education, and substance abuse prevention programs. This unified system allows users to apply for multiple programs through a single portal, streamlining the process considerably. Plus, this common application system allows groups like ours to efficiently connect patients with the help they need without the usual bureaucratic entanglements — it benefits us both.

Although Massachusetts made some progress with its limited common application for MassHealth and SNAP in 2021, it still doesn’t offer a fully unified system for all its programs. This means that many residents must continue navigating multiple applications and processes. During the recent Medicaid “unwinding,” people across the U.S. lost coverage because they couldn’t manage the renewal process. It’s estimated that between 8 million and 24 million people are at risk of losing Medicaid benefits nationwide(Center For Children and Families), not because they no longer qualify, but because of these application challenges.

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The Art of Political Jiu-Jitsu: Project 2025 and Donald Trump

By MIKE MAGEE

Funny think about that Project 2025’s  “Mandate for Leadership.” Trump declared in this week’s  debate, “I know nothing about it.” But in addition to the vast majority of authors and editors of the document having served in the prior Trump administration, the former President’s name is mentioned in the 887 page document over 300 times.

Described by Pulitzer Prize winning economics columnist, Carlos Lozada, the work itself is an “off-the-shelf governing plan.” It’s packed with conservative fan favorites, not simply “militarizing the southern border” and reversing what they call “climate fanaticism”, but especially placing DEI (diversity, equity, inclusion) efforts in the waste bin, banning abortion nationally, and pushing deregulation and tax cuts for the richy rich.

None of that is surprising if you’ve run into these characters on K street and beyond. This is who they are, and largely who they have always been. Over the years, I’ve bumped elbows with them in Washington and in corporate C-suites galore. What makes this effort a bit unique is, of course, the presence of a cooperative headliner who will clearly endorse “the elevation of religious beliefs in government affairs” and actively diminish “the powers of Congress and the Judiciary.”

This is political jiu-jitsu practiced at its highest level. Rather than dismantling the “deep state,” these operators are fast at work “capturing the administrative state” for their own self-serving purposes.

Understanding jiu-jitsu takes one a long way toward understanding the Heritage Foundation and Freedom Institute’s puppet masters. The word “Jū” means “gentle, soft, supple, flexible, pliable, or yielding.” It’s companion, “jutsu” is the “art or technique.” Combine the two, and you have the ”yielding-art.” The intent in bodily (or political) combat is to harness an opponent’s power against himself, rather that confronting him directly.

Political jiu-jitsu may be deceptive and confusing in the absence of visible weaponry, but it is anything but gentle. In the physical version, you are instructed in joint locks and chokeholds of course, but also biting, hair pulling, and gouging. Kevin Roberts, the President of the Heritage Foundation and editor of Project 2025, is a master of the political version. While he and Trump outwardly employed a “nothing to see here” stance, demographic realities were cued up in the document. The solution to the growing minority status for Republicans? “Voter efficiency” and a rigged census. Or in the Project’s words: “Strong political leadership is needed to increase efficiency and align the Census Bureau’s mission with conservative principles.”

Robert’s language is soft, but its impact hard indeed. In the introduction he suggests that the Declaration of Independence’s words “pursuit of happiness” were better understood to be “the pursuit of blessedness” while providing corporations a market free hand “to flourish.” Career civil servants are recast as “holdovers” without “moral legitimacy.” And the Justice Department suffers this put-down – “a bloated bureaucracy with a critical core of personnel who are infatuated with the perpetuation of a radical liberal agenda.”

Majority rules and demographic changes being what they may, alternative facts and voter suppression have been added to the tools of “political jiu-jitsu” artists. But Kelly Anne Conway was nowhere to be seen this week, and their headliner was long-winded, boring, and tired. As for voter integrity, the Democrats are fully funded and lawyered up. Finally, good Republicans everywhere have begun to recognize that towing the MAGA line much further puts their down-ballot hopes in the direct line of fire.  Those 300 mentions are beginning to look like a liability instead of an asset.

Mike Magee MD is a Medical Historian and a regular THCB contributor. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

Why We Still Kill Patients (And What We Need to Stop Doing It)

By MICHAEL MILLENSON

This article is adapted from a talk given Sept. 7 at the 11th Annual World Patient Safety, Science & Technology Summit in Irvine, California, sponsored by the Patient Safety Movement Foundation. World Patient Safety Day is Sept. 17, with a series of events in Washington, D.C. from Sept. 15-17 sponsored by Patients for Patient Safety (US). An agenda and registration, which is free, can be found here.

Since I started researching and writing about patient safety, one question has continually haunted me: given the grievous toll of death and injury from preventable medical harm that has been documented in the medical literature for at least 50 years, why have so many good and caring people – friends, family, colleagues – done so little to stop it?

To frame that question with brutal candor: Why do we still kill patients? And how do we change that? The answer, I believe, lies in addressing three key factors: Invisibility, inertia and income.”

When it comes to invisibility, we’ve all heard innumerable times the analogy with airline safety; i.e., plane crashes occur in public view, but the toll taken by medical error occurs in private. That’s true and important, but there are other factors that promote invisibility that we in the patient safety movement need to address.

For instance, while I’m not a physician, I can say with certainty that every patient harmed in the hospital had a diagnosis (right or wrong), and often more than one. Yet disease groups such as the American Heart Association and American Cancer Society have been uninvolved in efforts to eliminate the preventable harm that’s afflicting their presumed constituents.

Why have we let these influential groups sit on the sidelines rather than make them integral partners in raising public and policy visibility? For instance, there are a number of Congressional caucuses – bipartisan groups of legislators – focusing on cancer. While much attention is paid to the Biden administration’s cancer moonshot, what about the safety of cancer patients treated today, while we wait for an elusive cure?

In a similar vein about missed opportunities for visibility, the stories told by patient advocates about the harm a loved one has suffered are always powerful. However, the specific hospital where the harm took place is typically not mentioned, perhaps for legal reasons, perhaps because it’s become a habit. The effect, however, is to dilute the visibility of the danger. The public is not confronted with the uncomfortable reality that my reputable hospital and doctor in a nice, middle-class area could cause me the same awful harm.

Finally, one time-tested way to hide a problem is to use obscure language to describe it. Back in 1978, RAND Corporation published a paper provocatively entitled, “Iatrogenesis: Just What the Doctor Ordered.” It concluded: “In terms of volume alone, we are awash in iatrogenesis.”  

That would have been a compelling soundbite decades before the 1999 To Err is Human report if everyone in America studied ancient Greek. “Iatrogenesis” is a Greek term meaning “the production of disease by the manner, diagnosis or treatment of a physician.” In short, patient harm is “what the doctor ordered.” Although there was plain English in the paper, the technical focus allowed the stunning prevalence of patient harm to remain publicly invisible.

Of course, today we don’t need to use a foreign language to hide unpleasantness. We can use jargon and euphemism. We have “healthcare-acquired conditions” and “healthcare-associated infections.” At least the Greek term acknowledged causality and responsibility.

The invisibility of the scope and causes of patient harm leads inevitably to inertia and complacency.

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Moving the bar(rier) forward: the benefits of de-risking cytokine release syndrome

By SAMANTHA McCLENAHAN

Every breakthrough in cancer treatment brings hope, but it also comes with a staggering price, raising a critical question: how do we balance groundbreaking advances with the financial reality that could limit access for many patients? 

Developing new cancer medications involves extensive research, clinical trials, and regulatory approvals; a lengthy process that requires substantial financial investment. Within clinical trials, this includes maintaining stringent safety protocols and managing a variety of adverse events, from mild reactions requiring little to no care to extremely severe events with hefty hospital stays and life-saving medical intervention. Take Cytokine Release Syndrome (CRS), for example. CRS is a common adverse event associated with chimeric antigen receptor (CAR) T cell therapy and other immunotherapies that presents across this spectrum with flu-like symptoms in mild cases of CRS to organ damage, and even death, in severe cases. The median cost of treating CRS following cancer-target immunotherapy is over half a million dollars in the United States. Tackling that large price tag – in addition to another $500,000 for CAR-T cell therapies – and reducing associated risks are necessary to break down barriers to care for many patients – especially those who are uninsured or with limited resources hindering the ability to travel, miss work, or secure a caregiver.

Unlocking Cost Efficiency in Clinical Trials with Digital Health Technologies

Integration of digital health technologies (DHTs) including telehealth, wearables such as smart watches, remote patient monitoring, and mobile applications in oncology care and clinical trials has shown immense value in improving patient outcomes, despite the slow uptake within the field. General benefits during clinical trials are captured through: 

  1. Reducing clinical visits and shortening trial length – Remote patient monitoring and virtual consultations minimize the need for physical visits, accelerating trial timelines. 
  2. Enhancing recruitment, diversity, and participant completion – Targeted outreach supported by big data analytics and machine learning algorithms helps to effectively identify and engage with eligible candidates, leading to faster recruitment and lower dropout rates. Digital technologies also overcome traditional barriers to participation, such as location, transportation, language barriers, and information access.  for a broader representation of patient demographics and more generalized findings and improved healthcare equity. 
  3. Increasing availability of evidentiary and safety requirements – Continuous data collection and monitoring in the setting most comfortable to patients – extending beyond clinical walls. This provides a pool of data to support clinical endpoints and enhances patient safety by enabling early detection of adverse events. 

While the exact cost of these digital interventions varies by study, there is significant evidence that cost-saving measures are emerging.

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Everything you ever want to know about birth control and much more — Sophia Yen, Pandia Health

Dr. Sophia Yen is the Chief Medical Officer (and Founder) of Pandia Health. She is about as expert as it comes on the topics contraception, emergency contraception, medication abortion, menopause and lots more. Her PR peeps asked if I’d interview her about Pandia Health, which is a fantastic online clinic & pharmacy for women at basically all ages. But I couldn’t have her on THCB without having her tell all about the world of contraception, menopause and of course reproductive health. I promise you that if you are a woman or somone who knows a woman, this is a fascinating interview. You will learn a lot, and there are lots of suggestions for how to manage many aspects of your health–Matthew Holt

Convention Invisibility Teaches A Crucial Health Policy Lesson

By MICHAEL MILLENSON

It’s close to an iron rule: Politics drives policy. In that context, the health policy issues that were largely invisible at the Republican and Democratic conventions taught a crucial political lesson.

Start with access. According to KFF (formerly the Kaiser Family Foundation), more than 25 million Americans have been disenrolled from Medicaid as of Aug. 23. Ten states, all dominated by Republican legislatures and/or governors, have declined to expand the program, leaving 2.8 million Americans unnecessarily uninsured.

Yet if you were looking to either convention to find protestors telling heart-rending personal stories to humanize those statistics, you’d search in vain. There were none.

The Poor People’s Army, a group advocating for economic justice, did invite reporters covering both conventions to focus on one of the most urgent issues facing the poor and near-poor – not medical care access, but the lack of basic housing.

Homelessness set a record in 2023, according to the National Alliance to End Homelessness, affecting one in 500 Americans, while the number of renters forced to pay more than 50 percent of their income has surged since 2015. The former is apparent on the streets of every big city, while the latter is felt by millions in every paycheck.

The political lesson is clear. While support for Medicaid expansion was buried deep in the Democratic platform, at the grassroots level there’s no sign of the kind of passionate involvement that could drive votes in a close election. Medicare, of course, is a separate issue, with both parties promising to protect the program dear to the hearts of the nation’s elderly, who have the highest percentage voting turnout of any age group.

Of course, even those with good health insurance often have to worry about medical costs, with KFF polling finding that a shocking 41% of U.S. adults have medical debt. However, although the phrase, “It’s the prices, stupid!” has become a bipartisan policy refrain, there are no swing state votes to be swung by harping on the alleged cupidity of the local hospital. So while denouncing “medical debt,” no one did.

On the other hand, Democrats spoke repeatedly about the depredations of “Big Pharma.” The GOP platform satisfied itself with a vague promise to “expand access to new…prescription drug options” to address prescription drug costs that “are out of control.” The responsibility for those prices was unspecified.

As for health insurers, articles about questionable denials of medical claims by giant insurers like United Healthcare and Humana have garnered headlines and expressions of outrage. Once again, however, the grassroots reaction is the key. There has been no outpouring of public indignation remotely comparable to the HMO backlash of the 1990s. As a result, health insurers have largely vacated the role of politically visible corporate villain.

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How’s Human Evolution Going? The Harris-Walz Health Policy team wants to know.

By MIKE MAGEE

Clearly the Harris-Walz ticket has been doing their homework. Last week, the book above was spotted on one prominent thought-leader’s pile: “Human Evolutionary Demography.” It’s a 780 page academic Tour de force read by veteran scientist Oskar Burger, leader of the Max Planck Institute for Demographic Research and the Laboratory of Evolutionary Biodemography.

That’s the Institute founded in 1917 in Berlin whose first director was Albert Einstein. These days, its researchers work (in an age of “alternate facts”) to separate justified belief from opinion. Their major focus is on “categories of thought, proof, and experience” at the crossroads of “science and ambient cultures.”

This is the field of Human Evolutionary Demography, a blending of natural science with social science. Demographers study populations and explore how humans behave, organize and thrive focusing heavily on birth, migration, and aging.

This has been a year of just that in American politics. First, the fallout of the Dobbs decision caught Republicans with their electoral pants down in reproductive freedom referendums in Kansas, Michigan, Kentucky and Vermont. Southern migration of Democrats to former red states like Michigan, Arizona, Georgia, and North Carolina have turned them various shades of purple. And this summer, octogenarian candidates from both parties have been all the rage, literally.

Up until July 21, 2024, the race for the Presidency was between two aging candidates with visible mental and physical disabilities. The victor was destined to a term of office that would extend into his 80’s.

The emergence of Kamala Harris as the Democratic nominee was a reflection of the electorates growing discomfort with turning a blind eye to the realities of aging. It also suggested that Americans, especially Gen X’ers, have grown tired of Boomer dominance in the lives of an increasingly multi-cultural America – tired as well of growing income disparity, attacks on reproductive freedom, and declining life expectancy in America.

But why the sudden interest in “Human Evolutionary Demography?” The answer lies in the numbers. Back in 2012 Oskar Burger studied Swedes and noted that in 1800 their life expectancy was 32 years. They gained an additional 20 years in the century that followed, and 30 more years by 2000.

What stumped Burger was not the gains over these two hundred years. Instead he focused on the question, “Why did it take the human race so long to progress?” The bottom line is this, we left chimpanzees behind in the evolutionary dust some 6.6 million years ago. We limped along, not faring very well, for all but the last 200 years. In the past century, a moment in time spanning just 4 of our historic 8000 plus human generations, we took off.

This period coincided with rapid scientific and technologic advances, cleaner air and water, greater nutritional support, improved education and housing, expanded public health related governmental policy, and establishment of a safety net for our most vulnerable citizens.

But in the past decade, growth in U.S. life expectancy has all but stalled. For the first time, we actually saw declines each year from 2014 to 2019. For the decade just past, the numbers improved overall by less than 1/2 of 1 %. When first studied, declines were blamed on losses in working age adults due to trauma, addiction, suicide or “deaths of despair.”

But recent studies reveal losses due to poor maternal/fetal care, especially in red states, and made worse by fallout of the Dobbs decision. A second complicator has been losses starting at age 65 from complications of cardiovascular disease and diabetes, made worse by obesity and poor health care follow-up.

This has led the Max Planck Institute to issue an alert to U.S. health experts: “Our findings suggest that the U.S. faces a ‘double jeopardy’ from both midlife and old-age mortality trends, with the latter being more severe.”

Women’s reproductive advocates say it’s really a “triple jeopardy” demanding grass roots advocacy focused on access today, and political victory up and down the ballot in November. In their words, “Today, and every day, we work to ensure that every patient who seeks sexual and reproductive health care can access it, and to build a just world that includes nationwide access to abortion for all — no matter what.”

If this is true, a careful read of “Human Evolutionary Demography” could direct a 3-prong approach for the health policy leaders in the Harris-Walz campaign:

  1. Expanded safety net to address “deaths of despair.”
  2. Expansion of the ACA toward Universal Health Insurance to address the chronic disease burden of older Americans.
  3. Federal guarantees of reproductive freedom and open access to reproductive care.

Mike Magee MD is a Medical Historian and a regular THCB contributor. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

“Moral Distress” Has Arrived On Health Care’s Stoop

By MIKE MAGEE

When Andrew Jameton, a Nursing Professor at the Department of Mental Health and Community Nursing at UCSF in 1984 published “Nursing Practice: The Ethical Issues”, the term “Moral Distress” was a novel term in clinical health care. It focused primarily on “care that they were expected to provide but ethically opposed.”

Over the past four decades, the definition has expanded and now encompasses the “inability to provide the care that one feels morally compelled to provide.” Beyond its’ impact on individual health professionals, it has growing health policy implications, explosively reverberating in the wake of the recent Dobbs decision.

There are approximately 1600 health care facilities nationwide that provide abortion care in the U.S. In the wake of the Dobbs decision overturning Roe v. Wade, 14 states have near complete bans on all abortions and this reproductive care is severely restricted in an additional 11 states “with few or no exceptions for maternal health or life endangerment.”

The impact of these rulings has created not only a moral dilemma for health professionals, but also intense legal jeopardy. As one Tennessee Obstetrician recently put it, “There are weeks when I commit multiple felonies.”

There now exists a validated psychometric tool to measure the mental health impact of the Supreme Court’s actions called the Moral Distress Thermometer(MDT). Experts recently surveyed 310 practicing clinicians involved in women’s reproductive health care, with a focus on comparing moral distress in those from restricted versus unrestricted states. What they reported in JAMA was that those in restricted vs. protected states had scores on the MDT that were more than double their comparators.

As one might expect, high scores on the MDT also correlate with higher rates of job burnout and attrition. This means lower rates of abortion care, but also a smaller maternal health workforce overall. This is in states that had already been lagging behind in access to obstetrical and reproductive health care in general. Clinical shortages are expected to rise in the months approaching an historic Presidential election.

Project 2025’s agenda for future women in America is much more expansive and aggressive than restriction of abortion alone. Trump’s denials aside, his selection of JD Vance as a running mate signals an intent to thoroughly engage in restriction of women’s reproductive rights in allegiance with a Supreme Court that appears equally committed.

With that in mind, the massive response to the Harris-Walz ticket appears to be offering a response that appears to be go well beyond simple “weird” labeling. Those words are a promise to each other, “We’re not going back.”

Mike Magee MD is a Medical Historian and a regular THCB contributor. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

Fake News from MedPac on Medicare Advantage Needs to Be Corrected, Part 2

By GEORGE HALVORSON

Special Needs Plans Change Lives for The Lowest Income and Highest Need Patients

The people who benefit the most from Medicare Advantage are clearly the very low-income and high health-need people who are eligible for both Medicare and Medicaid as programs and who enroll as members in the Medicare Advantage Special Needs Plan programs.

There clearly aren’t any other programs existing in our country that do more good for large numbers of needing people than the Medicare Advantage Special Needs Plans do for those members.

Those people with that dual eligibility are in major need for care.

We have millions of retirees who are eligible for both programs who have gone through years of inequities, inadequacies, and deficiencies relative to our care systems for a number of reasons, and who are now in need of care and support at multiple levels in their lives.

The plans do extremely good things for those high-need patients.

Medicare Advantage Special Needs Plan programs now help and provide services to millions of people who’ve actually never had good or adequate care in their entire lives.

The Special Needs Plan programs for Medicare Advantage reach into people’s homes and provide layers of service and support that are life changing, badly needed, and the Special Needs Plans are much appreciated, with very high satisfaction levels from the patients they serve for that better care and far better life support levels.

We tend, as a country, to abandon and under serve people in too many settings and communities who are old and who have no money and who are in significant need of care. The Medicare Advantage programs do wonderful and badly needed things for many of those patients that we need to understand, appreciate, and then protect as we look at Medicare Advantage plans and the overall Medicare Advantage programs and approaches.

The people at MedPac who are trying so hard to reduce the benefit levels for Medicare Advantage members and who do shamelessly inaccurate, distorted, and clearly intentionally fake news pieces on the cost of Medicare Advantage plans are trying to undermine and weaken the Special Needs Plan program in order to somehow create a level playing field with higher income patients for Medicare for the patients who get the most benefits from those programs.

That’s a very bad practice, and protecting those high-income people is a very wrong functional priority for MedPac to have. But they have it year after year in uncaring, insensitive, and cold ways relative to those patients and they seem impervious to data and information from all of the plans about those patients and that care, and their need for those benefits and services in their lives.

We need MedPac to clean up their act relative to their lowest income people, and we need them to start telling the truth about the actual relative cost of Medicare Advantage.

And we very much need them to understand how much the lowest income members need those benefits.

We need them to stop saying that the plans are overpaid when they know better from having more than 6 million people enrolled as Special Needs Plan members and benefit levels, and when they know that two out of three of the lowest income Members are in plans, and it should be painfully obvious to even the most cold-hearted observer, that those people clearly need the care and benefits that they get there from the plans.

The Medicare Advantage attacks from MedPac in their current report now say that the total cost of Medicare Advantage is 22% higher than those members would have cost as normal Medicare members.

They actually say in their most recent report that if all of the Medicare Advantage enrollees were now actually enrolled in fee-for-service Medicare, those enrollees who are currently in the plans would cost 22% less money for the overall Medicare program.

That’s obviously impossible and it’s a complete fabrication that they do not support in their document with even a wisp of data.

They use that false information, and they use a very skillful and intentional fake news context to attack the plans with that information.

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