Healthcare News of Note: Even many people with ‘good’ health insurance incur medical debt

• Medical care inflicts debt on nearly one-fifth of U.S. households, including many with seemingly good health insurance and middle-class incomes.
  
• Regulators in Illinois have delayed approval of Advocate Aurora Health’s $27 billion merger with Atrium Health.
• The highest drug overdose death rates between March and August 2021 were among American Indian or Alaska Native men ages 15 to 34 and Black and American Indian or Alaska Native men ages 35 to 64, according to study results.

Over the last few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.     

1. Medical debt affects 20% of U.S. households and may cause deterioration of SDoH outcomes

Medical indebtedness is common, even among the insured, and may be associated with subsequent worsening of social determinants of health (SDoH), according to results of a study published Sept. 16 in JAMA Network Open.

“Medical care inflicts debt on nearly one-fifth of US households, including many with seemingly good health insurance and middle-class incomes,” wrote the authors of this cross-sectional and cohort study of survey data from 2017 to 2019. “Findings of this cohort study suggest that those debts appear to undermine housing and food security, with likely repercussions for debtors’ future health.”

Although “persons in the highest educational level and income categories had the lowest rates of medical debt … rates differed little between the lowest and middle categories,” the authors wrote.

Noteworthy takeaways

The key findings of the survey include:

• Uninsured individuals had the highest prevalence of medical debt (15.3%) followed by those with high-deductible private plans (12%).
• Nearly 11% (10.9%) of adults carried medical debt, including 10.5% of the privately insured and 9.6% of residents in Medicaid-expansion states.
• Residents of states that had declined to expand Medicaid were 40% more likely to have medical debt than those in Medicaid-expansion states.
• The lowest medical debt was among those with military coverage (6.9%) or traditional Medicare plus private coverage (7.5%).
• Women (12.3%) were more likely to have medical debt than men (9.2%).

Conclusions

“Hospitals and clinics might attenuate these problems by upgrading financial assistance programs, and forbearance in collecting debts,” wrote the authors, adding, “Clinicians’ efforts to screen for adverse SDOHs and make appropriate referrals may also be useful.

“However, clinicians’ efforts cannot substitute for policy change. Expanding Medicaid coverage nationwide may help reduce medical indebtedness. Eradicating medical debt would require implementing universal coverage that eliminates burdensome out-of-pocket costs.”

2. Multibillion-dollar health system merger is paused due to state regulatory concerns

Advocate Aurora’s mega-merger with Atrium Health unexpectedly was put on hold while Illinois regulators review the proposed change in ownership of 10 Advocate Aurora facilities located in the state.

As first reported in the Chicago Tribune, the Illinois Health Facilities and Services Review Board voted 3-2 in September to table approval. However, the board also voted to reconsider the issue no later than December.

It sounds as though the board’s key concerns involve a need for additional information about the deal. Advocate Aurora issued a statement saying it was “surprised” by the postponement and pledging to “work with the Review Board to address their questions.” The organization remains confident the transaction is “still on track to close by the end of the year.”

The combined organization would have $27 billion in revenue, span six states in the Upper Midwest and Southeast and feature 67 hospitals. It would be known nationally as Advocate Health, but individual hospitals would retain the Atrium, Advocate or Aurora solo name depending on location. The merged entity would be headquartered in Charlotte, site of Atrium Health’s current hub, “while continuing to maintain a strong organizational presence in Chicago and Milwaukee,” according to a joint statement issued when the deal was announced.

The Tribune noted that no money is slated to change hands in the transaction, with the merger taking the form of a joint operating company. Health system leaders have said they anticipate the creation of 20,000 additional jobs through the combination.

The report also notes that some constituencies have voiced reservations about the deal, including Service Employees International Union Healthcare Illinois, which expressed concerns about the impact on healthcare costs and quality, and potentially on healthcare access, in the Chicago area.

 — Nick Hut, HFMA senior editor

3. Drug overdose deaths before and during the pandemic increased overall, but disproportionately hit certain ethnic or racial groups of men

Although drug overdose deaths, primarily attributed to fentanyl/analogs and methamphetamine, continued to increase from a five-month period in 2018 through the same period in 2021 for almost all examined subgroups, researchers whose work was published Sept. 20 in JAMA Network Open found evidence of racial and ethnic disparities in U.S. drug overdose deaths in 2021.

The study authors wrote, “… across sexes, the highest drug overdose death rates were among American Indian or Alaska Native men aged 15 to 34 years and Black and American Indian or Alaska Native men aged 35 to 64 years.”

Key findings

In the 15-34 age group during March to August 2021, researchers found:

• American Indian or Alaska Native men had the highest overdose death rates per 100,000 population involving any drug (42.0), fentanyl (30.2) and methamphetamine without fentanyl (6.0).
• The highest overdose death rates involving methamphetamine with fentanyl were seen among American Indian or Alaska Native men (9.2) and women (8.0) and non-Hispanic white men (6.7).

In the 35-64 age group:

• Overall drug overdose death rates were highest among Black men (61.2) and American Indian or Alaska Native men (60.0).
• Fentanyl-involved death rates were highest among Black men (43.3).
• Rates involving methamphetamine with fentanyl were highest among American Indian or Alaska Native men (12.6) and women (9.4) and white men (9.5).
• Rates involving methamphetamine without fentanyl were highest among American Indian or Alaska Native men (22.9).

The results highlight the need for more prevention, treatment and harm reduction interventions geared to specific populations, especially the American Indian or Alaska Native population and Black population, according to the authors.

HFMA bonus content

Read the October issue of hfm magazine, including the cover story, “Inflation rattles hospital supply chain and labor pool with no end in sight.”

Listen to the Voices in Healthcare Finance podcast episode “Healthcare disruptors like Amazon get good patient reviews, but questions about quality abound” with Senior Editor Nick Hut and Policy Director Shawn Stack discussing issues of safety and quality that may emerge when customer convenience reigns supreme.

Read the article “Medicare payments for 340B drugs are set to increase immediately after recent court ruling,” by Nick Hut, senior editor.